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    Friday, August 31, 2007

    Second Hand Book Reviews: From The New England Journal, a review of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, a critique of the cookbook of psychiatric diagnosis. It shaped the thinking of a whole generation of physicians:

    As the title of this book — The Loss of Sadness — implies, psychiatrists who are influenced by the diagnostic practices that are encouraged in the DSM have become surprisingly imperceptive to the emotional miseries that life events evoke in their patients. These psychiatrists tend to perceive all such states of mind as major depressive disorder, with the result that they may reach for the prescription pad before they take a history. They practice, with the DSM as their guide, what Sir William Osler once dubbed "penny-in-the-slot therapeutics."

    ...Concentrating on depression, Horwitz and Wakefield describe how practicing psychiatrists gradually came to think about and treat specific states of demoralization and discouragement that arose from life contexts in the same way they treated pathologic mood disorders....

    ...The authors note that the DSM-III — by sorting conditions according to their resemblances, rather than by seeking essential differences — medicalized human suffering, diminished attention to human meaning in the field of psychiatry, and hampered communication between patients and physicians. This process encouraged psychiatrists to think only in terms of medications ....

    Some would argue that the loss of sadness is a good thing. If all it takes is a pill to eliminate sorrow and anger, then the world's a better place, right? Maybe not. Do poets on Prozac create great works?

    posted by Sydney on 8/31/2007 09:49:00 PM 2 comments


    How long do these authors feel a person should be miserable before receiving effective treatment? How many miserable people equal a potentially lost poem?

    By Anonymous Anonymous, at 10:30 AM  

    Since anti-depressants are fairly ineffective anyway, the real problem that the medicalization of sadness creates is the lack of alternative ways to manage it.

    People do not know how to cope with loss or sadness because it's assumed that the normal (or default) condition is happiness. Therefore, sadness becomes an illness to be treated instead of a situation to address by other means (family, friends, activities, prayer, whatever).

    And while happiness as the "normal" human condition is certainly desirable, is that really true? For instance, research has shown depressed people are better able to accurately assess some situations than non-depressed subjects. I suspect there's an evolutionary advantage to having at least a portion of the population depressed. While everyone else is out picking daisies, they're the ones looking for the snake in the grass.

    Certainly, there are people who are clearly incapacitated and need help. However, I think we're being set up for a psychological disaster, since the time will come when virtually all of us have to cope with depression, and we won't know how to do it aside from calling the psychiatrist.

    By Anonymous Danie, at 8:20 PM  

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