- Hardcover: 312 pages
- Publisher: Oxford University Press; 1 edition (June 18, 2007)
- Language: English
- ISBN-10: 0195313046
- ISBN-13: 978-0195313048
- Product Dimensions: 9.3 x 0.8 x 6.3 inches
- Shipping Weight: 1.2 pounds (View shipping rates and policies)
- Average Customer Review: 19 customer reviews
- Amazon Best Sellers Rank: #1,234,910 in Books (See Top 100 in Books)
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The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder 1st Edition
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"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
"This thought-provoking book challenges us to examine and re-examine our conceptions of normal sadness and depression. It makes an important contribution to the field and provides a powerful impact on the reader."--Families in Society: The Journal of Contemporary Social Services
"The Loss of Sadness may well be a wake-up call for North American psychiatrists."--History of Psychiatry
"The issue identified by the authors--increase of pathologising and prescribing--is serious and current; and they make clear one key possible diagnosis, that the limits of pathology are being illegitimately stretched. The authors are expert in this position and their book is essential reading for anyone concerned with these problems."--British Journal of Pyschiatry
"...[a] provocative and well-written book...impressively documented and meticulous detail..The result is often eye-opening and enlightening...."--Social Service Review
"...an iconoclastic yet careful, balanced, and scholarly work, which through sheer logic and force of argument compellingly challenges commonly accepted wisdom in all corners of the mental health world: research, epidemiology, public policy, prevention, diagnosis, treatment, and even university mental health...Read it--it will make you think about your profession, your practice, and your society."--As reviewed by Steven P. Gilbert, PhD, ABPP, LP, Minnesota State University Mankato in Journal of College Student Psychotherapy
"Finally, a book about anxiety disorders that is based on a deep understanding of normal anxiety! I wish every mental health clinician would read it. Its spectacularly clear prose reveals the landscape of normal anxiety like an airplane's radar reveals the ground beneath the fog." -- Randolph M. Nesse, MD, Department of Psychiatry, The University of Michigan, Ann Arbor, MI
"The area of anxiety disorders has needed a thorough review and a shake-up for a long time. In this bold and thought-provoking work, Allan Horwitz and Jerome Wakefield have relied mainly on the insights from the evolutionary theory to provide a critical and powerful analysis of the modern concept of anxiety disorders. Regardless of whether or to what extent one agrees with them, their book rightly challenges the prevailing notions and is likely to perturb current thinking about fear, anxiety and anxiety disorders. It will certainly add more substance to much-needed discussions and debates about the nature of these conditions, psychiatric diagnoses and an often-imperceptible boundary between normality and psychopathology." -- Vladan Starcevic, MD, PhD, Department of Psychiatry, Sydney Medical School, University of Sydney, Australia
"In their new book, Horwitz and Wakefield offer the same incisive analysis that they brought to psychiatry's medicalization of sadness in their first book, The Loss of Sadness, to explain the reasons for the soaring prevalence of anxiety disorders over the past 20 years, namely that psychiatry has been mislabeling normal anxiety and fear reactions as disorder. Most importantly, they bring their analysis to bear on the actual definitions of anxiety disorders that are enshrined in the American Psychiatric Association's manual of mental disorders, pointing out the various weaknesses and flaws with regard to construction of definitions of anxiety disorders that effectively delineate normal anxiety and fear from abnormal anxiety and fear." -- Michael B. First, MD, Department of Psychiatry, Columbia University, New York, NY
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.
Top customer reviews
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.
The authors have been very scholarly in addressing the majority of angles involved in this important debate about the boundaries between normal sadness (or expectable responses to adversity) and major depression. They insightfully expose many flaws in currently accepted ideas about the topic. All of this opens up thinking about these matters in potentially very important ways for understanding what "depression" represents in our current society.
Why I say "the majority of angles" is that I wish that they would delve more deeply into why some people who face terribly stressful conditions become "clinically depressed," whereas others who face similar conditions are better characterized as more benignly suffering from non-pathological "sadness." As I understand the authors' arguments, my question is why do some people under major stress become clinically depressed and incapacitated, whereas others under similar circumstances are understandably distressed, but not psychopathologically incapacitated? This, I think, is an important crux in the argument and a dividing line that needs a deeper probing.
Other than that (and my guess is that I am one of the few in the universe troubled by this), the book is an excellent and thorough treatise on a controversial and very important topic. After all, most surveys suggest that depression is one of the most incapacitating disorders world-wide. This volume contributes to a broader understanding of why this contemporary "fact" is so influential, and implicates both strengths and weaknesses in current understandings of the matter.
It's a position that cannot be ignored, but could be developed further.
- Can psychiatric diagnoses be done reliably? That is, can those diagnoses be
- Can psychiatric diagnoses be valid? That is, does a psychiatric diagnosis of a
particular disorder identify an underlying cause or something that can be treated.
- Are we, for example in the U.S. or in the U.K. over-diagnosing depressive disorder or
abnormal sadness? Are we labeling the normal sadness that someone exhibits after a loss
or setback as a disorder, as something that needs treatment, even as something that
calls for medication?
Horwitz and Wakefield go into much detail explaining why and how they think the
over-diagnosis of abnormal sadness has occurred. Some of the causes they suggest are: (1)
During the revision process that created DSM-III, there was a heavy emphasis on
identifying and listing *symptoms* that could be used to determine whether a person has a
psychiatric disorder or ailment and which particular disorder that person has. But, that
emphasis on symptoms leads, Horwitz and Wakefield contend, to ignoring underlying causes,
i.e. to ignoring what Horwitz and Wakefield call etiology. And, because we ignore causes,
we label the sadness that is an appropriate response as a disorder. (2) The social
sciences have encouraged us to have attitudes of cultural relativism. And, because some
cultures tolerate and label as normal or even admirable different levels of sadness, we
are led to feel that it's up to us to decide how much and what level and what length of
time is normal or abnormal for sadness. In other words, we can label as normal or as
abnormal any level of sadness that we choose. (3) And, of course there is the
possibility, Horwitz and Wakefield suggest, that the medical insurance providers and the
pharmaceutical industry have encouraged or discouraged the diagnosis of more or less
sadness as being in need of treatment and medication because it is in their (insurance and
pharmaceuticals) financial interest to do so.
Horwitz and Wakefield worry about an "over expansive" definition of sadness, one that
labels too many people as ill, dysfunctional, and in need of treatment.
What if, instead of talking about illness, dysfunction, and disorder, we talk about those
who want help and guidance to make their lives better and (since we are discussing
We have to ask ourselves who is helped and who is harmed by the use of symptom-based
criteria to label individuals depressed and suffering from disorder? I'm less worried
when we are talking about those who are seeking help; I'm more worried when people are
diagnosed as disordered and in need of treatment whether they want it or not. However,
this is *not* a simple issue. There are those in our society who resist taking their
psychotropic medications, often for real reasons (e.g. because of their side-effects), but
when they do, they become harmful and even dangerous to themselves and to those around
them. It's because of situations like this that we need Horwitz and Wakefield to remind
us about and make us think through the issues surrounding psychiatric diagnoses.
What about those of us who may not be abnormally sad and to whom it is not accurate to say
that they have a depressive disorder, but who are consistently sad and down. Someone who
suffers from long-term unhappiness with no apparent cause deserves help. Perhaps their
unhappiness does not lead them to suicide or even less harmful actions, but many of us
feel that they also need help. Some of these may try to improve their mood through the
use of medication, some might drink alcohol, some might even turn to religion. I'm one of
those who feels that any of these can be helpful, and any of them can be damaging.
Perhaps, a diagnosis of sadness or depression can, in some cases, be helpful, if it leads
to awareness, and can, in some cases, be harmful, if it leads to over use of medication,
to abuse of alcohol or other drugs, to fanatical religion, etc.
Many of us want happiness of some form or another. In the U.S., the right to "the pursuit
of happiness" is even written into our "Declaration of Independence". So, why would we
not want to be able to avoid sadness and seek happiness in a variety of different ways. I
suspect that Horwitz and Wakefield would not object to that, but would object to
encouraging any of us to do so without awareness, without consideration of the
consequences and alternatives, and without addressing possible real causes of that
One worry is over-medication. But, is that worry any greater than concerns about the
excessive use of drugs, alcohol, caffeine, etc? Maybe what we need to get used to and to
remember is that the use of drugs is always in need of caution, whether those drugs have
the approval of a psychiatric professional or not. And, it should be obvious that
prescribing psychotropic drugs to children is about as close to legally giving alcohol to
minors as you can get. As always, powerful drugs means the power to do much harm.
Horwitz and Wakefield have a definite stand on whether we over-diagnose sadness as a
disorder: they believe we do diagnose too many people as having a depressive disorder of
some kind and they argue strong and long for that position. Those arguments are very
informative and well thought out. You may agree or disagree with those arguments. But,
in either case, you will find much in this book to inform and help with your own thinking
about sadness and depression in particular, and psychiatry and psychology and mental
disorder in general.
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