Download PDF The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder

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Generally, two weeks, but in terms of loss of a loved one, two months, or perhaps longer. Has psychiatry over-diagnosed depressive symptoms, so that medications are prescribed for issues that might be better considered normal human sadness? Is depression a psychological or a biochemical illness? Rutgers University sociology professor Allan Horwitz and New York University professor of social work Jerome Wakefield argue that many normal emotional phases of sorrow are over-diagnosed as major depressive disorders.

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Horwitz and Wakefield agree that medication can be necessary for serious depressive disorders. But they take issue with using a few symptoms listed in the DSM-III and newer editions, such as sleeplessness, loss of appetite and fatigue lasting for at least two weeks as the time to write a prescription for an antidepressant. Horwitz argues that even with the newest edition, the DSM-5, that bereavement only as it applies to the loss of a loved one can cause these depressive symptoms that last longer two months.

He views other losses, such as financial ruin or loss of a romantic relationship, to be a form of bereavement that can also ause sorrow to linger. Horwitz and Wakefield also suggest that people dealing with depression seek the help of a mental health professional to discover underlying causes of the depressive symptoms and develop a plan to move beyond them.

They also suggest psychotherapy focuses on improving relationships. Stanford University neuroendocrinologist Robert Sapolsky concludes that the interaction of biology and life stressors can cause depression. Research has found a genetic factor in depression related to the production of seratonin, a chemical that can contribute to a feeling of well-being. Studies have found that the biological factor in itself does not cause depression, but may make a person more vulnerable when confronted by a combination of stressors, such as loss of a loved one and losing a job.

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But those who may be vulnerable to depression, possibly because of having that gene related to seratonin, may sink into a deeper and longer period of feeling fatigued and hopeless. For example, the mystery of life and death is an eternal human consideration, sometimes a fear, while a currently increasing anxiety is over food allergies, and now even growlingly intense fear of a random mass shooting. The challenge is to recognize the fears or anxieties and find ways to overcome them, or at least manage them. Although there are differing and evolving views of the causes of depression, social science and mental health professionals agree that the first step must be to seek diagnosis.

Treatment can include medication, psychotherapy, exercise, mindfulness training or meditation, or a combination of these. Nesse, Randolph M. We are pleased to support organizations locally and elsewhere who are doing good in the world. Please take a look at these fine organizations making a difference and consider joining us in our support.


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Brookline Community Mental Health Center. Phone: By Beta on September 17, in Depression. Facebook Comments. Like this: Like Loading What does Spirituality mean in Psychotherapy? Our Therapists Emily M. Popular Latest Tags. Media attention to depression. Depression has become a central concern in the culture more generally.

Popular television shows, best-selling books, and major articles in national magazines often feature this illness. A look at the new books in the psychology sections of bookstores reveals a virtual tidal wave of books on how to prevent or cope with depression of all sorts. A number of prominent public personalities, including Tipper Gore, Mike Wallace, and Brooke Shields, have received massive publicity after disclosing their depressive conditions.

Normal Versus Disordered Sadness Although the belief that depression is a widespread phenomenon is new, the symptoms we now associate with it, including intense sadness and the many other emotional experiences and physical symptoms that often accompany sadness, have been noted since the beginning of recorded medical history.


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These conditions were relatively rare but tended to be long lasting and recurrent. Because they were not proportional reactions to actual events, such conditions were assumed to stem from some sort of internal defect or dysfunction that required professional attention. Yet these pathological conditions involve the same sorts of symptoms— such as sadness, insomnia, social withdrawal, loss of appetite, lack of interest in usual activities, and so on—associated with intense normal sadness. This separation of normal sadness and depressive disorder is a sensible and legitimate, indeed a crucial, one.

Yet contemporary psychiatry has come to largely ignore this distinction. We argue that the recent explosion of putative depressive disorder, in fact, does not stem primarily from a real rise in this condition. The most commonly heard suggestions—such as that modern life is less socially anchored and involves more alienation or that media constantly expose us to extremes of wealth and beauty that cause us to feel inadequate by comparison—would tend to explain only normal sadness reactions analogous to the normal anxiety responses to which Auden pointed , not the massive growth of a mental disorder.

Certainly, progress in effectively treating depressive disorder with psychotropic medication has resulted in increased treatment of a condition about which physicians believe they can at least do some good, and perhaps it has motivated diagnosis of formerly ambiguous cases as depression in the hope of offering effective treatment.

But that does not by itself explain the vast growth in the numbers of people who seemingly have and are treated for this disorder; better treatments do not usually lead to a substantial increase in disease prevalence. Nor would improved treatments explain the results of epidemiological studies that bypass patients and directly interview community members not in treatment. Thus the seeming explosion of cases of depressive disorder is puzzling. What has happened to create the appearance of this epidemic?

Thus the recent focus in psychiatry on reliability of diagnosis based on symptoms has been pursued at some cost to validity—that is, whether the diagnosis represents a correct attribution of disorder. Its criteria might give rise to disagreements about particular symptoms, but each is widely and consensually believed to be an indicator of depressive disorder, and pre-DSM psychiatry recognized them as such.

One might also debate the exact number of symptoms needed for diagnosis; some would argue for laxer requirements with fewer symptoms, others for more stringent symptom requirements to ensure that disorder exists, and still others would insist that there should be no sharp cutoff but rather a dimensional continuum of severity.

Likewise, it seems reasonable to exclude people who are recently bereaved. The criteria are also fairly clear and, in most cases, not more difficult to measure than typical psychiatric symptoms in other disorders.

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The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder.

Such reactions, even when quite intense due to the severity of the experience, are surely part of normal human nature. Just as it is obvious why the DSM excludes bereavement from diagnosis, by parity of reasoning it seems obvious that it should also exclude these other sorts of reactions to negative circumstances. The diagnosis, however, does not exclude such nongrief responses. Consider, for example, the following cases: Case 1: Ending of a Passionate Romantic Relationship A year-old single female professor has sought psychiatric consultation to obtain medicine for insomnia.

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She must present a paper as part of a job interview and is afraid that she is not able to function adequately enough to do so. She reports that for the past 3 weeks she has experienced depressed mood and extreme feelings of sadness and emptiness, as well as lack of interest in her usual activities in fact, she has spent much of her time lying in bed or watching television.

Her appetite has diminished, and she lies awake long into the night unable to fall asleep due to the pain of her sadness. She is fatigued and lacking in energy during the day and cannot concentrate on her work. Because her painful feelings distract her during work, she is barely able to meet minimal occupational obligations e.

She has also avoided social obligations. When asked about what might have precipitated these distressing feelings, she reports that about a month before, a married man with whom she had had a passionate 5-year love affair decided he could not leave his wife and ended the affair. The woman had perceived this relationship as a unique, once-in-a-lifetime romance that had an extraordinary combination of emotional and intellectual intimacy. The woman agrees to check in with the psychiatrist periodically.

Eventually, she starts dating again, and after several more months the woman meets a new love interest, and any residual symptoms disappear. Case 2: Loss of a Valued Job A year-old married man has developed feelings of sadness and emptiness, lack of pleasure in activities, insomnia, fatigue and lack of energy, and feelings of worthlessness. He is not interested in seeing friends and seems unable to concentrate on anything.

He yells at his wife when she attempts to console him and rejects her efforts to comfort him. Subsequently, the couple is forced to sell their house and move to a small apartment. He remains bitter about how he was treated, but his symptoms gradually subside over time.

Case 3: Reaction to a Life-Threatening Medical Diagnosis in a Loved One A year-old divorced woman who is visiting a medical center distant from her home asks a physician at the center for medication to help her sleep. Each of these people easily meets the symptomatic requirements for MDD and the DSM would thus classify them as psychiatrically disordered.