Both the Washington Post and the New York Times reported yesterday on a study published in The Archives of General Psychiatry which reports that at least 25% of people diagnosed as depressed are not but are feeling the effects of grief, loss or other sources of sadness.
"The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs.
Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.
The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness...
"The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous," said lead author Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry. "There is a trend to treat people in this somewhat mechanized way."...
Still, Wakefield and Allan Horwitz, a researcher at Rutgers University who studies the sociology of mental disorders, said their study, which was published in this month's issue of the Archives of General Psychiatry, pointed out that sadness has increasingly come to be seen as pathological in the United States. They have written a book called "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder."
Pharmaceutical companies, the psychiatric profession and patient advocacy groups have all contributed to the phenomenon, Horwitz added. 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," he said.
Patient groups, Horwitz added, think that the stigma attached to mental illnesses would be reduced if they were shown to be more common.
"The way in which people interpret their emotions is changing," Horwitz said. "People are starting to think that any sort of negative emotion is unnatural, that they can take medication and feel better. What that can also do is . . . make it less likely for people to make real changes in their lives that might be better than medications."
I am heartened by this but I confess that I doubt that in the face of the powerful marketing forces pushing for medicating everything that breathes that much will change. Still, the news may be beginning to get out that life is filled with ups and downs and that there is meaning in them.