THE BLOG
03/18/2010 05:12 am ET Updated Nov 17, 2011

Depression: Illness Or Stuckness?

It is incontrovertible that depression itself accounts for much suffering in the world. It is estimated that approximately 16.2 percent of adults will have one major depressive episode at some point in their lives, and that in any 12-month period, about 5 percent of people in the US have depression (that is approximately 1 in 18-20). When people are depressed, they are not just "down in the dumps", but also have trouble sleeping and eating and may find their energy and concentration "low" with little interest in day-to-day activities. In the worst cases they may also be suicidal. Thus, this state of being can lead to tremendous diminutions in productivity and life can seem to pass by unless this problem is addressed. Antidepressants and certain forms of psychotherapy have been found to be helpful. Still, there are times when, despite the suffering that depression causes, I wonder: what makes this an "illness"? And does thinking of this as an illness help in the long-term?

In other aspects of medicine, illness is usually quite obvious. We either see organisms that should not be there under microscopes, or we see cells dividing as they should not be. This kind of "evidence" helps to convince us that something other than "ourselves" is causing what we have. While this is also debatable, it is not within the purview of this article. What is, though, is depression, and whether we have enough "evidence' to support thinking of it as an illness.

Points in support of depression being an illness are: (1) brain imaging studies that show that the brains of depressed people do not look like the brains of other people; (2) that the syndrome can be diagnosed using set criteria; (3) that when we put chemicals into peoples' bodies (like SSRIs), they feel better; (4) that sometimes, until people are "treated" they are stuck in their lives for years. These and some other factors support the view of depression as an illness, but I do not find them convincing or without some doubt.

It is clear from studies done so far that depression is part genetic, and part acquired. and that things that happen in our lives can make us feel badly. Divorce, separation loss and boredom can all lead to depression and the stuckness that depression brings. But why do we need to think of this as an "illness" in order to take it seriously? Is the suffering of depression not enough to take it seriously anyway? Do we do so because we have to refer the problem to psychiatrists? That is, because depression was defined by people in the psychological field who have to justify why you should consult us, is there not something biased about "marketing" the idea of "illness" to justify a living? Is it possible that people feel too ashamed about being "human" and being victims of this inert state, that since this state is pretty widespread, we all come to collude that this must in fact be an illness since thinking otherwise would have many deleterious impacts: it would mean that we are somehow responsible for being a way that appears to have come on suddenly; it implies that insurance companies would not reimburse for this and that somehow, if we do not call it an illness, then we can't "justify" our suffering.

Clearly, the world is growing in its perspectives about how to manage depression. Sports enthusiasts will swear to the benefits of physical activity (to eliminate an illness?), yoga practitioners will swear to the benefits of movement and new spiritual perspectives (to eliminate an illness?) and still others will swear to changing around one's life (new partner, new job, new place to live) to address this threatening quality of stagnation.

My objections to just widely accepting the "illness" view are these : (1) People come to integrate their "illnesses" into their identities, and in the long-term often bring more suffering into their lives; (2) People tend to hold a secret 'shame" about their illnesses; (3) People tend to feel disempowered to do anything about their illnesses; (4) People think only in terms of psychiatry, when in fact, coaches, physical trainers, yoga instructors and friends can all make a huge difference.

My view here is that depression is serious, affecting, needs to be attended to and well within the purview of psychiatry, psychology and related fields. We can be helpful. But the "label" of "illness" is best handled with questions: Am I really "ill" or am I experiencing something very difficult to handle? If I change my brain chemistry, what else am I doing to my brain? Is this a short-term or long-term state? How much of this is a part of being human and what are the other 80% of people who appear to never have depression doing?

My recommendations: even if you suffer from depression, always ask questions about this "state". Within the field of psychological and psychiatric research, we ask questions all the time-so why shouldn't you? What would it mean to you if depression was not an illness? Why would this matter?