Content uploaded by Sushrut Jadhav
Author content
All content in this area was uploaded by Sushrut Jadhav
Content may be subject to copyright.
http://isp.sagepub.com
Psychiatry
International Journal of Social
DOI: 10.1177/002076409604200403
1996; 42; 269 International Journal of Social Psychiatry
Sushrut Jadhav
The Cultural Origins Western Depression
http://isp.sagepub.com/cgi/content/abstract/42/4/269
The online version of this article can be found at:
Published by:
http://www.sagepublications.com
can be found at:International Journal of Social Psychiatry Additional services and information for
http://isp.sagepub.com/cgi/alerts Email Alerts:
http://isp.sagepub.com/subscriptions Subscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
http://isp.sagepub.com/cgi/content/refs/42/4/269
SAGE Journals Online and HighWire Press platforms):
(this article cites 8 articles hosted on the Citations
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
269.
THE CULTURAL
ORIGINS
WESTERN DEPRESSION
SUSHRUT
JADHAV
SUMMARY
Focusing
on
the
British
cultural
vocabulary
of
guilt,
fatigue,
energy,
stress
and
depression;
this
paper
argues
that
such
vocabularies
have
their
own
unique
histories
and
meanings;
deeply
embedded,
in
this
instance,
within
"white
British
and
western
European"
institutions.
Predicated
on
a
western
epistemology,
these
constructs
developed
in
response
to
prevailing
concerns
at
different
periods
in
western
history;
but
are
now
assumed
to
be
universal
natural
entities
that
await
further
scientific
research
and
investigation.
The
cross-cultural
validity
of
depression
as
a
universal
disorder
is
therefore
dubious
and
needs
an
extensive
re-examination.
Over
the
past
two
decades,
a
significant
body
of
research
has
outlined
major
problems
that
relate
to
the
deployment
of
psychiatric
diagnostic
classificatory
systems
and
standardised
research
instruments
in
cross-cultural
settings
(Jadhav,
1995;
~~teir~~~~.r~
&
Good,
1985;
Kleinman,
1987;
Littlewood,
1990;
Murphy,
1982).
Amongst
the
diagnostic
groups,
depression’
has
been
singled
out
as
one
that
raises
significant
issues
of
cultural
validity
and
which
poses
special
problems
as
a
universally
valid
disorder
(Jadhav & Littlewood,
199~;
Kleinman &
Good,
1985).
Fundamental
problems
include
a)
cross-cultural
variations
in
definitions
of
selfhood
(Heelas &
~,~ca~9
1981;
I~arsPil~. ~
White,
1982);
b)
dinering
local
categories
of emotions
(~~utz ~
~b~a®~,u~;i~~d5
1990);
c) cultural
variations
in
language
with
attendant
problems
of translating
emotions-
related
vocabulary
(~,ittie~~~d5
1990);
and
d)
the
absence
of
a universal
biological
specification
(i~iei~.~~~~
&
Good,
1985).
Despite
these
demonstrated
concerns,
medical
professionals,
psychiatrists
included,
consider
depression
as
universal
in
~®rrn9
with
cross-cultural
differences
in
symptoma-
tology
as
a
mere
artefact
(Kaplan &
Saddack,
1995;
Sartorius,
1983).
If
there
arc
such
major
difference
in
symptomatology&dquo;,
it
begs
the
question:
Why
do
they
receive
the
same
diagnosis?
and
how
does
this
contradiction
arise?
To
illustrate
how
this
might
have
occurred
and
continues
to
take
place;
I will
share
observations
from
clinical
experience
at
several
Indian
rural
and
urban
psychiatric
clinics 3
The
majority
of
psychiatric
assessments
in
India
take
place
in
national
and
regional
languages,
either
in
Hindi
or
the
language
spoken
in
a
particular
state.
However,
the
recording
of
case
notes
and
discussions
with
clinical
colleagues
almost
always
take
place
in
English
with
terminology
that
closely
mirrors
the
vocabulary
of
western
psychiatry.
Most
urban
psychiatric
clinics
have
standardized
forms
and
entry
sheets
with
printed
headers
and
guidelines
derived
from
established
psychiatric
history
talking
and
mental
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
270
state
schedules
used
in
Britain.
A
final
formulation
and
diagnosis
of
’the
case’,
together
with
planned
interventions,
take
place
in
a
manner
so as
to
match
the
canons
of
psychiatric
theory
delineated
in
Western
psychiatric
textbooks
(Kaplan &
Saddock,
1RR5).
Qualifying
examinations
for
mental
health
professionals
require
trainees
to
have
a
thorough
knowledge
of
such
texts,
with
inherit
accorded
to
one’s
ability
in
espousing
recent
theories
on
mental
disorders
published
in
international
journals
with
a
high
citation
index.
An
additional
requirement,
the
completion
of
a
research
thesis
vetted
by a
supervisory
panel
ensures
conformation
with
internationally
accepted
methods
and
instruments.
Pressures
of
learning
the
idioms
of
Western
psychiatric
vocabulary,
publishing
in
prestigious
journals
for
acceptance
by the
international
academic
com-
munity
(coupled
with
local
association
of
the
term
’Western’
with
progress,
refinement
and
technological
advancement)
seldom
allow
scope
for
developing
alternative
theore-
tical
formulations
on
mental
distress.
Further,
the
teaching
of
Western
psychiatric
history
as
a
factual
set
of
dates,
events
and
names
is
directly
linked
to
any
local
psychiatric
discourse,
and
is
thus
appropriated
as
a
common
academic
intellectual
heritage.
An
audience
with
pharmaceutical
representatives
armed
with
semiotics
that
reinforce
western
folk
psychiatric
images
(Kleinman &
Cohen,
1991;
Neill,
1989)
are
regular
features
at
out-patient
clinics.
Such
encounters
often
lead
to
the
introduction of
newer
pharmacological
products
into
clinical
practice,
sometimes
with
questionable
monitoring
of
adverse
drug
side-effects4.
In
this
situation,
local
worlds,
their
core
moral
and
cultural
values,
and
a
rich
emotional
vocabulary
associated
with
bodily
problems
and
expressed
through
a
range
of
non-English
languages
(Lynch,
1990),
are
often
glossed
over
or
pruned
to
fit
into
conventional
psychiatric
nosological
systems
(DSM
and
ICD).
This
process
of
system-
atically
acquiring
a
culture-blind
ability
is
considered
credible
and
meritorious,
both
locally
and
internationa11y5.
The
exclusion
of
culture
then
systematically
abolishes
the
ability
(and
sensibility)
to
consider
the
role
of
major
social
and
cultural
variables
such
as
poverty,
migration,
urbanisation,
gender,
caste,
stigma
and
other
socially
oppressive
situations
that
may
well
relate
to
depression
or
its
local
equivalent.
ironically,
these
are
precisely
the
very
issues
cited
by
the
international
community
as
relevant for
the
health
and
economic
development
of
the
poorer
nations
(Desjerlais
et
al.
1995).
Issues
of
cultural
validity
then
acquire a
significance
that
has
serious
implications
for,
and
beyond,
the
clinic
setting.
One
might
argue
that
such
a
selective
’cultural
cleansing’
of
patient
narratives
takes
away
the
opportunity
for
the
major
research
questions
that
cultural
psychiatry
seeks
to
investigate.
For
example,
how
may
local
idioms
of
distress
(currently
fitted
under
the
broad
rubric
of
depressive
or
somatisation
disorders),
such
as
s
naara
mein
dard (pain
in
the
nerves),
rneetha
dard
(sweet
pain),
sar
mein
garmi
(heat
in
the
head),
tidik
(twitch),
badan
mein
dard
(pain
in
the
body),
dil
mein
udasi
(sorrow
in
the
heart)
etc.,
provide
a
phenomenological
template
to
generate
appropriate
nosologies
of
distress
(Jadhav,
1986).
If
such
nosologies
were
to
develop,
they
might
perhaps
lead
to a
fundamental
re-conceptualization
of
depressive
disorders
(Krause,
1989;
Nichter,
1R81).
How
does
one
proceed
further? A
recent
line
of
inquiry
within
the
new
cross-cultural
psychiatry
framework
suggests
that
&dquo;western
psychiatric
theory&dquo;
has
often
over-
determined
its
own
cultural
distinctions,
objectified
them
through
empirical
data
and
then
received
them
back
as
if
they
were
universal
objective
&dquo;natural
scierace9’
categories
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
271
(DSM-IV,
1995;
Littlewood,
1990).
It
postulates
that
each
culture
generates
a
local
psychiatry
(termed
&dquo;ethnopsychiatry&dquo;)
that
constitutes
and
articulates
the
moral
values
and
health
concerns
of
that
particular
culture
(Gaines,
1992).
In
this
schema,
current
psychiatric
theory
is
just
another
instance
of
an
ethnopsychiatry,
embedded
however
in
western
society
and
developed
in
response
to
prevailing
concerns
at
differing
periods
in
history.
Such
an
approach
seeks
to
problematise
existing
psychiatric
concepts
that
are
otherwise
considered
culture-free
and
universally
applicable;
by
de-constructing
theory(ies)
to
reveal
their
culturally
constituted
foundation
(Good,
1994).
To
use
a
post-modern
clinch6,
such
a
project
is
about
’rewriting’
psychiatric
history:
the
losers’
perspective.
The
remainder
of
this
paper
will
address
this
issue
with
a
focus
on
the
historical
development
of
concepts
and
terminologies
associated
with
depression
in
Western
Europe
and,
in
particular,
in
Britain.
Although
limited
to
a
lexical
and
semantic
consideration
of
certain
terminos,
and
therefore
by
no
means
an
exhaustive
cultural
analysis,
it
is
an
attempt
to
provide
a
general
overview
of
the
ways
in
which
some
of
the
key
concepts
of
depression
have
been
culturally
shaped
yet
are
now
assumed
to
be
universal
natural
entities
that
await
further
scientific
research
and
investigation.
The
Mind-Body
~~~~i~a~~IO~9
concepts
of
Self
and
the
location
of
Emotions
The
literature
of
cultural
psychiatry
has
referred
to
the
separation
of
the
Mind
from
the
Body
as
a
fundamental
dualism
that
underpins
Western
psychiatric
diagnostic
and
classificatory
systems
(Gaines,
1992;
Kleinman
&
Good,
1985).
Although
the
history
of
mind-body
dichotomies
dates
back
before
the
17th
century
writing
of
Ren~
Descartes;
the
study
of
how
the
Western
Self
is
culturally
constituted
has
generated
few
ideas.
Whilst
some
consider
it
as
a
bounded,
unique,
homogenous
and
autonomous
entity
(Marsella &
White,
1982),
with
clear
boundaries
and
personal
space,
others
have
postulated
terms
such
as
’ego-centric’
(~ch~:~eder,
1991)
and
’indexicaF
(Gaines,
1992),
as
opposed
to
the
’socia-centric’
and
‘rcfere,~tial’
Self
of
other
societies.
Analysis
of
contemporary
Western
professional
and
folk
psychological
idioms
suggest
an
image
of
an
entity
that
generates
thoughts
and
emotions
from
inside
a
metaphorical
three-
dimensional
space
enclosed
within
firm
boundaries
and
containing
a
’substance’
(Goldman &
Montagne,
1986;
I~akoff
&
Johnson,
1980;
Mant &
Danoch,
1975;
~Ieill,
1989).
In
this
container,
past
experiences
are
stored
in
a
vertical
and
linear
fashion
(Littlewood,
1994)
that
can
be
’emptied’
out
in
cathartic
sessions.
The
’pressure’
brought
about
by
’life
events’
and
’traumas’
could
exhaust
such
a
culturally
constituted
psychological
space
and
lead
to
a
bursting
of
protective
dams
(such
as
psychodynamic
defence
mechanisms)
causing
disintegration
and
disorder
(Lakoff &
Johnson,
1980).
This
sort
of
’rational’
Self
therefore
helps
keep
in
check
its
emotions
which
if let
out
or
let
in,
could
prove
damaging.
The
worth
and
social
estimate
of
this
Self
is
then
measured
by
achievements
refracted
through
a
self-monitoring
structure
(affective
apparatus).
Thus,
low
self-esteem
occurs
when
the
affective
apparatus
is
depressed,
and
an
inflated
self-
esteem when
elated.
Interpersonal
and
social
problems
are
restructured
as
a
series
of
person-centric
’constructs’
(~_elly,
1955)
that
are
focused
on
the
individual
viewed
as
an
unitary
active
agent
acting
upon
the
natural
world.
Emotional
pathologies
are
represented
through four
primary
emotions:
depression,
elation,
anxiety
and
fear.
These
are
enshrined
in
the
form
of
affective
disorders
within
the
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
272
official
diagnostic
systems
(DSM
and
ICD)
as
pure
forms
and
mood
’incongruenf
disorders
(Schizoaffective
disorders)
if
they
occur
in
mixed
forms
(ie.
in
association
with
thought
disturbances).
Psychodynamic
forms
of
therapy
invoke
concepts
such
as
’engagement’
and
’disengagement’
with
the
affected
Self,
that
then
require
the
’transfer’
of
key
emotions
onto
a
’significant’
dummy,
the
therapist.
Although
this
metaphorical
description
is
a
brief
and
simplistic
account
of
the
Self,
it
is
derived
from
the
discourse
within
western
psychiatric
theory.
Here,
depression
is
primarily
a
&dquo;disorder
of
mood’’’
that
rests
upon
a
pathology
of
key
emotions
considered
to
arise
from
within
the
’mind’.
Predominant
expressions
of
bodily
distress
are
therefore
situated
within a
separate
diagnostic
category:
&dquo;Somatisation
disorders&dquo;
and
are
viewed
to
have
a
distinct
natural
history,
course,
diagnosis
and
intervention
from
that
of
&dquo;Mood
(Affective)
disorders’&dquo;
(~~1~-~~g
1995).
Against
this
background,
a
range
of
depressive
vocabularies
and
their
cultural
histories
need
to
be
examined
in
some
more
detail.
A
~.,~ ~~~~~
Analysis
of
Depression
Any
attempt
to
examine
the
origin
of
depression
and
related
feeling
states,
in
an
historical
context,
is
beset
with
two
major
problems:
(a)
relying
upon
ancient
written
texts,
their
interpretations
within
various
disciplines
and
the
general
problem
of
historical
interpretation;
and
(b)
the
semantic
and
conceptual
problem
of
retroactively
employing
a
term
or
concept.
There
are
problems
o~~
assuming
6d~pr~ssior~’
to
be
a
constant
feeling
state
that
is
merely
changing
in
its
vocabulary
over
time;
an
idiom
similar
to
the
form-content
debate
across
cultures
(Murphy,
1982).
If
the
vocabulary
of
emotion
is
itself a
cultural
construct,
that
is
shaped
and
in
turn
shapes
affect, then
there
is
a
clear
problem
of
assuming
constants
of
affective
states
over
time.
Not
surprisingly,
several
medical
historians
have
chosen
to
take
acedia,
sadness,
melancholia
and
depression
as
a
single
temporally
linked
and.
successive
feeling
state
that
has
simply
been
subject
to
changing
labels
over
time
(~lari~e9
1975;
Hunter &
~a~~ipi~~7
1963).
The
earliest
use
of
the
term
&dquo;depression&dquo;
in
English
language
dates
back
to
the
17th
century.
Its
subsequent
and
ubiquitous
use
in
describing a
state
of
mind,
the
weather
or
economy,
suggest
a
general
state
of
&dquo;lowering
of
affairs’’
(Fontana
Dictionary
of
Modern Thought,
1988).
The
first
standard
English
gloss
of
this
term
was
introduced
by
Samuel
Johnson
in
1755
in
his
dictionary
(Johnson,
1755),
and
the
Oxford
English
Dictionary
cites
its
etymology
from
Latin
roots:
~~’n?~~
(to
press
down).
An
idiom
initially
developed
as
a
spatial
metaphor,
represented
in
astrology
and
architecture,
later
acquired
gravitational
properties
to
represent
a
model
of
mood
states
along
a
vertical
axis
well
exemplified
in
1750s
engravings
by
William
Hogarth
(Littiewood,
1994).
How
did
such
a
metaphor
arise?
and
what
were
its
historical
antecedents?
If
the
current
western
European
vocabulary
of
dysphoric
mood
states
is
as
recent
as
the
seventeenth
century,
can one
claim
that
emotional
states
were
less
differentiated
or
configured
in
a
different
manner
before
this
period?
Although
earlier
research
has
suggested
the
development
of
Old
English
as
a medium
for
emotional
expression,
recent
work
by
Nicholson
argues
for
the
presence
of
a
prolific
vocabulary
of
emotions
during
the
Anglo-Saxon
period
(Nicholson,
1995).
His
analysis
of
Anglo-Saxon
literature
provides
evidence
of
a
rich
abstract
vocabulary
denoting
various
mood
states.
An
examination
of
Old
English
elegies
revealed
over
37
different
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
273
emotions
that
serve
as
equivalents
for
Modern
English
terms
such
as
sorrow,
misery,
grief,
fear,
caring
at
dawn,
anger,
sorrowful
love,
perpetual
grief,
etc.
Based
on
this
evidence,
he
challenges
the
premise
that
earlier
societies
neglected
and
undervalued
emotional
states
due
to
a
lack
of
emphasis
on
personal
choice
or
to
an
undifferentiated
psychological
vocabulary
(Left,
1973).
Whilst
acknowledging
that
Anglo-Saxon
vocabul-
aries
do
not
directly
relate
to
modern
English
words,
Nicholson
confirms
the existence
of
a
range
of
psychological
states
during
the
Anglo-Saxon
period.
Of
particular
interest
is
the
term
‘u~aaaz~r~y
which
in
old
translates
as
but
also
refers
to
a
disease
state
arising
from
the
stomach
(Cockayne,
1865).
This
bears
close
linguistic
affinity
with
the
Sanskrit
term
‘~,fr~~~~cl~’9 a
generic
term
in
ayurvedic
medicine
for
severe
mental
disorders
(Bhishagratna,
1991),
and
suggests
a
cultural
exchange
of
psycholo-
gical
language
and
concepts
may
have
taken
place
during
the
Anglo-Saxon
period,
possibly
introduced
into
Britain
through
Arabic
sources
(Clarke,
1975).
Historical
evidence
reveals
that
the
major
source
of
current
concepts
relating
to
psychological
disturbances
in
Europe
derived
from
the
Church,
followed
later
by
classical
Greek
and
Latin
texts
that
came
via
Arabic
sources.
The
most
popular
of
these
were
Acedia
and
Black
Bile
and
both
seemed
to
have
had
a
complex
with
the
Erzglish
term,
Melancholia
(Jackson,
1986).
Acedia,
Black
Bile
and
I%4eianchofia
Jackson’s
scholarly
and
exhaustive
research
on
Melancholia
in
general
and
Acedia
in
particular
(Jackson,
1986)
reveals
the
complexity
in
an
historial
analysis
of
psychiatric
vocabulary
and
the
dimculties
of
drawing
valid
conclusions.
The
absence
of popular
folk
literature
from
such
remote
historical
periods
further
complicates
this issue.
Historians
have
generally
had
access
to
surviving
written
documents
of
the
literate
elite,
and
this
poses
further
limitations
into
research
on
the
historiography
of
folk
concepts.
The
term
’acedia’
originated
from
Latin
t~~cf~~c~
which
may
be
glossed
as
&dquo;heedlessness
and
torpor’’’,
and
later
became
a
&dquo;favourite
ecclesiastical
word
to
describe
the
mental
prostations
of
recluses,
induced
by
fasting&dquo;
(OED,
1989).
Black
Bile
is
the
modern
English
translation
of
the
Greek
term,
melaine
~°~2csle
(Latin
with
Melancholia
in
English
deriving
directly
from
Latin
which
in
turn
was
acquired
from
the
Greek
(Jackson,1986).
Western
thought
on
melancholy
derives
from
the
Hippocratic
corpus
in
the
fifth
century
BC,
systematized
by
Galen
during
the
second
century
AD,
thereafter
preserved
and
elaborated
by
Arabic
and
other
Eastern
physicians
between
the
end
of
the
Classical
period
and
its
Arabic
re-introduction
into
the
West
(Rippere,
1981).
When
these
ideas
r~--ez~a~r~ed
in
the
late
Middle
Ages,
they
were
available
through
Latin
translations
which
were
then
adopted
into
academic
teaching
in
the
universities
(Clarke,
1975).
Such
a
process
could
th.erefore
have
lead
to
a
range
of
meaning
systems,
nomenclatures
and
theories.
Despite
such
cultural
transitions
and
reinterpretations,
the
term
Melancholia
seemed
to
prove
a
relatively
durable
concept
and
an
overarching
category
that
was
later
to
subsume
a
range
of
dysphoric
terms
including
Acedia
and
Guilt
(Bright,
1586).
Although
religious
literature
of
the
late
4th
century
AD
referred
to
Acedia
as
one
of
the
major
temptations
with
which
the
solitary
monk
bad
to
struggle
(Clarke,
1975),
~~.clcso~~’s
translations
of
the
writings
by
John
Cassian,
an
1--nfluential
monk
of
those
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
274
times,
suggests
bodily
metaphors
such
as
a
&dquo;weariness
or
distress
of
the
beartg’9
’’akin
to
dejection&dquo;
and
&dquo;especially
trying
to
solitaries’~.
He
describes:
&dquo;The
condition
was
characterised
by
exhaustion,
listlessness,
sadness
or
dejection,
restlessness,
aversion
to
the
cell
and
the
ascetic
life,
and
yearning
for
family
and
former
life.
The
afflicted
monk
became
restless,
complained
that
his
situation
was
no
longer
spiritually
fruitful
and
that
he
was
useless
in
it,
and
he
thought
that
he
would
never
be
well
unless
he
left
the
place.
In
his
continuing
resfi~ssz~ess9
time
seemed
to
pass
very
slowly,
he
yearned
for
company
and
considered
seeking
solace
in
sleep.
In
short,
he
tended
to
either
remain
idle
in
his
cell
or
to
wander
from
it
in
restless
pursuit
of
diversionary
activities,
in
either
case
to
no
spiritual
end.&dquo;
1986,
p.
66-67)
The
term
continued
to
be
used
by
theologians
over
the
next
decade,
and
by
the
12the
century
AD,
it
survived
monastic
politics&dquo;
to
be
officially
accepted
as
one
of
the
seven
deadly
temptations,
the
Sin
of
Sloth
(Jackson,
1986).
How
then
did
Acedia
acquire
folk
popularity
if
it
was
confined
to
monks,
given
their
solitary
lives
in
monasteries?
In
contrast
to
the
early
middle
ages,
when
medicine
was
taught
exclusively
in
monasteries,
there
was
then
little
chance
of
combining
the
humanities
and
hence
an
outward
diffusion
of
medical
ideas
did
not
occur
(Clarke,
1975). The
rise
of
Church
power
during the
12th
and
13th
century,
led
to
confessions
made
obligatory on
all
by the
Fourth
Lateran
Council
(Legge,
1963).
This
led
to
an
extensive
production
of
penitential
literature,
manuals
for
preachers
and
ca-iheticai
handbooks,
resulting
in
a
steady
diffusion
of
religious
and
medical
ideas
and
concepts
into
the
popular
culture.
During
the
sub-
sequent
scholastic
phase,
a systematic
analysis
of
theological
literature
resulted
in
the
integration
of
Acedia
with
Greek
theories
of
the
passions
that
had
started
arriving
into
Britain,
and
Acedia
6‘ezn~r~~d
as
a
disorder
in
z-~an9s
emotional
life.
At
times, it
came
to
be
thought
of
in
medical
terms&dquo;
(Jackson,
1986,
p.
70).
Its
status
as
a
Sin
however,
continued
within
the
Church
until
further
developments
led
to
its
association
with
Black
Bile
and
religious
Guilt.
The
Cultural
History
of
GuiM
The
word
Guilt
derives
from
the
early
medieval
German
gelt
(gold
or
gulti:
to
pay
for
an
®Pf’e~~~)9 ~
z~®rz~tary
penalty
for
commission
of crime but
commonly
used
to
indicate
a
failure
of
duty
(OED,
i ~~9).
The
literature
suggests
that
this
was
primarily
a
religious
and
social
category
that
became
interiorized
and
transformed
into a
secular
psychology.
To
follow
the
OED
citations:
&dquo;initially
conceived
as
a
Sin
(9th
century
AD).
later
as
the
fact
of
having
committed
some
specified
moral
offence
(&dquo;Christ
shed
his
blood
so
he
might
wash
us
from
the
sickness
of
guilt:
~ue~~~c~
~~~~~~r~~~d~~
~MMM/M~’~
lit
nos a
niol-bo
culpe
lavaret&dquo;,
14th
century
AD,
Siegfried, 1989,
p.
207),
and
then
as
of
conscience
(15-16th
century
AD),
and
as a
quasi-medical
term,
guilt-sick
conscience
(1625
AD),
it
later
acquired
physical
characteristics
such
as
being
pent-up
inside
the
body
(1605
AD),
and
evolved
into
a
more
elaborate
psychological
category,
guilt
complex
(1927
AD),
with
a
further
development
into
a
plural
form:
guilts
(1932
AD)&dquo;.
(OED,
1989).
If
guilt
originated
as
a
moral
and
social
category,
how
did
it
become
incorporated
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
275
within
a
medical
psychological
framework
and
acquire
a
pathological
connotation
(as
it
does
in
the
psychiatric
descriptions
of
contemporary
depressive
disorders)?
To
under-
stand
this,
one
needs
to
examine
the
changing
relationship
between
the
church
and
medical
profession.
Jackson
and
others
have
postulated
that
this
came
about
as a
result
of key
texts
and
teachings
of eminent
theologians
who
later
were
to
practice
medicine,
or
M’ce
versa
~~i~xl~~9
1975;
Jackson,
1986).
The
role
of
this
’medical
clergy’
in
merging
moral
guilt with
an
illness
concept
of
melancholy
and
its
postulated
cause,
ie.
black
bile,
is
succinctly
illustrated
in
the
following
passage
by
Saint
Hildegard
ol‘~ixa~~xa,
who
wrote
an
influential
medical
treatise
during
the
llfih
century,
titled
6G~’cr~r.~~e e~
6wa<?&dquo;
(~~la.aa~a~~aa9
1990,
p.
246):
&dquo;At
the
very
instant
when
Adam
disobeyed
divine
order,
melancholy
coagu-
lasted
in
his
blood,
just
as
clarity
vanishes
when
the
light
goes
out,
though
the
still
hot
oakum
produces
malodorous
smoke.
And
so
it
was
with
Adam,
for
while
his
own
light
was
being
put
out,
melancholy
curdled
in
his
blood,
which
filled
him
with
sadness
and
despair.
Indeed,
when
Adam
fell,
the
devil
breathed
melancholy
into
him,
that
melancholy
which
makes
man
faint-
hearted
aid
unbelieving&dquo;.
Yet
another
influential
fifth
century
saint,
Saint
Augustine,
commented
on
the
Christian
notion
of
inheritance
of
Sin
(ibid.,
p.
247):
‘6~r~~~
inherit
this
ignorance
and
concupiscence,
yet
we
are
also
guilty
of them.
For
at
the
time
of
his
sin,
Adam
formed
one
single
man
with
all
his
posterity;
all
of
us
were
contained
in
him.
The
unity
of
the
human
race
within
Adam
explains
how
the
first
offence
was
also
our
o~°~~~~°’.
Almost
five
hundred
years
following
Saint
Hildegard’s
teachings,
Burton
extended
this
logic
in
his
influential
Anatomy
of
Melancholy,
beginning
with a
discussion
on
the
Original
Sin
that
transformed
man,
&dquo;the
niiracle
~f rr cr~~rrTe,
i~2~
a
r~~~,~~r°crb~~
&~Mg- ~M~c~
to
~7/Hf?~~/~r,
M~~?M~M ....’
Heit
tristis
et
~~~d~r°vr~~.~~ ~~~ara~r~r~~a~ar~yj
p.
246).
The
Irrd].~rit:;uJ!œ
of
Guilt:
from.
Sin
to
Gene
Ail
this
suggests
how
Guilt
simultaneously
translated
into
a material
substance
(black
bile)
and
an
iliness,
to
acquire a
hereditary
property.
More
significantly,
through
its
association
with
black
bih,
it
established
a
direct
link
with
Melancholia.
Thus,
there
developed a
situation
wherein
the
triad
ofGuiit,
Sin
and
Black
Bile
was
firmly
linked
and
crystallized
into a
robust
category.
This
category
was
to
become
the
basis
for
further
elaboration
of
theories
on
melancholia
and
at
the
same
time,
considered
to
constitute
the
’clinical’
features
of
Melancholia,
the
disease.
Black
Bile
theories
of
Melancholia
remained
popular until
the
17th
century,
and
were
variously
viewed
as
heavy
impurities
that
either
produced
noxious
fumes
or
precipitated
and
blocked
blood
vessels
to
produce
Melancholia.
The
Spleen
was
considered
as
the
site
which
produced
Black
Bile,
its
spongy
texture
serving
to
absorb
and
store
this
thick
viscous
humour.
During
the
Renaissance,
developments
in
medicine
such
as
Paracelsus’s
challenge
to
Galenic
medicine
and
his
rejection
of
the
humoral
theory,
~,l~s~ii~s’s
work
on
anatomy,
together
with
~~x~~~y’s
theories
of circulation,
challenged
the
legitimacy
of
the
Black
Bile
theory
for
Melancholia.
It
was
replaced
by
competing
theories
cither
in
succession
or
in
a mixed
form.
Some
of the prevailing
popular
nicdicai
explanations
include:
Spirit
vitae
Mocking
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
276
the
brain
Affectations
of
the
mind~
and
Melancholic
vapours
rising
from
the
Spleen
to
obscure
the
mind9
together
with
a
range
of
Neo.Platonic
theories
invoking
supernatural
forces,
demons
and
spirits
as
causal
agents
(MacDonald,
1981).
In
this
piuraiistic
atmosphere,
the
introduction
of
chemical
theories
(Hunter
L
Macalpinc,
1963),
nerve
juices
and
mechanical
explanations
were
part
of a
paradigm
shift
that
emphasised
a
primary
pathology
in
the
nerves
(Jackson,
1986;
Porter,
1 99 I).
The
cultural
association
of
Guilt
with
Melancholia
survived
as
a ’complex’
to
become
symptoms
of
’Depression’.
M.edical
historians
consider
this
period
one
in
which
the
Body
underwent a
process
of
secularisation
(Delumeau,
1990;
Elias,
1939;
Porter,
199i),
Demons
and
malignant
spirits of
the
pre-Rcnaissance
period
were
objectivised
through
medical
theories
which
introduced
the
concept
of
Natural
Spirits
located
within
the
nervous
system
(as
compared
to
earlier
Neo-Piatonic
evil
spirits
from
the
supernatural
world),
and
with
the
discovery
of such
natural
laws
as
those
of
~~~v~:o~
and
Boyle,
Depression
acquired
metaphors
derived
from
physics
(such
as
stress,
fatigue
and
energy).
The
four
original
humours
including
Black
Bile
were
replaced
by
neuiohuiI1ours
(the
forerunner
ofneuroendocrine
theories),
the
metaphors
of
balance
and
excess-deficit
between
humours
retained
to
explain
various
mental
disturbances
and
normal
brain
functioning.
Idioms
such
as
sluggishness
and
heaviness
translated
into
psychomotor
retardation
and
drooping
body
posture,
whilst
Darkness
(derived
from
the
shadow
of
black
bile)
retains
popularity
in
contemporary
folk
vocabulary
exemplified
by
pharma-
ceutical
advertisements
for
anti-depressants;
although
the
current
metaphor
&dquo;feeling
blue&dquo;
owes
its
popularity
to
the
18th
century
notion
&dquo;to
burn
blue&dquo;
(a
burning
candle
emitting
a
flash
without
red
glare,
an
omen
of death
or
indicating
the
presence
of Devils
with
the
plural
form,
Blue
Devils,
referring
to
an
apparition
seen
in
delirium
tremcns:
OED,
1989).
Later,
the
psychoanalytic
theories
of
Freud
reinterpreted
religious
Guilt
(as
Guilt
Sickness)
into a
schema
that
explained
individual
guilt
as
having
originated
from
&dquo;a
great
traumatic
event:
the
murder
of
the
father
of
the
horde&dquo;
(Del-Limeau,
1990,
p. 251).
In
a
similar
manner,
earlier
quasi-hereditary
ideas
of
inheriting
depression
(through
its
association
with
guilt)
were
gradually
turned
into a
theory
of
heredity
by
Esquirol
(Jackson,
1986),
to
be
later
developed
into
the
late
19th
century
theory
of
degeneration
(F5oJntei. &
Macalpine,
1963)
and
then
further
shaped
into
20th
century
genetic
models
for
depressive
disorders.
The
popularity
of
Melancholia
The
cultural
shaping
and
transformation
of
Melancholia
into
a
fashionable
folk
category
lasted
for
well
over a
century
and
involved
the
whole
of
Europe.
Popular
interest
in
Melancholia
peaked
in
the
17th~ 18th
centuries
during
which
it
was
dichot.
or~~is~d:
as
a
disease
with
elaborate
physiological
explanations
and
as
a
sentiment
cultivated
by
the
elite
(Babb,
1951).
Dubbed
for
over
a century
as
the
English
Malady
or
the
Spleen,
its
status
as
a
disease
of
the
~~~t~~i
class
was
based
on
the
idea that
it
was
an
attribute
of
superior
minds,
of
genius
(Doughty,
1926).
A
number
of medical
historians
suggest
that
this
was
an
era
in
which
Europe
developed
an
immense
interest
in
Melancholia
(Babb,
1951;
Clarke,
1975;
Delumeau,
1990).
Its
diffusion
into
popular
literature
(Legoius &
Cazamian,
1964)
together
with
further
developments
in
European
society
such
as
the
developing
class
structure
(Macfarlane,
f 978),
the
private
ownership
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
277
of
property
(Marx,
1887),
the
advent
of
enclosures
and
the
notion
of a
private
cultural
space
(Johnson,
1993);
and
an
interest
in
psychological
idioms
by
the
elite
(Elias,
1939),
led
to a
personalisation
of
melancholic
feelings
with a
proliferation
of
terminology
(Carritt,
1948) -
thus
Ivlelancholy
was
described:
as
divine
(Hail,
divinest
Melancholy.
John
I~filt~r~, II
Pe~se~°~sc~, 16~5);
as
personality
(~ ~2e
l~f~lctt~c~a®ly ctt~d
humour
were
in
him
so
con-
that
each gave
to
the
other,
and
rnade
his
company
otae
of
the
J~’~~ o/’M~M~m~.
Isaac
Walton,
Life
of
John
Donne,
1640);
as
landscape
(~’he ~ct~~c
(at
... so
is
it
Jiirnishd
with
whatever
may
render
it
agreeable,
and
Here
is
a stately
/7,e~/~’, <~<?i~
~rm~
water,
artificial
cascades,
rocks,
grotts.
John
Evelyn,
8.9.
1640);
as
folly
(° ..
All
otherjov to
this
ct~e f~l~y,
None
so
sit)eet
as
t~a.e~at~cl2o~y.
Robert
Burton,
Anatomy
of
Melancholy,
1622);
as a
fit
(~a^ct~ ia~
a
pleasingfit
of
melancholy,
To
mediate
my
rural
ininstrelsy.
John
lB1ilton,
C~~a~s9
1635);
as
mood
(More, 7
more, 1
cccrt
suck
out
of a
song,
as a
ivectsel
sucks
eggs... I do
love
it
better
than
laughing.
William
Shakespeare,
As
You
Like
~t,
1600);
as a
desirable
sentiment
(,4 s~~eet
melancholy
1ny
senses
keeps.
Drii7vmond
of
When’as
She
Smiles,
1 ~~4)9
and
as a
national
character
(The
are
naturally
and
very
often
~’~7(9~~~~
thcat
Gloominess
and
of
temper,
which
is
so
frequent
ita
our
l~7-~t~o~ ... ,
John
Addison,
Spectator,
Pleasures
of
the
Imagination,
1712);
that
was
considered as
uniquely
English
(The
English
~cthtd~
Babb,
1 ~ ~ 1 l.
A
close
examination
of
the
historical
literature
suggests
that
this
was
perhaps
the
only
period
in
the
history
of
Western
Europe
when
’melancholy’
in
its
mild
form
denoted a
positive
desirable
and
fashionable
state
and
in
its
severe
form, a
disease
state
which
caused
suffering
and
stigma.
Against
the
background
of
two
major
recognised
epidemic
in
Europe -
black
death
and
suicide -
melancholia
was
viewed
on
the
one
hand
as
a
social
and
health
problem,
particularly
amongst
the
poor
and
unemployed
whilst
the
artistic
community
and
women
of
the
’genteel
class’
on
the
other,
were
expected
to
be
of
melancholic
disposition 10
(Dolumeau,
1990).
From
~~~~~~1~~~~
to
Depression
Against
the
background
of
Cartesian
dualism,
further
developments
in
medical
and
psychological
theories
associated
with
the
post-Renaissance
period,
led
to a
recatcgor-
isation
of
melancholia
into
somatic
and
psychological
types
(Jackson,
1986).
Later,
the
term
melancholia
itself
was
displaced
by
depression
which
subsequently
developed
into
a
major
ethn~~~~dic~l
category
(Jadhav &
Littlewood,
1994;
Games,
1992).
Although
Guilt
continued
to
remain a
feature
of
Depression,
it
was
to
soon
be
valorized:
In
its
excessive,
pathological
or
inappropriate
form:
as a
central
feature
of
depressive
disorders;
and
with
its
absence
or
lack:
as
one
of
the
core
features
of
anti-social
personality
disorder
(DSM-IV,
1995).
This
tenuous
link
continues
into
twentieth
century
concepts
of
heredity,
reflected
through a
contemporary
clinical
classification
that
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
278
associates
women
suffering
from
early
onset
depression
to
have
a
high
incidence
of
anti-
social
personality
disorder
amongst
their
first
degree
male
relatives
(~~i~~’~~~r,
1973).
With
the
increasing
popularity
of
physiological
and
chemical
theories
of
mental
disorders
in
an
era
dominated
by
advances
in
the
natural
sciences,
depression
seemed
congruent
with
emerging
natural
physical
science
concepts
that
implied
pressure,
force,
energy,
motion and
gravitation.
By
the
beginning
of
this
century,
the
term
was
deeply
embedded
in
meteorology
(high
pressure
and
low
pressure
areas),
stock
market
(The
Great
Depression),
speech
(lowering
of
piteb
and
musical notes)
and
lowering
of
vital
bodily
functions
(depressed
T
wave
in
electrocardiograms
and
depressed
immune
system)
to
became
a
robust
Western
etbnopsychological
construct.
As
an
illness
concept,
it
acquired
battle
metaphors:
popular
public
health
campaigns
in
Britain
now
refer
to
&dquo;defeating’
depression,
‘b~.tt~in~9
with
stress,
’strengihcning’
defences
and
’buffering&dquo;
vulnerabilities
(Jadhav &
Littlewood,
1994).
With
this
gradual
interioriza.tion
of
a range
of
dysphoric
emotions
that
were
relocated
and
postulated
to
originate
from
within
an
infra-psychic
space
(~,~1~~~ ~
Johnson,
1980),
fears
of
losing
‘c;~~tr®1’
over
such
emotions
shaped
the
further
development
of
contemporary
psychological
theories
and
insight
questionnaires
that
view
patients’
attribution
to
’external
loci
of
control’
as
indicative
of
poor
’M-.s~/M’’
and
an
unfavourable
prognosis
for
depression
(Kaplan 11
Saddock,1995).
The
birth
of
fatigue
and
the
category
off
somatisation
Originating
from
the
French
tcrm./~~Mf?
and
Spanish, fiaiigu,
in
English
fatigue
denotes
’lassitude
or
weariness
resulting
either
from
bodily
or
mental
exertion’’
(OED,
1989).
Its
use
in
the
current
psychiatric
vocabulary
originated
from
several
diverse
sources,
but
unlike
guilt
and
acedia,
fatigue
has
had
a
more
recent
medical
history;
commencing
around
the
end
of
the
eighteenth
century,
and
closely
related
to
the
Industrial
Revolution
and
the
discovery
of
labour
power
(Rabinbach,
1990),
The
prevailing
Protestant
concerns
about
the
importance
of work,
meant that
idleness
was
a
danger
to
be
guarded
against.
The
emergence
of
commercial
economies
under-
pinned
by
capitalism,
the
industrial
revolution,
and
the
birth
of chronological
clock
time
led
to
the
development
of
an
ethic -
’not
to
waste
time’ -
as
the
’new
measure
of
life’.
Thus
a
new
secular
remedy
for
the
medieval
Sin
of
Sloth,
evolved:
the
discipline of work.
Soon
idleness
was
virtually
regarded
as
the
primary
crime
against
industry
and
was
supported
by
influential
members
of the
scientific
and
political
community
in
Europe.
In
this
era,
a
significant
intellectual
framework,
the
doctrine
of materialism,
developed
the
idea
that
the
Body
was
a
source
of
energy
capable
of
transforming
universal
natural
energy
into
mechanical work.
This
ability to
generate
energy
and
perform
labour
could
then
be
harnessed
by
the
State for the
production
of
wealth
and
articulated
in
the
form
of
a
metaphor:
The
Body
as
lB1achine.
Offray
de
La
Mettrie’s
famous
18th
century
treatise
6~,’ho~~37ie
machine’,
provides an
example of
how
this
powerful
from
France
and
Germany
swept
through
Europe:
one
that
posited
the
human
body
as
analogous
to
&dquo;a
watch-spring
with
unique
self
winding
properties&dquo;
(ibid.
p. 51).
By
the
turn
of
the
century,
the
Body
was
modelled
on
the
thermodynamic
engine
and
linked
with
physical
forces
in
the
cosmos
through
a
unifying
category:
Energy,
the
antithesis
of
fatigue. As
a
generalisaMe
category,
it
was
picked
up
by
Freud
who
6‘~~~~tapc~s~(d)
two
universes
of
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
279
discourse,
that
of force
(or
energy)
and
that
of
meaning,
so
that
meaning
relations
(were)
entangled
with
force
relations&dquo;
(ibid.
p.
63)
and
developed
this
theme
to
form
the
basis
of
his
thesis
in
&dquo;Beyond
the
Pleasure
Principle&dquo;
and
into
a
theory
of
&dquo;libidinal
energy&dquo;
(Brill,
1938).
This
concept
of
energy
also
gained
popularity
amongst
late
nineteenth
century
physiologists
keen
to
understand
bodily
functions
through
principles
of
physics
and
chemistry
leading
to
the
development
of
terminology
such
as
calories
and
muscle
proteins
to
explain
energy
production
within
the
body
(Rabinbach,
1990).
Concerns
about
fatigue
within
industries
and
power
plants
peaked
ill
the
nineteenth
century.
The
traditional
western
proscription
on
idleness,
which
spiritualised
and
consecrated
labour,
was
displaced
onto
the
working
body
(or
class)
and
recast
in
scientific
and
medical
language
as
a
natural
category.
A
major
part
of
these
develop-
ments
originated
in
France:
Philippe
~’issic9
the
most
prolinc
advocate
of
a
national
policy
of
hygienic
resistance
to
fatigue
in
fin-de-siecle
France,
warned
that
a
&dquo;nation,
lice
a
,fc~ti~r~~~
i~aclivi~’u~l
is
aliiays
prepared to
obey
aiiy
~M~er
which
imposes
itself
oil it
hrtitally
f2M~
~vitla.f®a°ce&dquo;
(Rabinbach,
1990.
p.
146).
This
threat
of
’fatigue’
led
to
several
debates
within
a
medical
profession,
alarmed
at
the
’mental’
fatigue
of
youth
in
France
and
Germany,
and
who
expressed
concerns
over
their
exhausted
state
brought
about
by
overwork
and
overstudy.
The
popular
press,
dubbed
this
period
as
‘~,9~~L~cc~ti~~a
homicide’.
Several
texts
and
monographs
on
Fatigue
were
published
and
a
state
similar
to
the
Elizabethan
melancholic
era
had
developed.
With
the
invention
of
the
ergograph,
aesthesiometer
and
algesiometer,
attempts
to
measure
the
physical
consequences
off
mental
fatigue
were
balanced
by
others
who
tried
to
establish
and
develop
a
pure
psychological
category
of
fatigue.
Amongst
the
most
notable
was
Emil
Kraepetin
who
argued
for
devising
sophisticated
psychological
techniques
to
measure
fatigue.
Kraepeliri
differentiated
between
fatigue
~e~~r~aiir~a~a~g)
and
tiredness
(niiidigkeit)
as
severe
and
milder
forms
of
the
same
experience.
He
measured
and
plotted
graphs
on
fatigability
in
mental
terms
through
monitoring
psychological
performance
of
factory
workers
in
his
laboratory.
Kraepeiin
argued
for
a
system
in
which
the
’unsuitable’
would
be
left
behind
while
the
energies
of
the
more
capable
could
develop
and
be
enriched
&dquo;so
that
the
path
would
be
open
to
a
new
species
more
capable
of performance&dquo;
(ibid,
p.
i ~2).
Around
this
time,
George
Miller
Beard,
a
psychiatrist,
introduced
the
term
’neur-
asther~ia’
to
cover
‘6c~ll
t~~~’~r~a~as
and
ty~~~,s
of nervotis
exd~~a~s~ti®yL
c®~~ai~~~ fa~®a~~
the
brain
~K~/r~-M
the
spinal
cord&dquo;
(ibid.
p.
iS3).
This
term
was
then
shared
and
reinforced
by
prominent
physicians
and
social
scientists
including
Charcot,
Simmel
and
~ur~i~eir~.
Charcot’s
student,
Charles
Fere
became
a
leading
proponent
of
a
hereditary
link
between
the
’’neuropathic
family’
and
is
propensity
to
neurasthenia.
Yet
another
set
of
physicians
ascribed
this
hereditary
notion
to
’Jews
and
the
slave
race’
and
to
a
’kind
of
inverted
work
ethic,
an
ethic
of
resistance
to
work
or
activity
in
all
its
f~r~s9 .
This
incapacity
that
derived
from
impaired
energy
led
Pierre
Jane
to
develop
the
theory
of
’’psychological
tension’
that
postulated
a
hierarchy
of
energies
required
for
different
types
of
activities. Janet
argued
that
emotions
were
a
‘variety’
of
fatigue
and
viewed
the
psyche
as a
permanent
struggle
between
the
economies
of
energy
and
fatigue.
By
the
end
of
the
19th
century,
the
medical
establishment’s
interest
in
fatigue
as
a
bio-medical
disorder
was
highlighted
by
the
US
Surgeon
General’s
Index
listing
more
than
100
studies
of
muscle
fatigue,
asthenia
and
spinal
exhaustion,
along
with
numerous
studies
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
280
of
’nervous
exhaustion’
and
’brain
exhaustio~’.
The
search
for
a
physiological
marker
spurred medical
research
into the
chemistry of
fatigue
with
unsuccessful
attempts
at
discovering a
’vaccine’
against
this
state
(Rabinbach,
1990). ~
biological
origin
of
pathological
fatigue
eluded
the
medical
establishment
and
the
term
continues
as
a
psychiatric
disorder,
although
controversy
surrounds
variants
of
fatigue.
Nuances
like
Chronic
Fatigue
and
Myalgic
Enccphalomyclitis
reflect
how
their
causes
are
contested
by biological
and
psychological
theories,
whilst
reified
by an
industry of
sickness
benefits
and
litigation.
Although
a
cardinal
feature
of
depressive
disorder
(as
low
energy), it
retains
a
separate
identity
as
Chronic
Fatigue
Disorder
in
contemporary
wcstern
ethnopsychiatry
(DSM-IV,
1995).
Somatisation
followed
as
a
logical
continuation
of
this
discourse
on
Fatigue.
Defined
as
‘Gthc
occurrence
of
bodily
symptoms
in
consequence
of
or
as
an
expression
of
mental
disorder&dquo;
(OED,
1989),
the
term
was
introduced
into
the
psychiatric
literature
of
the
1920s
to
validate
emotional
origins
of
bodily
symptoms.
It
is
now
enshrined
within
the
DSM-IV
as
a
disorder
in
itself,
considered
resistant
to
treatment
and
continues
to
preoccupy
researchers
who
either
seek
a
biological
substrate
(Goodwin
&
Potter,
1978)
or
consider
it
prevalent
amongst
those
who
have
less
differentiated
psychological
vocabulary
(Leff,
1973).
Its
psychological
equivalent,
Alexithyrnia,
was
originally
defined
as
&dquo;an
affective
disorder
characterized
by
inability
to
recognize
or
express
emotions&dquo;
and
put
forward
by
psychotherapists
of
the
early
1970s
(Sifnoes,
1972).
However,
standard
textbooks
of
psychiatry
now
describe
it
as
a
means
of
communicat-
ing
affective
distress
through
somatic
language.
Curiously
enough,
a
range
of
psycho-
pathologies
associated
with
powerful
somatic
idiom
of
distress
such
as
Body
Image
disorders
are
not
considered
as
’’somatisation’
and
further,
are
deemed
appropriate for
psychotherapeutic
interventions
(Kaplan &
Saddock,
1995).
It
is
not
surprising
that
the
concept
of
somatisation
originated
in
an
era
when
eugenic
theories
dominated
academic
scientific
thinking.
The
association
of
high rates
in
non-western
societies,
with lower
socio-economic
and
educational
levels,
rural
origin,
active
and
traditional
religious
affiliation;
frustrations
with
efforts
to
accommodate
it
as
an
affective
disorder
together
with
a
poor
response
to
anti-depressive
therapies
(Kleinman
~
Good,
1985)
or
psychotherapeutic
interventions
have
lead
to
a
not
so
concealed
stigmatising
attitude
towards
&dquo;somatisers&dquo;.
The
discovery
of
stress
Originating
from
the
Latin
st~°~ctc~
(and
thence
French
estrée)
rn~ar~ing narrc~wness,
straitness,
oppression,
and
Middle
English
dis, tresse
the
term
connotes
hardship and
adversity
(OED,
1989).
Its
popular
usage
in
current
English
began
as
a
common
overarching
metaphor
(of
a
natural
force)
principally
in
physics
(14th-17th
century),
that
denoted
a
sense
of
weight,
pressure,
strain,
or
a
deformation
upon
a material
object.
Its
introduction
into
psychiatric
literature
occurred
at
the
end
of
the
19th
century
when
it
was
first
associated
with
neurasthenia
(Rabinbach,
1990),
and
was
considered
a
general
cause
of
mental
disorders.
It
reached
peak
popularity
in
the
1980s
following
the
introduction
of
an
independent
psychiatric
disorder,
Post-Traumatic
Stress,
argued
by
medical
anthropologists
as
a
North
American
~tl~nopsychologic~l
construct
invented
in
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
281
order
to
accommodate
the
collective
trauma
of
the
Vietnam
war
(Young,
1995).
This
diagnostic
term
is
therefore
a
good
example
of
an
aetiologically
(and
culturally)
based
disorder
(trauma)
within
a
diagnostic
system
that
claims
to
be
atheoretical
and
culture
free
(DSM-IV).
The
concept
of
stress
asssumes
the
existence
of
a
stressor
and
the
stressed:
disembo-
died
categories
that
are
built
into
a
higher
order
set
of
theories
which
connect
with
supports
and
vulnerabilities.
Stress
then
is
an
invisible
impersonal
’thing’
that
is
transmitted
from
the
stressor
to
the
stressed
and
which
can
only
be
empirically
documented
by
its
effect
on
the
recipient.
As
a
generic
equivalent
of
ba.ctcrial
or
viral
infection
of
the disease
model,
its
credibility
relates
to
non-stigmatising
qualities
such
as
an
impersonal
nature,
location
outside
the
body
and
a
semantic
distancing
from
other
emotion-related
vocabulary.
CONCLUSIONS
Focusing
on
the
British
cultural
vocabulary
of
guilt,
fatigue,
energy,
stress
and
depression;
this
paper
argues
that
such
vocabularies
have
their
own
unique
histories
and
meanings;
deeply
embedded,
in
this
instance,
within
&dquo;white
British
and
western
European&dquo;
institutions
(including
their
health
care
enterprises).
If the
cultural
validity
of
depression
can
be taken
as
local
experiences
(of
the
population)
that
are
clarified
and
validated
on
their
own
terms,
then
depression
can
be
construed
as
a
culturally
valid
concept
for
western
settings.
If
this
is
the
case,
it
is
a
fallacy
to
assume
that
depression
is
some
real
objective
disease
entity
which
can
be
found
elsewhere
or
for
that
matter,
packaged
and
transported
to
a
contrasting
setting
for
ready
use.
The
debate
is
not
about
the
universality
of
suffering
or
its
version
of
a
local
pathology
across
cultures,
but
whether
it
is
the
same
as
&dquo;western
depression&dquo;.
As
was
observed
earlier,
depression
for
the
culture-free
psychiatrist
in
India
is
merely
a
consensus
taxonomy
amongst
health
professionals
who
share
a
common
(western
medical)
cpistemology,
and
this
is
not
the
same
as
being
culturally
’valid’
among
the
general
population.
Although
I
do
not
wish
to
suggest
that
depression
does
not
’exist’
elsewhere
outside
of
western
European
and
north
American
cultures,
the
question
needs
to
be
problematised:
is
the
indigenous
Indian
version
of
depression
the
same
as
western
depression?
The
answer
is
that
we
do
not
know,
as
current
knowledge
is
derived
mainly
through
a
western
epistemological
framework.
To
proceed
further
entails
the
following:
1)
A
study
of
lived
experiences
of
everyday
suffering
and
recourse
to
help,
through
local
narratives
and
language
that
would
identify
key
constructs
and
examine
the
cultural
logic
of
constructing
illness
experience
in
both
Western
and
non-western
settings.
The
semantic
illness
network
is
one
such
approach
that
revealed
local
distress
models
for
the
Punjabi
community
in
Britain
(Krause,
1989)
and
Shiite
muslims
from
Iran
(Good,
1994).
2)
Such
local
models
would
generate
popular
and
locally
meaningful
patterns
of
distress
to
validate
local
experience
on
its
own
terms.
These
could
then
be
operationalised
and
validated
against
western
phenomenology
and
psychopathology
for
congruence
or
goodness
of
fit
in
form,
content
and
quality.
It
is
likely
that
some
patterns
of
distress
may
not
fit
with
western
descriptions
of
psychopathology
and
disorders,
and
may
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
282
therefore
need
separate
and
distinct
class
category
representation.
Examples
of
these
are
the
Japanese
concept
of
taijin
kyofusho
in
the
official
Japanese
diagnostic
system
for
mental
disorders;
the
qi-gong
(excess
of
vital
energy)
psychotic
reaction
and
.shc~ajiazg
shuairuo
(neurasthenia)
as
represented
within
the
Chinese
Classification
of
Mental
Disorders,
2nd
edition
(DSM-IV,
1995).
Alternatively,
some
patterns
may
well
reveal
common
universals
which
would
enrich
the
debate
on
cultural
validity.
3)
Development
of
instruments,
both
quantitative
and
qualitativc, tha.t
would
measure
such
distress
patterns
and
contribute
towards
the
development
of
higher
order
categories
or
syndromes.
Only
then
can
such
categories
be
comparable
with
western
psychiatric
concepts
for
cross
cultural
equivalence
and
validity. For
example,
a
study
of
&dquo;life
e~ver~ts9
contributing
to
mental
health
problems
would
require
at
first
a
full
picture
of
what
a
life
event
means
to
the
population
under
study.
What
are
its
relative
perceived
threats
to
marriage,
kinship
ties
and
integrity
of
the
community
on
the
one
hand
versus
economic
risks
or
unemployment
on
the
other?
Cultural
validity
apart,
there
is
an
additional
reason
that
merits
such
an
enquiry:
Mental
health
professionals,
particularly
from
developing
nations
have
often
expressed
surprise
at
the
manner
in
which
scholarly
discourses
on
medical
anthropology
remain
confined
to
Western
academic
institutions
with
little
impact on
changes
in
everyday
clinical
practice
in
their
own
settings.
Ironically
one
reason
for
this
is
the
subordinate
status
of
both
medical
anthropologists
and
non-western
health
professionals
within
health
institutions
across
cultures. Anthropologically
informed
methods
of
enquiry
have
potential
to
help
establish
clearer
links
between
personal
suffering
and
local
politico-
economic
ideologies.
Such
methods
can
generate
alternative
canons
of
culturally
valid
psychiatric
theory
and
practice
and
contextualise
them
in
both
time
and
space.
Although
auditious
in
its
aims,
research
that
will
critique
western
psychiatric
theory and
practice,
and
reveal
its
ethnopsychiatric
premise,
also
broadens
the
debate
on
cultural
validity
of
psychiatric
disorders
in
general.
Moreover,
this
process
might
generate
local
interest
into
indigenous
taxonomies
and
provide a
meaningful
framework
within
which
both
professionals
and
patients
from
non-western
cultures
could
reclaim
their
local
cultural
and
political
histories.
ACKNOWLEDGEMENT
I
wish
to
thank
Britt
Krause
for
her
patience,
helpful
comments
and
editorial
advice;
Roland
Littlewood
for
his
teachings
and
continuing
encouragement
to
help
shape
the
ideas
in
this
paper;
and
Roy
Porter
for
directing
me
towards
a
wealth
of
literature
in
the
social
history
of
medicine.
In
gathering
evidence
to
support
my
thesis,
I have
extensively
borrowed
material
from
two
key
historical
texts:
Jackson
(1986)
and
Rabinbach
(1990),
and
I
gratefully
acknowledge
these
scholarly sources.
NOTES
1
The
term
’Depression’
unless
specified,
deliberately
subsumes
both
mood
(normal
and
pathological)
and
disorder.
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
283
2
A
comprehensive
review
of
the
literature
(Kleinman &
Good,
1985),
suggests
significant
differences
in
guilt,
self esteem
and
somatic
symptoms;
between
western
3
developed
and
non-western
developing
societies.
3
Various
hospital
psychiatric
clinics
of
rural
and
urban
Bombay
(1978-83)
and
Bangalore
(1983-88).
4
Many
psychotropic
medications
do
not
undergo
local
efficacy
studies
in
view
of
their
approved
status
in
Britain
and
North
America.
Most
recently,
the
drug
Clozapine,
was
introduced
without
the
mandatory
blood
count
monitoring
(Personal
commu-
5
nication:
Professor R
Raguram,
Bangalore).
5
The
author
would
like
to
clarify
that
this
consolidated
description
of
everyday
clinical
routine
does
not
imply
that
such
culture-free
care
and
practice
is
deliberate
nor
does
he
question
professional
competence.
On
the
contrary,
great
care
is
taken
to
provide
consultations
in
a
humanistic
and
competent
manner
that
match
with
practices
at
internationally
renowned
premier
centres.
But
the
issue
here
is
about
the
criteria
used.
6
The
Church
went
through
a
few
centuries
of
competition
between
Gregory
the
Great
and John
Cassian’s
list
of
major
temptations,
Whilst
Cassian
suggested
eight
sins,
Gregory
reduced
the
number
to
seven .
Acedia
was
initially
dropped
from
this
but
was
finally
rehabilitated
as
another
related
Sin
in
Gregory’s
list,
Tristitia,
was
thought
to
be
synonymous
with
Acedia
(Jackson
1986).
7
Paracelsus
(1493-1541).
His
given
name
was
Theophrastus
Bombastus
von
Hohen-
heim,
His
work
titled
The
Diseases That
Deprive
Man
of
His
Reason
challenged
earlier
Galenic
theories
on
Melancholia.
He
suggested
that
melancholic
complexions
drive
the
spiritus
vitae
up
towards
the
brain
leading
to
an
excess
and
thus
cause
melancholia.
Thus
melancholics
are
disturbed
by their
own
nature
(Jackson
1986).
8
Thomas
Elyot
(1490-1546),
physician
turned
clergyman,
wrote
a
popular
domestic
guide,
The
Castle
of
Health.
In
it,
he
devoted
an
entire
chapter
to
the
"affectes
of the
mynde"
and
another
to
"hevynesse
of minde"
.
In
this
he
used
the
terms
passions
and
affectations
as
synonyms
for
sorrow,
which
was
a
result
of
black
bile
affecting the
mind.
His
prescription
included
dietary
restrictions,
company
of
women,
avoidance
of
darkness
and
keeping
a
busy
mind.
9
Timothy
Bright
(1550-1615),
a
physician
turned
clergy,
postulated
that
black
bile
vapours
rose
from
the
spleen
to
obscure
the
clear
mind
and
cause
melancholia;
his
other
significant
contribution
relates
to
a
distinction
between
’melancholia’
and
’guilty
conscience’
(affliction
of
the
soul
through
conscience
of sinne).
This
bears
some
resemblance
to
the
current
dichotomy
of
neurotic
and
endogenous
depression.
Delumeau
(10)
provides
an
example
of
"a
German
(who)
stayed
at
home
during
Holy
week
to
perform
devotion,
because he
feared
the
excessive
quantity
of
melancholic
vapour
exhaled
by
other
worshippers".
10
The
term
melancholy
was
recorded
disproportionately
amongst
those
of
higher
social
rank
with
many
merely
adding
the
label
to
enhance
themselves
and
give
a
dignified
status
to
their
conduct.
Babb
(1951)
suggests
that
the
Elizabethan
Englishman
believed
that
exerting
one’s
brain
led
to
depletion
of
heat
and
moisture
from
the
body,
and
consequently
at
least
a
little
melancholy
was
expected
as
a
result.
Consider
the
French
parallel
with
the
terms
spasmophilie,
one
that
is
biomedically
legitimized
as
a
disease
and
or
la fatigue,
which
is
a culturally
sanctioned
folk
illness.
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
284
(Gaines,
1992).
Compare
also
with
the
popular
northern
Indian
Hindi
term
"Udaas
Kabir",
commonly
reserved
for
the
dishevelled
appearance
of
young
men,
after
being
jilted by
their
lovers
(but one
that
is
neither
pathologised
by
the
local
culture
nor
related
to
social
rank);
although the
commonly
accepted term
for
depression amongst
clinic
populations is
’Udasi’.
11
This
highlights
a
key
western
cultural
pre-occupation
with
the
attainment
of
pleasurable
states
and
unlimited
happiness.
Obeyesekere
points
out
how
this
may
well
differ
in
non-western,
particularly Buddhist
societies,
where
states
of
general
hopelessness
are
an
expression of
an
ideology
that
"life
is
suffering
and
sorrow,
and
that
the
cause
of
sorrow
is
attachment
or
desire
and
craving..."
(Obeyesekere,
1985).
REFERENCES
AMERICAN
PSYCHIATRIC
ASSOCIATION
(1995)
Diagnostic
and
Statistical
Manual
IV.
Washington
D.C.
BABB,
L.
(1951)
The
Elizabethan
Malady:
A
Study
of Melancholia
in
English
Literature from
1580
to
1642.
East
Lansing:
Michigan
University
Press.
BALFOUR,
J.
(1876)
Journal
of
Mental
Science
22.
In
Clarke,
B.
(1975)
Mental
Disorder
in
Earlier
Britain.
University
of
Wales
Press:
Cardiff.
BHISHAGRATNA,
K.
(trans.)
(1991)
The
Sushruta
Samhita.
3
Vols.,
Chowlchamba
Sanskrit
Studies
Volume
XXX.
Varanasi.
BRIGHT,
T.
(1586)
A
Treatise
of Melancholie.
London.
Thomas
Vautrollier.
BRILL,
A.
(ed. &
trans.)
(1938)
The
Basic
Writings of
Sigmund Freud.
The
Modern
Library,
Random
House.
CARRITT,
E.
(1948) A
Calendar
of British
Taste.
From
1600
to
1800.
Routledge &
Kegan
Paul:
London.
CLARKE,
B.
(1975)
Mental
Disorder
in
Earlier
Britain.
University
of
Wales
Press:
Cardiff.
COCKAYNE,
O.
(1865)
Leechdoris,
Wortcunning
and
Starcraft
of Early
England.
Vol.
II.
London:
Longman,
Green,
Longman,
Roberts &
Green.
DELUMEAU,
J.
(1990)
Sin
and
Fear:
The
Emergence
of
Western
Guilt
Culture
13th-18th
Centuries.
Translated
from
the
French
by
Nicholson,
E.
St.
Martin’s
Press:
New
York.
DESJERLAIS,
R.,
EISENBERG,
L.,
GOOD,
B.
ET
AL
(1995)
World Mental Health:
Problems
and Priorities
in
Low-Income
Countries.
Oxford
University
Press.
DOUGHTY,
O.
(1926)
The
English
Malady
of
the
Eighteenth
Century.
Rev.
English
Studies,
2,
257-269.
FONTANA
DICTIONARY
OF
MODERN
THOUGHT.
Second
Edition,
1988.
Fontana:
London.
GAINES,
A.
(ed.)
(1992)
Ethnopsychiatry.
The
Cultural
Construction
of
Professional
and
Folk
Psychiatries.
State
University
of
New
York
Press.
GOLDMAN,
R.
&
MONTAGNE,
M.
(1986)
Marketing
mind
mechanics’:
decoding
anti-depressant
drug
advertisements.
Social
Science
and
Medicine,
22, 1047-1058.
GOOD,
B.
(1994)
Medicine,
rationality
and
experience.
An
anthropological
perspective.
Cambridge
University
Press.
GOODWIN,
F.
&
POTTER,
W.
(1978)
The
biology
of
affective
illness,
In
Depression:
Biology,
Psycho-
dynamics
and
Treatment.
J
Cole
et
al.
(eds).
New
York:
Plenum
Press.
HEELAS,
P.
&
LOCK,
A.
(eds)
(1981)
Indigenous
Psychology:
The
Anthropology
of
The
Self
London:
Academic
Press.
HUNTER,
R.
&
IVIACALPINE,
I.
(1963)
Three
Hundred
Years
of Psychiatry.
1535-1860.
Oxford
University
Press.
JACKSON,
S.
(1986)
Melancholia
and
Depression:
From
Hippocratic
to
Modern
Times.
Yale
University
Press.
New
Haven.
JADHAV,
S.
(1986)
Help-Seeking
Behaviour,
Choice
of Healers
and Explanatory
Models.
MD Thesis.
National
Institute
of
Mental
Health
and
Neurosciences,
Bangalore,
India.
JADHAV,
S.
&
LITTLEWOOD,
R.
(1994)
Defeat
Depression
Campaign:
Some
Medical
Anthropological
Issues.
Psychiatric
Bulletin,
18,
572 -573.
JADHAV,
S.
(1995)
The
Ghostbusters
of
Psychiatry.
Editorial
commentary,
The
Lancet,
345
, 808-810.
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
285
JOHNSON,
M.
(1993)
Housing
Culture
Traditional
Architecture
in
an
English
Landscape.
University
College
London
Press.
JOHNSON,
S.
(1755)
A
Dictionary
of
the
English
Language,
2
vols.
Longman:
London.
KAPLAN,
H.
&
SADDOCK,
B.
(ed.)
(1995)
Comprehensive
Textbook
of Psychiatry.
6th
edition.
Williams
and
Wilkins.
KELLY,
G.
(1955)
The
Psychology
of
Personal
Constructs.
Norton:
New
York.
KLEINMAN,
A.
(1987)
Anthropology
and
psychiatry:
the
role
of
culture
in
cross-cultural
research
on
illness.
British
Journal
of
Psychiatry,
151,
447-454.
KLEINMAN,
A.
&
GOOD,
B.
(eds)
(1985)
Culture
and
Depression:
Studies
in
the
Anthropology
and
Cross-
Cultural
Psychiatry
of Affect
and
Disorder.
Berkeley:
California
University
Press.
KLEINMAN,
D.
&
COHEN,
L.
(1991):
The
decontextualization
of
mental
illness:
The
portrayal
of
work
in
psychiatric
drug
advertisements.
Social
Science
and
Medicine,
32,
867-874.
KRAUSE, I.B.
(1989)
Sinking
heart:
a
Punjabi
communication
of
distress.
Social
Science
and
Medicine,
29,
563-575.
LAKOFF,
G.
&
JOHNSON,
M.
(1980)
Metaphors
We
Live
By.
University
of
Chicago
Press:
Chicago.
LEFF,
J.
(1973)
Culture
and
the
differentiation
of
emotional
states.
British
Journal of Psychiatry,
123, 299-306.
LEGGE,
M.
(1963)
Anglo-Norman
Literature.
Oxford
University
Press.
LEGOUIS,
E.
&
CAZAMIAN,
L.
(1964)
A
History
of English
Literature:
1650-1963.
Revised
edition.
J.M.
Dent
and
Sons
Ltd:
London.
LITTLEWOOD,
R.
(1990)
From
categories
to
contexts:
a
decade
of
the
"new
cross-cultural
psychiatry".
British
Journal
of
Psychiatry,
156,
308-327.
LITTLEWOOD,
R.
(1994)
Verticality
as
an
idiom
of
mood
and
disorder.
British
Medical
Anthropology
Review
(n.s.)
2(1),
44-48.
LUTZ,
C.
&
ABU-LUGHOD,
L.
(eds)
(1990)
Language
and
the
Politics
of Emotion.
Studies
in
Emotion
and
Social
Interaction.
Cambridge
University
Press.
LYNCH,
O.
(ed.)
(1990)
Divine
Passions.
The
Social
Construction
of Emotion
in
India.
University
of
California
Press.
MACDONALD,
M.
(1981)
Mystical Bedlam.
Madness,
Anxiety
and
Healing
in
Seventeenth
Century
England.
Cambridge
University
Press.
MACFARLANE,
A.
(1978)
The
Origins
of English
Individualism.
Blackwell:
Oxford.
MANT,
A.
&
DANOCH,
D.
(1975)
Media
images
and
medical
images.
Social
Science
and
Medicine,
9,
613-
618.
MARSELLA.
A.
&
WHITE,
S.
(eds)
(1982)
Cultural
Conceptions
of Mental
Health
and
Therapy.
Dordrechl:
Reidel.
MARX,
K.
(1887)
Capital,
3
vols.
Lawrence &
Wishart
Edition
(1954).
MURPHY,
H.B.M.
(1982)
Comparative
Psychiatry.
The
International
and Intercultural Distribution
of Mental
Illness.
Springer-Verlag:
Berlin.
NEILL,
J.
(1989)
A
social
history
of psychotropic
drug
advertisements.
Social
Science
and
Medicine,
28, 333-
338.
NICHOLSON,
S.
(1995)
The
expression
of
emotional
distress
in
old
English
prose
and
verse.
Culture,
Medicine
and
Psychiatry,
19, 327-338.
NICHTER,
M.
(1981)
Idioms
of
distress:
Alternatives
in
the
expression
of
psychosocial
distress.
Culture,
Medicine
and
Psychiatry,
5,
379-408.
OXFORD
ENGLISH
DICTIONARY
(1994)
CD-ROM
2.
Oxford
University
Press.
PORTER,
R.
(1990)
Mind-Forg’d Manacles: A
History
of Madness
in
England from
the
Restoration
to
the
Regency.
Penguin
Press.
PORTER,
R.
(ed.)
(1991)
The
Faber
Book
of Madness.
Faber
and
Faber:
London.
RABINBACH,
A.
(1990)
The
Human
Motor:
Energy, Fatigue
and
the
Origins
of Modernity.
Basic
Books.
New
York.
RIPPERE,
V.
(1981)
Depression,
commonsense
and
psychological
evolution.
British
Journal
of
Medical
Psychology,
54,
379-387.
SARTORIUS,
N.
ET
AL.
(1983)
Depressive
Disorders
in
Different
Cultures:
Report
on
the
WHO
Collaborative
Study
on
Standardised
Assessment
of Depressive
Disorders.
Geneva.
World
Health
Organisation.
SHWEDER,
R.
(1991)
Thinking
Through
Cultures:
Expeditions
in
Cultural
Psychology.
Harvard
University
Press:
Boston.
SIEGFRIED,
W.
(ed.
and
trans.)
(1989)
Fasciculus
Morum:
a
Fourteenth-Century Preacher’s
Handbook.
The
Pennsylvania
State
University
Press.
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
286
SIFNOES,
P.
(1972)
Short
Term-Psychotherapy
and Emotional
Crisis.
Harvard
University
Press:
Cambridge.
MA.
WINOKUR,
G.
(1973)
The
types
of
affective
disorders.
Journal
of Nervous
and
Mental
Disease,
156,
82-96.
YOUNG,
A.
(1995)
The Harmony
of Illusions:
Inventing Post-Traumatic
Stress
Disorder.
Princeton
University
Press.
New
Jersey.
Sushrut
Jadhav,
Clinical
Lecturer
in
Psychiatry,
University
College
London,
Gower
Street,
London
WCIE
6BT,
UK.
© 1996 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
by sushrut jadhav on September 23, 2007 http://isp.sagepub.comDownloaded from
