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Saturday, June 9, 2007

Science, gender and the emergence of depression in American psychiatry 1950-1980

This article by Laura D. Hirshbein is a clear description how depression became a specific disease category with concrete criteria. I thought depression was one of the most clearly described categories in human history. Depression was not a classification in the DSM I (1952). Depression as we know it today became only a diagnostic category in DSM III in 1980. There were certainly descriptions of melancholia in physicians writing throughout human history but the author states that depression as we know it is a twentieth-century phenomenon.
As a psychiatrist working on a depression unit I can most of the time clearly recognize depression. But many patient also present with depressive complaints which are clear depressions in terms of DSM IV criteria but differ from those patients in which a diagnosis of depression can't be missed at least to my opinion.
The author has strong arguments for this 20th century phenomenon.Depression became topic of research in the 1950's. In those days the inpatients mainly consisted of young women.The large number of women in clinical trials for depression in those days appeared to be a reflection of the hospital population of that time. Before the 50' in pre world war 2 period the inpatients of a psychiatric hospital were mainly older men.
In the develoment of DSM III, groups of researchers developed specific diagnostic criteria for depression. They looked at populations of patients in hospitals.Symptoms were counted and analyzed to see which best characterized depression.Patients with drugs or alcohol abuses were excluded as in medication trials. Researchers tested those criteria in hospitalized depressed women. The question whether women were depressed more than men was never raised. The connection between women and depression has been a closed circle. This article gives some food for thought.

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