Max Hamilton developed his scale to record the severity of clinical depressive illness, not to quantitate a metaphysical construct called "major depression." The Hamilton depression scale is a clinimetric index (1), focused on the patient’s burden of illness. That is why, for example, it contains anxiety symptoms that emerge prominently in depressive episodes but that are not diagnostic of depression. Consistent with the pleomorphic presentations of clinical depression, that is also why it includes so many symptoms. Used as Hamilton intended, by clinicians who actually know the patients, the Hamilton depression scale captures an impressive range of clinical phenomena from mild to extreme illness. In this light, complaints about nonalignment of the Hamilton depression scale with DSM-IV criteria are irrelevant. Likewise, demands for the ultimate in psychometric properties are misplaced. Abridged versions that aim for essentialist purity over untidy clinical reality have not gained acceptance. To echo the quip about democracy, the Hamilton depression scale may be the worst depression scale ever developed, except for all the others.