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Depression – a useful diagnosis or an unhelpful label?

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Concern about having the appropriate labels is something which is usually associated with fashion. For some people, the importance of showing the right label even appears to outweigh the look of the clothes or the bag. This may be puzzling to those of us who struggle to understand this particular phenomenon. Yet this fascination with labels is not limited to the content of contemporary wardrobes.  Within the world of counselling and therapy there is also a preoccupation with labels.

This may in part explain the growth in the reported levels of emotional dysfunction in the western world.  Those who may once have seen themselves as being just fed up with certain aspects of their lives may now wonder as to whether there is an illness labelled depression to be treated whilst those who once accepted that they were just shy may now be told that they are a classic case of social anxiety disorder which can be treated.

Definitions can be useful if they encourage individuals to take action to remedy an aspect of their being which is distressing and prevents them from enjoying life and realising their full potential.  The challenge comes if there is a continual move towards pathologising that which is simply a reflection of the natural differences found in the kaleidoscope of human nature. 

Many professionals who are active in the mental health field will be aware of the reference work known by the abbreviated title of DSM IV. The full and rather grandiose title of this volume is the Diagnostic and Statistical Manual of Mental Health Disorders – Fourth Edition and it is published by the American Psychiatric Association.  My particular version uses nine hundred and forty three pages to categorise all manner of emotional dysfunction from psychotic disorders to gambling addiction and from narcissism to insomnia.

DSM is an extremely useful manual.  There has however been some consternation about the next edition of this reference work.  DSM V is apparently close to release. There is a particular concern that the manual will encourage pathologising some behaviour traits which are perhaps more an everyday reflection of the changing human condition rather than some malevolent symptoms of an emotional illness.

One example of this may be some specific symptoms which it is rumoured may soon be attached to a condition called the Oppositional Defiant Disorder. These behavioural symptoms may apparently include concerns that the individual in question ‘argues with adults’ and ‘refuses to comply with adult requests’ (Source – Therapy Today April 2012).  Rather than being surprised at these traits many parents recognise those responses as fairly standard teenage behaviour which actually suggests that all is as it should be with the adolescent and not an indication of some underlying emotional disorder.

This discussion on diagnoses is however about more than just a case of semantics. Diagnoses matter and the increasing use of quasi medical terms can sometimes be alarming and impact on our sense of well-being. If a friend talks on a cold wet winter day of being fed up with her or his lot, we may encourage them to see out the day out wrapped up warm with the proverbial cup of tea and a box set. If however they talk of suffering from depression we may be much more concerned and feel far less certain as to how to offer support.

Yet these references to being elated, disappointed, fed up or down could be seen as just changing positions on a spectrum of mood from happy to sad.  We may move along that continuum over the course of days or weeks dependent on life events and how we are able to deal with them.  Our mood can be impacted by the weather, our relationships or even how well the car started that morning.  We do not need to turn to the counsellor or therapist or to take up a course of CBT or Solution Focussed Therapy if we are just having a bad day.  As with other physical conditions the key determinant on whether to seek treatment will lie in the persistency of the symptom. 

If we are able to emerge from that bad day with a sense that the world is an okay place, then perhaps we can accept it was just one of those things and get on with life.   If however the symptoms persist, even when the sun is shining and the car is starting each time we turn the key, then perhaps we do have an issue to face.    If we continue to retain an overwhelming sense of dread or emptiness when our relationships are actually going well, that is likely to be the time to consider some professional support.  

It is then, that making the first contact with the counsellor or therapist may prove to be the right step to take irrespective as to whether any subsequent counselling work uses CBT, Solution Focussed Therapy or some broader counselling methodology from psychodynamic to the existential.

And a final thought on these new diagnoses.  If you are concerned that your son or daughter does keep saying no and continues to argue with you, then why not reflect that you have clearly been incredibly successful in helping your offspring to develop the power of independent thought.  What a gift to pass to the offspring. And that may be much easier to deal with than worrying that she or he has developed something called Oppositional Defiant Disorder.




Geoff Boutle

added on 1st March 2013

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