An essential look at the current state of psychiatric diagnosis and treatment. Provides a history of DSM I through DSM-5, and documents how normal emotional ups-and-downs have become diagnoses which require specific treatment. A key point: DSM-III resulted in the loss of context for psychiatric diagnoses, so that all sadness has now become depression, which requires medical treatment, resulting in significant profits for both the pharmaceutical industry and physicians (more primary care physicians than psychiatrists).
An important and disturbing book. ( )

Was strange to read a book with that a theme... but strangely enough interesting too. Distinction from healthy sadness is really absent in the modern "psycho" science. So this work tackles it quite well. Through a various ideas and historical scenes, the idea becomes more and more seen in the new line of, how un-business orientated the bringing of this idea might be for most professionals, and how it is desperately needed by "lay" people experiencing the different sides and angles of life. ( )

It's been quite a while since I tackled an academic monograph, and I forgot how repetitive they can be. What I would greatly appreciate as a researcher becomes bogged down as a general reader. I would have been satisfied with a 100-page discussion. That being said, the topic is timely and the execution was perfect for its milieu. The authors' basic tenet is that the current methods of diagnosing depression are too broad, leading to a tremendous amount of false positive diagnoses and skewing the view of major depressive disorder. They argue that the next set of criteria for diagnosing major depression should include criteria that better allows for context.

The current diagnostic criteria are found in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). While these criteria are helpful for mapping out symptoms of depression, they only include bereavement as a contextual element that would explain the state of the depressed individual. The authors argue that there are many more life events that could provoke a depressive episode and depressive disorder. They posit that these life events do cause depression, but that this type of depression does not constitute disorder. The duration of the depression matched with the severity of the life event and other contextual clues about the individual's life need to be taken into account when diagnosing depression.

In addition, the authors delve into the history of depression, or melancholia as it was once referred to. The 2500-year history of this mood state has included contexts for depression, differentiating depression caused by life events and depression that is seemingly caused by nothing. Throughout these historical writings, severity and duration were measured against the context of the onset and the severity of the loss that caused depression. However, in the twentieth century physicians and researchers began to focus more on the symptoms than the context in an effort to enhance reliability.

While Horowitz and Wakefield do not go so far as to offer their own system of diagnosis for depression, they do offer numerous reasons why the current system is invalid and unreliable. Not only do the current diagnostic criteria lead to a significant amount of false positives and unnecessary medicalization, it also leads the culture to view normal sadness as disordered. They contend that the evolutionary and biological underpinnings for sadness should not be overlooked and that life events within context that cause sadness should not be treated as a disorder. If psychiatry is to remain relevant as a profession, clinicians and researchers need to be working with the right definitions, which they currently lack.

I tend to agree with Horowitz and Wakefield on most of their points, however weighted down I became in the nuances. It does seem like the surge in depression cases coincides with the new definitions and diagnostic symptoms provided in the DSM-III and the DSM-IV. I hope that the professional psychiatric community heeds the authors' call to create a more inclusive, grounded, and contextual basis for diagnosing depression, especially major depressive disorder. The background and discussion regarding biology, history, anthropology, and sociology provides excellent talking points in the fields of medicine and social science.

Contemporary psychiatry confuses normal sadness with depressive mental disorder because it ignores the relationship of symptoms to the context in which they emerge.

Dit boek is een frontale aanval op de DSM criteria voor depressie. De schrijvers pleiten ervoor dat artsen meer rekening houden met de context waarbinnen zich klachten voordoen die op depressie zouden kunnen wijzen. Zo is volgens de huidige maatstaven iemand depressief wanneer hij gedurende meer dan twee weken gedeprimeerd is en een aantal bijkomende klachten heeft (slecht slapen, geen eetlust, vermoeidheid, slecht kunnen concentreren etcetera), ongeacht eventuele uitlokkende factoren (met het overlijden van een naaste als enige uitzondering). Dat betekent dat iedereen die wordt ontslagen, gedumpt door een partner, of een andere ingrijpende tegenslag tegenkomt (bijvoorbeeld een ernstige ziekte) en daar langer dan twee weken van zijn of haar melk door is, depressief zou zijn. De schrijvers argumenteren –in een wat droge en repetitieve stijl- dat dit onzin is, en dat je in dergelijke gevallen beter van verdriet dan van depressie spreekt. De medicalisering van iets wat geen medisch probleem is, kan leiden tot een verkeerd begrip van de situatie, overspannen verwachtingen en een overconsumptie van medicijnen.

Verhelderend is ook het voorwoord van de hand van professor Spitzer, één van de opstellers van de DSM criteria. Hij geeft de auteurs eigenlijk op alle punten gelijk, maar toegeven dat hij een vergissing –en een verreikende vergissing- heeft gemaakt, dat krijgt hij net niet uit zijn pen. ( )