The book argues that psychiatry's love affair with the diagnosis of depression has become a death grip. Depression is a real illness, especially in its melancholic form. But most patients who get the diagnosis of "depression" are also anxious, fatigued, unable to sleep, have all kinds of physical symptoms, and tend to obsess about the whole thing. They do not have a disorder of "mood." It is a travesty to call them all "depressed." How did this happen? How did everyone become depressed? A well-known historian, Shorter describes how in the 19th century patients with those symptoms were considered "nervous," and when they lost control it was a "nervous breakdown." Then psychiatry turned its back on the whole concept of nerves, and - first under the influence of Freud's psychoanalysis and then the influence of the pharmaceutical industry - the diagnosis of depression took center stage. The result has been a scientific disaster, leading to the misdiagnosis and inappropriate treatment (with "antidepressants") of millions of patients.
Urging that the diagnosis of depression be re-thought, the book turns a dramatic page in the understanding of psychiatric symptoms that are as common as the common cold. The book makes an immediate contribution to the debate about DSM5, which is scheduled to be published in May 2013 just as Shorter's book is launched: Shorter proposes replacing the diagnosis of "major depression" with "melancholia" and "nonmelancholia"; he argues that depression and anxiety usually occur together and are really the same disease; and he says that patients with so-called mood disorders really have a disorder of the entire body. All of this will be highly unwelcome to the official disease designers of DSM5 because it involves throwing out much of their schema. The book's edge is its ability to make the enormous well of psychiatry's past history in several languages relevant to burning issues today. No other writer has been able to glean nuggets of gold from this huge record of the past and apply them to important discussions today of diagnosis and treatment.
Industry Reviews
"Why are you being told you have depression or anxiety and why are you being given antidepressants or anxiolytics, when in fact you've had a nervous breakdown? The answer lies in the fact that managing nervous breakdowns is a more complex clinical task than just simply giving a pill. There is more than just a simple change of words here, these are words that matter. In eliminating the nervous breakdown, psychiatry has come close to having its own nervous
breakdown." -- David Healy, MD, FRCPsych, Author of Pharmageddon, Professor of Psychiatry, University of Cardiff, Wales
"In this new survey of "nerves" Shorter recounts the shifting meanings and fashions over the ages concerning breakdowns, crackups, depression, anxiety, stress - what average person's thought ailed them and what the professionals thought. Labels come and go. Classifications come and go. Clear understanding waxes and wanes. Diagnostic boundaries come and go. Treatments come and go. Hard won insights are lost and rediscovered. Shorter brings it all alive with
graphic historical and contemporary material. With his polyglot command of the European literature, there is no one better for the task. Through it all, Shorter keeps his focus firmly on the issues that
matter to patients. This is a tale for everyone, not just the academics." -- Bernard Carroll, MBBS, PhD, FRCPsych, Pacific Behavioral Research Foundation
"Nerves stand at the core of common mental illness, no matter how much we try to forget them. As 'nerves' have jumped from one organ to another, from the hyopochondrium to the stomach, from the heart to the chest, and from the chest to the spleen before finally finishing up in neurowhimsical tangles in the brain, every performance has been applauded and enthused by physicians of all kinds in wild abandon. Science has taken a back seat. It can't be as bad as
all that, you may argue, we have made real advances in the last few years. Sorry folks, we ain't, and if you want to see what little distance we have travelled read this book at the same time you read
the glossy new DSM-5 Manual when it comes out in May 2013, and decide which is closer to the truth. Shorter exposes and discloses all in this witty and perceptive account of our foibles." -- Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London
"Professor Shorter has written a fascinating, scholarly and helpfully provocative book on 'nerves,' nervous breakdown, anxiety and 'depression.' Shorter strongly emphasizes the role of bodily malfunction in the melancholic vs. the non-melancholic depression debate. Thoroughly and elegantly the reader is guided through centuries of ideas and concepts [and] Shorter's criticism of contemporary views on 'nerves' and 'depression' are sharp, but well-founded. This
fine book deserves a wide readership - it should be mandatory reading for all professions working in mental health care." -- Tom G. Bolwig MD, DMSc, Emeritus Professor of Psychiatry, University of
Copenhagen, Denmark
"Enlivened by literary anecdotes." KIRKUS REVIEWS
As featured in the London Times, April 16, 2013
"[Shorter's] point is not to mitigate anyone's experience of depression, no matter how minor. Rather, he aims to underscore psychiatry's shortcomings, to shift the vantage from a narrow view of depression to a wide view of nervous illness and its causes. Shorter's polemical spirit is difficult not to admire." -- Luke Hallum, The Australian
"Historians and practitioners of psychiatry, psychology, neuroscience, and many other mental health professions will find this book illuminating, interesting, and challenging at the same time. Despite looming cuts in library and personal budgets, it would be a valuable addition in any departmental or personal library." -- PsycCRITIQUES
"Edward Shorter has become the historian of record for psychiatry. This is a fascinating and authoritative look at much recent history, cultural as well as medical. It should be added to every practitioner's library to foster historical perspective and suitable humility." -- Jennifer Radden, Metapsychology Online Reviews
