“Filled with insights into the social, historical, and economic forces responsible for the overmedicalization of human unhappiness and distress.” —George Graham, Metapsychology In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior. “Thought-provoking and important . . . Drawing on and consolidating the ideas of a range of authors, Horwitz challenges the existing use of the term mental illness and the psychiatric ideas and practices on which this usage is based . . . Horwitz enters this controversial territory with confidence, conviction, and clarity.” —Joan Busfield, American Journal of Sociology “Horwitz properly identifies the financial incentives that urge therapists and drug companies to proliferate psychiatric diagnostic categories. He correctly identifies the stranglehold that psychiatric diagnosis has on research funding in mental health. Above all, he provides a sorely needed counterpoint to the most strident advocates of disease-model psychiatry.” —Mark Sullivan, Journal of the American Medical Association “Horwitz makes at least two major contributions to our understanding of mental disorders. First, he eloquently draws on evidence from the biological and social sciences to create a balanced, integrative approach to the study of mental disorders. Second, in accomplishing the first contribution, he provides a fascinating history of the study and treatment of mental disorders . . . from early asylum work to the rise of modern biological psychiatry.”— Debra Umberson, Quarterly Review of Biology

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 necessitate 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.

A comprehensive history of PTSD. Post-traumatic stress disorder—and its predecessor diagnoses, including soldier’s heart, railroad spine, and shell shock—was recognized as a psychiatric disorder in the latter part of the nineteenth century. The psychic impacts of train crashes, wars, and sexual shocks among children first drew psychiatric attention. Later, enormous numbers of soldiers suffering from battlefield traumas returned from the world wars. It was not until the 1980s that PTSD became a formal diagnosis, in part to recognize the intense psychic suffering of Vietnam War veterans and women with trauma-related personality disorders. PTSD now occupies a dominant place in not only the mental health professions but also major social institutions and mainstream culture, making it the signature mental disorder of the early twenty-first century. In PTSD, Allan V. Horwitz traces the fluctuations in definitions of and responses to traumatic psychic conditions. Arguing that PTSD, perhaps more than any other diagnostic category, is a lens for showing major historical changes in conceptions of mental illness, he surveys the conditions most likely to produce traumas, the results of those traumas, and how to evaluate the claims of trauma victims. Illuminating a number of central issues about psychic disturbances more generally—including the relative importance of external stressors and internal vulnerabilities in causing mental illness, the benefits and costs of mental illness labels, and the influence of gender on expressions of mental disturbance—PTSD is a compact yet comprehensive survey. The book will appeal to diverse audiences, including the educated public, students across the psychological and social sciences, and trauma victims who are interested in socio-historical approaches to their condition. Praise for Allan V. Horwitz’s Anxiety: A Short History “The definitive overview of the history of anxiety.”—Bulletin of the History of Medicine “A lucid, erudite and brisk intellectual history driven by a clear and persuasive central argument.”—Social History of Medicine “An enlightening tour of anxiety, set at a sensible pace, with an exceptional scholar and writer leading the way.”—Library Journal

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.

The first comprehensive history of "psychiatry's bible"—the Diagnostic and Statistical Manual of Mental Disorders. Over the past seventy years, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, has evolved from a virtually unknown and little-used pamphlet to an imposing and comprehensive compendium of mental disorder. Its nearly 300 conditions have become the touchstones for the diagnoses that patients receive, students are taught, researchers study, insurers reimburse, and drug companies promote. Although the manual is portrayed as an authoritative corpus of psychiatric knowledge, it is a product of intense political conflicts, dissension, and factionalism. The manual results from struggles among psychiatric researchers and clinicians, different mental health professions, and a variety of patient, familial, feminist, gay, and veterans' interest groups. The DSM is fundamentally a social document that both reflects and shapes the professional, economic, and cultural forces associated with its use. In DSM, Allan V. Horwitz examines how the manual, known colloquially as "psychiatry's bible," has been at the center of thinking about mental health in the United States since its original publication in 1952. The first book to examine its entire history, this volume draws on both archival sources and the literature on modern psychiatry to show how the history of the DSM is more a story of the growing social importance of psychiatric diagnoses than of increasing knowledge about the nature of mental disorder. Despite attempts to replace it, Horwitz argues that the DSM persists because its diagnostic entities are closely intertwined with too many interests that benefit from them. This comprehensive treatment should appeal to not only specialists but also anyone who is interested in how diagnoses of mental illness have evolved over the past seven decades—from unwanted and often imposed labels to resources that lead to valued mental health treatments and social services.

Fears, phobias, neuroses, and anxiety disorders from ancient times to the present. More people today report feeling anxious than ever before—even while living in relatively safe and prosperous modern societies. Almost one in five people experiences an anxiety disorder each year, and more than a quarter of the population admits to an anxiety condition at some point in their lives. Here Allan V. Horwitz, a sociologist of mental illness and mental health, narrates how this condition has been experienced, understood, and treated through the ages—from Hippocrates, through Freud, to today. Anxiety is rooted in an ancient part of the brain, and our ability to be anxious is inherited from species far more ancient than humans. Anxiety is often adaptive: it enables us to respond to threats. But when normal fear yields to what psychiatry categorizes as anxiety disorders, it becomes maladaptive. As Horwitz explores the history and multiple identities of anxiety—melancholia, nerves, neuroses, phobias, and so on—it becomes clear that every age has had its own anxieties and that culture plays a role in shaping how anxiety is expressed.

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.

Since the earliest medical, philosophical, and literary texts in ancient civilizations, madness has posed some basic issues: how to separate sanity from insanity, to distinguish mental and bodily illnesses, and to specify the variety of internal and external forces that lead people to become mentally ill. This book explores the answers to these questions that have emerged over time and concludes that current portrayals are not much improved compared to those that emerged thousands of years ago. The puzzles that madness presents are likely to remain unresolved for the foreseeable future and perhaps forever.

The fascinating and controversial history of personality disorders. The concept of personality disorders rose to prominence in the early twentieth century and has consistently caused controversy among psychiatrists, psychologists, and social scientists. In Personality Disorders, Allan V. Horwitz traces the evolution of defining these disorders and the historical dilemmas of attempting to mold them into traditional medical conceptions of disorder. Using the Diagnostic and Statistical Manual of Mental Disorders, or DSM, as a guide, Horwitz explores the group of conditions that make up personality disorders and considers when they have been tied to or separated from other types of mental illnesses. He also examines how these disorders have often entailed negative moral and cultural evaluations more focused on perceived social deviance than on actual medical conditions. Deep conflicts exist in a variety of disciplines in determining the nature of these disorders. During the twentieth century, a particularly sharp division arose between researchers who study personality disorders and the clinicians who treat them. Because researchers strive to develop general laws and clinicians attempt to understand individuals' specific problems, their values, methods, and goals often conflict. Synthesizing historical and contemporary scholarship, Horwitz examines controversies over the definitions and diagnoses of personality disorders and how the perception of these illnesses has changed over time.