Welcome to our course on mental illness in which we are today talking about depression. In the early 1970s, American readers would invariably encountered articles with titles such as The Common Cold of Mental ailments, Depression, When the Blues Don't Go away, or what you should know about mental depression coping with depression or another if you're depressed. Depression was on an alarming rise spreading, it would seem like the common cold. 20 years later, the New York Times reported the continued rise of depression. In an article called the rising cost of modernity depression. The escalating rates worldwide were persuasively exhibited in a graph. Today nearly half a century since the 1970s media's reports, the prevalence and increased rates of reported depression have continued to climb. A global burden of disease study tracked depression rates from 1990 to 2017, finding that cases of depression worldwide increased by 49%. Other studies report that the increases are especially great among adolescents. They find that between 2009 and 2017, the rates of major depressive episodes among 12 to 17 year olds increased 52% and 63% among young adults 18 to 25. The history of depression is clearly a history of the present. A story of how we arrive where we currently are, a culture with high rates of depression. This class focuses on the science of depression. We will examine first the identification of the disorder its noseology, from early descriptions of melancholia to the DSM definitions and the quantified measures of depression. We will turn then to investigate the explanations, the ideology of depression that were advanced during the 20th century. Heads up as we go forth, note that the life story of depression is entangled with that of neurasthenia in a number of ways. From melancholy to depressant, diaries, scientific writings and art give ample evidence of the long history of melancholy. In 1621, Robert Burton's text, anatomy of melancholy to find Melancholy as and I will quote, a serious ailment which causes anguish, dullness, heaviness, and vexation of spirit, anyways opposite pleasure, mirth, joy or delight causing forwardness in us, or just like in which equivocal and improper sense, we call him melancholy. That is dull, sad, sour, lumpish, ill disposed, solitary, anyway moved or displeased. For Burton, melancholy was a physical condition. Yet emotion could be both a cause and a consequence of that condition. His was no simple formula. Melancholy is cultural significance was captured in art even before Burton's writing. Experts have studied this long history and differ on whether melancholy actually referred to conditions that we now call depression. There are certainly similarities including gloominess, isolation, fearfulness, and suicidal thoughts, but what is important to see however, is the eventual making of a distinction between melancholy and depression. In fact, the term depression came into use in the 19th century. The word was borrowed from the medical term that had been used to describe a general decline in physical function. Historian Jonathan Sadowski, the author of one of your readings, sees depression as an empire for how and I quote Sadowski, it became a dominant way of interpreting mental distress, upending other languages in a gradual process that gained powerful momentum starting the leader 20th century, though it became before then. Depression was already in the psychiatric lexicon by the early 20th century. For instance, it was named as a common symptom of neurasthenia. Additional croplands categorization of mental illness included two types of depression, manic depression and in delusional depression, the second emerging in late adulthood. Some early 20th century researchers describe depressions in the plural, indicating that there were multiple kinds. Others drew from Freud's 1917 ECM melancholy to investigate forms and causes of depression. By the 1930s, depression had been accorded a number of sub forms. Throughout this formative period, there was no consensus on the cause of depression. Some experts emphasized the psychogenic causes, most often those of early childhood experiences, whereas others postulated depression to be a fixed sometimes hereditary condition. The proliferation of kinds, subtypes and symptoms channel is not only diagnosis and treatment of individual patients, but also psychiatrist identity as a medical science. One solution to the lack of consensus about nozoology and ideology of depression lay with the creation of quantitative measures. Quantification was taken as unquestionably scientific. The first scales appeared in the 1930s. The home Wadsworth temperament scale, measures what was called psychloyd depression, along with other psychiatric conditions. Here are the first 20 of 252 questions in that scale. The Beck Hamilton inventory introduced in the 1960s, measures the presence and intensity of depression using a set of symptoms that were derived from clinical experiences. Subsequently, numerous other scales were developed and counting of a different sort became available in the revisions of the DSM. For instance, DSM three included a criteria for depression. Interestingly only four criteria needed to be present to diagnose depression, thereby expanding the number of patients who would be diagnosed with a disorder. These and subsequent quantitative tests controlled for patients assumed unreliable reporting, established and agreed upon set of symptoms and enabled measure not only the presence but also the intensity of patients symptoms over time. However, standardized quantitative measures did not directly locate causes of depression. What's more, the scales risk conflating forms of sadness and mental disorders of depression. As a psychiatrist, Alan Francis asked, and I quote him, can we use statistics in some simple and precise way to define mental normality? Can the bell curve provide a scientific guide in deciding who is mentally normal and who is not? Conceptually the answer is why not? But practically, the answer is hell no. Decisions about what are normal and what are abnormal emotional states about what degrees of emotional lows are depression, continues to this day to spawn debates. I didn't find the causes of depression was and does remain an unsettled matter. Depressions shares with neurasthenia not only a set of symptoms as we've seen, but also multiple theories of its causes. Causes both somatic bodily and environmental. Like near sena, some experts believe that depression was a somatic condition, seeing it as in born either is a hereditary trait or is a fixed personality trait. Others, especially psychoanalysts working after Freud located the origins of depression and early experiences, notably in individual loss or poor parenting. Other experts view depression is anger turned inward. As with the case of neurasthenia some experts believe that depression is caused by modernity, including modernity's fast paced lifestyles, isolation escalating ideals of success, changing family structures, increasing obsession with the idea of normality and a mounting dependence on medical cures. Surveying depressants vibrant lives in the 20th century, Sadowski suggests something akin to an integrated perspective. He suggests, depression is a complex problem. It has multiple causes, which makes it unlikely. Only one kind of response will do. Our next class will canvas the various clinical responses. The treatments developed to alleviate what has become an escalating and predominant mental health condition.
