Edward Shorter’s blog on Psychology Today attempts to parse the difference between supposed differences in types of depression:  melancholic and one that is a mixture of “anxiety, dysphoria, fatigue, insomnia and somatic symptoms” or “non-melancholic depression.” This exercise in futility is yet another example of how psychiatry continues to rearrange deck chairs on the Titanic.  

The profession is sinking under the weight of its nonsensical and nonscientific diagnostic labels and its continued pill-pushing, yet here it is having extended discussions about unimportant diagnostic fine-tuning. 

Shorter says this debate about two types of depression is “The Big Divide in US Psychiatry.” Actually, the more important divide is between psychiatry, which continues to believe in some alleged “disease model” of “mental illness,” and those of us who have read the research and have correctly concluded that “depression” and other purported illnesses are merely normal, natural emotional and behavioral reactions. There has never been proof that depression, anxiety, bi-polar, ADHD, etc., etc., are functional brain diseases or neuro-chemical imbalances. 


From Self-Acceptance PsychologyTM

“In clinical settings, low self-worth, loneliness and the fear of being excluded underlie nearly all complaints of anxiety, depression, obsessive-compulsive disorder, and other psychological conditions. Psychiatrists Jacqueline Olds, M.D., and Richard S. Schwartz, M.D., writing in “The Lonely American,” note that they began to notice that their patients’ suffering was related largely to isolation and loneliness, irrespective of diagnostic label. Yet it was difficult for the patients to talk about their isolation, because the feeling filled them with deep shame.(Olds, J.M., & Schwartz, R.S., 2009, The Lonely American: Drifting Apart in the Twenty-first Century. Boston: Beacon Press, p. 4.)

It is clear that in many instances a person’s internal or external shaming experience leads to a reaction of fear that causes:

  • emotional over-regulation (depression, social avoidance, schizoaffective disorder, etc.) or 
  • emotional under-regulation (which the DSM labels as ADHD, anxiety, oppositional defiant disorder, mania, etc.) 
  • a mix of under-regulation and over-regulation (bi-polar disorders, borderline personality disorder)

“It is a mistake to view depressed feelings as a ‘disease.’  Instead, it is merely a kind of unhappiness that involves helpless self-blame and guilt, a belief of being undeserving of happiness, and a diminished interest in life.” (Breggin, P. R., 2001,  The Anti-Depressant Fact Book. Cambridge, MA; Da Capo Press, p.14)

If shame and the threat response are so clearly linked in physiology, why does the DSM not address the emotion of shame as a root for diagnoses such as generalized anxiety disorder and depression? …

It is clear: Shame is a major driver of human behavior, leading to depression and anxiety. Why is this fact completely ignored in the DSM? Why should the emotion of shame be considered a “mental disorder?


So, psychiatry debates new subcategories of “depression” But how does this help? Does it lead to new, improve treatment options? Does it help explain why people are “depressed?” Does it provide any clinical utility whatsoever? 

The power of Self-Acceptance Psychology is that it offers numerous benefits, because it: 

  • explains human emotional, cognitive, and behavioral patterns as natural, predictable responses to real threats or perceived fears
  • normalizes and de-stigmatizes thoughts, feelings, and behaviors as adaptive and self-protective
  • improves the likelihood that clinicians will view clients as normal and not disordered
  • encourages client accountability
  • directly addresses the emotion (shame) and cognition (low self-worth) that lead to most “mental illnesses”
  • is based on common sense, facts, and scientific research, so is more accurate and reliable than the DSM
  • is a simple, transparent, and understandable conceptual framework accessible to clinicians and the public
  • uses behavioral explanations that lead directly to case formulation and to effective methods of therapeutic intervention and self-help
  • provides hope for permanent change through research-proven strategies of mindful self-compassion leading to self-acceptance
  • interventions are harmless, unlike medications, and provide hope for permanent change.

Let’s stop tweaking, as Shorter’s blog does, with a fundamentally broken system of the DSM and the “medical model” of mental illness.” Let’s develop a new system that is based on real facts and science. 

Lots more in Self-Acceptance Psychology!

Share this post!