The modern Western mindset has it that depression is an abnormal state. That when you're a bit down, it means you have a medical problem that requires treatment. Of course, this isn't necessarily true. While depression is clearly a major problem for many people that does require treatment of some type, do we all need to be treated every time we are down? More than this, though, if we become depressed, should we consider ourselves in some way abnormal?
What has been called the 'medicalisation' of mental health issues has long been noted by groups like the anti-psychiatrists. Indeed, Adam Curtis' new documentary provides a stark reminder of how modern mental health is driven by numbers. "Check-lists are nothing more than statistically derived descriptions of what is considered 'abnormal'"In creating the manuals relied on by many, but not all, psychiatrists (and psychologists) for diagnosis, the complexity of human thought and emotion has been reduced to a number of check-lists. These check-lists are nothing more than statistically derived descriptions of what is considered 'abnormal' - and therefore normal - human behaviour. By their very nature they make no attempt to understand the person themselves.
Mental illness may have been exaggerated
One of the major architects of this manual for diagnosing mental disorders is Dr Robert Spitzer. Dr Spitzer is interviewed in Adam Curtis' documentary. When asked what he thinks of his creation he admits, looking rather uncomfortable, that the rates of mental disorders have probably been exaggerated. The rate of exaggeration? Dr Spitzer says no one really knows, but it might be 20, 30, even 40%.
Certainly this is a worrying idea, but what worries me more is the effect it has on the way people view themselves and their personal experience. If doctors, a highly respected group in society, adopt certain yardsticks of mental health, it is only natural that these are going to affect the way we all think about our private emotional lives.
Those with a Machiavellian bent might ask who the medicalisation of depression benefits. Roger Mulder, a psychiatrist in New Zealand suggests that both researchers and clinicians have something to gain from the increased prevalence of depression (Mulder, 2005). Clinicians make more work for themselves while researchers can attract more money to their research. And there's the pharmaceutical industry, but let's not start with them.
"If you continue to tell someone they have a disorder, they soon come to believe it."One group the increasing medicalisation of depression certainly doesn't benefit is those people who previously thought they were 'a little down', and are now labelled with a 'disorder'. If there's one thing that decades of research in psychology has taught us, it's that human beings are extremely susceptible to suggestion. If you continue to tell someone they have a disorder, they soon come to believe it.
Depression across cultures
Perhaps the clearest way to understand the modern Western attitude to depression is to compare it to that in other cultures. Derek Summerfield, a consultant psychiatrist at the Institute of Psychiatry, points out that Westerners tend to view emotion as internal, unintentional, biological and unrelated to cognition (Summerfield, 2006).
"At least non-Western attitudes to depression acknowledge that a situation can be changed." By contrast, a non-Western viewpoint is often characterised by a focus on situational and moral factors. The Western depression-as-disease model has the hallmarks of a condition inescapable without 'treatment'. How can you change your biology or tame emotions apparently arising unbidden from the deep? At least non-Western attitudes to depression acknowledge that a situation can be changed.
It's OK to be depressed sometimes
Ultimately we don't often hear the simple message that it's OK to be depressed sometimes. It's not pleasant, but it's part of being human. It doesn't necessarily mean professional treatment is required.
Summerfield, D. (2006). Depression: epidemic or pseudo-epidemic? Journal of The Royal Society of Medicine, 99(3), 161-162.
Mulder, R. (2005) An epidemic of depression or the medicalisation of unhappiness. New Zealand Family Physician, 32(3), 161-163.
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