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

By Allan V. Horwitz; Jerome C. Wakefield | Go to book overview

Foreword

The book you are about to read is a brilliant tour de force of scholarship and analysis from two of our leading thinkers about psychiatric diagnosis and the nature of mental disorders. Allan Horwitz and Jerome Wakefield+U0027s The Loss of Sadness represents the most cogent and compelling [inside] challenge to date to the diagnostic revolution that began almost 30 years ago in the field of psychiatry. The authors begin by arguing for the existence of a universal intuitive understanding that to be human means to naturally react with feelings of sadness to negative events in one+U0027s life. In contrast, when the symptoms of sadness (e.g., sad feelings, difficulty sleeping, inability to concentrate, reduced appetite) have no apparent cause or are grossly disproportionate to the apparent cause, the intuitive understanding is that something important in human functioning has gone wrong, indicating the presence of a depressive disorder. Horwitz and Wakefield then persuasively argue, as the book+U0027s central thesis, that contemporary psychiatry confuses normal sadness with depressive mental disorder because it ignores the relationship of symptoms to the context in which they emerge. The psychiatric diagnosis of Major Depression is based on the assumption that symptoms alone can indicate that there is a disorder; this assumption allows normal responses to stressors to be mischaracterized as symptoms of disorder. The authors demonstrate that this confusion has important implications not only for psychiatry and its patients but also for society in general.

The book+U0027s thesis is of special interest to me, because I was the head of the American Psychiatric Association+U0027s task force that in 1980 created the DSM-III (i.e., the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the Association+U0027s official listing of recognized mental disorders and the criteria by which they are diagnosed). This was the first edition of the Manual to offer explicit symptomatic criteria for the diagnosis of each mental disorder. Now in its fourth edition, the DSM is generally considered to have revolutionized

-vii-

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

Table of contents

  • The Loss of Sadness - A Textbook iii
  • Foreword vii
  • Preface xi
  • Contents xv
  • 1: The Concept of Depression 3
  • 2: The Anatomy of Normal Sadness 27
  • 3: Sadness with and Without Cause 53
  • 4: Depression in the Twentieth Century 72
  • 5: Depression in the Dsm-Iv 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 - Notes 227
  • Reference 249
  • Index 281
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