When Did Sadness Become a Disease? How We've Pathologized Everyday Life
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In his scathing critique, he argues that we’d be better off dividing depression into two separate disorders and using an older terminology to distinguish them. He advocates using melancholia to define the severe depression that affects body and mind. While the malady of melancholia may include symptomatic mood disturbances, it goes beyond fluctuating moods and “may lead to despair, hopelessness, a complete lack of pleasure in one’s life and suicide.” He adds, “Melancholia means a dejection that appears to observers as sadness but that the patients themselves often interpret as pain,” numbness, and the inability to experience joy. Readers of Shakespeare will recognize in this the melancholia that Hamlet describes.
Further, Shorter advocates using the term nonmelancholia in reference to the low mood and sadness commonly referred to as depression. Using melancholia andnonmelancholia would contrast and distinguish between what he sees as “two different kinds of depression, as different as tuberculosis and mumps.” Rethinking the nature of depression in this way, he believes, would help clinicians refine their treatments. Rather than resorting to one-size-fits-all solutions—which all too often means prescribing an antidepressant—psychiatrists and therapists would look to a wider array of therapeutic tools.
Shorter’s perspective has much to recommend it. He can be fascinating as he traces the origins of the uses and meaning of depression and melancholia. And though his detailed chronicle of the endless squabbling that’s gone into the writing of different editions of the DSM is disheartening, it goes a long way toward explaining the manual’s weaknesses. Even so, as one fact follows another, his larger arguments can be hard to follow. His research is thorough, but it becomes trying to navigate.
In the end, the message both books provide is clear: as cloudy as the concepts of stress and depression have become, they can still be useful—but only if we can see through the layers of misuse and misunderstanding that too often veil their true meanings.
Contributing editor Diane Cole is the author of the memoir After Great Pain: A New Life Emerges and writes for The Wall Street Journal and many other publications. Contact: email@example.com.