The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder

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Depression has become the single most commonly treated mental disorder, amid claims that one out of ten Americans suffer from this disorder every year and 25% succumb at some point in their lives. Warnings that depressive disorder is a leading cause of worldwide disability have been accompanied by a massive upsurge in the consumption of antidepressant medication, widespread screening for depression in clinics and schools, and a push to diagnose depression early, on the basis of just a few symptoms, in order to prevent more severe conditions from developing.

In The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that, while depressive disorder certainly exists and can be a devastating condition warranting medical attention, the apparent epidemic in fact reflects the way the psychiatric profession has understood and reclassified normal human sadness as largely an abnormal experience. With the 1980 publication of the landmark third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mental health professionals began diagnosing depression based on symptoms--such as depressed mood, loss of appetite, and fatigue--that lasted for at least two weeks. This system is fundamentally flawed, the authors maintain, because it fails to take into account the context in which the symptoms occur. They stress the importance of distinguishing between abnormal reactions due to internal dysfunction and normal sadness brought on by external circumstances. Under the current DSM classification system, however, this distinction is impossible to make, so the expected emotional distress caused by upsetting events-for example, the loss of a job or the end of a relationship- could lead to a mistaken diagnosis of depressive disorder. Indeed, it is this very mistake that lies at the root of the presumed epidemic of major depression in our midst.

In telling the story behind this phenomenon, the authors draw on the 2,500-year history of writing about depression, including studies in both the medical and social sciences, to demonstrate why the DSM's diagnosis is so flawed. They also explore why it has achieved almost unshakable currency despite its limitations. Framed within an evolutionary account of human health and disease, The Loss of Sadness presents a fascinating dissection of depression as both a normal and disordered human emotion and a sweeping critique of current psychiatric diagnostic practices. The result is a potent challenge to the diagnostic revolution that began almost thirty years ago in psychiatry and a provocative analysis of one of the most significant mental health issues today.

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Editorial Reviews

Doody's Review Service
Reviewer: Brett C. Plyler, M.D.(Northwestern Memorial Hospital)
Description: This book explores the idea that our current concept of depression is flawed because it does not include the context or circumstances in which the depression occurred.
Purpose: The purpose is to demonstrate that human sadness has been misclassified as depression.
Audience: The book is written for both mental health practitioners and lay people.
Features: In their discussion of the flaws in our definition of depression, the authors detail a number of reasons why normal, human sadness has been wrongly included as a depressive illness. They begin with a historical examination of depression versus sadness and proceed forward in time to consider the modern contributors to the misunderstanding of sadness. The authors consider a number of reasons for this, but a few stand out: the DSM and its definition of depression that needs more qualification to distinguish it from sadness more readily; scientific publication on depression that has become an industry unto itself; and the widespread availability of antidepressant medications.
Assessment: This is an interesting and thought provoking book that underscores the need to examine more fully each patient's psychological illness and the factors contributing to it. Though a well trained mental health practitioner should be able to distinguish sadness from depression, the authors do an excellent job of breaking down the flaws in the mental health field, particularly the problems with the DSM, that have led to the sudden explosion of depressive diagnoses over the past 25 years. I would recommend this book to anyone interested in understanding depression more fully and the place normal sadness has in our society.
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Product Details

  • ISBN-13: 9780195313048
  • Publisher: Oxford University Press
  • Publication date: 6/18/2007
  • Edition description: New Edition
  • Pages: 312
  • Product dimensions: 9.30 (w) x 6.30 (h) x 0.80 (d)

Meet the Author

Allan V. Horwitz is Professor of Sociology and Dean of Social and Behavioral Sciences at Rutgers University. He is the author of many articles and a number of books on various aspects on mental illness, including The Social Control of Mental Illness, The Logic of Social Control, and Creating Mental Illness. Jerome C. Wakefield is University Professor and Professor of Social Work at New York University, and he has also taught at the University of Chicago, Columbia University, and Rutgers University. He is an authority on the intersection between philosophy and the mental health professions and the author of many articles on diagnosis of mental disorder.

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Table of Contents

Foreword by Robert Spitzer, M.D.
1. The Concept of Depression
2. The Anatomy of Normal Sadness
3. Sadness With and Without Case: Depression from Ancient Times through the Nineteenth Century
4. Depression in the Twentieth Century
6. Importing Pathology into the Community
7. The Surveillance of Sadness
8. The DSM and Biological Research about Depression
9. The Rise of Antidepressant Drug Treatments
10. The Failure of hte Social Sciences to Distinguish Sadness from Depressive Disorder
11. Conclusion

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Sort by: Showing all of 4 Customer Reviews
  • Anonymous

    Posted April 4, 2008

    Fundamentally Flawed Alright

    This book basically suggests that the field of Psychiatry has mistakenly diagnosed depression and that medications have been prescribed unnecessarily. This is far from the truth. Eighty percent of psychiatric medications are prescribed by family doctors, or PCPs, who do tend to misdiagnos mood disorders. The Diagnostic Manual that mental health professionals use for diagnosing mental health conditions very clearly differentiates Major Depression from Adjustment Disorders, which is a temporary condition that may include sadness, depression, or anxiety. Educated mental health professionals know that symptoms must be present a minimum of 6 months (not 2 weeks as stated in the book) for it to be considered a 'major depression.' Even with major depression, medications are not usually recommended by psychiatrists or other mental health professionals unless symptoms rate moderate to severe and have persisted beyond 6 months. Persistent strong, painful emotions can alter neurochemistry and require medications to readjust the chemistry to a normal balance. It practically takes an act of God, or wealth, to see a psychiatrist these days anyway. Managed Healthcare has attacked the field of psychiatry with a vengance, cutting salaries by almost 50%, so many of the best trained mental health professionals do not accept insurance any longer,or have dropped out of medicine all together. So, those getting diagnosed and prescribed medications by their family doctors, again, 80% of the cases, are often misdiagnosed and improperly treated and most of the time never referred for counseling. Many individuals treated in the primary care office with antidepressants actually recover from the placebo affect, but if they are not given the chance to have therapy, they do not gain any new life skills for the next time crisis strikes. Treated improperly, symptoms may escalate or persist to the point of causing a major or biological depression, which can be disabling.

    1 out of 1 people found this review helpful.

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  • Posted February 15, 2012


    A well researched and well written treatment of the issues. He looks at the history of our human response to this emotion, sadness, and puts things into a broader perspective. A welcome corrective.

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  • Anonymous

    Posted September 17, 2008

    sadness should not be medicalized

    At last! The normal sadnesses life brings are not per se `clinical depression' and can be endured, not easily, but without resorting to medication. Virgil said it all `sunt lacrimae rerum et mentem mortalia tangunt'. This is a necessary and bracing book.

    0 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 5, 2009

    No text was provided for this review.

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