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.