From a diagnostic‐therapeutic to a social‐existential response to ‘depression’

This paper provides a critique of the current diagnostic and therapeutic orthodoxy in relation to the concept of depression. It argues that there are substantial problems with the conceptual validity of the diagnosis, and that both empirical and moral objections can be raised to the current preference for a therapeutic response. It makes the case for an alternative that conceptualises misery, distress and sadness as existential states arising in particular social and biographical contexts. Its central argument is that the varieties of determinism that underpin the diagnostic and therapeutic discourse obscure important aspects of human agency and diminish options for its expression in the life world of the people receiving the diagnosis of ‘depression’. On this basis the focus of interest for health workers becomes the ability, working with patients, to discover dignity, meaning and purpose in the midst of suffering and distress.