Is it possible that almost 90% of Americans who are diagnosed with clinical depression are diagnosed incorrectly? Is it possible that most of them are really just going through a natural process of normal sadness that happens to most people when they suffer loss of one kind or another? The stakes in a massive misdiagnosis of thousands of people for the same illness are huge. The sector of the drug industry that produces medication related to helping people cope with medical depression, bipolar and the like is vast, well-funded and has a lot at stake in the continual diagnosis of these diseases. Through varied sorts of advertisements, one could draw the conclusion that a huge number of people could be (or are) suffering from medical depression and similar ailments. In fact, it is estimated that over 25% of Americans at any given time are believed to be suffering from depression, anxiety or bipolar disorder (p. 20).
No doubt there are people who genuinely suffer from an abnormal type of sadness that is sometimes unexplained, such that it is proper to call it a disease and treat it accordingly. I know of three family members and long-time friends who have dealt with depression and bipolar. This issue is very real to me and I have put a lot of thought into understanding the disease, diagnosis and treatments.
If it is true that the majority of people diagnosed with depression and the like may not truly be clinically depressed, then what hope is there to offer them outside of medical and psychological treatments? In his new book, Good Mood Bad Mood: Help and Hope for Depressed and Bipolar Disorder, medical doctor and counselor Charles D. Hodge offers his insights and experience on these sensitive diagnoses.
To say that the history of depression is peppered with obscurity and subjectivity is to ignore it altogether. Prior to 1980, manic depression was the closest diagnosis to depression. Then, depression entered the picture in the DSM 3rd Ed. and now one in four people are diagnosed with it. Something seems amiss.
Sadness vs Depression
The crux of the issue for Hodge and others is two-fold: (1) there are no clear criteria to establish the difference between clinical depression and normal sadness associated with loss and (2) if many people with normal sadness are misdiagnosed as having clinical depression then what else might be the cause and potential treatments?
In dealing with the first issue Hodge points out that “there is an important difference between sadness that came with adversity and sadness that appeared without any cause” (p. 63). What Hodge calls “normal sadness” is the kind of sadness that is a natural result of dealing with loss in life which is connected with adversity. True clinical depression would be defined as sadness that is not connected with adversity in a person’s life and is therefore apparently without cause.
There are three features of normal sadness. First, the sadness one feels fits the situation. The loss of a child or job can trigger sadness. Second, the intensity and duration of the sadness are related to the size and duration of the loss. The loss of a child can bring about very intense sadness and the length of being without a job can determine the length of time a person feels sadness. Finally, normal sadness goes away when the trigger that set it off goes away. With the loss of a child, sadness can carry on throughout a person’s life. When a person gets a new job after losing their previous one then their sadness should go as well (p. 62). With clinical depression there is no apparent trigger in the person’s life, no explanation for any intense feelings of sadness for a duration of time and there is no apparent end in sight.
The problem with the diagnosis criteria for clinical depression is that there are no built in guidelines to distinguish between normal sadness and apparently unexplainable sadness. Thus, there is a significant over-diagnosis for the wrong problem and many people are not receiving the treatments that could most likely help them through their normal experiences of sadness. To be misdiagnosed can have devastating consequences. Hodge writes,
Being labeled has its own set of difficulties. It makes a person feel as if he is a victim of disease. The label (or rather the diagnosis) means that the bearer is ill and cannot recover without help. The label means that I must depend on someone else to fix me. (p. 154)
What is the Hope for the Naturally Sad?
So if many people with normal sadness are not receiving the help they need, what is it that they need? For these people Hodge states,
The labels they receive and the prescriptions they are given might only result in more labels and prescriptions without a cure and at some expense. This opens a door of opportunity for us to look at depression from a different angle. (p. 35)
Drawing heavily on the story in Luke 8 where Jesus healed the women with the hemorrhage after the doctors could find not cure, Hodge teases out from Scripture how the sadness we experience from the adversity in our lives can be addressed through the gospel of Jesus Christ as revealed to us in Scripture. Throughout the main portion of the book Hodge seeks to offer help for those dealing with sadness by answering three questions:
- Where does sadness come from?
- What benefit can come from it?
- What can we do as Christians to bring it to a useful end? (p. 75)
In answering these three questions Hodge digs deeply in Scripture through the lives of many people saddened for one reason or another and from many passages in Scripture that offer freedom from the sadness that life in a sin-cursed world can bring. There is hope for the sad. We are not a helpless and hopeless victim of our circumstances or genetics. We must see the redemptive blessings that God wants to draw us to through our suffering. What is best is that God understands our suffering and sadness in Christ. Jesus experienced loss and sadness throughout his life leading up to the cross. This is encouraging and freeing. There is hope for the sad in Christ.
While Hodge is trying to help us rightly distinguish between natural sadness and genuine depression, the reader must not come away thinking he does not believe there is no one who suffers from clinical depression or bipolar disorder. Hodge is sanely open minded to the reality that there are those whose sadness is apparently unexplainable and that it is right for them to undergo medical treatments along with counseling for the accompanying spiritual and life struggles that will go with them.
In Good Mood Bad Mood Hodge takes the right perspective on the issue of depression. Hodge speaks with the experience of a medical doctor and counselor and with a true grasp of how Scripture speaks to our normal sadness. This is a sane book amidst the insane world of over diagnosis of depression. Don’t let a label keep you from help and hope.
About the Author
Charles D. Hodges Jr. M.D. is a family physician who practices medicine in Indianapolis. He is a graduate of the Indiana University School of Medicine, Liberty University and Liberty Baptist Theological Seminary with degrees in medicine, counseling and religion. He is board certified in Family medicine and Geriatrics and is a licensed marital family therapist. Dr Hodges teaches and counsels at the Faith Biblical Counseling Ministry and teaches on medical subjects in Biblical counseling around the country and abroad. He and his wife Helen have been married 41 years and have 4 children and 12 grandchildren.
[node:disclaimer body collapsed]