The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder
Abstract
The Loss of Sadness argues that the increased prevalence of major depressive disorder is due not to a genuine rise in mental disease, but to the way that normal human sadness has been 'pathologised' since 1980. That year saw the publication of the landmark third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which has since become a dominant force behind our current understanding of mental illness overall. As concerns at least major depression, the authors argue that the DSM's definition of the condition is too broad and that as a result virtually all research and clinical approaches to the condition have been based on a flawed understanding about it. The social, political, and scientific implications of this are far-reaching - from the overselling of antidepressants to treat ordinary sadness, as Big Pharma exploits the DSM for its own purposes; to intrusive and expensive depression screening programs at all levels of society, as well-meaning but misguided initiatives translate the DSM into simple terms to catch any whiff of depressive pathology in our midst; and funded research into the 'epidemic' of depression, which advances the field very litttle and the public even less. Ultimately, the definition of depression that is in operation today has formed the basis for an entire system of social control (e.g. community-wide screening initiatives, intrusive public health policy) that benefits psychiatry, primary care providers, and the pharmaceutical and insurance industries by turning everyone else into a potential consumer of services, needed or not. The authors do recognise that depression is a devastating illness that affects some people. Their chief concern is with the use of this diagnosis as a catch-all for anyone who has experienced sadness for more than a few weeks at a time. The result is a pointed yet nuanced critique of modern psychiatry that will stir controversy of the sort that will reacquaint us with sadness as a primary human emotion and that could productively influence the way that depression the actual illness is characterised in the future.
... Moreover, depression found more and more space in both the scientific, political, and economic discourse, as well as in common sense. In the 1980s, depression entered the most used classifications of mental disorders and since then become more frequent in the public discussion (Horwitz & Wakefield, 2007). Recently, during the COVID-19 pandemic, we have learned about this constant reference to depression and mental distress. ...
... Western and modernized countries, should be explained by these theories (Coppo, 2005;Ehrenberg, 1997;Horwitz and Wakefield, 2007). ...
... Diagnosis is the active process of labelling the patient's experiences through an explicative category, defining its traits and development (Georgaca, 2013). In this sense, some authors claim that depression should be regarded as a culturally and historically situated phenomenon, giving attention to the way the distress is conceptualized and assessed in the general population (Coppo, 2005, Horwitz, 2010Horwitz and Wakefield, 2007). ...
This thesis focuses on depression, examining its clinical representations, treatments, and determinants through a sociological lens, while incorporating concepts from psychiatry.
The first part analyses depression prevalence, utilizing data from various global and national sources to highlight its increased diagnosis and explore the term "epidemic." It critically evaluates whether this increase constitutes an actual epidemic, delving into the sociological explanations for the rise in depression, contrasting social change theories with diagnostic practice explanations. It argues that depression's depiction as a widespread issue is influenced by social, historical, and cultural contexts.
The second part presents an empirical investigation into depression as a sociological object, using qualitative methods like semi-structured interviews, participant observation, and document analysis in two healthcare settings in Milan, Italy. The study explores both professional and patient perspectives, examining representations of depression among mental health professionals and the social dynamics involved in depressive and anxiety disorders in patients. It also addresses the diagnostic and treatment practices concerning depression, considering the biopsychosocial model. The thesis contributes to understanding the complexity of depression and its treatment in the context of public healthcare systems.
... As a universal experience to humans, grief is often perceived as a common response from an emotional separation of a significant other. It is a natural part of one's life experience and a paradigm of "normal sadness" (Horwitz & Wakefield, 2007). ...
... However, grief is not a disease. Grief can be generally categorised as an intensified sadness (Horwitz & Wakefield, 2007). In the American Psychiatric Association's 3rd edition of the Diagnostic and Statistical Manual (DSM-III), grief is not mentioned (Archer, 1999;Averill & Nunley, 2006). ...
... In the American Psychiatric Association's 3rd edition of the Diagnostic and Statistical Manual (DSM-III), grief is not mentioned (Archer, 1999;Averill & Nunley, 2006). Additionally, Horwitz and Wakefield (2007) find that a grieving person, though they might show symptoms, is not perceived as someone with a physical or mental illness. ...
Grief is a universal human experience that has become a recurring theme in various literature genres, especially in memoirs. This study aims to discover how grief is portrayed in a contemporary memoir. Using Kübler-Ross and Kessler (2014)’s five stages of grief, this qualitative study examines the embodiment of grief as expressed by the main character, Michelle, in the memoir Crying in H Mart (2021). The method of this study is qualitative approach. This research results reveals Michelle to have undergone the five stages of grief: denial, anger, bargaining, depression, and acceptance. Certain stages, however, were found to be more prominently expressed by the main character. This study is expected to provide contribution on better awareness and understanding of grief and its impacts on individuals and our modern societies.
... En este artículo revisamos críticamente esta asociación, y siguiendo a Horwitz y Wakefield (8) , planteamos que estas investigaciones presentan problemas metodológicos derivados de la aplicación de un método diagnóstico basado en la identificación de síntomas inespecíficos y, en segundo lugar, que sus resultados se interpretan sin referencia al propio contexto epidemiológico en el cual estas manifestaciones podrían ser reacciones esperables. Además de enfatizar un uso más riguroso de términos y conceptos de la especialidad, planteamos que es necesario rescatar la importancia del juicio clínico y de abordar el sufrimiento psíquico desde un enfoque más amplio como contrapeso a una creciente medicalización. ...
... Además, obviamente, de las altas cifras de depresión que se reportan en el contexto de la pandemia, estas investigaciones fueron realizadas de manera transversal con instrumentos diseñados para el tamizaje y no para el diagnóstico de depresión; muchos de estos estudios, sino todos, se realizaron sin un contacto cara a cara con los entrevistados y sin considerar la duración, intensidad y repercusión funcional de los síntomas incluidos. Siguiendo a Horwitz y Wakefield (8) , existirían dos problemas metodológicos y nosológicos fundamentales que llevarían a una interpretación errónea de los resultados de estos estudios. Primero, basar el diagnóstico de depresión en la presencia de síntomas inespecíficos y, segundo, y paradojalmente, en la situación epidemiológica descrita, la falta de referencia al contexto en el cual estos síntomas podrían ser reacciones esperables. ...
... Esto, porque los elementos subjetivos que podrían contaminar la labor diagnóstica son minimizados. Por otra parte, la utilización de estos instrumentos disminuiría el costo y el tiempo requerido por los estudios, incluyendo el entrenamiento y la experiencia clínica del entrevistador (8) . Si bien, este cambio aparentemente ha facilitado la investigación, junto con la confiabilidad y la comunicación interclínica, también parece acarrear ciertas dificultades: a). ...
... En este artículo revisamos críticamente esta asociación, y siguiendo a Horwitz y Wakefield (8) , planteamos que estas investigaciones presentan problemas metodológicos derivados de la aplicación de un método diagnóstico basado en la identificación de síntomas inespecíficos y, en segundo lugar, que sus resultados se interpretan sin referencia al propio contexto epidemiológico en el cual estas manifestaciones podrían ser reacciones esperables. Además de enfatizar un uso más riguroso de términos y conceptos de la especialidad, planteamos que es necesario rescatar la importancia del juicio clínico y de abordar el sufrimiento psíquico desde un enfoque más amplio como contrapeso a una creciente medicalización. ...
... Además, obviamente, de las altas cifras de depresión que se reportan en el contexto de la pandemia, estas investigaciones fueron realizadas de manera transversal con instrumentos diseñados para el tamizaje y no para el diagnóstico de depresión; muchos de estos estudios, sino todos, se realizaron sin un contacto cara a cara con los entrevistados y sin considerar la duración, intensidad y repercusión funcional de los síntomas incluidos. Siguiendo a Horwitz y Wakefield (8) , existirían dos problemas metodológicos y nosológicos fundamentales que llevarían a una interpretación errónea de los resultados de estos estudios. Primero, basar el diagnóstico de depresión en la presencia de síntomas inespecíficos y, segundo, y paradojalmente, en la situación epidemiológica descrita, la falta de referencia al contexto en el cual estos síntomas podrían ser reacciones esperables. ...
... Esto, porque los elementos subjetivos que podrían contaminar la labor diagnóstica son minimizados. Por otra parte, la utilización de estos instrumentos disminuiría el costo y el tiempo requerido por los estudios, incluyendo el entrenamiento y la experiencia clínica del entrevistador (8) . Si bien, este cambio aparentemente ha facilitado la investigación, junto con la confiabilidad y la comunicación interclínica, también parece acarrear ciertas dificultades: a). ...
Introducción:
En el contexto del análisis de las repercusiones psicológicas, asociadas a la pandemia del COVID-19, especial importancia han alcanzado los estudios que informan altas tasas de depresión en la población general.
Método:
Revisión crítica no sistemática de la literatura
Resultados:
Siguiendo a Horwitz y Wakefield, planteamos que estas investigaciones presentan problemas metodológicos derivados de la aplicación de un método diagnóstico basado en la identificación de síntomas inespecíficos y, en segundo lugar, que sus resultados se interpretan sin referencia al propio contexto epidemiológico en el cual estas manifestaciones podrían ser reacciones esperables.
Conclusiones:
Además de enfatizar un uso más riguroso de términos y conceptos de la especialidad, planteamos que es necesario rescatar la importancia del juicio clínico y de abordar el sufrimiento psíquico desde un enfoque más amplio como contrapeso a una creciente medicalización.
... For example, anxiety over public speaking that may well be a normal-range evolved human anxiety is categorized and treated as a mental disorder, "social anxiety disorder" (Wakefield et al. 2005). Intense sadness that is likely not pathological is sometimes misclassified as the disorder of major depression (Horwitz and Wakefield 2007;Wakefield et al. 2017). Difficulty adjusting one's sleep schedule to shift work that requires working at night and sleeping during the day challenges the normal circadian cycle, but such normal difficulties due to meeting social demands are categorized and treated as a mental disorder, "circadian rhythm sleepawake disorder, shift work type" (Wakefield in press). ...
... In the modern era, German physician Wilhelm Griesinger (1882), for example, asserted in his mid-nineteenth-century psychiatry textbook that mental disorders are always symptoms of brain diseases. More generally, psychological symptoms have historically often been analogized to psychological changes that accompany physical disorders, for example, psychotic depression was long characterized as "delirium without a fever" by analogy to the delusions people have during high fevers accompanying physical diseases (Horwitz and Wakefield 2007). ...
... As noted earlier, there is a certain amount of nonsense in psychiatric classification, and the diagnostic criteria are often overly inclusive, creating false-positive diagnoses that mislabel normal experiences as disorders (Wakefield 2015a), as in the inflated categories for depressive and anxiety disorders (Horwitz and Wakefield 2007, 2012, 2023Wakefield 2013Wakefield , 2022b. Some categories are likely entirely composed of nondisorders. ...
... Personality disorders fall in the middle: rather than being purely about distress or impersistence, they are about long-standing, maladaptive traits that cut across typical ways of relating to other people and oneself. This ambiguity has sparked ongoing controversies regarding their essence and how this essence is related both to psychiatric illnesses and character flaws [14]. Standards and values within a society have a strong influence on whether something is viewed as a character flaw or as a mental disorder. ...
... Typically, these do not involve distinct episodes or marked changes from baseline functioning. While causing interpersonal difficulties, they generally do not reach the threshold of clinical significance required for a psychiatric diagnosis [14]. For instance, chronic procrastination or having a habit of being judgmental may impede one's life personally or socially but would not be termed as psychiatric illnesses unless they were severe enough to meet specific diagnostic criteria. ...
This paper considers the fine line dividing psychiatric illnesses from character flaws: an integrative multidisciplinary perspective. Biological predisposition, and environmental and social factors are analyzed to show how these aspects contribute to the formation and manifestations of mental health issues as opposed to personality characteristics. The study challenges simplistic classifications by showing that what is behind human behavior and psychological states results from an intricate interplay of genetic inheritance with environmental influences. Our position is that while psychiatric illnesses are more biological in origin, based on specific diagnostic criteria, character flaws are more dependent on environmental factors and social constructs. This nuanced conceptualization has significant diagnostic, treatment, and societal implications regarding mental health and personality.
... No Brasil, o aumento do uso de psicotrópicos para sintomas associados ao luto, como tristeza e insônia, sobretudo em usuários da Atenção Primária à Saúde (APS) e a falta de treinamento especializado, levanta preocupações sobre a adequação desse tratamento e seus potenciais efeitos adversos (Horwitz;Wakefield, 2007;Frances, 2013;Rodrigues;Lima, 2021;Olfson, et al., 2014). ...
... No Brasil, o aumento do uso de psicotrópicos para sintomas associados ao luto, como tristeza e insônia, sobretudo em usuários da Atenção Primária à Saúde (APS) e a falta de treinamento especializado, levanta preocupações sobre a adequação desse tratamento e seus potenciais efeitos adversos (Horwitz;Wakefield, 2007;Frances, 2013;Rodrigues;Lima, 2021;Olfson, et al., 2014). ...
... In doing so, they imply that depression and 'normal' or 'healthy' distressing states are intrinsically or psychologically alike, and so cannot be told apart independent of aetiology. For instance, consider the title of Horwitz and Wakefield's (2007) polemic against the DSM: The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Davies (2016, p.293) similarly claims that a key reason for defending the Irrationality View is that divorcing depressive symptoms from their aetiology would leave one unable to "distinguish pathological depression from normal sadness." ...
... Although the depression/grief contrast is only implicit in the writings of some defenders of the Irrationality View, it is especially explicit inHorwitz and Wakefield (2007). ...
The received view about depression in the philosophical literature is that it is defined, in part, by epistemic irrationality. This status is undeserved. The received view does not fully reflect current clinical thinking and is motivated by an overly simplistic, if not false, account of depression’s phenomenal character. Equally attractive, if not more so, is a view that says depression can be instantiated either rationally or irrationally. This rival view faces challenges of its own: it appears to entail that there are situations when not being depressed is rationally sub-optimal and that resilience to, and healthy coping strategies for avoiding, depression can be rationally remiss. I criticise an existing reply to these challenges before motivating a better one from the perspective of epistemic consequentialism.
... In the context of mental disorder, it involves a wider variety of conditions (horizontal creep) and less severe problems (vertical creep) coming to be regarded as disorders. This semantic expansion has featured in critiques of diagnostic inflation (Frances, 2013), medicalization (Conrad and Slodden, 2013), pathologization (Brinkmann, 2016), and psychiatrization (Beeker et al., 2021;Horwitz and Wakefield, 2007). Research examining large historical text corpora has found evidence that anxiety, depression, and trauma have undergone both forms of concept creep in recent decades (e.g., Haslam et al., 2021;Xiao et al., 2023). ...
... The specter of these effects has been raised by critics of what has been variously dubbed diagnostic inflation, medicalization, pathologization, and psychiatrization (e.g., Beeker et al., 2021;Brinkmann, 2016;Conrad and Slodden, 2013;Frances, 2013;Horwitz and Wakefield, 2007). The common thread of these criticisms is that concepts of mental disorder have swelled and spread over time, with the result that behaviors and experiences previously considered "normal" have come to be defined as pathological or disordered. ...
Understanding why people identify themselves as having a mental disorder is crucial for making sense of recent rises in self-diagnosis and help-seeking. Previous studies have implicated factors such as levels of distress, mental health literacy, and stigma. Motivated by concept creep research, we tested whether self-diagnosis is also associated with the expansiveness of people's concepts of mental disorder. A nationally representative sample of 474 Americans completed measures of distress, impairment, mental health literacy, stigma, and newly validated concept breadth scales, in addition to current and lifetime mental disorder (both self- and professionally-diagnosed) and help-seeking. Structural equation modeling demonstrated that participants with broader concepts of disorder were more likely to self-diagnose and seek help, independent of distress and impairment, mental health literacy, and low stigma. Holding broader concepts also partially accounted for higher levels of self-diagnosis among younger and more liberal participants and predicted self-diagnosis independently of formal diagnosis. Implications for the surge in self-diagnosis and concerns about pathologization of everyday life are discussed.
... Lacking the concept of postpartum Kay will be emotionally recovered. Some would, therefore, argue that diagnosing a depressive episode in Kay would mean to medicalize a social or interpersonal problem, and that this would be unwarranted (Horwitz & Wakefield, 2012). ...
... In addition, social constructivist approaches to depression assume that the definition of mental disorders inherently depends on social practices and value judgments; proponents stress that mental disorders cannot be defined or identified without referring to social factors (Horwitz, 2012;van Riel, 2016). Horwitz and Wakefield (2012) argue that not considering the social context of a change in functioning may lead to the pathologizing of behavioral or emotional responses to stressful social situations. It seems that DP-apps, by neglecting the social context, risk misidentifying states as pathological that are norm-deviant, but otherwise unproblematic. ...
Smartphone apps might offer a low-threshold approach to the detection of mental health conditions, such as depression. Based on the gathering of ‘passive data,’ some apps generate a user’s ‘digital phenotype,’ compare it to those of users with clinically confirmed depression and issue a warning if a depressive episode is likely. These apps can, thus, serve as epistemic tools for affected users. From an ethical perspective, it is crucial to consider epistemic injustice to promote socially responsible innovations within digital mental healthcare. In cases of epistemic injustice, people are wronged specifically as epistemic agents, i.e., agents of the production and distribution of knowledge. We suggest that epistemic agency relies on different resource- and uptake-related preconditions which can be impacted by the functionality of passive self-tracking apps. We consider how this can lead to different forms of epistemic injustice (testimonial, hermeneutical, and contributory injustice) and analyze the influence of the apps’ use on epistemic practices on an individual level, in mental healthcare settings, and on the structural level.
... Jerome Wakefield first published his harmful dysfunction theory of mental disorder in a paper in the early 1990s (Wakefield, 1992). He has since explained, defended, and applied his theory to discussions of different mental disorders, often in collaboration with sociologist Allan Horwitz (e.g., Horwitz & Wakefield, 2007. He has also critically discussed new and emerging psychiatric diagnoses such as prolonged grief disorder (Wakefield, 2013). ...
... A noteworthy consequence of Wakefield's hybrid theory is that quite a few of psychiatry's existing diagnoses turn out to be ill founded, because they pathologize ordinary life problems by breaking down the distinction between psychopathology and everyday distress. Horwitz and Wakefield have thus argued that the diagnostic criteria for depression (Horwitz & Wakefield, 2007) and anxiety (Horwitz & Wakefield, 2012) are overinclusive and do not make possible a necessary distinction between common sadness and clinical depression, or between normal fear and pathological anxiety. The reason is that the dysfunction component has not been adequately identified in the psychiatric models that have conflated symptoms with diseases (Nesse, 2020). ...
A shared problem in psychology, psychiatry, and philosophy is how to define mental disorders. Various theories have been proposed, ranging from naturalism to social constructionism. In this article, I first briefly introduce the current landscape of such theories, before concentrating on one of the most influential approaches today: The harmful dysfunction theory developed by Jerome Wakefield. It claims that mental disorders are hybrid phenomena since they have a natural basis in dysfunctional mental mechanisms, but also a cultural component in the harm experienced by human beings. Although the theory is well thought through, I will raise a critical question: Is it possible to isolate mental mechanisms as naturally evolved from cultural factors? I will argue that it is not, but that the theory could still be helpful in an understanding of mental disorders, albeit on a new footing that does not operate with a natural and a cultural component as two separate factors. I argue that we need to develop a “naturecultural” approach to psychopathology that avoids mentalism, based on the fact that human beings are irreducibly persons.
... Yet, the expansion of psychiatric scope has not gone unnoticed or unchallenged. Scholars, researchers, patients, and their advocates have raised various critiques, expressing disagreement or advising caution against the increasing "psychiatrization" of daily experiences, emotions, and behaviors (Beeker et al., 2021;Horwitz & Wakefield, 2007;Paris, 2015). ...
This chapter examines the micropolitics of pathologization and depathologization in Chilean schools, focusing on ADHD diagnoses. Through ethnographic research in two schools, it explores how care intersects with medicalization, shaping the everyday lives of diagnosed children. While traditional critiques emphasize the pathologizing effects of medicalization, this study argues for a nuanced view that considers diagnosis as a “matter of care.” The research highlights how diagnoses function not just as labels but as tools that can both constrain and empower children. By contrasting the practices of two schools—one enforcing conformity and the other supporting individual needs—the chapter reveals the dual nature of diagnoses as both medical and care-oriented technologies. It concludes by advocating for a careful approach to diagnosis, recognizing its potential to foster inclusion while remaining cautious of its capacity to stigmatize. This analysis contributes to discussions on the ethics of care and the role of educational institutions in mental health.
... There are many challenges in the management of normal emotional responses to life experiences in the medical setting. Psychiatrists often rely on psychiatric diagnoses to lead treatment decisions and prescriptions (Horwitz & Wakefield, 2007). However, when clients are dealing with substantial life stressors, they may not meet the criteria for most psychiatric diagnoses beyond adjustment disorder. ...
Stress, an inevitable aspect of human existence, triggers complex physiological and behavioral responses aimed at maintaining internal equilibrium. It requires a multifaceted understanding encompassing its physiological, pathophysiological, and behavioral dimensions to inform effective treatment approaches. This narrative literature review attempts to understand the evolution of research on stress, from its historical roots to current physiological, pathophysiological, and conceptual understandings. Pathophysiological consequences of chronic stress, including cardiovascular disease and immune system dysregulation, highlight the need for comprehensive prevention and intervention strategies. The results demonstrate the importance of adopting a holistic approach to stress management, combining pharmacological interventions with psychological therapies such as cognitive-behavioral therapy and other third-wave approaches. For chronic stress, long-term strategies focusing on lifestyle modifications, social support, and coping skills enhancement are recommended, whereas acute stress may benefit from immediate pharmacological interventions to mitigate physiological arousal and promote relaxation. The review results also indicate the significance of the biopsychosocial framework in understanding stress by acknowledging its multifaceted nature, emphasizing the effectiveness and sustainability of diverse intervention strategies, and highlighting the role of societal factors in shaping stress experiences and treatment outcomes. Further research is warranted to clarify the mechanisms underlying stress responses and refine intervention strategies for optimal efficacy and sustainability.
... Forbes-Mewett and Sawyer, [19] noted that the policies on mental health in the Western world have prioritised the development of early detection, treatment and management programmes specifically for young adults. This is a result of concerns in a broader context of widespread and debated claims that poor mental health has been on the increase in the Western world [20,21]. Research has also shown that compared to home students, the prevalence of mental stress in international students is high [19] which has been closely linked to academic performance. ...
Background: In the last couple of years, the number of international students entering the United
... In these cases, the appearance of milder symptoms might signal a risk for more impaired functioning in the future. In addition, as Horwitz and Wakefield (2007) persuasively argue, the attribution of disorder to a cluster of depression symptoms is more warranted when the depressive symptoms appear out of the blue-for no apparent reason-or if there is a precipitant, the response is excessive and not in proportion to the trigger. ...
Conversations in Critical Psychiatry’ was an interview series led by Awais Aftab for Psychiatric Times from 2019 to 2022, exploring critical and philosophical perspectives in psychiatry and engaging with prominent commentators within and outside the profession who had made meaningful criticisms of the status quo. The series was well received and generated international interest with a multidisciplinary readership. This volume brings together an edited selection of interviews with new material, including a detailed introductory essay, ‘Psychiatry and the Critical Landscape’, new interviews, a new Foreword, and book reviews. The interviews cover a wide array of philosophical and scientific topics in an accessible manner without compromising scholarly rigour. The edited volume presents a sweeping overview of psychiatry’s relationship to critique, and Aftab offers a synthesis of themes encountered in critical and philosophical discussions around psychiatry. Mental health problems are complex, value-laden, and multidimensional. They require a pluralistic approach that takes into account their dimensional, developmental, and idiographic aspects. The volume makes the case for mainstream psychiatry to embrace the critical tradition and tackle the sociopolitical dimensions of madness, while urging critical psychiatry to engage in a process of self-critique and move towards a philosophically informed view of psychiatric science.
... Sadness and grief are very common climate emotions (e.g., Hickman et al. 2021;Benham and Hoerst 2024), but they often remain half-hidden due to disenfranchised grief (Doka 2020): any kind of profound sadness is difficult for the contemporary mainstream. Cultural norms in industrialized societies have very often disavowed sadness as a sign of weakness, commonly associating it with femininity (Greenspan 2004;Horwitz and Wakefield 2007). As a result, it is difficult for many individuals to display sadness in public or to even recognize their grief (e.g., Levine 2017;Beran 2024;Cunsolo and Landman 2017). ...
Climate change evokes many kinds of emotions, which have an impact on people's behavior. This article focuses on three major climate emotions-guilt, grief, and anger-and other closely related emotional phenomena, such as climate anxiety/distress. The article explores ways in which these emotions could be engaged with constructively in religious communities, with a certain emphasis on Christian, monotheistic, and Buddhist communities. These religious communities have certain special resources for engaging with guilt and grief, but they often have profound difficulty working with constructive anger. The ways in which these emotions can affect each other are probed, and the complex dynamics of climate guilt are given special attention. Based on the work of psychologists Tara Brach and Miriam Greenspan, a four-step method of engaging with these emotions is proposed and discussed: self-reflection, exploration of various forms of these emotions, contextualization, and creative application of various methods to channel the energies in these emotions. The article draws from interdisciplinary research on eco-emotions, religion and ecology studies, and psychology.
... Critics have argued that this rise in awareness and cultural attention has expanded our concepts of mental ill health. Some point to changes in official psychiatric classifications, contending that diagnostic inflation has led everyday anxiety and sadness to be pathologized as disorders [4,5] and that DSM-5 colonized large swathes of normality [6]. Others propose that social media [7], mental health awareness campaigns [8], and broad cultural shifts [9], rather than diagnostic systems themselves, are responsible for increasingly expansive concepts of mental illness. ...
Two experimental studies (Ns = 261, 684) investigated how diagnostic labels affect perceptions of people experiencing marginal levels of mental ill-health. These effects offer insight into the consequences of diagnostic “concept creep”, in which concepts of mental illness broaden to include less severe phenomena. The studies found consistent evidence that diagnostic labeling increases the perception that people experiencing marginal problems require professional treatment, and some evidence that it increases empathy towards them and support for affording them special allowances at work, school, and home. The studies also indicated that labels may reduce the control people are perceived to have over their problems and their likelihood of recovering from them. These findings point to the potential mixed blessings of broad diagnostic concepts and the cultural trends responsible for them. Expansive concepts may promote help-seeking, empathy, and support, but also undermine perceived agency and expectations that problems can be overcome.
... The term and framework are related to long-standing issues in grief and bereavement research, including an inquiry about various difficult forms of grief and the question about what kinds of grief count as clinically significant. Another often-used term is prolonged grief, and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) includes a description of prolonged grief disorder (for overviews and discussion, see Horwitz & Wakefield, 2007;Prigerson et al., 2022;Worden, 2018). ...
Ecological grief results from human-caused environmental changes. While it is a growing subject of study, research on the relationship between it and spirituality/religion remains scarce. This article explores the topic by focusing on the frameworks of religious coping and (complicated) spiritual grief. Religion and spirituality can be resources for coping with ecological grief, but there can also be difficulties which cause spiritual grief: crises about beliefs, estrangement from one’s spiritual community, and disruption in spiritual practice. The author proposes a new term for the combinations of ecological and spiritual grief: eco-spiritual grief. Frameworks of religious coping (the RCOPE) and spiritual grief (the Inventory of Complicated Spiritual Grief, ICSG) are analyzed in relation to ecological grief and eco-spiritual grief. The author argues that elements in these frameworks can be useful in relation to ecological grief and spirituality, but modifications should be made for this particular topic. Research about ecological grief should avoid individualizing tendencies, strong anthropocentrism, and a narrow focus on monotheism. Some items in the RCOPE and ICSG are especially relevant for monotheism, but they could be broadened to include other forms of spirituality. Themes for nuanced research about the matter are charted. The results are relevant for anyone who wants to explore the intersections of spirituality/religion and ecological grief, as well as theology and psychology, and they have special relevance for researchers and (pastoral) psychologists.
... Across the last 25 years, scholars have devoted increasing attention to the 'therapeutic turn' in contemporary societies. A range of high-profile publications has analysed the growing prominence of psychologically and psychotherapeutically informed discourses and practices in everyday life (Madsen, 2018;Rose, 1998), the psychologisation and commodification of human emotions (Horwitz and Wakefield, 2007;Illouz, 2008), the development and everyday uses of hybrid, part psychological part religious or spiritual, therapeutic discourses (Purser, 2019;Salmenniemi, 2019), the concomitant commercial success of the 'happiness industry' (Davies, 2015), and the implication of therapeutic discourses and practices in the social organisation of power and governance (Klein and Mills, 2017;Yang, 2013Yang, , 2018. Theorising the intersections of technological change, scientific developments in psychology and the neurosciences, and the success of the latter in furnishing publics and policymakers with plausible explanations of personal troubles and public issues, research has moreover pointed to profound and accelerating transformations of subjectivation technologies, self-identities, and social relationships (Binkley, 2011;Rose, 2019). ...
... 373) The key to Wakefield's analysis is that its two criteria complement and constrain each other: the natural criterion -asking for the presence of a dysfunction-aims to prevent the undue pathologization of mental conditions merely because they are disvalued, while the harm criterion aims to prevent the classification of every single departure from the natural order as a mental disorder. Indeed, the HDA has been employed to criticize and attempt to contain the diagnostic expansion that has taken place since the introduction of the DSM-III in 1980 (Horwitz and Wakefield 2007;Wakefield and Horwitz 2010;2016). Interestingly, Wakefield and Horwitz (2010) have commented on the expansion of Post-Traumatic Stress Disorder (PTSD) -which is particularly relevant to our paper because PTSD is arguably the current diagnosis that most closely resembles KZ-Syndrom, the psychiatric diagnosis usually given to Holocaust survivors. ...
This paper addresses the Harmful Dysfunction Analysis of mental disorder. We argue that some mental conditions meet both of its criteria —the dysfunction criterion and the harm criterion— and yet should not count as mental disorders because of their value. We contend that the harm criterion, by taking harm as a proxy for disvalue, is an inadequate normative criterion in these cases. Therefore, further ethical considerations should be included as a normative criterion. To illustrate our view, we draw on the experience and reflections of Jean Améry, a philosopher and Holocaust survivor who resisted the diagnosis of KZ-Syndrom.
... The DSM, therefore, makes an error by classifying such depressive reactions as disorders. It is only when depression occurs out of the blue, or does not resolve once the stressor is no longer active, or is accompanied by some specific features (such as suicidal ideation, psychosis, or psychomotor retardation), that it becomes reasonable for us to assume that mechanisms designed to regulate sadness in response to loss and adversity have failed 55,56 . ...
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important – psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence‐based and values‐based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi‐level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of “difference‐makers”, as well as a consideration of “lived experience” in both research and practice. Third, in considering a range of questions about the brain‐mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain‐mind as embodied, embedded and enactive offers a conceptual approach to the mind‐body problem that facilitates the clinical integration of advances in both cognitive‐affective neuroscience and phenomenological psychopathology.
... А. Горвіц та Дж. Вейкфілд стверджували, що психіатрія перетворила повсякденний смуток на серйозну депресію [9], а звичайну сором'язливість на соціофобію [10]. У подальшому вони поширили свій аналіз на тривожні розлади, стверджуючи, що DSM зазвичай неправильно діагностує адаптивну тривогу як клінічні стани [11]. ...
У статті проаналізовано семантичне розмаїття та психологічне сприйняття терміну «тривога», визначені суб’єктивні уявлення про тривогу та об’єктивна багаторівневість цього стану. Подана у статті інформація свідчить про те, що на сьогодні в наукових дослідженнях представлена термінологічна розмитість терміну «тривога». Зазначено, що дефініція поняття «тривога» може мати різні сенси та інтерпретації у різних контекстах та для різних людей. Вивчення образу тривоги проводилось у контексті наративного підходу на прикладі суб’єктивного персоніфікованого образу. Аналіз отриманих результатів дозволив зробити деякі узагальнюючі висновки. Встановлено, що розуміння тривоги, який можна назвати класичним (очікування загрози, небезпеки для організму та особистості; відчуття невизначеності, нерозуміння джерела цієї загрози) не знайшло повне відображення серед отриманих суб’єктивних описів. Під час проведеного дослідження виявлена розбіжність між зовнішніми проявами людини (поведінка, зовнішній вигляд) та її внутрішніми переживаннями (емоційна нестабільність, напруга). При цьому встановлено, що стан тривоги супроводжується низькою стресостійкістю, імпульсивністю, невпевненістю в собі, соціальною тривожністю; спостерігається вплив тривоги на різні сфери функціонування людини – емоційну, поведінкову, соціальну, психосоматичну; акцентується увага на хронічному, тривалому характері тривожного стану, що заважає людині реалізувати свій потенціал. Зазначено, що тривога існує на кількох рівнях: індивідуально-психологічному – емоційна нестабільність, невпевненість, замкнутість, сприйняття світу як загрози; поведінковому – уникнення контактів, ізоляція, емоційні розлади в спілкуванні; соціальному – відсутність підтримки з боку середовища, недоброзичливість, критика; інтерперсональному – відсутність взаєморозуміння і «діалогу» між особистістю і соціумом. Дослідження змістовного навантаження терміну «тривога» дасть змогу краще зрозуміти цей спектр значень та конотацій і в подальшому використати його у системі психокорекційної практики.
... This type of collaboration should be encouraged as a team approach to addressing student issues is highly effective (Westefeld et al., 2005). It must be stressed that not all spiritual issues, such as certain expressions of meaninglessness, are indicative of a mental illness (Eneman et al., 2019;Horwitz & Wakefield, 2007). Accordingly, it would not be good practice to send every student who expresses a lack of meaning to a mental health professional on campus. ...
... Medicine is depicted to be more willing to take increasing responsibility for treating problems clinically that once were viewed as normal, including, in Conrad's view, natural outcomes such as short stature and male baldness, among others. This situation is seen in psychiatry when normal sadness and grief are defined as a depressive disorder and hyperactivity in children as an attention-deficit/ hyperactivity disorder (ADHD) (Horwitz 2011(Horwitz , 2021(Horwitz , 2022Horwitz and Wakefield 2007). ...
... It has been argued that depression can be adaptive in certain circumstances. For example, when there is a loss of important goods in life, momentarily disengaging from one's environment can be key to adjusting to the new condition, and eventually better face a changed environment (Andrews & Thomson, 2009;Del Giudice, 2018;Horwitz & Wakefield, 2007;Nesse, 2000). If the content of a delusion represents the subject's circumstances as being better than they really are, then this adaptation could be lost. ...
... These are the most clear-cut cases, but even the most common of all diagnoses, major depression, is a problem, as it covers a very broad set of symptoms ranging from lifeendangering melancholia to "garden-variety" changes in mood after losses (Horwitz & Wakefield, 2007). These difficulties have been recently underlined by the addition of a new diagnosis of pathological grief in the DSM-5-TR. ...
Ten years after the adoption of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and with the recent publication of a text revision (DSM-5-TR), the limitations of this system for diagnostic classification of mental disorders remain. However, given that the alternatives that have been proposed have their own serious problems, DSM is likely to be retained for some time to come. It is generally accepted by courts as reflecting expert opinion. This paper highlights problems with the reliability and validity of DSM diagnoses, the tendency to overdiagnosis of certain categories, leading to problems with the use of these criteria in the courts, both in criminal and civil laws. The review argues that the categories in the DSM should be considered heuristics, not as disease entities equivalent to medical diagnoses supported by biomarkers and endophenotypes.
... The scientific standing of and prospects for progress in psychiatry and whatever other areas study psychopathology allegedly depend on the answer. Horwitz and Wakefield's (2007) attack on current DSM classifications of depression proceed in roughly this way. ...
Scholars question the extent to which current psychiatric classification systems are inadequate for diagnosis, treatment, and research of mental disorders and offer suggestions for improvement.
In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM), asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly to the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications.
The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as “oppositional defiance disorder” and pathological gambling.
Contributors
George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar
... Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) gibi yeni "bozuklukların" teşhisleri çok kısa bir süre içinde muazzam bir artış göstermiştir (Timimi, 2003). Mutsuzluk ve utangaçlık gibi duygular, depresyon ve sosyal fobi olarak patolojikleştirilirken psikiyatrik bozukluk ve sıklıkla stres olarak etiketlenen şey arasındaki ayrım giderek belirsizleşmiştir (Horwitz & Wakefield, 2007). Dolayısıyla insan hakları alanındaki gelişmelerle birlikte her ne kadar deliliğin tecridi ortadan kalkmaya başlasa da kontrol ve kısıtlanma uygulamaları terapötik uygulamalar aracılığıyla sürdürülmüştür. ...
Bu çalışma, deliliğin kültürel temsilini bir sosyal içerme meselesi olarak sorunsallaştırarak yerli televizyon anlatılarında delilik söylemlerine odaklanmaktadır. Çalışma, üretilen söylemlerin yaşanmış deneyimi olan kişileri ne dereceye kadar failliklerini ve deneyimin kolektif boyutlarını öne çıkaracak şekilde güçlendiren veya kişileri nesneleştirme ve deneyimi bireyselleştirme yoluyla güçsüzleştiren mesajlar ürettiğini incelemektedir. Deliliğe dair popüler anlatılar, deliliği bir hastalık veya anomalite olarak gören tıbbi söylemin hakimiyetindedir. Tıbbi perspektiften çerçevelenen bu temsiller, deneyimi bireyselleştirdiği ve karmaşıklığını görünmez kıldığı gerekçesiyle deliliği sosyokültürel perspektiften incelemeyi öneren disiplinlerce eleştirilmiştir. Literatür, son yıllarda televizyon ve sinema anlatılarında deliliğin tıbbi temsillerinin yanı sıra deneyimin farklı katmanlarını ortaya çıkaran sunumlarının da belirmeye başladığını göstermektedir. Bu çalışma, bu verilere dayanarak yerli televizyon anlatılarında delilik temsillerinin çeşitlenip çeşitlenmediğini incelemek için son yılların en popüler televizyon dizilerinden biri olan “Kırmızı Oda”ya odaklanmaktadır. Çalışma engellilik çalışmalarının sunduğu eleştirel perspektiften yararlanarak Kırmızı Oda dizisini Eleştirel Söylem Analizi yöntemiyle çözümlemektedir. Bulgular, Kırmızı Oda dizisinin klişelerin ötesinde bazı alternatif söylemler sunmasına rağmen deliliği baskın bir şekilde hastalık, anomalite ve kişisel bir trajedi olarak çerçeveleyerek hakim söylemleri yeniden ürettiğini göstermektedir. Çalışma, engellilik çalışmalarının eleştirel perspektifini kullanarak, delilik hakkında üretilen popüler anlamları, ayrımcılık, erişilebilirlik ve savunuculuk temaları ile ilişki içinde incelemeyi amaçlamaktadır.
In this paper I investigate whether "depression" is a vague concept in psychiatry and the consequence of this for philosophers who would like to contribute to the elaboration of an objective definition of it. Assuming that this concept aims at referring to a mental disorder, I show that the current definition of "depression" is controverted: we lack a unified scientific model of it, so a consensual objective definition of it. Actually there is its clinical definition in the nosology but this definition consisting in a list of criteria is accused of being unsufficient to draw a sharp limit between normal and pathological cases. Hence vague boundaries of the extension of the concept as referring to a mental disorder. Moreover its clinical criteria, as descriptive and non distinctive, need to be interpreted by clinicians in a way that remains implicit and contextually variable, and they can apply to completely different clinical pictures. I interpret this as a variability of the descriptive definition of "depression", so that its conditions of use depend on the context: it may apply to two cases that have nothing in common except similarities. Applying the famous wittgensteinien characterization of the concept of "game" to "depression", I argue that this vagueness can be interpreted as showing that "depression" works as cluster of concepts whose instances only share "family resemblances". From this philosophical interpretation I draw the conclusion that the "vagueness problem" of depression at a theoretical level does not make the use of this concept problematic, since this in practice use is always related to a context conferring a specific meaning to the concept. I conclude that philosophers should not look in the clinical sciences for an objective definition of depression as a list of necessary and sufficient conditions pointing at its essence: they should rather either describe the family resemblances between the different versions of this concept, or try to stipulate a definition providing it sharp boundaries. A stipulative definition would be motivated by a pragmatic purpose while not delegitimizing other uses that could be made of the concept. Such a purpose could be to target only medically relevant conditions; actually such conditions do not necessarily have to be conceived of as conditions where there is a disease understood as pathological process that we could objectively define, but they can be seen as conditions that we have medical means to take care of with more benefits than disadvantages.
This book offers a comprehensive examination of trust and its relationship with mental illness and wellbeing. Engaging with a broad range of mental health research, theory, and practice through various transdisciplinary theoretical models of trust, this book highlights the social and family contexts surrounding the making and breaking of trust and mental health. It examines various sociological conceptual and theoretical frameworks of risk and trust while also engaging with evolutionary perspectives on the human need for cooperation and trust. The author describes how, in a world of
constant connectivity, the drawing of boundaries assigns some people as strangers, using stigma as a form of power. The book concludes by considering the future of mental health and where trust-building may be possible. Each chapter is interspersed
with observations and insights from the author’s personal research covering many populations, communities, and issues over several decades. Drawing on a wide range of interdisciplinary literature, the book will be of interest to mental health practitioners, researchers, and scholars interested in the psychosocial aspects of mental illness and stigma.
‘Professor Leavey’s book throws light on a far too long neglected factor with a powerful impact on structures of society and the management of problems ranging from care for people with diseases to the continuation of war or the maintenance of peace’.
– Professor Norman Sartorius (MD, PhD, FRCPsych) is a leading
international expert in psychiatry. He has been the President of the World Psychiatric Association and of the European Psychiatric Association, and Director of the Mental health Division of the World Health Organization
‘This remarkable book takes the concepts of trust and mental health and moves them around each other as if they were reciprocal moons of our planetary existence. Trust is a concept perfectly central to individuals, families, communities and society. For almost a thousand years the idea of ‘trust’ has grown from the ancient roots of meaning that include: integrity, alliance, faithful, steadfast, shelter, safety,
hope, and consolation. This book is a fascinating tour-de-force which gazes at trust and hope, and their inversions, from multiple perspectives, and asks how we can strengthen trust and hope and mental health in the future’.
– Sir Graham Thornicroft is Emeritus Professor of Community Psychiatry at King’s College London. He was Knighted in 2017 for services to mental health; Graham has authored over 30 books and written over 670 peer-reviewed scientific papers, shaping global mental health policies.
Online depression forums are emerging platforms of the e-mental health sector. Exploring the ongoing lay discourses has the potential of better understanding first-person accounts of depression and developing new technologies of health promotion. Based on these premises, the article analyzes the hypothesis concerning the discursive transformation of sadness into depression (elaborated by Horwitz and Wakefield), that is the ‘medicalization’ and ‘psychologization’ of social suffering. While these generic theoretical diagnoses describe a long-term discursive transformation, they rely on a limited methodological toolset as they are based on the retrospective examination of key discursive sources (such as the consequent generations of DSM). While these analyses certainly have a heuristic value, their conclusions require further empirical testing. Our analysis focuses on the largest English-language online depression forums, while relying on word-embedding modelling. Our results do not simply reinforce or falsify the original hypotheses; instead, they imply a more complex model: on manifest level, the medicalization or psychologization of social suffering is detectable only partially; however, on a latent level, many of these solutions still follow either an instrumental-medical or a supportive-psychological logic. Based on these results, the reinforcement of online forums hosting social suffering discourses of depression is suggested.
Discourse is the very heart of universal human society and its cultural diversity. To make sense of the meaningless unspoken world around us and inside us, we give meaning to the sense data we perceive, translating them into experience. But meaning is not fixed. We discourse participants negotiate the meaning of words, text segments and whole texts, always reserving the right to disagree. Thus it is discourse that drives our creativity. Or is it? Do not the recent Large Language Models, fed with discourse and trained to say the right things, demonstrate that they can perfectly emulate human utterances? Are we in charge of what we say or are we just the mouthpiece of discourse? Because meaning is not fixed, utterances must be interpreted. The quantitative approach of corpus linguistics is no more than a heuristic tool. Even if there will never be a true or final interpretation, it is the art and craft of hermeneutics that can make sense of what has been said. Exploring discourse as a fabric of intertextual links, interpretive linguistics takes account of the diachronic dimension of discourse. This is how linguistics finds its purpose at the centre of the social and human sciences.
While understandings of the nature and scope of spirituality vary, it is nevertheless clear that spirituality, however understood, is not only disrupted by bereavement but can also be a resource for living with bereavement. The extent to which bereavement models take spiritual need and spiritual resources into account varies according to the assumptions and emphases of the disciplinary framework in which each model is based.
In this chapter, we discuss how the perspective provided by a spiritual care approach both complements and critiques current approaches to bereavement care; and how bereavement care might incorporate and contribute to spiritual care. We suggest that a spiritual perspective can hold together the insights offered by diverse bereavement theories, provide perspective on the importance and relevance of clinical interventions, and suggest further strategies to complement those currently recognised and funded (usually) through health services.
We also discuss the extent to which bereavement theories have been shaped by data from selected populations and show how paying attention to the ways bereavement is experienced in society in general shifts the focus of care away from professional interventions towards support provided in the community. Our contention in this chapter is that the social aspects of bereavement are the least developed in most bereavement theories and therapies, and that a public health approach can restore a more-nuanced social aspect that also accommodates spiritual aspects through their social expression. This public health approach needs to be grounded in the ecological perspective exemplified in compassionate communities’ strategies. In such a framework, spiritual care can be provided implicitly as well as explicitly, so that spiritual care does not need to be initiated alongside debates about whether a spiritual care framework applies to all, or just some, people.
Psychiatric language and concepts, and the norms they embed, have come to influence more and more areas of our daily lives. This has recently been described as a feature of the ‘psychiatrization of society.’ This paper looks at one aspect of psychiatrization that is still little studied in the literature: the psychiatrization of our emotional lives. The paper develops an extended account of emotion pathologizing as a form of affective injustice that is related to psychiatrization and that specifically harms psychopathologized people, i.e., people who are socially perceived to be mentally ill. After introducing an initial account of emotion pathologizing as articulated in Pismenny et al. (2024), we extend the account by demonstrating how processes and practices of emotion pathologizing are informed by (1) the dominant biomedical approach to psychiatry and (2) sanism, a system of discrimination and oppression that disadvantages people who have received a psychiatric diagnosis, or are perceived as in need of psychiatric treatment. We then argue that emotion pathologizing can manifest as an affect-related hermeneutical injustice that disadvantages psychopathologized individuals by unfairly constraining how they make sense of and understand their own emotional experiences.
Psychiatric language and concepts, and the norms they embed, have come to influence more and more areas of our daily lives. This has recently been described as a feature still little studied in the literature: the psychiatrization of our emotional lives. The paper develops an extended account of emotion pathologizing as a form of affective injustice that is related to psychiatrization and that specifically harms psychopathologized people, i.e., people who are socially perceived to be mentally ill. After introducing an initial account of emotion pathologizing, as articulated in Pismenny et al. (2024), we extend the account by demonstrating how processes and practices of emotion pathologizing are informed by 1) the dominant biomedical approach to psychiatry and 2) sanism, a system of discrimination and oppression that disadvantages people who have received a psychiatric diagnosis, or are perceived as in need of psychiatric treatment. We then argue that emotion pathologizing can manifest as an affect-related hermeneutical injustice that disadvantages psychopathologized individuals by unfairly constraining how they make sense of and understand their own emotional experiences. 8962 words, excluding bibliography
The zeitgeist of contemporary psychiatry is reflected in a move toward a neurobiological model of psychopathology. Yet there is insufficient knowledge to develop a classification of mental disorders based on neuroscience, and diagnosis continues to be based on observable phenomena, not endophenotypes. The problem is illustrated by the phenomenon of affective instability (AI). This symptom has been assumed to lie in a bipolar spectrum but is more closely linked to borderline personality disorder (BPD), a complex multidimensional diagnosis in which unstable mood is only one feature. This problem demonstrates the need for careful phenomenological study of symptoms, as opposed to assumptions about diagnostic spectra based on superficial similarities.
En los últimos años, en territorios muy diversos de la filosofía y las humanidades, se ha vuelto a plantear, con ímpetu renovado, el problema del “sentir” en términos no dualistas. En este marco, los fenomenólogos Matthew Ratcliffe y Thomas Fuchs –entre otrxs– se han abocado al problema de la depresión, avanzando hacia una comprensión más profunda de lo anímico y lo afectivo de un modo que le debe mucho a Merleau-Ponty y su trabajo sobre el problema del cuerpo y los sentimientos. Sin embargo, en la medida en que estos autores suelen refrendar las definiciones vigentes de la psiquiatría convencional, tomándolas como punto de partida, terminan traicionando lo que es, a mi entender, la riqueza principal del enfoque fenomenológico de raigambre merleau-pontiana: entender a los sentimientos no como estados internos al sujeto, ubicados en su mente (ni en su cerebro-mente), sino como siempre situados en un mundo, que se nos revela como un mundo con sentido según nuestra existencia, experiencia y orientación corporales. Retomando también los aportes del giro afectivo crítico –con autorxs como Sara Ahmed y Ann Cvetkovich–, este artículo se propone pensar la depresión no en los términos de una fenomenología de la enfermedad, sino en el marco de una fenomenología del sentir.
This book provides a cutting-edge overview of emotion science from an evolutionary perspective. Part 1 outlines different ways of approaching the study of emotion; Part 2 covers specific emotions from an evolutionary perspective; Part 3 discusses the role of emotions in a variety of life domains; and Part 4 explores the relationship between emotions and psychological disorders. Experts from a number of different disciplines—psychology, biology, anthropology, psychiatry, and more—tackle a variety of “how” (proximate) and “why” (ultimate) questions about the function of emotions in humans and nonhuman animals, how emotions work, and their place in human life. This volume documents the explosion of knowledge in emotion science over the last few decades, outlines important areas of future research, and highlights key questions that have yet to be answered.
This book is authored in Persian language in four volumes, each dedicated to a specific crisis. The third volume is On boredom based on five articles with personal discourse on the matter.
Research investigating whether depression is an adaptation or a disorder has been hindered by the lack of an experimental paradigm that can test causal relationships. Moreover, studies attempting to induce the syndrome often fail to capture the suite of feelings, thoughts, and behaviors that characterize depression. An experimental paradigm for triggering depressive symptoms can improve our etiological understanding of the syndrome. The present study attempts to induce core symptoms of depression, particularly those related to rumination, in a healthy, nonclinical sample through a controlled social experiment. These symptoms are sad or depressed mood, anhedonia, feelings of worthlessness or guilt, and difficulty concentrating. One hundred and thirty-four undergraduate students were randomly assigned to either an exclusion (E) or control (C) group. Participants in the exclusion group were exposed to a modified Cyberball paradigm, designed to make them feel socially excluded, followed by a dual-interference task to assess whether their exclusion interfered with their working memory. Excluded participants: (a) self-reported a significant increase in sadness and decrease in happiness, but not anxiety or calmness; (b) scored significantly higher in four of five variables related to depressive rumination; and (c) performed significantly worse on a dual-interference task, suggesting an impaired ability to concentrate.
Conceptualisations of grief have transformed significantly in recent decades, from an experience accepted and expressed in community spaces to a diagnosable clinical phenomenon. Narratives of this transformation tend to focus on grief’s relationship to major depression, or on recent nosological changes. This paper examines the possibility of a new narrative for medicalisation by grounding in the networks of language and power created around ‘grief’ through a critical discourse analysis of psy‐discipline articles ( n = 70) published between 1975 and 1995. Focusing on shifts in definitions of, methods used to approach, and rationales motivating study of the experience, it posits that the psy‐disciplines exerted exclusive expertise over grief decades before its creation as a diagnosis. By reconceptualising grief in the terms of psy‐specific symptoms and functional performance and by approaching it with the decontextualising and interventionist methods of an increasingly scientific psy‐discipline, the psy‐community medicalised grief between 1975 and 1995. Identifying neoliberal and other cultural influences shaping this process of medical construction and reconsidering narratives of grief’s history mindful of the powers exerted in medicalisation, this paper establishes that these moments played a critical role in the development of the present’s grief.
In this article, I side with those who argue that the debate about the definition of “disease” should be reoriented from the question “what is disease” to the question of what it should be. However, I ground my argument on the rejection of the naturalist approach to define disease and the adoption of a normativist approach, according to which the concept of disease is normative and value-laden. Based on this normativist approach, I defend two main theses: (1) that conceptual analysis is not the right method to define disease and that conceptual engineering should be the preferred method and (2) that the method of conceptual engineering should be implemented following the principles of Alexandrova’s account of social objectivity in the context of the definition of disease.
The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief—an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry.
The disease debate in philosophy of medicine has traditionally been billed as a debate over the correct conceptual analysis of the term “disease.” This paper argues that although the debate’s participants overwhelmingly claim to be in the business of conceptual analysis, they do not tend to argue as if this is the case. In particular, they often show a puzzling disregard for key parameters such as precise terminology, linguistic community, and actual usage. This prima facie strange feature of the debate points to an interesting and potentially instructive hypothesis: the disease debate makes little sense within the paradigm of conceptual analysis but makes good sense on the assumption that pathology is a real kind.
Flexible ionic conductive electrodes, as a fundamental component for electrical signal transmission, play a crucial role in skin-surface electronic devices. Developing a skin-seamlessly electrode that can effectively capture long-term, artifacts-free, and high-quality electrophysiological signals, remains a challenge. Herein, we report an ultra-thin and dry electrode consisting of deep eutectic solvent (DES) and zwitterions (CEAB), which exhibit signi cantly lower reactance and noise in both static and dynamic monitoring compared to standard Ag/AgCl gel electrodes. Our electrodes have skin-like mechanical properties (strain-rigidity relationship and exibility), outstanding adhesion, and high electrical conductivity. Consequently, they excel in consistently capturing high-quality epidermal biopotential signals, such as the electrocardiogram (ECG), electromyogram (EMG), and electroencephalogram (EEG) signals. Furthermore, we demonstrate the promising potential of the electrodes in clinical applications by effectively distinguishing aberrant EEG signals associated with depressive patients. Meanwhile, through the integration of CEAB electrodes with digital processing and advanced algorithms, valid gesture control of arti cial limbs based on EMG signals is achieved, highlighting its capacity to signi cantly enhance human-machine interaction.
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