Depression or “Proper Sorrows”—Have Physicians Medicalized Sadness?

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Sir: Most patients who feel “down in the dumps,” “blue,” or depressed will first see their primary care physician—not a psychiatrist. How that family practitioner or general practitioner sees the patient’s complaint—ordinary sadness? major depressive episode?—will have momentous implications for the patient’s health and well-being. Now, in their book The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that “normal sadness . . . has three essential components . . . it is context- specific; it is of roughly proportionate intensity to the provoking loss; and it tends to end about when the loss situation ends . . . ”2(p16)

Prim Care Companion J Clin Psychiatry 2009;11(1):38-39 [letter]