Bob Rich’s Self-Therapy Guide: What Depression IS NOT

Bob Rich’s book From Depression to Contentment: A self-therapy guide is therapy in your pocket. Depression, anxiety, and other forms of suffering are all too common in our crazy world. Bob teaches you how to rise from that to “normal,” which is the walking wounded, then far above that, to inner strength enabling you to cope in any situation.

Recovering the Self published the first segment of Bob’s book in a series of posts starting from commentary on staying sane in a crazy world and ending with the quest for meaning via correspondence with young minds. The second segment of Bob’s work begins here with special attention to the meaning of depression, happiness, and resilience as well as the various influences in early and later life that make one vulnerable to depression.

Bob starts the second segment of his Self-Therapy Guide by addressing the very definition of depression and what you have been told it is while explaining why the standard medical definition lacks clarity.

Depression Is Not What You Are Told

Human suffering has been medicalized. Depression is one of many “mental disorders” classified in the International Classification of Disorders (ICD 10) and in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5).

I agree with critics like Gary Greenberg, who consider the whole concept to be invented.

As the rest of medicine became oriented toward diagnosing illnesses by seeking their causes in biochemistry, in the late 19th, early 20th century, the claim to authority of any medical specialty hinged on its ability to diagnose suffering. To say ‘okay, your sore throat and fever are strep throat.’ But psychiatry was unable to do that and was in danger of being discredited. As early as 1886, prominent psychiatrists worried that they would be left behind, or written out of the medical kingdom. – The Atlantic (May 02, 2013)

Giving impressive-sounding names to aspects of human suffering is an excellent tool — for overmedicating people, as Whitaker states in his 2010 book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the rise of Mental Illness in America.

You see, a psychiatric diagnostic category is a list of symptoms. You “have” the disorder if you experience a sufficient number of the symptoms on the list.

Here is the list for “major depressive episode:” (DSM 5)

1. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
   2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.)
   3. Significant weight loss when not dieting, or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
   4. Insomnia or hypersomnia nearly every day.
   5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
   6. Fatigue or loss of energy nearly every day.
   7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
   8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
   9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

If you and/or someone observing you report the first two, plus three others, then you qualify for the diagnosis of “major depressive episode.” There are a number of provisions to exclude other diagnoses.

So, “he is depressed” is shorthand for “he is sad most of the time, can’t find pleasure in anything much, probably has sleeping or eating problems of some kind, and…”

Next, we can ask, “Why does he feel sad most of the time?”

Because he is depressed, of course.

Can you see the circularity?

So, the label is not an explanation, but merely a summary description. It’s like saying, “He is overweight because he weighs significantly more than he should, given his height.”

A diagnostic system, putting suffering in boxes, is politically and commercially motivated science fiction. The diagnosis, “Post-Traumatic Stress Disorder” (PTSD), was invented for the very good reason of validating the suffering of Vietnam war veterans. Each revision of the classificatory systems adds new disorders, has others removed. Drug companies have been shown to campaign for new markets for their products. And so on.

Another problem is “comorbidity.” A diagnostic category should be, well, a category. A great deal of evidence shows it’s rare to find someone suffering from “pure” Depression. In my case, when I was young, I also qualified for a diagnosis of PTSD. About 80% of people diagnosable with major depression are also diagnosable with one or more of the “anxiety disorders.”

People diagnosed with all sorts of other conditions very often also “have” depression. For example, one study published in the Journal of Urology in February, 2018, showed that diagnosable depression and anxiety were reduced after an operation that improved men’s ability to urinate and have sex.

So, a psychiatric disorder is not a category, and doesn’t actually explain anything. Otherwise it’s very useful… for pharmaceutical companies.

Also, while there have been huge advances in neuroscience, no DSM category has ever been validated with any biological markers.

Sorry, I promised that I wouldn’t get into academic arguments, and here I am, doing it. This, however, is an essential issue. If Depression is a disease, a malfunction of the brain, a chemical imbalance, then medicines are the only solution. This is very profitable, but leaves people either suffering the symptoms, or suffering the drugs’ effects, or both. That’s not to say that antidepressants don’t work. They do have a role to play, but at best, they ease the symptoms while you take the drug, so you can work on your problems.

However, if Depression is not something you are, and not even something you have, but something you DO, then there is hope.

Homework

Make yourself a cup of coffee, tea, or whatever your favorite non-alcoholic drink is, and enjoy it.

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