Social Origins of Depression . By George Brown and Tirril Harris. (Pp. 399; illustrated; £12.50.) Tavistock: London. 1978.

Let me begin by placing my cards face up on the table: I am a George Brown fan. This important book contains the results of some years' painstaking research from the Social Research Unit at Bedford College on the psycho-social causation of depression. Since some papers have already appeared in both medical and sociological journals, we have been able to observe over a period of time the building of an edifice which now, although incomplete (the authors point out many remaining avenues of research), has sufficient walls standing for an assessment of its design and strengths to be made. Brown & Harris, co-authors of this book, present a sophisticated model of clinical depression in women. They argue that, while there must always be a bodily basis to psychiatric disorder, it can be produced by cognitive and emotional responses alone. These responses are made to the experience of daily life. It is this belief which provides the basis for the model which, briefly, posits 3 main categories of social factors which combine to produce depressive illness. They are: (a) provoking agents, including life-events such as the loss of a job, and long-term difficulties, such as poor housing; (6) symptom-formation factors (i.e. determining only the form and severity of the illness, not whether it occurs at all), such as a previous episode or past loss of a loved person; (c) vulnerability factors, i.e. the presence of 3 or more children under 14 at home, loss of mother before the age of 11, no employment outside the home, and lack of an intimate relationship. The study was conducted by interviewing 2 main samples of women in Camberwell: (i) 114 psychiatric patients (both in-patients and out-patients), (ii) 458 women living at home collected in two random samples. Because the authors are aware of the vital effects of the selective process of referral to different stages of treatment, they also drew a further small sample of 34 women who were being treated by their general practitioners. There are 2 main camps from which guns are likely to be fired one sociological, the other psychiatric. Some cannon balls deserve to thump home, but it is my belief that they are, on the whole, the smaller ones, dealing with detailed problems resulting from inadequate editing and poor presentation producing considerable confusion over definition of categories. I have in mind here, for example, the confusion over the definition of the crucial vulnerability factor 'loss of mother before 11'. Nowhere in this book could I find a clear statement of how this category was used, despite various discussions about the likely differences in the experience if loss was by death rather than, say, by adoption or by the removal of the child on a Care Order. Furthermore, the various groups of categories (a, b and c, above) do not appear clearly distinguished and, despite an evident awareness of the problem of overlap, 'loss of mother before 11' is influential both as provoking agent and as a vulnerability factor, and is also included in 'past loss' as a symptom-formation factor. Some rather heftier cannon balls arguing (a) that some unwarrantable conclusions have been drawn on the basis of the data here presented and (b) that some omissions (notably the lack of adequate data to assess the influence of the referral process) detract seriously from the validity of the model, and may inflict some holes and cracks in the edifice, but these can be repaired since it is my contention that it rests on firm foundations. The first line of attack might come from the psychiatric camp; Professor Brown is, after all, a sociologist. Neither he nor Tirril Harris is medically qualified. Yet they have chosen a topic the aetiology, the causation of depressive illness in women which is a central concern of medical practitioners who daily define and diagnose a condition described as a sickness of the mind and treat that condition with drug therapy, electro-convulsive therapy and various forms of psychotherapy. Sociologists practise no therapy. Yet, if the model of depression put forward in this book is correct, the therapeutic and preventive implications are profound, for, while sadness, unhappiness and grief may be' inevitable in all societies', Brown & Harris 'do not believe that this is true of clinical depression' (p. 3). They believe that psycho-social factors actually cause depression and, further, that these factors can be discovered and known. On the first page of their book the authors quote C. Wright Mills, who argued in The Sociological Imagination that 'the relation of personal troubles to public issues of social structure was the central feature of all classical work in social science', whether the example is Durkheim's Suicide or Marx on the effects of capitalism on the wellbeing of individuals.