Happiness & Public Policy

In the post below I say I’m skeptical of numbers showing an explosion in rates of depression. Here, in part, is why… From yesterday’s New York Times.

About one in four people who appear to be depressed are in fact struggling with the normal mental fallout from a recent emotional blow, like a ruptured marriage, the loss of a job or the collapse of an investment, a new study suggests. To avoid unnecessary diagnoses and stigma, the standard definition of depression should be redrawn to specifically exclude such cases, the authors argue.

The study, appearing today in The Archives of General Psychiatry, is based on survey data from more than 8,000 Americans; it did not analyze the number of people who had been misdiagnosed.

Psychiatrists and other doctors who take careful medical histories do so precisely to rule out such life blows, as well as the effects of physical illnesses, before making a diagnosis of depression.

But the American Psychiatric Association’s diagnostic manual does not specifically exclude people experiencing deep but normal feelings of sadness, unless they are bereaved by the death of a loved one. And an increasing number of school districts and health clinics use simple depression checklists, which do not take context into account, the authors said.

“Larger and larger numbers of people are reporting symptoms on these checklists, and there’s no way to know whether we’re finding normal sadness responses or real depression,” said Jerome C. Wakefield, a professor of social work at New York University and the study’s lead author.

This is big. As I’ve pointed out before, the depression stats and the happiness stats seem to be in conflict. There has been a stable or shrinking percentage of the population in the bottom happiness category despite alleged huge increases in the incidence of depression. This creates a problem for researchers who lean hard on both sets of data, like Diener and Seligman do in their paper “Beyond Money.” Here’s the dialectic as I see it…

If the depression data is right, the happiness data must be broken for failing to detect any increase in the proportion of the population feeling unwell. You would then have to give up on using the happiness data as evidence that many people are not getting happier, since you’ve already established the unreliability of self-reportinng to track important changes in psychological well-being. Now, you could argue that depression and unhappiness are different and statistically unrelated things. But then you need to convince us which one is more important for well-being. If the depression numbers are right, and depression is a huge deal, but has no relationship to unhappiness, then perhaps self-reported happiness and unhappiness are not very relevant to well-being. But then you don’t get to skip back and forth from one set of data to the other, whenever it is convenient to your argument.

You could argue that the happiness data are right, in which case, you’ll have a problem with the depression data. Again, you could distinguish between unhappiness and depression, and argue that they could vary independently. But, again, you’ll have to take a stand on what matters for well-being. Or argue that they are both important, but incommensurable. Alternatively, you could argue that both sets of data have their problems. This is my view. In this case, for the reasons Wakefield and Horwitz lay out, I am more skeptical of the depression data than the happiness data, which I think is likely to be most accurate at picking up changes at the bottom, since bad feelings are more psychologically salient and available than good ones, and therefore more likely to be accurately reported.

My hunch: much depression is misdiagnosed for failing to distinguish between functional sadness and disordered malaise, as above. And much is more or less intentionally misdiagnosed in order to give non-depressed people legal, insurance-covered access to SSRI’s, as Wakefield and Horwitz describe elsewhere. Importantly, SSRI’s really do make people feel better. Since there are far fewer truly depressed people than we think there are, but prescriptions for SSRIs based on bad depression diagnoses continue to rise, increasing rates of diagnosed depression may actually correlate with an improvement in the average tone of experience. O Brave New World!