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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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.
Andreasen, Nancy. 1984. The Broken Brain: The Biological Revolution in Psychiatry. New York: Harper and Row.
Aronowitz, Robert. 1998. Making Sense of Illness. New York: Cambridge University Press.
Behrouzan, Orkideh. 2016. Prozak Diaries: Psychiatry and Generational Memory in Iran. Stanford: Stanford University Press.
Bell, Matthew. 2014. Melancholia, The Western Malady. Cambridge: Cambridge University Press.
Benedict, Ruth. 1934. Anthropology and the Abnormal. Journal of General Psychology 10, 5-82.
Berrios, German E. 1996. The History of Mental Symptoms: Descriptive Psychopathology Since the Nineteenth Century. Cambridge: Cambridge University Press.
Blazer, Dan G. 2005. The Age of Melancholy: Major Depression and Its Social Origins. New York: Routledge.
Bottéro, Alain. 1991. Consumption by Semen Loss in India and elsewhere. Culture, Medicine, and Psychiatry 15 303-320.
Braslow, Joel. 1997. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Berkeley: University of California.
Brendel, David H. 2003. A Pragmatic Consideration of the Relation Between Depression and Melancholia. Philosophy, Psychiatry, and Psychology 10, (1) 53-55.
Callahan, Christopher M., and German E. Berrios. 2005. Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940-2004. Oxford: Oxford University Press.
Callard, Felicity. 2014. Psychiatric Diagnosis: The Indispensability of Ambivalence,” Journal of Medical Ethics 40, 526-530.
Cvetkovich, Ann. 2012. Depression: A Public Feeling. Durham: Duke University Press.
Danquah, Meri Nana-Ama. 1998. Willow, Weep for Me: A Black Woman’s Journey Through Depression. New York: Ballantine Publishing Group.
Decker, Hannah. 2013. The Making of DSM-III: A Diagnostic Manual’s Conquest of American Psychiatry. Oxford: Oxford University Press.
Dorwick, Christopher. 2013. Depression as a Culture-Bound Syndrome: Implications for Primary Care. British Journal of General Practice 63 (610) 229-230.
Ecks, Stefan. 2014. Eating Drugs: Psychopharmaceutical Pluralism in India. New York: New York University Press.
Edington, Claire E. 2019. Beyond the Asylum: Mental Illness in French Colonial Vietnam. Ithaca: Cornell University Press.
Ehrenberg, Alain. 2010. The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age. Chicago: McGill Queen’s University Press.
Ellenberger, Henri. 1981. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychology. New York: Basic Books.
Elliott, Carl and Tod Chambers, eds. 2004. Prozac As A Way of Life. Chapel Hill: University of North Carolina Press.
Frances, Allen. 2013. Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-V, Big Pharma, and the Medicalization of Ordinary Life. New York: William Morrow.
Gaines, Atwood D, and Paul E. Farmer. 1986. Visible Saints: Social Cynosures and Dysphoria in the Mediterranean Tradition. Culture, Medicine, and Psychiatry 10, (4), 295-330
Gask, Linda. 2015. The Other Side of Silence: A Psychiatrist’s Memoir of Depression. Chichester: Sommersdale Publishers Ltd.
Gelman, Sheldon. 1999. Medicating Schizophrenia: A History. New Brunswick: Rutgers University Press.
Gonaver, Wendy. 2018. The Peculiar Institution and the Making of Modern Psychiatry, 1840-1880. Chapel Hill: University of North Carolina Press.
Good, Byron, J., Mary-Jo DelVecchio Good, and Robert Moradi. 1985. The Interpretation of Iranian Depressive Illness and Dysphoric Affect. In Arthur Kleinman and Byron Good, eds., Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press.
Greenberg, Gary. 2010. Manufacturing Depression: The Secret History of a Modern Disease. New York: Simon and Schuster.
Greenberg, Gary. 2013. The Book of Woe: The DSM and the Unmaking of Psychiatry. New York: Plume.
Grob, Gerald. 1973. Mental Institutions in America: Social Policy to 1875. New York: The Free Press.
Hanson, Jennifer. 2003. Listening to People or Listening to Prozac? Another Consideration of Causal Classifications. Philosophy, Psychiatry, and Psychology 10, (1) 57-62.
Harrington, Anne. 2019. Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness. New York: W. W. Norton and Sons.
Healy, David. 1997. The Anti-Depressant Era. Cambridge: Harvard University Press.
Healy, David. 2002. The Creation of Psychopharmacology. Cambridge: Harvard University Press.
Healy, David. 2004. Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression. New York: New York University Press.
Herzberg, David. 2009. Happy Pills in America: From Miltown to Prozac. Baltimore: The Johns Hopkins University Press.
Hirshbein, Laura D. 2014. American Melancholy: Constructions of Depression in the Twentieth Century. New Brunswick: Rutgers University Press.
Hoch, Paul H. and Joseph Zubin, eds. 1954. Depression. New York: Grune and Stratton.
Horwitz, Allen and Jerome Wakefield. 2007. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. New York: Oxford University Press.
Jackson, Stanley W. 1986. Melancholia and Depression: From Hippocratic Times to Modern Times. New Haven: Yale University Press.
Kirsch, Irving. 2010. The Emperor’s New Drugs: Exploding the Antidepressant Myth. New York: Basic Books.
Kitanaka, Junko. 2012. Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton: Princeton University Press.
Kleinman, Arthur. 1986 Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China. New Haven: Yale University Press.
Klibansky, Raymond, Erwin Panofsky, and Fritz Saxl. 1964. Saturn and Melancholy: Studies in the History of Natural Philosophy, Religions, and Art. London: Thomas Nelson and Sons.
Kneeland, Timothy, and Carol A. B. Warren. 2002. Pushbutton Psychiatry: A History of Electroshock in America. Westport: Praeger Publishers.
Kramer, Peter. 1993. Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Penguin Books.
Kramer, Peter. 2016. Ordinarily Well: The Case for Antidepressants. New York: Farrar, Straus and Giroux.
Kutchins, Herb and Stuart A. Kirk. 1997. Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press.
Lawlor, Clark. 2012 .From Melancholia to Prozac: A History of Depression. Oxford: Oxford University Press.
Loring, Marti and Brian Powell. 1988. Gender, Race, and DSM-III: A Study of the Objectivity of Psychiatric Behavior. Journal of Health and Social Behavior 29 (1) 1-22.
Lutz, Catherine. 1985 Depression and the Translation of Emotional Worlds. in Arthur Kleinman and Byron Good, eds., Culture and Depression: Studies in the Anthropology and Cross-Psychiatry of Affect and Disorder. Berkeley: University of California Press.
MacCurdy, John T. 1925. The Psychology of the Emotions: Morbid and Normal. New York: Harcourt, Brace & Company.
McGovern, Constance M. 1986 The Myths of Social Control and Custodial Oppression: Patterns of Psychiatric Medicine in Late Nineteenth Century Institutions. Journal of Social History 20: 3–23.
Merkin, Daphne. 2017. This Close to Happy: A Reckoning with Depression. New York: Farrar, Strauss and Giroux.
Metzl, Jonathan. 2003. Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs. Durham: Duke University Press.
Midlefort, Erik C. 1980. Madness and Civilization in Early Modern Europe: A Reappraisal of Michel Foucault. In: Barbara Malament, ed., After the Reformation: Essays in Honor of J H Hexter. Philadelphia: University of Pennsylvania Press.
Moncrieff, Joanna. 2008. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Houndsmills: Palgrave MacMillan.
Murphy, Jane. 1976. Psychiatric Labeling in Cross-Cultural Perspective. Science 191 (4231) 1019-28.
Obeyesekere, Gananath. 1985. Depression, Buddhism and the Work of Culture in Sri Lanka,” In: Arthur Kleinman and Byron Good, eds., Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press.
Peters, Toine. 2017. The Antidepressant Era Revisited: Towards Differentiation and Patient-Empowerment in Diagnosis and Treatment. In: Greg Eghigian, ed., Routledge History of Madness and Mental Health. New York: Routledge.
Pressman, Jack D. 1988. Last Resort: Psychosurgery and the Limits of Medicine. Cambridge: Cambridge University Press.
Radden, Jennifer. 2003a Is This Dame Melancholy Equating Today’s Depression and Past Melancholia. Philosophy, Psychiatry, and Psychology 10 (1) 37-52
Radden, Jennifer. 2003b The Pragmatics of Psychiatry and the Psychiatry of Cross-Cultural Suffering. Philosophy, Psychiatry, and Psychology 10, (1) 63-66.
Radden, Jennifer. 2009 Moody Minds Distempered: Essays in Melancholy and Depression. Oxford: Oxford University Press.
Rasmussen, Nicolas. 2008. On Speed: The Many Lives of Amphetamine. New York: New York University Press.
Rosenberg, Charles. 1992. Framing Disease, in Charles Rosenberg and Janet Golden, eds., Framing Disease: Studies in Cultural History. New Brunswick: Rutgers University Press.
Rosenfield, Sarah. 1984. Race Differences in Involuntary Hospitalization: Psychiatric vs. Labeling Perspectives. Journal of Health and Social Behavior 25, 14-23.
Rothman, David. 1971 The Discovery of the Asylum: Social Order and Disorder in the New Republic. Boston: Little, Brown, and Company.
Sadowsky, Jonathan. 2016. Electroconvulsive Therapy in America The Anatomy of a Medical Controversy. New York: Routledge.
Sadowsky, Jonathan. 2017. Somatic Treatments, in Greg Eghigian, ed., Routledge History of Madness and Mental Health. New York: Routledge.
Sadowsky, Jonathan. 2021. The Empire of Depression: A New History. London: Polity Books.
Schiesari, Juliana. 1992 The Gendering of Melancholia: Feminism, Psychoanalysis, and the Symbolics of Loss in Renaissance Literature. Ithaca: Cornell University Press.
Scheff, Thomas. 1982. Being Mentally Ill: A Sociological Theory. Chicago: Aldine de Gruyter.
Scull, Andrew. 1977. Decarceration: Community Treatment and the Deviant: A Radical View. Englewood Cliffs: Prentice Hall
Scull, Andrew. 1993. The Most Solitary of Afflictions: Madness and Society in Britain, 1700-1900. New Haven: Yale University.
Scull, Andrew. 1994. Somatic Treatments and the Historiography of Psychiatry. History of Psychiatry 5: 1–12.
Scull, Andrew. 2007. Madhouse: A Tragic Tale of Megalomania in Modern Medicine. New Haven: Yale University Press
Scull, Andrew. 2015. Madness in Civilization. Princeton: Princeton University Press.
Scull, Andrew. 2019. Psychiatry and its Discontents. Oakland: University of California Press.
Shorter, Edward. 1998 How Prozac Slew Freud, American Heritage 49, 5.
Shorter, Edward. 2009. Before Prozac: The Troubled History of Mood Disorders in Psychiatry. Oxford: Oxford University Press
Shorter, Edward. 2013. How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown. Oxford: Oxford University Press.
Shorter, Edward, and David Healy. 2007. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. New Brunswick: Rutgers University Press.
Skultans, Vieda. 2003 From Damaged Nerves to Masked Depression: Inevitability and Hope in Latvian Psychiatric Narratives, Social Science and Medicine 56, 2421-2431.
Slater, Lauren. 1998. Prozac Diary. New York: Penguin Books.
Smith, Jeffrey. 1999. Where the Roots Reach for Water: A Personal and Natural History of Melancholia. New York: North Point Press.
Snowden, Frank M. 2019 Epidemics and Society; From the Black Death to the Present. New Haven: Yale University Press.
Styron, William. 1990. Darkness Visible: A Memoir of Madness. New York: Vintage Books.
Summerfield, Derek. 2012 Afterword: Against ‘Global Mental Health, Transcultural Psychiatry 49 (3-4) 519-530.
Szasz, Thomas. 1961. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Hoeber-Harper.
Szasz, Thomas. 2007 Coercion as Cure: A Critical History of Psychiatry, New Brunswick, N.J.: Transaction Publishers.
Thompson, Tracy. 1996. The Beast: A Journey Through Depression. New York: Penguin Books.
Tran, Allen. 2016. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital, Medical Anthropology Quarterly 31, (2) 198-217.
Valenstein, S. Elliot. 1986. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York: Basic Books.
Whooley, Owen. 2019. On the Heels of Ignorance: Psychiatry and the Politics of not Knowing. Chicago: The University of Chicago Press.
Winters, Eunice. 1951. The Collected Papers of Adolph Meyer: Volume II, Psychiatry Academic Medicine, 26, 3.
World Health Organization. 2017. “Depression: Let’s Talk,” Says WHO, As Depression Tips List of Causes of Ill Health. http://www.who.int/mediacentre/news/releases/2017/world-health-day/en/.
Wurtzel, Elizabeth. 1994. Prozac Nation: Young and Depressed in America. New York: Riverhead Books.
Zilboorg Gregory and George W. Henry. 1941. A History of Medical Psychology. New York: W. W. Norton and Company.
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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