To inform future research, treatment, and policy decisions, this book traces the scientific and social developments that shaped the current treatment model for depression in primary care over the past half century. While new strategies for diagnosing and treating depression have improved millions of people's lives, there is little evidence that the overall societal burden of depression has decreased. Most experts point to a gap between what psychiatrists know and what primary care doctors do to explain untreated depression. Callahan and Berrios argue, however, that the problem stems mainly from lack of a public health perspective, that prevailing etiologic models underestimate the roles of society and culture in causing depression and over-emphasize biological factors.
The current conceptual model for depression is a scientific and social invention of the last quarter century. Such models are important because they shape how society views people with emotional symptoms, defines who is sick, and determines who should get care. Most parents who seek treatment for depression receive antidepressant medications in primary care. The authors show that although depressed patients' help-seeking behavior and primary care doctors' clinical approach have changed little over the past half century, the field of primary care medicine has changed dramatically. They describe how the specific diagnoses and treatments developed by psychiatrists in the past 50 years have often collided with the non-specific approaches that dominate primary care practice. In examining the research seeking to close the gap between psychiatry and primary care, Callahan and Berrios offer public health models to explain the ongoing societal burden of depression. By exploring the history of depression in primary care, they open a pathway for improvements in the care of people with depression, where primary care physicians should play a greater leadership role in the future.
"I really enjoyed reading this book, and I think it is very useful for individuals involved in health care planning and service distribution and for people interested in the history of the treatment of depression, particularly in primary care." --David L. Dunner, Journal of Clinical Psychiatry
"...mental health service researchers interested in primary care...will surely deepen their understanding and appreciation of how depression is diagnosed and treated..."--Health Affairs
"If the past informs the present, and is truly prologue to the future, then we could use a history lesson. Callahan and Berrios provide the very best kind--well-written, informative, clearly referenced, and lucidly conceptualized--to tell a story of how we came to approach mental illness in primary care as we do...Now and again, a book or paper appears that seems to part the fog, not only showing things as they are but explaining how they arrived to be that way. Reinventing Depression is that kind of book."--Journal of Clinical Psychiatry
"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."--Social History of Medicine
"This book is timely and welcome, given the fact that the contemporary policymakers are still actively debating the merits of different strategies to enhance the treatment of depression."--Bulletin of the History of Medicine
Table of Contents:
Part I The Care of Emotional Disorders in Primary Care
1. Why Depression?
2. The Myth of the Old-Time Doctor
3. The Myth of the Old-Time Patient
4. A More Accurate Picture of Primary Care at Mid-Century
5. Primary Care in Crisis
Part II Origins of the Current Treatment Model for Depression
6. From World War to Magic Bullets to Mass Strategy
7. The Fall and Rise of Specialty Psychiatry
8. "Perfect Drugs" for Primary Care
9. The Birth of the Current Treatment Model
10. From Helping the Doctor to Fixing the System
Part III Lessons Learned and Moving Forward
11. Boundaries and Limitations
12. Dead Reckoning and Moving Forward