First of all, thank you Dr. Diamond for writing this two-part article. I found it very interesting and enlightening. Your two-pronged approach -- treating both the biochemical and the psychological causes of Depression -- seems quite reasonable, while still respectful to the patients and their needs.

Unfortunately, I cannot say the same of Dr. Ryan, with whom I must respectfully disagree. Let me start by owning up front that I'm not a doctor. I'm a patient. As such, I must question the professional opinion of any so highly educated person who would persist in putting the word "depression" in air quotes, protesting any application of a label as an automatic deterrent to the use of unnamed (yet apparently widely available) tools for treatment, and then insisting upon commitment to change and personal responsibility without listing any examples of what kinds of changes one is supposed to make or how one is supposed to claim responsibility for Depression. I doubt this opinion because it was my own uneducated, uninformed, biased opinion for the majority of my life. This stigmatizing view of Depression as an air-quoted illness, one that can be resolved simply by owning one's own actions and striving toward health and wellness, kept me from seeking treatment for two agonizing years. My mother might shamelessly seek treatment for her thyroid problems. My father might take a pill to keep his diabetes in check. For me to take that step and receive treatment, however, required me to brave exactly this sort of stigma. In order to get help, I had to sacrifice my own self-respect and the respect of others, including my own father, who share Dr. Ryan's view of Depression.

Seeking help was the best thing I ever did. I don't see myself as a victim. I don't think Depression gives me a free pass. I do, however, find that understanding Depression as a legitimate disease that can be treated gives me hope. For two years, I tried to take personal responsibility and to commit to change alone. With medicine and a supportive doctor to assist me, I find my commitment renewed rather than diminished. Every day, I struggle to do more than I did the day before. Every day, I meet and fight this disease head on. Every day, I make a little bit of progress. A significant part of that progress, however, is based on the biological view of Depression as a disease and the medicines that have been developed to treat it. Along with well-regulated sleep schedules, healthy diet and exercise regimens, and other habits of healthy people, biological and psychological treatments *are* among the available tools that Dr. Ryan recommends.

How are patients with Depression supposed to take responsibility for their own wellness if even experts like Dr. Ryan put the name of our disease in air quotes and claim that taking advantage of available treatments renders us somehow lacking in personal responsibility? It is vital to my own recovery and to the recovery of others like me that we not be so shamed by those with opinions like Dr. Ryan's that we refrain from taking advantage of these valuable resources. As a result, patients may suffer needlessly or even die. For that reason, I cannot agree with Dr. Ryan, however more learned than myself she may be.

I'm glad it's recognized as a disease, then there will be less shame associated with it.
You are always in control of diseases, you can choose not to take blood pressure lowering medicine if you have hypertension, you have the choice of therapy in depression as well.

Thanks very much for your comments. It is always heartening to hear from colleagues, especially psychiatrists like yourself, who try to take a more "humanistic" approach to treating depression than merely medicating it. Yes, Jung's comment that the emergence of the Self is always experienced as a defeat to the ego is very much to the point. It is the defeated or, perhaps more aptly, deflated ego that brings the depressed patient into treatment, forcing him or her to acknowledge the limitations of ego, rationality and intellectualism, as well as the powerful compensatory phenomenenon of what Freud called the "unconscious," what Jung referred to as the "shadow," and what Rollo May described as the "daimonic." Depending on how this recognition of the unconscious is handled in treatment, this "defeat" can be turned into a victory. If you are interested in getting more involved in humanistic or existential psychotherapy, check out the website of the Existential-Humanistic Institute in San Francisco, and have a look at the Journal of Humanistic Psychology, for which I serve as one of the editorial board members. For a more Jungian approach, see the websites of the International Society for Jungian Studies and your local C.G. Jung Institute, as well as the original in Zurich, Switzerland.