Thomas Goetz (7:14)
welcome back to Drug Story. Each episode has three parts the diagnosis, the prescription, and side effects. This is part one, the diagnosis, where we look at the disease behind the drug and how that condition emerged in modern days. In this episode, we're talking about depression, or what is known today clinically as major depressive disorder, or mdd. Depression goes back as far as humanity itself. It has had many names over the centuries, often known as melancholy, a word that comes from the Greek word for black bile. An excess of black bile secreted by the spleen was long believed to be the cause of depression. Unfortunately, it's a lot more complicated than that. Depression has been described in many ways by many people. Abraham Lincoln probably suffered from depression, as did Winston Churchill and Georgia o'. Keeffe. Even Sigmund Freud likely had depression. He self medicated with cocaine. Maybe the most succinct description comes from an 1802 poem by Samuel Taylor Coleridge. A grief without a pang, void, dark and drear, a drowsy, stifled, unimpassioned grief which finds no natural outlet or relief in word or sigh or tear. The phrase a depression of spirit emerged in the 18th century, and by the mid-19th century, the word depression was being used to describe a state of diminished emotional or mental capacity. In the 20th century, as psychoanalysis and psychiatry emerged, depression began to be recognized as a true psychiatric condition, a disorder. But even as depression was recognized as a distinct problem, it was still very hard to understand what was going on and still very little to be done about it. Like so much of mental illness, depression has also carried a lot of stigma. Sigmund Freud considered depression the result of guilt and. And self loathing. It was, as the cliche goes, all in the head. That myth meant there has been a lot of shame and embarrassment and fear surrounding depression. So much so that for decades, for centuries, many people took pains to hide their struggles from others. In certain societies and in certain times, it could in fact be very dangerous to be depressed with the threat of ostracization or institutionalization or worse. But in the 1930s, more clinical, more medical understanding of mental health started to emerge with the idea that depression and other forms of mental illness, like paranoia or schizophrenia, they could be measured and diagnosed. But there was no blood test, no X ray that could peer inside someone's head and discern what was going on. So the only alternative was to ask. The first effective questionnaire for depression was the Minnesota Multiphasic personality inventory, or MMPI. This was first published in 1943. The test was developed by two scientists at the University of Minnesota, Stark Hathaway and J.C. mcKinley. These were two serious, meticulous researchers. The MMPI was their attempt to systematize various forms of mental illness. They crafted a process to map out personalities and states of mental health. The MMPI wasn't a questionnaire per se. It was a series of 504 statements that someone would answer true or false. The statements were mostly benign. I wake up fresh and rested most mornings. I think I would like the work of a librarian. There seems to be a lump in my throat much of the time. My table manners are not quite as good at home as when I am out in company. But some of the statements hinted at something darker. I brood a great deal often. I can't understand why I have been so cross and grouchy. I cry easily. I believe I am being plotted against. Hathaway and McKinley gave the test to hundreds of visitors at the University of Minnesota Hospital where they both worked. They called these the Minnesota Normals. Everyday Minnesotans, often farmers or laborers of Scandinavian or German heritage, almost all white. Their answers would create a yardstick for what was considered normal or healthy. They also gave the test to patients at the hospital with known mental health. Paranoia, depression, hysteria. Yes, in those days, there was something called hysteria. It's been debunked NOW. Hathaway and McKinley matched the way these patients answered the MMPI questions with their diagnosis, so that these test takers created patterns that mapped to certain personality types and mental states. The test was fairly routine, but it took a long time to answer all 504 questions, at least an hour or two. In the end, all those questions created a lot of data that seemed to open the door to what was going on inside. The magic of the MMPI was not in any one of those true false statements, but in their combination and how. Different answers revealed different personality types, different scores could reveal not only a condition, but also its severity. Very quickly, the MMPI became the most widely used tool for diagnosing mental health and including depression. The U.S. army soon adopted it as a way to screen draftees by personality and aptitude. The Catholic church gave it to new seminarians to make sure they were fit for the priesthood. Airlines gave it to pilot applicants. Police and fire departments asked recruits to take the test. And psychiatrists and psychologists used the MMPI as a standard part of patient intake. Within a few years, it was translated into Spanish, French, Canadian, French, Chinese, and Japanese. The MMPI has been revised several times, but it is still used today. Now that depression could be measured, it could also be diagnosed. And it turned out that a good many people were depressed. In 1950, somewhere about 5% of Americans qualified as having depression. That number would grow over time. The condition became better understood and more people seemed to feel depressed, perhaps in part as a result of this modern life. Today, depression is often called a disease of civilization or a disease of modernity. It's one of a handful of conditions like anxiety or obesity or type 2 diabetes that modern life just seems to make worse. Lack of sleep, poor eating habits, social isolation, lack of exercise, lack of purpose. Each of these have been associated with higher rates of depression. And each of these problems has become widespread in modern America and have all increased in recent decades. Indeed, a review of MMPI results from the development of the test in 1938-2007 showed a six fold increase in people scoring as depressed. But even if the MMPI made it easier to see depression, there was still the matter of how to treat it. In those early days of the 1940s and 50s, there just wasn't a lot that medicine could do for people with depression.
