There are several definitions of depression. It is the medicalisation of
misery however there's an important quality of what an illness - there's
a biological component. Personality disorders apparently have no
biological component which is why some people don't consider them mental
illnesses.
The idea of the (true) illness is important when considering what
depression is. In practice the diagnosis may cover condition other than
a biologically /caused/ syndrome. Reactive depression or an adjustment
disorder (which is often not diagnosed and a diagnosis of depression
given instead) are states of misery that may not hold to the classic
view of an illness. Endogenous depression is a biological depression and
in that sense a true mental illness.
However both reactive and endogenous depression are diagnosed as
depression. The US diagnostic criteria and I'm pretty sure the one used
in the rest of the world doesn't make the distinction. The distinctions
are made on things like severity and course. I think earlier versions of
the diagnostic criteria have attempted to make the distinction however
I'm unaware of why the distinction was removed or not ever included in
the definition of depression.
In the US there's a large research program attempting to find biomarkers
which should be able to reliably identify endogenous depression. Their
much better funded medical system uses a lot more testing than here in
the UK. It's only in mental healthcare that they've been forced to rely
on guess work whereas UK doctors have been using it for years.
Eventually they may be able to establish who has a biological problem
and who doesn't. This may result in better response rates for
antidepressants - something noted by the researchers on the STAR*D trial
in a recent review of antidepressant trials with unpublished data
presented (which again showed the lack of efficacy).
Clearly non-biological depression wouldn't respond to biological
treatments. Or would it? This will be the interesting experiment once
the biomarkers have been established. Will people with endogenous
depression respond to talking therapies and will those with reactive
depression still find drugs work? I can guess yes to both of those.
Importantly, to the true definition of mental illness it's not the
medicalisation of misery. However the 'true' definition has changed
radically in well over a century. Mental illness should perhaps now be
called mental health problems but not on some whim of the politically
correct movement. The concept is rooted in the problematicness of the
emotions and behaviours of the individuals who are unable to mask or
cope. This is the cause of the social disability. In fact mental illness
could now simply be called social disability, so someone would ask the
question "What disability has society given you?"
Precise concepts aside, clinical depression is know by everyone as a
mental illness. According to that modern definition personality
disorders are also mental illnesses as is substance misuse (though this
has been recognised for far longer as a mental illness).
This wouldn't be true of the phrase "mental illness" when it was first
conceived. This is a problem because of the privilege of medicalisation.
It is assumed that if it is an illness it can only be treated by doctors
and approved medical treatments, it is healthcare and it is pure. The
last bit - the goodness and purity of medicalising misery - is the most
dangerous. It blinds people to seeing beyond. It bamboozles ethical
considerations.
The idea of mental illness allows doctors to 'treat' unmarried mothers.
In the UK in the mid-20th century the medico-legal framework classified
these individuals as mentally ill. I very much doubt the National
Association for Mental Health or Together or any of the other mental
health charities at the time said a word about unmarried mothers being
mentally ill but their modern counterparts, with the benefit of
hindsight and the change in cultural norms, would break down the doors
of parliament to get that particular mental illness unpathologised. At
least I hope they would.
Their antecedents wouldn't have said a word because it was doctors who
told them it was an illness, a genuine biological one that must be
treated and anyone who considered anything different would either be a
challenging patient or someone with lack of insight into their condition.
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