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156). Thus, the authors underline that depression is a term used both too widely and too narrowly. Psychiatrists who use it too widely apply it to diverse normal states, like sadness and grief, and diverse abnormal states, like paranoid paralysis due to fear, and obsessive ambivalent paralysis. "Revolutionary transformations" in psychiatry allow identify new causes and manifestation of emotional and mental disorders classified as depression. The authors give a special attention to strengths and weaknesses of such types as DSM I and DSM II editions. The new edition, DSM III proposed a new approach to psychiatric diagnosis criteria. Thus, the author underline that 'the main drawback of symptom-based criteria was they eliminated the consideration of the context in which the symptoms arose" (Horwitz & Wakefield 2005, p. 157). The authors take into account research studies comparing statistical results obtained during 1980s and 1990s. They found that some psychiatrists who apply the concept too narrowly deny depressive dynamics in others to hide them in themselves, from themselves. Or the diagnosis is not made because the patient disguises the illness: (1) as a behavioral symptom; (2) as an attitudinal symptom; (3) as a physical symptom; (4) as another psychological disorder. The authors claim that the main limitation of these studies that they ignored the context of symptoms. As the most important, the traditional symptom-based approach is easy to use but it is less effective. The description of the clinical manifestations of depression is organized according to the parameters of the mental status examination. While the diagnosis of depression is not warranted unless a significant number of the signs and symptoms are present, it should be suspected even in the presence of just a few of them. The authors state that "it is important to make distinction between the normal and sadness responses" in order to provide effective treatment because "medical interference in normal sadness can be even harmful" (Horwitz & Wakefield 2005, p. 159). Horwitz & Wakefield come to conclusion that DSM III has many limitations and inadequate criteria which caused 'unintended consequences' for general public and society.
The authors of the articles discuss an important problem of criteria applied to the state of depression and negative consequences of misdiagnosis. I agree with the authors that it is crucial to apply both symptom-based and content-based criteria to diagnose mental disorders. According to DSM III, psychiatrists diagnose depression from depressive-like symptoms that are in fact part of another syndrome. Because symptoms characteristic for depression are also characteristic for other disorders, most depressive symptoms have a differential diagnosis. For instance, a patient can be misdiagnosed as "depressed" because he/she is unable to relate to others. In some cases, psychiatrists diagnose depression in the absence of illness. This happens when normal moodiness is misidentified as depression. Here the clinician fails to distinguish getting depressed from having a clinical depression, the symptom from the syndrome.
The main limitations of the article are lack of current research and statistical data. The author use statistical information and research studies ...Show more
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The article "The Age of Depression" by Allan V. Horwitz & Jerome C. Wakefield discusses advanced methods diagnosis and identification applied to depression and sadness, and criticizes limitations and disadvantages of the DSM I, II and III editions (Diagnostic and Statistical Manual of Mental Disorder)…
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