The Loss of Sadness

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Depression is now the most commonly treated mental disorder, with claims that one in ten Americans experience it annually and 25% at some point in their lives. This has led to increased antidepressant use, widespread screening, and early diagnosis efforts based on a few symptoms to prevent severe conditions. In their work, Allan V. Horwitz and Jerome C. Wakefield argue that while depressive disorder is real and can be debilitating, the perceived epidemic reflects a reclassification of normal sadness as an abnormal experience. The DSM-III, published in 1980, shifted the diagnosis of depression to symptom-based criteria—such as depressed mood, loss of appetite, and fatigue lasting at least two weeks. The authors contend this approach is flawed as it overlooks the context of symptoms. They emphasize the need to differentiate between internal dysfunction and normal sadness due to external factors. The current DSM system complicates this distinction, leading to potential misdiagnoses, where typical emotional responses to distressing events, like job loss or relationship endings, could be incorrectly labeled as depressive disorder. This misinterpretation contributes to the perceived epidemic of major depression today.