Scientific American has an accessible and interesting interview with the authors of a new book called The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Illness. Despite the book’s title, the authors argue that there’s no new epidemic of depression, just greater awareness (and treatment seeking) of it:
Our book argues that, despite widespread beliefs to the contrary, the rate of depressive disorders in the population has not undergone a general upsurge. In fact, careful studies that use the same criterion for diagnosis over time reveal no change in the prevalence of depression. What has changed is the growing number of people who seek treatment for this condition, the increase in prescriptions for antidepressant medications, the number of articles about depression in the media and scientific literature, and the growing presence of depression as a phenomenon in popular culture. It is also true that epidemiological studies of the general population appear to reveal immense amounts of untreated depression. All of these changes lead to the perception that the disorder itself has become more common. […]
Yet loss events such as a betrayal by a romantic partner, being passed over for a much-anticipated promotion, failing an important test, having a mortgage foreclosed, or discovering a serious illness in oneself or a loved one could naturally lead the same symptoms to arise and endure for a two-week period. When such criteria are applied to the general population, very large estimates of untreated depressive disorder emerge, because one is capturing intense normal reactions to losses as well as genuine depressive disorder.
What the authors of the new book, Allan Horwitz and Jerome Wakefield, are really arguing is that the psychiatric definition for depression is too general and not specific enough to limit the diagnosis of depression when a person might just be going through a normal and expected period of grief following a significant loss in their life.
The problem is two-fold, as the authors note. One is that major depression as a diagnosis gets an insurance reimbursement (meaning you can get more easily treated for it and not have to pay $120/hour). Two is that depression is often diagnosed in primary care settings by a family physician, who might not be applying the criteria as rigorously as a mental health professional would. And with patients walking into their doc’s office demanding the latest antidepressant they saw advertised on TV, it’s not surprising.
In fact, extrapolating the authors’ conclusions to virtually any psychiatric disorder, we might be pleasantly surprised to surmise that we’re not really undergoing a time of great emotional upheaval where every child and adult has some disorder they meet the diagnostic criteria for. The diagnostic categories have simply gotten progressively broader, the practitioners lazier in applying the criteria, and the pharmaceutical companies more marketing-savvy.
Read the full interview: Is There Really an Epidemic of Depression?