MASKED DEPRESSION AND
MASKED DEPRESSION is one of the more common clinical ailments seen in western medicine and rivals overt depression in frequency. Indeed, it is the type of depression most often encountered by nonpsychiatric physicians. The subject of masked depression and depressive equivalents presents us with a paradox: In spite of the frequency of the syndrome, only a relative handful of clinicians have a meaningful awareness or understanding of it. The depressive affect and even many depressive syndromes may be so masked that a nonpsychiatric or even psychiatric physician may be unaware of the fact that a serious emotional disorder is at hand until a massive, full-blown depression erupts and dominates the clinical scene.
The term "depression," in the minds of most laymen and physicians alike, usually refers only to a mood, which in psychiatric circles is more specifically labeled as sadness, melancholy, dejection, despair, despondency, or gloominess. If this overall mood pattern is not dominant in the clinical picture, the patient is not considered depressed. This view is universal among laymen. However, this narrow concept is also held by some physicians and even by psychiatrists. The masking veneer or facade may vary depending upon many factors, including: (1) the culture, (2) age of patient, (3) socioeconomic and sociophilosophic background, (4) hereditary and congenital processes, and (5) ontogenic development.
While the masked depression syndrome, hidden behind a broad spectrum of masking processes, is broadly represented in all cultures, the relevant literature is very sparse and deals primarily with those syndromes that are essentially manifested clinically as psychosomatic disorders or hypochondriacal complaints referred to various organ systems. Masked depression has been referred to by a variety of labels, which in themselves have contributed to the confusion surrounding this syndrome. The various diagnostic labels include: (1) masked depression, (2) de