Abstract
Thomas Kuhn noted that scientific paradigms survive through a mixture of their explanatory power but also by virtue of what they can ignore. The treatment of depression is dominated by both the medical model and cognitive behavioural psychotherapy. For both these models they focus on certain aspects of a client's presentation in arguing for their particular point of view. It is as much what they do not say as what they do that intrigues me. In my clinical practice depression manifests itself in such a number of varied ways that it often defies classification. For instance, we speak of depression with psychotic features as if somehow all other forms of its presentation are free from breaks with reality. Or again we speak of anxiety and depression as if somehow they are distinct, however my clients tell me that much of their depression finds expression as a generalized anxiety.