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The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder By Allan V. HorwitzJerome C. Wakefield ( Oxford University Press, USA )
Release Date: 2007-06-18
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Product Description
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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 Depression is not the same as normal sadness ( dianetrachtenberg )
Any psychoanalyst worth-his-salt
will tell you there IS a difference between normal sadness and Depression.
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 A must read for clinical researchers and DSM critics ( pem )
To say I enjoyed this book might be a stretch. There were parts that were laborious because it was like reading a very long journal article on the topic. My effort to get through the book were paid off by how I conceptualize two things - the role of context in classification and the art of criticism without destructive criticism. I will detail both below.
Context: The authors make it clear from the beginning that depression is inappropriately diagnosed these days. Typical behavioral responses to sadness are probably misconstrued as depression. I found that part of the thesis quite compelling. Even more compelling was the fact that the evidence seems to favor their perspective. The point is driven home by anecdotes, data, and theory. I liked the combination because it kept the reader (me) thinking throughout the book.
Criticism: Where I think the authors deserve the most praise is for their delicate and precise criticism of the DSM. They do a remarkable job of detailing the merits of clinical diagnosis while also describing the warts. Unlike most DSM critics who want to throw all classification out, they recognize the importance of mental illness types. I was reminded of Paul Meehl's critique of the antinosological critics (in "Why I don't attend case conferences") while reading this book. These authors did not fall into Meehl's trap. Instead, they offered both sides of the situation and made it clear that their omission of context did nothing to denigrate the DSM specifically. Perhaps they were cautious of the criteria and the application of DSM diagnostic criteria without considering the context and history of the patient.
If you find either point worth reading then buy this book. I plan to make all my graduate students read parts of this book for both points above.
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A vast conspiracy to pathologize and medicate sadness! ( tfarrell43 )
Americans collectively made enormous sacrifices and suffered enormous losses in the effort to emerge as victors in World War II. Perhaps we should have had an official year or more of public mourning to grieve publicly the various losses we collectively suffered as a result of WWII. Unfortunately, we had no such period of public mourning of our losses.
Now, in the half century or so since the end of WWII, American society has apparently turned sick, as vast numbers of Americans have come to consider ordinary experiences of sadness as medical problems that need to be medicated. Evidently, there is a vast conspiracy afoot in American society to pathologize and medicate ordinary sadness. This apparent conspiracy has been advanced enormously by the decontextualized symptoms of Major Depressive Disorder (MDD) listed in the DSM-III (1980) and the DSM-IV-TR (2000), the diagnostic manuals published by the American Psychiatric Association.
Allan V. Horwitz and Jerome C. Wakefield present an excellent critique of the decontextualized criteria for MDD set forth in DSM-III and DSM-IV-TR.
But will their critique lead to any significant reforms in the DSM-V (due out in 2011) or in the field of psychiatry or in our collective social attitudes about experiences of sadness? For experiences of sadness in mourning, for example, to lead to healthy mourning and healing, the mourning persons evidently need to have a properly supportive environment, which means that we collectively need to learn how to play a proper supportive role for people around us who are mourning.
It is hard in our contemporary American culture to argue in favor of suffering sadness when one could take a pill instead and make it go away. But I would raise the following questions: Does the experience of suffering sadness serve a healthy psychological purpose? Is the psyche structured in such a way that suffering experiences of sadness serves a healthy and constructive role for further positive psychological development? Erich Neumann's _The Origins and History of Consciousness_ (original German 1949; English translation 1954) suggests that the psyche is indeed structured in such a way that requires suffering -- and presumably also sadness -- in the service of psychological growth.
Conversely, when we take a medication to make ordinary sadness go away, are we perhaps postponing our reckoning with experiences of sadness until a later time when such experiences may catch up with us?
When we consider stories from ancient cultures, we notice that heroes undergo tests and ordeals that are accompanied by suffering. When we consider the Homeric epic the _Odyssey_, for example, we notice that Odysseus cries rather often, and he is not crying tears of joy, but tears of sorrow and sadness. Ancient stories of heroes prompt the following observations: No suffering, no ordeal. No suffering, no test. No suffering, no growth?
Perhaps we Americans need to reexamine the roles of suffering and sadness as possibly healthy and enhancing experiences. Horwitz and Wakefield have provided us with an excellent discussion of sadness with which to begin such a reexamination.
--Thomas J. Farrell, author of Walter Ong's Contributions to Cultural Studies: The Phenomenology of the Word and I-Thou Communication (Media Ecology)
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