Sally Satel has written an excellent review of Horwitz & Wakefield 's recent book, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder. The review is published in the Feb 27th edition of the New Republic, but for those without a subscription, Powell's Books has posted it for free on their website. There is much to recommend in both Satel's extensive review and Horwitz & Wakefield's book; especially relevant for the neuroethics crowd is the book's exhaustive treatment of the route by which psychological variations from the mean become codified into disease in successive editions of DSM. As Satel points out,
"The Loss of Sadness comes at a fortuitous time for American
psychiatry. The APA has just selected the hundreds of clinicians and
scientists who will develop the DSM-V. They would be wise to consider
the work of Horwitz and Wakefield, and their demand that we avoid
pathologizing normal reactions to the vicissitudes of life. Normal
reactions to timeless human heartache are not the same as mental
disorders. Horwitz and Wakefield call for changes to major depressive
disorder that would exempt patients whose depression is triggered by a
serious loss, just as bereaved patients are ineligible for the
diagnosis. This is certainly worth considering."
The issues that Horwitz & Wakefield raise are hardly confined to the fuzzy line that has been drawn between sadness and depression. The Loss of Sadness is a clarion call to all who think incisively about what constitutes disease in the context of behavior.
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