Psychiatric diagnosis are not made on the basis of checklists – even though the checklists are very helpful
Depression and related mental health problems are complex and have multiple “causes”. This is important to understand before anyone is to answer the question of whether some is simply dejected due to the life events or is depressed as in ill. The current understand of depression and related mental health condition is that they are Bio-Psycho and Social in nature. This means that they have causes and effects in each of these three realms namely biological, psychological and social.
Let me explain this further with a few examples with depression as the core illness category. There are individuals who experience symptoms of depression such as continuous low mood that does not improve in any situation, crying spells, lack of interest in all activities, changes in sleep and appetite, energy levels and so on and so forth in the absence of any clear environmental precipitating event. Here we would consider a diagnosis of Depression (i.e. biological cause) if the symptoms cause sufficient dysfunction. Now on the flip side, persons with depression (whether life situation related/ biological) have a tendency to be more sedentary (or be less active overall compared to previously). This leads them to have a higher risk of developing certain lifestyle related disorders including elevated blood pressures, risk of cardiac disease and so on. Here the diagnosis has changed certain aspects of biology. There are similar effects and causes in the psychological and social realms.
A diagnosis of depression is made after understanding the context of the emergence of symptoms, the symptoms themselves and the degree of impairment in functioning afforded by the symptoms.
Now, how do we integrate this knowledge with what we already know. The first thing is that psychiatric diagnosis are not made on the basis of checklists (even though the checklists are very helpful). A diagnosis of depression is made after understanding the context of the emergence of symptoms, the symptoms themselves and the degree of impairment in functioning afforded by the symptoms.
Impairment is the core of what psychiatry would aim to reduce.
What is this impairment? Of the many definitions available, the easiest to use is that impairment is the difficulty that mediates the long term outcome related to the illness. Basically what does this illness do that prevents the person fulfill his/ her role. In order to reduce the impairment (again which is Bio-Psycho-Social in nature), treating the underlying symptoms will be essential in a biological, psychological and social fashion.
So, the long and short of it would be that the degree of dysfunction/ impairment, in the context of the presence/ absence of sufficient number of symptoms while keeping in mind the context in which the symptoms emerge determine whether a label of depression is applied to a person or not.
Finally the person who is suffering does not care about whether they have a label or not, all that they care about is not suffering as much – whatever the person who is willing to help can do.
-Dr. Shiva Prakash
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