In the perpetual quest to distinguish the factors that constitute mental illnesses, the DSM-IV and psychodynamic theory take quite different approaches. The DSM-IV should be thought of more as a descriptive, if simplistic, classification system for psychopathology. It is concerned with symptomology criteria, complete with time-frames and checklists to create a universal diagnosis template for mental illnesses.
For depression, a “mood disorder” according to the DSM-IV, several symptoms must be present nearly every day in order to receive a diagnosis. These include five (or more) of the following: feeling sad or empty, anhedonia, weight loss or weight gain, insomnia/hypersomnia, psychomotor agitation, fatigue, inappropriate guilt, difficulty concentrating, and recurrent thoughts of death. Five or more per day for two weeks and it can be classified as a Major Depressive Episode.
While taxonomy has its merits, it does not account for the subjective experience of the person who is suffering. Psychodynamic theory attempts to do just that. It looks at the developmental etiology of depression, the defenses that might predominate in a depressed person, and an appropriate course of treatment that is suited to the individual. McWilliams describes the classical Freudian model of ‘anger turned inward’ to illustrate psychodynamic etiologies for the disorder. This thought led to the Ego Psychologists understanding of the defensive processes of depressive people in which introjection and turning against the self dominate. McWilliams also describes the developmental phenomenon that children who are raised by ‘unreliable or badly intentioned’ caretakers will often attribute unhappiness to themselves over the adults. She stresses that, in treating depressive patients, it is important to present an atmosphere of acceptance and empathy while simultaneously unearthing unconscious guilt and other negative beliefs about the self.