Symptoms Of Depression Dsm, Are We Becoming A Nation Of Healthy Hypochondriacs?
Q: The new, intensive focus on depression as a widespread disease has been
underpinned by the work of nosologists, specialists in classifying and defining
illness. The foremost definitions of depression are those developed by panels
of experts convened by the American Psychiatric Association. The APA’s
Diagnostic and Statistical Manual was first compiled in 1952 to assist the
national census of mental disability, but has since been transformed. The
fourth edition, known as DSM-IV, was published in 1994 and is now
internationally recognised as the prime definition of how to recognise
depression and, implicitly, when and how to treat it. DSM-IV definitions are
also closely linked to those in the WHO’s International Classification of
Diseases (ICD-10) and arguably now drive them.
A:DSM-IV is in some sense a great achievement, each new edition representing
decades of development and years of expert work. The task is formidable and
very costly: establishing the ground rules demands feats of understanding,
organisation and painstaking application, and great political skill would have
been needed to secure anything like consensus and general acceptance. And
clearly the need for good definition is paramount. It is fundamental to common
understandings, good communication and effective diagnosis; lack of definition
increases the risk of wishful, misguided thinking and unhelpful treatment and
practice.
However, what matters it is how useful the definitions are and to what effect
on health - and this depends on many different pluses and minuses, with much
judgement needed about which is which. If DSM-IV were a fishing net, the
question would be: what mesh size should be used to catch depressed fish but
not others ? The mesh has been getting smaller over the years, but it this a
good or bad thing ?
Five editions of the DSM have produced a threefold increase in "disease
entities". What Hippocrates knew as melancholy is now identifiable in 300
manifestations (including manic depression), detectable through the expression
of many commonplace symptoms and characterised by often familiar behaviours.
But how much does this explain ill-health and help doctors to relieve
suffering, and has the time come for "National Depression Screening Days"
(1997) to be extended beyond the US?
Perhaps the DSM classification offers convenient rather than convincing
solutions and has rationalised rather than reduced diagnostic chaos. Perhaps
longer definitions make less sense, by directing towards a circumference of
blurry understandings, the more they elaborate the central point. In expanding
definitions of "depression", perhaps these guidelines have helped to promote
something like hypochondriasis (DSM-IV, F45.2) as well:
"If people are educated to believe they