The DSM-IV specifically states that conditions that mirror depression caused by GRIEF are excluded from a diagnosis of depression, something the author completely fails to grasp.
But there’s a much simpler way to explain this. Society’s attitude toward bipolar disorder and other depression, veering wildly from “you must create your own happiness” (because it’s all in your control, after all) to “let the world wear you down to shape you into your true self” (because none of it is in your control, after all) …
IS ITSELF BIPOLAR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
No wonder we’re stigmatized. Freud noted aptly that projection is a powerful human impulse.

What an insightful article!
I have grown very, very sick of the happiness industry. Literally. As someone who has struggled with depression since…well, since I could breathe…I am tired of being told that I am not trying hard enough to be happy, because I don’t go around wearing my smiley face all the time.
Yet, it is an equally slippery slope to say that I am somehow better off sad. I am a writer, and while cerain elements of my writing do flow more freely when my depression is left untreated, those elements are dark, macabre, and potentially lethal. I can write myself into a suicidal despair, left to my own treatment-free devices. When a depressive goes without treatment, they are not experiencing the entire gamut of human emotions. They are experiencing depression, in doses that can have fatal results.
I was hospitalized in 1999 when I crashed and burned due to years of struggling with untreated depression. After I got out of the hospital, I received outpatient treatment for awhile, until I felt well enough that I did not think I needed treatment anymore. For years to come, I would have bouts of depression that got severe from time to time, but I wanted my smiley face and did not want the label.
Finally, 2007 came around and kicked the snot out of me, and I fell into a horrible, desperate depression that I tried to drink myself out of. I should be dead, as I was horribly abusing narcotic pain medications and drinking large amounts of heavy liquor along with it. Had I been treating the depression all along, I may not have ended up in that place. Choosing not to wear the label nearly cost me my life.
I am doing better now. I write, and my writing reflects what I feel: Alive. Not merely awake and breathing, but alive. Treating my depression allows me to truly experience what it is to be alive and be human as it is meant to be experienced. Life isn’t meant to be lived with a permanant smiley face, nor is it meant to be lived with crippling depression. Given the option, I would rather err on the side of caution and be medicated and labeled than flirt with the potential disaster of depression left to do with me as it will.

i practice smiling to exercise a muscle i’ve used far too little in my life. i don’t smile at others to fake happiness, but in spite of my sadness. i learned this as one technique to use in a book called “how i stayed alive when my brain was trying to kill me: on person’s guide to suicide prevention” by susan rose blauner.
i still allow myself some time to be absolutely morose and morbid everyday, but i don’t allow it to take my whole day away from me. some days are better than others.
i like “happy faces.” they remind me of being a kid in the early 70s. i sometimes see mean ones on bumper stickers that stick out their tongues or have an evil smile and horns.
i have always appeared sad to people even when i thought i was smiling. my grandmother once gave me a bookmark with a sad old basset hound on it that said “but i am smiling!” yet others have told me i can appear peaceful, empathetic and even funny.
i don’t want to become a always cheery, bubbly type. but i like exercising the smile muscle because in moderation it really does help some. a very low dose of anti-depressants help, too, though. my husband , who was a therapist didn’t want me to go on them because it lowers the sex drive, but now that he’s gone it isn’t really an issue.
i’m determined to “get my happy back” using every trick in the book.

I think what the author is saying is that by taking medicine you don’t fully feel your feelings or fully get to grieve such that you can get it over with totally, in the quickest way possible. If the grief gets complicated with some concurrent condition or a secondary or tertiary trauma than I agree meds might be needed. As far as it not being fair for others to pick up the pieces while someone is grieving, isn’t that what communities and families are for? At least, it used to be. I guess in modern society not so much, and that’s a damn shame. In college I was involved in some sick codependent relationship and my nurse mother, who thinks all MD’s are Supreme Gods, hauled me to the doctor who put me on triavil (an antipsychotic?? really?? that’s what I needed??) that doped me to the point that I couldn’t see what a mess I was and what a bigger mess my boyfriend and our so-called relationship was. Years later, while off of meds, I finally got to the root of my codependency, traced it back to my mother, her sick marriage and enmeshed relationship with her parents, and kissed crappy relationships goodbye forever. I have in years since went back on meds and gained a tremendous amount of weight. The cons outweighed the pros for me. I went on an alternative treatment with an alternative practitioner and feel at least as good if not better than I ever did on meds. I will stick with this course of treatment for the prescribed time. It works for me. I don’t presume to say anyone else should do it. If this means I’m out of the depressive club b/c I choose not to take meds, so be it. Am I still “sad?” Sure, sometimes – I have a low set-point for happiness. Rather I strive to lead a life of meaning and service, as best I can. I don’t judge people who take meds, and they better not judge me. It is inappropriate to ask for things you’re not willing to give. If you want me to support you in your depression and pharmaceutical treatment, then extend me the same courtesy please.

i am all for anyone trying anything that will work. i was not quick to go on meds. i had three babies at home sans medication and was loathe to take an aspirin preferring to try a warm bath or massage instead. but after my husband and i separated and then he committed suicide, i could not function. i would go to the market and begin crying in the bread aisle because i was overwhelmed by all the choices of brands. i broke down in a chemistry class when the instructor began drawing a diagram of covalent bonds. i was in intensive therapy weekly, seeing a spiritual director, and getting massages and exercise regularly. i suppose there were more alternative options to try but they were very expensive and my insurance paid for meds, so i opted for that route. many people cannot afford the expense of alternative medicine.
and there is some quackery in the alternative medicine business. an amish community i once served as a midwife comes to mind. an alternative medicine group in mexico got into a racket convincing the guiless and unsuspecting amish around the country they had hodgkin’s disease or other cancers and they would make the train trip down there for expensive treatments they could hardly afford. one of my clients found out they were faking the diagnoses when they were closed down. i believe the mother suffered from severe depression and some dietary problems. (contrary to popular belief, amish do not have such a great diet.) so one must use a combination of self awareness, self education and intuition when finding the right caregiver or treatment. i remember a self published zine called the icarus project that was by bipolar sufferers who all worked together without judgment to share their experiences and give encouragement.

**I think what the author is saying is that by taking medicine you don’t fully feel your feelings or fully get to grieve such that you can get it over with totally, in the quickest way possible. If the grief gets complicated with some concurrent condition or a secondary or tertiary trauma than I agree meds might be needed.**
I support ANYONE in depression with what will make them better. Period.
All I ask (just ask, I can’t demand it) is the same support in return.
You almost seem to be saying that only having two of the elements of grief, depression/bipolar disorder and PTSD merits taking medicine.
Most assuredly, at least for bipolar disorder, not taking medicine for only bipolar disorder without comorbid illnesses, EVEN WHEN THERE ARE NO SYMPTOMS, can be a death sentence — because the highs and lows, like a tornado out of the Midwestern sky, can blow in at any time.

re:”As a depressive, I, of course, don’t think that Sharon Begley, the Newsweek writer, made a clear enough distinction between what is healthy sadness and what is crippling depression—”
after reading the posts from Stephanie, Nillawafer, and Kathy – all very important because they are all depressives, I would have to ask, Does anyone “made a clear enough distinction between what is healthy sadness and what is crippling depression”? Instead of looking to the depressed person to place blame or stigma shouldn’t we be looking at the people who put themselves in the position(s) of medical experts? Why should I (or anyone be) held accountable for my (their) illness not being “cured”? We do what the people we have put our trust in tell us is the right thing to do, and when it doesn’t work fast enough for the people around us (like we are enjoying the whole thing!!) then we are told to take a pill or get over it and whatever we do we are still the one at fault.
Blessings on all of us (pilltakers and non-pilltakers) and a pox on those who pass judgements on us!
Cully

Its a tough problem and I don’t claim to have some miracle solution, but I do have a reaction to over medicating everyone that is a bit counter to the theme of your writing, but I think it may possibly give a different perspective. It seems to make sense to do a cost to benefit assessment and it seems that everyone with an opinion about something like this does do this albeit in a semi-direct way. I am concerned, however, that both the “truly depressive” and the “too proud” to admit need of help as well as those in between are biased in their assessment. Indeed, I think I am quite possibly biased, but with something like this it is hard not to be. As an example of what I mean:
Some of the possible problems with over medicating is that a person is not allowed to grieve and process normally as perhaps they should. This has its own consequences and could fuel and entire industry – in fact it is my opinion that it does, but that is slightly beside the point.
On the other hand if those who are truly depressive as well as those who are “too proud” (or whatever their reason is for being opposed to seeking help) too not get diagnosed and properly treated it can lead to , well, it can lead to those individuals continuing to suffer through life like depressive humans always have with the chief difference being that most of them no longer need to because we have since discovered very effective ways of treating depression with side-effects that are much easier to cope with than the depression itself. It can also lead to suicide and as you pointed out it can lead to long lasting ill effect on those who care for the depressive.
So the problem is at least two-fold:
1. Where the truth lies in over-diagnosis
2. Where do we draw the balancing line in the cost to benefit analysis.
Let me explain further. Let’s assume that it is almost wholly agreed that we (The U.S. – incidentally the most successful pharmaceutical profiteer) are over medicating.
Let’s also assume that the reason for this is to ensure that those who actually need help are more likely to get it.
Then the cost to benefit ratio is no longer an individual assessment – depression versus slightly diminished creative edge (eloquence isn’t exactly the same as a creative edge.. Michelangelo might be a good manic depressive example of creative edge and drive…), but instead is a ratio of statistics between false positives and false negatives.
Depressive “Normal”
Diagnosed + True Positive False Positive
Diagnosed – False Negative True Negative
a = True Positive
b = False Positive
c = False Negative
d = True Negative
Obviously we want the ratio of true to false to increase, e.g., we want to increase the ratios a/b, d/c, & (a+d)/(b+c) with these ratios being overlapping normal distribution curves. But the real problem is where we draw the ratio line. I am concerned, however, as I now explain that people who have been successfully treated with anti-depressive medication are biased toward increasing rates of Diagnosed +’s so as to increase the total number of true positives, but at a much higher “cost” or penalty of increasing False Positives and decreasing True negatives. With the Pharmaceutical companies whose bottom line is their bottom line this is great. For those concerned parents or for those that are concerned for the well being of all fellow humans and mammals this may be a turn in the wrong direction.
There will always be overlap, but when we complain of too many people being medicated we are actually complaining about False Positives not the number of True Positives. In other words it’s not just that there are so many people that need medication that is alarming, it’s that so many people who don’t “need” it are getting it and abusing it. They have a tendency to blame and run toward their medication when their symptoms seem comparatively trivial.
On the other hand if “evidence” is compiled that a large portion (like 1/4 – 1/2) of society suffers from depression left untreated then is it really a disorder? An ABnormality? It is seemingly contradictory. So we figured out that drinking a cup of coffee improves concentration and memory – if 2/3 of people drink a cup of coffee and have better focus and concentration than someone who doesn’t (on average) does than mean the remaining 1/3 have a disorder? Or that they are abnormal? It is a choice. Which returns me to my bias. I am perhaps biased to think people should be more willing to shoulder others problems and their own instead of running to a pill. At the same time it should be a choice and we should respect each others choices and have the utmost concern for each others education and understanding rather than the choice that comes from the understanding.

Mike:
I intellectualize as much as anyone.
But d*mn it, I just want to feel better. Assuming I’m using psychiatric rather than psychotropic drugs, why is that so wrong?

Larry, it’s not wrong to take medication when you and your doctor feel it is the right choice for you.
I think people who become situationally depressed at some time might need medication to function if the sadness lasts long enough to impair their: judgement, relationships, job. The differeence with depressives ( I am bipolar) is we become impaired at times regardless of the situation we are in. WE are like a car engine running low on oil and water ie: we need medication to function to the best of our ability

To finish…..
We also need to take care of our car in other ways besides the oil and water….keep it clean, tuned and the radio loud. But the medication is the foundation of the treatment, the therapy, diet, exercise, etc, is the supporting points.
T – why don’t you submit a rebuttal to the magazine on our behalf? Thanks for bringing it to light.
Lisa (ilibertyi)

I’m with both Larry and Cully, bless’em
I also have a problem with the misuse of the biblical quote “through a glass darkly”since the true meaning of that verse is that NONE of us will lose that dark lens until we die! (and move on to heaven, of course) So, what? we’re all supposed to wait until THEN to lose our depression? That’s the implication as i read it, and no thanks, thank you very much! Enough, too many, actually, people are taking their owm livesto escape the pain as it is!

First of all, emotions like happiness, sadness, anger or what you think is funny, are very subjective to individual interpretation. So, as an individual, here is my interpretation of my emotions evoked by this article.
This is one of those articles that makes me think the writer was “looking for something to write about that would be published in Newsweek.” It read more like political posturing than journalism.
I am one of the lucky depressives! I never had experience with depression until I was 39 years old. I didn’t suffer my whole life with undiagnosed depression. I know the difference between sadness and depression.
I AM the girl that got dumped by the guy she dated & was engaged to for 5 years. When I got dumped, at 27, I still got up & went to work. I sat at my desk & cried. I hardly ate. I called my girlfriends & cried, and then talked about what a jerk he had been. I sat up at night wondering what I did wrong, or how to get even, etc… That was sadness.
At 39, I woke up in the middle of the night. I paced without stopping for almost 2 weeks with little sleep. Once I went to sleep, I couldn’t get out of bed. It became harder for me to get to work every day. I had to call on my family to help me. Then, I stopped talking or going places. I didn’t even want to see my boys. I became unrecognizable to the people who knew me.
Things like that don’t happen overnight or without cause. We don’t go asking for it. We aren’t looking for a way out of work. Trust me, it’s not worth getting out of work.
I call myself a “lucky depressive” because I know without question the difference between feeling sad & being depressed.
Everyone has sadness in their lives & popping a pill won’t fix it. Not everyone becomes depressed.
Anyone who has been diagnosed with depression, knows that any insurance co. is going to require what they constitute as “proof” of the condition before they pay a dime.
Judgement of whether or not to take meds has to be based on each individual.
I know that I am naive. I know that I see things in a most black/white fashion. There are always 2 sides to every story. I believe that decisions shouldn’t be made without hearing both sides.
Articles, like this one, shouldn’t be published without both sides of the story.

I’m glad you wrote about this article. IMHO, Begley succeeded in confusing people and not much else. “The Loss of Sadness” by Wakefield and Horowitz offers an unusually balanced and thorough examination of a complicated and important subject. It’s virtually impossible to find such a sensible and sensitive examination of any controversial topic in psychiatry. These guys managed to please Dr.Robert Spitzer, one of the most prominent and conservative psychiatrists around. Usually, mainstream psychiatrists would simply ignore a book with such a title.
I’m fairly sure that readers of BB would find this book quite refreshing. The authors view clinical depression as a disease and are very ‘pro-medicine’. In a nutshell, they suggest that it is essential to consider history and context when making a diagnosis. The most ‘outrageous’ idea in the book is that it might be unwise to automatically start somebody on medicine just because they continue to feel sad one month after a loved one dies or following the end of a long term relationship. During an interview with Wakefield, he readily acknowledged that he would be inclined to initiate psychopharmacologic treatment immediately in the above situations if a person had a personal history of major depression. That gives people a sense of how carefully they cover this topic.
“The Happiness Institute” and all the smiley face folks can be dangerous. The uniquely American insistence that everyone must be happy at all times that fuels the ‘happiness movement’ is truly bizarre; it does lead people to feel pressured to put on a happy face at all times. Loads of people automatically assume ‘something is wrong’ if their cosmic bliss waxes and wanes. The Europeans just shake their heads and sigh at our obsession with happiness.
Yeah, the ‘happy-happy-beautiful people’ are enough to make me vomit. Why give them the time of day.
Somebody mentioned whether to use the term ‘psychiatric’ or ‘psychotropic’ re their medications. For what it’s worth, I take ‘medicine’. Period. Almost without exception, I ‘correct’ people who use the word ‘drugs’….”you mean ‘medicine’….when someone in your family takes aspirin or an antibiotic, you don’t say “have you taken your drugs…….?…..No, you use the term ‘medicine’….so antidepressants and the rest are simply called ‘medicine’.
I encourage people to do the same. “Medicine” doesn’t carry the negative connotation associated with “drugs” and ‘psychiatric/psychotropic drugs’. Little things can make a difference.
Let the ‘happy beautiful people’ wear themselves out trying to be happy.

Such a great discussion here. And I really love the distinctions being made: “medicine” vs “drugs” and “sadness” vs “depression.” And how I love Dr. Kramer’s over-and-over-and-over insistence that we’re talking about a disease here people — not simply a deeply felt negative emotion. Is there a tendency to throw pills at things too quickly in this society? Perhaps. But people seem to forget that one of the reasons drugs are prescribed — and one of the useful applications of drug samples from pharmaceutical reps — is to help diagnose the problem in the first place. Is it “sadness” or “fatigue” or “depression”? Sometimes I can’t even tell, but recently — in my usual weary dreary battle to slog through the winter — I added Prozac back into the mix of other meds, vitamins, and alternative-med therapy (had half a bottle left after weaning myself off them early last summer), and dang, I felt so GOOD for the first time in many months. (And I wanted to cry, then, NOT because I was sad but because I was happy and relieved…if I was sad, then it was because I waited so long to think about trying it, all the beating up of myself I was doing and the half-life version of myself that I was giving to my kids.) My point: Sometimes it’s the taking of the meds — and getting (or not getting) the expected/desired response — that helps pinpoint the malady, even sorting out when “depression” is emotional upheaval vs chemical upheaval. (BTW: This is similar to what happens to me with migraines during flu season. When I get a pounding headache, nausea, and unmentionable intestinal misery my first reaction is to toss some Imitrex at it — and I do so without hesitation, because with migraines time is of the essence, otherwise your stomach shuts down and the medicine you take just sits there without dissolving and going into the blood stream — and if it eventually provides relief I can be sure that I’ve averted a full-blown migraine that would otherwise escalate and land me in the ER. If Imitrex DOESN’T make a dent, I can be pretty sure it’s “just a virus” and nature has to run its course, which it does and I’m eventually fine like anybody else.
I don’t about anybody else, but more than once in this whole sadness-vs-illness debate I’ve found myself wishing for a different word than “depressed.” When people say, “How depressing!” or “Man, I’m sure depressed” they’re not talking about the same kinds of things that have most of us turning to SSRIs. And maybe that in itself contributes to the confusion and the ignorance, of having my mom for instance say to me that she wished my sister could “pull herself together” so that she could “get off all those d*mn pills.” Maybe if chemical depression was called something like Peter Kramer Syndrome, like Lou Gehrig’s Disease or Tay-Sachs people would finally “get it”??? Get that ingesting the right chemical, in manufactured pill form — to address the body’s inability to manufacture it on its own (much like insulin for the diabetic) IS IN ITSELF part of “pulling yourself together.” They’re not mutually exclusive realities! God bless the people who can do this on their own, with talk-therapy alone or a right mix of alternative therapies — I applaud you, I envy you, and sometimes for months at a time I can BE you. But sometimes that SSRI is exactly the crutch I need — and I use the term “crutch” on purpose, because even tho it has a negative connotation, a crutch used properly is an effective and needed tool when you’re in danger of falling and hurting yourself, or of causing further damage when a healing part of your body is still vulnerable.
My own problem with depression — and this is where the people around you are so important, to help you get a reading on what’s going on with yourself — is that I don’t always recognize when a new or deeper episode is creeping up on me. Usually, a major depressive episode happens so gradually that I don’t notice it. (It’s like that adage that if you throw a frog into boiling water, it knows enough to jump out. If you put a frog into cold water and gradually turn up the heat, it will of course stay put and get cooked.) Once major depression settles in and is firmly rooted, I typically lose my ability to be the good and vigil advocate of myself that I’d be in the case of other health problems. Instead of thinking “Oh crap, my neurotransmitters are petering out again, better go see the doc” the tendency instead is to do just about everything OTHER than that — work harder, guzzle more caffeine to work harder, wallow in self-hate, subject myself to overly critical people who feed into that self-hate, more work and more caffeine and less sleep, and voila your chemical imbalance shuts you down just like a washing machine that aborts the the spin cycle whenever its balance is off. (I heard a great quote at a retreat recently that may apply here: “Your mind can play tricks on you, but the body never lies.”) After a while, how can you reasonably expect yourself to haul your sorry butt into a doctor’s office when you can’t even manage the basics like remembering to eat, take a shower, or changing your clothes?
Because our obsessively optimistic society — control your own destiny, pull yourself up by your bootstraps (assuming you have bootstraps, which the untreated depressive doesn’t) — can’t figure out what to do with the likes of us, because our reality simply doesn’t “compute,” doesn’t fit their model and belief system, we need to be removed from the landscape of the American Dream somehow, just as surely as Native Americans who got in the way of land-grabbing westward “progress.” And so if our depression becomes too bothersome to be written off as mere emotional travail (trivializing the disease), then we’re “put on a pedestal” (romanticizing the disease) like Poe and Van Gogh in the name of great art. To which I respond, like Dr. Kramer: That’s not BECAUSE OF depression — that’s DESPITE depression. Kinda makes you wonder what other great works of art Van Gogh might have evolved to, as his techniques matured, had he not killed himself. I mean, duh! Had he survived depression, we might be thinking of “Starry Night” as his early/immature work instead of his crowning glory!

Boy, does’nt that ever feed the “What If” syndrome?

I still cherish the point my psychiatrist made to me, when I first rejected the idea of any and all medications, “because I didn’t want to get hooked.”
If you aren’t clinically depressed, the prozac wasn’t going to have much of an effect. It isn’t a street drug. It is a very specific medication, which she was prescribing for a very specific illness – clinical depression. It’s purpose is to get a person re-engaged with life…happy, sad, melancholy, hungry, thirsty, tired joyful….whatever. The point was to be able to FEEL again.