The Freudians thought they had the answers to life’s riddles and the Prozac proponents thought we were about to enter a depression-free age. Both were wrong—but not entirely, in Jonathan Sadowsky’s nuanced and thought-provoking account, The Empire of Depression: A New History.
As a professor of medical history at Case Western Reserve, Sadowsky takes a long view of the condition once known as melancholia and now generally called depression. He investigates many profound questions, beginning with definitions and boundaries. To be sad and to know sorrow is part of the human condition, but when does persistent sadness become a chronic, maybe even fatal condition? Has modern medicine turned normal behavior into a medical condition, a revenue stream for the pharmaceutical giants with diagnoses defined by insurance companies?
To the former question, answers vary and to the latter, it’s no and yes. The border between illness and normal emotional response is porous. Sadowski emphasizes that depression when accurately diagnosed is never simply a “mental illness.” It’s always also a physical malady—and whichever side is taken in the debate between psychological versus biological causes, health and healing, he insists, “are always set in a social context.” Social conditions and the politics of inequality have determined what science chose to see. Science once deemed Africans as immune to depression because depression was thought to be a “capacity” held only by advanced races. That train of thought was still running in the early 1960s.
The role of medical science is part of the debate over whether depression is actually on the rise or if the alarming increase is the result of the broadening definitions offered by psychiatry. Could the widespread currency of “depression” as a diagnosis encourage healthy people to think of unhappiness as an illness? “Counting depression is a vexed project,” Sadowsky writes. And the different explanations for the apparent prevalence of depression “all have smart advocates.” There are more answers than there are questions.
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Sadowsky cautions against making grand conclusions. As a historian of science, he is aware, as reductive science boosters are not, that many grand conclusions have been proven both dangerous and baseless. In the field of human consciousness, the study of the psyche, the self-correcting aspect of science has been remarkably slow to yield unimpeachable results. Individuals respond differently to medication and psychotherapy—the conditions of life are highly variable, as are human responses to conditions. Sadowski warns against believing the hype over any “remedy” for depression, but also warns against being too dismissive. The causes of depression are many, as are the symptoms and seriousness. “The least productive idea is that only one approach has merit,” Sadwoski concludes.
The Empire of Depression is a wise and discerning work whose analysis of the complexity of one particular illness is applicable to many other fields. The rise and fall of theories for treating depression show how academic science is as subject to fashion as the clothing industry. Mind and body are constantly influencing each other. Most conditions and situations—political and economic as well as medical—have multiple causes. There isn’t always one answer to every query.
