Science, gender, and the emergence of depression in American psychiatry, 1952-1980

Journal of the History of Medicine and Allied Sciences

Volumn 61, Issue 2, 2006, Pages 187-216

  Hirshbein, Laura D ^a  

^a UNIVERSITY OF MICHIGAN   (United States)

Author keywords

Depression; Gender; Melancholia; Neurology; Nosology; Psychiatry

Indexed keywords

ATTITUDE TO HEALTH; CLINICAL TRIAL; CULTURAL ANTHROPOLOGY; DEPRESSION; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; ETHNOLOGY; FEMALE; GENDER IDENTITY; HISTORY; HUMAN; MALE; PSYCHIATRY; REVIEW; SEX DIFFERENCE; UNITED STATES;

ATTITUDE TO HEALTH; CLINICAL TRIALS; CULTURE; DEPRESSIVE DISORDER; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; FEMALE; GENDER IDENTITY; HISTORY, 20TH CENTURY; HUMANS; MALE; PSYCHIATRY; SEX FACTORS; UNITED STATES;

EID: 33644976905     PISSN: 00225045     EISSN: 14684373     Source Type: Journal    
DOI: 10.1093/jhmas/jrj037     Document Type: Review

References (202)

1. Robert A. Woodruff, Jr., Paula Clayton, and Samuel B. Guze, "Is Everyone Depressed?," Am. J. Psychiatry, 1975, 132, 627-28.
2. American Psychiatric Association, Diagnostic and Statistical Manual: Mental Disorders (Washington, D.C.: American Psychiatric Association, 1952). For an excellent analysis of the emergence of DSM-I,
3. see Gerald N. Grob, "Origins of DSM-I: A Study in Appearance and Reality, "Am. J. Psychiatry, 1991, 148, 421-30.
4. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (Washington, D.C.: American Psychiatric Association, 1980). On ways in which depression as a symptom appeared in the medical literature,
5. see for example John Madison Taylor, "Climate or Environment as a Factor in the Repair of Neurasthenia and Melancholia," Boston Med. Surg. J., 1897, 137, 415-16;
6. Smith Ely Jelliffe and William A. White, "The Psychoneuroses and Actual Neuroses," in Diseases of the Nervous System: A Text-Book of Neurology and Psychiatry (Philadelphia: Lea & Febiger, 1915), 593-631;
7. Henry M. Swift, "The Progress of Recurrent Insanity of the Manic Depressive Type," Am. J. Insanity, 1907, 64, 311-26.
8. See for example Lothar B. Kalinowsky and Paul H. Hoch, Shock Treatments and Other Somatic Procedures in Psychiatry (New York: Grune & Stratton, 1946);
9. Max Fink, "EST: A Special Case in Pharmacotherapy," in Phenomenology and Treatment of Depression, ed. William E. Fann et al. (New York: Spectrum Publications, 1977), 285-94.
10. One author in 1960 did ascribe to ECT the role of the intervention that began "The era of the modem treatment of depressive disorders" (starting with the Italian team of Cerletti and Bini in the late 19305). Fritz A. Freyhan, "The Modern Treatment of Depressive Disorders," Am. J. Psychiatry, 1960, 116, 1057-64.
11. On earlier physician descriptions of melancholia, see Stanley W. Jackson, Melancholia and Depression: From Hippocratic Times to Modern Times (New Haven, Conn.: Yale University Press, 1986). For other descriptions of depression over the centuries,
12. see Jennifer Radden, ed., The Nature of Melancholy: From Aristotle to Kristeva (New York: Oxford University Press, 2000). Berrios and Porter have provided a good overview on this topic in the nineteenth and twentieth centuries in the United States and Great Britain.
13. See German E. Berrios, "Mood Disorders: Clinical Section," and
14. Roy Porter, "Mood Disorders: Social Section," in A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders, ed. German E. Berrios and Roy Porter (New York: New York University Press, 1995), 384-408, 409-20.
15. Charles E. Rosenberg and Janet Golden, eds., Framing Disease: Studies in Cultural History (New Brunswick, N.J.: Rutgers University Press, 1992).
16. For an unsurpassed overview of the history of American psychiatry, see Gerald Grab's series of volumes: Mental Institutions in America: Social Policy to 187; (New York: Free Press, 1973);
17. Mental Illness and American Society, 1875-1940 (Princeton, N.J.: Princeton University Press, 1983);
18. From Asylum to Community: Mental Health Policy in Modern America (Princeton, N.J.: Princeton University Press, 1991).
19. David Healy, The Antidepressant Era (Cambridge, Mass.: Harvard University Press, 1997).
20. Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (New York: Cambridge University Press, 1997).
21. Joan W. Scott, "Gender: A Useful Category of Historical Analysis," Am. Hist, Rev., 1986, 91, 1053-75;
22. Peter G. Filene, Him /Her/Self: Sex Roles in Modern America, 2nd ed. (Baltimore, Md.: Johns Hopkins University Press, 1986). For additional work on the history of women and mental illness, as well as critiques of mainstream psychiatry,
23. see Nancy Tomes, "Historical Perspectives on Women and Mental Illness," in Women, Health, and Medicine in America, ed. Rima D. Apple (New York: Garland Publishing, Inc., 1990), 143-72;
24. Tomes, "Feminist Histories of Psychiatry," in Discovering the History of Psychiatry, ed. Mark S. Micale and Roy Porter (New York: Oxford University Press, 1994), 348-83.
25. I located the primary source articles in three ways: first, I reviewed the whole time period in the Am. J. Psychiatry; second, I reviewed articles from this time period that had been cited by currently well-accepted articles in the field of depression studies; and third, I used Medline (the medical database) to find other sources on clinical research and diagnosis in depression in this time period.
26. Manic-depressive psychosis was differentiated from dementia praecox (or schizophrenia) by clinical course: patients with manic-depressive psychosis had a waxing and waning presentation of symptoms, while patients with dementia praecox seemed to primarily decline. See William A. White, Outlines of Psychiatry (New York: The Journal of Nervous and Mental Disease Publishing Company, 1907), pp. 108-24.
27. See for example Francis X. Dercum, Rest, Suggestion and Other Therapeutic Measures in Nervous and Mental Diseases, 2nd ed. (Philadelphia: P. Blakistori's Son & Co., 1917), pp. 212-24.
28. Andrew Abbott has argued that psychiatry and neurology split in the 19205, with a psychiatric focus on the psychoanalytic and a neurological focus on the organic. See Andrew Delano Abbott, "The Emergence of American Psychiatry, 1880-1930" (Ph.D. diss., University of Chicago, 1982);
29. Abbott, The System of Professions: An Essay on the Division of Expert Labor (Chicago: University of Chicago Press, 1988), pp. 280-314.
30. See for example Clarence B. Farrar, "On the Methods of Later Psychiatry," Am. J. Insanity, 1905, 61, 437-66;
31. Lewellys F. Barker, "The Relations of Internal Medicine to Psychiatry," Am. J. Psychiatry, 1914, 71, 13-28;
32. H. A. Tomlinson, "The Unity of Insanity," Am. J. Psychiatry, 1906, 63, 155-66.
33. Committee on Statistics of the American Medico-Psychological Association and Bureau of Statistics of the National Committee for Mental Hygiene, Statistical Manual for the Use of Institutions for the Insane (New York: National Committee for Mental Hygiene, 1918);
34. H. B. Logic, ed., A Standard Classified Nomenclature of Disease (New York: The Common-wealth Fund, 1933).
35. For examples of how these classification systems were used, see Horatio M. Pollock, "The Future of Mental Disease from a Statistical Viewpoint," Am. J. Psychiatry, 1924, 80, 423-34;
36. Neil A. Dayton, "The First Year of the New Standard Nomenclature of Diseases in Massachusetts Mental Hospitals," Am. J. Psychiatry, 1935, 92, 589-613.
37. See also Gerald N. Grob, "Origins of DSM-I," Am. J. Psychiatry, 1991, 148, 421-30.
38. Jackson, Melancholia and Depression, pp. 207-11.
39. Swift, "The Prognosis of Recurrent Insanity of the Manic Depressive Type." For a general overview of involutional melancholia,
40. see D. K. Henderson, "Affective Reaction Types: II - Involutional Melancholia," in A Text-Book of Psychiatry for Students and Practitioners, 3rd ed. (Oxford: Oxford University Press, 1933), pp. 160-83.
41. See for example Purcell G. Schube et al., "Involutional Melancholia: Treatment with Theelin," Arch. Neurol. Psychiatry, 1937, 38, 505-12;
42. C. C. Ault, Emmett F. Hoctor, and August A. Werner, "Theelin Therapy in the Psychoses," J. Am. Med. Assoc., 1937, 109, 1786-88;
43. A. E. Bennett, "Metrazol Convulsive Shock Therapy in Affective Psychoses," Am. J. Med. Sci., 1939, 198, 695-701.
44. By the late 19605, researchers were identifying the old diagnosis of involutional melancholia as quaint, and the specific diagnosis disappeared. See for example Saul H. Rosenthal, "The Involutional Depressive Syndrome," Am. J. Psychiatry, 1968, 11 Suppl., 21-35.
45. On the history of the pharmaceutical industry and its relationship to medicine, see Jonathan Liebenau, Medical Science and Medical Industry: The Formation of the American Pharmaceutical Industry (Baltimore, Md.: Johns Hopkins University Press, 1987);
46. Louis Galambos and Jane Eliot Sewell, Networks of Innovation: Vaccine Development at Merck, Sharp & Dohme, and Mulford, 1895-19995 (New York: Cambridge University Press, 1995).
47. While this relationship is currently seen as extremely problematic (see for example David Healy, Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression [New York: New York University Press, 2004]), the nature of the relationship of pharmaceutical companies to physicians in the middle of the twentieth century bears further investigation.
48. Healy, The Antidepressant Era.
49. Gerald N. Grob, The Mad Among Us: A History of the Care of America's Mentally Ill (Cambridge, Mass.: Harvard University Press, 1994).
50. During this time period, ECT was accepted by virtually all the authors in the psychiatric literature as the definitive treatment for a variety of ailments. The success of medication in helping patients to avoid ECT was frequently mentioned in the 19505 and 19605. See for example Benjamin Pollock, "Clinical Findings in the Use of Tofranil in Depressive and Other Psychiatric States," Am. J. Psychiatry, 1959, 116, 312-17;
51. David C. English, "A Comparative Study of Antidepressants in Balanced Therapy," Am. J. Psychiatry, 1961, 117, 865-72;
52. William A. Horwitz, "Physiological Responses as Prognostic Guides in the Use of Antidepressant Drugs," Am. J. Psychiatry, 1968, 12;, 60-68. On the importance of discharge from the hospital as an outcome measure in this time period,
53. see William F. Orr et al., "Factors Influencing Discharge of Female Patients from a State Mental Hospital," Am. J. Psychiatry, 1968, 111, 576-82.
54. See for example Herman C. B. Denber and Etta G. Bird, "Chlorpromazine in the Treatment of Mental Illness. III: The Problem of Depression," Am. J. Psychiatry, 1956, 112, 1021;
55. Joseph A. Barsa and Nathan S. Kline, "Depression Treated with Chlorpromazine and Promethazine," Am. J. Psychiatry, 1957, 113, 744-45.
56. Another medication tried in this time period, orphenadrine, was also originally tested in Parkinsonism, found to have euphoric effects, and then tried in patients with depressive symptoms. Jonas B. Robitscher and Sydney E. Pulver, "Orphenadrine in the Treatment of Depression: A Preliminary Study," Am. J. Psychiatry, 1958, 114, 113-15.
57. See for example Antonio J. DeLiz Ferreira and Harry Freeman, "A Clinical Trial of Marsilid in Psychotic Depressed Patients," Am. J. Psychiatry, 1958, 114, 933-34.
58. For an example of improvement in outpatients on an antidepressant "stimulating" agent, see Howard D. Fabing, J. Robert Hawkins, and James A. L. Moulton, "Clinical Studies on a-(2-Piperidyl) Benzhydrol Hydrochloride, a New Antidepressant Drug," Am. J. Psychiatry, 1955, 111, 832-37.
59. H. Azima and R. H. Vispo, "Imipramine: A Potent New Anti-Depressant Compound," Am. J. Psychiatry, 1958, 115, 245-46.
60. Roland Kuhn, the researcher credited with the discovery of imipramine, summarized his research in Switzerland in his 1958 review article, "The Treatment of Depressive States with 622355 (Imipramine Hydrochloride)," Am. J. Psychiatry, 1958, 115, 459-64.
61. Theodore R. Robie, "Iproniazid Chemotherapy in Melancholia," Am. J. Psychiatry, 1958, 115, 407 (italics added).
62. Pollock, "Clinical Findings in the Use of Tofranil in Depressive and Other Psychiatric States," 314.
63. William Furst, "Therapeutic Re-Orientation in Some Depressive States: Clinical Evaluation of a New Mono-Amine Oxidase Inhibitor (W-1544-a) (Phenelzine) (Nardil))," Am. J. Psychiatry, 1959, 116, 429-34.
64. The issue of consent and psychiatric treatment and research is a large and complicated one, and its history has not been fully explored. Turner in 1962 mentioned that, with the changing demographics of hospital populations by the 19605 and the increasing number of voluntary patients, electroshock therapy declined because voluntary patients would not agree to it (William J. Turner, Francis J. O'Neill, and Sidney Merlis, "The Treatment of Depression in Hospitalized Patients before and since the Introduction of Antidepressant Drugs," Am. J. Psychiatry, 1962, 119, 421-26).
65. The first mention I could find of a researcher mentioning that patients signed an informed consent prior to participation in a clinical trial was Sidney Malitz and Maureen Kanzler, "Are Antidepressants Better than Placebo?," Am. J. Psychiatry, 1971, 127, 1605-11.
66. For a history of earlier human experimentation, see Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore, Md.: Johns Hopkins University Press, 1995).
67. Denber and Bird, "Chlorpromazine in the Treatment of Mental Illness";
68. Barsa and Kline, "Depression Treated with Chlorpromazine and Promethazine";
69. Ferreira and Freeman, "A Clinical Trial of Marsilid in Psychotic Depressed Patients";
70. Wilson G. Scanlon and William M. White, "Iproniazid (Marsilid): Its Use in Office Treatment of Depression," Am. J. Psychiatry, 1958, 114, 1036-37;
71. Azima and Vispo, "Imipramine";
72. Pollock, "Clinical Findings in the Use of Tofranil in Depressive and Other Psychiatric States."
73. See for example Turner, O'Neill, and Merlis, "The Treatment of Depression in Hospitalized Patients";
74. Donald F. Klein and Max Fink, "Psychiatric Reaction Patterns to Imipramine," Am. J. Psychiatry, 1962, 119, 432-38;
75. Saul H. Rosenthal, "Changes in a Population of Hospitalized Patients with Affective Disorders, 1945-1965," Am. J. Psychiatry, 1966, 123, 671-81;
76. Gerald L. Klerman and Eugene S. Paykel, "Depressive Pattern, Social Background, and Hospitalization,"J. Nerv. Ment. Dis., 1970, 150, 466-78.
77. As several researchers have pointed out, the vast majority of research on heart disease interventions was completed on samples of men and then extrapolated to women. In 1990, the National Institutes of Health created an Office on Women to ensure that women were adequately represented in clinical trials. Joan L. Thomas and Patricia A. Braus, "Coronary Artery Disease in Women: A Historical Perspective," Arch. Intern. Med., 1998, 158, 333-37;
78. Kathryn M. King and Pauline Paul, "A Historical Review of the Depiction of Women in Cardiovascular Literature," West. J. Nurs. Res., 1996, 18, 89-101;
79. Janet W. Rich-Edwards et al., "Medical Progress: The Primary Prevention of Coronary Heart Disease in Women," N. Engl. J. Med., 1995, 332, 1758-66;
80. Teresa S. M. Tsang et al., "Risks of Coronary Heart Disease in Women: Current Understanding arid Evolving Concepts," Mayo Clin. Proc., 2000, 75, 1289-303;
81. Christine L. Miller and Cynthia R. Kollauf, "Evolution of Information on Women and Heart Disease 1957-2000: A Review of Archival Records and Secular Literature," Heart Lung, 2002, 31, 253-61;
82. Joseph Palca, "Women Left Out at NIH," Science, 1990, 248, 1601-2;
83. Ruth B. Merkatz et al., "Women in Clinical Trials of New Drugs," N. Engl. J. Med., 1993, 329, 292-96.
84. Marks, The Progress of Experiment.
85. One Detroit researcher in 1958 explained that his trial of iproniazid did not involve the use of "sales talk" prior to giving the medication to his clinical subjects. Robert R. Schopbach, "Clinical Note Concerning Iproniazid (Marsilid)," Am. J. Psychiatry, 1958, 114, 838-39.
86. Erwin L. Linn, "Sources of Uncertainty in Studies of Drugs Affecting Mood, Mentation or Activity," Am. J. Psychiatry, 1959, 116, 97-103.
87. John P. Holt, Eleanore R. Wright, and Arthur O. Hecker, "Comparative Clinical Experience with Five Antidepressants," Am. J. Psychiatry, 1960, 117, 533-38.
88. See also English, "A Comparative Study of Antidepressants in Balanced Therapy."
89. Milton Greenblatt, George H. Grosser, and Henry Wechsler, "A Comparative Study of Selected Antidepressants and EST," Am. J. Psychiatry, 1962, 119, 144-53;
90. Norman Roulet et al., "Imipramine in Depression: A Controlled Study," Am. J. Psychiatry, 1962, 119, 427-31;
91. Milton Greenblatt, George H. Grosser, and Henry Wechsler, "Differential Response of Hospitalized Depressed Patients to Somatic Therapy," Am. J. Psychiatry, 1964, 120, 935-43.
92. John E. Overall et al., "Nosology of Depression and Differential Response to Drugs," J. Am. Med. Assoc., 1966, 193, 946-48.
93. For a contemporary overview of changes in research over this time period, see H. Keith H. Brodie and Melvin Sabshin, "An Overview of Trends in Psychiatric Research: 1963-1972," Am. J. Psychiatry, 1973, 130, 1309-18.
94. The National Institute of Mental Health (NIMH) organized a large group to work on the problem of depression in the 19705. For contemporary explanations of the group, see Martin M. Katz and Gerald L. Klerman, "Introduction: Overview of the Clinical Studies Program," Am. J. Psychiatry, 1979, 136, 49-51;
95. Martin M. Katz et al., "NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression," Arch. Gen. Psychiatry, 1979, 36, 765-71.
96. For a retrospective account of the group, see Morris B. Parloff and Irene Elkin, "The NIMH Treatment of Depression Collaborative Research Program," in History of Psychotherapy: A Century of Change, ed. Donald K. Freedheim (Washington, D.C.: American Psychological Association, 1992), pp. 442-49.
97. See for example A. Kessell, T. A. Pearce, and N. F. Holt, "A Controlled Study of Nortriptyline and Imipramine," Am. J. Psychiatry, 1970, 126, 938-45;
98. Arthur J. Prange et al., "Enhancement of Imipramine by Thyroid Stimulating Hormone: Clinical and Theoretical Implications," Am. J. Psychiatry, 1970, 127, 191-99;
99. Karl Rickels et al., "Amitriptyline and Trimipramine in Neurotic Depressed Outpatients: A Collaborative Study," Am. J. Psychiatry, 1970, 127, 208-18;
100. Robert V. DeSilverio et al., "Perphenazine-Amitriptyline in Neurotic Depressed Outpatients: A Controlled Study," Am. J. Psychiatry, 1974, 131, 25-30;
101. Allen Raskin, "A Guide for Drug Use in Depressive Disorders," Am. J. Psychiatry, 1974, 131, 181-85.
102. See for example Lino Covi et al., "Drug and Psychotherapy Interactions in Depression," Am. J. Psychiatry, 1976, 133, 502-8. For an example of the use of case summary data,
103. see James J. Cadden and Frederic F. Flach, "Differential Response to Treatment as a Function of the Changing Character of Depression," Am. J. Psychiatry, 1970, 126, 1013-16.
104. The first study I found that was sponsored (including study design and statistical analysis) by a pharmaceutical company (Geigy) was Abraham Heller, Rorry Zahourek, and H. G. Whittington, "Effectiveness of Antidepressant Drugs: A Triple-Blind Study Comparing Imipramine, Desipramine, and Placebo," Am. J. Psychiatry, 1971, 127, 1092-95. The current pharmaceutical industry role in clinical research is a subject of intense discussion and disagreement.
105. See for example Healy, Let Them Eat Prozac.
106. See for example Helmut Beckmann and Frederick K. Goodwin, "Antidepressant Response to Tricyclics and Urinary MHPG in Unipolar Patients: Clinical Response to Imipramine or Amitriptyline," Arch. Gen. Psychiatry, 1975, 32, 17-21;
107. Patricia Neely Wold and Kirby Dwight, "Subtypes of Depression Identified by the KDS-3a: A Pilot Study," Am. J. Psychiatry, 1979, 136, 1415-19.
108. John Feighner and his group used a preliminary criteria-based definition of depression in a study published in 1972 on the effects of augmenting imipramine. John P. Feighner et al., "Hormonal Potentiation of Imipramine and ECT in Primary Depression," Am. J. Psychiatry, 1972, 128, 1230-38.
109. See for example Anthony LaPolla and Harry Jones, "Placebo-Control Evaluation of Desipramine in Depression," Am. J. Psychiatry, 1970, 127, 335-38;
110. Heller, Zahourek, and Whittington, "Effectiveness of Antidepressant Drugs."
111. See for example Alberto DiMascio et al., "Differential Symptom Reduction by Drugs and Psychotherapy in Acute Depression," Arch. Gen. Psychiatry, 1979, 36, 1450-56;
112. Bruce J. Rounsaville, Brigitte A. Prusoff, and Nancy Padian, "The Course of Nonbipolar, Primary Major Depression: A Prospective 16-Month Study of Ambulatory Patients," J. Nerv. Ment. Dis., 1980, 168, 406-11.
113. Joe Dorzab et al., "Depressive Disease: Familial Psychiatric Illness," Am. J. Psychiatry, 1971, 127, 1128-33.
114. See for example Betty Friedan, The Feminine Mystique (New York: Dell Publishing, 1963);
115. Barbara Ehrenreich and Deirdre English, For Her Own Good: 150 Years of the Experts' Advice to Women (Garden City, N.Y.: Anchor Press, 1978).
116. Some contemporary feminist psychiatrists also engaged with the issues of sex, gender, and women's relationship to psychiatry in the past and present. See Anne M. Seiden, "Overview: Research on the Psychology of Women. I. Gender Differences and Sexual and Reproductive Life," Am. J. Psychiatry, 1976, 133, 995-1007;
117. Seiden, "Overview: Research on the Psychology of Women. II. Women in Families, Work, and Psychotherapy," Am. J. Psychiatry, 1976, 133, 1111-23.
118. See for example Walter R. Gove, "The Relationship between Sex Roles, Marital Status, and Mental Illness," Soc, Forces, 1972, 51, 34-44;
119. Lenore Radloff, "Sex Differences in Depression: The Effects of Occupation and Marital Status," Sex Roles, 1975, 1, 249-65.
120. For a contemporary thoughtful commentary on women's social roles and their interactions with psychiatry, see Virginia Abernethy, "Cultural Perspectives on the Impact of Women's Changing Roles on Psychiatry," Am. J. Psychiatry, 1976, 133, 657-61.
121. See for example Myrna M. Weissman, Gerald L. Klerman, and Eugene S. Paykel, "Clinical Evaluation of Hostility in Depression," Am. J. Psychiatry, 1971, 128, 261-66;
122. Gerald L. Klerman et al., "Treatment of Depression by Drugs arid Psychotherapy," Am. J. Psychiatry, 1974, 131, 186-91.
123. Weissman and Klerman were by no means the only ones to study only women and then generalize to everyone. See also Eva Y. Deykin and Alberto DiMascio, "Relationship of Patient Background Characteristics to Efficacy of Pharmacotherapy in Depression," J. Nerv. Ment. Dis., 1972, 155, 209-15.
124. Myrna M. Weissman and Gerald L. Klerman, "The Chronic Depressive in the Community: Unrecognized and Poorly Treated," Compr. Psychiatry, 1977, 18, 523-32.
125. The book that encapsulated Weissman's and Klerman's findings did explain that their studies were performed on women. Myrna M. Weissman and Eugene S. Paykel, The Depressed Woman: A Study of Social Relationships (Chicago: University of Chicago Press, 1974).
126. Brigitte A. Prusoff et al., "Treatment of Secondary Depression in Schizophrenia: A Double-Blind, Placebo-Controlled Trial of Amitriptyline Added to Perphenazine," Arch. Gen. Psychiatry, 1979, 36, 569-75.
127. Myrna M. Weissman and Gerald L. Klerman, "Sex Differences and the Epidemiology of Depression," Arch. Gen. Psychiatry, 1977, 34, 98-111.
128. Eduard Ascher, "A Criticism of the Concept of Neurotic Depression," Am. J. Psychiatry, 1952, 108, 901-8.
129. See David R. Hawkins and Joseph Mendels, "Sleep Disturbance in Depressive Syndromes," Am. J. Psychiatry, 1966, 123, 682-700;
130. Jackson, Melancholia and Depression, 211-19.
131. See for example Robert A. Woodruff, Jr., George E. Murphy, and Marijan Herjanic, "The Natural History of Affective Disorders - I. Symptoms of 72 Patients at the Time of Index Hospital Admission," J. Psychiatr. Res., 1967, 5, 255-63;
132. Charlotte Silverman, "The Epidemiology of Depression - a Review," Am. J. Psychiatry, 1968, 124, 883-91.
133. See for example Frederick Lemere and James H. Lasater, "Deanol (Deaner) a New Cerebral Stimulant for the Treatment of Neurasthenia and Mild Depression: A Preliminary Report," Am. J. Psychiatry, 1958, 114, 655-56;
134. Ralph N. Wharton et al., "A Potential Clinical Use for Methylphenidate with Tricyclic Antidepressants," Am. J. Psychiatry, 1971, 127, 1619-25;
135. Robert M. Post, Joel Kotin, and Frederick K. Goodwin, "The Effects of Cocaine on Depressed Patients," Am. J. Psychiatry, 1974, 131, 511-17.
136. After the apparent success of iproniazid, other researchers tried out other anti-tuberculosis medication to see if they would help with depressive states. See for example George E. Crane, "Cyloserine as an Antidepressant Agent," Am. J. Psychiatry, 1959, 115, 1025-26.
137. T. R. Robie, "Marsilid in Depression," Am. J. Psychiatry, 1958, 114, 936-37.
138. Joseph J. Schildkraut, "The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence," Am. J. Psychiatry, 1965, 122, 509-22.
139. See also Joseph J. Schildkraut et al., "Norepinephrine Metabolism and Drugs Used in the Affective Disorders: A Possible Mechanism of Action," Am. J. Psychiatry, 1967, 124, 600-8;
140. Joseph J. Schildkraut, "Norepinephrine Metabolites as Biochemical Criteria for Classifying Depressive Disorders and Predicting Responses to Treatment: Preliminary Findings," Am. J. Psychiatry, 1973, 130, 695-99.
141. A few researchers noted at the time that there were major biochemical problems with the catecholamine hypothesis. See for example David L. Dunner and Ronald R. Fieve, "Affective Disorder: Studies with Amine Precursors," Am. J. Psychiatry, 1975, 132, 180-83;
142. Joe Mendels et al., "Amine Precursors and Depression," Arch. Gen. Psychiatry, 1975, 32, 22-30.
143. A similar process of inferring backwards from drug effect occurred in schizophrenia. Researchers in the 19605 and 19705 concluded that, since chlorpromazine seemed to help in schizophrenia and since the medication reduced dopamine, schizophrenia is caused by abnormal dopamine levels. This hypothesis has been seriously questioned in recent years, however. See Robert E. McCullumsmith, Sarah M. Clinton, and James H. Meador-Woodruff, "Schizophrenia as a Disorder of Neuroplasticity," Int. Rev. Neurobiol., 2004, 59, 19-45.
144. Milton Kramer et al., "Drugs and Dreams III: The Effects of Imipramine on the Dreams of Depressed Patients," Am. J. Psychiatry, 1968, 124, 1385-92.
145. See also Cadden and Flach, "Differential Response to Treatment as a Function of the Changing Character of Depression."
146. See for example Denis Hill, "Depression: Disease, Reaction, or Posture?," Am. J. Psychiatry, 1968, 125, 445-57;
147. Eugene S. Paykel et al., "Life Events and Depression: A Controlled Study," Arch. Gen. Psychiatry, 1969, 21, 753-60;
148. Wallace Wilkins, "Psychoanalytic arid Behavioristic Approaches toward Depression: A Synthesis?," Am. J. Psychiatry, 1971, 128, 358-59.
149. Donald F. Klein, "Endogenomorphic Depression: A Conceptual and Terminological Revision," Arch. Gen. Psychiatry, 1974, 31, 447-54;
150. Hagop S. Akiskal and William T. McKinney, Jr., "Overview of Recent Research in Depression: Integration of Ten Conceptual Models into a Comprehensive Clinical Frame," Arch. Gen. Psychiatry, 1975, 32, 285-305.
151. Although I focus here on biological themes, some psychiatrists saw the strong relationship between women and depression in terms of women's presumed dependence on social relationships. See for example Alfred S. Friedman, "Interaction of Drug Therapy with Marital Therapy in Depressive Patients," Arch. Gen. Psychiatry, 1975, 32, 619-37.
152. Edward L. Klaiber et al., "Effects of Estrogen Therapy on Plasma MAO Activity and EEG Driving Responses of Depressed Women," Am. J. Psychiatry, 1972, 128, 1492-98. Klaiber's group continued to believe that estrogen played some role in depression, and continued to perform clinical trials of estrogen in depression.
153. See Edward L. Klaiber et al., "Estrogen Therapy for Severe Persistent Depressions in Women," Arch. Gen. Psychiatry, 1979, 36, 550-54. Psychiatrists had been convinced for decades, despite the meager evidence in their published research, that estrogen was going to turn out to be a treatment for women (particularly post-menopausal women) with mental illness.
154. See for example Herbert S. Ripley, Ephraim Shorr, and George N. Papanicolaou, "The Effect of Treatment of Depression in the Menopause with Estrogenic Hormone," Am. J. Psychiatry, 1940, 96, 905-13. For more historical discussion of assumptions about menopause and aging in women,
155. see Lois Banner, In Full Flower. Aging Women, Power, and Sexuality (New York: Vintage Books, 1992);
156. S. E. Bell, "Changing Ideas: The Medicalization of Menopause," in The Meanings of Menopause: Historical, Medical, and Clinical Perspectives, ed. R. Formanek (Hillsdale, N.J.: Analytic Press, 1990), pp. 43-63.
157. Ian C. Wilson, Arthur J. Prange, and Patricio P. Lara, "Methyltestosterone with Imipramine in Men: Conversion of Depression to Paranoid Reaction," Am. J. Psychiatry, 1974, 131, 21, 23. Wilson and his group refer to imipramine's greater effectiveness in men, but I have not found specific mention of this (other than in passing with no references) in the literature.
158. Researchers continued to ask questions about the relationship of depression to menopause, even when they could find no relationship. See for example George Winokur, "Depression in the Menopause," Am. J. Psychiatry, 1973, 130, 92-93.
159. Martin G. Blinder, "The Pragmatic Classification of Depression," Am. J. Psychiatry, 1966, 123, 261.
160. Interestingly enough, the fact that the introduction of new treatments seemed to be driving a substantial increase in interest in theories about depression was not much acknowledged at the time. Many instead began to insist by the 1960s that depression was an ancient illness but had been unsatisfactorily treated until recently. See for example Max L. Lurie and Harry M. Salzer, "Tranylcypromine (Parnate) in the Ambulatory Treatment of Depressed Patients," Am. J. Psychiatry, 1961, 118, 152-55.
161. Some psychiatric researchers used components of the MMPI in their research but generally commented that this scale was not sensitive to changes with treatment over time. On the history of psychological assessment, see Roderick D. Buchanan, "The Development of the Minnesota Multiphasic Personality Inventory," J. Hist. Behav. Sci., 1994, 30, 148-61;
162. Paul Davis Chapman, "Schools as Sorters: Testing arid Tracking in California, 1910-1925," J. Soc. Hist., 1981, 14, 701-17;
163. Michael M. Sokal, ed., Psychological Testing and American Society, 1890-1930 (New Brunswick, N.J.: Rutgers University Press, 1987). On the growth of the influence of psychology in the post-World War II years,
164. see Ellen Herman, The Romance of American Psychology: Political Culture in the Age of Experts (Berkeley: University of California Press, 1995).
165. Max Hamilton, "A Rating Scale for Depression," J. Neurol. Neurosurg. Psychiatry, 1960, 23, 56-62.
166. Max Hamilton, "Development of a Rating Scale for Primary Depressive Illness," Br. J. Soc. Clin. Psychology, 1967, 6, 278-96.
167. Aaron T. Beck, Cognitive Therapy and the Emotional Disorders (New York: International Universities Press, 1976).
168. As several researchers pointed out at the time, some viewed self-assessment scales as less biased than observer scales because they assessed the patient's symptoms directly. See for example William W. K. Zurig, "A Cross-Cultural Survey of Symptoms in Depression," Am. J. Psychiatry, 1969, 126, 116-21.
169. A. T. Beck et al., "An Inventory for Measuring Depression," Arch. Gen. Psychiatry, 1961, 4, 561-71. Myron Sandifer and his group developed a rating scale in the 1960s to try to differentiate endogenous and reactive depression. Like the Beck scale, Sandifer's scale included a number of thoughts and feelings, but it also included one item on "somatization." Sanifer's group developed and tested their scale on an entirely female ward.
170. Myron G. Sandifer, Ian C. Wilson, and Linda Green, "The Two-Type Thesis of Depressive Disorders," Am. J. Psychiatry, 1966, 123, 93-97.
171. Healy, The Antidepressant Era, pp. 98-100.
172. For an overview on constructions of masculinity over the twentieth century, see Michael S. Kimmel, Manhood in America: A Cultural History (New York: Free Press, 1996).
173. Horwitz, "Physiologic Responses as Prognostic Guides in the Use of Antidepressant Drugs."
174. Allen Raskin et al., "Replication of Factors of Psychopathology in Interview, Ward Behavior and Self-Report Ratings of Hospitalized Depressives," J. Nerv. Ment. Dis., 1969, 148, 87-98, p. 87.
175. See for example John P. Feighner, "Nosology: A Voice for a Systematic Data-Oriented Approach," Am. J. Psychiatry, 1979, 136, 1173-74. While many members of the profession accepted the idea that psychiatry needed an improved nosology by the 19705, some within (and without) the field strongly objected to the disease model of mental disorder implied by a classification scheme.
176. See for example Thomas S. Szasz, "The Problem of Psychiatric Nosology: A Contribution to a Situational Analysis of Psychiatric Operations," Am. J. Psychiatry, 1957, 114, 405-13. Szasz would go on to make this critique even more strongly in subsequent years.
177. Thomas S. Szasz, "The Myth of Mental Illness," Am. Psychol., 1960, 15, 113-18.
178. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 2nd ed. (Washington, D.C.: American Psychiatric Association, 1968). DSM-II had represented a substantial departure from the first edition of DSM in 1952. The American Psychiatric Association's Committee on Nomenclature and Statistics, headed by Spitzer, had authorized the 1968 revision in order to bring the United States in line with psychiatric diagnoses used in the International Classification of Disease (ICD-8).
179. Robert L. Spitzer and Paul T. Wilson, "A Guide to the American Psychiatric Association's New Diagnostic Nomenclature," Am. J. Psychiatry, 1968, 124, 1619-29.
180. Stuart A. Kirk and Herb Kutchins, The Selling cf DSM: The Rhetoric of Science in Psychiatry (New York: Aldine de Gruyter, 1992);
181. Herb Kutchins and Stuart A. Kirk, Making Us Crazy: DSM, the Psychiatric Bible and the Creation of Mental Disorders (New York: Free Press, 1997).
182. John P. Feighner et al., "Diagnostic Criteria for Use in Psychiatric Research," Arch. Gen. Psychiatry, 1972, 26, 57-63;
183. Robert L. Spitzer, Jean Endicott, and Eli Robins, "Research Diagnostic Criteria: Rationale and Reliability," Arch. Gen. Psychiatry, 1978, 35, 773-82;
184. Jean Endicott and Robert L. Spitzer, "Use of the Research Diagnostic Criteria and the Schedule for Affective Disorders and Schizophrenia to Study Affective Disorders," Am. J. Psychiatry, 1979, 136, 52-56.
185. American Psychiatric Association, DSM-III, pp. 205-24.
186. Although the mood descriptor of "irritability" was included in DSM-III, it disappeared for adults by the next edition (DSM-IIIR), Irritability was noted to be a possible symptom for children and adolescents. It is not clear why this descriptor was eliminated. Most clinicians who treat men now agree that irritability is a prominent feature of depression in men. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. ed. (Washington, D.C.: American Psychiatric Press, 1987), pp. 213-33.
187. Darrel A. Regier et al., "One-Month Prevalence of Mental Disorders in the United States: Based on Five Epidemiologic Catchment Area Sites," Arch. Gen. Psychiatry, 1988, 45, 977-86;
188. Lee N. Robins and Darrel A. Regier, eds., Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (New York: Free Press, 1991).
189. Johns Hopkins researchers in the 19705 had investigated this issue in a small community sample and found that the presence of symptoms was not the best way to differentiate clinical and community samples. See Thomas J. Craig and Pearl A. Van Natta, "Presence and Persistence of Depressive Symptoms in Patient and Community Populations," Am. J. Psychiatry, 1976, 133, 1426-29.
190. See also Frederick S. Mendelsohn, Gladys Egri, and Bruce P. Dohrenwend, "Diagnosis of Nonpatients in the General Community," Am. J. Psychiatry, 1978, 135, 1163-67.
191. See for example Weissman and Klerman, "Sex Differences and the Epidemiology of Depression."
192. See for example S. G. Kornstein et al., "Gender Differences in Chronic Major and Double Depression,"J. Affect. Disord., 2000, 60, I-II;
193. Mary V. Seeman, "Psychopathology in Women and Men: Focus on Female Hormones," Am. J. Psychiatry, 1997, 154, 1641-47;
194. Kenneth S. Kendler et al., "The Prediction of Major Depression in Women: Toward an Integrated Etiologic Model," Am. J. Psychiatry, 1993, 150, 1139-48.
195. Jonathan O. Cole, "Depression," Am. J. Psychiatry, 1974, 131, 204-5.
196. In 1974, Aaron Beck adopted his Depression Inventory as a screening tool to address what he identified as the major problem of undiagnosed depression (with a high risk of morbidity and possible risk of suicide). Aaron T. Beck and Alice Beamesderfer, "Assessment of Depression: The Depression Inventory," Mod. Probl. Pharmacopsychiatry, 1974, 7, 151-69. On family physicians and the diagnosis and treatment of depression,
197. see for example Michael J. Garvey, "Biochemistry arid Treatment Strategies for Depression," J. Fam. Pract., 1980, 11, 215-19.
198. Both Joel Braslow and Jack Pressman pointed out that women were more often subjected to (or provided with, depending on the interpretation) psychiatric interventions in the past than men. Joel Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley: University of California Press, 1997);
199. Jack D. Pressman, Last Resort: Psychosurgery and the Limits of Medicine (New York: Cambridge University Press, 1998).
200. Edward Shorter has argued against the social constructivists in the history of mental illness by pointing out that there is true, biologically based mental illness. See Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997). While I would agree that there is real mental illness, I would also argue that what counts and is experienced as illness by a patient and by others is very much socially constructed. On changing patterns of interpreting symptoms in a cultural context,
201. see Elaine Showalter, Hystories: Hysterical Epidemics and Modern Media (New York: Columbia University Press, 1997).
202. There are relatively few primary sources on racial differences in psychiatry theory and practice. See for example Allen Raskin and Thomas H. Crook, "Antidepressants in Black and White Inpatients: Differential Response to a Controlled Trial of Chlorpromazine and Imipramine," Arch. Gen. Psychiatry, 1975, 32, 643-49.