Tuesday, August 28, 2012

Does the diagnosis of depression medicalize "normal sadness"? (Anthropology)

That is a great question. Even though everyone experiences minor bouts of depression or sadness at different points in their life, clinical depression is a medical illness. Major depression is more than sadness. Sadness is typically a reaction to events in life or stress that is situational, whereas major depression may occur without any reason(even though it can be triggered by life events as well). The DSM-V outlines the criteria to receive a medical diagnosis. In some cases depression is life threatening and extremely intrusive to ones life over an extended period of time. Whereas sadness may occur for a short period of time, one is still able to function, and the feeling goes away on its own. Along with these facts there are various brain scans that show how the brain is "depressed" during a depressive episode. This is further evidence to support the notion that depression is a true medical condition that requires medical intervention. Please look at the link below as further information to answer your question.


Several recent articles by interdisciplinary researchers have suggested that the DSM-5’s diagnostic criteria for Major Depressive Disorder (MDD) are so broad that at least 10% of the population would be affected by it. Depression is categorized as a mood disorder, falling among a group of conditions that share the defining characteristic of a labile emotional state. Among the symptoms that can lead to a diagnosis of MDD are diminished interest in pleasurable activities (in severe states, this is called anhedonia), fatigue, slowing of thought processes and physical movement, inability to concentrate, depressed mood that lasts for most of the day almost every day, loss of appetite and consequent weight loss, feelings of worthlessness or guilt, and suicidal ideation. In theory, the individual would experience at least five of these symptoms over a two-week period. In practice, the diagnosis is likely applied even more generously.

What is happening? Is depression more prevalent in modern society, or are people becoming less tolerant of “normal sadness”? Increasingly, studies by social science researchers (as opposed to clinicians) have supported the latter. The conclusions of these studies share a general theme: popular culture has changed the way people view normality. Self-perception has been greatly affected by social media presentations of reality. Television and movie portrayals of depression have abounded—as have advertisements that suggest that you, too, could have a psychosocial problem.

This is not to say that depression is not a serious condition when the diagnosis is fairly applied. Researchers, including the duo that coined the term “medicalization of sadness,” Allan Horwitz and Jerome Wakefield, suggest that not only are many people overtreated, many are undertreated. So, what makes for a fair application of an MDD diagnosis? Above all, context. Was there a precipitating factor to the shift in mood, such as complicated grieving or trauma? How long has the person been experiencing these feelings, and are the feelings expected to endure in the absence of treatment?

“Medicalization” assumes that some level of clinical intervention is required, either pharmacological or psychotherapeutical. Those who believe that the former is used with too little restraint argue that the latter should be best practice, at least initially. Before sadness is redefined as depression, we must first try to understand its context.

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