The Recent History of Seasonal Affective Disorder (SAD)

Abstract

Psychiatric diagnosis is controversial and is regarded by some principally as a means of reinforcing the vested interests of medical professionals and pharmaceutical companies. On the other hand, the phenomena that are described in clinical psychiatric practice are real and clearly extend across time and between cultures. ‘In every culture there is some notion of emotional or psychological difference. Not all cultures identify these differences in the same way, nor do they use identical terms. Equally, however no culture is indifferent to those who are sad, frightened or unintelligible in their conduct.’ 1 The description and diagnosis of Seasonal Affective Disorder (SAD) or ‘winter depression’ is a comparatively recent development which provides an unrivalled opportunity to explore the construction of a psychopathological entity through the relevant peer-reviewed publications, as well as the professional and public reaction to these scientific discoveries. This Witness Seminar provides a riveting insight into the thinking of some key protagonists, both the scientists who developed the diagnosis of SAD as well as those for whom this new clinical entity resonated so clearly with their own experiences. What is the point of diagnosis? Ideally a diagnosis should point to a particular disease process, though even in general medicine this is often not the case. However, in a pragmatic sense the value of diagnosis is that it enables a group of people manifesting particular clinical phenomena to be identified as sharing a common prognosis and response to treatment – in the case of SAD a therapeutic response to artificial bright light. Indeed with SAD, it may be that increasing knowledge about the circadian effects of bright light stimulated a search for medical conditions in which it might be effective, that is, in some sense the availability of a treatment led to the identification of the condition. How truly recent is the identification of SAD as a diagnostic entity? In fact, seasonal variation in mood disorder has long been recognized and Rosenthal and colleagues (1984) quote the eminent nineteenth-century psychiatrist, Emil Kraepelin, as commenting in his standard textbook: ‘Repeatedly I saw in these cases moodiness set in in autumn and pass over in spring ... corresponding in a certain sense to the emotional changes which come over even healthy individuals at the changes of the season