The sadness

OK so i’m on a roll with my BMJ RSS feed.

I find this aspect of medicine one of the most interesting and complicated boundaries of medicine and the emotional and the spiritual and the just plain old “life”.

I am completely unclear as to what to make of psychiatric illness in the context of the human experience. I have a few psychiatrist friends who i’m sure could make much more sense of all this.

I do sick people – and pretend that that just means abnormal physiology. I avoid psychiatry, leaving it as someone else’s problem, just as i do with many of the difficult ethical medical debates.

Anyhow.

One guy puts it this way:

In truth, “depression” is a very difficult thing to define and any doctor who says that they can reliably differentiate it from sadness is deluding themselves.

Another takes issue and puts it this way:

Depression is not the same as ordinary unhappiness. It is a state unlike any other I have experienced. Ideas about being vulnerable neither made me ill nor ameliorated my distress: in truth like many twenty-year olds, before it hit me I had thought myself invulnerable. Defining suffering away does not diminish it. It insults it. Be wary what you mean when you say to patients, as Ginn does: you do not need anti-depressants, you’re a lot tougher than you think. It could be the cruellest form of paternalism yet.

Any thoughts?