Customer Reviews

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

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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.

If you read psychiatric books, this one is excellent (though very academic and clinical), as it discusses subject matter that has been hotly debated for the last decade regarding what the disorder called depression really is, and if it needs to be treated so extremely with antidepressant medications, longterm therapy, etc.

Primarily, this book is written by two very thoughtful professionals who have dedicated their lives to the helping professions, but do not want to see every human thought, feeling and emotion turn into an over-treated disease, disorder or condition. Some mood swings and emotional adjustments are simply normal reactions to life, aren't they?

A must for anyone in any mental health-related field, but you know what? I recommend this book to everyone, it's just that well written. Horwitz and Wakefield use arguments from anti-psychiatry, social constructionism, cultural relativism, evolutionary psychology and the interpretation of empirical research to uphold that psychiatry no longer differentiates between normal responses and pathological ones. The topic is extremely interesting and it is developed in a surprisingly easy to understand manner.

Why are so many people in this country seemingly suffering from depression and why are anti-depressants one of the biggest selling drugs? The answer, according to the authors of The Loss of Sadness is that the definition of depression has been set in such a way that many more people than should will be diagnosed as suffering from depression. What's so bad about that? For one, people will be medicated who are not suffering from depression but appropriately responding to a life circumstance, like the loss of a job or the breakup of a romantic relationship. The problem is that reaction to these life events will express the same symptoms as those delineated in the latest version of the mental health diagnostic manual, the DSM. Second, a false measure on the true extent of depression will shift resources to where they are not truly needed. Third, there is the philosophical issue, not directly addressed by the authors, of what persistent medicalization against life's unwanted but unavoidable circumstances does to us as human beings.

Authors Wakefield and Horwitz show how normal sadness was always understood as a natural response to certain types of life events, and that abnormal responses were always differentiated as such. The latter was seen as a type of condition that was without context or out of proportion to the event in question. The effort to focus on symptoms at the exclusion of context was partly driven by the mental health profession's desire to systematize diagnosis, thereby making it more likely that psychiatrists or general practitioners would arrive at the same diagnosis given the same symptoms. Unfortunately the human mind is not so submissive to external labeling, and this cookie cutter approach was bound to identify a great number of false negatives. This Wakefield and Horwitz show as they expose the biased results of community surveys, particularly those of adolescents, whose lives and mindsets can fluctuate in mood almost daily, depending on where they are on the "cool" scale.

Now that so-called Big Pharma is a major player in the Name the Disease Game, it seems virtually impossible that the mental health profession will reverse on this issue. Nevertheless, as the next version of the DSM is revised (due out in 2011), Wakefield and Horwitz urge their mental health colleagues to consider reuniting context with symptoms so as to revive the traditional distinction between normal sadness and true depression.

This is a great read on the history of how depression came to be defined the way it is today. In particular, it sheds light on how the wrong premises can lead to faulty conclusions and to misguided public policy. In how many other fields could this exist?

When is Depression not depression, but a normal reaction to a sad circumstance?
A diagnosis of a stab wound is clear cut. A diagnosis of a broken limb, diabetes or cancer is confirmed by radiographic studies or blood, and other tests.
Psychiatry's tool for making diagnoses are check lists in the latest version of the DSM, which has been revised 5 times since 1952.
The authors contend that the DSM does not have a valid definition of Depression; inflates the diagnosis of Depression and does not differentiate a mental disorder from normal sadness.
"Because of the symptom-based nature of the criteria, any sadness response involving enough of the specified symptoms for at least 2 weeks will be misclassified as a disorder, along with genuine psychiatric disturbances."

A misdiagnosis can be a dangerous thing. I think many patients move into their diagnosis --- even if incorrect--- and live their lives accordingly.

For those of us with the life altering power of diagnosing, and for our patients who put their faith in us, this is a thought provoking book.

I didn't know what to expect when I got this book. Many authors that go against psychiatry or any other conventions of society seem to be ranting extreemists. I was pleasantly suprized because Horwitz made a very balanced and valid argument about how that the diagnostic criteria for Major Depression leads to an overdiagnosis of the disorder. He also made the point that there sometimes is no clear line between normal nondisordered grief and Major Depression Disorder. I highly recommend this book.

I have read from many scientific journals that incidence of depression has increased 5-10 times during the past 100 years. This cannot be true, because a catastrophe is waiting us in less than 50 years - or is it present already? We have two alternatives: either there are many dangerous trends in the western societies or something has changed in explanations of misfortunes and life's problems. Plainly speaking, we are in the middle of ever increasing medicalization. Normal problems of life are now included in diagnostic classifications.

Loss of Sadness makes this all very clear. It is one of the best books I have read lately. The arguments for the main thesis are persuasive: Normal sorrows sufferings and pains of life must not be called depression.

This is a very well written analysis. I read a library copy, now I am going to buy one for my own library!

A tired literary imagination concocting justification for a field best understood as social rather than clinical. The effigy of truth cringes at its pretentious scholarship and bogus science.