53: Allan Horwitz studies sadness, depression

Everybody’s talking about mental health these days. That's, by and large, a good thing.

But did you ever wonder why the incidence of diagnosed depression has been skyrocketing even as we talk more openly about our mental and emotional issues? What's going on? 

That’s what I talk to retired professor emeritus Dr. Allan Horwitz about. Dr. Horwitz has tilted at the DSM (The Diagnostic and Statistical Manual of Mental Disorders) windmill with books like All We Have to Fear: Psychiatry’s Transformation of Normal Anxieties into Mental Disorders (2012) and The Loss of Sadness: How Psychiatry Transformed Normal Misery into Depressive Disorder (2007). It was that 2007 book that caught my eye recently. In it, Dr. Horwitz and Dr. Jerome Wakefield argue that in the late 20th century, the psychiatric community chose to remove context from its depression diagnoses. Despite centuries (millennia even) of ancient thought and modern psychiatric approaches to anxiety, sorrow and depression that poignantly considered and recognized how great sadness could be an orderly, normal response to terrible circumstances (romantic breakup, divorce, death, illness and other rough life events), American diagnosticians chose in editions of the famous and widely used DSM to ignore almost all context for painful episodes of sadness (save a short period of time for grief after the death of a loved one). 

Drs. Horwitz and Wakefield made the pitch to the psychology and medical community that terrible sadness sometimes might be a normal, healthy response in some cases, not a disordered response needing immediate medical intervention … and, of course, pills. 

To boil it down: Sometimes you feel bad about life, but you should feel bad about life, because life, in that moment, is bad and hard and hurtful. You may not be crazy! You may be functional and responding appropriately to crappy things. He’s not saying all the people with diagnosed anxiety disorders, depression or trauma should not seek help. He’s saying in some cases, if he had his way, he would counsel “watchful waiting” for medical health professionals to see whether things improve with changes in life circumstances. 

Did the psychiatric community listen for later editions to consider more context in diagnosing Major Depressive Disorder? Listen and find out …  

Caveat: Nowhere is Dr. Horwitz saying people with mental illness or struggling with mental problems should not seek help. He’s only saying we might not be doing the best service to individuals in need of help—either psychiatric, medicinal, psychological, etc.—if we are diagnosing too many people with more severe mental illness than they actually have. 

To Feed Further Curiosity: 

• A fairly comprehensive listing for Dr. Horwitz’s journal articles and books appears here. Other interesting stand-outs besides the two referenced earlier for non-academic readers who are deeply interested in the topic could also include What's Normal?: Reconciling Biology and Culture and Anxiety: A Short History. All of Horwitz’s works are accessible to laypeople but are deeply researched enough and often focused towards clinicians wrestling with the big picture of “Who’s sick?” and “How do we know it?” and “Are we using the right tools or benchmarks to assess the difference between normal, painful psychic pain and mental disorders?”  
• Also recommended by Dr. Horwitz is the book Good Reasons for Bad Feelings: Insights Into the Frontiers of Evolutionary Psychology by Dr. Randolph Nesse. Dr. Horwitz says the book is very accessible and covers many of the hypotheses and new ideas that have come out of theories that try to figure out how our current feelings might have developed over the millennia, what they might be trying to do, and how they might be supporting or sabotaging us in the modern world today.