Yes, I'm a Szaszhole

Cato's Will Wilkinson -- blogging at his new site focused on the subject of "happiness studies," and its intersection with public policy -- is rightly skeptical of the claims of folks like The Loss of Happiness in Market Democracies author Robert Lane, who would look to draw grand inferences about the present state of human happiness from an observed rise in diagnosis of depression.

This grandly evasive passage from Lane captures the thinness of the evidence and the desperation to build mansions of conjecture upon it:

Rising depression of this magnitude is a tragedy for any civilization, but the epidemological study of these tragic phenomena is dependent on measurement instruments that are being perfected, and the longitudinal data are in their infancy.

That is to say, “We can’t really say with any certainty whether the incidence of depression is really rising or not, but my book will be much more exciting if I act like I know that civilization is in the throes of tragedy.”

As an antidote to depression hysterics, I strongly recommend “The Age of Depression,” by Allan Horwitz and Jerome Wakefield in the penultimate edition of the Public Interest.

After examining the epidemiological numbers, they write:

No plausible theory of depressive disorder, whether genetic, psychological, or social, can explain why rates of depression would have increased so much in such a short period of time. Instead, the explanation appears to lie in changes in the ways that physicians, mental-health professionals, and people themselves characterize and diagnose their mental states. There are, and always have been, true depressive disorders, in which the response to loss goes awry and takes on a debilitating life of its own. But in the past, such disorders were distinguished from normal sadness that arises in response to life’s vicissitudes. That traditional, common-sense distinction has broken down in contemporary psychiatry, resulting in the conflation of depressive disorders with normal sadness. The sources and social implications of this breakdown are as yet largely unappreciated. [emphasis added]

Horwitz and Wakfield provide a fascinating history of depression through the ages and an extremely illuminating account of how theory wars over the DSM categories led to an overly inclusive “theory neutral” clinical conception of depression.

Valuable points, all, but I think Will is still being too forgiving of the initial proposition that there could be anything "scientific" about subjective, normative evaluations of revealed behavior.

Horwitz and Wakefield draw a line in the sand between the historic contextual conception of melancholy, which distinguished between sadness "with or without cause," and the modern diagnostic tools of the DSM-4 that look only at symptoms. But both still essentially posit a "disorder" for which no discernable and corresponding abnormal pathology of the brain or body can be identified.

Perhaps depressive behavior is a manifest symptom of disease, which we'd normally say is caused either by a bug (virus or bacterium) or from misfiring of some physical system due to damage from either external sources (say, exposure to carcinogens, or simply too much ingested cholesterol) or internal ones (such as genetic abnormality.) Neuroscience seeks out the answers to these questions, but it still has a long way to go. The psychiatric profession, by and large, pretends the questions don't matter.

But without those answers, it seems to me no less capricious and arbitrary to hinge diagnosis of a presumed "depressive disorder" on whether a person appears to have a "good" reason to display sadness, than simply whether that display exists at all. Actually, presuming there might be asymptomatic manifestations of "depressive disorder" -- a presumption applied to most medical disorders, but rarely pondered by psychiatry -- how could one conclude that a person who otherwise appears perfectly cheerful isn't actually similarly afflicted?

For that matter, without an identified bug we could point to definitively as cause the depressive behavior, who is to say that Prozac is any more effective a treatment to alleviate its effects than whiskey and wine, those time-honored lubricants for smoothing life's more jagged edges?