While acknowledging the biological antecedents and value of emotions such as sadness and anxiety, and the possibility that ‘ordinary’ sadness and anxiety may now be over-diagnosed as disorders and over-medicalised, we must not forget that we are dealing with a spectrum of severity. Thus, far from being ordinary, major depression is an extreme form of sadness – described by those like Lewis Wolpert who have experienced it (Vignette 1) as ‘malignant sadness’ (Wolpert, 2001). There can be no doubt that severe depression is a disorder, associated as it is with self-harm, inability to work and even suicide. What might underlie such disorders, and why do some people experience such extremes of sadness, and of other emotions such as anxiety, while others do not? This question is addressed in the related OpenLearn course, where we consider the possible causes of emotional disorders.
Any examination of emotional disorders needs to done against the backdrop that emotional phenomena have evolved over millions of years, and that negative as well as positive emotions have functions. There is evidence that sadness and worry can be beneficial.
The concept of the ‘triune brain’ postulates that the human brain can be thought of as ‘three brains’. Some are ‘ancient’ in evolutionary terms, while others are newer. Parts of our brains are very similar to those in other animals, and include the brain bases of emotional responses such as the fear response.
There is good evidence for the universality of emotions such as fear, anger, sadness and joy amongst humans, as a result of shared biological bases. However, culture affects which emotions are displayed and what they are associated with.
Observations of the behavioural tendencies of animals in situations of defeat and outranking have inspired important insights into human depression and anxiety.
DSM-IV-TR distinguishes between affective (or mood) disorders and anxiety disorders. First-person experiences of major depression (MD) and generalised anxiety disorder (GAD) are described and considered in the light of DSM criteria for these disorders.
There are established diagnostic criteria for deciding whether particular affective or anxiety disorders are present in an individual or not. However, the process of diagnosing such disorders is not straightforward. This is an important issue, not just for the treatment of patients suffering from emotional disorders (for instance, GPs get a significant proportion of diagnoses of major depression wrong) but also for those trying to clarify the risk factors for these disorders.