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The Loss of Sadness
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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-forexample, 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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Table of Contents

1. The concept of depression ; 2. The anatomy of normal sadness ; 3. Sadness with and without cause: depression from ancient times through the nineteenth century ; 4. Depression in the twentieth century ; 5. Depression in the DSM-IV ; 6. Importing pathology into the community ; 7. The surveillance of sadness ; 8. The DSM and biological research about depression ; 9. The rise of antidepressant drug treatments ; 10. The failure of the social sciences to distinguish sadness from depressive disorder ; 11. Conclusion

About the Author

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.

Reviews

...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

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