Drugging sadness

In today’s rush to medicalize virtually every human condition — and thereby require treatment, namely medications — increasing numbers of medical professionals are saying: “Hold on a minute.” Maybe we’re letting ourselves believe there is something wrong with us when we’re simply human.

Today, as we’re inundated by gloomy news telling us the world is a horrible place and trying to convince us that bad things have us surrounded, perhaps it shouldn’t be surprising that more people feel anxious, fearful and depressed. It certainly has made a ready market for the $12 billion Americans spend on antidepressant drugs each year. Never mind that things in our world today are not nearly as dire as many want us to believe.

True depression can be a devastating psychological and biological illness, and an important diagnosis to get right because to miss someone could cost a life. Still, a study published this week in the Archives of General Psychiatry calls attention to the fact that the symptoms of grief that are normal to experience after a loss such as a death, end of a marriage or loss of a job, are nearly identical to those used to clinically identify people who are labeled with a depressive disorder. They note that, incredibly, the guidelines used by mental health professionals to diagnose depressive disorders, the Diagnostic and Statistical Manual of Mental Disorders, fail to consider the context and reasons for symptoms, including bereavement.

The study, led by Jerome Wakefield, Ph.D., DSW, at New York University, examined the records of more than 8,000 Americans, aged 15 to 54 years, who had met the criteria for major depressive disorders and found that for 25% of them their symptoms had been triggered by either bereavement or other loss — situations without the complications associated with major disorders. Meaning, they’d been given a diagnosis that could lead to inappropriate treatments and drugs, where time and support might have been more appropriate for some.

They said that many types of loss can trigger “intense, normal sadness ... [including] rejection, economic misfortune, severe physical illness, loss of cherished possessions, and failure to attain important goals, among others.”

Yet the resulting signs of normal sadness — feelings of sorrow, difficulty sleeping, loss of appetite, lack of interest, trouble concentrating, lack of energy, etc. — are increasingly being seen as pathological in our culture. We no longer accept that it’s normal to feel sad at times. We’ve come to see the normal emotional responses to life’s stressors —things that would make anyone feel sad — as abnormal, while at the same time diminishing the significance of true depressive disorders.

Another researcher in this study, Allan Horwitz, Ph.D., of Rutgers University in New Brunswick, NJ, told the Washington Post this week that pharmaceutical companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease makes it easier to do studies, and psychiatry has come to think of itself as “the arbiter of normality.”

Not only are people being labeled and stigmatized and assuming the role of a patient, it’s led to the popular perception that depressive disorders are growing at an alarming rate, said Dr. Wakefield.

Today, depressive disorders are said to afflict 10% of American adults but, according to Drs. Horwitz and Wakefield in their new book,The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, there hasn’t been a genuine rise in depressive mental disease, simply a terribly misguided expansion of the diagnosis. They write that pharmaceutical companies overselling anti-depressants in direct-to-consumer advertisements, the psychiatric profession, and patient advocacy groups exploiting suffering for political purposes, have all contributed to the phenomenon. They argue that perhaps it’s time for all of us to reflect and question the medicalization of yet another normal part of life.