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Multiple Depression

Making Mood Manageable

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Abstract

The subject of this paper is the problematisation of depression in today’s mental health care. It is based on a study of the professional discussion on depression in Finland from the mid-1980s to the 1990s. The ways in which Finnish mental health experts define the object of depression treatment bring out an ambivalence that stems from the discrepancy between two parallel but incongruent notions of what depression is: the psychopharmacological and the psychotherapeutic. The analysis of the discussion demonstrates how clinical and practical rationales of today’s mental health care are formed in the space between the two poles. Two tendencies of these rationales are also pointed out: first, the DSM paradigm of depressive illness inclines to become problematic and to dissolve in the actual practices. Second, they insinuate emphasis on antidepressant medication and overall neuropsychiatric approach in the treatment of depressive disorders, although in an ambivalent way.

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Notes

  1. See Klerman, “The nature of depression: mood, symptom, disorder”.

  2. Henriksson, Isometsä, Huttunen and Lönnqvist, “Masennustilojen diagnostiikan keskeisiä käsitteitä ja ongelmia,” 227.

  3. See Jackson, Melancholia and Depression; Rousseau, “Depression’s forgotten genealogy”; Radden, “Introduction: From melancholic states to clinical depression”; Radden, “Is this dame melancholy?”

  4. See Martin, “Illness, insight, and identity”; Ghaemi, “Depression: illness, insight, and psychopharmacological Calvinism”; Ehrenberg, La fatigue d’être soi; Kramer, “The valorization of sadness”; Elliott: “Pursued by happiness and beaten senseless”.

  5. See. Wilson, “Melancholic biology”.

  6. See. Martin; Wilson; Ehrenberg.

  7. My study is based on analyses of articles and research reports on clinical aspects, epidemiology, and treatment of depressive illness in Finnish medical and psychiatric journals (Psychiatria Fennica, Duodecim, and Suomen lääkärilehti), textbooks, special issues of journals, and guidelines and instructions for diagnosis and treatment of depression and for the use of antidepressants. Articles published in international psychiatric or medical journals by Finnish doctors are also included in the data.

  8. See Hale, The Rise and Fall in Psychoanalysis in the United States, 276–299; Metzl, Prozac on the Couch, 71–98.

  9. See Hale, 185–379; Luhrman, Of Two Minds, 158–265.

  10. Depressio—tunnistaminen ja hoito, 4.

  11. Tamminen, Mielet maasta, 52.

  12. For a review, see Regier, Goldberg and Taube, “The de facto US mental health services system: a public health perspective”; Blacker and Clare, “Depressive disorder in primary care”; Katon, “The epidemiology of depression in primary care”; Katon and Schulberg, “Epidemiology of depression in primary care”.

  13. Castel, Castel and Lovell, The Psychiatric Society, 60–213; Grob, From Asylum to Community, 209–301; Shorter, A History of Psychiatry, 229–238, 227–280.

  14. Salo, Sietämisestä solidaarisuuteen, 195–268; Taipale, “Hallitusta muutoksesta hallitsemattomaan alasajoon?”

  15. Lönnqvist, “National suicide prevention project in Finland: a research phase of the project”; Isometsä, Henriksson, Aro, Heikkinen, Kuoppasalmi and Lönnqvist, “Suicide in major depression”.

  16. Finnish Statistics on Medicines 1988–2004. The new type of antidepressants were approved in Finland almost immediately after fluoxetine (Prozac) was launched to the main U.S. market in 1988; see Healy, Let Them Eat Prozac, 37–39.

  17. Cf., Glenmullen, Prozac Backlash; Healy, Let Them Eat Prozac

  18. Poutanen, “Depression in the primary health care patient”, 125.

  19. Achté and Tamminen, Depressio ja sen hoito, 11; Tamminen, Depression tunnistaminen, 3.

  20. Shorter, passim.

  21. Hale, 300–321; Shorter, 26, 238, 305–313; Luhrmann, 203–238; Healy, The Antidepressant Era, 103, 157, 163.

  22. Berrios, The History of Mental Symptoms, 15–22; Castel, The Regulation of Madness, 85–97; Shorter, 17–29, 69–77.

  23. On the latter, see Danziger, Naming the Mind, 124–131.

  24. On this concept, see Hacking, Historical Ontology, 173–175, 190–192.

  25. Salokangas, Kliininen depressio, 107.

  26. Ibid., 6.

  27. Ibid., 26.

  28. Ibid., 25–26.

  29. Ibid., 91.

  30. Ibid., 162.

  31. On the design and results of TADEP, see Salokangas, Poutanen and Stengård, “Screening for depression in primary care”; Salokangas et al., “Prevalence of depression among patients seen in community health centres and community mental health centres”: Poutanen, “Depression in the primary health care patient”; Poutanen, Depressio terveyskeskuspotilailla.

  32. Radden, “Introduction: from melancholic states to clinical depression,” 49–51.

  33. Paykel and Priest, “Recognition and management of depression in general practice: consensus statement”, 1198.

  34. See Poutanen, Depressio terveyskeskuspotilailla, 45–47.

  35. For a review, see Blacker and Clare.

  36. Regier et al., “The NIMH Depression Awareness, Recognition, and Treatment Program: Structure, aims, and scientific basis”; Rutz et al. “An educational programme on depressive disorder for general practitioners on Gotland: background and evaluation”; Priest, “Improving the management and knowledge in general practice in the UK Educational Programme”; Katon et al., “Collaborative management to achieve treatment guidelines”; see also Healy, Let Them Eat Prozac, 8–11.

  37. “Mood disorders: pharmacological prevention of recurrences”; “Pharmacotherapy of depressive disorders”; “Practice guideline for major depressive disorders in adults”; Depression in primary care, vols 1 and 2; Paykel and Priest; see also Spigset and Mårtensson, “Drug treatment of depression”.

  38. Wilson, “DSM-III and the transformation of American psychiatry”. For a detaild analysis, see Kirk and Kutchins, The Selling of DSM.

  39. Ian Hacking developed this concept by further elaborating A. C. Crombie’s (Styles of Scientific Thinking in the European Tradition) analysis of six styles of thinking in the history of Western science. Hacking, Historical Ontology, 159–199.

  40. Forrester, “If p, then what? Thinking in cases”.

  41. See Cooper, “What is wrong with the DSM?”

  42. See Henriksson, Isometsä, Huttunen and Lönnqvist; Riikonen and Mattila, “Ovatko psykiatriset ongelmakäsitykset ja—luokitukset masentavia?”

  43. For an overview, see Kutchins and Kirk, Making Us Crazy.

  44. Healy, The Antidepressant Era, 48–56, 76–77.

  45. Ibid., 98–99.

  46. DSM-IV-TR, xxxi.

  47. This concept is Annemarie Mol’s, in her book The Body Multiple.

  48. See Paykel and Priest; Widmer and Cadoret, “Depression in primary care”; Goldberg, “Detection and assessment of emotional disorders in a primary care setting”; Freeling et al., “Unrecognised depression in general practice”; Freeling, “Diagnosis and treatment of depression in general practice”.

  49. Paykel and Priest, 1198.

  50. See DSM-IV-TR, 679–683.

  51. Poutanen, Depressio terveyskeskuspotilailla, 45.

  52. Spigset and Mårtensson, 1188.

  53. For the similar emphasis in the U.S., see Tasman, Riba and Silk, The Doctor-patient Relationship in Pharmacotherapy.

  54. Healy, Let Them Eat Prozac, 2, 7–11; Rose, “Becoming of neurochemical selves”.

  55. Depression in primary care, vol 1 and 2.

  56. Ian Hacking and Allan Young present fine illustrations of how psychic phenomena are transformed into facts of empirical sciences by triangulating. See Hacking, “Memory sciences, memory politics,” 70–76 and Young, The Harmony of Illusions, 134–135.

  57. Depression in primary care, vol. 2, 23, 35.

  58. Rimón and Rimón, “Depression hoito terveyskeskuksessa”; Achté, “Psykofarmakologian vuosikymmenet”.

  59. On professional, public and judical controversies over the SSRIs since the late 1980s, see Glenmullen; Healy, Let Them Eat Prozac.

  60. Huttunen, “Masennuslääkkeiden laajenevat käyttöaiheet”; Tamminen, Mielet maasta, 150; see also Rose.

  61. Healy, The Anti-depressant Era, 102–103; Healy, Let Them Eat Prozac.

  62. Spigset and Mårtensson, 118; see also Depression in primary care, vol 2, 36.

  63. Poutanen, Depressio terveyskeskuspotilailla, 45.

  64. Tamminen 19.

  65. Lehtinen, Depression hoito terveyskeskuksessa.

  66. Spoov and Syvälahti, Depressiolääkkeet, 57.

  67. Salokangas, 113, 162–163.

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  1. Department of Sociology, University of Helsinki, Research Unit, P.O. Box 10 (Snellmaninkatu 12), 00014, Helsinki, Finland

    Ilpo Helén

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Helén, I. Multiple Depression. J Med Humanit 28, 149–172 (2007). https://doi.org/10.1007/s10912-007-9036-y

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