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

by Allan V. Horwitz (Author), Jerome C. Wakefield (Author), Robert L. Spitzer (Foreword)
Key Phrases: normal loss responses, loss response mechanisms, normal sadness responses, Major Depression, United States, Major Depressive Disorder (more...)

Editorial Reviews

Review

"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
"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
"A tightly reasoned, paradigm-shaking new book."--Reason Magazine
"This book is highly recommended to any scholar, student, or layperson who is interested in exploring unresolved aspects of psychiatric taxonomy, and especia...

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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Product Details

• Hardcover: 312 pages
• Publisher: Oxford University Press, USA; 1 edition (June 18, 2007)
• Language: English
• ISBN-10: 0195313046
• ISBN-13: 978-0195313048
• Product Dimensions: 9.3 x 6.4 x 0.9 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars See all reviews (6 customer reviews)
• Amazon.com Sales Rank: #58,795 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

43 of 47 people found the following review helpful:

5.0 out of 5 stars A vast conspiracy to pathologize and medicate sadness!, August 25, 2007

By	Thomas J. Farrell (Duluth, MN USA) - See all my reviews (REAL NAME)

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)

19 of 20 people found the following review helpful:

5.0 out of 5 stars A must read for clinical researchers and DSM critics, February 8, 2008

By	Patrick E. Mcknight (Fairfax, VA USA) - See all my reviews (REAL NAME)

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.

5 of 6 people found the following review helpful:

4.0 out of 5 stars The Loss of "Depression", September 11, 2008

By	Daniel Raphael - See all my reviews (REAL NAME)

The authors of this book are primarily speaking to other professionals in the field of psychotherapy, but their argument is presented in an easily accessible, non-jargon manner. Their concern is for the inadequacy of the criteria for diagnosis of people as suffering from depression. They make their argument in the kind of plodding way (review of the literature, beginning with the ancients) familiar to anyone who has been through academia. They consider various qualifying concerns, counterarguments, and so forth. They are reasonably thorough and never commit the literary equivalent of raising their voices. They are, in short, moderate though concerned in their expression.

I hope they are heard, not the least because the DSM IV is in preparation. The DSM (Diagnostic & Statistical Manual) is the de facto Bible of those psychologists and other therapists in the field of mental health, and the authors of the book here under discussion are rightly concerned that the inadequate criteria for defining clinical depression will be adopted wholesale and across the board, in the new version.

With all that said, what I find most striking about this book is its absolute commitment to preserving something that ought not to be accepted: the notion that emotional suffering equates to illness. You don't have to accept the entire postmodern schtick to realize that Foucault is onto something when he points out the historical relativeness of punishment...and like it or not, being labeled with a major mental disorder, is a form of punishment. (If you doubt this, then please read more widely--Elyn Saks's book, The Center Cannot Hold, is a good, contemporary place to start.) The authors want to uphold the disease model and the profession that depends on it. They do a good job of trying to correct one of its more glaring absurdities--absurdities that are, ironically and terribly, paid for by the "patients" who result from the desire to "treat" human suffering as a disease. What they cannot admit is the implicit indictment of the very profession to which they are committed.