Dissatisfaction

Depression is a common illness in both general practice and hospital settings. Its severity ranges from mild to severe. The more severe cases certainly warrant treatment. At its milder end it merges into general human unhappiness, misery, moans and groans, bad jobs, poor relationships, bitter experiences, disappointments and so on. These are a normal part of life, and although unpleasant they do not of themselves make an illness. However too many of them, acting for too long, can lay the soil for depression to take root. 

There is currently an attempt to medicalise (Bring within the sphere of medicine, rather than to normalise) a lot of human distress and as a GP I am resisting this. Chris Dowrick's excellent book Beyond Depression tackles this area well.

There is an extreme view that sees life as a 100% fatal, sexually transmitted illness. There's a lot of it about - and if you are reading this you?ve already got it. Blame your parents. We cannot treat all of life as a disease.

So to come to medical attention depression has to be more than simple dissatisfaction with life. It has to be more severe than this and more chronic (last longer through time) to count as an illness needing treatment. The exact point at which general misery becomes depressive illness is unclear, but criteria of severity and chronicity are important in making the distinction.

Depression as an illness holds up a mirror to human life in general, and to our concepts of whether life has purpose or meaning. Camus puts it, 'There is but one truly serious philosophical problem and that is suicide.' (Camus The Myth of Sisyphus)

"Ah, mon cher, for anyone who is alone, without God and without a master, the weight of days is dreadful... For if there is a sin against life, it consists perhaps not so much in despairing of life as in hoping for another life and in eluding the implacable grandeur of this life."
Viktor Frankyl, an Austrian Jewish psychiatrist who had been in a concentration camp for a long time in WW2 asks the question even more forcefully, "OK, if your life's so awful why don't you commit suicide?" At this point his patient would have to come with reasons why their life was worth living, and Frankyl got them to focus on these. 'Ever more people today have the means to live, but no meaning to live for... Challenging the meaning of life is the truest expression of the state of being human.'
(Viktor Frankyl Man's Search For Meaning)

A lot of the people I meet with depression have not thought clearly about who they are, their context, and what their purpose is in life. Medicine can make them feel better, but I am never sure how many are taking drugs as an alternative to thinking hard for themselves.