Involutional Melancholia

“Not only was involutional melancholia more common in women because the went through menopause, but menopause appeared itself to be a cause of illness [Hirshbein, IV, 722]. . . . Om 1922. Edward Strecker and Baldwin Keyes, both of the Pennsylvania Hospital Department for Mental and Nervous diseases, argued that the difference between menopause and involutional psychosis was only in degree rather than in kind. . . . Since menopause appeared to precipitate mental problems, psychiatrists concluded that treatment with hormones would reverse the disease process. In 1932, for example, Karl Bowman and Lauretta Bender tested the hypothesis that involutional melancholia would improve with ovarian hormone . . .” (724). . . . In 1937, two different groups, one at the Boston State Hospital and one at a hospital in St. Louis, experimented with an injectable estrogen preparation marketed under the trade name Theelin” (725) . . . In 1940s and 50s, shock therapies replaced hormone therapy as treatment of choice for involutional melancholia (731- 35): “Here again, the diagnosis of involutional melancholia made sense to describe a coherent patient population, one that responded to the specific treatment of electroshock” (734-5). . . . American psychiatrists by this time period [midcentury] generally assumed that old age could (and usually did) result in a serious mental illness that might be explained through psychoanalytic investigation and/or treated with shock therapy” (735). FADING OF THE DIAGNOSIS: In 50s and 60s, “psychiatrists used a broad concept of depression as a way of describing a condition for which medication therapies were effective. All patients who looked depressed and who responded to medications were lumped together, including patients who had previously carried a diagnosis of involutional melancholia (737) . . . Advocates for depression research emphasized that depressive symptoms had become less common in older patients and were becoming more of a concern for younger patients” (737) . . . “With the older classification systems – within which involutional melancholia had played a significant role – psychiatrists grouped patients by their different prognoses and compared results among institutions. But with the 1960s’ focus on medication effects, the older divisions made less sense. Instead, researchers and practitioners focused on symptoms. Since involutional melancholia was defined primarily by the stage of life of the patient, it did not match other categories. . . . patients who improved after medication were studies to determine which symptoms were most significant to describe depression. In the grouping of patients in medication trials, patients’ ages and menstrual statuses became less important than their responses to treatment” (738).