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Health & Science

The New Book 'The Empire of Depression' Examines How the Western Concept of Depression Has Colonized the World

 Jonathan Sadowsky in Dittrick Library
Case Western Reserve University
Jonathan Sadowsky is a professor of medical history at Case Western Reserve University. His new book, "The Empire of Depression" looks at how melancholia became depression and colonized the world.

More than 300 million people worldwide are currently diagnosed with depression.

That’s according to Jonathan Sadowsky, who teaches the history of medicine at Case Western Reserve University.

In his new book "The Empire of Depression," he looks at how our modern view of depression has overtaken other ways of looking at sadness and grief.

WKSU’s Jeff St.Clair asked Sadowsky about his book’s title.

Has depression really taken over the world?

I don't really take a firm position on whether it's simply more depression cases going up or more cases of calling things depression.

Both could actually be happening.

When you consider that 20 years ago in American society and most of the industrialized world, antidepressants were being widely prescribed. But 20 years ago, it wasn't broadly true about the world.

Now it's true everywhere. The World Health Organization has listed depression as one of the leading, if not the leading, major cause of disability worldwide. And this is part of where the empire metaphor comes in. It's sort of colonized the language, so other ways of naming human distress have been squeezed out by depression.

In your book you talk about how other cultures have other names for what we call depression, which really provide insights into how it how it affects people.

In Punjabi culture there's a concept called "sinking heart," and if you look at the symptoms for sinking heart, there's a lot of overlap with what we call depression. But if you simply translate it as depression, you lose some of the local cultural resonances because they have a different model of how these things play out in the body.

Another idiom of distress that's very common, and it's been documented in at least 20 different societies across the world, translates into English as "thinking too much." You find this in many, many cultures, and excessive rumination is something you can observe in people with depressive illness. Often they they're thinking about things, and they're sort of paralyzed. They're looking at all kinds of different angles of things, and maybe, you know, not acting that much.

I think it's interesting that depression is a relatively new term. For centuries it was called melancholy.

Does the name really matter that much?

Well, another example which actually originated in America, but which is now used more in Asian cultures, is neurasthenia, which looks a lot like depression. Neurasthenia, though in its original formulation by the American neurologist George Beard, was thought to be a physical condition that had emotional signs, whereas depression we consider it to be an emotional condition that has some physical signs. And it always does. It always has physical signs, whether it's insomnia or some kind of physical symptoms.

Sadowsky on the need to balance medication with psychotherapy in treating depression

An anthropologist named Allen Tran studied neurasthenia and depression in Vietnamese hospitals, and what he found was that while the patients came in wanting to call their illness neurasthenia, the doctors wanted to use the term depression.

The reason they wanted to use the term depression is because they thought antidepressants would help, and they needed a depression diagnosis in order to prescribe the antidepressants.

This is a kind of imperialism, right? I mean it is a kind of empire where the depression is displacing other words, and the pharmaceutical companies are getting their products sold in lots of different places where they had no cultural meaning before or would have not been understood as culturally.

But I also thought it was important to consider whether there might be upsides to that. That is, there might be people getting treatments that can help them, who wouldn't have been getting them otherwise.