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-for example, 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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