StayOnTop: Depression

Yesterday the Shorpy historical photo blog had a very interesting picture of a 1924 “Mental Hygiene” exhibition. Below is a small copy. To view it in huge format (so you can read everything on the wall) see the original photo at Shorpy.

The fascinating thing about this photo is it shows an early stage of what I like to call “illnification”: the gradual process of how, over the last 150 years, everyday mental problems became more and more formally classified and treated as illness. This includes depression.

    Of course depression has always interested doctors – in fact, since the earliest times. In the 1st century AD, the prominent Greek physician Rufus of Ephesus already studied depression; he thought it was caused by “black bile”. Do you want to know what in his view was the best remedy? Sex! He said that having sexual intercourse settles and calms the passions, and thus would counteract depression. Apparently, he did not yet recognize that severe depression can make it difficult to have satisfying sex.

    Interestingly, Rufus also thought that depression had something to do with intellectual genius (a notion that was later revived by 18th-century Romanticists). Now maybe that’s a comfort to some of us! A commented edition of Rufus’ 2000-years-old treatise can still be ordered from Google Books, Amazon, or directly from the publisher here.

But I digress. The real process of “illnifying” depression began much later, in the second half of the 19th century. It has accelerated significantly since about 1900. Gradually, pharmacists, psychiatrists and hospitals discovered that there was big business in treating common mental health problems – including depression.

    The 1924 Shorpy photo illustrates this in a striking way. It shows advertisements of four psychiatric clinics offering a first examination for free (or 50 cents). Sheets inform the public how to recognize the symptoms of mental problems: “Nervous Mannerisms are Mental Danger Signals – SEE THE DOCTOR”. They list danger signals in children: “Inactivity, Morbidness, Unsociability, Fits of ‘Blues’, Excitability, Extreme Timidity ARE UNCHILDLIKE BEHAVIOR – Should Be Attended To”.

Prominently on the 1924 exhibition wall is this quote:

“We see a time – When the strange child, the worried mother, the confused and depressed workman will appeal to the hospitals for relief – as they now run to them for diabetes, appendicitis, or typhoid fever”.

Here you have it: illnification, 1924-style. Largely, the time they saw coming, has indeed come.

    Partly thanks to the commercial motives behind this illnification process, today we have professional attention, medication, therapies and insights that didn’t exist 100 years ago. When something is seriously wrong psychically, today we are indeed more inclined to “appeal to the hospitals for relief”. By itself, surely this is not a bad thing.

    But often it looks like this process is still going on, continuously pushing further the boundaries between what are fairly common mood or behavior problems at one side, and what is labeled “illness” or “disorder” on the other side. A prime example is of course ADHD in children: diagnosed with “Attention Deficit Hyperactivity Disorder” today, forty years ago most of the same children would have been simply called “unruly”. Instead of giving them pills, parents would just have waited for them to grow up a little.

    The same kind of border-shifting illnification is still going on with mild forms of depression, too. People who forty years ago might have labeled themselves simply as “sad” or “somber”, may today tend more to seek professional help or medication because they now view themselves as suffering from Depression Disorder.

    The question that arises here is, haven’t we pushed the borders far enough by now? Aren’t we beginning to overdo it?

    Basically, the problem here seems to be that we’ve gotten used to setting our goals a little too high. We all want (hope, maybe even expect) to be perfect. From that perspective, there must be something wrong with everyone who’s not perfect – they ought to be helped and cured. But consequently, because no one is really perfect, because no one of us is happy all the time, we might end up classifying nearly everyone as suffering from some kind of illness or disorder.

    This would be pointless and in a few cases (where this classification might have the effect of a self-fulfilling prophecy) it might even be counterproductive. So the question remains: where and how do we draw the border line between common mood problems and depression?

    The approach of those 1924 mental health people may have been better than ours. They did not yet strive for perfection. The message on their exhibition was focused on recognizing indications of something abnormal in mood or behavior. Back then, the boundary between just being distressed or suffering from depression still was defined by a simple common-sense notion of what was fairly normal on the one hand, and what was definitely not normal on the other hand.

Maybe that’s where we should draw the border line between illness and non-illness again. And, resisting commercial impulses, stop further illnification.

    There may be a personal lesson in this: nobody can be all right all the time. Many of us can hardly expect to go through life without incidental episodes of depression. In many cases, this is not abnormal. It’s just a fact of life. If we won’t run immediately to the doctor for every slight bout of headache, then why should we run immediately to the psychiatrist for every slight bout of depression?

• tip: If you wonder if something is really wrong with you, first ask yourself: isn’t it fairly normal what I am going through?
    If what happens to you will also happen frequently to other people around you, then maybe the answer is: yes. Maybe in that case you’re not seriously ill, but just reacting in a natural way.
    Of course I do not mean to suggest here that you shouldn’t look for professional help when you really need it.

 
Author: Henk van Setten