on 30 September 2008
Written by Allan Horvitz and Jerome Wakefield, both distinguished University Professors working in the USA, 'The Loss of Sadness' is a pointed and persuasively argued critique of the conflation between what the authors describe as on the one hand:- (A) 'normal' sadness/sorrow that arises in reaction to negative events/social stressors in one's life such as relationship difficulties, job losses etc and is in fact a natural response to loss and:- (B) True 'Depressive Disorder' which either has no apparent cause or is grossly disproportionate to the apparent cause and which does not remit when the person's social circumstances change, stressful situations end or simply go away with the passage of time but seems to have 'a life of it's own.'
The authors argue that the Bible of American Psychiatry, the Diagnostic and Statistical Manual (DSM) - which lists all the different mental disorders and sets the specific criteria for their diagnosis - has, since it's revision and major overhaul in 1980, set the stall for this erroneous conflation by dramatically inflating the number of people diagnosed with Depression (and subsequently treated with Anti-Depressants of course) through a simple change in diagnostic criteria that allowed for the first time, and in the name of diagnostic RELIABILITY, a diagnosis of Depression to be made purely on the basis of symptoms alone. In this case five symptoms from a checklist of nine and then solely for a period of two weeks.
The criteria set in place by DSM has one exclusion criteria and that is that the symptoms are not better accounted for by Bereavement, which the authors state is the 'definition's only acknowledgement that some instances of normal intense sadness might satisfy the symptomatic criteria.' The central flaw of the defintion and the central thesis of the book is that the DSM defintion of Depression fails to take into account the context in which the person's symptoms emerged and thus fails to exclude intense sadness, other than in reaction to the death of a loved one, that arises from the way human beings NATURALLY respond to major losses.
The authors therefore argue that: the exclusion criteria should be expanded to take into account of the myriad circumstances other than bereavement that triggers 'normal sadness' and that would be better categorised as social problems/problems of living. The authors emphasise a truly VALID diagnosis of Depression can only be made when the context of the person's life is taken fully into account and thus the tickbox/checklist criteria of DSM is insufficient for it's purpose.
This might just be the most important book written about Depression since Robert Burton's 'Anatomy of Melancholy' and I would urge anyone with an interest in the subject to read it and take note for the implications of their argument are far-reaching. Also recommended reading on a similiar vein is David Healy's 'The Antidepressant Era.'