email page    print page

All Topic Reviews
A Mood ApartA Sadly Troubled HistoryActive Treatment of DepressionAdolescent DepressionAdult Bipolar DisordersAgainst DepressionAgents in My BrainAmerican ManiaAmerican MelancholyAn Unquiet MindArtificial HappinessBeating the BluesBefore ProzacBeyond BlueBiological UnhappinessBipolar DisorderBipolar Disorder DemystifiedBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar ExpeditionsBlaming the BrainBoy InterruptedBritain on the CouchCalm EnergyCase Studies in DepressionChange Your ThinkingChronic DepressionComprehending SuicideConquering Postpartum DepressionConquering the Beast WithinCry Depression, Celebrate RecoveryDamageDepressionDepressionDepression 101Depression and GlobalizationDepression and NarrativeDepression Doesn't Always Have to Be DepressingDepression FalloutDepression in ContextDepression Is a ChoiceDepression SourcebookDepression, Emotion and the SelfDepression, the Mood DiseaseDepression-Free for LifeDetourDiagnostic Issues in Depression and Generalized Anxiety DisorderDown Came the RainDowning Street BluesDysthymia and the Spectrum of Chronic DepressionsEight Stories UpElectroboyElectroshockEssential Psychopharmacology of Depression and Bipolar DisorderExperiences of DepressionFacing BipolarFast GirlFatal AttachmentsGetting Your Life BackGod HeadHandbook of DepressionHandbook of DepressionHello to All ThatHelping Students Overcome Depression and AnxietyHow Everyone Became DepressedHow I Stayed Alive When My Brain Was Trying to Kill MeHurry Down SunshineI am Not Sick I Don't Need Help!Journeys with the Black DogLeaving YouLet Them Eat ProzacLife InterruptedLifeForce Yoga to Beat the Blues--Level 1LifeForce Yoga to Beat the Blues: Level 2Lifting DepressionLifting the WeightLincoln's MelancholyLiving Without Depression and Manic DepressionLong ShotLucy Sullivan Is Getting MarriedMadnessMaking Sense of SuicideMalignant SadnessManiaManicManic DepressionManufacturing DepressionMelancholiaMindfulness for Urban Depression: Tools for Relief from Stressful City LivingMindfulness-Based Cognitive Therapy for DepressionMood GenesMoody Minds DistemperedMy DepressionNatural Healing for DepressionNew Hope for Children and Teens with Bipolar DisorderNew Hope For People With Bipolar DisorderNew Hope for People with DepressionNight Falls FastNovember of the SoulOn DepressionOn the Edge of DarknessOne in ThirteenOrdinarily WellOut of the BlueOutsmarting DepressionOvercoming DepressionPerfect ChaosPotatoes Not ProzacProzac and the New AntidepressantsProzac BacklashProzac HighwayProzac NationProzac NationPsychotic DepressionPuppy Chow Is Better Than ProzacQuiet Your Mind & Get to SleepRaising a Moody ChildReasons to Stay AliveScattershotSelf-CoachingSightlinesSilencing the Self Across CulturesSilent GriefSongs from the Black ChairSongs Without WordsSpeaking of SadnessSpontaneous HappinessStudent DepressionSubordination and DefeatSuicidal Behavior in Children and AdolescentsSuicideSunbathing in the RainSurvival Strategies for Parenting Children with Bipolar DisorderSurviving Manic DepressionSwing LowSylvia Plath ReadsTalking Back to ProzacTaming Your Inner BratThe Aesthetics of DisengagementThe American Psychiatric Publishing Textbook of Mood DisordersThe Anatomy of MelancholyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe BeastThe Bell JarThe Best AwfulThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Blue Day BookThe Breakthrough Depression SolutionThe Clinical Science of Suicide PreventionThe CorrectionsThe Cruelty of DepressionThe Depressed ChildThe Depression CureThe Depression WorkbookThe Devil WithinThe Emotional RevolutionThe Family SilverThe Feeling Good HandbookThe Forgotten MournersThe Loss of SadnessThe Memory of LightThe Mindful Way through DepressionThe Mood CureThe Myth of Depression as DiseaseThe Naked Bird WatcherThe Nature of MelancholyThe Noonday DemonThe Pits and the PendulumThe Postpartum EffectThe Secret Strength of DepressionThe Van Gogh BluesThe Van Gogh BluesThe Weariness of the SelfThe Years of Silence are PastThirteen Reasons WhyThis Close to HappyTo Walk on EggshellsTreatment for Chronic DepressionUndercurrentsUnderstanding DepressionUnderstanding DepressionUndoing DepressionUnhappy TeenagersUnholy GhostUnstuckViniyoga Therapy for DepressionWhat Goes UpWhat the Birds SeeWhat Works for Bipolar KidsWhen a Parent is DepressedWhen Nothing Matters AnymoreWhen Someone You Love Is DepressedWhen Words Are Not EnoughWhen Your Body Gets the BluesWhere the Roots Reach for WaterWhy Are You So Sad?Why People Die by SuicideWill's ChoiceWriting Through the DarknessYou Are Not AloneZelda

Related Topics
On DepressionReview - On Depression
Drugs, Diagnosis, and Despair in the Modern World
by S. Nassir Ghaemi
Johns Hopkins University Press, 2013
Review by Helga Meier
Jul 8th 2014 (Volume 18, Issue 28)

Bottom Line

This is a fun and stimulating read for anyone interested in depression and other mood disorders.


On Depression by Nassir Ghaemi is aimed at a general, educated audience. He advances several points. The current classification of mood illnesses is based on pragmatic, not scientific considerations and doesn’t respect biological facts. Therefore, our understanding of mood disorders, depression in particular, has not advanced much. Instead of current practice, depression should be considered a mental disease if and only if it is recurrent. For this illness we should find treatments through proper research into biological causes. The vast majority of current instances of depression are not a (medical) disease. Instead they are, as the existentialists suggested, an unavoidable part of human life. Certainly we should aim at relieving the suffering, but the proper response is to deal with the existential problems instead of medicating away the symptoms.

Most Depression is Not a Disease

Recent books on the status of depression tend to view all depression as illness requiring treatment (pills or therapy), view only major depression as justifying treatment, or tout the benefits of melancholia to human growth. In all these discussions, it is taken for granted that the severity of symptoms (according to common sense or some version of the DSM) or trigger (upset over minor stress or understandable grief) allows a classification of cases of depression as either illness (major depressive disorder) or merely a low mood after a difficult life event. Ghaemi, refreshingly, argues for a completely different approach. According to him, mood disease is defined by recurrent episodes for which anything can be a trigger. One-off depressions, no matter how painful or debilitating are not diseases. This is quite different than the current division of mood disorders into those with manic episodes (bipolar disorder) and those without (major depressive disorder). But, says Ghaemi, whether mood is too high (manic) or too low (depressed) is not what distinguishes illness from a natural reaction to life. Because we are using false categories in research, research is not progressing much.

Western societies already have to face the sad fact that helping those with mood disorders has not much progressed since lithium and tricyclic antidepressants were discovered. Many of our mentally ill are in jail or homeless. But if Ghaemi is correct (and I’m inclined to belief he is), we’re wasting a lot of money on research which cannot be successful. Ghaemi uses syphilis as an illustration. When the syphilis-causing bacterium was discovered, clinicians had through careful observation identified a clear subgroup among those in mental asylums. When the syphilis blood test mapped those who were infected mapped onto the identified group, neurosyphilis was identified. Had the mental patients been classified according to pragmatic DSM-criteria, those infected with syphilis would have been placed in different subgroups and we would not have discovered that a certain kind of mental illness can be avoided by early syphilis treatment. Similarly, categorization of depression by practical consideration may be the reason that some patients are greatly helped by antidepressants while others show little effect and why some are greatly helped by psychotherapy and others not.

Postmodernism and the DSM

The division of mood disorders according to recurrence has been suggested before and was even used for a while. Ghaemi blames the loss of this insight on postmodernism, which he defines as the belief that the "modernist goal of discovering the truth through reason and science (the Enlightenment project) has failed. All ideas are merely based in culture and easily adjusted when beliefs change. This attitude allowed practical concerns to outweigh scientific insight. The reasonable order is to identify illnesses first and then develop treatments for them. But after the initial success of antidepressants, profit driven companies created illnesses to fit their medications and initiated major ad campaigns to help people realize that they had these illnesses. This then also led to changes in the DSM such as the addition of dysthymia and Generalized Anxiety Disorder which then also allowed psychotherapists to bill for these "diseases."

Ghaemi criticizes the approach taken in the DSM IV: science is deliberately considered least relevant for diagnosis, pragmatics most relevant. These pragmatic concerns include beliefs of clinicians, wishes of patients, general ignorance about many scientific facts, limitations of treatments, and the needs of insurance reimbursements. The wide use of DSM criteria has achieved high levels of reliability, but because of lack of a link to scientific fact, there had been little progress in validity, resulting not only in inefficient treatment but also in unsuccessful research.

Hippocrates versus Galen

I found the discussion of the Hippocratic and Galenic traditions in medicine particularly interesting. Hippocrates advocated that nature is the best healer and thus the physician should only aid nature in healing, and this only when the benefits of interfering clearly outweigh negative side effects. Galen, on the other hand, viewed nature as the cause of illness which physicians should fight with everything available to them. The Galenic tradition brought us bloodletting, induced vomiting and emetics. Any interference is better than allowing the illness to take its course. According to Ghaemi, psychosurgery, electroshock therapy and much of our psychopharmacology are squarely in the Galenic tradition causing more harm than good. This is because we don’t have a good understanding of mood disorders yet clinicians feel the need (and societal pressure) to do something, anything to fight back mental disorders and fix what is wrong.

Ghaemi sees himself in the tradition of Hippocrates and advocates that medicine return to this model.

In order to do that he suggests two rules. First (credited to William Osler), "Treat diseases, not symptoms." Second (credited to Oliver Wendell Holmes), "All medications are guilty [harmful] until proven innocent." Following these two rules would encourage more careful diagnosis based on biological reality (instead of pragmatic desires) and eliminate all the extra suffering caused by many current treatments.

Helping Those with Non-Disease Depression

If only recurrent mood episodes indicate illness, what are we to do with all those who are suffering from a single but severe depression, anxiety or dysthymia? These patients are the vast majority of cases encountered by clinicians. Even if they don’t have a medical illness, their suffering is real and they deserve relief. Ghaemi sees as the cause of their suffering the unavoidable anxiety of human lives already identified by the existentialists. It is only through coming to terms with the loneliness and Angst of the human condition brings not only relief but also valuable insight and growth. To give us some idea how this may be done, Ghaemi devotes several interesting chapters to "guides" which can show us ways to deal with this: Victor Frankl, Rollo May, Elvin Semrad, Leston Havens, Paul Roazen, and Karl Jaspers. Ghaemi extracts from each a helpful response to the difficulties of being human.


© 2014 Helga Meier 


Helga Meier is a graduate student in Philosophy at Texas A&M University. 


Welcome to Metapsychology. We feature over 8200 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716