Abstract
This article examines the historiography of depression, with an eye to illuminating wider issues in the social study of psychiatry and depression. It argues that the advent of Prozac caused notable shifts in how scholars in the looked at depression. Far from solidifying the medical status of depression and psychiatry’s treatment of it, the spread of pill-oriented depression treatment strengthened social researchers’ emphasis on psychiatry’s social nature. The article further argues that a depiction of psychiatry as mainly a social phenomenon both unduly diminishes its status as medicine, and implicitly underestimates the social in the rest of medicine. This matters if people can benefit from psychiatric treatment. Put another way, if people taking psychiatric medications are indeed ill, and taking medicines that can help them, social analysis should acknowledge this, even as it rightly investigates psychiatry as embedded in social and cultural contexts, as all of medicine is. Doing so means treating psychiatry, whatever its limitations, as a kind of medicine, not as a special case.
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Notes
This article uses and expands on ideas and material developed in a book recently published by the author (Sadowsky 2021). The article, though, focusses on historiography, which was mostly left out of the book. The author states that there is no conflict of interest. I would like to thank Awais Aftab, Jeremy Greene, and Anne Helene Kveim Lie for their comments on drafts.
In an essay that was influential in history of medicine, Charles Rosenberg’s argued for the word “framing” over “social construction” of disease, because the term “social construction” connotes too much arbitrariness. “Social construction” thus might be best reserved for certain kinds of sickness, such as those that lack a well-understood biological basis, or those that carry a great deal of stigma. Many mental illnesses would qualify by both of those criteria (Rosenberg 1992). One risk in this approach is insufficient attention to the “constructedness” of diseases with well-understood biology and less stigma, such as the attention paid in Robert Aronowitz’s Making Sense of Illness (Aronowitz 1998).
They also left an imprint in lay and popular conceptions, but documenting that lies outside the scope of this article.
In the second edition of Being Mentally Ill, Scheff expressed regret that he had asserted an entirely social theory arguing that the extent to which mental illness had social versus biological causes was an empirical question, not a theoretical one.
For a response to Obeyesekere, see Bottéro (1991).
As readers of this journal know, much ethnographic study of depression has moved beyond binary questions of whether it is “Western” or not and turned to questions of how its deployment as a diagnostic category, and the use of antidepressant drugs, are inflected by cultural variations (Skultans 2003; Kitanaka 2012; Ecks 2014; Behrouzan 2016; Tran 2016).
For an opposing view, see Kramer 2016.
Statements like this make me skeptical of claims that “depression” was foisted on the public because the pharmaceutical companies had something they decided to call antidepressants. There is no question drug companies promoted depression, but substances could only be labeled “antidepressants” in the first place if there was a problem, depression, people were looking to solve.
Hirshbein (2014) argues that much of this research involved a circularity, in figuring depression as female, then studying it in women, reinforcing the figuring.
For much of European history, the terms “melancholy” and “melancholia” were synonymous (Radden 2009).
Melancholia was gradually becoming considered as a sub-type of depression. In the newest, 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, “Depression with Melancholic Features” is a specifier referring to depression characterized by certain features that can include severe psychomotor retardation or agitation, and the lack of a clear precipitating event. Some psychiatrists believe that it has a clearer biological basis than other forms of depression.
Schiesari (1992) argues compellingly that this heroic dimension lasted for only as long as the illness (melancholia) was culturally gendered as male, and the illness lost its luster in the twentieth century when it (depression) became gendered female.
Psychiatrist Nancy C. Andreasen’s The Broken Brain (Andreasen 1984), for example, treated melancholia and depression as the same thing. The Broken Brain is discussed below.
This was also a fervent wish of Nathan Kline, a key figure in the development of both antipsychotic and antidepressant drugs.
Frances argues that it is now too easy to get a DSM diagnosis of major depression because you feel somewhat bad about life circumstances, but also says that one third of people with severe depression warranting treatment do not get it.
Edward Shorter is a major exception in this respect, showing no timidity in assessing efficacy of treatments he writes about.
Callahan and Berrios 2005 goes beyond questioning continuity between melancholia and depression, and stresses the newness of the category of depression since about 1980.
Wendy Gonaver has recently shown that the diagnosis was even more ideological than it is usually taken to be, since no one seems to have actually used it in medical practice (Gonaver 2018).
This is often the message of critiques of the DSM and psychiatry diagnosis in general. See, for example, Kutchins and. Kirk, 1997. I am more persuaded by the argument for ambivalence articulated by Felicity Callard (2014).
Aronowitz, Making Sense of Illness; Jeremy Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: The Johns Hopkins University Press, 2008).
Nasser Ghaemi, “Thomas Szasz: An Evaluation,” Psychology Today, January 5, 2018, https://www.psychologytoday.com/us/blog/mood-swings/201801/thomas-szasz-evaluation, accessed September 30, 2020.
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Sadowsky, J. Before and After Prozac: Psychiatry as Medicine, and the Historiography of Depression. Cult Med Psychiatry 45, 479–502 (2021). https://doi.org/10.1007/s11013-021-09729-2
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DOI: https://doi.org/10.1007/s11013-021-09729-2