The Loss of Sadness : How Psychiatry Transformed Normal Sorrow into Depressive Disorder by Allan V Horwitz and Jerome C. Wakefield pdf
The Concept of Depression
The poet W. H. Auden famously deemed the period after World War II the “age of anxiety.” For Auden, the intense anxiety of that era was a normal human response to extraordinary circumstances, such as the devastation of modern warfare, the horrors of the concentration camps, the development of nuclear weapons, and the tensions of the cold war between the United States and the Soviet Union. Were Auden still alive, he might conclude that the era around the turn of the twenty-first century is the “age of depression.” There would, however, be a crucial difference between the two characterizations: whereas the age of anxiety was viewed as a natural response to social circumstances that required collective and political solutions, ours is viewed as an age of sadness that is abnormal—an age of depressive psychiatric disorder that requires professional treatment.
Consider Willy Loman. the lead character in Arthur Miller’s classic play Death of a Salesman and possibly the fictional character most representative of American life during the decades following World War II. As he enters his 60s. despite his fervent belief in the American dream that hard work will lead to success. Willy Loman has never accomplished very much. He has heavy debts, his health is failing, he is barely able to continue working at his job as a traveling salesman, and his sons despise him. When he is finally fired from his job. he is forced to admit to himself that he is a failure. He kills himself in an automobile accident in the hope of getting his family some money from an insurance settlement. The tremendous popularity of Death of a Salesman on its introduction on Broadway in 1949 stemmed from Willy Loman’s embodiment of the Everyman in American life who embraced the goal of achieving great wealth but found himself destroyed by it.
Death of a Salesman received a very different response during its revival 50 years later.4 According to a piece in The New York Times titled “Get That Man Some Prozac.” the director of the revived version sent the script to two psychiatrists. who diagnosed Loman as having a depressive disorder.’ The playwright. Arthur Miller, objected to this characterization, protesting: “Willy Loman is not a depressive… Не is weighed down by life. There are social reasons for why he is where he is.” The response of the psychiatrists is as exemplary of our time as Loman was of his. What our culture once viewed as a reaction to failed hopes and aspirations it now regards as a psychiatric illness. The transformation of Willy Loman from a social to a psychiatric casualty represents a fundamental change in the way we view the nature of sadness.
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
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