1 Boring Old Man

The pre-DSM-III version of psychiatry was fine with me. My internal medicine and research training had been heavily weighted on the objective side. But practicing, I had realized that the subjective experience of illness [and life] was a much more important part of things than I had realized. So the mix of objectivity and subjectivity in those days was exactly what I personally was looking for. And when the DSM-III and its changes came, I naively thought that it was a call for more balance. It took me a while to get it that subjectivity [at least the version I was interested in] was being given its walking papers. Once I realized it was more war zone with a long history than a matter of emphasis, I walked.

Looking back, psychiatry itself might’ve been better off aiming for that balance after all, but that’s a speculation about things long passed. What still haunts us, however, are some of the consequences of the decisions made in those days – specifically the decisions about classifying the depressions [see what price, reliability?…]. Whether an honest mistake or testimony to bias, those choices became a tragic flaw that’s still playing out thirty-five years later. Paradoxically, they crippled research into both Depression-the-Disease [Endogenous Depression, Melancholia, the Depressions of Manic Depressive Illness, etc] as well as the much more common depression-as-a-symptom. And it became a categorical error that opened a wide portal for commerce-driven  bull-shit  malarkey like this…

^{"Major depression is now recognized as a highly prevalent, chronic, recurrent, and disabling biological disorder with high rates of morbidity and mortality. Indeed, major depression, which is projected to be the second leading cause of disability worldwide by the year 2020, is associated with high rates of mortality secondary to suicide and to the now well-established increased risk of death due to comorbid medical disorders, such as myocardial infarction and stroke…"}
^{VNS Therapy in Treatment-Resistant Depression [2006]}

Of course it is within the purview of good medical practice for a physician to notice and comment on depressive mood states, much as it is to follow other signs of dysfunction like jaundice or dyspnea. But there’s no rationale that I can see to put depression into the domain of legitimate Preventive Medicine. If Primary Care Physician visits are too short to even notice depressive affect and simply say, "You seem down today. What’s up?" They’ve been shortened way too much.

Brain expert: Why I jumped ship to Google

… after giving heart and soul to mental-health problems over the last 13 years working in government, I have not seen any improvement for either morbidity or mortality for serious mental illness – so I’m ready to try a different approach…