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  • American Melancholy: Constructions of Depression in the Twentieth Century
  • John C. Burnham, Ph.D.
Laura D. Hirshbein . American Melancholy: Constructions of Depression in the Twentieth Century. New Brunswick, New Jersey, Rutgers University Press, 2009. xii, 195 pp. $42.95.

There is already a library of books and articles showing how diagnostic categories in psychiatry have been socially constructed. Recently, historians such as David Healy, Peter Kramer, and Edward Shorter have shown particularly how pharmaceutical companies influenced psychiatrists to construct the disease of depression in the second half of the twentieth century. Now a practicing psychiatrist who is also a historian of medicine, Laura Hirshbein, goes beyond this familiar narrative of commercial and political considerations that distorted scientific and clinical considerations. She builds on the existing literature and her own research to lay out a much fuller social and cultural history of the modern diagnosis of depression as it has functioned in the United States. The result is a marvelously concise history that contains many telling insights in each chapter. Hirshbein is respectful of Stanley Jackson's classic history of melancholia, but the story she tells is of a different order.

The book should have multiple audiences. For psychiatrists, Hirshbein provides a sobering example of how time-bound and contingent a major psychiatric diagnostic category can be. Moreover, and specifically, [End Page 438] Hirshbein uses her history to launch a major attack on symptom-based diagnostic categories such as appeared in the notorious DSM-III in 1980.

For the general reader, Hirshbein confronts directly the extent to which ordinary life experiences can and should be medicalized. Are Americans supposed never to be unhappy? Should a physician with a medication or treatment system be called in to treat feeling contents that would, in another day, have been experienced as normal in normal lives in the workplace and social world?

For the historian of medicine, Hirshbein has several contributions of different kinds. In talking about one disease, she implicitly calls into question all disease conceptions. Largely assuming, reframing, and bypassing the pharmaceutical company story, she considers how transition to a consumer society shaped physicians' aspirations to practice scientific medicine and the public's desire to benefit from scientific medicine. By mid-century, the language of mental health and mental illness had become "imbued with the language of consumerism" (20).

Beyond consumerism were cultural attitudes and practices that she traces in popular magazines of the twentieth century. Hirshbein produces vivid evidence of the ways in which changing assumptions about female and male social roles played into marketing, consumerism, and treatment, as well as diagnosis—and particularly, of course, the diagnosis of depression. Hirshbein is, of course, aware that the problem of therapy multiplies with questions about diagnosis, as Christopher M. Callahan and German E. Berrios have shown so vividly (Reinventing Depression: A History of the Treatment of Depression in Primary Care, Oxford, Oxford University Press, 2005).

In the end, Hirshbein substantiates in new ways the contention that how both psychiatrists and the literate public conceptualized mental illness shaped general ideas about the self, the patient, and medicine. She concludes that "the consumer desire for depression treatments that has been tapped by the pharmaceutical industry significantly predated the industry's direct marketing efforts" (105).

Between the 1950s and the 1980s, a movement arose to move psychiatry from a basis in patients' stories to the hopefully scientific trials of medications and the statistical manipulations of outcomes. The end product was a quantitatively defined disease, depression, that was responsive to commercially produced medications. In addition, by the 1970s and 1980s, structured psychotherapies came in alongside the medications as another type of consumer product designed for psychiatric use.

What emerged was a disease of depression that was based on "deeply embedded gender assumptions. . . . It is worrisome . . . that a diagnosis of depression that is so historically contingent should be the basis of ongoing research that looks at differences between brains of men and women in order to uncover the biochemical basis of this disease" (78, 101). [End Page 439]

Hirshbein is deeply concerned that both psychiatrists and members of the general public have come to assume that feelings, especially women's feelings, can be managed not by...

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