The myth of affluenza

Will Wilkinson has reviewed a useful-sounding book in the December issue of Reason which rejects the view that material abundance is causing higher levels of depression. Allan V Horwitz and Jerome C Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder (Oxford University Press) is a polemic against the arguments on depression put forward by the likes of Ed Diener and Martin Seligman. (Oliver James and Richard Layard have proposed similar arguments in Britain).

According to the review what has really happened is that the definition of depression has widened enormously to include many who are simply unhappy:

“According to Horwitz and Wakefield, ‘There are no obvious circumstances that would explain a recent upsurge in depressive disorder.’ The ranks of the depressed are bulging, they argue, because the clinical category fails to make the elementary distinction between normal, functional sadness and true mental disorder. The depression data are littered with false positives—jilted lovers, white-collar workers who missed out on a promotion, and kids nobody asked to the prom. People who are suffering but aren’t sick.”

This broadening definition of depression is reflected in the standard reference book on the subject:

“Since its third edition was published in 1980, the Diagnostic and Statistical Manual (DSM), the standard handbook used by clinicians to classify mental problems, has defined major depressive disorder with a complex checklist of symptoms. In order to meet the exigencies of 15-minute doctor’s visits and the needs of public health surveys, the few diagnostic qualifications calling for expert judgment were stripped away to produce a simple rule of categorization that family doctors, mental health epidemiologists, and even—or especially—computers can apply. To simplify only slightly, if you meet five of nine mundane requirements over the course of two weeks, you qualify as suffering from major depression. The checklist: a persistently low mood, a diminished interest or pleasure in almost everything, an increase or decrease in appetite leading to a gain or loss in weight, too much or too little sleep, fatigue or low energy, fidgetiness or listlessness, feelings of worthlessness or guilt, difficulty concentrating or indecisiveness, and thoughts of death, suicide, or an attempt of suicide.”