The anatomy of normal sadness

I have counseled many people who feel stuck in sadness. They feel like they cannot escape the dark cloud that looms over their minds.

Life is hard when you feel stuck in a flight pattern you can’t escape. Many of those who battle depression have given up hope of ever living a life of joy and contentment.

But the battle these folks face is compounded by a sense of guilt because they often feel they should be stronger and better able to deal with things. And there is always a well-intentioned person ready to remind them of how many people face worse circumstances.

Until rather recently those facing this kind of challenge did not have reliable medicinal solutions to help them get to a better place. Things are much different now.

Medicines for depression and anxiety are now the most prescribed drugs by family medical practitioners. I know people who have been greatly helped by some of these medicines. Yet the number of people requesting medication for depression has rightly alarmed some sociologists.

Without doubting or discouraging those who genuinely need and benefit from medicinal aids, we should ask some important questions about the significant increase in diagnoses of depression and quick prescription of medications.

Treatment of depression in outpatient services increased 300% by the end of the 20th century. Antidepressant medications have become the largest selling prescription drugs in America. During the 1990s, spending increased 600% exceeding 7 billion dollars annually by the year 2000. Estimates now indicate that major depression afflicts 10-12% of Americans. A disconcerting by-product has been an inability to distinguish biologically based depression from normal sadness.

One of the more important questions being raised is whether or not we have room in our lives for normal sadness. Do we now live in cultures that entertain unrealistic expectations for gregariousness? These are questions explored in the helpful book, “The Loss of Sadness: How Psychiatry Transformed Normal Sadness Into Depressive Disorder,” by Alan V. Horwitz and Jerome C. Wakelfield.

The authors suggest that a standard criteria for diagnosing depressive disorder does not adequately distinguish intense normal sadness from biologically disordered sadness. Their aim is to offer a critique of what they view as the “over-expansive psychiatric definitions of disorder.”

They offer extensive insight for distinguishing “sadness due to internal dysfunction” from “sadness that is a biologically designed response to external events.” The chapters exploring the anatomy of normal sadness and the failure of social sciences to distinguish this kind of sadness from depressive disorder should be required reading for all medical and psychiatric professionals — as well as all counselors.

But along with the work of these sociologists, one should consider the emotional aspect of depression in a spiritual context. Humans were created as physical, emotional, psychological, social and spiritual beings. Although doctors are primarily charged with caring for physical health, they should be advocates for holistic treatment. I realize that they face both time and professional constraints but medicinal aid must never be approached one-dimensionally.

We are more than bodies with physical needs. The other dimensions of our being (emotional, psychological, social and spiritual) must be given consideration in our battle for health. A holistic approach respects all the dimensions of personhood created by God.

I encourage doctors to be cautious about prescribing medicines for moods or behaviors without confidence that those receiving them are pursuing some form of counseling in a support system of caring people (see: Caring for the whole person).

For further help addressing the emotional and spiritual dimensions, see the following links:

Steve Cornell

This entry was posted in Anxiety, Change, Christian Counselor, Counseling, Depression, Despair, Discouragement, Doctor, Dysfunctional, Emotions, Encouragement, Freedom, Holistic ministry, Hope?, Loss, Medicine, Mind, Mind Renewal, Neuroscience, Pain, Post-abortion, Restoration, Sadness, Wisdom and tagged , , . Bookmark the permalink.

3 Responses to The anatomy of normal sadness

  1. Steve,
    Just an anecdotal comment.
    I’m in my 40th year of pastoring. Last year was the hardest/darkest. Having worked with people over those decades I know that if, at my darkest time, I had gone to a physician, I would likely have been medicated. If I had been the prescriber, I would likey have gotten out the magic pad.
    Looking back, I learned some things that I wouldn’t have learned without the pain. (I’m working on that blog post (those posts). In a sense, I needed to hurt.
    Brand and Yancy’s book on pain is a good development of some of your thoughts.

  2. Pingback: Biologically based sadness | WisdomForLife

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