It is a well-known phenomenon that human beings tend to become more depressed during the winter months. The cold weather, shorter days, and lack of sunshine lend themselves to a worsened mood and less energy. Come springtime when the flowers bloom and the earth seems to come alive again, people tend to feel a renewed sense of purpose and joy.

Like many people, I realized this and decided to move south from the perpetually rainy and overcast Pittsburgh to the warm and sunny state of Florida, where it is endless summer. For millenia, people have probably felt better in the sunshine and warm weather. This is no secret. Not long ago, doctors would prescribe trips to the beach for various ailments.

The entity known as “season affective disorder” was first described in the 1980s by the South African-born psychiatrist Norman E. Rosenthal and colleagues at the National Institute of Mental Health. Initially met with skepticism by the psychiatric profession, the disorder is now generally accepted as a legitimate condition complete with its own treatment protocol, which includes “light therapy” and antidepressant medication. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders reclassified seasonal affective disorder from a unique mood disorder to a subtype of major depressive disorder. Its current nomenclature is “major depressive disorder with seasonal pattern.”

I contend that seasonal affective disorder provides a prime example of medicalization in psychiatry. While of course people can and do become more depressed during the winter months, the claim that this phenomenon represents a medical-psychiatric disease (or “disorder”) is unfounded. The “symptoms” of the condition are real enough; surely, the weather affects human mood. What is problematic is the classification of this phenomenon as disease.

For thousands of years—long before the invention of seasonal affective disorder by psychiatry—human beings have dealt with the winter blues in a variety of ways: sitting by the fire, thoughts of warmer weather, vacations to Florida. As we shall see, the pathologization of winter sadness proves to have many consequences, both for patients and for the psychiatric-pharmaceutical industry.

What happens when the winter blues is converted from normal human experience to psychiatric illness? For one, individuals are led to believe that they are literally ill and in need of medical treatment. The problem here is that seasonal affective disorder—like all psychiatric conditions—has no known biological pathology. Strictly speaking, there is no disease entity to be “treated,” only human emotions, feelings, and perceptions—in short, behavior. The psychiatrist Szasz (1961) asserted that this misclassification of behavior as disease resulted from a basic category error. It is upon this category error that psychiatric medicalization occurs.

Thus, seasonal affective disorder is not something that a person has (in the way a person is said to have cancer or diabetes) but rather a way that a person feels or experiences. Hidden in this seemingly trivial distinction is the essence of medicalization and the great power and weight that it carries.

Inherent in medicalization is a sense of brokenness, helplessness, and dependency. In the case of seasonal depression, the person comes to see himself as suffering at the mercy of neurochemistry, bad genes, or a broken brain—none of which has been validated by any credible evidence.

A second related consequence of the medicalization of winter sadness is the assumption that only medical-psychiatric treatment can alleviate the suffering it causes. Patients are prescribed expensive “light therapy” and profitable antidepressant drugs, meanwhile the true causes of their sadness may go unaddressed. Many patients become more depressed during the winter season not only because of the weather but also because of painful memories associated with the holiday season. Medicalizing this pain discounts its existence. Drugs and light boxes replace conversation and understanding.

The fact that seasonal affective disorder represents perhaps the best example of medicalization in psychiatry has not stopped an entire industry from developing around it. Psychiatrists have built their entire careers on the study and treatment of this medicalized human condition. Costs for light boxes specifically marketed for seasonal affective disorder run into the hundreds of dollars. Antidepressant drugs are routinely prescribed for it, and one has even gained FDA approval specific to seasonal depression.

It is clear that the medicalization of winter sadness has served to be a very profitable endeavor indeed. But the consequences are far-reaching. It is time to see winter depression for what it is: a predictable and widespread reaction to the change in season—not a medical-psychiatric disease.

References

Szasz, T. S. (1961). The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper & Row.