How did depression "pop"?
By talking about some relevant research data, including the current situation in China, we can understand depression in depth, and I hope that we can give you some inspiration and help in understanding depression or other mental disorders.
01
Depression is currently based on a phenomenological diagnosis
The diagnosis of mental illness is still based on phenomenological diagnosis, and at the current level of discipline, most diagnosis of mental illness lacks an objective diagnostic basis.
Therefore, it is inevitable that some factors that are not purely scientific empirical, such as cultural concepts, will have a greater influence on the diagnosis of a certain mental disorder.
In our post-70s era, people prefer children to be more obedient, which children are too lively and active, we call it ADHD (scientific name attention deficit disorder).
Now, we want my child to be warm and cheerful, and if the child is not so enthusiastic and outgoing, the child may be diagnosed with autism or autism.
Our diagnostic criteria seem to follow some socio-cultural standard, rather than a biological or more scientific standard.
What does phenomenology mean? I see a phenomenon, and then I see a lot of people doing this, so I call this phenomenon a disease.
For example, now we are still in the epidemic, in the epidemic everyone is probably afraid of their own fever, if your current body temperature, 38.3 °, first you have to do a nucleic acid test, but the fever must be new crown pneumonia?
In fact, fever may be anything, it may be pneumonia, cold, nephritis, meningitis, etc., any inflammation will cause a febrile reaction.
Therefore, the clinical emergency department has a diagnostic name called fever to be checked, and a temperature of 38.3 ° has come, the cause is not known, but it is only known that it must be fever, so it is called fever to be investigated.
Fever to be investigated refers to the fact that in the case of not knowing the cause, such as where there is inflammation and what virus, the physical cooling is done first, the body temperature is controlled, and it is reduced to basically normal, or to the extent that the brain is not burned out.
When the control is good, we will go to find the cause and then go to the cause treatment.
02
Depression is the "fever to be investigated" of mental disorders
Depression is currently based on a phenomenological diagnosis, we now only see one person emotionally depressed, but what is the reason for his depression?
I think there are 100 causes of depression in 100.
Most of the clients I am consulting now are consistent with the diagnosis of depression, but the reasons for each of them are different, of course, everyone's reasons are different, and the treatment must be different?
In fact, it can be similar.
We can use antidepressants, just like antipyretics.
What are antidepressants? Antidepressants are antipyretics (antipyretic analgesics), which can lower body temperature, which can improve mood and physiological symptoms, and this is similar.
Can drugs directly change the cause?
Clients may be depressed due to value-level issues such as marital and family, academic stress in the workplace, childhood trauma, or hollow heart disease.
Although they are all depressed and lack of interest, their reasons are different, and there is no specific treatment plan that is necessarily suitable for all depressed patients.
Everyone has a different cause of illness, so psychological counseling and treatment are very individualized.
Although we have a better theory, such as CBT, which is the deeper reason I don't care what kind of person he is, what I see is that he has a distorted cognition, so can I correct the cognition?
Of course.
But we have to ask a little more about where does distorted cognition come from?
Obviously, it is related to the specific environmental experience he has experienced, so I want to tell you that the depression diagnosis is very important.
From a psychiatric point of view, it is possible that the patient's treatment plan is similar, so we will have treatment guidelines.
However, from the psychological point of view of psychological counseling, everyone seeking help has its own characteristics, and the difference is still very obvious, so it is more necessary to have a good treatment and more individualized treatment.
03
Has depression been overdiagnosed?
After the reform and opening up, the prevalence of schizophrenia is very stable from the 80s to the present, basically a little increase, I am afraid that it is because of the high screening rate of people, about 0.5%.
Why is it so stable?
The reason is simple, schizophrenia is basically a mental disorder caused by biological genetic factors, so the prevalence is very stable.
In the 1980s and 1990s, the prevalence of depression was about 0.04% and 0.05%.
Over 12 years, the number has increased to 6 percent, meaning that about 70 million people across the country suffer from depression, and while that doesn't seem to be that high, it actually increased 120-fold between '93 and 2005.
Why did it become so "popular" between 1993 and 2005?
In the various editions of the DSM developed in 1980 and later, the concept of neurasthenia was eliminated.
Depression has become a new fashionable diagnosis, and some psychiatrists may now be diagnosed with depression in patients who have previously been diagnosed with neurasthenia, and some patients have only some physical symptoms at the time of treatment and do not experience depression, but these patients are considered to be "somatized depression".
In addition, the diagnosis of depression changes from strict to wide, and more people are diagnosed with depression. It is mainly affected by the following factors:
- New varieties of antidepressants are constantly being developed and widely used.
- Rapid development of mental health: Psychiatrists are paying more and more attention to mental health in general hospitals, primary health institutions and communities, and to the quality of life of people, especially the sick and the elderly.
- The pace of modern life accelerates, work and life lose boundaries, we pass our stress and anxiety to each other, and the ultimate victim is often the lowest child.
Behind the depression epidemic are economic, social, commercial, and phenomenological factors that we now understand depression, and we look at depression with a more scientific, prudent, and rigorous attitude.
Finally, I would like to emphasize to you that from a psychiatric point of view, there is no essential difference between patients, but from the perspective of psychological counseling and treatment, every depression has a different cause.
We must be individualized, because according to its characteristics to carry out meticulous analysis and understanding, to carry out effective consultation.
Author: Kevin Xu
Ph.D. and Associate Professor of Clinical Psychology
Founder of Da Ru Psychology, General Supervisor
Registered supervisor of the Chinese Psychological Association
A practicing psychiatrist at United Family Hospital