4.2 Medicalising sadness?
Depressive disorders are amongst the most commonly diagnosed mood disorders. Indeed by some accounts there is a veritable epidemic of depression all across the world (Murray and Lopez, 1996).
Some critics have suggested that the apparent increase in depressive disorders may be due to changes in the criteria used to diagnose depression. The main issue here is how to distinguish depressive disorder from normal suffering. DSM’s own definition of a mental disorder is that a disorder involves a dysfunction in an individual; hence an expected response to a stressor should not be considered a disorder. Critics argue that DSM’s own criteria subvert this definition – DSM lists the symptoms that must be present for a given diagnosis, but ignores the context in which the symptoms developed.
Why might context be important here?
In some contexts the kinds of symptoms listed for a diagnosis of depressive disorder might be a normal and expected response to a stressor; in other words, the suffering is ‘normal’, not ‘dysfunctional’.
DSM-IV-TR is thus accused of medicalising ordinary, in the sense of ‘to be expected in the circumstances’, sadness; that is, of having criteria that allow conflation of the kind of sadness expected after a loss or disappointment, with the altogether different phenomenon of long-term and apparently inexplicable ‘melancholia’ (Horwitz and Wakefield, 2007). For example, DSM-IV-TR, while recognising the legitimacy of depressive symptoms for 2 months following bereavement in the shape of the loss of a loved one, does not recognise that other losses (e.g. of a job, a marriage) can also be a form of bereavement and lead to depressive symptoms.
What is the effect of DSM-IV-TR ignoring other contexts that could legitimately precipitate a loss or bereavement response?
Depressive disorder (rather than context-related sadness or grief) would be diagnosed. This could lead to inflation of the number of cases of depressive disorder diagnosed and referred for treatment.
Ordinary sadness is a common human experience that may have an adaptive function and for most people it dissipates on its own without treatment in days or weeks. Nevertheless, it is probably the case that many people experiencing it find it unacceptable and unbearable, and welcome any diagnosis that allows treatment and relief from the symptoms.
Indeed many people now appear to see low mood and anxiety as a ‘disease’ that can and should be cured as quickly as possible with drugs. Thus some of those who experienced low mood and anxiety consequent on severe financial set-backs or job losses in the UK recession of 2009 apparently ‘pressured’ their doctors into prescribing antidepressant and other pills, wanting a ‘quick fix’, even though other forms of help (such as advice on how to cope with debt) might have been more appropriate.
It is difficult to argue the rights and wrongs of this, and this course certainly cannot do full justice to such a complex issue.