Carl commented on a popular article summarizing work of @kristensyme & mine

What& #39;s the conflict? A short https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread">

tl;dr: Carl& #39;s evolutionary model of major depression (MD) is based on how MD should be defined in the DSM, but isn& #39;t. Ours is based on the actual, screwy DSM def.

1/ https://twitter.com/CT_Bergstrom/status/1298471118286667779">https://twitter.com/CT_Bergst...

Bergstrom & Meacham have a model of MD:

https://academic.oup.com/emph/article/2016/1/214/2802659

v.">https://academic.oup.com/emph/arti... similar to a model by Trimmer et al:

https://academic.oup.com/emph/article/2015/1/123/1796383

Both">https://academic.oup.com/emph/arti... models assume that MD symptoms are (1) prolonged, (2) even when conditions improve.

(The screenshot is the Trimmer et al. version)

2/

The Bergstrom/Meacham/Trimmer criteria are how major depressive disorder *should* be defined. Symptoms whose severity & duration are disproportionate to circumstances clearly indicate mental disorder. Spitzer, leader of DSM-III, suggested exactly this

https://pubmed.ncbi.nlm.nih.gov/10588397/ 

3/">https://pubmed.ncbi.nlm.nih.gov/10588397/...

Unfortunately, the DSM does *not* define MD this way. Instead, symptoms need only persist for 2 weeks, & there is no consideration of conditions or circumstances whatsoever. In fact, the DSM-5 rejected concerted efforts to add consideration of circumstances for MD diagnosis.

4/

The evidence is clear that most cases of MD, as defined in the DSM, are caused by genuine adversity, such as sexual assault or divorce, & resolve in <1 year (the median is 6 months). There is little evidence that most are disproportionate responses.

5/

https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.12753">https://onlinelibrary.wiley.com/doi/abs/1...

Our models, in contrast, take MD as given in the DSM. Most such cases are unlikely to be brain dysfunctions.

More details here:

https://grasshoppermouse.github.io/2018/12/16/seven-reasons-why-major-depression-is-probably-not-a-brain-disorder/">https://grasshoppermouse.github.io/2018/12/1...

One area of disagreement might be the "normal" range of severity, which I think can be pretty high. Ex: child mortality has been high for most of human evo history. As an anthropologist I& #39;ve witnessed families reacting to child deaths: it& #39;s as devastating as you would guess

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