Allan V. Horwitz

Jerome C. Wakefield

'The Loss of Sadness' argues that the increased prevalence of major depressive disorder is due not to a genuine rise in mental disease, as many claim, but to the way that normal human sadness has been 'pathologised' since 1980.

How Psychiatry Transformed Normal Sorrow Into Depressive Disorder

The Loss of Sadness

Allan V. Horwitz, PhD

Argues that anxiety and fear are a part of everyone's life, and that the medical industry has created an epidemic out of over-diagnosing these conditions.

Psychiatry's Transformation of Natural Anxieties Into Mental Disorders

All We Have to Fear

Steeves Demazeux

The World Health Organization states that depression is the leading cause of disability worldwide, and predicts that by 2030 the epidemic of depression raging across the world will be the single biggest contributor to the overall burden of disease of all health conditions. Yet this gloomy picture masks a number of paradoxes concerning the diagnosis and cultural interpretation of depression that appear to challenge the claimed prevalence rates on which it is based. This book’s essays by some of the world’s leading researchers and scholars on depression explores these anomalies in detail from multidisciplinary and multicultural perspectives, and in doing so reshapes the debate on the nature of depression that is currently under way in the US and abroad. At the book’s core is the exploration from the multiple perspectives of a key dilemma: is the epidemic of depression real or is it just apparent? In particular, could it be the result of criteria laid down in the official American classification system of mental disorders, the DSM, interacting with cultural changes to reshape our view of melancholy, pathologizing what were formerly normal symptoms of grief or intense sadness? The debate over the DSM's conception of depression has an international relevance, with the WHO’s upcoming revisions to its International Classification of Diseases requiring coordination with the DSM. This collection of perspectives has an unprecedented international dimension, as scholars from Europe and around the world join US academics to explore a central and controversial element of contemporary psychiatric diagnosis - and one that has enormous practical implications for the future of mental health care and how we view our emotions. The book’s accessible essays will make it useful to scholars, practitioners, and students across a wide range of disciplines.

International Perspectives on the Depression Epidemic and Its Meaning

Sadness or Depression?

First published in 2013. Routledge is an imprint of Taylor & Francis, an informa company.

Rethinking Freud's Oedipus Complex in the Case of Little Hans

The Day the Horse Fell Down

In Attachment, Sexuality, Power, Jerome C. Wakefield challenges established views of Freudian psychoanalysis by applying Foucault’s concept of ‘power/knowledge’ to Freud’s case of Little Hans, illuminating the role that Oedipal theory has played in reorganizing intimate family relationships. Combining close examination of the Hans case with accounts of the history of marriage and psychology of co-sleeping, this book argues that the Oedipal theory achieved prominence because its implications for family dynamics supported changing social values. Wakefield identifies a previously overlooked reason for Hans’s anxiety—his father attempted to protect Hans from his supposed Oedipal desires by separating Hans from his mother. Thus, Wakefield argues, the father’s exercise of power based on his belief in Oedipal theory, not an actual Oedipus complex, caused Hans’s vulnerability to anxiety—revealing the theory’s potential to cause harm by distancing children from their parents, even as such distancing made the theory socially appealing. This book’s novel and carefully documented articulation of the mechanisms of power by which Oedipal theory exerts its influence on family life will be of interest to psychoanalysts and psychotherapists alike, and essential for scholars in the fields of psychoanalysis, philosophy of science and the history of psychiatry.

Oedipal Theory as Regulator of Family Affection in Freud’s Case of Little Hans

Attachment, Sexuality, Power

In this close reading of Freudian theory, Jerome C. Wakefield reconstructs Freud’s argument for the Oedipal theory of the psychoneuroses, placing the case of Little Hans into a philosophy-of-science context and critically rethinking the epistemological foundations of psychoanalysis. Wakefield logically evaluates four central Freudian arguments: the "undirected anxiety" argument which contends that Hans suffered from anxiety before he developed his horse phobia; the "day the horse fell down" argument where, engaging in some scholarly detective work, Wakefield resolves a century-old dispute between behaviorists and psychoanalysts about when Hans witnessed a frightening horse accident; the "N=1 sexual repression" argument that the trajectory of Hans’s sexual desires matches the Oedipal theory’s predictions; and lastly, the "detailed symptom characteristics" argument that the Oedipal theory is needed to understand otherwise inexplicable details of Hans’s symptoms. Wakefield demonstrates that, although Freud’s arguments are brilliantly conceived, he misread the facts of the Hans case and failed to support the Oedipal theory as judged by his own stated evidential standards. However, this failure creates an opportunity for renewed consideration of psychoanalysis’s distinctive contribution: the understanding of an individual’s unique meaning system and confrontation with meanings outside of focal awareness in order to reshape an individual’s fate. This book will be of interest to psychoanalysts and psychotherapists alike, and will prove essential for scholars working in the fields of psychoanalysis, philosophy of science, and the history of psychiatry.

A Philosophy of Science Analysis of the Case of Little Hans

Freud's Argument for the Oedipus Complex

Depression has become the single most commonly treated mental disorder, amid claims that one out of ten Americans suffer from this disorder every year and 25% succumb at some point in their lives. Warnings that depressive disorder is a leading cause of worldwide disability have been accompanied by a massive upsurge in the consumption of antidepressant medication, widespread screening for depression in clinics and schools, and a push to diagnose depression early, on the basis of just a few symptoms, in order to prevent more severe conditions from developing. In The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that, while depressive disorder certainly exists and can be a devastating condition warranting medical attention, the apparent epidemic in fact reflects the way the psychiatric profession has understood and reclassified normal human sadness as largely an abnormal experience. With the 1980 publication of the landmark third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mental health professionals began diagnosing depression based on symptoms--such as depressed mood, loss of appetite, and fatigue--that lasted for at least two weeks. This system is fundamentally flawed, the authors maintain, because it fails to take into account the context in which the symptoms occur. They stress the importance of distinguishing between abnormal reactions due to internal dysfunction and normal sadness brought on by external circumstances. Under the current DSM classification system, however, this distinction is impossible to make, so the expected emotional distress caused by upsetting events-for example, the loss of a job or the end of a relationship- could lead to a mistaken diagnosis of depressive disorder. Indeed, it is this very mistake that lies at the root of the presumed epidemic of major depression in our midst. In telling the story behind this phenomenon, the authors draw on the 2,500-year history of writing about depression, including studies in both the medical and social sciences, to demonstrate why the DSM's diagnosis is so flawed. They also explore why it has achieved almost unshakable currency despite its limitations. Framed within an evolutionary account of human health and disease, The Loss of Sadness presents a fascinating dissection of depression as both a normal and disordered human emotion and a sweeping critique of current psychiatric diagnostic practices. The result is a potent challenge to the diagnostic revolution that began almost thirty years ago in psychiatry and a provocative analysis of one of the most significant mental health issues today.

How Psychiatry Transformed Normal Sorrow into Depressive Disorder

This book consists of a focused and systematic analysis of Freud’s implicit argument for unconscious mental states. The author employs the unique approach of applying contemporary philosophical methods, especially Kripke-Putnam essentialism, in analyzing Freud’s argument. The book elaborates how Freud transformed the intentionality theory of his Cartesian teacher Franz Brentano into what is essentially a sophisticated modern view of the mind. Indeed, Freud redirected Brentano's analysis of consciousness as intentionality into a view of consciousness-independent intentionalism about the mental that in effect set the agenda for latter-twentieth-century philosophy of mind.

Jerome C. Wakefield

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