Allan V Horwitz

Allan V. Horwitz is Professor of Sociology and Dean of Social and Behavioral Sciences at Rutgers University. He is the author of many articles and a number of books on various aspects on mental illness, including The Social Control of Mental Illness, The Logic of Social Control, and Creating Mental Illness. Jerome C. Wakefield is University Professor and Professor of Social Work at New York University, and he has also taught at the University of Chicago, Columbia University, and Rutgers University. He is an authority on the intersection between philosophy and the mental health professions and the author of many articles on diagnosis of mental disorder.
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Allan V. Horwitz
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.
Allan V. Horwitz, PhD
Thirty years ago, it was estimated that less than five percent of the population had an anxiety disorder. Today, some estimates are over fifty percent, a tenfold increase. Is this dramatic rise evidence of a real medical epidemic? In All We Have to Fear, Allan Horwitz and Jerome Wakefield argue that psychiatry itself has largely generated this "epidemic" by inflating many natural fears into psychiatric disorders, leading to the over-diagnosis of anxiety disorders and the over-prescription of anxiety-reducing drugs. American psychiatry currently identifies disordered anxiety as irrational anxiety disproportionate to a real threat. Horwitz and Wakefield argue, to the contrary, that it can be a perfectly normal part of our nature to fear things that are not at all dangerous--from heights to negative judgments by others to scenes that remind us of past threats (as in some forms of PTSD). Indeed, this book argues strongly against the tendency to call any distressing condition a "mental disorder." To counter this trend, the authors provide an innovative and nuanced way to distinguish between anxiety conditions that are psychiatric disorders and likely require medical treatment and those that are not--the latter including anxieties that seem irrational but are the natural products of evolution. The authors show that many commonly diagnosed "irrational" fears--such as a fear of snakes, strangers, or social evaluation--have evolved over time in response to situations that posed serious risks to humans in the past, but are no longer dangerous today. Drawing on a wide range of disciplines including psychiatry, evolutionary psychology, sociology, anthropology, and history, the book illuminates the nature of anxiety in America, making a major contribution to our understanding of mental health.
Allan V. Horwitz, PhD
Thirty years ago, it was estimated that less than five percent of the population had an anxiety disorder. Today, some estimates are over fifty percent, a tenfold increase. Is this dramatic rise evidence of a real medical epidemic? In All We Have to Fear, Allan Horwitz and Jerome Wakefield argue that psychiatry itself has largely generated this "epidemic" by inflating many natural fears into psychiatric disorders, leading to the over-diagnosis of anxiety disorders and the over-prescription of anxiety-reducing drugs. American psychiatry currently identifies disordered anxiety as irrational anxiety disproportionate to a real threat. Horwitz and Wakefield argue, to the contrary, that it can be a perfectly normal part of our nature to fear things that are not at all dangerous--from heights to negative judgments by others to scenes that remind us of past threats (as in some forms of PTSD). Indeed, this book argues strongly against the tendency to call any distressing condition a "mental disorder." To counter this trend, the authors provide an innovative and nuanced way to distinguish between anxiety conditions that are psychiatric disorders and likely require medical treatment and those that are not--the latter including anxieties that seem irrational but are the natural products of evolution. The authors show that many commonly diagnosed "irrational" fears--such as a fear of snakes, strangers, or social evaluation--have evolved over time in response to situations that posed serious risks to humans in the past, but are no longer dangerous today. Drawing on a wide range of disciplines including psychiatry, evolutionary psychology, sociology, anthropology, and history, the book illuminates the nature of anxiety in America, making a major contribution to our understanding of mental health.
Allan V. Horwitz
Since the emergence of Western philosophy and science among the classical Greeks, debates have raged over the relative significance of biology and culture on an individual's behavior. Today, recent advances in genetics and biological science have pushed most scholars past the tired nature vs. nurture debate to examine the ways in which the natural and the social interact to influence human behavior. In What's Normal?, Allan Horwitz brings a fresh approach to this emerging perspective. Rather than try to solve these issues universally, Horwitz demonstrates that both social and biological mechanisms have varying degrees of influence in different situations. Through case studies of human universals such as incest aversion, fear, appetite, grief, and sex, Horwitz first discusses the extreme instances where biology determines behavior, where culture dominates, and where culture overrides basic biological instincts. He then details the variety of ways in which genes and environments interact; for instance, the primal drive to eat and store calories when food supplies were scarce creates serious problems in a society where food is abundant and obesity stigmatized. Now that it's often easier to change our biology rather than our culture, an understanding of which behaviors and traits are simply normal or abnormal, and which are pathological or necesitate treatment is more important than ever. Wide-ranging and accessible, What's Normal? provides a crucial guide to the biological and social bases of human behavior at the heart of these matters.
Allan V. Horwitz
Since the emergence of Western philosophy and science among the classical Greeks, debates have raged over the relative significance of biology and culture on an individual's behavior. Today, recent advances in genetics and biological science have pushed most scholars past the tired nature vs. nurture debate to examine the ways in which the natural and the social interact to influence human behavior. In What's Normal?, Allan Horwitz brings a fresh approach to this emerging perspective. Rather than try to solve these issues universally, Horwitz demonstrates that both social and biological mechanisms have varying degrees of influence in different situations. Through case studies of human universals such as incest aversion, fear, appetite, grief, and sex, Horwitz first discusses the extreme instances where biology determines behavior, where culture dominates, and where culture overrides basic biological instincts. He then details the variety of ways in which genes and environments interact; for instance, the primal drive to eat and store calories when food supplies were scarce creates serious problems in a society where food is abundant and obesity stigmatized. Now that it's often easier to change our biology rather than our culture, an understanding of which behaviors and traits are simply normal or abnormal, and which are pathological or necesitate treatment is more important than ever. Wide-ranging and accessible, What's Normal? provides a crucial guide to the biological and social bases of human behavior at the heart of these matters.
Allan V. Horwitz
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.
Jérôme C. Wakefield
Quand on a fait de la tristesse une maladie... Critique du diagnostic de la dépression

Ce livre dresse une critique rigoureuse de la manière dont la psychiatrie américaine a réformé, dans les années 1980, le diagnostic de la dépression. Selon les auteurs, le diagnostic actuel de la dépression est trop inclusif et trop large ; il tend à « pathologiser » les réactions normales d’abattement qui se produisent à l’occasion de certaines situations difficiles de la vie.
Les auteurs accusent précisément le DSM-III (texte de référence internationale de la classification américaine des troubles mentaux, troisième version) d’avoir contribué à faire de la tristesse une maladie et, du coup, à en favoriser la médicalisation, avec des conséquences financières très favorables pour l’industrie pharmaceutique. Tandis que la tradition médicale, depuis l’Antiquité, avait clairement cherché à distinguer entre les épisodes de tristesse qui affectent toute vie humaine et cette pathologie de la dépression qui frappe l’individu sans raison apparente, le DSM-III, dans son souci de rendre les définitions cliniques plus opérationnelles, a malencontreusement négligé l’importance de la prise en compte du contexte dans l’établissement du diagnostic de dépression. Les conséquences en matière de recherche sur le trouble dépressif et d’épidémiologie, donc de mobilisation des ressources des services de santé, sont également analysées.
L’ouvrage entend réhabiliter la tristesse, aussi intense puisse-t-elle être, comme un événement normal de la vie humaine, pour ensuite caractériser à rebours la dépression comme une tristesse proprement pathologique, c’est-à-dire dysfonctionnelle. Pour les auteurs, la tristesse est un fait biologique avant d’être un fait social – même si les facteurs culturels ont un poids important dans la modification et la modulation de cette émotion naturelle. Les sociétés individualistes contemporaines refusent bien souvent de l’accepter comme telle, sans reconnaître que cette tristesse normale est sans doute bien davantage le résultat plutôt que la cause des problèmes sociaux.

Un ouvrage guide pour les professionnels de la santé, chercheurs en psychiatrie, en sciences humaines et sociales, travailleurs sociaux et sociologues

CE QU’EN PENSE LA CRITIQUE

- « Ce livre se veut une incitation des professionnels de santé à connaître cette fragilité diagnostique pour mieux prendre en charge les patients. » Pratiques et Organisation des Soins

- « Une critique de l’évolution de la psychiatrie américaine qui a réformé, dans les années 1980, le diagnostic de la dépression. » La Recherche, n°87

A PROPOS DES AUTEURS

Allan V. Horwitz est Professeur de sociologie à l’Université Rutgers dans le New Jersey. Il est spécialisé dans la sociologie du contrôle de la santé mentale et a publié en 2002 Creating mental Illness.
Jerome C. Wakefield est Professeur à la Faculté de Médecine de l’Université de New York. Il est spécialiste des fondements conceptuels de la psychiatrie.
Françoise Parot est Professeure d’Épistémologie et d’Histoire de la Psychologie à l’Université Paris Descartes. Auteure d’un Dictionnaire de la psychologie (PUF) et d’une Introduction à la psychologie (PUF), elle a dirigé, en 2008, l’ouvrage collectif Les fonctions en psychologie (Mardaga).
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