Understanding Sadness vs. Depression: Insights from Therapy
Feeling sad, discouraged, lonely, or emotionally drained is part of being human. Yet in modern culture, it can sometimes feel as though every difficult emotion is quickly labeled as a mental health disorder. If you're struggling after a breakup, grieving a loss, feeling overwhelmed at work, or navigating a life transition, you may wonder: Is this normal sadness, or am I depressed?
A thought-provoking study by Christian Bröer and Broos Besseling (2017) explored how ordinary people make sense of low mood in everyday life. Their findings challenge the assumption that sadness is automatically viewed as a medical problem and offer valuable insights for therapists helping clients understand their emotional experiences.
The Growing Question of Medicalization
Bröer and Besseling examined a concept known as medicalization—the process by which ordinary human experiences become understood and treated as medical conditions. They investigated whether people routinely interpret low mood as clinical depression in everyday conversations. Their study analyzed 316 observations of naturally occurring interactions in the Netherlands in which people discussed feeling down, discouraged, lonely, or emotionally distressed.
The researchers found something surprising: although the language of depression was widely recognized, people did not automatically medicalize feelings of sadness. Instead, many individuals actively searched for personal, relational, and situational explanations for their emotional struggles.
In other words, most people still distinguish between life's hardships and mental illness.
Not Every Low Mood Is Depression
One of the study's most important findings is that people frequently "de-medicalized" low mood. When discussing sadness, they often connected it to understandable life circumstances such as:
Relationship difficulties
Family conflict
Work stress
Loneliness
Life transitions
Disappointment or loss
Rather than immediately concluding that someone had a mental disorder, many conversations focused on understanding the context of the emotional experience.
This distinction is important in therapy. Emotional pain often serves a psychological purpose. Sadness can signal loss. Anxiety can signal uncertainty or threat. Grief can reflect love and attachment. Difficult emotions are not always symptoms to eliminate; sometimes they are experiences to understand.
How Therapy Helps Differentiate Sadness From Depression
A common fear among clients is that feeling persistently sad means something is fundamentally wrong with them.
Therapy often begins by exploring questions such as:
What happened before these feelings emerged?
Are these emotions connected to specific events or losses?
How long have they been present?
How much are they affecting daily functioning?
Are there signs of clinical depression beyond sadness alone?
A therapist's role is not simply to diagnose but to help clients make sense of their experiences.
Bröer and Besseling's findings suggest that people naturally engage in this process of sense-making when confronted with low mood. Therapy provides a more structured and supportive environment for that same exploration.
The Pressure to Be Happy
Another key insight from the study is the influence of cultural expectations. The researchers found that social norms emphasizing happiness, productivity, and active citizenship were highly visible in conversations about low mood. People often felt pressure to "get back to normal," be productive, and maintain a positive outlook.
This pressure can create an additional layer of suffering.
Many therapy clients express concerns such as:
"I should be over this by now."
"Everyone else seems happy."
"I shouldn't feel this way."
"Something must be wrong with me."
Therapy can help challenge these assumptions and create space for emotional experiences that are normal responses to difficult circumstances.
Sometimes the goal is not to stop feeling sad but to stop judging ourselves for feeling sad.
When Sadness Becomes Depression
Recognizing that sadness is normal does not mean depression is not real.
Clinical depression typically involves more than temporary sadness. It may include:
Persistent low mood
Loss of interest or pleasure
Feelings of hopelessness
Significant changes in sleep or appetite
Difficulty concentrating
Fatigue
Thoughts of death or suicide
When symptoms become persistent, severe, and interfere with daily functioning, professional support is important.
Therapy helps identify whether someone is experiencing a natural emotional response to life events, a depressive disorder, or a combination of both.
Relationships Matter
One of the study's most interesting findings was that relationship conflicts were particularly likely to trigger discussions that framed low mood in medical terms. The authors found that concerns involving partners, friends, and family members often increased the likelihood that emotional struggles would be viewed through the lens of depression.
This finding highlights something therapists have long recognized: relationships profoundly affect mental health.
Many clients enter therapy believing their distress is solely an internal problem when, in reality, unresolved relational stress may be a major contributor. Exploring communication patterns, attachment histories, interpersonal boundaries, and social support often reveals important pieces of the emotional puzzle.
Moving Beyond Labels
Perhaps the most valuable takeaway from Bröer and Besseling's research is that human emotional suffering is complex.
The study found that everyday understandings of low mood were characterized by uncertainty, nuance, and multiple explanations rather than automatic medical labeling. People often moved between psychological, social, relational, and medical interpretations of their experiences.
Effective therapy embraces that complexity.
A diagnosis can sometimes provide clarity and access to treatment. But therapy is also about understanding the person's story, circumstances, relationships, and values, not just their symptoms.
A More Compassionate Perspective
In a culture that often demands constant happiness, sadness can feel like failure. Yet emotional pain is often a natural response to life's challenges.
Therapy invites a different question.
Instead of asking, "How do I stop feeling this way?" we might begin with, "What is this feeling trying to tell me?"
Sometimes the answer reveals a depressive disorder that deserves treatment. Other times, it reveals grief, loneliness, disappointment, burnout, or a need for connection and change.
Either way, understanding the meaning behind our emotions is often the first step toward healing. ThinkSpot Therapy’s therapists will work with you in collaborative and personalized individual counseling to help you do just that.
Reach out or schedule your first appointment here. We’re here to help.
References
Bröer, C., & Besseling, B. (2017). Sadness or depression: Making sense of low mood and the medicalization of everyday life. Social Science & Medicine, 183, 28–36. https://doi.org/10.1016/j.socscimed.2017.04.025
Conrad, P. (2007). The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Johns Hopkins University Press.
Horwitz, A. V., & Wakefield, J. C. (2007). The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford University Press.
Durà-Vilà, G., Littlewood, R., & Leavey, G. (2013). Depression and the medicalization of sadness: Conceptualization and recommended help-seeking. International Journal of Social Psychiatry, 59(2), 165–175.