This book is written with a great deal of thought and erudition. It is not a clinical book; rather it concerns the history and philosophy of depression and melancholia, which the author, Jennifer Radden, Ph.D., has been studying for decades. Dr. Radden is a professor of philosophy at the University of Massachusetts Boston and a consultant in ethics to McLean Hospital.
Her philosophical inquiries concern the nuances and differences between various common manifestations of depression as a mood, a disorder, a state of mind, a kind of pain—just to list a few. In the process, her work encompasses a historical perspective on historical change in depression’s conceptualization. For example, she points out that the heroic concept of melancholy from the 17th and 18th centuries largely disappeared by the end of the 19th century. Instead, the disorder became increasingly feminized. She points out that “…through a series of editions of Kraepelin’s Textbook of Psychiatry, melancholy became more conspicuously ‘gendered’ during this era” (p. 19). Freud’s “Mourning and Melancholia” is an important reference point in this transition, particularly since it focuses on loss as a major factor in depression.
Perhaps the most interesting aspect of her work is her thesis of culture as an aspect of both melancholia and depression. We know that depression has different external appearances among different cultures and societies, but for those who want to make the illness of depression more “universal” in its conceptualization, these differences are problematic. Dr. Radden sees culture as a much stronger determinant of symptoms than most biological psychiatrists might believe. “The philosophical distinction between illnesses and diseases,” she writes, “would perhaps allow us to say that there were two illnesses here (melancholia and depression) but only one disease—a solution employed when it is asserted that different cultures sometimes produce a variety of symptom profiles. The concept of masked depression is invoked, for instance, to explain why men’s depression symptoms include none of the felt sadness and dispiritedness of women’s. (Depression in China, it has been argued, takes the culturally acceptable form of somatized symptoms—headache, back pain, dizziness, and such—while Western men’s acting out and excessive drinking are the depressive idiom permitted by their gender roles.)” (p. 9).
Although this is not a clinical book, psychiatrists might appreciate this historical and theoretical approach as a well-reasoned attempt to better understand the illness with which we are preoccupied in our practice.
