Sadness, Not Depression

In a timely article published Christmas Eve on the Project Syndicate site, Allan Horowitz and Jerome Wakefield, both who teach courses on the conceptual frameworks of psychiatry at the NYU School of Medicine, examine the ways in which the medical profession and pharmaceutical industry have profited from the removal of a diagnostic distinction between sadness or grief and depression. As they note

The distinction between contextually appropriate sadness and depressive disorders remained largely unchanged for two and a half millennia. But the psychiatric profession abandoned this distinction in 1980, when it published the third edition of its official diagnostic manual, the DSM-III.

The definition of Major Depressive Disorder (MDD) became purely symptom-based. All conditions that display five or more of nine symptoms – including low mood, lack of pleasure, sleep and appetite difficulties, inability to concentrate, and fatigue – over a two-week period are now considered depressive disorders.

In other words only the most pathologically cheerful are likely to avoid the snares of depression over a lifetime. Perhaps as in Huxley's Brave New World, the one unforgivable crime has become despondency.

Soma anyone?