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

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Oxford University Press, Jun 18, 2007 - Psychology - 312 pages
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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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I read the review in either TIME or NEWSWEEK mag and it appeared quite good. BUT I was sorely dissapointed. Its like one of those bad textbooks you had in college where you have to read it. But I ... Read full review

The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder

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According to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Assoc., 2000. 4th ed.), widely used by health professionals, a patient is clinically depressed only if he ... Read full review

Contents

1 The Concept of Depression
3
2 The Anatomy of Normal Sadness
27
Depression From Ancient Times Through the Nineteenth Century
53
4 Depression in the Twentieth Century
72
5 Depression in the DSMIV
104
6 Importing Pathology Into the Community
123
7 The Surveillance of Sadness
144
8 The DSM and Biological Research About Depression
165
9 The Rise of Antidepressant Drug Treatments
179
10 The Failure of the Social Sciences to Distinguish Sadness From Depressive Disorder
194
11 Conclusion
212
Notes
227
References
249
Index
281
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About the author (2007)

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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