Sadness is an emotion all people feel at times. Few people can get through life without bouts of sadness. This emotion is a natural response to losses of many kinds: loss of a loved one, a pet, a relationship, or a job. Even when life is just challenging, we may find ourselves sad. Deciding the degree to which these feelings are normal and how you measure them is very difficult.
Nevertheless, according to the Diagnostic and Statistical Manual of Mental Disorders III, (DSM III) published in 1980, psychiatrists have attempted to differentiate between normal sadness and mental disorder. Depression has been defined as sadness that lasts for longer than two weeks, causes difficulty eating or sleeping, makes you less interested in your normal life or leads to feelings of suicide. Today if you take the Mayo Clinic’s test on depression, and answer, “yes” to whether your symptoms have lasted for more than two weeks, the Clinic recommends seeing a physician right away and suggests your condition will not improve without medical care.
While depression is a very real, sad feelings lasting for more than two weeks is fairly normal, especially if you have real reasons to be sad. The death of a spouse or child, for instance, will evoke powerful emotions that will make you grieve for a long time. Even a painful divorce can cause feelings of sadness to last for months or even years.
In 2007, Drs. Allan Horowitz and Jerome Wakefield, published a groundbreaking book, The Loss of Sadness, which analyzes the way the mental health profession has treated and diagnosed depression. Their main contention is that sadness and depression are diagnosed without context, since the DSM III was published. This has led to a rise in the number of diagnosed cases of major depression. Their book makes a powerful argument that without understanding context for sad feelings, psychiatry has gone overboard in diagnosing depression, and that it has forgotten that real reasons may exist for pervasive sad feelings. Certainly this is the case with the Mayo Clinic test, which recommends seeing a physician if you’ve been sad or depressed for two weeks, without asking you anything about your circumstances.
Where can you draw the line then? When do you feel too much of this emotion and how much is normal? It should be emphatically understood that suicidal feelings cross into the area of clinical depression and need emergency care. If you feel at all suicidal, you should speak to a doctor right away. Sadness during specific times, like after the birth of a child, may signify significant postpartum depression and needs treatment too.
Even if you have legitimate reasons to feel sad, when that sadness seems overwhelming, all-encompassing, and is significantly interfering with your ability to continue your normal life, a good therapist or support group can help. Furthermore, when you have few reasons to really feel sad, and yet you do, this may not be “normal.” If you are constantly blue and depressed for little reason, this deserves medical attention because it may be caused by brain chemical imbalance. Major depression is a real disease, and many people respond well to treatment.
Determining whether your feelings are normal may take some deep self-scrutiny. It’s hard to go by the opinion of others. Most people find that others expect them to recover from even major grief, long before they do. In fact a common complaint among those grieving is that after a few intensive weeks when everyone is helpful, most people (friends, family) no longer want to listen or seem to bounce back to their normal lives while the grieving person still feels awful.
Even if medication is not appropriate to treating grief, therapy may be. With a few exceptions, most people will continue to be sad for a long time, and though this may be normal, it may not be tolerated in our society. Dealing with the attitudes of others who expect you to get immediately back on track can fuel your feelings even more, and having a therapist or a support group that understands how isolating sad feelings can be is of extraordinary help.
In sum, in the absence of any obvious causes, long-term sadness should be evaluated as potential depression. Suicidal thoughts and feelings deserve immediate medical attention. Yet sadness should be understood in the context it occurs, and when it occurs in context of true loss, the best help may be talk therapy and time.
