Winston Churchill called his own depression his "black dog." Others simply suffer from "the blues." Borrowing from these words, Case Western Reserve University Associate Professor of English Kimberly Emmons found the title for her forthcoming book, "Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care" (Rutgers University Press).
"Since no blood, imaging or X-ray tests exist to diagnose depression, it is an illness known primarily through the language people use to describe it," Emmons said.
Emmons specializes in understanding the meaning of words and is particularly interested in medical writing.
In "Black Dogs and Blue Words," she focuses on depression information in the public arena over the past 20 years.
The popularity of the selective serotonin reuptake inhibitor drugs—of which Prozac was the first to be approved by the FDA in 1987—combined with the relaxed marketing restrictions on direct-to-consumer pharmaceutical advertisements contained in the Food and Drug Modernization Act of 1997 catalyzed an explosion of public discussion of depression.
"Once the dark matter of anti-rhetoric," Emmons said, depression has emerged from behind closed doors through a relatively recent public expansion of information venues. While for centuries depression has been the subject of lengthy medical, philosophical, and personal meditations, the recent immediacy of television, Internet, and self-help genres has focused public attention on the illness.
Depression is no longer a closet illness for 18 million Americans—or about 13 percent of the population—who suffer annually from at least one bout of it.
Now, memoirs like Elizabeth Wurtzel's "Prozac Nation" or Andrew Solomon's "Noonday Demon" top the bestseller's list as people crave these texts in their search to understand how this illness has become a part of their own personal experiences.
"One thing I found in all this literature, even in the National Institute of Mental Health brochures, is that depression is never precisely defined," Emmons said. "It is a little of everything, a collection of symptoms: low moods, loss of interest in usual activities, fatigue, crying, and even over or under eating."
These vague descriptions have become so pervasive in the literature that they are the ones doctors listen for in their patients' descriptions of what is wrong.
Emmons said, "I want individuals to pay attention to where some of these messages about health and illness come from and to think about what some of the metaphors for depression mean."
An example she gives for having the blues, feeling out of sorts, or being in a Prozac moment is a mechanical metaphor of a malfunctioning thermostat or a washing machine that needs a quick fix. In the context of laundry, the metaphor's setting targets women, reinforcing the statistical findings that they are twice as likely as men to report and be diagnosed with depression.
"Socially we do not recognize or even look for depression in men with the same frequency we do in women," Emmons explained.
The result is women and men are portrayed differently.
A popular message: depressed women are sad; depressed men are mad. Women take pills, and men act out through violent actions from suicides to assaults and homicides, she said.
Consistent with the message, an example is of an ad portrayal of a mother in the depths of depression. SHE sits dejected in the foreground of a popular anti-depression medication ad on television. Her concerned children stand frightened in the background. All the mother has to do, the ad implies, is pop a pill and suddenly she is back in the pink, ready to feed her family as good mothers do. Everyone is happy; order is restored. In addition to promoting the message that depression is easily remedied (by taking a pill), this ad also shapes public attitudes toward women's roles and responsibilities in their families.
Emmons does not want to underplay the realities of the illness of depression, but has concerns about the messages these ads leave with the viewer and the impression that women can be restored quickly to their traditional roles of being good moms.
She pointed out what's missing from the message: anti-depression medications come with side effects, use may be lifelong, and in some people the medications actually trigger suicidal thoughts and actions.
"Being an empowered health care consumer requires more than just reading words on the page. It requires being critical about whose interests are served by the messages one receives and about the underlying implications of the tag lines, mascots, and shorthand terms we all use to describe complex illnesses such as depression," the author of "Black Dogs And Blue Words" stated.
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