the Nineteenth Century
Depression has been an omnipresent phenomenon over several millennia of human history. For virtually all of that time, from the earliest writings of the ancient Greek physicians to the late twentieth century, Western diagnosticians routinely distinguished depressive disorders, as a form of madness, from symptomatically similar but nondisordered, normal sadness responses to a wide range of painful circumstances. Then, in 1980, seeking a more scientific foundation for diagnosis by focusing on decontextualized criteria based on symptoms, the DSM-III inadvertently abandoned this critical traditional distinction, which is now essentially lost in current thinking about depression. This chapter and the next trace the history leading up to this momentous and, we argue, ultimately detrimental conceptual shift.
Why is reviewing this history important? Current diagnostic practices may seem obviously right and sensible just because they are accepted, and they are all that many of us have ever known. To understand the problems with the current diagnostic approach to depressive disorder and to recognize the choices it represents, it helps to place it in historical context. This history reveals that the way we think about depressive disorder now is quite new—and radically diverges from what has traditionally been considered appropriate.
But the importance of history is more than simply providing context and contrast. It is easy to assume that current practices, if they are different, must have emerged from a process in which the traditional alternatives were found to be flawed and were superseded by a superior approach. The history of thinking about depression specifically in regard to the role of context in diagnosing disorder dispels such beliefs and reveals instead the contingency and even arbitrariness of some aspects of current diagnostic practices. It shows that the reasons for the recent divergence from the traditional approach, although well intentioned and shaped by admirable scientific aspirations, are anchored neither in evidence nor