Table of Contents

Foreword, by Robert L. Spitzer

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

Notes
References
Index

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

"Relentless in its logic, Horwitz and Wakefield's book forces one to confront basic issues that cut to the heart of psychiatry. It has caused me to rethink my own position and how the authors' concerns might best be handled. It will shape future discussion and research on depression, and it will be an indispensable guide to those rethinking psychiatric diagnostic criteria in preparation for the DSM-V. [A] watershed in the conceptual development of the
field."--from the Foreword by Robert L. Spitzer, M.D., Professor of Psychiatry, New York State Psychiatric Institute, and Head of the Task Forces for the DSM-III and DSM-III-R
"The Loss of Sadness is a tour de force. Horwitz and Wakefield bring much-needed conceptual clarity to the understanding of depression and provide a powerful model for the analysis of all psychological disorders. I predict that it will have a monumental impact."--David M. Buss, Ph.D., Professor of Psychology, University of Texas at Austin, and author of Evolutionary Psychology: The New Science of the Mind
"Drs. Horwitz and Wakefield make a persuasive argument that has major public health implications. Integrating historical, philosophical, and psychological evidence, they have written a comprehensive, incisive, and quite readable book that is sure to challenge psychiatry's notions of what is disorder and what is normal."--Michael B. First, M.D., Professor of Clinical Psychiatry, Columbia University Medical Center, and Editor, DSM-IV-TR
"Depression is the mental health problem of our generation. In this important and penetrating book, Horwitz and Wakefield show that psychiatry no longer clearly differentiates between normal sadness and depressive disorder. A must read for anyone who wants to understand how so much "depression" has become medicalized."--Peter Conrad, Ph.D., Professor of Sociology, Brandeis University, and author of The Medicalization of Society
"With superb scholarship and crisp prose, Horwitz and Wakefield examine the fatal flaw at the core of depression diagnosis. This book describes, with devastating clarity, why the DSM went off track and how the resulting scientific train wreck slows research and distorts our experience of our own sadness. If the DSM was based on biology, this book would signal a new beginning."--Randolph Nesse, M.D., Professor of Psychiatry, University of Michigan, and
author of Why We Get Sick: The New Science of Darwinian Medicine
"Not another hackneyed anti-psychiatry polemic, The Loss of Sadness is a brilliant analysis of how mental health professionals can avoid pathologizing normal, emotional responses to life's stressors while accurately identifying those suffering from genuine depressive disorders. Erudite and engagingly written, The Loss of Sadness is destined to have a major impact on our field."--Richard J. McNally, Ph.D., Professor of Psychology, Harvard University, and
author of Remembering Trauma
"Excellent scholarship and wonderful writing. Without doubt, this book will stimulate reflection and debate among psychiatrists, epidemiologists, and social and behavioral scientists."--Leonard Pearlin, Ph.D., Department of Sociology, University of Maryland
"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...I would recommend this book to anyone interested in understanding depression more fully and the place normal sadness has in our society."--Doody's
"Allan Horwitz and Jerome Wakefield's important book...is part of a gathering blowback against the pathologization and medicalization of the ordinary human condition of sadness after loss...Important enough to make much of this book required reading for depression researchers and clinicians."--Lancet
"These collaborators maintain a constructive, scholarly tone and display a total command of the pertinent literature, they will gain a respectful hearing from psychiatrists."--New York Review of Books
"This book is highly recommended to any scholar, student, or layperson who is interested in exploring unresolved aspects of psychiatric taxonomy, and especially to any of the scholars currently involved in the DSM-V revisions. This is an important intellectual tour de force that will propel further substantive debate on these critical issues."--PsycCRITIQUES
"Meticulous and timely."--British Medical Journal
"When historians try to understand why psychiatric diagnosis abandoned validity for the sake of reliability in the years surrounding the millennium, they will rely on The Loss of Sadness. In measured tones and exacting prose, Horwitz and Wakefield deliver not only a devastating critique of the DSM diagnostic criteria for depression, but also a thoughtful and authoritative assessment of how they came to exist and persistIf this book cannot change the
DSM criteria for depression, nothing will."--Psychiatric Times
"This wonderful book will alter professional thinking."--Nursing Standard
"The Loss of Sadness is one of the most important books in the field of psychiatry published in the last few years...In short, this is a brilliant book with a significance well beyond its narrow but important subject."--Spectator
"The Loss of Sadness is a useful and interesting review of the history of depression and its diagnosis over time...a cautionary tale for those conducting depression research, shaping policy, and developing DSM-V."--Psychiatric Services
"This thought-provoking book challenges us to examine and re-examine our conceptions of normal sadness and depression. It makes an important contribution to the field and provides a powerful impact on the reader."--Families in Society: The Journal of Contemporary Social Services
"The Loss of Sadness may well be a wake-up call for North American psychiatrists."--History of Psychiatry
"The issue identified by the authors--increase of pathologising and prescribing--is serious and current; and they make clear one key possible diagnosis, that the limits of pathology are being illegitimately stretched. The authors are expert in this position and their book is essential reading for anyone concerned with these problems."--British Journal of Pyschiatry
"...[a] provocative and well-written book...impressively documented and meticulous detail..The result is often eye-opening and enlightening...."--Social Service Review
"...an iconoclastic yet careful, balanced, and scholarly work, which through sheer logic and force of argument compellingly challenges commonly accepted wisdom in all corners of the mental health world: research, epidemiology, public policy, prevention, diagnosis, treatment, and even university mental health...Read it--it will make you think about your profession, your practice, and your society."--As reviewed by Steven P. Gilbert, PhD, ABPP, LP, Minnesota
State University Mankato in Journal of College Student Psychotherapy
"Finally, a book about anxiety disorders that is based on a deep understanding of normal anxiety! I wish every mental health clinician would read it. Its spectacularly clear prose reveals the landscape of normal anxiety like an airplane's radar reveals the ground beneath the fog." -- Randolph M. Nesse, MD, Department of Psychiatry, The University of Michigan, Ann Arbor, MI
"The area of anxiety disorders has needed a thorough review and a shake-up for a long time. In this bold and thought-provoking work, Allan Horwitz and Jerome Wakefield have relied mainly on the insights from the evolutionary theory to provide a critical and powerful analysis of the modern concept of anxiety disorders. Regardless of whether or to what extent one agrees with them, their book rightly challenges the prevailing notions and is likely to perturb
current thinking about fear, anxiety and anxiety disorders. It will certainly add more substance to much-needed discussions and debates about the nature of these conditions, psychiatric diagnoses and an
often-imperceptible boundary between normality and psychopathology." -- Vladan Starcevic, MD, PhD, Department of Psychiatry, Sydney Medical School, University of Sydney, Australia
"In their new book, Horwitz and Wakefield offer the same incisive analysis that they brought to psychiatry's medicalization of sadness in their first book, The Loss of Sadness, to explain the reasons for the soaring prevalence of anxiety disorders over the past 20 years, namely that psychiatry has been mislabeling normal anxiety and fear reactions as disorder. Most importantly, they bring their analysis to bear on the actual definitions of anxiety
disorders that are enshrined in the American Psychiatric Association's manual of mental disorders, pointing out the various weaknesses and flaws with regard to construction of definitions of anxiety disorders that
effectively delineate normal anxiety and fear from abnormal anxiety and fear." -- Michael B. First, MD, Department of Psychiatry, Columbia University, New York, NY