How Everyone Became Depressed Read Online Free PDF Page A

moved into the language of mood disorders centering about “depression.”
    Now, in switching from nerves to mood diagnoses such as depression, the idea was that depressed people are basically sad, rather than having wholebody diagnoses. The essential concept of a mood disorder is that your mood is either euphoric, as in mania, or sad, as in depression. Yet depressed mood is often not present in depression as the term is used today (see also Chapter 11). As Philadelphia psychiatrist Aaron Beck discovered in the 1960s: Of patients with mild depression, only 50% had a dejected mood; of those with moderate depression, 75% had it. 20 These are the great majority of depressions. So moving the spotlight from nerves to depression has illuminated a large number of people who are not sad at all, but are discouraged, or unhappy, or uncomfortable. All these people, however, are encouraged to think that they have a mood diagnosis called depression and that their moods are down. As Max Hamilton, the great English student of mood disorders, said in 1989 of patients with depression and anxiety, “Not all of these have a depression of mood. In a sense, we have the paradox of depression without depression.” 21
The Ranks of the Nervous
    The frequency of nervous illness gave its stamp to an era. Robert Musil, the great Viennese novelist who in 1930 composed The Man Without Qualities, spoke of “a nervous age” (ein nervö ses Zeitalter). 22 And the ranks of the nervous were indeed numerous.
    There are formal epidemiological data. One German epidemiological survey conducted in 1935–1938 found the “nervous” to number about 9% of the population of a rural area. Of the 284 nervous individuals identified in a door-to-door count, 74 also had organic illnesses; 59 had a “neurasthenia” that was “not immediately conspicuous”; and 13 had “nervous disorders of a clearly psychogenic nature.” Of the nervous, a further 50 individuals had thyroid problems (thyroid difficulties can have psychic ramifications). The nervous were thus almost one in ten. 23 In rural Sweden in 1947, the lifetime incidence of the population suffering from “neurosis” was put at 7.0%. 24 A survey of morbidity in general practice in England in the mid-1950s estimated the prevalence of “psychoneurotic conditions” as about 7.4 per 100 population. 25 These studies are not readily comparable but they do indicate that those suffering from nerves in one form or another represented a not inconsiderable share of the population.
    There was a reason that German psychiatrists were called “nerve doctors” (Nervenä rzte), and when they left the asylum for community practices, it was nerves and not insanity that they saw. In 1882, Conrad Rieger, a psychiatrist in Würzburg, tried to advise his colleague Emil Kraepelin, then in Leipzig (who was shortly to become world famous for devising the diagnoses “dementia praecox” and “manic-depressive disorder”), about how to plan Kraepelin’s future career. “As near as I know the situation in Leipzig, you would have, as an assistant at the university psychiatric outpatient clinic, a good opportunity to found a private psychiatry practice on the side. Erb [Wilhelm Erb, director of the outpatient clinic] would probably try to give you a boost rather than make things difficult, and the whole business would be just terrific for you. You’ve actually seen enough ‘mentally ill patients’ in Munich [where Kraepelin earlier worked at the Munich asylum]. And I’m finding increasingly that it’s precisely the middle classes, that one never sees in an asylum, who are very common in a private nervous practice.” 26
    In Britain, the ranks of the nervous were legion. In 1968, at a conference at McGill University celebrating the 25th anniversary of the founding of the Department of Psychiatry, London psychiatrist Stephen Taylor (later Lord Taylor) described community nervousness. In 1959, he and Sidney Chave had done a