OVER-DIAGNOSED: The vexing issue of when bereavement or sadness becomes a disorder, and how it should be treated, requires much more research. Psychiatry Has Medicalized Normal Sadness By Failing To Consider The Social And Emotional Context
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 fiancee 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 Horwitz and Jerome 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.
To Be Continued ....
