The terms depression refer to both expected and pathologically chronic or severe levels of sadness, perceived helplessness, disinterest, and other related emotions and behaviours. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: “depressed, sad, hopeless, discouraged, or ‘down in the dumps’.
Let’s say a patient walks into my office and says he’s been feeling down for the past three weeks. A month ago, his fiancée left him for another man, and he feels there’s no point in going on. He has not been sleeping well, his appetite is poor and he has lost interest in nearly all of his usual activities.
Should I give him a diagnosis of clinical depression? Or is my patient merely experiencing what the 14th-century monk Thomas a Kempis called “the proper sorrows of the soul”? The answer is more complicated than some critics of psychiatric diagnosis think.
To these critics, psychiatry has medicalized normal sadness by failing to consider the social and emotional context in which people develop low mood — for example, after losing a job or experiencing the breakup of an important relationship. This diagnostic failure, the argument goes, has created a bogus epidemic of increasing depression.
In their recent book “The Loss of Sadness” (Oxford, 2007), Allan V. Horwitz and Jerome C. Wakefield assert that for thousands of years, symptoms of sadness that were “with cause” were separated from those that were “without cause.” Only the latter were viewed as mental disorders.
With the advent of modern diagnostic criteria, these authors argue, doctors were directed to ignore the context of the patient’s complaints and focus only on symptoms — poor appetite, insomnia, low energy, hopelessness and so on.
The current criteria for major depression, they say, largely fail to distinguish between “abnormal” reactions caused by “internal dysfunction” and “normal sadness” brought on by external circumstances. And they blame vested interests — doctors, researchers, pharmaceutical companies — for fostering this bloated concept of depression. But while this increasingly popular thesis contains a kernel of truth, it conceals a bushel basket of conceptual and scientific problems.
For one thing, if modern diagnostic criteria were converting mere sadness into clinical depression, we would expect the number of new cases of depression to be skyrocketing compared with rates in a period like the 1950s to the 1970s. But several new studies in the United States and Canada find that the incidence of serious depression has held relatively steady in recent decades.
For more details Redefining Depression as Mere Sadness visit www.halfvalue.com and www.halfvalue.co.uk For more information on books visit www.Lookbookstores.com. Also visit our partner sites http://www.dealsolow.com
