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

by Allan V. Horwitz (Author), Jerome C. Wakefield (Author), Robert L. Spitzer


Editorial Reviews

"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

"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

"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

"This book demonstrates how much a medical discipline can learn from thoughtful
colleagues in the other scientific disciplines (sociology, in this case)...As
Horwitz and Wakefield proclaim, if the DSM-V merely expands on, rather than
amends, its predecessors, the field of psychiatry, to its detriment,will spend
another decade engrossed in a field guide, tolerating thoughtless
therapies."--Paul R. McHugh, New England Journal of Medicine

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.

Product Details

Hardcover: 312 pages
Publisher: Oxford University Press, USA; 1 edition (June 18, 2007)
Language: English
ISBN-10: 0195313046



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