Medicalization of Sadness

Can it ever be healthy to be sad? Does sadness serve any useful purpose, or does it always indicate pathology?

It's a question that troubles our society (including Psychiatry).

Coached by pharmaceutical companies, some might believe immediate intervention is needed for any 'down' emotions whatsoever. Lose your boyfriend? Get fired from a job? Here: take a Prozac, it'll be all better.

As a psychiatrist I know there's a difference between life-numbing depression and basic everyday suffering. Not to discount the painfulness of the latter, this difference matters even if it's not always clear.

A patient come in the other day telling me about his first visit with another psychiatrist. "Within the first 15 minutes," he said, "that doctor started writing prescriptions and explaining how they would help me 'feel better.' But I wanted to know what I was feeling better from."

He tried the medicines (antidepressants and antianxiety agents) for awhile, but wanted a second opinion and possibly different approach.

I thought about how pressured we often are to feel "good" these days, as if there is no room for regular human discomfort -- even suffering. But, short of life-sapping depression that engulfs us in apathy, can't sadness and discontent alert us to things needing change? Can they even result in growth? This has often been true in my own life . . . and probably in both Barack Obama's and Hillary Clinton's campaigns. :-)

This week Newsweek (Feb 11, 2008) published a story entitled: "Happiness: enough already" ; it is a kind of backlash against being flooded with demands for constant joy. We've been flooded by ads for well-being, as if normal ebb and flow of emotional responses cannot be a part of this.

I admit that Sigmund Freud's idea of successful psychoanalysis sounded pretty dour: "substituting hysterical misery for basic human unhappiness." We focused on pathology for so many years, leaving out what facilitates health and healing. Then there was valuable research on happiness, resulting in an entire field: "Positive Psychology". Nothing wrong with that -- but what about regular okayness, simply being?

Jerome Wakefield, a professor at New York University, tells all about it in his book: The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder.

Making room for this seems realistic to me, but maybe Pfizer and others will disagree.