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Carol Craig is the Centre's Chief Executive. She is author of The Scots' Crisis of Confidence, Creating Confidence: A Handbook for Professionals Working with Young People, The Tears that Made the Clyde: Well-being in Glasgow and The Great Takeover: How materialism, the media and markets now dominate our lives. Her latest book is Hiding in Plain Sight: Exploring Scotland's ill health. She is Commissioning editor for the Postcards from Scotland series. Carol blogs on confidence, well-being, inequality, every day life and some of the great challenges of our time. The views she expresses are her own unless she specifically states that they reflect the Centre's thinking.

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Posted 30/06/2008

I have a friend whose teenage son was very keen on a girl he was going out with. Unfortunately after a few months, she chucked him. He felt awful. For at least a month he went off his food, lost interest in normal activities and seemed to be up half the night because he couldn't sleep. A few months on he is back to normal. He has now forgotten the romance and is happily on the look out for a new girlfriend.

However, if at any point during these few months he had been asked to complete a mental health questionnaire, he would have been classified as 'depressed'. This young man's perfectly normal, human reaction to loss and sadness would have been misdiagnosed and turned into a disorder.

This is the argument set out in a revolutionary new book called 'The Loss of Sadness: How Psychiatry transformed Normal Sorrow into Depressive Disorder'. It is written by Allan Horwitz, a Professor of Sociology and Jerome C. Wakefield, a Professor of Social Work.

Horowitz and Wakefield argue that for more than 2,500 years thinkers and healers interested in mental illness made a huge distinction between negative feelings caused by an incident in life (such as bereavement, illness or loss of status or money - anything important to us) and those negative feelings that seem to have no reason. The first type we have traditionally seen as sadness. Though it can be acute and painful it is part of normal life as human beings have been programmed to experience sadness as a result of loss. The latter type of negativity - bad feelings for no real reason, once called melancholia, are according to the authors rightly seen as a disorder.

What changed this common sense view of negative feelings with cause/without cause was the creation of the DSM-III in 1980. The DSM is the Diagnostic and Statistical Manual of Mental Disorders used internationally to diagnose mental conditions. In 1980 psychiatry was in disrepute as there was no consistency in medical diagnosis - something which did not go down well in the USA with insurance companies. The DSM-III changed all that, for depression at least, by coming up with a simple check list of symptoms (such as loss of appetite and sleeplessness). If a patient had five of these symptoms for a two week period then they qualified for the diagnosis 'depressed'. The only contextual caveat was whether the person had suffered bereavement in the past two months. If so then their symptoms could be attributed to this loss rather than a depressive disorder. But as Horowitz and Wakefield point, the DSM-III (and its successors) ignored the context of people's lives by not taking into account any other losses in the patient's life. This is why my friend's lovelorn son would be classified as 'depressed' rather than sad.

This book suggests that all the current statistics on depression are overblown and therefore meaningless - particularly for adolescents who are often much more affected by the loss of romantic attachments or everyday failures than the rest of the population. Indeed, this book must force mental health practitioners, psychiatrists and psychologists to think again.

You don't have to take my word for the importance of this book. The man who was head of the American Psychiatric Association's task force in the creation of DSM-III Robert L. Spritzer wrote the foreword to the book. He begins by saying it is a 'tour de force of scholarship and analysis'. He says that he finds the critique 'valid' and writes 'Horowitz and Wakefield's book forces one to confront basic issues that cut to the heart of psychiatry'.

In short, every time you read about a rising tide of depression in modern times, be sceptical. Much of this is normal sadness not a mental disorder.

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