Healthy Dose of Sadness May Be Good For You
Jessica Marshall, New Scientist Magazine
Misery is inconvenient, unpleasant, and in a society where personal happiness is prized above all else, there's little tolerance for wallowing in despair. Especially now that we've got drugs for it.
Antidepressants can help banish sad feelings -- not just the life-sapping black dog of clinical depression, but the rough patches most people go through sometimes, whether it's after losing a job, the break-up of a relationship or the death of a loved one. So it's no surprise that more and more people are taking them.
But is this really such a good idea? A growing number of cautionary voices from the world of mental health research are saying it isn't. They fear that the increasing tendency to treat normal sadness as if it were a disease is playing fast and loose with a crucial part of our biology. Sadness, they argue, serves an evolutionary purpose -- and if we lose it, we lose out.
"When you find something this deeply in us biologically, you presume that it was selected because it had some advantage, otherwise we wouldn't have been burdened with it," says
Perhaps, then, it's time to embrace our miserable side. Yet many psychiatrists insist not. Sadness has a nasty habit of turning into depression, they warn. Even when people are sad for good reason, they should be allowed to take drugs to make themselves feel better if that's what they want.
So who's right? Is sadness something we can live without or is it a crucial part of the human condition?
Hard evidence for the importance of sadness in humans is difficult to come by, but there are lots of ideas about why our propensity to feel sad might have evolved. It may be a self-protection strategy, as it seems to be among other primates that show signs of sadness. An ape that doesn't obviously slink off after it loses status may be seen as continuing to challenge the dominant ape -- and that could be fatal.
Wakefield believes that in humans sadness has a further function: it helps us learn from our mistakes.
"I think that one of the functions of intense negative emotions is to stop our normal functioning, to make us focus on something else for a while," Wakefield says. It might act as a psychological deterrent to prevent us from making those mistakes in the first place. The risk of sadness may deter us from being too cavalier in relationships or with other things we value, for example.
What's more, says
Then there's the notion that creativity is connected to dark moods. There is no shortage of great artists, writers and musicians who have suffered from depression or bipolar disorder. It would be difficult to find enough recognized geniuses to test the idea in a large, controlled study, but more run-of-the-mill creativity does seem to be associated with mood disorders.
The researchers suggest that such negative feedback makes people ruminate on the unhappy experience, which allows subconscious creative processes to come to the fore, or that it pushes depression-prone people to work harder to avoid feeling bad in the future (Personality and Social Psychology Bulletin).
DON'T BE HAPPY, WORRY
There's also evidence that too much happiness can be bad for your career.
This could simply demonstrate that the happiest people are those who cherish close relationships over power and success, but it could also signal that people who are "too happy" lose their willingness to make changes to their lives that may benefit them.
Medicating sadness, Keedwell suggests, could do the same -- blunting the consequences of unfortunate situations and removing people's motivation to improve their lives. Giving antidepressants to people whose real problem is something else -- a bad relationship, for instance -- may allow the person to continue in an unhealthy situation instead of addressing the underlying problem.
Whether or not a little sadness is useful, everyone agrees that clinical depression is not. Unfortunately it's not clear exactly where to draw the line between the two. So which is more dangerous: to over-medicate normal sadness, a feeling which may lead us to re-evaluate our lives after the loss of a job or the end of a relationship, or under-medicate clinical depression?
Wakefield, however is uneasy about prescribing pills where there is no certainty that they are needed. After all, he points out, antidepressants have side effects, some of them serious.
THE NEED FOR SAD
So where does this leave the notion of human sadness? Should we accept that major life events may make us so sad that we are temporarily disabled? Or should we run to the doctor in the hope that pills will speed up our emotional journey back to happiness?
"That seemed to me to be an irreproachable logic on her part," Kendler says. "I started her on antidepressants. She came back much brighter. The idea that I was depriving this woman of the proper grieving experience and preventing her from experiencing deeply the meaning of this rang very hollow in this particular case."
For those of us not faced with such an extreme problem,
Keedwell agrees. "Clearly, if we didn't feel sad when we were unsuccessful at achieving certain goals, we would not stand back from that goal and introspect and perhaps try to change our strategies," he says, echoing Wakefield and the
So is there some middle ground? Both sides agree that there are ways to lift the gloom without pills. "An alternative would be thinking about what is making you unhappy," says Wakefield. "Another possibility is watchful waiting. A more nuanced view of the situation will help people think about their options better."
Diener also suggests we stop obsessing about being happy all the time. "One of the things we want to do is disabuse people of the notion that they're not happy enough," he says. He cites a study that used emotion-recognition software to work out the Mona Lisa's inner feelings (New Scientist). It concluded that she is 83 percent happy. The rest is a mix of negative emotions like fear and anger. That, it seems, is just about right.
A PILL FOR EVERY ILL
When the first antidepressant came to market in the 1950s, the company that marketed it did not think there were enough depressed people for the drugs to make a profit. By 2000, though, antidepressants were a
Many people blame the pharmaceutical industry for huge increases in the number of depression diagnoses, especially in countries like the US where drug companies can advertise their products directly to consumers on television, radio and in magazines. One recent study by
Kravitz sent actors into doctors' offices. Half presented symptoms of depression, half did not. Each actor either asked for the antidepressant Paxil specifically, asked for help from a drug without specifying which one they wanted, or made no request. Those who asked for a drug were more likely to get one than those who did not request medication, whether or not they had symptoms of depression (
Others are not so convinced that patients are being led towards a decision. "One view is that this is being marketed by the doctors and the pharmaceutical industry. I think that misses the argument that people themselves are much more interested in having a better life," says
SAD OR DEPRESSED?
If you've experienced five of the symptoms below for two weeks or more, including at least one of the first two, you meet the diagnostic criteria for major depressive disorder:
Reduced interest or enjoyment in normal activities
Loss or gain of weight or appetite
Insomnia or excessive sleep
Fatigue or loss of energy
Feelings of worthlessness, or excessive or inappropriate guilt Indecisiveness or reduced ability to concentrate
Agitated motion like pacing or hand-wringing, or physical slowing down
Thoughts of death or suicide
This definition, introduced in the third edition of the
There is one notable caveat. According to the DSM criteria, if you have these symptoms after the death of a loved one you are not considered to be depressed, but suffering a normal reaction to bereavement.
Some, however, say that bereavement isn't the only type of grief that should be left out of a diagnosis of depression.
"It does make one worry that any negative emotion (except the grief of bereavement) that disrupts your ability to function in a happy manner could be classified as a disorder," he says.
In a study published in 2007, Wakefield's team reported on more than a thousand people who met the criteria for major depressive disorder, some of whose episodes were triggered by "standard" bereavement and others whose depression was triggered by another loss. They found that the depression they suffered was very similar.
"That suggested that about 25 percent of people who would be diagnosed in the community as being depressed are probably actually suffering from normal reactions," Wakefield says. Moreover, the symptoms of those who were grieving for reasons other than bereavement were indistinguishable from those of the bereaved (Archives of General Psychiatry).
Wakefield says this means that other forms of normal sadness should be exempted from the DSM criteria. Other researchers, though, feel the opposite is true: that far from being excluded, anything that creates depressive symptoms -- grief included -- should be diagnosed as clinical depression and treated accordingly.
With the next edition of DSM due in 2012, the debate is likely to hot up over the next couple of years. For some, however, the problem isn't just about exemptions, it is also about setting the bar too low. For
"(It) has taken psychiatry into the dark ages," he says. In his view, there's no use in having a definition of depression that is broad and devoid of context. "Say you go along to your general practitioner and he says, 'I know what you've got. You've got major breathlessness.' You're not going to be very impressed. You want to know whether you've got pneumonia or asthma, or a pulmonary embolus, because you then know that the treatment will be rational. If you go with a generic diagnosis, how can you possibly work out what is the key, underlying pathology?"
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(c) 2009 Jessica Marshall, New Scientist Magazine