Introduction

Depression is considered a type of mood disorder by the National Institutes of Mental Health in the United States, as well as, the Canadian Public Health Agency. About 9.5% of the population in the United States, 18 and over was diagnosed with a mood disorder in 2006 (NIMH, No. 06-4584). About 6.77% of Americans were diagnosed with major depressive disorder (NIMH, No. 06-4584). About 4.5% of the national population, according to the Canadian Community Health Survey suffered major depression in the 12 months prior to the survey (2002). The World Health Organization has estimated that depression is increasing and will be the second leading cause of disability worldwide within 20 years (Community Health Survey 2003). Clearly depression has been constructed as a significant health issue today.

Along with the increasing incidence of depression there have been dramatic changes in treatments over time. For example, in the USA, between 1990 and 1998 there was a 147.5% increase in the prescription rates of anti-depressants and correspondingly, a 10.9% decrease, in the use of psychotherapy (Skaer et al. 2000). One anti-depressant alone, Prozac CR, the first of the SSRIs was associated with a 50% increase in anti-depressant use (Blum and Stracuzzi 2004). Over time depression has been less likely to be treated in hospital. From 1987 to 1999 the rates of hospitalization decreased 33 1/3% for both men and women while the time in hospital per episode decreased by 20% (A Report of Mental Illness in Canada 2002).

Many different explanations have been offered for the increase in rates of depression. Among them are the (1) “commonsense” idea that the stresses and strains of modern life are greater than in the past; (2) growth in inequity both within and between nations around the world (Chen et al. 2005; Inaba et al. 2005; Patel and Kleinman 2003); (3) presence of, and accessibility to, more inexpensive and effective medications and the corresponding growth in the medicalization of ‘moods’ (Metzl and Angel 2004; Kramer 2005) and (4) growth in power of the pharmaceutical industry along with the rapid increase in and success of direct-to-consumer advertising and through these processes an expansion of the types of behaviors, attitudes and feelings that are incorporated in the category of depression (Moynihan et al. 2002; Moynihan and Cassels 2005). Certainly changes in the social construction and/or broadening of the medical definitional criteria would be an important part of changes in incidence over time.

One of the possible windows into our understanding of the increased diagnosis of, as well as [changing], meanings of depression is its portrayal in mass media. Media are basic to life in modern mass societies. Lives are lived, arguments held, views constructed and deconstructed, policies legitimized, and concerns and solutions identified through media stories. Media both create and reflect social realities. Indeed, Altheide (2002) has noted that our life experiences are mediated. There are two major traditions in the study of media portrayal of mental illness. The first is the social constructionist analysis of its meanings as presented in mass media. The second is the positivist study of the degree of correspondence between scientific findings or policy directions and media representation. This paper falls into the first tradition but focuses on a specific mental illness depression.

The following literature review briefly describes the highlights of each body of research consecutively. A large body of research has examined the social construction of, and the meanings associated with mental illness in popular mass media. Much of this research has documented the presence of stigma regarding mental illness and the media association of mental illness with violence or criminality (see, for instance; Signorelli 1989; Beveridge 1996; Philo et al. 1996; Allen and Nairn 1997; Deifenbach 1997; Hazelton 1997; Ward 1997; Rose 1998; Nairn 1999; Olstead 2002; Sieff 2003). As recently as 2002, for example, Olstead found that “portrayals of mental illness are not only highly inaccurate, but also harmful to mentally ill people” (p. 622) for whom the mental illness becomes a ‘master status’ through which everything else about the person’s life is filtered.

A number of other researchers have evaluated the extent to which media stories reflect ‘scientifically accurate’ information about people with mental illnesses and the diagnostic indicators of the illnesses themselves (Rowe et al. 2003). For example, Francis et al. (2005) investigated 13,389 samples of media communications from radio, television, and newspapers. They assessed the quality of the information by asking and answering questions such as ‘Is the headline inaccurate or inconsistent with the focus of the article?’ These authors found that the media portrayal was of a fairly high quality and exhibited a reasonable concordance with the government policy. They also noted that a very small minority (5.6%) of the articles associated crime with mental illness (Francis et al. 2005). In another study, Nairn et al. (2001) compared newspaper articles with their information sources and found substantial agreement between the scientific information and information portrayed in this mass medium.

The previously reviewed work deals with the portrayal of mental illness, in general, in the media. There is much less written about the specific case of depression (Rowe et al. 2003). Yet depression is the most commonly diagnosed mental illness and its rates have grown substantially in the past 15 years or so (Metzl and Angel 2004). Rowe et al. (2003) addressed this paucity of studies of the portrayal of depression in the media in 2000. They found that the emphasis in the portrayal of depression was, in contrast to that of mental illness in general, on the suffering individual rather than on the impact of the behavior on others. This contrasts sharply with many studies of the portrayal of mental illness which focus on the impact of the, often criminal and violent behaviors of the mentally ill, on others.

The other significant tradition in the investigation of depression in the media relates to the representation of issues of gender. For instance, Gattuso et al. (2005) compared the portrayal of depression in two women’s magazines and found that the magazine version of depression contrasted clearly with the expressed views of policy initiatives which emphasized medical interventions. Instead, women’s magazines focused on women’s own abilities, as individuals, to manage difficult life events and to develop and maintain supportive relationships. The magazine stories thus, they argued, underscored prevalent notions of feminine identity in suggesting alternate ‘feminine’ means of coping with depression.

Blum and Stracuzzi (2004), building on the evidence that women are two to three times as likely to be diagnosed with depression as men, examined the extent to which media portrayed depression as gendered. In order to address this question Blum and Stracuzzi (2004) undertook a detailed content analysis of 83 articles on Prozac and other Selective Serotonin Reuptake Inhibitors (SSRIs), in popular periodicals. They found that while talk about the anti-depressants was “overwhelmingly” manifestly gender neutral, there were numerous gendered latent messages. In particular white professional and managerial women were targeted in these latent messages and described as both chemically unbalanced, and as needing to enhance their productivity and flexibility to be fit for the new economy. Metzl and Angel (2004) searched 261 articles in newspapers and magazines to study the portrayal of gender in stories about Prozac, anti-depressants and SSRIs. Their purpose was to investigate whether or not there was an expansion of popular categories of causes and types of depression for women in the mass print media with the introduction of the SSRI medications. They found support for their hypothesis that there would be an increase in the variety of symptoms of depression portrayed over time. They noted that the new drugs increasingly became targeted at women who were described as needing the pharmaceuticals because they were ‘overwhelmed by sadness’, ‘feeling down’, or troubled by their social roles and normative life events such as menstruation, birth and menopause. They concluded that stories about SSRIs served to widen the boundaries of behaviors that were presented to women readers as necessitating treatment with antidepressants (Metzl and Angel 2004). In contrast they found that men’s ‘depressive behaviors were described in ways that had not expanded over time and continued to be more narrowly associated with the extant psychiatric (DSM) categories’.

The purpose of this research is to describe the portrayal of depression in popular mass media–magazines from 1980 to 2005 and indexed in the Reader’s Guide to Periodical Literature. In particular, the research will investigate the possibility of a changing media picture of depression from the 1980s to the 1990s and beyond to 2005. This period of time extends that of earlier research and corresponds to the decade before and after the introduction of Prozac and other highly popular SSRI anti-depressants. The focus will be on changes in the framing of depression. In particular we asked of the media stories questions such as who gets it (depression)? What is it? Where is it located? What causes it? What or who is to blame or responsible? What is to be done about it? What metaphors are associated with depression? Are celebrities invoked in depression stories?

Methods

This study was based on all 98 available full text articles found indexed under the topic heading of depression in the Reader’s Guide to Periodicals and published in English language magazines available in Canada and published in Canada or the United States from 1980 to 2005.

In accepting the organization and classification from the index of the Reader’s Guide to Periodicals we must accept their definitional decisions and acknowledge that they may have been influenced by changing definitions of the notion of depression in an unknown and immeasurable manner over large sample of magazine articles on a particular topic over a length of time in the specified geographic area. Nevertheless, this is the best avenue for gathering a sample of articles, across magazines, on a given topic area.

These years (1980–2005) were selected in order to provide enough data over a long enough period of time to avoid the bias of the selection of one year only when a particular event, such as the announcement of new ‘natural’ treatment products such as St. John’s Wort, a new pharmaceutical such as Prozac, or a new policy, such as payment for medications, might occur.

They were also chosen to encompass the years before and after the introduction of the most popular anti-depressant in history, Prozac (Kramer 1993). There were 16 (locatable) articles found in the 1980s, 38 (locatable) articles found in the 1990s and 44 (locatable) articles found in 2000 and beyond. The numbers of articles on depression increased over time, however, there were, nevertheless relatively few as compared to other ‘diseases such as, cancer. For example, in just 1 year, 2005 there were 58 full text articles on breast and 19 on prostate cancers in the Reader’s Guide to Periodical Literature’. It is possible that this early infrequency of articles is a reflection of the relative shame and stigma associated with mental illnesses, particularly in the past, while the dramatic increase in numbers over time may reflect the diminution of stigma. It could also be a reflection of the development and successful marketing of more effective drugs from some mental health problems, among other things.

Magazine stories were selected as data because magazines are broadly circulated and often read and reread. Many public including medical offices have tables with magazines available for customers as they wait for service. Magazines may be passed from person to person for the sharing of stories. Depression was selected as a topic because of the dramatic increase in incidence, the development of new and highly popular treatment protocols, as well as, the continuing popular debates about whether the new treatments might be used to make people ‘better than well’ (Elliott 2000) or as ‘cosmetic psychopharmacology’ (Kramer 2000).

All magazines, including general interest, news, science, women’s, men’s and African—American, were chosen because they are more likely to reflect/effect the breadth of opinion including conventional viewpoints, although this research is not designed to make claims about audience responses or interpretations. The 29 different magazines quoted in this paper include: Black Enterprise, Commonweal, Dance Magazine, Ebony, Essence, Forbes, Fortune Magazine, Harper’s Bazaar, Jet, Ladies’ Home Journal, McCall’s, Mother Earth News, Mother Jones, Natural History, New York Times, Newsweek, Psychology Today, Readers’ Digest, Redbook, Saturday Night, Science News, Sports Illustrated Magazine, Teen Magazine, The Nation, The New Republic, Time, U.S. News and World Report, USA Today, and Vogue. Clearly these magazines are directed towards different audiences. Since it is not audience reaction, however, that is of interest in this paper, but content, and in full acknowledgment of the likely ensuing limitations, the magazines were investigated together as a broad overview of available content regarding depression.

Data Analysis

Initially all articles were read to categorize them for manifest content. The first step was to ensure that they focused on psychological and not economic depression. Next they were read to code for a description of the person (if an individual or group was discussed) in respect to social characteristics such as social class and gender. We examined whether the point of view or voice was a person with depression, a doctor, a researcher or another. We noted which experts were cited, and focused on one or another treatment or several treatments. Subsequently, all articles were read inductively and qualitatively summarized as to topics of discussion and attitudes toward depression, its causes and treatments (Berg 1989; Neuman 2000). In the end only the data found in Tables 1, 2 and 3 was repeatedly and consistently manifestly evident in the magazine articles and thus able to be coded. Thus, for example, we were unable to discern, in most articles, whether the writer was a person with depression or not and could not code for gender or social class sufficiently constantly, repeatedly and systematically to include either as a topic for discussion.

Table 1 The dominant voice
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Table 2 The preferred treatment
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In the latent analysis the emergent themes were the responses to the questions asked above in the paragraph on study purpose (e.g. what is it?). These questions were ‘theory smart’ questions because they arise from other work on the portrayal of different diseases in the mass media (see for instance Clarke 2006, Clarke and Binns 2006, Clarke and Everest 2006). Morse (2002) suggests developing ‘theory smart’ initial codes so that qualitative work can build incrementally on previous work and lead to the growth of theoretical explanations. Some additions were made as a result of the findings in the data such as the category which linked depression to other illnesses. Illustrative quotations were highlighted. Particular attention was paid to metaphors related to depression such as “black dog” or “common cold” (as in the common cold of mental illnesses), exemplars or specific, timely examples such as Winston Churchill and his depression and catchphrases (common/popular descriptive terms such as “disorder” or “disease”) (Gamson and Modigiliani 1989).

Results

Manifest Analysis

Tables have been used to summarize the major findings from the manifest analysis. Table 1 demonstrates the relative importance of medical, as compared to other focuses, in constructing depression in these stories. Medical perspectives were in a minority in the 1980s and constituted 37.5% of all of the articles but the majority in the 1990s (58%) and 2000s (72%). Table 2 reinforces the findings from the first table as it shows how medicine (usually anti-depressant medications) was the preferred treatment approximately half of the time in the 1980s and subsequently in the later periods was the preferred treatment in the vast majority of cases (92% in the 1990s and 87.5% in the 2000s). Table 3 shows that when drugs were depicted in stories of depression they were increasingly likely to be portrayed as positive (from 37.5 to 50–72%). It is notable that drugs are portrayed in an increasingly positive light over time.

Table 3 The valence of the description of drugs
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Latent Analysis

What is it?

The 1980s: Depression as Many Things In the 1980s depression was described in a multitude of ways, some seemingly casual descriptions of lifestyles and behaviors clearly within the range of the normal; others were more narrowly medical. Often there were contradictory and multifaceted understandings of depression presented within the same article. There was no clear or unanimous definition of depression that was repeated from story to story. Instead the early years described depression in ad hoc ways depending on the idiosyncratic views of the particular reporter and information source. For instance, Vogue (Phillips and Albertini, August 1980: p. 255) described depression as “pessimism, anxiety, dissatisfaction, lethargy, crying, irritability and (emphases ours) decreased sexual drive”.

Some of these symptoms are common to just about everyone at one time or another. Dance Magazine (Horosko, February 1985: p. 79) asked a series of questions related to symptoms and presented depression as composed of a collection of disparate indicators or warning signs. “Do you feel that your unemployment or failure at auditions is because of politics? Bad luck? Your body image?” (Horosko, February 1985: Dance Magazine, p. 78). Emphasizing a different symptom is the following “…depressed people have trouble staying asleep and tend to wake up early” (Unknown Author, May 1980: Time, p. 65). The New Republic suggests that depression is “to be in a state of emotional paralysis, to dare nothing, to try nothing, to freeze” (Scarf, July 1980: p. 25).

Women, in several articles, were portrayed as depressives because of the way they were said to prefer to relate to others. For example, “women are vulnerable to depression because emotional attachments are much more important to them than to men. When these bonds break—through death, divorce, or children leaving home—they often suffer depression. Some say they would rather kill themselves than live alone” (Wilson and Gelman, September 1980: Newsweek, p. 81).

The 1990s and Beyond: Depression Becomes Defined as Biomedical By contrast the definition of depression in the 1990s and beyond almost entirely relied on different aspects of biology, biochemistry, genetics and other biomedical explanations from the human biological sciences. Despite the fact that there are competing theories and very little evidence within biology about the actual causes of depression (Kramer 2005) the focus appears to be entirely on the malfunctioning of the biological body. Depression comes to be associated with science, technology and medicine. Notice the link being made in the following quotation to several different types of techniques for measuring depression. “The growing body of work that establishes depression as a disease that is biologically based, at least in its most disabling forms. Both severe depression and manic depression involve dramatic physiological changes and the evidence points to a hereditary vulnerability that is then triggered by environmental stress. Using high-tech scanners, chemical probes and genetic mapping techniques—the newest tools of a rapidly developing science—researchers are starting to fill in the unknowns of an immensely complicated equation…” (Goode, Linnon and Burke, March 1990: US News and World Report, p. 50). The following quote demonstrates the way that stories frequently asserted a specific definition of depression even though this might be contradicted in another story. Brain chemistry is implicated in the following description. “Manic depression, also known as bipolar disorder, has a well-deserved reputation as a biologically based condition. Wayward brain chemicals and genes gone bad seem to bully people back and forth between weeks of moderate-to-intense euphoria and comparable spells of soul deadening depression”. (Bower, April 2000: Science News, p. 232). Other bio-causes are explained in the following quotation “Both depression and mania are also accompanied by changes in brain chemistry, though these changes are not fully understood. … Depression, for example, was thought to stem from an insufficiency of norepinephrine, one of many substances mediating the transmission of nerve impulses in the brain. Now, few experts talk about “too much” or “too little” of a single chemical. Instead, they believe mood disorders are the result of a complex interplay among a variety of chemicals, including neurotransmitters and hormones” (Goode, Linnon and Burke, March 1990: US News and World Report, p. 55).

By the 1990s and 2000s there were very few traces of the informal, sometimes contradictory, common sense definitions of depression (which characterized the 1980s) as a ragbag of types unhappiness. Following is one of very few examples “[Depression is] anything from a murky blandness to a crashing despair—and a destabilization of sleep, appetite and hope” (Slater, October 2000: Harper’s Bazaar, p. 220).

What Causes it?

The 1980s: Many Different Things There were a number of putative causes for depression in the 1980s. Depression was linked to normal events and social life. Notice the distinct accounts of different types of depression in the following quotation. “Reactive depression occurs in response to real happenings in one’s life. The death of a loved one, a family breakup, the loss of a job, the move to a new home—all these can cause a person to feel grief or fear or sadness, which is perfectly understandable under the circumstances. Endogenous depression is due to an actual physical disorder or chemical imbalance within a person’s body….The third kind is neurotic depression, caused by deeply rooted inner conflicts, which in a sense weaken a person’s capacity to deal with the normal problems of everyday life” (Salk, November 1980: McCall’s, p. 72). Although there was a great deal of talk about life events leading to depression there were small signs of the beginning ‘biologization’ of depression. The following quote suggests that a chemical or hormonal imbalance was sometimes said to be causative: “Such fluctuating mood swings definitely can be caused by a chemical or hormonal imbalance, and doctors have been obtaining dramatic results through the use of drugs that correct this imbalance and restore one’s sense of well-being. Unquestionably, factors in a person’s past, or problems in the present, also play a part” (Salk, November 1980: McCall’s, p. 72). The birth control pill was also mentioned as a possible factor in depression. “Oral contraceptives can have an important side effect you may not be aware of: depression; and in fact, this is one of the most common reasons women stop the Pill, perhaps unnecessarily” (Phillips and Albertini, August 1980: Vogue, p. 255).

Self-help and being helpful to depressed friends and loved ones was emphasized in the 1980s as described in the following quotations. Here, a woman is asked to watch her husbands’ moods with the implication that she can help change them. “Examine what’s happening in his life to see if you can uncover the reasons for his upset. He may be feeling rejected or unloved, or he may be feeling a sense of loss” (Salk, November 1980: McCall’s, p. 72). Normal life transitions and stages were highlighted as causative in some articles. For instance, “Scarf concluded that a woman’s depression is related to specific phases of her life. At key points, all women must make and break a series of emotional bonds. If they fail to do so, if they become emotionally stranded, their “unfinished business” almost inevitably leads to depression” (Wilson and Gelman, September 1980: Newsweek, p. 82). That depression is caused by incorrect thinking patterns is also noted in the earlier time period. For example, “Dr. David D. Burns argues that most depression arises from erroneous thinking” (Ziegler, December 1980: Reader’s Digest, p. 124).

The 1990s and Beyond: Caused by a Malfunctioning Body The vast majority of explanations were scientific, technical or physical explanations. While there is no unanimity about cause, the focus for examination has narrowed and become (almost) exclusively the result of a problem in one or another system of the biological body. For instance; “Ever so slowly researchers are beginning to identify some of the molecular and cellular triggers of depression, including stress hormones run amok and bad genes. Progress on these fronts may lead to a new generation of far more efficient treatments, as well as new diagnostic tests to pinpoint patients at risk. The more daring new theory suggests that depression is caused not only by chemical imbalances but also by the inability of the brain to grow new brain cells” (Langreth, February 2004: Forbes, p. 139). A different part of biology –ageing- is implicated in the following quote: “The aging brain is also a factor—researchers believe seniors are more prone to “vascular depression”, a condition in which interrupted blood flow causes subtle damage to nerve pathways involved in mood and motivation” (Miller, January 2004: Newsweek, p. 66).

In a minority of cases, life experiences were blamed for depression. Two very different examples follow: (1) “What explains the surge of depression among college students?…Certainly, when there’s a trauma like 9/11, it stirs up whatever losses and fears we’ve had in our own lives. Also, families are incurring higher debt, which adds to the pressure. And what’s happening in high school and society creates stress: Kids are being raised in a culture of high expectations and have very structured activities and less family time” (McGrath, November 2004: US News and World Report, p. 63). (2) “Depression occurs so often during the holidays because people’s expectations aren’t met” says Joyce Hamilton Berry, Ph.D., a clinical psychologist in Washington, D.C.” (Unknown Author, December 1994: Ebony, p. 46).

Who Gets it?

The 1980s: Individual and Specific Groups of People are at Risk In the 1980s depression seems oddly infrequent and is described as occurring to particular types of people. For instance, the elderly and women were described as likely to be depressed. Old people were described as vulnerable for reasons of the generalized process of aging. “Unfortunately, your grandmother’s depression is very common in older people” (Salk, November 1980: McCall’s, p. 72). Women’s reproductive processes were sometimes implicated; “Following childbirth, there is an abrupt change in the balance of hormones in a woman’s body, which can make her vulnerable to postpartum depression” (Salk, November 1980: McCall’s, p. 72). The depression of dancers was described as “frequent” (Horosko, February 1985: Dance Magazine, p. 78).

The 1990s and Beyond In contrast to the 1980s where the answer to the question of who gets it was that it was specific types of people, the later descriptions of those likely to be diagnosed are more ‘objective’ and comprehensive. Anyone and everyone became a possible sufferer of depression in the 1990s and beyond. Following are several examples of population based statistics used to estimate the incidence and prevalence of depression in the 1990s and later. “According to the latest figures, an astounding one in eight Americans is now taking antidepressants. Captains of the mental health industry believe that depression is still under- diagnosed and that with just a little more public education, every fifth adult American will soon be groping for peace of mind in a prescription” (Marino, May 2004: Commonweal, p. 9). The next examples highlight the focus on generalized incidence that varies by large social-structural conditions such as age, gender and race. “Each year, approximately 1 in 20 teenagers experiences the anguish of major depression” (Bower, August 2004: Science New, p. 116). “Researchers have consistently reported that women in the United States suffer from major depression at roughly twice the rate men do. Extensive international data now indicate that in many other countries, depression similarly afflicts more women than men, although absolute rates of depression vary greatly from one country to another” (Bower, June 1995: Science News, p. 346). “Blacks, in particular, may feel blue or even severely depressed more often than others” (Unknown Author, August 1995: Ebony, p. 102).

What Should and Can be Done About it?

The 1980s: Varieties of Self-Help and Psychotherapy In the 1980s magazines offered a plethora of options regarding what could and should be done about depression. When depression was understood to be caused by flawed thinking patterns, the patient was to enter cognitive therapy (Ziegler, December 1980: Reader’s Digest). When depression was understood to be the result of the feminine tendency to define oneself by personal relationships, the solutions was as follows: “At a time when one marriage in three ends in divorce, when women outlive their husbands by nearly a decade and when geographic mobility ruptures family ties, [women] must learn to live alone and like it” (Wilson and Gelman, September 1980: Newsweek, p. 82). When depression was the result of having delivered a baby (Unknown Author, March 1980: p. 58) “proper support from husband and hospital” is described as helping to fend off depression. Even doctors were quoted as offering non-medical advice. Dr. Salk, in McCall’s (Salk, November 1980: p. 72) provided a variety of solutions which are relevant to peculiar situations such as examining life events, talking things out, visiting friends and going for walks. Scarf, (August 1980: Vogue, p. 255) recommended a realignment of relationships to a more productive and constructive state. Vogue (Phillips and Albertini, August 1980: p. 255) also provides some brief commentary on vitamin B6 and its potential to ameliorate symptoms. In addition, women’s responsibility to protect themselves through exercise is emphasized (Unknown Author, August 1980: Vogue).

The 1990s and Beyond: Medical Treatments In the 1990s and beyond, the solution to depression is almost unilaterally drugs, therapy or some combination of the two. Though other options, such as prevention or exercise, are sometimes included as adjuncts, drugs and therapy prevail. There is a focus on expertise and the need to consult with experts—neither therapy nor drugs can be bought by the lay patient without the intervention of a medical expert. Do-it-yourself solutions are scarce: medicalized solutions common. “In cases of moderate to severe depression, medication combined with exercise and psychotherapy may be the most prudent choice” (Slater, October 2000: Harper’s Bazaar, p. 221).

When depression is considered to be the result of biology it may be intractable. The following quote suggests that it sometimes ‘goes away’. “Does depression ever go away? Research suggests it does—or can—and it won’t necessarily recur when someone stops taking antidepressants. People who combine medication with psychotherapy may have the best shot at long-term recovery” (Graves, May 2000: Harper’s Bazaar, p. 100). Shock treatment continued to be described as an option in a minority of articles. For instance, “More than 100,000 patients receive ECT each year, and according to this month’s American Journal of Psychiatry, the latest refinements of ECT are producing consistent and dramatic results…ECT will remain a treatment only to be used after psychotherapy and drugs have failed to alleviate a life-threatening depression” (Fischer, January 2000: US News and World Report, p. 46).

Connection to Other Illnesses

The 1980s The construction of depression as both cause and effect of other illnesses was largely absent from the 1980s dataset. Following is one of the two instances: “Investigators reported that lymphocytes, the cells most involved in immunity, proliferate far less in severely depressed, hospitalized patients than they normally would when stimulated to reproduce” (Bower, V. 127: Science News, p. 100).

The 1990s and Beyond In the 1990s and beyond repeated connections were made between depression and physical ailments. The relationship between the two forms of illness was bi-directional. In some instances, it was suggested that depression caused or at least contributed to a secondary physical illness. Less frequently, it was claimed that physical illness might lead to depression. In the first example physical pain is said to cause depression and in the next depression is said to cause physical illness: (1) “However, chronic pain is more than just a physical burden, researchers are finding. It is also a top risk factor for depression, a complicated pattern that has a cyclical “chicken or egg” quality” (Smith, July 2004: Psychology Today, p. 20). In the second, depression has negative implications for physical health; (2) “Patients who are depressed at the time of bypass surgery are more than twice as likely to die in the next 5 years” (Underwood, September 2004: Newsweek, p. 54).

Common Metaphors

The 1980s and the 1990s and Beyond One metaphor that existed in the 1980s was that of depression through the dominant medical metaphor, as an illness or disorder. There was only one other instance of a depression related metaphor in the 1980s: “It is the common cold of psychological disorders. Each year, millions of dollars are spent on medicines to alleviate the withering melancholy, blighted hopes and dismal inner weather that are the symptoms of depression” (Ziegler, December 1980: Reader’s Digest, p. 124). Aside from the leading medical metaphors there were a number of others used to describe depression in the 1990s. For example, Lord Byron experienced what he called “savage moods” (Bower, June 1995: Science News, p. 378). Depression continued to be likened to “the common cold of mental health” (Unknown Author, August 1995: Ebony, p. 102). It was also described as “weakness” (Townes and Johnson, November 1995: Essence, p. 94). Recounting Winston Churchill’s expression the metaphor of “black dog” was used as well (Unknown Author, April 1995: USA Today, p. 12). Other than medical there were no metaphors of depression in the 2000s. There were, however, metaphors related to pharmaceuticals as treatments for depression, for example “Mother’s Little Helper” (October 2000: p. 17 and “America’s aspirin for the psyche” (Jones, October 2000: New York Times, p. 88).

Celebrity Exemplars

The 1980s and the 1990s and Beyond There were no celebrities as exemplars found in the 1980s. There were, however, numerous celebrities used to exemplify and embody depression in the 1990s and beyond. Celebrities were drawn from the worlds of professional sport, international, national and state-wide politics, movies and television stars, arts and literature and science. Basketball’s Kendal Gill (of the Seattle SuperSonics) battled clinical depression and is mentioned twice, in Jet (April 1995, p. 50). NFL stars Dimitrius Underwood and Alonzo Spellman (both of the Dallas Cowboys) are both reported to be bipolar (King, July 2000: Sports Illustrated Magazine, p. 76). US News and World Report (March, 1990: pp. 48–52) lists Mike Wallace (news correspondent), Patty Duke (actress) and Salvador Luria (Nobel Prize winner) as suffering from depression. Newsweek suggests that “a history of mental problems or substance abuse is no longer an automatic death sentence in American politics” (April 1990: p. 22), and names Betty Ford, Michael and Kitty Dukakis, Ann Richards and Lawton Chiles (then a candidate for governorship of Florida) as well as the writers and artists Anne Sexton, Vincent van Gogh and photographer Diane Arbus as having been depressed. Deceased leaders Abraham Lincoln and Winston Churchill (Unknown Author, April 1995: USA Today, p. 12) are also remembered as having suffered from depression.

Depression May Reflect Special Qualities

Along with an association of depression with celebrity there was, in the 1990s at times, a positive cast put on depression. In fact, US News & World Report goes so far as to argue of Virginia Wolf and others that “all fought the demons of mental disintegration, and all managed to turn the battle to their creative advantage” (March 1990: p. 51). Of Lincoln and Churchill, one writer even asks (Unknown Author, April 1995: USA Today, p. 12) “would a revolutionary antidepressant drug such as Prozac have rendered them content, hard working men instead of great, determined leaders—or would it have heightened their abilities?” This suggests that depression may sometimes occur to the most gifted and sensitive of people.

Discussion

The findings of this research point, consistently and powerfully to the increasing biomedicalization of depression over the past 25 years. The answers to the questions of what depression is and where it is located have become condensed. They became reduced in scope and clearer and narrower in definition in the 1990s and 2000s. In these later time periods depression is consistently portrayed as some type of a physical problem related to the functioning of the brain. It may be biochemical or anatomical. It may have to due with hormones or epinephrine or serotonin reuptake inhibitors or genes or a chemical or hormonal imbalance (among other possibilities noted in the mass media). Despite the fact that there are many different biological theories and little evidence offered for any of them (Kramer 2005), depression is almost always investigated as a biomedical phenomenon.

The answer to the question of who gets it was that depression was more common among particular, especially vulnerable, groups such as the elderly or dancers or women in the 1980s.

While earlier research noted a link between mental illness and violence or criminality, these are not themes in the present investigation. Other research has noted the gendering of depression whereby women’s lives are increasingly and disproportionately represented as depressed (Blum and Stracuzzi 2004; Metzl and Angel 2004). The findings of this work, however, demonstrate a different trend, not just women, but, and in contrast, anyone and everyone ‘with a brain’ is said to be, increasingly, vulnerable to depression. Treatment, or the answer to the question of what is to be done about it, is increasingly limited. Pharmaceuticals are to be taken, and in extreme cases electro-convulsive therapy (ECT), by the depressed person. Although it is sometimes mentioned that depression can be exacerbated by stress, the treatment is still the same—medication, ECT and sometimes psychotherapy as an adjunct to medication.

Buttressing the bio-medicalization of depression are the links made between depression and other ‘diseases’. Depression is said to both cause and be caused by various other physical conditions. Such associations reinforce the notion that depression is fundamentally biological and caused by malfunctioning in the body/brain. In the 1980s there was only one common sense nonmedically defined metaphor associated with depression- the common cold. By the 1990s there were several. After 2000, the metaphors were linked not to depression but to the pharmaceuticals used in depression’s treatment. The increased prevalence of metaphors in general suggests a widening of popular identification and understanding of the problem of depression within the population and thus, an ability to speak metaphorically about it. In addition, while there were no celebrity exemplars in the early years by the 1990s they were numerous.

In the 1980s depression was uniformly portrayed as a negative experience if not usually terribly serious (note the common cold metaphor). By the late 1990s and 2000s, while sometimes described as serious, (hence the necessity for psychosurgery) there were hints that the experience of depression might also have positive aspects. The association of depression with celebrities is one reflection of the possibility that depression is sometimes being portrayed as having desirable aspects or some appeal for especially gifted or artistic people. The explicit discussion of whether or not some great historical and artistic figures could have done the outstanding work that they did had they not been depressed is another instance of the possible transforming of depression into a ‘cloud with a silver lining’. These links between depression and creativity, leadership and celebrities, in a context where a drug is easily available and widely thought to make people ‘better than well’ may well reflect on a situation is which being depressed has some measure of growing attraction (Elliott 2000).

There are a number of things that are conspicuously absent from the discussion of depression in these mass market magazines, across all time periods. Firstly, reactive and short-lived depression may sometimes be a temporary and appropriate reaction to difficult and painful life events. Thus, for instance, one might be more concerned about the new widow or widower who is upbeat and optimistic rather than the one whose sleep and eating patterns are disrupted (and he or she exhibits some classic but temporary DSM signs of depression) as he or she faces the painful loss of a long-time life partner. Secondly, there is almost no discussion of the side or long- term effects of medications or indeed whether or not they are likely to be needed throughout the lifetime of the depressed person. Thirdly, there is no consideration of the time demands and financial costs of recommended treatments. Fourthly, while epidemiologists cite social structural causes of depression rates so that poorer, less educated, racialized people and women are more likely to suffer depression (Chen et al. 2005), there is virtually no discussion of social justice or equity issues in regard to depression rates. Fifthly, medication tends to be treated as the cure rather than one aspect of long-term healing. Finally, there is a prevailing assumption that depressed people are capable of making good choices about treatment even though their described symptoms suggest otherwise.

These absences need to be understood as potentially reflecting significant social tensions in North American societies (and likely other Western nations) at micro, meso and macro levels. At the micro level this increasingly reductionist focus on the body at the expense of individual selfhood ignores the very real possibility of individual self awareness and growth through the facing of life challenges that may have caused the sadness and anxiety. A broadening definition of who is susceptible to depression along with a narrower set of causal explanations may lead to the alienation of the individual from his or her self, from self development, control and change. Selfhood, as Rose has argued (2001) has “become intrinsically somatic” (p. 18) and in modern societies the “biological identity” (in this case as a person who is responsible enough to get quick, efficient pharmaceutical treatment for depression) “becomes bound up with more general norms of enterprising, self-actualizing, responsible personhood”(p. 18). At the meso level thoughtful attention to and individual understanding of feelings provide a window into what is acceptable and what is unacceptable about the ways we live together. Choice and moral (or immoral) decision-making depend on self awareness. Looking to an individualistic solution such as medical treatment may limit the potential for working together to find other sorts of community-based solutions to sadness and other social issues. At the macro level, depression is associated with oppression, discrimination, inequality, racism and the like. To the extent that these large social inequities are ignored by a potential tendency to too readily medicate; there may be no attempt to make crucial political and economic changes. Moreover because the pharmaceutical industry is such a significant aspect of global and national economies without active critique of pharmaceutical products, at times, the industry could grow even more powerful and more capable of controlling the discourse about sadness, anxiety and well-being (Moynihan and Cassels 2005).

In conclusion, this data analysis demonstrates how the mass magazines have increasingly reflected a bio-medical and pharmaceutical understanding of depression, have linked pharmaceutical treatments as well as depression to only positive benefits and to celebrated historical and contemporary figures and have described it as occurring increasingly to anyone and everyone.

This portrayal reflects the triumph of medicalization and pharmaceuticals over the past quarter of a century or so. Although there are obvious benefits both to the de-stigmatization of depression (as may be evident in its link with celebrities) and to the growing use of pharmaceuticals for treatment, these trends must also be critically examined.

Limitations and Suggestions for Further Research

There are a number of limitations in this study. In the first place magazines are only one of the possible media providing information about health and other life matters. Moreover, they may not be the most important in respect to their influence and reflective character because a sizable proportion of the population is illiterate (Ronson and Rootman 2004). However, it must be emphasized that this paper does not claim to make any assertions about the effects of the stories on readers. Second, while the study included all sorts of magazines and magazines directed towards different populations (including men’s, women’s, African American, general interest, science magazines among others) it has not delved deeply nor comparatively into possible differences in magazines directed towards different audiences. As it is primarily a qualitative study, other researchers, from somewhat different standpoints may notice different characteristics and themes in the data. This analysis has not included pictures in magazine stories. Attention to pictorial representation would be of interest in further studies.

Further research is warranted and might, for example, compare and contrast media representations about depression across North American magazines and cross nationally. It could be useful to compare magazine stories in a country such as the USA where direct-to-consumer advertising is legal with one such as Canada or the UK where it is not legal. It would also be interesting to look at the portrayal of depression across magazines for people of different income levels and different access to health care and prescription medicine. It may be, for example, that the positive presentation of pharmaceuticals reflects the generally higher social class represented by people who read the magazines listed. A comparison of African American magazines with mainstream (white) magazines because of the cultural differences in the role of the church in health as well as the relatively greater proportion of people with access to health care among African Americans (Clarke et al. 2006) might be instructive.