历史视角下的两次大萧条学说
The doctrine of the two depressions in historical perspective.
作者信息
Shorter E
机构信息
History of Medicine Program, Faculty of Medicine, University of Toronto, Toronto, Canada.
出版信息
Acta Psychiatr Scand Suppl. 2007(433):5-13. doi: 10.1111/j.1600-0447.2007.00957.x.
OBJECTIVE
To determine if the concept of two separate depressions - melancholia and non-melancholia - has existed in writings of the main previous thinkers about mood disorders.
METHOD
Representative contributions to writing on mood disorders over the past hundred years have been systematically evaluated.
RESULTS
The concept of two separate depressions does indeed emerge in the psychiatric literature from the very beginning of modern writing about the concept of 'melancholia'. For the principal nosologists of psychiatry, melancholic depression has always meant something quite different from non-melancholic depression. Exceptions to this include Aubrey Lewis and Karl Leonhard. Yet the balance of opinion among the chief theorists overwhelmingly favors the existence of two quite different illnesses.
CONCLUSION
The concept of 'major depression' popularized in DSM-III in 1980 is a historical anomaly. It mixes together psychopathologic entities that previous generations of experienced clinicians and thoughtful nosologists had been at pains to keep separate. Recently, there has been a tendency to return to the concept of two depressions: melancholic and non-melancholic illness. 'Major depression' is coming into increasing disfavor. In the next edition of DSM (DSM-V), major depression should be abolished; melancholic mood disorder (MMD) and non-melancholic mood disorder (NMMD) should become two of the principle entities in the mood disorder section.
目的
确定两种不同类型的抑郁症——忧郁症和非忧郁症——的概念是否存在于以往关于情绪障碍的主要思想家的著作中。
方法
对过去一百年来有关情绪障碍的代表性著作进行了系统评估。
结果
从现代关于“忧郁症”概念的著作一开始，两种不同类型抑郁症的概念确实就出现在精神病学文献中。对于精神病学的主要疾病分类学家来说，忧郁性抑郁症的含义一直与非忧郁性抑郁症截然不同。奥布里·刘易斯（Aubrey Lewis）和卡尔·莱昂哈德（Karl Leonhard）是例外。然而，主要理论家们的观点压倒性地支持存在两种截然不同的疾病。
结论
1980年在《精神疾病诊断与统计手册》第三版（DSM-III）中普及的“重度抑郁症”概念是一个历史反常现象。它将前几代经验丰富的临床医生和深思熟虑的疾病分类学家一直努力区分的精神病理实体混在了一起。最近，有一种回归两种抑郁症概念的趋势：忧郁症和非忧郁症。“重度抑郁症”越来越不受青睐。在《精神疾病诊断与统计手册》的下一版（DSM-V）中，重度抑郁症应该被废除；忧郁性情绪障碍（MMD）和非忧郁性情绪障碍（NMMD）应该成为情绪障碍章节中的两个主要实体。
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