Loss of Sadness

A piece at Business Day (Zimbabwe) makes some nice points about depression. The referrence The Loss of Sadness by two sociologists, Allan Horowitz and Jerome Wakefield. The article is written in the context of recent findings that SSRIs may be no better than placebo, that in some places access to talk therapy is limited, and that, finally, it appears that antidepressants (SSRIs) may be being overprescribed.

1. There’s no blood test for depression (yet it exists).

Depression is not an illness that has a blood test to exclude or diagnose it. Rather, it is a diagnosis reached by observation, talking, and sometimes also by questionnaire, using criteria set out by the Diagnostic and Statistical Manual (DSM).

2. Some symptoms of depression.

A depressed person may suffer loss of appetite or loss of the ability to feel pleasure, early-morning wakening, a feeling of hopelessness, fatigue, and often a feeling that life is not worth living. The number and intensity of these feelings results in categorisation of the disorder into mild, moderate or severe.

3. Sad feelings in response to day-to-day challenges — not necessarily depression.

But not all such feelings are necessarily abnormal. After bereavement, or a relationship breakdown, it is normal to have a disturbance of mood. However, the criteria used to diagnose depression do not take account of the context of the life in which they occur. The DSM criteria suggest that symptoms of depression lasting over two weeks merits a diagnosis. This means that an understandable and proportionate response to a significant loss in a person’s life is instead viewed as an abnormality, and the patient is diagnosed as depressed.

And by extension, they are prescribed antidepressants, for problems of living. This may temporarily remove a symptom, but it is covering over a conflict that needs to be addressed. Examining these sorts of conflicts in talk therapy — this is where psychotherapy really does good work.

Kalea Chapman, Psy.D.

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