The Hamilton Rating Scale for Depression: The making of a “gold standard” and the unmaking of a chronic illness, 1960–1980

Abstract

Objectives: To show why and how the Hamilton Rating Scale for Depression became the ‘Gold Standard’ for assessing therapies from the mid-1960s and how it was used to frame depression as a short-term and curable illness rather than a chronic one. Methods: My approach is that of the social construction of knowledge, identifying the interests, institutional contexts and practices that produce knowledge claims and then mapping the social processes of their circulation, validation and acceptance. Results: The circulation and validation of Hamilton Rating Scale for Depression was relatively slow and it became a ‘Gold Standard’ ‘from below’, from an emerging consensus amongst psychiatrists undertaking clinical trials for depression, which from the 1960s were principally with psychopharmaceuticals for short-term illness. Hamilton Rating Scale for Depression, drug trials and the construction of depression as non-chronic were mutually constituted. Discussion: Hamilton Rating Scale for Depression framed depression and its sufferers in new ways, leading psychiatrists to understand illness as a treatable episode, rather than a life course condition. As such, Hamilton Rating Scale for Depression served the interests of psychiatrists and psychiatry in its new era of drug therapy outside the mental hospital. However, Hamilton Rating Scale for Depression was a strange kind of ‘standard’, being quite non-standard in the widely varying ways it was used and the meanings given to its findings.