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The Rise and Fall of the Nervous Breakdown

by Edward Shorter

Pub Date: March 1st, 2013
ISBN: 978-0-19-994808-6
Publisher: Oxford Univ.

Shorter (Psychiatry and History of Medicine/Toronto Univ.; co-author: Endocrine Psychiatry, 2010, etc.) charges that current diagnoses of mood disorders are fatally flawed and becoming “close to unintelligible.”

The author attributes this to political infighting within the discipline of psychiatry, compounded by the marketing strategies of the pharmaceutical industry. He argues that the Diagnostic and Statistical Manual of Mental Disorders represents a step backward from the pre-Freudian diagnosis of depression as a medical disorder of the nerves and which was treated under the rubric of internal medicine. Past practice was closer to the truth than what is presented in the DSM, which lumps together mood disturbances with severe depression (a debilitating disorder). In the annals of modern science,” he writes, “I am unaware of any comparable wholesale demolition of a field of scientific knowledge and its replacement with a fairy castle of fantasies…the spotlight shifted from nerves, a diagnosis that implicated the whole body, to mood, a diagnosis that implicated mainly the mind.” Compounding the problem is the current practice of treating anxiety and panic attacks as disorders separate from depression. Shorter suggests that a combination of barbiturates and amphetamines was a superior treatment than today's pharmacopoeia, which relies on Prozac and similar antidepressants. The release of DSM5 (the latest revision of the manual) has been the occasion for a critical review of current treatment practices, but Shorter's contribution to that discussion, while timely, is questionable.

Enlivened by literary anecdotes, but less appealing as social history.