Seattle Therapist: Stress and Depression – What’s In A Diagnosis?

Meaning of “Stress” and “Depression”

According to a recent book review, two books have raised provocative points about the most common complaints that clients present to psychotherapists: stress* and depression. While the books have very different ways of treating their subjects, the review points out a link between them:

“While Becker’s book [One Nation Under Stress: The Trouble with Stress as an Idea by Dana Becker] focuses on stress and Shorter’s [How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown by Edward Shorter] solely on depression, they tell a larger, and largely similar, story: how these concepts have eroded through the decades into catchall conditions so pervasive that they’ve become virtually meaningless as terms for diagnosis or treatment.” More troubling, according to these authors, is that each of these “conditions” has become so prevalent that the distinction between normal and abnormal pressures or moods has become completely blurred.” [emphasis added]

Another way of saying this is: if everyone suffers lots of stress, and/or is “depressed”, than these terms lose their meaning. If clinical terms are bandied about in everyday language, diagnostic confusion would be unavoidable.

Is this a problem?

One might argue that there’s no real problem here if people mean different things when they have these complaints, as long as professionals maintain a consistent meaning. I would disagree.  Diagnosis must be part of a shared meaning and agreement – a treatment alliance – between therapist and client. And health insurance carriers are also developing their meanings of these terms, and what they are prepared to pay to treat them.

Changing Ways To Listen

So what’s a therapist to do?  I believe one answer is to have a dialogue where the client’s meaning of these words emerges. Rather than applying only a traditional meaning to either term, stress and depression can be used as guides to deeper, clearer meanings. I challenge myself to listen to clients more intensively, and with greater ingenuity, “unpacking” exactly what is going on and what is meant by these complaints.

There’s a challenge here to clients too. If you use the words “stress” or “depression”, be a bit prepared to say what you mean. There is no general agreement existing anywhere as to what is meant by those terms.

And then there’s “anxiety”

From my years of practice, I would add anxiety to the list of diagnostic words that have lost most of their meaning or usefulness.  Anxiety has become a catch-all for “all things bad”, from repeated worrying to a full-on panic disorder.  Few people think that common anxiety (the fear of what might happen) is a part of life. There’s a widespread belief that every form of it is pathologic.

The discussion about anxiety is likely much larger than the one about depression. But a blog post is not a book.


*[“Stress”, by itself, is not formally a diagnosis, and neither is “depression”. There are formal diagnoses that include the word, such as Acute Stress Disorder, and Post-traumatic Stress Disorder, or Major Depressive Disorder. Yet these are more specifically defined in the DSM, and not necessarily what clients refer to on an everyday basis.]

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