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

By Allan V. Horwitz; Jerome C. Wakefield | Go to book overview
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The Failure of the Social Sciences to Distinguish
Sadness From Depressive Disorder

The field of psychiatry does not exist in a vacuum; it depends on other disciplines for much of the intellectual underpinnings of its clinical theory. One might thus expect that disciplines such as anthropology and sociology should be in good positions to help correct the confusion in psychiatric nosology about the distinction between depressive disorder and normal intense sadness. Anthropologists could identify universal emotional mechanisms that are part of human nature and elaborate the cultural variations in their expression, and they could pinpoint when these normal variations lead to mistaken labeling of disorder. Sociologists could demonstrate how stressful social arrangements often produce nondisordered sadness, which can sometimes be severe enough to meet DSM criteria, and could distinguish between the study of normal emotional responses to social stress and the study of mental disorder.

In fact, however, rather than offering the grounds for a critique of psychiatry+U0027s conflation of normal sadness and disorder, these disciplines have functioned as [enablers] of psychiatry+U0027s overinclusive definitions of disorder by themselves failing to draw the appropriate distinctions within their disciplinary domains. Anthropologists focus on the presumed cultural relativity of definitions of sadness and disorder, claiming that no definitions of these conditions are possible outside of each culture+U0027s particular value system. Sociologists interchangeably use concepts of distress and disorder without separating the two. This chapter examines how the failure of these disciplines to adequately distinguish ordinary sadness from depressive disorder has not only abandoned psychiatry to its conceptual challenges but has also caused these disciplines to descend into confusion in their own research.

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