Written by a psychiatrist and historian, American Melancholy: Constructions of Depression in the Twentieth Century looks at how culture, politics and, in particular, gender have played a role in the development of a diagnosis.  Hirshbein moves between several different worlds, showing how they intercalate and, indeed, are very much part of the same world: psychiatric nosology and cultural attitudes to the gendered expression of emotion and feelings, medication trials and magazine advice to women about how they should deal with the blues, the relations between treatment paradigms and how society views suffering.


This book is a useful primer on gender and depression in the twentieth century, and though the blurbs focus on gender, it is perhaps most surprising and thought-provoking when dealing with the development of psychiatric nosology in The Diagnostic and Statistical Manual of Mental Disorders (through the lens of a historian interested in gender).  The history is often quite broad, as when Hirshbein divides the twentieth century up into two halves, or speaks of the "malaise and depression of the 1970s" and the "optimistic" 1980s (69), but Hirshbein points to important cultural trends over these periods to show how they create environments, pressures, and opportunities that guide how we make sense of emotional suffering. 

A particularly important contribution to the literature is how Hirshbein demonstrates that the differentiation of depression as a disease entity and disorder occurs through a complex sociocultural process, frequently involving circularities and feedback loops (as when epidemiologists study depression in groups that have more women, then wonder if depression is more common in women, and then create instruments based on these groups that are developed by what they see in these groups, and subsequently use these instruments to show that depression is more common in women); but, in particular, she shows that this process is not just foisted onto a gullible public but is also a response to broader sociocultural themes, ones that, for example, create a milieu in which women are identified in the first place as more depressed, and how women (including women psychiatrists) subsequently seek to address this (or, at times, critique it or reject it - the circularities are never fully circular, never fully closed off).  And so Hirshbein demonstrates an ambivalence that is suited to someone speaking with two voices, as a psychiatrist and a historian; for example, as she notes, if depression is "gendered" towards women, it may be a way of taking seriously the emotional suffering of women.



Rutgers University Press

Place Published

Piscataway, N.J.



Page Count