The depression paradigm and beyond

The practical ontology of mood disorders

Abstract

This paper is an analysis of three elements of which depression as the primary target of current Western psychiatry and mental health care is made: the quest of psychiatrists to identify a depressive disease proper; the category of ‘major depression’ as defined by the diagnostic manuals; and the epidemiological view emphasising risk factors of depression. These elements are pivotal to the present understanding and experience of what depression is since they delineate the space of reasoning in which claims about depression are presented, problematised, and disputed. The paper presents how these elements have historically evolved and coalesced, and how depression has been formed and transformed as an object of knowledge and treatment in psychiatry and how the claims about depressive disorders acquire objectivity in the current mental health discussions. The paper also demonstrates how the quest of depression as a neurophysiological disease, consolidation of Major Depression as the diagnostic core of mood disorders, and the central role of the epidemiological notion of risk are both interlocked and discordant with each other in the current depression paradigm. In addition, tendencies of subversion of the depression paradigm are discussed.