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Depression has become the most frequently diagnosed chronic mental illness, and is a disability encountered almost daily by mental health professionals of all trades. "Major Depression" is a medical disease, which some would argue has reached epidemic proportions in contemporary society, and it affects our bodies and brains just like any other disease. Why, this book asks, has the incidence of depression been on such an increase in the last 50 years, if our basic biology hasn't changed as rapidly? To find answers, Dr. Blazer looks at the social forces, cultural and environmental upheavals, and other external, group factors that have undergone significant change. In so doing, the author revives the tenets of social psychiatry, the process of looking at social trends, environmental factors, and correlations among groups in efforts to understand psychiatric disorders.
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THE AGE OF
Melancholy
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THE AGE OF
Melancholy “MAJOR DEPRESSION”
AND ITS
SOCIAL ORIGINS
DAN G. BLAZER
NEW YORK AND HOVE
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Published in 2005 by Routledge Taylor & Francis Group 270 Madison Avenue New York, NY 10016
Published in Great Britain by Routledge Taylor & Francis Group 27 Church Road Hove, East Sussex BN3 2FA
© 2005 by Taylor & Francis Group Routledge is an imprint of the Taylor & Francis Group Formerly a Brunner-Routledge title Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-10: 0-415-95188-7 (Hardcover) International Standard Book Number-13: 978-0-415-95188-3 (Hardcover) No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-In-Publication data: Blazer, Dan G. (Dan German), 1944The age of melancholy : “major depression” and its social origins / Dan G. Blazer. p. cm. Includes biblographical references and index. ISBN 0-415-95188-7 (hardback : alk. paper) 1. Depression, Mental—Social aspects. 2. Depression, Mental—History. 3. Social psychiatry—History. I. Title. RC537.B527 2005 362.2’5—dc22
2005006824
Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the Routledge Web site at http://www.routledgementalhealth.com
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To Berton Kaplan, Ph.D. Mentor, Colleague, Sometime Rabbi, Friend
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Contents
Preface
ix
Section I. The Diagnosis of Depression 1
Introduction
3
2
The Birth and Growth of Major Depression
19
3
The Evolution of Depression as a Diagnosis
39
Section II. Social Psychiatry 4
The Birth and Growth of Social Psychiatry
59
5
The Retreat of Social Psychiatry
77
Section III. The Frequency of Depression and a Lesson from War and Society 6
Interpreting the Burden of Depression
7
A Lesson from War Syndromes
vii