Christopher M. Callahan and German E. Berrios, Reinventing Depression: A
History of the Treatment of Depression in Primary Care, 1940–2004, Oxford:
Oxford University Press, 2005. Pp. 234. £30.50 (hbk). ISBN 0195165233.

Depression is thought to be the world’s most prevalent mental illness, affecting at least
10 per cent of all adult and child populations with mild to severe psychological misery
and a variety of physical illnesses, ranging from hypertension and headaches to ulcers.

Suicide can be the ultimate outcome of the illness. The toxic combination of hidden stress
and environmental stigma often causes depressed people to internalize their suffering and
consequently to seek help for somatic symptoms from their primary care physicians. What is more, neither primary care doctors nor public health leaders have changed their
approach to the treatment of depression in the last half-century and aetiological definitions of the illness have barely evolved, although psychopharmacology itself has changed dramatically. The result has been a consistent failure to provide adequate relief for depression on a large scale.

Why has this happened? In their well-researched and genuinely interesting Reinventing Depression, Callahan and Berrios propose that depressed people (and the world around them) are trapped by the very thing that they were told would be their cure:
individualized medical care without a social context.

Christopher Callahan is an American professor of medicine and German Berrios is a
British neuropsychiatrist. There is an agreeable international synergy to their thinking.
They are as comfortable contrasting British and American views of national health care
or scrutinizing the intricacies of psychosocial statistics as they are using Joseph Heller’s mistrusting caricatures in Catch 22 to discuss public ambivalence toward psychiatry. Their
book organizes a vast amount of quantitative and narrative information into a chronological overview of the care of depression since the Second World War. Callahan and Berrios expose the historical gap between psychiatry and primary care and demonstrate what untreated depression means in cultural and economic terms. They then argue that
society has failed to ‘solve’ the problem of depression one person at a time and, as such, a long-term public health strategy is in order. Increased involvement on the part of primary care physicians in matters of mental health will result in very practical improvements on both the micro individual level and the macro community and cultural levels.

To achieve this, the authors point to the need for a new kind of leadership requiring
competence in at least two kinds of thinking; activist problem-solving skills that are
important for community organizing and public health; and the explicit knowledge that comes from clinical experience and rigorous data collection. Callahan and Berrios
argue that primary care physicians should now assume this leadership, and take on a
new role as wide-scale ‘problem solvers’ when, historically, they have been office-based
clinicians. The vision amounts to the ‘reinvention’ of depression, as it would require the re-conceptualization of the condition as a broad social issue instead of a personal trouble (to borrow from the sociologist C. Wright Mills). The benefits seem obvious; mental illness is de-stigmatized and the treatment paradigm shifts from one predicated on individual defect to one based on a planned, structural public responsibility.

There is a refreshing lack of moralizing in Reinventing Depression. The 1998 comments of
a medical researcher who compared fifteen data sets on treatment of depression throughout the world, cross-nationalism being one of the themes in this book, and concluded that there was no evidence to ‘support the view that failure to recognize depression has serious consequences’, tells us everything about the persistence of stigma versus the needs of depressed people and about the extraordinary efforts our societies must still make to overcome the first and meet the second. If it is necessary to ‘reinvent’ depression then so be it.

Elizabeth Ann Danto
City University of New York
doi: 10.1093/shm/hki058

Harriet Deacon, Howard Phillips, and Elizabeth van Heyningen (eds), The Cape
Doctor in the Nineteenth Century: A Social History, Amsterdam/New York:
Rodopi (Clio Medica 74/The Wellcome Series in the History of Medicine