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Understanding Depression, written by two prominent and highly respected psychiatrists, is subtitled A Complete Guide To Its
Diagnosis and Treatment. Klein and Wender are writing to educate the public about this potentially deadly illness and about effective biological treatments. Unfortunately, the important public service that is accomplished is offset by a cynical, denigrating, and stereotypic notion of how therapists work with depressed patients.
Writing primarily about severe depression (Major Depression), the authors recommend that a biological psychiatrist evaluate such a condition, as medication is almost always seen as the first step in treatment. They point out that medication should not be regarded simply as an adjunctive treatment and caution that therapists who cannot prescribe medication tend to downplay its importance. I think both points are well taken. There is a consensus that biological therapy has a crucial role in the treatment of Major Depression. This approach involves a frame of reference that differs markedly from that of the psychoanalyst. While it is imperative that therapists of all persuasions be able to recognize Major Depression so that appropriate biological therapy can be initiated, the authors go much further and assert that psychotherapy of any type has no primary role. Their dismissive attitude toward psychotherapy is a problem I elaborate later.
Chapter 2, “Symptoms of Mood Disorders: Recognizing Biological Depression,” is a major descriptive part of the book. It gives clear examples of the cardinal symptoms of Major Depression along with self-rating scales that readers can score and, if above a certain threshold, seek out help. Vignettes are presented to bring the particular symptoms to life, and I think the chapter does a good job letting the reader know that Clinical Depression presents with typical symptoms, including neurovegetative disturbances, anergia, psychomotor disturbances, guilt, hopelessness, and suicidal thinking. A