The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder . Allan V. Horwitz and Jerome C. Wakefield. New York: Oxford University Press, 2007, 312 pp., $31.95 (hardcover). Beginning with the 1980 publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders ( DSM-III, 3rd ed.), mental health professionals and, consequently, various other disciplines including sociology and journalism used a much more inclusive diagnostic definition of depression. Eschewing both psychodynamic understanding and the contexts of depression, the DSM-III criteria for major depression were satisfied by a mere listing of symptoms, an assumption allowing normal responses to stressors to be mischaracterized as disorder. Sadness, with the exception of some bereavement reactions, was officially transformed from normality to pathology by psychiatric declaration. Perhaps it is not coincidental that the number of prescriptions for antidepressants and the people on these drugs have increased exponentially from 1980 to the present. Illustrating this trend, ". . . spending for antidepressants increased by 600% in the United States, exceeding $7 billion annually by the year 2000" (p. 5). As the title of their richly illuminating book suggests, Horwitz, a PhD sociologist, and Wakefield, who has both a PhD and a DSW in social work, show that sadness, that is normal sorrow-a human emotion that has vital adaptive utility grounded in our biological nature-has been lost in the relentless process of diagnosing even normal human sensibility to loss as depression. Thus, the new psychiatry, ostensibly based on scientific knowledge of our biological natures, has violated its own premise. In his foreword to their book, psychiatrist Robert Spitzer, who headed the task force that created the DSM-III, remarks "Because their analysis is anchored in psychiatry's own assumptions, it will be hard for those now constructing the DSM-V (expected publication in 2011) to ignore" (p. ix). Meanwhile, the DSM-III and its successor DSM-IV have persuaded more and more professionals and the lay public to regard sadness as a kind of pathology that should be quelled, particularly by prescribed drugs. Looking at the massive personal and societal effects thus generated since 1980, one is reminded of Aldous Huxley's 1932 book Brave New World and the 1956 and 1978 versions of the movie Invasion of the Body Snatchers. In Brave New World, unrelenting social pressure is used to persuade people to ingest soma, a drug that causes imbibers to lose their normal human nature and become like those who have already submitted to the ersatz normalization-by-soma. In Body Snatchers, humans who resist giving up their bodies to aliens are exploited by their normality, their biological need to sleep, a vulnerability used to steal their humanity. Seeing now what has happened via the new biological psychiatry bears out some of the ominous portents of the fictional soma and snatching societies. Horwitz and Wakefield present the findings of their thorough study soberly, patiently, and methodically as they proceed to their inexorable conclusions. Attesting to its thoroughness, the book's 11 chapters comprise: the concept of depression, the anatomy of normal sadness, sadness with and without cause, depression in the twentieth century, depression in the DSM-IV, importing pathology into the community, the surveillance of sadness, the DSM and biological research about depression, the rise of antidepressant drug treatments, the failure of the social sciences to distinguish sadness from depressive disorder, and the conclusion. Every chapter is well worth reading. The authors immediately present their central tenet: "We argue that the recent explosion of putative depressive disorder . . . does not stem primarily from a real rise in this condition. Instead, it is largely a product of conflating the two conceptually distinct categories of normal sadness and depressive disorder and thus classifying many instances of normal sadness as mental disorders" (p. …
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Apr 1, 2022
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