Depression
Resources

 email page    print page

All Topic Reviews
A Mood ApartA Sadly Troubled HistoryActive Treatment of DepressionAdolescent DepressionAdult Bipolar DisordersAgainst DepressionAgents in My BrainAmerican ManiaAmerican MelancholyAn Unquiet MindArtificial HappinessBeating the BluesBefore ProzacBeyond BlueBiological UnhappinessBipolar DisorderBipolar Disorder DemystifiedBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar ExpeditionsBlaming the BrainBoy InterruptedBritain on the CouchCalm EnergyCase Studies in DepressionChange Your ThinkingChronic DepressionComprehending SuicideConquering Postpartum DepressionConquering the Beast WithinCry Depression, Celebrate RecoveryDamageDepressionDepression 101Depression and GlobalizationDepression and NarrativeDepression Doesn't Always Have to Be DepressingDepression FalloutDepression in ContextDepression Is a ChoiceDepression SourcebookDepression, Emotion and the SelfDepression, the Mood DiseaseDepression-Free for LifeDetourDiagnostic Issues in Depression and Generalized Anxiety DisorderDown Came the RainDowning Street BluesDysthymia and the Spectrum of Chronic DepressionsEight Stories UpElectroboyElectroshockEssential Psychopharmacology of Depression and Bipolar DisorderExperiences of DepressionFacing BipolarFast GirlFatal AttachmentsGetting Your Life BackGod HeadHandbook of DepressionHandbook of DepressionHello to All ThatHelping Students Overcome Depression and AnxietyHow Everyone Became DepressedHow I Stayed Alive When My Brain Was Trying to Kill MeHurry Down SunshineI am Not Sick I Don't Need Help!Journeys with the Black DogLeaving YouLet Them Eat ProzacLife InterruptedLifeForce Yoga to Beat the Blues--Level 1LifeForce Yoga to Beat the Blues: Level 2Lifting DepressionLifting the WeightLincoln's MelancholyLiving Without Depression and Manic DepressionLong ShotLucy Sullivan Is Getting MarriedMadnessMaking Sense of SuicideMalignant SadnessManiaManicManic DepressionManufacturing DepressionMelancholiaMindfulness for Urban Depression: Tools for Relief from Stressful City LivingMindfulness-Based Cognitive Therapy for DepressionMood GenesMoody Minds DistemperedMy DepressionNatural Healing for DepressionNew Hope for Children and Teens with Bipolar DisorderNew Hope For People With Bipolar DisorderNew Hope for People with DepressionNight Falls FastNovember of the SoulOn DepressionOn the Edge of DarknessOne in ThirteenOrdinarily WellOut of the BlueOutsmarting DepressionOvercoming DepressionPerfect ChaosPotatoes Not ProzacProzac and the New AntidepressantsProzac BacklashProzac HighwayProzac NationProzac NationPsychotic DepressionPuppy Chow Is Better Than ProzacQuiet Your Mind & Get to SleepRaising a Moody ChildReasons to Stay AliveScattershotSelf-CoachingSightlinesSilencing the Self Across CulturesSilent GriefSongs from the Black ChairSongs Without WordsSpeaking of SadnessSpontaneous HappinessStudent DepressionSubordination and DefeatSuicidal Behavior in Children and AdolescentsSuicideSunbathing in the RainSurvival Strategies for Parenting Children with Bipolar DisorderSurviving Manic DepressionSwing LowSylvia Plath ReadsTalking Back to ProzacTaming Your Inner BratThe Aesthetics of DisengagementThe American Psychiatric Publishing Textbook of Mood DisordersThe Anatomy of MelancholyThe Anti-Depressant Fact BookThe Antidepressant EraThe Antidepressant SolutionThe Antidepressant Survival ProgramThe BeastThe Bell JarThe Best AwfulThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Blue Day BookThe Breakthrough Depression SolutionThe Clinical Science of Suicide PreventionThe CorrectionsThe Cruelty of DepressionThe Depressed ChildThe Depression CureThe Depression WorkbookThe Devil WithinThe Emotional RevolutionThe Family SilverThe Feeling Good HandbookThe Forgotten MournersThe Loss of SadnessThe Memory of LightThe Mindful Way through DepressionThe Mood CureThe Myth of Depression as DiseaseThe Naked Bird WatcherThe Nature of MelancholyThe Noonday DemonThe Pits and the PendulumThe Postpartum EffectThe Secret Strength of DepressionThe Van Gogh BluesThe Van Gogh BluesThe Weariness of the SelfThe Years of Silence are PastThirteen Reasons WhyThis Close to HappyTo Walk on EggshellsTreatment for Chronic DepressionUndercurrentsUnderstanding DepressionUnderstanding DepressionUndoing DepressionUnhappy TeenagersUnholy GhostUnstuckViniyoga Therapy for DepressionWhat Goes UpWhat the Birds SeeWhat Works for Bipolar KidsWhen a Parent is DepressedWhen Nothing Matters AnymoreWhen Someone You Love Is DepressedWhen Words Are Not EnoughWhen Your Body Gets the BluesWhere the Roots Reach for WaterWhy Are You So Sad?Why People Die by SuicideWill's ChoiceWriting Through the DarknessYou Are Not AloneZelda

Related Topics
The Loss of SadnessReview - The Loss of Sadness
How Psychiatry Transformed Normal Sorrrow into Depressive Disorder
by Allan V. Horwitz and Jerome C. Wakefield
Oxford University Press, 2007
Review by Ian Jakobi
Oct 16th 2007 (Volume 11, Issue 42)

In this book Horwitz and Wakefield have brought to light a central problem with the way that American psychiatrists think about depression. The problem, the authors claim, is that psychiatry, and the social sciences which apply psychiatry to non-medical populations, has lost sight of the fact that sadness can be a normal response to adverse situations. Certain events--the break-up of marriage, a failed career, the death of a loved one--often result in a condition that is very similar to that caused by a mental disorder (in this case, depression). However, such responses can be perfectly normal and there is a case to be made that instances of what Freud called 'ordinary human misery' should not be confused with real mental disorder. It is this line of argument which Horwitz and Wakefield seek to elucidate.

The authors start the book by setting out a distinction between 'normal sadness' and 'genuine depressive disorder', arguing that the latter must be separated from the former in order to allow the development of psychiatry as a scientific enterprise. This distinction is brought to light by an examination of sadness in other cultures and times. Whether it be in our own (that is Western) culture a few decades ago, or the Ancient Greek civilization, we can see that sadness has traditionally been viewed as falling into two categories: the appropriate and the diseased. The next stage in their argument is to see how the former has dissolved into the latter in contemporary American psychiatry. To do this the authors chart the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a book often referred to as the "psychiatric Bible".

The DSM lists all the mental disorders that are currently recognized by American psychiatry. Each category--depression, schizophrenia, anorexia nervosa et al.--comes with a "Chinese menu" style symptom list that the psychiatrist can use to check off the patient's problems: 'depressed mood', 'change in appetite', 'loss of pleasure', etc.  Horwitz and Wakefield argue it is this very system, which is entirely focused on symptoms and not causes, that is responsible for the loss of sadness. They also note the irony that this same system was introduce into the DSM in order to save psychiatry from the anti-psychiatry movement of the 1960s that, in part, lambasted psychiatry for not making consistent diagnostic decisions (i.e. failing to always diagnose depression given the same set of symptoms). The problem now is not whether psychiatrists can call a set of symptoms 'depression' but whether what they call depression is really a mental disorder.

The problems Horwitz and Wakefield detect in psychiatry are not restricted to the inpatient psychiatric hospital wards. Indeed, the second part of the book shows, in depth, the movement of psychiatry out of the clinic and into the community. It is the increasing use of 'screening programs' based on the DSM criteria, which are designed to spot potential cases of mental disorder as well as untreated cases, in our schools and other 'nonclinical' settings that make the issues Horwitz and Wakefield raise pertinent to one-and-all. Perhaps this is the more important part of The Loss of Sadness. The irony is that the great project to renew and revive the DSM in 1980, which the authors do discuss, was aimed to undo the wrongs of post-war psychiatry that maintained the large majority of people suffered from mental illness. The problem with this claim was that it fuelled the anti-psychiatry movement's fire; people rebelled against the charge they were ill, no matter what the psychiatrist thought. The DSM tackled this fear of 'over-medicalization' by narrowing the remit of psychiatry to only those presenting themselves as in need of treatment. But through lower threshold for symptom detection in the new screening program, we are risking repeating this past mistake.

To solve this problem, Horwitz and Wakefield argue that there should be a refocus on the distinction between 'normal sadness' and 'genuine depressive disorder' via two amendments of the DSM. Firstly, when sadness is in response to an event and is seen as an appropriate response, diagnosis should be withheld (this is already the case with bereavement). Secondly, diagnosis should only be applied in cases where there is an 'evolutionary dysfunction'. Unfortunately, one weakness of The Loss of Sadness is that it fails to make a cogent argument for the second of these amendments. Indeed, one will have to go and look at Wakefield's other work to fully understand the reasoning behind the move from a clinician's diagnosis to the dysfunction of an evolutionary mechanism.

Part of the reason for the appearance of this book is surely that the DSM is currently going through a process that will lead to the production of its fifth edition, and the American Psychiatric Association has said that it is looking at how the definition of mental disorder could, or should, be changed. And that is of course exactly what The Loss of Sadness is about: how should we define depression qua mental disorder. Like Horwitz and Wakefield, the APA are also concerned something isn't right with the DSM, and in particular they note that the rise of screening programs is leading to a growing concern in the general population that 'normal' experience is being medicalized. This is such an obvious case of the past repeating itself that more attention could have been paid to it in Horwitz and Wakefield's analysis to make the link clearer.

Overall this book is written in an accessible style and works as a powerful critique of modern American psychiatry (and since much of the world follows the APA's lead its importance is even more encompassing). The arguments found in The Loss of Sadness will make anyone who listens think about how psychiatry, as well as society at large, is dealing with the phenomenon of sadness.

© 2007 Ian Jakobi

Ian Jakobi (ian.jakobi@googlemail.com) after undergraduate studies in psychology has recently completed a postgraduate course in the philosophy of mental disorder at King's College London and is seeking to extend his studies in the philosophy and history of psychiatry.


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7800 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716