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10 - Revising Diagnoses, Reinventing Psychiatry: DSM and Major Depressive Disorder
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- By Owen Whooley
- Edited by Martin Halliwell, University of Leicester, Sophie A. Jones, University of Strathclyde
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- Book:
- The Edinburgh Companion to the Politics of American Health
- Published by:
- Edinburgh University Press
- Published online:
- 12 August 2023
- Print publication:
- 31 August 2022, pp 167-182
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- Chapter
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Summary
During the 1990s, depression captured the imagination of the United States. In the decade prior, the American Psychiatric Association (APA) had reformulated depression into ‘major depressive disorder’ (MDD), an entity more tractable, more measurable and, so hoped reformers, more manageable. MDD reflected the professional strivings of a new breed of psychiatrists who were seeking to reassert psychiatry's credibility as a medical specialty. MDD commandeered the American zeitgeist, not merely because so many people purportedly had the reconstituted diagnosis, but also because it suddenly seemed so curable. On the heels of the diagnostic change, the antidepressant Prozac came to market in 1987. Other medications in the selective serotonin reuptake inhibitor (SSRI) class soon followed: Zoloft in 1991, Paxil in 1992, Luvox in 1994. But it was Prozac that signalled a new dawn in psychiatry, and the hype surrounding it was breathless.
Hitched together, MDD and Prozac became cultural icons. Magazine covers heralded Prozac as the ‘Breakthrough Drug for Depression’ (Newsweek, 1990) that led those who took it ‘out from the darkness’ (Time, 1992), declaring ‘Bye, Bye Blues’ (New York, 1989). Cultural depictions of depression proliferated, reaching a high point in the year between September 1993 and 1994, a period bookended by two best-selling books. Peter Kramer's Listening to Prozac attested to the ‘transformative power’ of Prozac, which not only seemed ‘to flip a switch, to turn black and white into Technicolor’ for those with depression, but also had the potential to make people ‘better than well’. A year later, Elizabeth Wurtzel published her memoir Prozac Nation, which spoke to the experiences of a depressed generation. Noting ‘the widespread nature of depression – particularly among people my age’, Wurtzel recounts her depression and eventual recovery facilitated by Prozac. By the mid-1990s, MDD had solidified its place as the framework through which the American public made sense of its distress, and Prozac became its solution.
Epidemiological data seemed to confirm the overabundance of depression in the US. The prevalence of the disorder skyrocketed in the 1980s. While the dominance of MDD and Prozac in American cultural discourse has ebbed since its peak in the 1990s, MDD remains epidemiologically prevalent. The 12-month prevalence of MDD is 10 per cent of the US population, and 1 in 5 Americans will experience depression over the course of their lives. And those with MDD get prescribed medications at high rates.
3 - Defining Mental Disorders: Sociological Investigations into the Classification of Mental Disorders
- from Part I - Theoretical Perspectives on Mental Health and Illness: Introduction to Part I
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- By Owen Whooley, Assistant Professor, Department of Sociology, University of New Mexico
- Edited by Teresa L. Scheid, University of North Carolina, Charlotte, Eric R. Wright, Georgia State University
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- Book:
- A Handbook for the Study of Mental Health
- Published online:
- 28 May 2018
- Print publication:
- 08 June 2017, pp 45-65
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- Chapter
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Summary
How mental distress is understood and defined has significant social and political implications. For this reason, psychiatric nosology – the classification of mental disorders – has come to occupy a central role in debates over mental health policy, patient identity politics, and the professional authority of psychiatry. This chapter explores the sociological research on psychiatric nosology. The first section examines the history of classification of mental disorders in the United States, focusing on the professional dynamics that have shaped the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second section describes three key areas of sociological research on psychiatric nosology – medicalization, diagnostic practice, and patient identity – that highlight the manner in which social and political factors influence the classification of mental disorders and the concomitant effects of psychiatric nosology. How does medicalization impact our understanding and classification of mental health disorders? How do social and political factors affect the categorization of mental disorders? Specifically, how has the production, use, and reception of the DSM shaped political (professional or otherwise) considerations?
Introduction
In the early 1970s, fresh off the dramatic events of the Stonewall Riots, gay activists converged on the typically staid meetings of the American Psychiatric Association (APA) to challenge the classification of homosexuality as a mental disorder. The second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) defined homosexuality as a sexual deviation on par with pedophilia and, in turn, subject to psychiatric treatment that included aversion therapy, electroconvulsive therapy (ECT), and even lobotomy. Although an improvement on the traditionally held view of homosexuality as an abomination, activists derided psychiatry's diagnosis of homosexuality as a disease, arguing that it unjustly pathologized sexual orientation. They descended upon the APA's annual meetings to pressure psychiatrists to remove homosexuality from the DSM-II. Supportive psychiatrists, some of them homosexuals themselves, joined the protest. At the 1972 meeting, psychiatrist John E. Fryer – using the pseudonym of “Dr. Anonymous” – spoke eloquently of his struggles as a gay psychiatrist, while donning a mask to maintain his anonymity so as to avoid any professional repercussions that might stem from his testimonial. Eventually the disruptive tactics worked.
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