01. Depression is not a "disease" in the traditional sense, it is a "disorder"
Is depression a disease? Different people have different opinions on this.
Last week, we shared an article by Peng Xiaohua, a traveler, author, counselor and psychotherapist. She believes that depression is still not diagnosed by laboratory tests and imaging tests, and psychiatrists only look at the symptoms, not the cause, "this diagnosis is subjective and arbitrary."
She also believes that depression is not a physical disease, but an individual's pain and despair after encountering interpersonal conflicts/injuries, life challenges, and negative life events, but is "constructed" as "depression" by psychiatry and drugs.
I agree with some of Peng Xiaohua's views, but she questioned the diagnosis of "depression", which I think is unreasonable.
In fact, "depression" is only a common name in our Chinese context, its real name is actually "major depressive disorder", the English name is "major depressive disorder", which is the most common one in the "depressive disorder" category. We'll talk about this category later.
In English, "disease" generally refers to a disease with physiological lesions. "disorder" refers to mental psychological or behavioral problems that have a negative impact on the individual's life, so it is called "disorder", the patient has not found any problems physically, but there are indeed obstacles that make it difficult for them to live normally, which is not a concept of physiological disease.
However, whether it is "disease" or "disorder", it is customary to collectively call "disease" in the Chinese, so there is a common name of "depression".
So, from this point of view, depression is indeed not a "disease" in the traditional sense. But in a broad sense, it does belong to one of the clinical diseases and disorders.
In fact, from the current situation in the mainland, popularizing the disease of "depression" to the public, making everyone aware of its existence and characteristics, and looking at it rationally, is more beneficial than harmful. On the contrary, if you blindly question or even deny that there is a "depression" disease, there will be many people who are deeply in pain, but they do not receive timely attention and treatment, and it is easy to embark on the road of suicide.
In the last century, most people did not have an objective understanding of depression, and they felt: What is depression? The so-called depression is actually those people who have poor stress resistance, hypocrisy, too sensitive, self-trouble, drilling, careful eyes, a tendon, shaft, laziness...
In short, they believe that depression is a matter of personal character or thought, purely "not sick and sick", or even an excuse to escape reality. This vision of others makes depressed patients have a strong sense of shame and huge psychological pressure, they dare not and are not willing to seek help, let alone seek medical treatment, and eventually it is easy to cause tragedy.
Image from the Internet
To be honest, even now, there are quite a few people who hold this view. For example, some children have obvious symptoms of depression, but parents cannot understand it, and it is easy to adopt the following wrong coping methods:
First, parents feel that the child is just experiencing something unpleasant and think that it is not a big deal.
So they tend to comfort their children like this, "You want to open a little", "This is a big deal, you don't want to be worried", "You have to learn to let go"... Parents thought that their children would feel more comfortable listening to it, but they did not expect that the child was more irritable, and even lost his temper with his parents.
This is because in a way, these words spoken by parents are "correct nonsense". This is true, but parents do not realize that their child is already sick, and these words do not play a positive role for depressed people.
Moreover, depressed people are also easy to interpret these words from the negative, "My parents always let me go, they are accusing me of not being generous and open-minded!" "Yes, everyone else can put it down, why can't I?" I'm so useless." This may lead to further deterioration of the parent-child relationship, or lead to more self-denial and aggravation of the patient's illness.
Second, after some children suffer from depression, the symptoms of decreased interest and activity are particularly prominent, and the function of learning and social interaction is severely impaired, that is, they want to go to school and make friends like normal people, but they can't.
But if parents can't understand this depression symptom, it's easy to think that the child is lazy, "This guy is obviously not uncomfortable, why is he not going to school, and he is still at home all day doing nothing, sleeping in, playing games?!" ”
They are very dissatisfied and put forward requirements for children in all aspects of life and learning, such as children should go to bed early and get up early, insist on physical exercise, how long to study every day, and so on. Sick children simply cannot complete these tasks, and parents are so disappointed that they may be tempted to blame their children.
The child was already very depressed, and the parents' incomprehension and accusations were like a knife cut on the child's heart, continuing to cause superimposed psychological trauma to the child, and the child's condition continued to deteriorate.
Third, many children have symptoms of depression during adolescence, in addition to being depressed, sometimes very irritable, and more likely to conflict with their parents than before.
At this time, many parents confuse these symptoms with adolescent rebellion. Some parents think that it will be good to wait for this period to pass, while others think that they should not condone their children's rebellion, but should discipline them more harshly, requiring their children to be sensible and obedient. This can also lead to more intense parent-child conflicts, and the child's condition intensifies.
As early as 2015, depression was ranked as the 4th leading disease in the world. More appalling data, depression has a suicide rate of more than 10%, making it the second largest health killer after cancer.
Depression is very harmful!
And if you want the majority of parents to be aware of these hazards, you must first make them realize that this is a disease, not "the child is in a bad mood", "the child is lazy" and "the child is rebellious", and then they will be willing to change the way they get along with their children, pay attention to the emotional needs of their children, seek medical advice if necessary, and try to find ways to help their children restore their mental and physical health.
02. Depressed mood≠ depression
With the increasing attention of the mainland to the mental health of the people, coupled with the vigorous publicity and popularization of the country in the past decade, more and more people know and understand the disease "depression", and more gratifyingly, more and more people have learned to respect and understand depressed patients. This is the progress of society and deserves to be affirmed!
However, the public's understanding of "depression" is still relatively superficial, and in many cases, what the public calls "depression" is not real depression in psychiatry.
Among them, the concepts of "depressive mood", "depression" and "depressive disorder" are still unclear to the public, and it is easy to confuse. This can lead many people to mistake situations that are not depression for depression.
Image from the Internet
"Depressive mood" is a normal emotion that almost everyone has experienced, or will experience, and can also be understood as "depressive state". When we encounter greater or more difficulties, setbacks and blows in our daily lives, we may have depression, manifested as low, not like to speak, easy to sigh and cry. In the language of the Internet, it is "emo", but it is not the same as depression.
According to the "Report on the Development of Chinese National Mental Health (2019-2020)" released by the Institute of Psychology of the Chinese Academy of Sciences, the detection rate of adolescent depression was 24.6% (including 7.4% for severe depression).
Many people are skeptical about this data, "On average, 1 in 4 adolescents has depression?" How could it be so serious? In fact, this depression detection rate refers to adolescents who have had a "depressive mood" or "depressive state", not the prevalence of depression.
However, if the individual's "depressed mood" lasts for more than 2 weeks and affects normal life, it is indeed possible to suffer from depression, which requires timely attention.
So what is the difference between "depression" and "depressive disorder"? Are they just called differently? Of course not, the biggest difference between the two is that "depressive disorder" encompasses a wider range.
In the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (hereinafter referred to as "DSM-5") compiled by the American Psychiatric Association, one of the world's most authoritative diagnostic criteria, "depressive disorder" contains 7 types:
Disruptive mood dysregulation disorder;
Major depressive disorder;
persistent depressive disorder (dysthymia);
Premenstrual dysphoric disorder;
Substance/drug-induced depressive disorder;
Depressive disorders due to other medical conditions;
Other specified and unspecified depressive disorders.
When psychiatrists say "depression", they mainly refer to the second type, Major Depressive Disorder (MDD). The following are specific diagnostic criteria for "major depressive disorder":
A. Presence of 5 or more of the following symptoms showing different changes from previous functions during the same 2-week period, at least 1 of which is 1. or 2.
1. Depressed mood almost most of the day, either subjectively reported (e.g., feeling sad, empty, hopeless) or observed by others (e.g., tears)
2. Almost every day or most of the day, for all or almost all activities the pleasure or pleasure is significantly reduced
3. Significant weight loss without dieting, or weight gain (e.g., weight change of more than 5% in a month), or loss or increase in appetite almost every day
4. Insomnia or excessive sleep almost every day
5. Almost daily psychomotor agitation or retardation
6. Fatigue or low energy almost every day
7. Almost daily feeling worthless, or excessive and inappropriate guilt (can reach delusional levels and do not blame themselves only for illness)
8. Decreased ability to think or concentrate or hesitate almost every day
9. Recurrent thoughts of death, repeated suicidal thoughts without a specific plan or a certain suicide attempt, or a specific plan to carry out suicide.
B. These symptoms cause clinically significant distress or cause impairment in social, occupational, or other important functions.
C. These symptoms cannot be attributed to the physiological effects of a substance or other medical illness
D. Not better explained by schizoaffective disorder, schizophrenia, delusional disorder, or other psychotic disorder
E. From no manic episode or hypomanic episode
However, after reading the above diagnostic criteria, do not diagnose yourself. If you suspect that you or your relatives and friends have depression, you should still see a professional psychiatrist for examination. In the clinic, the diagnosis process of depression is not simple, and we will discuss it in detail in the next column article.
The "depression" that the public calls is not necessarily "major depressive disorder", it is likely to be other types in the general category of "depressive disorder".
03, these mental and psychological disorders are easily mistaken for "depression"
Also, some mental and psychological disorders do not belong to the general category of depressive disorders at all, but they are also easily confused with depression. Not to mention that the public can't tell the difference, even many clinical psychiatrists may not be able to distinguish well.
For example, "bipolar disorder", also called "bipolar disorder". Readers who believe that our public account are no strangers to it. As the name suggests, bipolar disorder has two "phases", one is the "manic/hypomanic phase" and the other is the "depressive phase", when the patient is in the "depressive phase", a major depressive episode will occur, and its symptoms are basically the same as depression.
Some self-media articles say that Churchill, Van Gogh, Leonardo da Vinci, and Hemingway are bipolar disorder patients, but there are also many articles saying that they are depressed patients, which shows that many people can't tell the difference between the two.
By the way, the painter Van Gogh is known as the most famous person with bipolar disorder, and the "World Bipolar Disorder Day" is set on his birthday. But Van Gogh was not officially diagnosed with the disease during his lifetime, it was after his death that psychiatrists made inferences based on his performance during his lifetime.
Image from the Internet
From the perspective of the multidisciplinary diagnosis and treatment model (MDT), we believe that Van Gogh is not really bipolar disorder, he should be depressed with other serious mental and psychological problems.
In addition, many people suffer from post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) after suffering major psychological trauma, but do not get accurate diagnosis and targeted treatment in time, and are also prone to major depressive episodes, which are confused with depression, and patients will have difficulties when they want to defend their rights.
For example, in June 2018, Li Mouyi, a 19-year-old girl in Qingyang, Gansu Province, committed suicide by jumping off a building. At that time, when many people saw the news, their first reaction was, "Oh, she committed suicide by jumping off a building, that must be depression."
But later the police investigated and found that in 2016, the girl had been molested by her high school head teacher Wu Yonghou, and then she soon developed mental and emotional problems, and was subsequently diagnosed as depression by a psychiatrist at the local hospital.
Li Mouyi's family was angry with the head teacher Wu Yonghou and tried to report the case and defend his rights. However, because "depression" is a symptomatic diagnosis, mainstream psychiatry believes that its cause is unknown, and it cannot prove that Li Mouyi's onset is directly related to being molested, at most it is only one of the predisposing factors. As a result, the local police only allowed Wu Yonghou to accept 10 days of administrative detention.
Later, Li Mouyi's state became worse and worse, and her family accompanied her to Beijing Anding Hospital to see a doctor, and experts from the hospital believed that she was not depressed at all, but had post-traumatic stress disorder (PTSD) after being molested!
This accurate diagnosis was more conducive to the girl's family defending their rights, but by this time her condition was already very serious, and she finally chose to commit suicide. After her suicide, it caused a sensation in public opinion, and the public prosecution and legal departments intervened again to investigate. Two months later, Wu Yonghou was arrested; Two years later, in 2020, Wu was sentenced to 2 years in prison for forcible indecency. Justice came, but it came too late.
There are many more similar examples. For example, after the "pink-haired girl" in Hangzhou was raped by the Internet, it caused huge psychological trauma, and she actually suffered from PTSD, and eventually suffered a major depressive episode. However, many media outlets have promoted that he suffered from depression.
There are also Wenzhou rural couples who said on the Internet to cure depression by dancing "ghost step dance" and also became popular on the Internet, and their husband Fan Duo had suffered a serious car accident before they developed emotional symptoms. He didn't suffer from depression, but PTSD.
04, in vicious events, depression often becomes a "pot man"
In addition to PTSD secondary depressive episodes are easy to confuse with depression, there is also a situation that is also easy to make depression "behind the black pot".
In recent years, many social malignant incidents, such as driving to hit people, mother-killers, stabbing classmates to death, deliberately jumping off buildings in downtown areas to commit suicide and smashing people, media investigations found that many murderers have been diagnosed with mental illness, and even found that their medical records have depression or depressive disorder.
Then, there is often a sea of scolding of depressed patients on the Internet.
In fact, many netizens only see the appearance. Being diagnosed with a mental illness does not necessarily mean depression or other depressive disorders, and even if the killer has been diagnosed with depression, their actions of harming others often do not stem from depression.
Simple depressed people will be completely internal, always inferior, self-guilty, and self-blame, thinking that it is all their own fault, that they have brought trouble to others and society. Therefore, unless they have psychotic symptoms such as hallucinations and delusions, thinking that others want to harm them, they generally do not harm others, let alone retaliate against society. When they decide to commit suicide, they try to avoid crowded places and hope to leave quietly.
A hot event that caused a sensation in society some time ago: 4 people in Zhangjiajie, Hunan Province committed suicide in a group, and these people are likely to be simple depressed patients. Their willingness to leave this world is very resolute, but they are unwilling to hurt the innocent, and the suicide note also specifically stated that their suicide was completely their own decision and had nothing to do with the scenic spot.
Therefore, simple depressed people are often very kind, and they are very worried that they will cause inconvenience to others, and they will not intentionally hurt others.
If a patient diagnosed with depression engages in extreme, aggressive behavior, it is actually because they are accompanied by severe personality abnormalities, most commonly severe paranoid personality disorder and antisocial personality disorder, and it is very doubtful whether this diagnosis of "depression" is misdiagnosed.
Image from the Internet
In addition, patients who do not have mood disorders will have severe personality disorders, and many people without mood disorders also have. Like the recent hot search "a man was killed by a stranger with a knife on the train", the man just had an altercation with the murderer, and the murderer suddenly pulled out a knife and slashed at him.
The murderers in such "bizarre" cases are often severe paranoid personality disorder or severe antisocial personality disorder. They tend to be free of depression, because setbacks are rarely attributed internally, only blame outsiders.
Therefore, it is not depression that causes aggression to the outside world, but personality abnormalities. Just because the public is not familiar with personality abnormalities, they are more familiar with depression, so as soon as they saw that the murderer had been diagnosed with depression, they all buckled the "black pot" on depression. This is very unfair.
Of course, this is not all to blame on the public. Because even professionals, most psychiatrists and mental health practitioners at home and abroad, have insufficient knowledge of personality disorders.
The mainstream psychiatric clinical diagnosis in China is still a single-axis diagnosis, with only the first axis diagnosis (i.e. depression, obsessive-compulsive disorder, addiction, etc.), and lacks a second axis diagnosis, that is, a personality diagnosis. Many people with mental and psychological disorders actually have personality problems, and they are quite serious, but they are often missed, so there is no record in the medical records, leaving great room for misunderstanding by the media, public opinion and the public.
I hope that when the public sees some vicious events in the future, they will not blame depression for their evil deeds, let alone look at patients diagnosed with depression with colored eyes, thinking that they are "black sheep".
Of course, if we want the public's view to be more positive and rational, we professionals must continue to work hard. It is hoped that more mental health practitioners can deepen their understanding of personality abnormalities, popularize more relevant knowledge, and stop inadvertently letting depression always lie down.
In fact, the public has never known what depression is and does not think that depression is a disease, to now more and more familiar with depression, which has been a great social progress.
However, whether it is mental health practitioners or the general public, the understanding of depression still needs to be deepened.
The main cause of depression is actually caused by patients suffering from superimposed psychological trauma and continuous self-denial. And everyone's mental and psychological state is dynamically changing, and we cannot predict whether the future road of life will be smooth sailing or ups and downs.
From this point of view, in fact, as long as each of us lives, we may suffer from depression; Or because of other mental and psychological problems, but was labeled as "depression".
I hope that each of us can have an objective, correct and scientific understanding of "depression", avoid inadvertently "stigmatizing" patients diagnosed with depression, try to establish good interpersonal relationships with them, and learn some knowledge on how to make depression recover faster and better.
If this can be achieved, I believe that each of us will not be afraid to become "depressed", and the patient group will be more likely to have access to a good and friendly social support system to speed up recovery.