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The language has shifted as well. You’re not sad, you’re depressed. You don’t worry, you have anxiety. Depression and anxiety are medical diagnoses. The othe

The language has shifted as well. You’re not sad, you’re depressed. You don’t worry, you have anxiety. Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience. If you don’t ever worry or get sad about anything there’s probably something else wrong with you. In terms of diagnoses, the DSM-4 included a “bereavement exclusion” from the depression diagnostic criteria. Thinking being if someone close to you dies a normal person almost should feel the symptoms of depression for some period of time. You don’t have depression, you’re mourning. It was (controversially) removed in DSM-5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/ The “slap a medical diagnosis on a normal feeling” described in the article seems to have entered society across the board.

cloutchaser 4y ago
- ajsnigrutin 4y ago
  - nemo44x 4y ago
Retric 4y ago
That’s wildly wrong. The medical community adopted depression and anxiety from general use dating back to the 1500’s rather than the other way around. “The meaning "dejection, state of sadness, a sinking of the spirits" is from early 15c. (as a clinical term in psychology, from 1905);” https://www.etymonline.com/word/depression https://www.etymonline.com/word/depression “anxiety (n.) 1520s, "apprehension caused by danger, misfortune, or error, uneasiness of mind respecting some uncertainty, a restless dread of some evil," from Latin anxietatem (nominative anxietas) "anguish, anxiety, solicitude," noun of quality from anxius "uneasy, troubled in mind” https://www.etymonline.com/search?q=anxiety https://www.etymonline.com/search?q=anxiety
- kkielhofner 4y ago
  I think we’re talking past each other here? The medical diagnoses are generalized anxiety disorder and major depressive disorder (with a variety of variations). Both of which, in common usage, have meaning. The average person with their arm in a cast doesn’t say they “have a compound fracture of the radius and ulna”. They say they broke their arm or MAYBE fractured their arm. In this case the simple language and medical diagnosis is fracture. Just like people with SERIOUS, life ruining disabling and debilitating depression don’t say they “have non-psychotic major depressive disorder”. They say they have depression. I’m not gatekeeping, just being extreme for the purposes of discussion. To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry. To me (again) the issue comes in when you apply a diagnosis to a feeling. When you bump your funny bone you don’t tell people your arm is fractured.
  - Apocryphon 4y ago
    > To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry. You are contradicting your own examples: > You’re not sad, you’re depressed. You don’t worry, you have anxiety. It's possible the people are expressing they are feeling depressed or having anxiety in a colloquial way without confusing the emotion for the diagnosis. Your prior examples indicated that to use those words is problematic, yet you now say that "you can be depressed about something" and that "you can be anxious about something."
    - kkielhofner 4y ago
      You missed the sarcasm/jest on my first examples. I should have tagged them or been clearer. On the later the separation is: “I’m depressed” = Sad or a variation of it. “I have depression” = Diagnosis of a disorder
      - Apocryphon 4y ago
wincy 4y ago
It made us feel so insulted and betrayed that when my wife would cry in the NICU for any reason the nurses would tattle on her and she’d get a call from the pill pushers trying to prescribe her psych meds. It’s like look, my kid has literally been in the NICU for 6 months now (it ended up being 9 months total) and you’re strongly pressuring us to get her a tracheostomy (let’s not use medical euphemism here though, they wanted to put a tube into our babies throat which would make her unable to cry and necessitate round the clock nursing care) as the “standard of care” (bullshit, it would have made her quality of life worse). But she’s a little upset, better prescribe her happy pills! For anyone wondering, this was 2019 and my daughter is right this moment peacefully sleeping in her bed with no external breathing aids necessary aside from a wedge pillow to help with her sleep apnea. My blood boils when I think of what we were forced through (especially my wife) dealing with the medical establishment after our daughter was born, but the psych meds being dangled in front of us is a particularly sore spot.
- SoftTalker 4y ago
  > she’d get a call from the pill pushers trying to prescribe her psych meds If your only tool is a hammer.... This is part of why I avoid the medical establishment.
- jnovek 4y ago
  I’m sorry for this entire experience that you’ve had. It sounds like a waking nightmare. I’m curious, did any doctor bring up therapy? I have major depressive disorder and I take antidepressants to help manage it. There was a landmark study a few years ago indicating that, while SSRIs/SNRIs are beneficial for people like me, they are no more effective than the placebo for people experiencing transient depression. Therapy, however, would’ve been a sound recommendation for her. In this case it would have given her a place to vent and taught her some tools to cope. Finally, you should consider whether you and your wife experience any post-traumatic stress from this experience. Your experience meets the qualifications for one that can lead to PTSD in DSM V. There are extremely effective therapy approaches that can put PTSD in complete remission.
  - stephenhuey 4y ago
mtlmtlmtlmtl 4y ago
I think the main point of removing this exclusion is that you can be depressed and bereaved at the same time. Or you could be so depressed due to bereavement that you still need treatment. In DSM-V it's left to the clinician to distinguish between clinically significant depression and a healthy, transitory reaction to bereavement. The reason for this is to avoid cases where people who need treatment are dismissed too easily because they happen to be bereaved. There is still a distinction drawn, it's just that it's not currently easy to make that distinction in a standardised way, and so it was decided to remove it from the DSM, which is meant to be as rigorous and statistically grounded as possible.
- kkielhofner 4y ago
  As the other comment with his wife and the NICU situation noted, the point here is people should be left to deal with life if they’re going through some shit. IIRC the bereavement exclusion was six months? This made sense to me, if you had some terrible event in your life and you’re not back to something resembling your baseline mood and function after roughly that time period there’s probably something going on that needs to be looked at. To me this is the mental health equivalent of “Sorry you sprained your ankle and it hurts a little, here’s a month of OxyContin and what could very well be a lifelong addiction”. We don’t do that anymore - today you’ll get ibuprofen and ice. Even with more serious injuries you’re more likely to get lifestyle suggestions, physical therapy, etc than opioids. In many cases we’re throwing pills that change mood and brain chemistry at people suffering from what is basically “life”. I’m not saying people shouldn’t be treated, I’m saying general practitioners throwing SSRIs at someone and diagnosing them with depression after talking to them for literally five minutes doesn’t seem right to me. But it is easier and faster than hours and hours of therapy. What comes first? An irresponsibly written anti-depressant prescription because someone said they have depression, or someone says they have depression because someone irresponsibly wrote them a prescription for an anti-depressant?
  - mtlmtlmtlmtl 4y ago
    The point is that it's non-trivial to determine whether someone is simply bereaved. Or depressed, and bereaved. If someone is already depressed, bereavement is one of those things that can push them over the edge into attempting suicide. The exclusion criterion was too simplistic to cover the nuance of the differential diagnosis, so it was removed. It is a non-sequitur to say that the removal from the DSM is an endorsement of diagnosing MDD in all bereaved people. Some doctors might be doing that, but then the problem is that those doctors are doing the wrong thing, and whatever societal pressures might have affected them to do so. There is still disagreement about it in the field, and if the consensus shifts again it could very well end up being added back in, but probably I think it will evolve into a more specific diagnostic procedure to tell the cases apart.
kube-system 4y ago
Just because it is a "normal" thing doesn't mean it isn't something that medicine can address. Many of the unpleasant things our bodies go through are "normal" reactions to events. The fact that bereavement may be different than other causes of depression may be a reason to treat it differently, but not a reason to ignore it.
- navjack27 4y ago
  But should we be treating those kinds of things with a medication or should we be treating it with education? Should we be more forgiving to people and allowing them the space they need to process life events instead of worrying about money or their jobs or all this crap. The difference is handing someone a bottle and saying "here this will go away quick!" Vs just generally having a better more emotionally aware society. Some processes that are brains go through should be allowed and it should be accepted that they run their full natural course given that the human that has the brain is also being cared for and guided in some sort of way during this process and not just isolated and shunned away.
  - kube-system 4y ago
    No, just because something is diagnosable doesn’t mean the treatment is a pill. It is perfectly reasonable to address concerns about the bereavement process with therapy.
standardUser 4y ago
I strongly disagree. I think most people I know are careful to not throw around the word "depression" when they talk about being sad. They are keenly aware of the difference. And they know the difference between "being anxious" or "having anxiety" and having an actual anxiety disorder. Of course, a lot of times the lines are blurred. Whole most medical professionals are forced to draw a stark line in order to make an actionable diagnosis, actual people realize that these are all on a spectrum. Some of us may have occasional OCD tendencies or mild body dysmorphia without needing medical intervention. Though self-awareness and discussing the issue with friends and a therapist always seem to help, even if meds or more involved therapy aren't needed.
- sushid 4y ago
  No offense but if most people around you are throwing around the word "depression," I would personally consider that a red flag (unless you're in the medical profession). Either your friend circle are unusually showing symptoms of depression or they're misusing the term/self-diagnosing themselves.
  - standardUser 4y ago
    I clearly stated that "most people I know are careful to not throw around the word "depression". The rest of what I wrote syncs with this perspective. Not sure what you read.
somesortofthing 4y ago
> Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience. Why? In what sense are they "normal"? They're unpleasant and they leave you worse off than you were before you experienced them. It's also becoming clearer that frequently experiencing them has harmful physical effects from stress responses. Over-diagnosis with depression and anxiety is bad because the treatments have such a wide array of potential side effects and limited evidence for efficacy, but it makes no sense to not categorize something as a disease just because we can't treat it.

cloutchaser 4y ago

ajsnigrutin 4y ago
- nemo44x 4y ago

Retric 4y ago

That’s wildly wrong. The medical community adopted depression and anxiety from general use dating back to the 1500’s rather than the other way around. “The meaning "dejection, state of sadness, a sinking of the spirits" is from early 15c. (as a clinical term in psychology, from 1905);” https://www.etymonline.com/word/depression https://www.etymonline.com/word/depression “anxiety (n.) 1520s, "apprehension caused by danger, misfortune, or error, uneasiness of mind respecting some uncertainty, a restless dread of some evil," from Latin anxietatem (nominative anxietas) "anguish, anxiety, solicitude," noun of quality from anxius "uneasy, troubled in mind” https://www.etymonline.com/search?q=anxiety https://www.etymonline.com/search?q=anxiety

kkielhofner 4y ago
I think we’re talking past each other here? The medical diagnoses are generalized anxiety disorder and major depressive disorder (with a variety of variations). Both of which, in common usage, have meaning. The average person with their arm in a cast doesn’t say they “have a compound fracture of the radius and ulna”. They say they broke their arm or MAYBE fractured their arm. In this case the simple language and medical diagnosis is fracture. Just like people with SERIOUS, life ruining disabling and debilitating depression don’t say they “have non-psychotic major depressive disorder”. They say they have depression. I’m not gatekeeping, just being extreme for the purposes of discussion. To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry. To me (again) the issue comes in when you apply a diagnosis to a feeling. When you bump your funny bone you don’t tell people your arm is fractured.
- Apocryphon 4y ago
  > To me, you can be depressed about something and not have depression. You can be anxious about something and not have anxiety. Those are slightly more sophisticated uses of sad and worry. You are contradicting your own examples: > You’re not sad, you’re depressed. You don’t worry, you have anxiety. It's possible the people are expressing they are feeling depressed or having anxiety in a colloquial way without confusing the emotion for the diagnosis. Your prior examples indicated that to use those words is problematic, yet you now say that "you can be depressed about something" and that "you can be anxious about something."
  - kkielhofner 4y ago
    You missed the sarcasm/jest on my first examples. I should have tagged them or been clearer. On the later the separation is: “I’m depressed” = Sad or a variation of it. “I have depression” = Diagnosis of a disorder
    - Apocryphon 4y ago

wincy 4y ago

It made us feel so insulted and betrayed that when my wife would cry in the NICU for any reason the nurses would tattle on her and she’d get a call from the pill pushers trying to prescribe her psych meds. It’s like look, my kid has literally been in the NICU for 6 months now (it ended up being 9 months total) and you’re strongly pressuring us to get her a tracheostomy (let’s not use medical euphemism here though, they wanted to put a tube into our babies throat which would make her unable to cry and necessitate round the clock nursing care) as the “standard of care” (bullshit, it would have made her quality of life worse). But she’s a little upset, better prescribe her happy pills! For anyone wondering, this was 2019 and my daughter is right this moment peacefully sleeping in her bed with no external breathing aids necessary aside from a wedge pillow to help with her sleep apnea. My blood boils when I think of what we were forced through (especially my wife) dealing with the medical establishment after our daughter was born, but the psych meds being dangled in front of us is a particularly sore spot.

SoftTalker 4y ago
> she’d get a call from the pill pushers trying to prescribe her psych meds If your only tool is a hammer.... This is part of why I avoid the medical establishment.
jnovek 4y ago
I’m sorry for this entire experience that you’ve had. It sounds like a waking nightmare. I’m curious, did any doctor bring up therapy? I have major depressive disorder and I take antidepressants to help manage it. There was a landmark study a few years ago indicating that, while SSRIs/SNRIs are beneficial for people like me, they are no more effective than the placebo for people experiencing transient depression. Therapy, however, would’ve been a sound recommendation for her. In this case it would have given her a place to vent and taught her some tools to cope. Finally, you should consider whether you and your wife experience any post-traumatic stress from this experience. Your experience meets the qualifications for one that can lead to PTSD in DSM V. There are extremely effective therapy approaches that can put PTSD in complete remission.
- stephenhuey 4y ago

mtlmtlmtlmtl 4y ago

I think the main point of removing this exclusion is that you can be depressed and bereaved at the same time. Or you could be so depressed due to bereavement that you still need treatment. In DSM-V it's left to the clinician to distinguish between clinically significant depression and a healthy, transitory reaction to bereavement. The reason for this is to avoid cases where people who need treatment are dismissed too easily because they happen to be bereaved. There is still a distinction drawn, it's just that it's not currently easy to make that distinction in a standardised way, and so it was decided to remove it from the DSM, which is meant to be as rigorous and statistically grounded as possible.

kkielhofner 4y ago
As the other comment with his wife and the NICU situation noted, the point here is people should be left to deal with life if they’re going through some shit. IIRC the bereavement exclusion was six months? This made sense to me, if you had some terrible event in your life and you’re not back to something resembling your baseline mood and function after roughly that time period there’s probably something going on that needs to be looked at. To me this is the mental health equivalent of “Sorry you sprained your ankle and it hurts a little, here’s a month of OxyContin and what could very well be a lifelong addiction”. We don’t do that anymore - today you’ll get ibuprofen and ice. Even with more serious injuries you’re more likely to get lifestyle suggestions, physical therapy, etc than opioids. In many cases we’re throwing pills that change mood and brain chemistry at people suffering from what is basically “life”. I’m not saying people shouldn’t be treated, I’m saying general practitioners throwing SSRIs at someone and diagnosing them with depression after talking to them for literally five minutes doesn’t seem right to me. But it is easier and faster than hours and hours of therapy. What comes first? An irresponsibly written anti-depressant prescription because someone said they have depression, or someone says they have depression because someone irresponsibly wrote them a prescription for an anti-depressant?
- mtlmtlmtlmtl 4y ago
  The point is that it's non-trivial to determine whether someone is simply bereaved. Or depressed, and bereaved. If someone is already depressed, bereavement is one of those things that can push them over the edge into attempting suicide. The exclusion criterion was too simplistic to cover the nuance of the differential diagnosis, so it was removed. It is a non-sequitur to say that the removal from the DSM is an endorsement of diagnosing MDD in all bereaved people. Some doctors might be doing that, but then the problem is that those doctors are doing the wrong thing, and whatever societal pressures might have affected them to do so. There is still disagreement about it in the field, and if the consensus shifts again it could very well end up being added back in, but probably I think it will evolve into a more specific diagnostic procedure to tell the cases apart.

kube-system 4y ago

Just because it is a "normal" thing doesn't mean it isn't something that medicine can address. Many of the unpleasant things our bodies go through are "normal" reactions to events. The fact that bereavement may be different than other causes of depression may be a reason to treat it differently, but not a reason to ignore it.

navjack27 4y ago
But should we be treating those kinds of things with a medication or should we be treating it with education? Should we be more forgiving to people and allowing them the space they need to process life events instead of worrying about money or their jobs or all this crap. The difference is handing someone a bottle and saying "here this will go away quick!" Vs just generally having a better more emotionally aware society. Some processes that are brains go through should be allowed and it should be accepted that they run their full natural course given that the human that has the brain is also being cared for and guided in some sort of way during this process and not just isolated and shunned away.
- kube-system 4y ago
  No, just because something is diagnosable doesn’t mean the treatment is a pill. It is perfectly reasonable to address concerns about the bereavement process with therapy.

standardUser 4y ago

I strongly disagree. I think most people I know are careful to not throw around the word "depression" when they talk about being sad. They are keenly aware of the difference. And they know the difference between "being anxious" or "having anxiety" and having an actual anxiety disorder. Of course, a lot of times the lines are blurred. Whole most medical professionals are forced to draw a stark line in order to make an actionable diagnosis, actual people realize that these are all on a spectrum. Some of us may have occasional OCD tendencies or mild body dysmorphia without needing medical intervention. Though self-awareness and discussing the issue with friends and a therapist always seem to help, even if meds or more involved therapy aren't needed.

sushid 4y ago
No offense but if most people around you are throwing around the word "depression," I would personally consider that a red flag (unless you're in the medical profession). Either your friend circle are unusually showing symptoms of depression or they're misusing the term/self-diagnosing themselves.
- standardUser 4y ago
  I clearly stated that "most people I know are careful to not throw around the word "depression". The rest of what I wrote syncs with this perspective. Not sure what you read.

somesortofthing 4y ago

> Depression and anxiety are medical diagnoses. The other are normal emotions everyone can, should, and does experience. Why? In what sense are they "normal"? They're unpleasant and they leave you worse off than you were before you experienced them. It's also becoming clearer that frequently experiencing them has harmful physical effects from stress responses. Over-diagnosis with depression and anxiety is bad because the treatments have such a wide array of potential side effects and limited evidence for efficacy, but it makes no sense to not categorize something as a disease just because we can't treat it.