How everyone became depressed : the rise and fall of the nervous breakdown

About one American in five receives a diagnosis of major depression over the course of a lifetime. That's despite the fact that many such patients have no mood disorder; they're not sad, but suffer from anxiety, fatigue, insomnia, or a tendency to obsess about the whole business. "There is a term for what they have," writes Edward Shorter, "and it's a good old-fashioned term that has gone out of use. They have nerves." In How Everyone Became Depressed , Edward Shorter, a distinguished professor of psychiatry and the history of medicine argues for a return to the old fashioned concept of nervous illness. These are, he writes, diseases of the entire body, not the mind, and as was recognized as early as the 1600s. Shorter traces the evolution of the concept of "nerves" and the "nervous breakdown" in western medical thought. He points to a great paradigm shift in the first third of the twentieth century, driven especially by Freud, that transferred behavioral disorders from neurology to psychiatry, spotlighting the mind, not the body. The catch-all term "depression" now applies to virtually everything, "a jumble of non-disease entities, created by political infighting within psychiatry, by competitive struggles in the pharmaceutical industry, and by the whimsy of the regulators." Depression is a real and very serious illness, he argues; it should not be diagnosed so promiscuously, and certainly not without regard to the rest of the body. Meloncholia, he writes, "the quintessence of the nervous breakdown, reaches deep into the endocrine system, which governs the thyroid and adrenal glands among other organs." In a learned yet provocative challenge to psychiatry, Shorter argues that the continuing misuse of "depression" represents nothing less than "the failure of the scientific imagination." The book argues that psychiatry's love affair with the diagnosis of depression has become a death grip. Depression is a real illness, especially in its melancholic form. But most patients who get the diagnosis of "depression" are also anxious, fatigued, unable to sleep, have all kinds of physical symptoms, and tend to obsess about the whole thing. They do not have a disorder of "mood." It is a travesty to call them all "depressed." How did this happen? How did everyone become depressed? A well-known historian, Shorter describes how in the 19th century patients with those symptoms were considered "nervous," and when they lost control it was a "nervous breakdown." Then psychiatry turned its back on the whole concept of nerves, and - first under the influence of Freud's psychoanalysis and then the influence of the pharmaceutical industry - the diagnosis of depression took center stage. The result has been a scientific disaster, leading to the misdiagnosis and inappropriate treatment (with "antidepressants") of millions of patients. Urging that the diagnosis of depression be re-thought, the book turns a dramatic page in the understanding of psychiatric symptoms that are as common as the common cold. The book makes an immediate contribution to the debate about DSM5, which is scheduled to be published in May 2013 just as Shorter's book is launched: Shorter proposes replacing the diagnosis of "major depression" with "melancholia" and "nonmelancholia"; he argues that depression and anxiety usually occur together and are really the same disease; and he says that patients with so-called mood disorders really have a disorder of the entire body. All of this will be highly unwelcome to the official disease designers of DSM5 because it involves throwing out much of their schema. The book's edge is its ability to make the enormous well of psychiatry's past history in several languages relevant to burning issues today. No other writer has been able to glean nuggets of gold from this huge record of the past and apply them to important discussions today of diagnosis and treatment. "In this provocative book, Edward Shorter describes how in the 19th century patients with anxiety, fatigue and unable to sleep and obsess about the whole thing were considered "nervous," and when they lost control it was a "nervous breakdown." Then psychiatry turned its back on the whole concept of nerves, and--first under the influence of Freud's psychoanalysis and then the influence of the pharmaceutical industry--the diagnosis of depression took center stage. The result has been a scientific disaster, leading to the misdiagnosis and inappropriate treatment (with "antidepressants") of millions of patients. And with the new 5th edition of the Diagnostic and Statistical Manual (DSM-5), the trend of inappropriate treatment is sure to continue. Urging that the diagnosis of depression be re-thought, this book turns a dramatic page in the understanding of psychiatric symptoms that are as common as the common cold. A gripping historical argument on psychiatric diagnosis and its flawed heritage and future."-- Book jacket. In this work, Edward Shorter, a professor of psychiatry & the history of medicine argues for a return to the old fashioned concept of nervous illness. These are, he writes, diseases of the entire body, not the mind, & as was recognized as early as the 1600s. Shorter traces the evolution of the concept of 'nerves' & the 'nervous breakdown' in western medical thought. He points to a great paradigm shift in the first third of the 20th century that transferred behavioural disorders from neurology to psychiatry, spotlighting the mind, not the body. The catch-all term 'depression' now applies to virtually everything, 'a jumble of non-disease entities, created by political infighting within psychiatry, by competitive struggles in the pharmaceutical industry, and by the whimsy of the regulators.' Depression is a & very serious illness - it should not be diagnosed without regard to the rest of the body Nerves as a problem -- Rise of nervous illness -- Fatigue -- Anxiety -- Melancholia -- Nervous breakdown -- Paradigm shift -- Something wrong with the label -- Drugs -- Return of the two depressions -- Nerves redux