Something akin to this has happened with depression. Think about it like this. People experience a range of emotions that are an essential aspect of being human. On the down side we become sad, anxious, fearful, and desperately low (and even despair). It could be work, stress, people, circumstances – a whole spectrum of situations, people and concerns weigh heavily upon us. We are not ill, we don’t have a medical condition - and that’s not to minimise the distress and suffering associated with feeling depressed.
But in the public and professional (psychiatric) perception a change has occurred: distress is now an illness and has become an aspect of a physician’s responsibility. As Dr Iona Heath points out, “disease mongering relies on the pathologising of normal biological or social variation. 6” This is what has happened with the construct of depression, and it is of course “in the interests of pharmaceutical companies to extend the range of the abnormal so that the market for treatments is proportionately enlarged.” 6
A key factor in the medicalisation of depression was a radical change in the way depression was defined and thus diagnosed. This came about with the publication of the DSM-III reference book in 1980 by the American Psychiatric Association. These classification changes “transformed a condition that was thought to be very serious and rare into one that was extremely common”4 - thus changing the way we think about depression. From now on people who are sad, weary with work, wrestle with interpersonal difficulties and the like have a diagnosable disease, a “depressive disorder” 4. Well, that’s what people were led to believe even though the diagnostic changes were bereft of scientific substance. Public perception about depression radically changed so that “while as recently as the late 1970s depression was a relatively uncommon disorder, just fifteen years later it had become a public health problem.” 7
Drug companies also recognised the potential for re-framing our everyday emotional and mental distress as a medical condition that supposedly needs drug treatments. Here in the UK there was a carefully orchestrated campaign to extend the boundaries of what constituted depression. This was the 5-year “Defeat Depression Campaign” (1992-1997) which helped raise prescriptions for antidepressants by well over 200% in Britain within just 10 years. “Coincidentally”, this was at a time when the drug companies were releasing newer antidepressants (following on from the release of Prozac after its licensing in 1987) onto the market.
By the 1980s it was widely known that the benzodiazepines (the so-called anti-anxiety drugs) were seriously addictive and harmful. The drug companies tried to keep a lid on this news for as long as possible (not dissimilar to the tobacco companies fighting earlier assertions that smoking is linked to cancer). At that time many people who were reliant upon the so-called anti-anxiety drugs were then being prescribed antidepressants - which the Defeat Depression Campaign was keen to promote as non-addictive. (How history repeats, as today millions of people struggle to come off these antidepressants). In fact, the Hamilton Rating Scale for Depression (HAM-D) originally devised in 1960, is in some ways testing for anxiety – thus, in psychiatric diagnosis the boundaries between depression and anxiety are often merged.
The misleadingly called “Defeat Depression Campaign” was largely funded by manufacturers of the SSRI antidepressants (like Prozac) and aimed to help GP's better recognise depression (that’s the new liberal version of depression) and to encourage the public to be more likely to seek treatment (synonymous with drugs in this context). “Only two years into the campaign, over 3 million leaflets about depression had been circulated to the public and many other initiatives had been sponsored as well 8.” Essentially, it was a marketing promotion campaign for depression and the need for antidepressants that co-opted the endorsement of the Royal College of Psychiatrists and the Royal College of General Practitioners.
And now to the present day. It only takes one small change to make an enormous difference in the numbers of people being diagnosed as depressed. The recently published diagnostic guidelines, DSM-5, make it possible for the sadness of grief to be diagnosed as depression if this lasts for more than two weeks. Previously (with DSM-IV) the time considered appropriate for normal grieving was two months. Both of these are sheer folly as any reasonable person knows that grieving takes not just months but years too. As we read in the Lancet medical journal: “Medicalising grief, so that treatment is legitimised routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed…Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. Putting a timeframe on grief is inappropriate.”9
In a sense, the Age of Depression has replaced the Age of Anxiety 4. In reality the personal concerns and heart-felt pains experienced by people are much the same - but re-branded for commercial purposes into the modern-day diagnostic entity "depression".
Whilst it is true that the idea that many of us are depressed is being promoted for commercial gain, it is equally true that there is much about modern life that can get us down [see my web here]. We look at what might help those who feel depressed here.
References - Bibliography - Further reading
1 The Bible. Jeremiah 4:19; Lamentations 2:11
2 WHO here
3 Moncrieff, J. (2008) The Myth of the Chemical Cure. UK: Palgrave MacMillan
4 Horwitz, A. (2011) Creating an Age of Depression: The Social Construction and Consequences of the Major Depression Diagnosis. Society and Mental Health. American Sociological Association 2011 1: 41
5 Welch, H.G. (2011) (With Schwartz, L.M., Woloshin, S) Over-diagnosed: Making people sick in the pursuit of health. Massachussets: Beacon Press.
6 Heath, I. 2006 Combating disease mongering: Daunting but nonetheless essential. PLoS Medicine April 2006 Vol 3 Issue 4. Available here.
7 Grob, G. & Horwitz, A. (2010) Diagnosis, therapy, and the evidence: Conundrums in modern American medicine. Rutgers University Press.
8 Medawar, C. 1997 The antidepressant web: Marketing depression and making medicines work. International Journal of risk and safety in medicine, 1997, 10, 2 75-126. Available here
9 The Lancet, Volume 379, Issue 9816, Page 589, 18 February 2012. Full article here