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Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Print Price: $45.50

Format:
Hardback
312 pp.

ISBN-13:
9780195313048

Publication date:
May 2007

Imprint: OUP US


The Loss of Sadness

How Psychiatry Transformed Normal Sorrow into Depressive Disorder

Allan V. Horwitz and Jerome C. Wakefield

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.

Readership : Broad audience of both specialists and nonspecialists: professionals (mental health professionals--psychiatrists, clinical psychologists, epidemiologists, social workers, sociologists) and educated general readers. This is an academic trade book.

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
  • "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
  • "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
  • "A tightly reasoned, paradigm-shaking new book."--Reason Magazine

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

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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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Special Features

  • A pointed critique of modern psychiatry's approach to major depression, revealing how it has misdiagnosed appropriate feelings of sadness as a mental disorder
  • Well-known authors in the field
  • Controversial, high-profile thesis that depression is largely a made-up phenomenon by the mental health profession, and especially psychiatry. This will likely draw significant review attention in professional journals as well as in high-end mainstream press (NY Times, The New Yorker, etc.)
  • Robert Spitzer, MD, a major name in psychiatry and the leading force behind current psychiatric diagnostic practice, has a provided a foreword endorsing the book's thesis AGAINST the DSM.