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In the 1960s, the Pharmaceutical Company Sandoz marketed its tranquilizer Serentil with ads suggesting the drug be prescribed to “the newcomer in town who can’t make friends...The woman who can’t get along with her new daughter-in-law. The executive who can’t accept retirement.” But the U.S. Food and Drug Administration (FDA) stopped the ads. Drugs are supposed to treat illnesses, the agency said, not the changes of living.
Isn’t that an unusual idea? The FDA was worried back then about an overmedicated society. Today 7% of Americans are on antidepressants (many more have tried them), and ads try to persuade people to buy drugs for problems like fatigue, loneliness and sadness. Still, drug companies aren’t the (sole) villain. Horwitz, dean of social and behavioral sciences at Rutgers, and Wakefield, an expert on mental-illness diagnosis at New York University, persuasively argue that many instances of normal sadness are now misdiagnosed as depressive disorder. They also point out that the capacity to feel sad is an evolutionarily selected trait that we might not want to drug away.
We’ve been living in an age of sadness for at least two decades. But while it’s tempting to blame our culture—fear of terrorists, too much caffeine—there’s a more straightforward explanation for the boom in sadness. In 1980, the American Psychiatric Association published a new definition of depression that was a radical departure from the old one, which had described “depressive neurosis” as “an excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object.” To be diagnosed with major depressive disorder today, you need have only five symptoms for two weeks, which can include depressed mood, weight gain, insomnia, fatigue and indecisiveness. The definition does make an exception for bereavement: if you recently lost a loved one, such symptoms are not considered disordered. But it doesn’t make exceptions for other things that make us sad—divorce or financial stress.
Still, is there anything wrong with medicating normal sadness if you don’t mind side effects? Horwitz and Wakefield take no position on this. They point out that women giving birth take painkillers even though pain is a normal part of the process. But they also note that “loss responses are part of our biological heritage.” Nonhuman primates separated from sexual partners or peers have physiological responses that correlate with sadness. Human infants express despair to evoke sympathy from others. These sadness responses suggest sorrow is genetic and that it is useful for attracting social support, protecting us from aggressors and teaching us that whatever prompted the sadness—say, getting fired because you were always late to work—is behavior to be avoided. This is a brutal economic approach to the mind, but it makes sense: we are sometimes meant to suffer emotional pain so that we will make better choices.