I continue to think about the way we speak of emotional/psychological problems. As I said before, one doesn't "have depression" like one has a cold; one "is depressed", that is depression becomes part of identity. And it seems one is never cured.
Consider this from the Journal of the American Medical Association
Theoretically, patients who do not have depression symptoms as listed in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) are not depressed. But recent studies indicate that the lack of symptoms alone is not an adequate gauge of remission.
Think about that -- the person who has no symptoms, who reports being fine, is not "cured" nor perhaps even "in remission". If I get develop an illness other than a psychiatric one, if I have no symptoms, I am considered not to have the disease. I had a cold a couple of weeks ago. I no longer have symptoms. I would not be diagnosed as having a cold "in remission" even though it is a certainty that I will develop other colds, maybe even this year. Does this strike you as odd?
In the JAMA article, it is suggested that physicians should use this questionnaire to evaluate whether or not their patients are still depressed -- because you know, simply asking would be to trust the patient and everyone who watches House knows that patients lie:
I once worked with a therapist who would respond to generalities from me by saying, "Pretend I am from Mars and explain please what exactly you mean."
I would say to the researchers and others obsessed with "complete symptom remission" -- "I'm from Mars. Please explain to me just what you mean when you say "complete remission".
It seems to me that one significant problem here is the notion that medications are the solution and by implication, that depression is pretty much purely a medical disease. The whole disease model disposes toward this view. And therefore, questionaires carry more weight than ordinary patient self-report does.
What would "complete remission" look like? Would that be a state of steady happiness? Would there be normal ups and downs? How would anyone know what complete remission is as there is nothing to measure except via symptom checklist and surely these are greatly influenced by individual perception. Is my "off day" someone else's mild depression? We have no way to know. There is nothing to measure, no tests or indices to measure against so there is just theory.
And what about those people who are Eeyores -- gloomy, kind of depressed looking by virtue of their personality? Should they be medicated into happiness? How? To what end?
And what of the people who move out of depression by working in therapy? Oh right, we don't know about them because we don't study them.
With a psychiatric diagnosis, the patient becomes the illness. A bi-polar. A depressive. A schizophrenic. Psychiatric diagnosis seems to be less a identification of illness than it is a state of being. And maybe that is why once diagnosed, one is never cured but can only hope for remission. Because the illness, the diagnosis is the person and how does one recover from that?