Synopses & Reviews
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.
Review
"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
Review
"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
Review
"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
Review
"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
Review
"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
Review
"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
Review
"The Loss of Sadness comes at a fortuitous time for American psychiatry....This book is a humbling reminder of how much more we need to learn..." Sally Satel, The New Republic (read the entire New Republic review)
Synopsis
There is a widespread perception that depressive disorder is growing at an alarming pace indeed, ten percent of all American adults are said to be afflicted with it, a rate that is disturbingly higher than a generation ago. Now, in
The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that that the increased prevalence of major depression is due not to a genuine rise in mental disease, but to the way that normal human sadness has been "pathologized" since 1980.
Feelings of sorrow, difficulty sleeping, reduced appetite, lack of energy most people realize that symptoms stemming from bereavement, the dissolution of a marriage, the loss of a valued job, or a life-threatening illness are simply signs of normal sadness. But remarkably, as the authors show, the "bible of psychiatry," the Diagnostic and Statistical Manual of Mental Disorders (DSM), defines all these symptoms except in the case of bereavement as grounds for a diagnosis of major depression. The authors argue that this definition, first introduced in 1980, is far too broad yet has influenced virtually everything that has been said and done about the diagnosis ever since. The results have been alarmingly misguided, as various groups in mental health research, advocacy, policy, and industry exploit the DSM definition for their own purposes. For example, the rampant overselling of antidepressants in direct-to-consumer ads in magazines and on television, and in appeals to prescribing clinicians has occurred in part because Big Pharma's marketing of ordinary sadness as a symptom of illness is legitimized by the DSM. What is genuine depressive disorder, the authors ask? Using the new science of evolutionary psychology to distinguish between normal and disordered emotions, they describe how true mental disorders like major depression stem from dysfunctions of naturally selected psychological mechanisms.
A provocative analysis of one of the significant mental health issues of our time, The Loss of Sadness will spark debate for years to come by challenging the very validity of that diagnosis.
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 Spitzer, M.D. Preface
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
5.
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
Endnotes
Bibliography
Index