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

by Allan V. Horwitz, Jerome C. Wakefield

Overview

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.

Product Details

ISBN-13:	9780199921577
Publisher:	Oxford University Press
Publication date:	03/22/2012
Edition description:	Reprint
Pages:	304
Product dimensions:	6.10(w) x 9.20(h) x 0.70(d)

About 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.

Table of Contents

Foreword, by Robert L. Spitzer

1. The Concept of Depression
2. The Anatomy of Normal Sadness
3. Sadness With and Without Cause: Depression From Ancient Times Through the Nineteenth Century
4. Depression in the Twentieth Century
5. Depression in the DSM-IV
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 the Social Sciences to Distinguish Sadness from Depressive Disorder
11. Conclusion

Notes References Index

Editorial Reviews

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.

Doody's Review Service

"Relentless in its logic, Horwitz and Wakefield's book forces one to confront basic issues that cut to the heart of psychiatry. It has caused me to rethink my own position and how the authors' concerns might best be handled. It will shape future discussion and research on depression, and it will be an indispensable guide to those rethinking psychiatric diagnostic criteria in preparation for the DSM-V. [A] watershed in the conceptual development of the field."—from the Foreword by Robert L. Spitzer, M.D., Professor of Psychiatry, New York State Psychiatric Institute, and Head of the Task Forces for the DSM-III and DSM-III-R

"The Loss of Sadness is a tour de force. Horwitz and Wakefield bring much-needed conceptual clarity to the understanding of depression and provide a powerful model for the analysis of all psychological disorders. I predict that it will have a monumental impact."—David M. Buss, Ph.D., Professor of Psychology, University of Texas at Austin, and author of Evolutionary Psychology: The New Science of the Mind

"Drs. Horwitz and Wakefield make a persuasive argument that has major public health implications. Integrating historical, philosophical, and psychological evidence, they have written a comprehensive, incisive, and quite readable book that is sure to challenge psychiatry's notions of what is disorder and what is normal."—Michael B. First, M.D., Professor of Clinical Psychiatry, Columbia University Medical Center, and Editor, DSM-IV-TR

"Depression is the mental health problem of our generation. In this important and penetrating book, Horwitz and Wakefield show that psychiatry no longer clearly differentiates between normal sadness and depressive disorder. A must read for anyone who wants to understand how so much "depression" has become medicalized."—Peter Conrad, Ph.D., Professor of Sociology, Brandeis University, and author of The Medicalization of Society

"With superb scholarship and crisp prose, Horwitz and Wakefield examine the fatal flaw at the core of depression diagnosis. This book describes, with devastating clarity, why the DSM went off track and how the resulting scientific train wreck slows research and distorts our experience of our own sadness. If the DSM was based on biology, this book would signal a new beginning."—Randolph Nesse, M.D., Professor of Psychiatry, University of Michigan, and author of Why We Get Sick: The New Science of Darwinian Medicine

"Not another hackneyed anti-psychiatry polemic, The Loss of Sadness is a brilliant analysis of how mental health professionals can avoid pathologizing normal, emotional responses to life's stressors while accurately identifying those suffering from genuine depressive disorders. Erudite and engagingly written, The Loss of Sadness is destined to have a major impact on our field."—Richard J. McNally, Ph.D., Professor of Psychology, Harvard University, and author of Remembering Trauma

"Excellent scholarship and wonderful writing. Without doubt, this book will stimulate reflection and debate among psychiatrists, epidemiologists, and social and behavioral scientists."—Leonard Pearlin, Ph.D., Department of Sociology, University of Maryland

"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...I would recommend this book to anyone interested in understanding depression more fully and the place normal sadness has in our society."—Doody's

"Allan Horwitz and Jerome Wakefield's important book...is part of a gathering blowback against the pathologization and medicalization of the ordinary human condition of sadness after loss...Important enough to make much of this book required reading for depression researchers and clinicians."—Lancet

"These collaborators maintain a constructive, scholarly tone and display a total command of the pertinent literature, they will gain a respectful hearing from psychiatrists."—New York Review of Books

"This book is highly recommended to any scholar, student, or layperson who is interested in exploring unresolved aspects of psychiatric taxonomy, and especially to any of the scholars currently involved in the DSM-V revisions. This is an important intellectual tour de force that will propel further substantive debate on these critical issues."—PsycCRITIQUES

"Meticulous and timely."—British Medical Journal

"When historians try to understand why psychiatric diagnosis abandoned validity for the sake of reliability in the years surrounding the millennium, they will rely on The Loss of Sadness. In measured tones and exacting prose, Horwitz and Wakefield deliver not only a devastating critique of the DSM diagnostic criteria for depression, but also a thoughtful and authoritative assessment of how they came to exist and persistIf this book cannot change the DSM criteria for depression, nothing will."—Psychiatric Times

"This wonderful book will alter professional thinking."—Nursing Standard

"The Loss of Sadness is one of the most important books in the field of psychiatry published in the last few years...In short, this is a brilliant book with a significance well beyond its narrow but important subject."—Spectator

"The Loss of Sadness is a useful and interesting review of the history of depression and its diagnosis over time...a cautionary tale for those conducting depression research, shaping policy, and developing DSM-V."—Psychiatric Services

"This thought-provoking book challenges us to examine and re-examine our conceptions of normal sadness and depression. It makes an important contribution to the field and provides a powerful impact on the reader."—Families in Society: The Journal of Contemporary Social Services

"The Loss of Sadness may well be a wake-up call for North American psychiatrists."—History of Psychiatry

"The issue identified by the authors—increase of pathologising and prescribing—is serious and current; and they make clear one key possible diagnosis, that the limits of pathology are being illegitimately stretched. The authors are expert in this position and their book is essential reading for anyone concerned with these problems."—British Journal of Pyschiatry

"...[a] provocative and well-written book...impressively documented and meticulous detail..The result is often eye-opening and enlightening...."—Social Service Review

"...an iconoclastic yet careful, balanced, and scholarly work, which through sheer logic and force of argument compellingly challenges commonly accepted wisdom in all corners of the mental health world: research, epidemiology, public policy, prevention, diagnosis, treatment, and even university mental health...Read it—it will make you think about your profession, your practice, and your society."—As reviewed by Steven P. Gilbert, PhD, ABPP, LP, Minnesota State University Mankato in Journal of College Student Psychotherapy

"Finally, a book about anxiety disorders that is based on a deep understanding of normal anxiety! I wish every mental health clinician would read it. Its spectacularly clear prose reveals the landscape of normal anxiety like an airplane's radar reveals the ground beneath the fog." — Randolph M. Nesse, MD, Department of Psychiatry, The University of Michigan, Ann Arbor, MI

"The area of anxiety disorders has needed a thorough review and a shake-up for a long time. In this bold and thought-provoking work, Allan Horwitz and Jerome Wakefield have relied mainly on the insights from the evolutionary theory to provide a critical and powerful analysis of the modern concept of anxiety disorders. Regardless of whether or to what extent one agrees with them, their book rightly challenges the prevailing notions and is likely to perturb current thinking about fear, anxiety and anxiety disorders. It will certainly add more substance to much-needed discussions and debates about the nature of these conditions, psychiatric diagnoses and an often-imperceptible boundary between normality and psychopathology." — Vladan Starcevic, MD, PhD, Department of Psychiatry, Sydney Medical School, University of Sydney, Australia

"In their new book, Horwitz and Wakefield offer the same incisive analysis that they brought to psychiatry's medicalization of sadness in their first book, The Loss of Sadness, to explain the reasons for the soaring prevalence of anxiety disorders over the past 20 years, namely that psychiatry has been mislabeling normal anxiety and fear reactions as disorder. Most importantly, they bring their analysis to bear on the actual definitions of anxiety disorders that are enshrined in the American Psychiatric Association's manual of mental disorders, pointing out the various weaknesses and flaws with regard to construction of definitions of anxiety disorders that effectively delineate normal anxiety and fear from abnormal anxiety and fear." — Michael B. First, MD, Department of Psychiatry, Columbia University, New York, NY

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