Henderson 1

Daniel Henderson
Rhetoric and Civic Life
Dr. Raman
3 November 2014
The Changing Face of Depression
What is depression? Sometimes the best way to determine somethings true nature is by
examining its pure opposite. In his TED Talk, Depression, the secret we share, famed author
and lecturer Andrew Solomon said: The opposite of depression is not happiness, but vitality.
The symptoms of depression have always created a lack of vitality, but only in recent years has
depression been defined as a serious yet treatable disorder. According to Google Ngram Viewer,
the medical term, major depression, began appearing in published books around 1930. The
usage of the term remained constant until 1980 when a steady increase began through to the
current day. The American Psychiatric Association (APA) first published the Diagnostic and
Statistical Manual of Mental Disorders (DSM) in 1952 as a guide for the diagnosis of patients.
They released the third and most influential edition in 1980 (DSM-III), correlating with the
progression of the term major depression. DSM-III fueled a paradigm shift in depression by
categorizing the typical symptoms of depression, leading to improvement in the procedure of
diagnosis and solidifying the usage of psychopharmacology over psychotherapy.
This gives rise to the question: why is the categorization of symptoms important for
depression and mental health? First and foremost is that depression is dangerous. People can be
hurt. CDC FastStats reports that 8.0 million ambulance calls in 2009 and 2010 were made
because of major depression. Some may see suicide as the only release from their agony. 39,518
chose that path in 2011 (FastStats: Depression). Secondly, the previous organization (or lack

Henderson 2
thereof) was ineffective in helping the mentally ill. Prior to the standardized classifications,
diagnoses and subsequently treatments were at the will of the psychiatrist. So, differing and
perhaps ineffectual treatments could have been administered to patients experiencing the same
problems. Through DSM-III, a disorder like depression could be pinpointed and researched
further because the psychiatrists had a clear archetype of what depression looked like. The APA
continues to revise and expand on the DSM, and they released the most recent edition, DSM-5,
in 2013. Finally, the newly organized symptoms affected public opinion, one of the strongest
forces of progress in the United States. While the organization of symptoms did not directly
affect the entire population, it helped to alter the publics view of depression. Once the doctors
and scientists knew how to classify depression, the knowledge trickled down to the public
through publications and other means. A survey conducted by Kate H. Blumner and Steven C.
Marcus shows that the perception of depression significantly changed in the ten year period from
1996 to 2006. The participants were asked about their beliefs of the causes and treatments of
depression. More respondents selected the biological causes and treatments, increasing by over
ten percent over the ten years, respectively (308). With this trend in mind, it is likely that more
research conducted about depression will lead to an even stronger, medically informed public.
The next question in understanding this shift is: to what extent were the diagnoses
revolutionized? Contrary to what one might assume, DSM-III did not establish new ways of
treating mental health disorders. Rather, its effectiveness arose from organizing and compiling a
disorders typical symptoms under one name, such as major depression, and it reasserted the
treatments already known to help the disorder. Professors Rick Mayes and Allan V. Horwitz
indicate that until the 1970s, psychiatrys ruling psychodynamic paradigm viewed mental
disorders as conflicts of personality and intrapsychic conflict (249). Acceptance of the

Henderson 3
biological causes of mental illness grew in the 1970s, but before the causes could be accurately
explored, there needed to be established symptoms for mental health disorders. Mayes and
Horwitz employed this example to express the effect of DSM-III: if ten psychiatrists saw the
same depressed patient separately, all ten should concludebased on the patients observable
symptomsthat the patient had a depressive disorder (260). The creators of DSM-III looked at
patterns of mental health disorders and grouped symptoms which often occurred together.
Eventually the groups received names like major depression. Currently, the National Institute
of Mental Health considers the following symptoms to be typical of depression: Persistent sad,
anxious, or empty feelings, Feelings of hopelessness or pessimism, Feelings of guilt,
worthlessness, or helplessness, and more. Before the blanket term of depression existed,
psychiatrists took shots in the dark when trying to determine the problem. Assigning a diagnosis
before the symptoms were categorized would be like convicting one out of three possible
suspects of murder before a trial is conducted. In addition to helping the psychiatrists diagnose
the disorder, patients were able to know that their problem had a name and that they were not
alone.
Psychopharmacology already had a secure position in the treatment of depression in the
1970s, but DSM-III set it in stone. Mayes and Horwitz state: Psychiatrists use of
psychotherapeutic drugswas becoming a familiar modality of treatment before the
development of the DSM-III. The symptom-based diseases that the new manual would create
greatly facilitated the expanding role of drug treatments in psychiatry (255). While DSM-III did
not advocate for new treatments, the categorization of symptoms made it easier for the drug
companies to create medications and doctors to prescribe them. Instead of prescribing medicine
for abstract symptoms such as, feelings of hopelessness, the doctors and drug companies were

Henderson 4
able to prescribe medicine specifically for the blanket term depression. In the late 1980s and
the early 1990s, the drugs Prozac, Paxil, and Zoloft hit the shelves. These antidepressants
improved the symptoms of depression more quickly than any treatment before, and it was not
long until millions were taking these drugs (Mukherjee). There are increasingly more effective
paths to treatment, but there is still room for improvement.
The focus on biology and psychopharmacology angered some conservatives in the
psychiatric profession. For the most part, traditional Freudian psychoanalysts were the biggest
resisters of this reclassification of depression. One psychiatrist, Karl Menninger, felt that it was
impossible to combine the individual mental experiences of patients into one disorder because
they were always unique (Mayes). Others rejected the idea of biological causes of depression,
remaining convinced that it was caused by an internal conflict of personality. Many
psychotherapists using talk therapy would not administer prescriptions to patients. They felt that
talk therapy worked well enough and got to the root of the problem rather than just hiding the
symptoms. However, some traditionalists were prescribing drugs because even they could not
deny the results (Mayes). At one point in time, these beliefs were the leading ideas in treating
depression, but as time often shows, leading ideas are often replaced by emergent ones.
With a transition this large, the affected parties were not only those who needed treatment
or those who were giving treatment. As stated earlier, public opinion and drug companies
received residual effects from DSM-III. Mayes and Horwitz expand on this and encompass the
entirety of DSM-IIIs effects as concisely as possible, saying:
DSM-III contributed significantly to a biological vision of mental healthwhich stresses
the neurosciences, brain chemistry, and medications[focusing] on the symptoms of
mental disorders rather than their causes and [emphasizing] pharmacological treatments

Henderson 5
over talk therapy and behavioral changesIn short, it realigned the incentives of a great
many stakeholdersclinicians, insurers, the government, pharmaceutical companiesto
standardize the criteria for defining and treating mental disorders (258).
While this is a long excerpt, it adequately aggregates the effects of DSM-III. The stakes of such a
transition are phenomenal, and history has shown DSM-III to be a highly beneficial turning point
for the advancement of mental health.
The third edition of the Diagnostic and Statistical Manual of Mental Disorders released
by the American Psychiatric Association proved to be the strongest factor inciting the paradigm
shift in depression. It categorized symptoms to specific disorders, creating for the first time bythe-books definitions of mental health problems such as depression. The effects of the
categorization led to advancement in diagnosis by giving psychiatrists a guideline when
identifying a patients malady. It also provided for the promotion of psychopharmacology over
psychotherapy; while the tried-and-true method of talk therapy sometimes worked, medications
warranted better results. Traditionalist Freudian psychoanalysts resisted this change, but the cold
hard facts stood before them, and they were unable to refute the truth. Even though it is a
problem which affects many and touches even more, depression took a remarkably long time to
be recognized fully first by the medical community and subsequently by the general public.
However, there is still room for improvement in what is known about depression and the
treatments for it, and it appears that current trends will continue into the future. Perhaps one day,
everyone might be able to say their life is filled with vitality.

Henderson 6
Works Cited
Blumner, K. H., and S. C. Marcus. "Changing Perceptions of Depression: Ten-Year Trends From
the General Social Survey." Psychiatric Services 60.3 (2009): 306-12. Web. 21 Oct. 2014.
"Depression." National Institute of Mental Health. National Institute of Health, n.d. Web. 23 Oct.
2014.
"FastStats: Depression." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 14 July 2014. Web. 19 Oct. 2014.
""Major Depression"" Google Ngram Viewer. Google, n.d. Web. 21 Oct. 2014.
Mayes, Rick, and Allan V. Horwitz. "DSM-III and the Revolution in the Classification of Mental
Illness." Journal of the History of the Behavioral Sciences 41.3 (2005): 249-67. Web. 27
Oct. 2014.
Mukherjee, Siddhartha. "Post-Prozac Nation." The New York Times. The New York Times, 21
Apr. 2012. Web. 24 Oct. 2014.
Solomon, Andrew. Depression, the secret we share. Video. Ted.com. TED, Dec. 2013. Web. 17
Oct. 2014.