top of page
  • Writer's pictureH. Paul Putman III, MD

The Word "Depression": Common Misperceptions about Mental Health and Mental Illness

Updated: May 29

It is often confusing for the public to comprehend how psychiatrists use the terms “depression” and “depressed.” Admittedly, we are very unclear with you.  We use the terms to refer to a symptom within many different diagnoses, but also choose to include them in the names of several disorders. And then, as fellow humans, we also use these words in the same generic sense that most people do. What are we thinking?

We define depression as a mood or a symptom, but also list bipolar disorder – depressed phase, post-partum depression, schizoaffective disorder - depressive type, persistent depressive disorder, adjustment disorder with depressed mood, substance-induced depressive disorders and major depression as diagnoses, even though there is no “minor” depression: that we call dysphoria, just as we do milder forms of the mood or symptom. We have also just added prolonged grief disorder to our diagnoses.[1] In the past, we used the terms reactive and endogenous depression to indicate which treatments might be helpful, and these terms still occasionally appear in the general lexicon. Often, though, we just say "depression."

Amazingly, we seem to understand each other as we bandy the terms about, quickly changing from symptom to diagnosis, among diagnoses, and back again. Psychiatrists readily follow each other because we are aware of the context in which we are using these terms: when we hear them we inherently know if our colleague means mood state, symptom, or disorder. Most people, though, don’t. As treatment outcomes are linked to a physician’s communication skills, I wonder what impact this may be having on our work with our patients and our outreach to the public, as we could be referring to any one of these perspectives at any time. 

The world is on its own journey to explore and understand mental illness, particularly mood. Books such as An Unquiet Mind by Dr. Kay R. Jamison, The Noonday Demon by Andrew Solomon, Darkness Visible by William Styron, and River of Time by Naomi Judd and Marcia Wilkie are very popular in the lay press, focusing on sadness, grief, loneliness, loss, and emotional pain, some of the public terms that might fit “depression.”

Our puzzling use of these words in many contexts evolved organically, but probably does not serve us well as we attempt to inform the public of what problems can be helped. We create terms for ourselves to use, after all, not just to communicate with the public at large. It also does not help that our human languages contain many kinds of definitions: literal, figurative, precise, stipulative, ostensive, and operational.[2] 

This is even more complicated by what is called “the definition argument” – that we cannot have a clear understanding of an issue unless we understand exactly what a term means.[3] We are in a conundrum. There is no central authority in the world for sanctioning definitions outside of diagnoses - dictionaries describe rather than dictate word meanings - and we all proceed as though the other person understands which definition we mean.

This dilemma may make it difficult to convince some people that serious medical problems, such as major, post-partum, and bipolar depression, can and must be treated; too many people still think sucking it up and “pulling yourself up by your bootstraps” is the only option. After all, “everyone gets sad, don’t they? Buck up!” Not everyone has observed or understands the degree of suffering the serious forms of depression we diagnose and treat impose.  

Those who truly suffer these, though, know that what they have is not common sadness. They are intelligent, capable, resourceful people who have been stricken with a debilitating illness; they can no more think it away on their own than they can diabetes or a broken leg. Psychotherapy and, when indicated, medication or somatic treatments, are essential tools to help us when we have these illnesses - when we have “depression” defined as a medical diagnosis.

I wish we had developed distinctive and clearer terms for the mood state, the symptom, and the disorders of “depression,” and perhaps someday we shall. Psychiatry is constantly reexamining how we define, describe, and label mental health problems, sometimes looking at cause, often at symptoms, and other times at daily function. We are a group of very concerned, smart, and motivated caregivers, seeking to help people when they cannot help themselves; when “boot straps” are just not enough.

Perhaps someday we’ll also learn how to better communicate this.


[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TR (American Psychiatric Association Publishing, 2022),

[2] “The Appeal to Definition Fallacy: When People Misuse the Dictionary – Effectiviology,” accessed May 27, 2024,

Recent Posts

See All


bottom of page