“ ‘Then you should say what you mean’, the March Hare went on. ‘I do,’ Alice hastily replied; ‘at least - I mean what I say-that's the same thing, you know.’ ” (Lewis Carroll, Alice in Wonderland).
Tuma (Reference Tuma2000) gives a ‘recovery’ rate of 24% for depressed elderly patients but this figure actually refers to his category ‘lasting recovery’. If the term recovery may be used to include those who have relapsed but then recovered for a (specified) period of time, the rate from Tuma's study is 44%, or 66% once natural deaths have been removed. Tuma appears to be following Murphy's (Reference Murphy1987) view of recovery in depression as being a pint-pot only half-full.
This is not to disagree with the conclusion drawn from the study's data that elderly patients with depression have a poorer prognosis than younger adults, but there is a need to respond to the call for more clarity, if not unanimity, in what terms mean (Reference Frank, Prien and JarrettFrank et al, 1991). Low detection and treatment rates for depression in older patients in the community are not likely to be improved by ‘term’-inally induced therapeutic nihilism. If we are to avoid such confusion, we should heed the words of another Lewis Carroll character :
“ ‘When I use a word,’ Humpty Dumpty said in a rather scornful tone, ‘it means just what I choose it to mean - neither more nor less.’ ”
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