each other. This is a serious problem for diagnosis and for treatment
as well as for research. Don't be surprised if you get conflicting
In most instances, the person knows when he/she is unhappy. If
you feel sad, that's it; you are the final authority. However, the victim
doesn't always recognize his/her own depression (so the "final
authority," i.e. you, may need to re-think the situation). Physical
complaints sometimes hide depression.
Consider this: Gillette and Hornbeck (1973) reported a case of a
54-year-old housewife who went to an emergency room with a painful
earache. She had seen three other MD's in recent weeks. None could
find the cause. Again, nothing could be found wrong with her ear and
she was sent home with pills (aspirin). Three days later she jumped off
a bridge. She hadn't opened the aspirin bottle. Accurate diagnosis of
depression is a problem. Depressed people frequently have physical
complaints; ill people are often depressed. Certainly some don't tell
their doctor even if they are aware of sadness. This concealed gloom is
called masked or smiling depression.
Even when depression is clearly expressed, physicians often ignore
it. A follow up of 25 people who committed suicide showed that 23 had
visited a physician within the last few weeks--and, according to the
doctors' own notes, 80% "showed clear evidence of depression." Yet,
few were actually diagnosed as depressed and none were given anti-
depressant medication! Physicians might do better if they used a brief,
simple questionnaire. But don't expect your doctor to read your mind
or even to ask about depression, you must be very clear about your
feelings and your needs. It is crucial that doctors know and DO
SOMETHING about your emotional state. And, if your doctor or anyone
thinks you have a psychological problem, please listen carefully.
Thirdly, the diagnostic picture is often complex, i.e. a person isn't
just depressed and that's all. On the negative side, many depressed
people are also anxious, and they may have personality disorders,
such as cyclothymic, borderline, schizoid, dramatic, passive-
aggressive, avoidant, and so on. On the positive side, perhaps more
than half of well known poets, playwrights, and novelists have mood
disorders, unfortunately several have severe manic-depression as well
as great creativity and sensitivity.
Fourthly, it is tempting to believe there are two separate, unrelated
processes going on in depression, one biological-chemical and one
psychological, each causing a different kind of sadness. Several
experts (Free & Oei, 1989) say the evidence for this basic assumption
is scant, because the organic and the cognitive components seem to
be very interrelated.
Even the professionals often have difficulty detecting depression,
so recognize that self-diagnosis may be hard. When in doubt, get help.
In its serious form, depression is a dangerous illness. Even in its