“There is no such thing as depression”: How Claims of Non-existence Transform the Epistemic Infrastructure of Psychiatric Knowledge Production

• In Event: Something from Nothing: Exploring Non-discovery and Negative Claims

Abstract

Major depressive disorder (MDD) is frequently considered the leading cause of disability worldwide. It was ‘invented’ as a standardized mental disorder in 1980, as part of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM-III and its subsequent editions met the interests of psychiatric researchers and pharmaceutical companies by establishing symptom-based definitions of psychiatric diseases. This process of standardization promised to advance bio-psychiatric research and to foster drug development.
However, the high expectations remained unfulfilled. Today, there is still no valid biomarker for any of the main psychiatric disorders. An increasing number of relevant actors (e.g. the US National Institute of Mental Health) link this scientific and medical failure to the design of the DSM, which currently serves as the ‘gold standard’ in mental health research. According to this claim, biomarker studies in major depressive disorder were doomed to fail, because MDD does not exist as a homogeneous entity.
Based on interviews with experts in depression research and document analysis, we will map this controversy. Our paper shows how the assertion of non-existence is mobilized to transform the epistemic infrastructure of mental health research. These critiques lead to an integrative analysis of various forms of biological and psychological information, which is designed to enable the “bottom-up” identification of “data-driven biotypes”, instead of using the DSM classification as the starting point. As we will show, this strategy of ‘nosological abstinence’ establishes the brain as an obligatory passage point of psychiatric knowledge production.

Authors

• Thomas Lemke

• Jonas Rueppel, University of Frankfurt