Jonathan Sadowsky, The Empire of Depression: A New History, Polity Press, 2020.

Associate Professor of History Department of Lingnan University, Hong Kong, Du Chunmei,

Jonathan Sadowsky, The Empire of Depression: A New History, Polity Press, 2020

There are few diseases and such powerful powers. It seems to be able to devour the soul in the air, making people feel that life is worse than death. WHO has listed depression as one of the world's major burden of disease. By 2019, there were more than 264 million patients of all ages, and suicide has also become the second leading cause of death for people aged 15 to 29. However, the numerous academic discussions, social concerns and legends of the world seem to be increasingly confusing: is depression an inevitable normal emotion in life, or a disease that must be treated and cured? Is it a universal physiological product of human beings, or a social existence that is inseparable from culture? Does the medicalization of depression help eliminate social prejudice, or does it mean that people rely too much on drugs to ignore real life problems? Medical historian Jonathan Sadowsky asked these soul questions straight to the point in his new book "The Empire of Depression: A New History".

If you want to get the exact answers to these questions from the book, you will be disappointed; because no one can give a satisfactory answer so far. But if you are willing to accept an interpretation that is not divided into binary, then this book will reveal to you the various dimensions and complex aspects of depression. The book has two meanings on the proposition of "empire": one is that in Western society and psychiatry, depression has replaced other related vocabulary and concepts since the late 20th century, becoming a dominant way to explain spiritual distress; the other is that although different societies have different descriptions of depression, depression has spread and spread around the world and has become a global disease.

When analyzing the huge empire of depression, the author selected four dimensions throughout the book: First, depression is shaped by history and culture, but comparisons across time and region are both possible and necessary. Second, we do not have to be obsessed with the question of whether depression is biological, psychological or social, but should regard it as a comprehensive existence. Third, there is a realistic politics of inequality in depression. Fourth, disputes within the profession have negatively affected the social perception of depression.

Like the writing of mainstream medical history today, the history of depression in this book is also a history dominated by Western medicine, and the concept of depression is also regarded as a product of modern Western history. During the European Renaissance, " melancholia" (melancholia) was said to be caused by excessive black bile and should be treated by diarrhea. In the Christian-led medieval times, depression became a moral issue—the focus of the debate was whether the patient's suffering was condemned, and the treatment was similar to punishment. The Enlightenment Age, which held high the torch of rationality, began to focus on the material attributes of depression, and the modern shift from "melancholy" to "depression" officially began in the 18th century. In 1987, Prozac ( fluoxetine ) was approved for use by the U.S. Food and Drug Administration, opening a new chapter in the history of contemporary depression; another major brand of antidepressants is Zoloft (also known as Zoloft), a pharmaceutical giant Pfizer. Since the late 1970s, a new perception of depression has been widely accepted - depression is caused by "chemical imbalance" and is associated with neuronal conduction, hormone content and genetic composition in the brain; therefore, some people are more likely to suffer from depression, and depression may also be inherited. With the vigorous publicity of pharmaceutical companies, the biological nature of depression has been increasingly emphasized from the medical community to society: since depression is well-founded, it is indeed a "real" epidemic, so it must be treated, and even medication for life.

"I have medicine, are you sick?" is an excellent irony for capital to influence diseases and treatment. Depression seems to have become a symptom of our time. In , Aldous Huxley , in 1932's "Brave New World ", he described that in the future, humans in the utopian world, always have a "universal pill" at hand. As long as they swallow it, their worries will disappear immediately.But in fact, "Prozac" not only cannot solve Prozac, but sometimes it can also bring serious side effects and drug addiction. At the same time, the danger of overdiagnosis does exist as commercial drugs become increasingly important for medicine and culture. However, Sadowski also emphasized that the sharp increase in in patients with depression cannot be entirely attributed to capital manipulation and constraint. There are at least three other possible reasons for coexistence: the patient is indeed increasing; the diagnostic methods and capabilities are enhanced; and the diagnostic criteria themselves have changed. Some emotions that were not considered a disease in the past are now diagnosed as depression. At the same time, the medicalization of depression can help many patients get rid of the pain of self-blame, relieve social shame, and make it easier to accept themselves and receive treatment.

Although most people agree that serious mental illnesses belong to the category of diseases, such as schizophrenia, it is difficult for both experts and ordinary people to reach a consensus on depression. What is normal? What is a disease? Who will define it? How to draw that clear dividing line within the spectrum of health and disease is a marathon-style tug-of-war that won't stop. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) prepared by the American Psychiatric Association is currently the most authoritative reference guide in the West. There are clear diagnostic criteria for depression: patients must have more than five of the nine symptoms, including depression most of the day, loss of interest or pleasure for almost all activities, insomnia or drowsiness, feeling worthless or excessive guilt, etc., and meet the conditions for the symptoms to last for more than two weeks.

As one of the earliest efforts to standardize psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 1952. The fifth edition in 2013 took ten years to revise it based on the fourth edition. But even this guide, written by the industry's most authoritative person, has been controversial since its publication. Famous psychiatrists and psychologists have led the public criticism that it "medical" the "normal" conditions, such as the grief after the loss of a loved one, was also included in the category of depression, and was listed as "exception" in the previous version of the manual. Some people who hold extreme opinions believe that the diagnosis of depression does not meet real medical standards at all because it does not have clear and visible wounds, only a definition of blur and change; depression is only a social and cultural issue.

The author points out that for most of human history, depression is regarded as a comprehensive existence; mental illness has never been about the "spirit", but has always been about the body. Considering the conclusion that depression is biological, psychological or social as a single option, this exclusive thinking is originally a product of recent history. Medical anthropologist Arthur Kleiman shows that (see Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China) traditional East Asian culture emphasizes the interaction and intrinsic relationship between the body and the mind, believing that the body is not just a representation of the psychology. It is this mental and physical perspective that makes neurasthenia generally accepted in China, but in the West, it has long since withdrawn from the stage of history. The medical model and the social model are not contradictory. Health, disease and healing have always existed in a certain social background, which does not weaken its medical nature.

In a discussion of the third dimension of depression, the author targets the politics of epidemics. There are many examples of using mental illness as a label to punish specific groups of people. For example, in the nineteenth century, the United States regarded black slaves who tried to escape the atrocities of slave owners as mental illnesses (drapetomania), and European society also listed the anti-colonial struggle of people of color as mental illness; political resistance was stigmatized as a mental disorder in order to achieve the goal of social control. Even the early "Diagnostic and Statistical Manual of Mental Disorders" also listed homosexuality as a psychiatric disorder with antisocial personality. Discussion on depression as an epidemic must include thinking about the politics of inequality. As Susan Sontag said in "H Metaphor of Disease ", cultural metaphors affect how diseases are defined, understood and experienced. The disease overflows beyond the physiology of the scientific level, is interpreted by different societies, and changes due to time and space. In the history of mental illness, power is everywhere.

The depression that exists as a disease is closely related to real politics.In addition to racial factors, class, gender and other social injustice also affect the occurrence and diagnosis of depression. Why do women with depression account for the majority of the society in the world, and the probability of getting sick is twice as high as that of men? On the one hand, during adolescence, pregnancy, miscarriage and menopause, hormone changes will increase the risk of women contracting diseases. On the other hand, women often bear more burdens of the family and face huge physical and mental pressure when balancing the conflict between work and family. Why are people with low cultural levels often considered not to have mental problems, as if mental illness is a "class privilege"? In fact, there are many geniuses who suffer from depression, but not only geniuses can get sick, but most patients have not been able to leave their names in history.

In the discussion of the last dimension, the author turns his focus to the dispute over the treatment of depression. Questions about the two main means of psychiatric treatment - drugs and psychological counseling - are common: drug treatment is invasive, it is a poison rather than an antidote, and may even be abused and addicted; psychological counseling is not scientific, and if chat is useful, it can be solved by yourself and your friends. These criticisms are widely known by the publicity of professionals and mass media. The movie "Flying Over the Crazy Asylum" is the best example, which deeply and powerfully criticizes cruel treatment methods and inequality in mental hospitals. Frontal lobe resection is notorious because of this, and even leaves indelible trauma to the entire public's psychology.

In fact, the most violent attacks on various treatment methods often come from different sects of psychological diseases treatment. As the author of medical historian, he sorted out the internal disputes in the field of depression treatment. The definition and treatment of depression have changed dramatically over the past century. Psychoanalytic therapy pioneered by Freud in the nineteenth century was once very prosperous, but since the first half of the twentieth century, behavioral cognitive therapy has dominated the mainstream. The psychodynamic school represented by the former emphasizes insight into inner contradictions and requires long-term and frequent treatment; the latter is more in line with the requirements of the commercial insurance system for efficiency, focusing on correcting distortions of ideological logic in treatment, and encouraging behavioral changes.

It can be seen that the history of depression is not only a history of continuous development of cognition and treatment, but also accompanied by fierce internal struggles within the profession. The author proposes that we should not whitewash the disgraceful history of psychiatry, it has indeed caused harm to many people; but we should not forget to treat and help more patients. Even the electroshock therapy that is now very rare is not completely useless. Most patients are not ghosts who are anesthetized by drugs and fooled, but beneficiaries of their lives that have indeed improved. However, the academic criticism and the bad competition for patients/customers have to a certain extent led to the magnification of the limited nature of society for treatment. Coupled with the traditional prejudice against mental illness, many people hesitate and be discouraged in the face of treatment. In fact, each treatment may only work for certain populations, but that doesn’t mean it should be abandoned. If depression is a very difficult monster to tame, then we need to deploy a batch of weapons to fire at it, rather than sticking to one.

Today, Chinese society is no stranger to many criticisms surrounding depression: overdiagnosis, overtreatment, and appealing to drugs under the driving force of commercial interests, people are objectified, the pain of life is medicalized, and the value of human beings is flattened. Nietzsche, Heidegger , Foucault... The intellectual community is familiar with similar philosophical thinking. However, if any theory is limited and varied, can we abandon the black-and-white attitude when it comes to the issue of depression? Acknowledging the uncertainty of depression does not mean that it does not exist, acknowledging the ambiguity of definition does not mean that there is no difference between authenticity, and acknowledging the limitations of treatment methods does not mean that the harm is more harmful than good or is simply ineffective. The so-called dualism of treating symptoms and root causes may be a false question.If even surgical surgery to survive with broken arms and chemotherapy to fight against poison can be accepted by society, why should we be so deterred and regarded as a daunting path when it comes to seeking help from depression?

People have inevitable troubles in their survival, whether it is old age, illness, death, injury, separation, or poverty, discrimination, war, class anxiety, political oppression, or sudden SARS and the new crown. Coexisting with depression is not just an abstract theoretical discussion, but the real pain of the individual at the moment. In the face of depression, there is no romance and you must ask for help.

Editor in charge: Yu Shujuan

Proofreading: Ding Xiao