Why we should care about history: a medical historian’s perspective
Are old solutions ‘old’ because they became useless, and is the past irrelevant because it will never happen again?
Chair and Theodore J. Castele Professor, Department of History, College of Arts and Sciences
Vice president and president-elect of the American Association for the History of Medicine
Area of Focus: medical history, medicine, psychiatry, African colonialism, depression
Why do we care about the past?
The fundamental element of developing medical treatments—trial and error—calls us to pay attention to the deep history of lessons that came before. With each attempt to develop a medical treatment, debates over its humanity, effectiveness, and which component of a disease to be targeted resurface again and again.
Perhaps a more effective way to address recurring challenges in medicine is not just to continually bring up these concerns, but to look back at patterns and arguments that were discussed in the past.
According to Jonathan Sadowsky, PhD, Chair and Theodore J. Castele Professor in the Department of History, knowledge of the past can inform and guide decisions in the present.
Medical history, Sadowsky’s field of expertise, documents and analyzes how diseases, healing measures, institutions, and the society revolving around those matters evolve across different social, cultural, and political contexts.
“Science is what is going to prepare us with things like vaccines and other measures, but science is not going to prepare us for the social effects,” said Sadowsky. “That is what history can do.”
The history of depression: a cycle of hype and disappointment
An illness like major depressive disorder was once viewed and described very differently from today. Over a century ago, it was described as a mood or emotional state rather than a complex medical condition with underlying causes. As understanding gradually transformed depression into a medical diagnosis, treatment and classification of the disease also changed.
In a 2019 book, Sadowski outlined this progression of depression’s definitions and its treatments over the past century.
The Empire of Depression: A New History, the book that took Sadowsky two years to write, has been translated from English into six languages, with a seventh translation on the horizon.
In the book, Sadowsky discusses four of the major treatments for depression that rose to prominence during different periods of the 19th and 20th centuries: psychoanalysis, electroconvulsive therapy, antidepressants, and cognitive behavioral therapy. Interestingly, he points out that public perceptions of each treatment tended to follow a similar pattern over time.
“Most treatments tend to be overhyped when they are new; and then, there is a period of disillusionment that sets in,” Sadowsky said. “Sometimes then some new treatment comes along, and then that becomes overhyped. And so there is this cycle of hype and disappointment.”
This cycle demonstrates how the public may overlook the value of past treatments while often over-glamorizing newer ones. To Sadowsky, past and present treatments, thus, should be considered alongside one another.
“What I think we learned from history is that we shouldn't discard past treatments just because we have some shiny new object. We also shouldn't overhype the new ones, because that leads to disappointment,” Sadowsky said.
One of the most gratifying experiences for Sadowsky after the book was published was seeing the impact it had on readers, especially those with depression. One reader said that, if they could give their parents just one book to help them understand what depression felt like for them, this would be that book.
The history piece of data interpretation
As a professional analyst of history, Sadowsky recommends using caution when interpreting data.
“We need to be skeptical about what the numbers and the epidemiological studies mean,” he said.
For instance, the rate of depression has been rising exponentially both within the United States and globally, with a significant jump starting in the 1950s.
“They could mean that the actual number of people getting depressed is growing,” Sadowsky said. “On the other hand, as pointed out in my book, (in) the first half of the 20th century– when there was less attention to depression and less diagnosis of depression, you had Jim Crow, the Holocaust, two world wars, the Great Depression. It is not obvious to me that we are living in more depressing times.”
Without knowing how we once viewed and approached depression differently from how we are now, it would be hard to have adequate assumptions about the burden of the disease in the past, and thus failing to understand which factors have truly contributed to the progression of that disease today.
And this is just one example of the important role history plays in how we interpret data.
Preparing for the future with the knowledge of the past
At the dawn of the COVID-19 epidemic, Sadowsky recalled attending an online conference hosted by the American Association for the History of Medicine—where he is now the vice president and president-elect. Experts in the field of medical history gathered to discuss the history of infectious diseases and epidemics, and what we can learn from the past.
Many of their predictions, based on patterns observed in the past, came true: The pandemic would expose and deepen existing social inequalities, fuel resistance to public health measures, and lead to the unfair blaming of certain groups.
“This is maybe a pipe dream on my part, but I started thinking: “What if we made the study of epidemics part of the standard social studies curriculum in high school?”,” Sadowsky said. “Then the next time we have an epidemic, we might be better prepared for the social effects.”
The future of medicine has seen and is expected to see major changes with the introduction of AI, telehealth, and even the sociocultural impact following the COVID-19 pandemic. The investigation of the past and how it influenced subsequent events and shaped the future remains as significant as ever.
