The History of Depression Diagnosis and Treatment

More and more renowned personalities are succumbing to suicide as a result of despondency, while the realm for engaging in discourse on depression is progressively constricting.

Individuals diligently restrain and meticulously govern their recollection under the lamentation of “physical ailment,” repeatedly concluding the impotent “verdict” of “depression”—just as the author Samuel Beckett, tormented by depression, proclaimed, “This malady knows no remedy.”

Naturally, we do not refute the physiological aspects of depression. The writer Hemingway perished by his own hand, and a lineage spanning four generations bears the burden of depression and suicide. Nevertheless, the social factors surrounding mental illnesses such as depression are frequently unconsciously disregarded: in our “mobile” modern era, scarce are the steadfast foundations amidst the vast sea, leaving desolate individuals unaware of where to entrust their flickering hope for salvation, nor the direction it shall meander.

The inquiries akin to those depicted in “One Flew Over the Cuckoo’s Nest” still possess profound implications. Who defines depression? Who reaps the benefits from the notion of “depression”? And where lies the demarcation between patients and “ordinary individuals”? The mounting populace afflicted by mental ailments in this era of mobility reflects the ethical aspirations that humans, as “refined beings,” harbor in their quest for the true essence of “happiness.”

“Fener Standard”

According to the World Health Organization, approximately one billion individuals worldwide endure mental disorders. Following the outbreak of the COVID-19 pandemic, the incidence of depression surged by 53 million cases globally, marking a staggering rise of 27.6%.

According to the World Health Organization, depression ranks among the most prevalent mental disorders, characterized by “persistent pessimism and desolation, diminished interest or pleasure in previously enjoyable activities, disrupted sleep and appetite, chronic fatigue, and impaired concentration.” These symptoms align closely with the portrayal found in the third edition of the American Diagnostic and Statistical Manual of Mental Disorders.

The third edition of the “Diagnostic and Statistical Manual of Mental Disorders,” published in 1980 and colloquially known as the “Bible” of depression, established the medical groundwork for diagnosing depression for nearly half a century.

Prior to this publication, the preceding two editions merged the dominant concepts of Freud and Meyer, employing psychoanalytic notions and comprehensive therapies to address patients with depression.

Freud’s seminal work, “Mourning and Melancholia” (1917), dissected “melancholia” as a patient’s reaction to the “loss” of childhood and the subsequent internalized expression of anger. He pioneered the emphasis on the patient’s emotional state as opposed to physical imbalance or dysfunction. Simultaneously, Freud responded to the historical glorification of “melancholia,” asserting that it is accompanied by extraordinary endowments, and numerous patients are bestowed with “genius.” Much like Hamlet, Shakespeare’s “Prince of Melancholy,” who, according to Freud, “perceives the truth more lucidly than those untouched by melancholia.”

Adolf Meyer introduced the “biopsychosocial” approach, which diverged from Freud’s perspective. His methodology tailors treatment individually, accounting for the patient’s unique psychological, social, and biological attributes, as well as their occupational domain.

Following World War II, “mental health” emerged as a prevalent subject in society. Soldiers grappling with psychological issues during the war received diagnoses and therapies from psychiatrists, thereby heightening social awareness of mental illnesses and destigmatizing such conditions. The 1954 “Midtown Manhattan Study” report engendered a widespread realization that war, along with other social factors, exerts a substantial impact on the human psyche. It illuminated the possibility that individuals lacking a genetic predisposition may also suffer from mental afflictions.

By the 1970s, the understanding and practice of depression had become exceedingly bewildering. The debate regarding its endogenous or exogenous “motivation” remained inconclusive and diagnosed symptoms lacked a consensus in terms of which mental illness they indicated. It would not be an exaggeration to assert that doctors were “prescribing medication haphazardly.” In 1972, the U.S.-British Joint Diagnostic Project revealed a fivefold higher prevalence of “depressive” patients in the United Kingdom compared to the United States, leading to public outcry.

The Academy Award-winning film “One Flew Over the Cuckoo’s Nest” in 1974 encapsulated the public’s apprehension that mental institutions were abusing their authority, rendering ordinary individuals no longer “ordinary.” This film epitomized the anti-psychiatry movement that permeated the 1960s. French scholar Foucault and British scholar Ryan both contended that psychiatry merely functioned as an instrument of social control, devoid of any genuine intent to “cure” patients.

The third edition of the Diagnostic and Statistical Manual of Mental Disorders arrived at the opportune moment, resolving the prevailing confusion. It incorporated the “Feiner Criteria” proposed byRobert Spitzer, which aimed to establish standardized diagnostic criteria for mental disorders, including depression. The Feiner Criteria emphasized a more empirical approach, relying on observable symptoms and behaviors rather than on subjective interpretations of underlying causes.

The adoption of the Feiner Criteria and the subsequent publication of the DSM-III brought some clarity to the diagnosis of depression. It helped align healthcare professionals in their understanding and identification of depressive symptoms, facilitating more consistent treatment approaches. However, the DSM-III also received criticism for medicalizing normal human experiences and emotions, potentially pathologizing individuals who might not truly have a mental disorder.

Since the publication of the DSM-III, subsequent editions have been released, refining and expanding the diagnostic criteria for depression. The DSM-5, published in 2013, is the most recent edition as of my knowledge cutoff in September 2021. It includes specific criteria for major depressive disorder (MDD) and other depressive disorders, taking into account various symptoms, duration, and impairment levels.

While the psychiatric community has made significant strides in understanding depression and developing diagnostic frameworks, debates and discussions surrounding the nature of depression continue. There is recognition that depression is a complex interplay of biological, psychological, and social factors. Efforts are being made to approach mental health from a more holistic perspective, considering the individual’s unique circumstances and experiences.

In recent years, there has been a growing focus on mental health awareness and destigmatization. Public figures and organizations have played a crucial role in raising awareness about depression and other mental illnesses. However, societal attitudes and perceptions still have a long way to go in fully understanding and supporting individuals with depression.

It is essential to continue engaging in open and compassionate conversations about depression, ensuring that individuals feel safe seeking help and receiving appropriate care. Research and advancements in mental health treatment are ongoing, aiming to improve the lives of those affected by depression and other mental disorders.

If you or someone you know is struggling with depression or any mental health issue, it is important to reach out to a healthcare professional or a helpline in your country for support and guidance.

　　By 1994, Prozac was the second best-selling drug in the world, and some teenagers even regarded it as a “trend” and if they didn’t take it, they would be left behind. Ronald Wallace wrote a poem called “Prozac”, which was full of praise: “It’s so happy! It’s like everything I touch is shining and smiling at me.”
　　The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 2000, further distinguished between major depressive disorder and psychological depression (lower levels of depression). The former contains five categories of symptoms, while the latter lists only two symptoms.
　　Regardless of the third or fourth edition, the intuitive symptoms and refinement of standards have promoted the popularization and expansion of psychotherapy services. Along with the emergence of the definition of mild depression comes the emergence of unconscious “monitoring of sadness” in society. The “threshold” for mild depression is so low, and people are accustomed to self-examination according to the “handbook” items, so it is “natural” to regard themselves as a “patient”.
　　In recent decades, pharmaceutical companies have played an important role in the definition and treatment of depression. Its approach is to promote drugs to “people who are rich and not sick” and continue to expand the medical market to cover all patients with depression defined in the “Manual”. They fund research in universities, “design” the diagnosis of depression to be more scientific, conduct political lobbying, and support drug trials and control the results of trials.
　　In fact, barbiturates, opiates, and amphetamines are more effective in treating depression and have fewer side effects. However, they are nothing like the “best seller” of Prozac. The first reason is that these drugs need to be prescribed by professional doctors rather than general practitioners. The second reason is that their patents have expired and they can no longer generate revenue for pharmaceutical companies.
　　From the end of the 20th century to the beginning of the 21st century, the number of depression surged, and “miracle drugs” for treating it were also born and sold well at the same time. It can hardly be said to be a “coincidence.”
　　Many academics are highly critical of antidepressants. Like “Let Them Take Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression” by David Healy, “The Emperor’s New Drugs: Busting the Antidepressant Myth” by Irving Kirsch, Richard Ben Toll’s “Healing the Heart: Why Psychiatric Treatment Fails” and Gary Greenberg’s “Making Depression: The Secret History of a Modern Illness” both lash out at the unnecessary health risks posed by this class of drugs, and The unethical profit grabbing behind the “placebo effect”.
“The Age of Trauma”

　　Even when examining the cultural construction of depression through a postmodernist lens, the existence of real pain cannot be denied. From the time of Hippocrates to today, whether it is “melancholy”, “depression” or “endogenous depression”, although the “names” are different, they are all described with highly consistent words. Same sentiment.
　　Depression is not a myth, let alone an illusion. It is clearly “produced” through the definition and construction of the biomedical industry and the reinforcement of social culture, and becomes a community with the creator.
　　The chronic diseases of the times – gender and racial issues, are also concentrated on depression. According to “The Social Roots of Depression: A Study of Mental Illness in Women,” co-edited by sociologists George Brown and Tyrell Harris, the vast majority of women in the sample were depressed due to external causes rather than innate mechanisms. The British mental health charity “Mindset” conducted interviews with African-American and Asian patients with mental illness in 2000. The results showed that compared with white people, African-American patients often cannot get antidepressants because medical institutions believe that “black people cannot Will be depressed”.
Along with the emergence of the definition of mild depression comes the emergence of unconscious “monitoring of sadness” in society.

　　According to George Brown, depression can be changed by changing social stressors. He believes that humiliating experiences, such as those that lead to submission or loss of self-esteem, or entrapment experiences, such as situations from which one cannot escape, are particularly likely to lead to depression. He also emphasized the “loss” mentioned by Freud, and found in the survey that the “loss” of today’s patients is closely related to self-image and personal expectations.
　　Anthropologists have also revealed in their research the social relationships—the “moral economic structure”—hidden behind mental illness. Didier Fasan was a French infectious disease physician. His new work “The Empire of Trauma” considers individual experience, collective memory, social moral structure and institutional mechanisms from the perspective of psychological trauma. He quotes Proust’s famous quote “the full extent of the matter” to illustrate that the psychological trauma caused by major events has long transcended the single perspective through which they are often interpreted.
　　It can be said that after the COVID-19 epidemic, the number of depression patients worldwide increased by 53 million, which is a strong proof of the “empire of trauma”.
　　One of the mental symptoms worth pondering is: why were people in the mid-20th century “anxious” but people today are still “anxious”?
　　From the perspective that the number of depression has increased significantly and the subject words of different eras remain unchanged, depression may be a “modernity” problem. First of all, modernity has changed from a solid to a “fluid”, and social forms, social norms, and behavioral patterns cannot be maintained for a long time, and it cannot give people a stable frame of reference. Secondly, the relationship between power and politics has gradually become alienated, and citizens have become increasingly alienated. Political institutions are also desperately discarding “redundant” social functions, and individual spirit has become a “three no matter” zone; thirdly, communities continue to shrink and reduce, and the “consensus” between groups is greatly fragmented; finally, the environment is always It’s so ever-changing, and the pressure to solve all dilemmas can only fall on the individual.
　　In fact, the risks faced by individual decisions are themselves caused by forces beyond individual understanding and individual behavioral capabilities, but individuals have to pay for such risks. Society cannot provide any authoritative “cure”, but only leaves a series of fragmented short-term “windows” and “traps”.
　　Freedom and liberation and sadness and depression have become two sides of the same coin in modern society. People cannot have only one of them, because there is no capitalism without bankruptcy, no religion without hell, and no love without hate.
　　After reading one neurological and biological paper after another, we should not forget that the core of the helpless pain and fatigue of patients with depression is that they have lost cherished interpersonal relationships or faced heavy personal difficulties. Crisis of meaning.
　　Who has not experienced such a moment? Everyone is a “depressive patient”, but the difference is the length of time.
　　We cannot return to the strict “self-interest” mechanism, but we must also have the cultural consideration of “making a living for the people.”