A Review of “Loss of Sadness” by Allan Horwitz and Jerome Wakefield

9780195313048_custom-746764532ffebd5b853a00db50326ac50b166f6a-s99-c85Horwitz and Wakefiled are not fringe extremists criticizing modern psychology as outsiders. Nor are they Biblical counselors following the trend of critiquing the field because of its contrast with the Biblical worldview. They are insiders who are proposing an alternative answer to the so-called depression epidemic in America. Their proposal, no doubt, will be appealing to both the aforementioned groups. Though Loss of Sadness is written from within the field of psychology, its conclusions will have wide reaching attraction.

Ours has been called the “age of depression.” The rise of Major Depressive  Disorder, in America in particular, is noteworthy. The disease has increased its impact such that “Each successive birth cohort has reported more depressive disorders than previous generations showed” (4), and “there is a widespread perception that depressive disorder is growing at an alarming rate.” There has also been an increase in the number of patients in treatment for depression, and the number of anti-depressants prescribed. The question to ask of this increase, however, is what is causing it? According to Horwitz and Wakefiled the answer is increased misdiagnosis, largely related to failures if the DSM definition of depression.

The Diagnostic and Statistic Manual of Mental Disorders is the “bible of psychiatry.” It is the book used to assist clinicians in their diagnosis of mental disorders. To help with this the DSM lists symptoms that may be looked for and when observed under the right conditions in a patient can be properly labeled and treated. According to the authors by ignoring the importance of context the editors of the DSM have created a faulty definition of depression and therefore contributed to “diagnostic inflation” (7).

The importance of context cannot be overstated. Sadness, they argue, is a normal part of existence,  a “biological designed functioning” (15). Though we cannot explain everything about the proper exercise of this “loss mechanism,” we can still operate on the ground of a distinction between normal and disordered sadness. The failure of the DSM III has been its nearly entire ignorance of the role of context. The authors write:

In attempting to characterize the kinds of symptoms suffered in depressive disorders without reference to the context in which the symptoms occur, contemporary psychiatry has also inadvertently characterized intense normal suffering as disease. (9-10)

Diagnostic inflation is a result of confusing normal sadness for disordered sadness, or from outright ignorance about the role of context. This is such a huge claim, and such a strong pushback to the field. It’s one many of us hope that modern clinicians will hear.

The claims of the book are so thoroughly defended, argued, and supported that its hard to find fault with this work. Even Dr. Robert L. Spitzer, chief editor of DSM III states in his preface that the work of Horwitz and Wakefiled changed his mind. That is no small bit of information to commend the work to us as readers. The work is dense, and field specific. Those not overly familiar with terminology will find this a challenging read. For those who can muscled through it, and/or who are familiar with the nomenclature and the field of psychology as a whole, this will be a very insightful and possibly ground breaking work.

Biblical counselors in particular can appreciate the claims of this book. We have often thought that the solutions offered by psychology are not always the best, nor are their diagnoses always accurate. While Horwitz and Wakefiled may not agree with all our conclusions, presuppositions, and solutions their work validates many of our concerns with modern psychology. The authors are sensitive to their colleagues and sympathetic with their desires to help others, Biblical counselors, likewise, should believe the best of our friends in psychology. Even as we do that, however, we can hope that they will listen to these two voices speaking from within their discipline. The diagnostic inflation going on in modern psychology needs and immediate corrective. We have some potential answers to sadness that we believe are true and effective in bringing about change, hope, and healing. But even if our neighbors don’t accept those answers, we’d be delighted to see less misdiagnosis. Loss of Sadness is a ground-breaking work, and worthy of the time it takes to work through its content.


  1. A very helpful and wise review!

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