We have turned sadness into a psychiatric disorder. And that is a problem that is devouring us socially.

When Roland Kuhn discovered the first antidepressant in history, imipramine, the directors of Geygi hesitated to put it on the market because depression was so rare who did not believe it could become a profitable medicine (Healy, 1999). It was the 50s of the 20th century, but it seems like an alternative reality.

Today, depression is omnipresent. Only in Spain, the consumption of antidepressants has grown 200% in the last fifteen years and it is nothing more than the reflection of an unstoppable international trend. How is it possible that, in just over half a century, depression has become “so common”? Are we confusing normal sadness with a psychiatric disorder, as many experts say? Are we pathologizing everyday life?

I am not going to enter into terminological debates, no matter how interesting and necessary they may be. When talking about “invention of mental illness” or “pathologization of everyday life” we run the risk of minimizing problems as serious as depression and that is something that is not in question. On the contrary, the idea is understand her better to treat her better.

As the neurologist Luis Querol said“if we stick to the conventional concept of diseaseanyone who has seen a melancholic depressive SUFFER (…) will recognize that it is an illness.” It is totally true: that is enough for now. Depression is a particularly insidious and destructive disorder. According to the WHOnot only is it the main global cause of disability, but it affects 350 million people and is behind 800,000 deaths each year.

Synopsis of an epidemic

However, this does not explain why depression has become an epidemic. Above all, because it is not a disease that we “just” discovered. Melancholy is one of those psychiatric disorders so old that they were already diagnosed by Hippocrates and classical Greek medicine.

Since the 19th century, the European diagnostic tradition separated most mood disorders from deep melancholy and included this among the diseases that end up consuming the person (such as senile dementia). At the beginning of the 20th century, psychiatric practice already clearly differentiated between endogenous or melancholic depression (which affected between 1 and 2% of patients) and reactive or neurotic depression (much more common) which was a product of stress, loss or pain.

In 1980, in the middle of a deep reputation crisis for psychiatric practiceDSM-III changed the way we think about depression. It moves from an etiopathogenic model (which asked about the cause of the disease) to a semiological one (which, in its claim to atheoretical nature, was based on symptomatology).

A careless eye might think that the change was terminological and that “endogenous” was only replaced by “major” and “reactive” by “dysthymia”; but, in reality, the DSM-III expanded the playing field. Melancholia became one of the five subtypes of major depression and, with this, the underlying depressive disorder went from having a prevalence of 2% to a prevalence of up to 17% (Kessler et al., 2005).

In recent years, a good number of historians (and activists) have insisted that this change and the commercial pressure of pharmaceutical companies (Horwitz and Wakefield, 2007) have taken us to overdiagnosis current disease (Mojtabai, 2013; Parker, 2007).

At its strongest, it is a difficult argument to reject. Especially because it is not that the existence of depression is denied, but rather that it is argued that the failure of epidemiologists, psychiatrists and social scientists to differentiate ‘normal sadness’ and ‘depressive disorder’ is leading to health policies that condemn many people to taking unnecessary medications and carrying the weight of stigma on their backs.

Whys, doubts and conspiracy

Basically, although it is not usually said clearly, we are talking about ‘iatrogenesis’; That is, suffering or damage to health caused by health professionals themselves. The current opioid crisis in the US It shows that, far from being pure conspiracy, pharmaceutical companies and their balance sheets can create a health problem of colossal dimensions.

However, we must not be unfair, nor fall into banal Manichaeism. Although it may seem counterintuitive and paradoxical, many problems only appear when we have the solution them. Without antidepressants or effective behavioral therapies, depression was deep sadness, black sorrow that wells up, black shadow that amazes me. Something that was between us and there was nothing we could do to avoid it.

Horwitz and Wakefield say that “tolerance for normal but painful emotions has fallen” in the West. And it may be true. But they forget two fundamental things: that, for the first time in the history of humanity, we can do without them and that it is not a personal problem, the modern world has tended to prioritize productive optimism and has forgotten how to live with sadness.

At this point we realize that, if we want to learn to better separate “illness” from “normality”, it is not just a matter of challenging depressive overdiagnosis, but of claim sadness. The problem is that, why would we want claim sadness? And the answer, honestly, may surprise us.

Sadness, said Lazarus (1991), promotes personal reflection after the loss. Focus our gaze on ourselves, promote resignation, invite acceptance (Izard, 1993). It allows us to waste time to update “our cognitive structures” (Welling, 2003); that is, to accommodate the loss.

That reflective function of sadness It allows us to stop. And weigh actions, review our goals, modify our plans (Bonanno & Keltner, 1997; Oatley and Johnson-Laird, 1996). It makes us more attentive to detail, more precise. It makes us flee from heuristics and stereotypes (Bodenhausen, Gabriel and Lineberger, 2000; Schwarz, 1998) and distrust first impressions (Schwarz, 2010).

Physiological arousal decreases and makes us more prone to slow thinking (Overskeid, 2000). Furthermore, it shapes us as a group. Causes sympathy, empathy and altruism in others (Keltner and Kring, 1998).

The complex balance between “normality” and “disease”

In 1843, Charles Darwin wrote a letter of condolence to a distant cousin in which he said that “strong affections have always seemed to me the noblest part of man’s character and the absence of them an irreparable failing; perhaps you should be consoled to know that your grief is the necessary price of having been born with them (for I am convinced that they are not learned).”

It was, in fact, a half-truth. It is true that human beings are born with certain natural tendencies, but culture, society and education end up giving them the shape definitive. There are many examples that show how different cultures have constrained parts of the human personality to the point of making it almost pathological. The strange way of waiting for the bus in Finland is funny, but we must not forget that they are just an expression that a Scandinavian It is 13 times more dangerous to develop ‘social anxiety’ than a Mediterranean.

As I noted at the beginning, depression is the leading global cause of disability and its economic cost is several tens of billions of dollars in the United States alone (Wang, 2003). Furthermore, it is deeply painful. It seems logical (and human, if you press me) that there is a cultural pressure to eliminate everything that has to do with it. Including sadness.

However, if, as researchers point out, sadness has an evolutionary function that promotes updating our cognitive structures and allows us to adapt to profound changes in our environment, deleting it could be a mistake. It would be, if you allow me the expression, not letting the wounds heal and that, no matter how many painkillers we take, leaves marks on a personal and social level.

That, among all the noise, is the underlying problem. How we treat depression without pathologizing sadness and how we live with sadness without neglecting depression. In short, it is a problem that has always been with us: how to separate what kills us from what makes us stronger. And in this field we still have a lot to learn.

Image | Unsplash

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