In a relatively brief, inviting Preface, Tom Ban recounts the history of research in European psychopathology during the 20th century. He details the contributions o f many of its leading figures and covers ground unfamiliar to many American psychiatrists. These early workers arrive at different formulations of depression, different diagnostic systems and different treatments. Of specific interest is the development of “phenomenologic psychopathology” referencing the roles of Karl Jaspers and Kurt Schneider, noting that they reopened the science in a more enlightened context. The new antidepressants have clearly shaken the approaches to treatment. Such earlier theoretical concepts have been set aside as clinicians adopt a more practical trial and error approach with the new drugs and show less concern for lessons in this historical sphere. Ban is more at home in that context because the approach which relies less on ideas about etiology, provides the foundation for the methodology he will use in the book to “deconstruct major depression, (to) open the path in the study of the biology and genetics of the different depressive subtypes” In so doing he hopes to achieve a “personalized medicine” capable of individualizing the treatment approach for each depressed patient. Ban’s approach will attempt to provide psychiatrists with a new context within which to work. One can look forward to a more complete blueprint for this strategy in the text that follows.

Martin M. Katz
 July 25, 2013

This is a reply to this comment

Thank you for your encouraging comments on the “Preface” of “Toward Personalized Treatment of Depression,” a monograph still in preparation, in which the need for deconstructing the consensus-based diagnostic concept of “major depression” is addressed. As you rightly noted, my “Preface” is focused on “phenomenological psychopathology,” a research method of psychiatry developed in Europe in the second and third decades of the 20th century that separates “abnormal psychology” from “mental pathology” and distinguishes between diagnostic concepts (and sub-forms within these diagnostic concepts), on basis of “abnormal forms of experience” instead of behavioral measures and social performance. Employment of “phenomenological psychopathology” should yield diagnostic concepts closer to “prototype-based” diagnoses of “depression“ than current “consensus-based” diagnoses. It might also yield pharmacologically sufficiently homogeneous populations for neuropsychopharmacological research in depression. But, even if that would not be the case, it would facilitate a more discriminate use of “antidepressants” by restricting the depressive population to those with “abnormal forms of experience,” and by separating within “major depression” subpopulations with different “abnormal forms of experience.”

Thomas A. Ban
August 22, 2013