Product Description

The Loss of Sadness argues that the increased prevalence of major depressive disorder is due not to a genuine rise in mental disease, but to the way that normal human sadness has been 'pathologised' since 1980. That year saw the publication of the landmark third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which has since become a dominant force behind our current understanding of mental illness overall. As concerns at least major depression, the authors argue that the DSM's definition of the condition is too broad and that as a result virtually all research and clinical approaches to the condition have been based on a flawed understanding about it. The social, political, and scientific implications of this are far-reaching - from the overselling of antidepressants to treat ordinary sadness, as Big Pharma exploits the DSM for its own purposes; to intrusive and expensive depression screening programs at all levels of society, as well-meaning but misguided initiatives translate the DSM into simple terms to catch any whiff of depressive pathology in our midst; and funded research into the 'epidemic' of depression, which advances the field very litttle and the public even less. Ultimately, the definition of depression that is in operation today has formed the basis for an entire system of social control (e.g. community-wide screening initiatives, intrusive public health policy) that benefits psychiatry, primary care providers, and the pharmaceutical and insurance industries by turning everyone else into a potential consumer of services, needed or not. The authors do recognise that depression is a devastating illness that affects some people. Their chief concern is with the use of this diagnosis as a catch-all for anyone who has experienced sadness for more than a few weeks at a time. The result is a pointed yet nuanced critique of modern psychiatry that will stir controversy of the sort that will reacquaint us with sadness as a primary human emotion and that could productively influence the way that depression the actual illness is characterised in the future.

Product Details

• Amazon Sales Rank: #286095 in Books
• Published on: 2007-06-21
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 312 pages

Review
...one of the most important books in the field of psychiatry published in the last few years...a brilliant book with a significance well beyond its narrow but important subject. (Spectator )

This wonderful book will alter professional thinking. (Nursing Standards )

...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...[a good book for] anyone interested in understanding depression more fully and the place normal sadness has in our society. (Doody's Notes )

...[this book] could alter the official definition of depression, change the way we get mood-enhancing drugs, and clarify how effectively our culture delivers well-being. (Reason Magazine )

Allan Horwitz and Jerome Wakefield's important book... is part of a gathering blowback against the pathologisation and medicalisation of the ordinary human condition of sadness after loss... what they do accomplish in critiquing psychiatric diagnosis of depression is important enough to make much of this book required reading for depression researchers and clinicians. (The Lancet )

...a work of deep scholarship... (Hugh Freeman, Times Literary Supplement )

Customer Reviews

FIRST RATE CRITIQUE OF THE MODERN UNDERSTANDING OF CLINICAL DEPRESSION
Written by Allan Horvitz and Jerome Wakefield, both distinguished University Professors working in the USA, 'The Loss of Sadness' is a pointed and persuasively argued critique of the conflation between what the authors describe as on the one hand:- (A) 'normal' sadness/sorrow that arises in reaction to negative events/social stressors in one's life such as relationship difficulties, job losses etc and is in fact a natural response to loss and:- (B) True 'Depressive Disorder' which either has no apparent cause or is grossly disproportionate to the apparent cause and which does not remit when the person's social circumstances change, stressful situations end or simply go away with the passage of time but seems to have 'a life of it's own.'

The authors argue that the Bible of American Psychiatry, the Diagnostic and Statistical Manual (DSM) - which lists all the different mental disorders and sets the specific criteria for their diagnosis - has, since it's revision and major overhaul in 1980, set the stall for this erroneous conflation by dramatically inflating the number of people diagnosed with Depression (and subsequently treated with Anti-Depressants of course) through a simple change in diagnostic criteria that allowed for the first time, and in the name of diagnostic RELIABILITY, a diagnosis of Depression to be made purely on the basis of symptoms alone. In this case five symptoms from a checklist of nine and then solely for a period of two weeks.

The criteria set in place by DSM has one exclusion criteria and that is that the symptoms are not better accounted for by Bereavement, which the authors state is the 'definition's only acknowledgement that some instances of normal intense sadness might satisfy the symptomatic criteria.' The central flaw of the defintion and the central thesis of the book is that the DSM defintion of Depression fails to take into account the context in which the person's symptoms emerged and thus fails to exclude intense sadness, other than in reaction to the death of a loved one, that arises from the way human beings NATURALLY respond to major losses.

The authors therefore argue that: the exclusion criteria should be expanded to take into account of the myriad circumstances other than bereavement that triggers 'normal sadness' and that would be better categorised as social problems/problems of living. The authors emphasise a truly VALID diagnosis of Depression can only be made when the context of the person's life is taken fully into account and thus the tickbox/checklist criteria of DSM is insufficient for it's purpose.

This might just be the most important book written about Depression since Robert Burton's 'Anatomy of Melancholy' and I would urge anyone with an interest in the subject to read it and take note for the implications of their argument are far-reaching. Also recommended reading on a similiar vein is David Healy's 'The Antidepressant Era.'