Stress can stimulate the release of cortisol, which can negatively affect both body and mind. And many other medical conditions can also result in symptoms of depression. However, as noted, the DSM states that a patient should not be diagnosed with the psychiatric disorder depression when the symptoms of depression are due to the "direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)." If hypothyroidism is considered a medical condition, it's unclear why the overproduction of cortisol would not also be considered a medical condition.
Thus, rather than a specific psychiatric brain disorder causing depression, we are simply talking about the uncontroversial reality that certain physical, familial, and societal pains can trigger depression.
While individuals vary in their belief about the benefits and costs of continuing to view depression as a psychiatric disorder caused by a brain defect, as long as depression is considered a psychiatric disorder caused by a brain defect, Americans are unlikely to ever elect another pained depressive such as Abraham Lincoln as president. I can't help but wonder what American political leadership would be like if Americans had been led to believe that it's actually the insipidly upbeat who have a brain defect.
Bruce E. Levine , a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite . His Web site is www.brucelevine.net
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