Many people are under the false impression that the diagnosis of depression is solidly grounded upon scientific principles.

What follows is a passage from my new 2015 book Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance: 

“Science plays no part in the diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists nine criteria which psychiatrists have decided provide evidence of depression. Neither laboratory investigations nor physical findings specific to depression receive a mention in any of these nine criteria.

Criterion 1 describes the mood in a major Depressive Episode as ‘depressed, sad, hopeless, discouraged’, or ‘down in the dumps’, feeling ‘blah’, having no feelings or feeling anxious, irritability, and bodily experiences such as aches and pains.

Criterion 2 refers to loss of interest or pleasure, including a loss of interest in hobbies.

Criterion 3 describes changes in eating habits, either an increase or a decrease in appetite or weight.

Criterion 4 refers to sleep disturbance such as insomnia or oversleeping.

Criterion 5 describes bodily expressions of distress including ‘agitation, e.g. the  inability to sit still . . . or retardation e.g. slowed speech, thinking or bodily movements’.

Criterion 6 refers to decreased energy, tiredness and fatigue.

Criterion 7 includes a ‘sense of worthlessness or guilt, unrealistic negative evaluations of one’s worth’, and ‘guilty preoccupations or ruminations’ about the past.

Criterion 8 describes people’s reported ‘inability to think, concentrate or make decisions’, appearing ‘easily distracted’, or ‘memory difficulties’.

Criterion 9 speaks of ‘thoughts of death, suicide ideation, or suicide attempts’.

The Diagnostic and Statistical Manual of Mental Disorders asserts that a diagnosis of a Major Depressive Episode can be made when the severity and duration of a person’s mood meets Criterion 1 and the person is experiencing four of the remaining eight criteria.

In my book Beyond Prozac: Healing Mental Distress (2001, 2004 {UK} and 2005), I questioned many aspects of the diagnostic approach to depression, including the following:

Why did the American Psychiatric Association select five criteria as the magic figure? What is the difference between a person who meets six criteria—and is therefore diagnosed as having a Major Depressive Episode and needing antidepressant treatment—and one who meets four criteria, and therefore receives no psychiatric diagnosis or treatment? Why five criteria? Why not three? Or seven? How valid are these criteria? [i]

Nine years later in his 2010 book Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, American psychiatrist Daniel Carlat asked similar questions and went one better. Carlat interviewed Robert Spitzer, lead psychiatrist of the DSM-3, the 1980 edition of the DSM in which this approach to depression was first set out as the way to diagnose depression. Here is an extract from that interview: [ii]

Carlat: How did you decide on five criteria as being your minimum threshold for depression?

Spitzer: It was just consensus. We would ask clinicians and researchers, “How many symptoms do you think patients ought to have before you would give them a diagnosis of depression?” And we came up with the arbitrary number of five.

Carlat: But why did you choose five and not four? Or why didn’t you choose six?

Spitzer: Because four just seemed like not enough. And six seemed like too much.

Carlat commented that ‘Spitzer smiles mischievously’ as he uttered the last sentence above. This is the quality of the “science” upon which the diagnosis of depression is based ” (end of quote).

“The arbitrary number of five”, “It was just consensus”, “four seemed like not enough”, “six seemed to much”–does this rationale fall within your definition of science?

Not for one second am I questioning the realness of these experiences and behaviours, but I most certainly am questioning the medical profession’s interpretation of these experiences and behaviours.

[i].   Terry Lynch, Beyond Prozac: Healing Mental Distress, Ross-on-Wye: PCCS Books, 2004, p. 103.

[ii].   Daniel Carlat, Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, London: Free Press, 2010, pps. 53-4.