Les campagnes nationales d’information sur la dépression. Une anthropologie biopsychosociale ?

Abstract

Information and prevention campaigns are privileged tools for public health institutions in their risk reduction policies concerning heath disorders and their consequences. Mental health in general, and depression in particular, have been the focus of several public campaigns in different countries for 20 years. The aim of this paper is to analyse depression campaign messages, to highlight their underlying logics and to show some of their effects, in particular in relation to contextual conflicts between professionals that possibly emerge because of these campaigns. Previous depression campaign materials were analysed, and the recent French campaign launched in November 2007 was the subject of specific attention. Common messages of the campaigns are centred on the prevention of emergence, recurrence, worsening and individual, social and economic consequences of depressive disorders. Depression is always presented as "a disease"; a position which differs from international classifications describing depression as "a disorder", a much less affirmative statement. This choice, which has important "performance" values is based upon several factors including the difficulty to "popularise" psychological technology, a consensus resulting from a political struggle between professionals, a reaction to the current norms of autonomy implying a new set of rights and responsibilities from and towards the people who are "sick", and the importance given to the reduction of stigmatisation from which the "mentally ill" suffer. From all of these aspects appears a logic of "dementalisation" corresponding to a "deficit" model, in which depression is presented as something external to the individual, and where treatment is supposed to "fix" the deficit. The French campaign shares many of those fundamental characteristics: prevalence, seriousness of the disease's consequences, low level of services use, preference for biological monoaminergic theories, and environmental risk factors to explain the disease (an aetiology which is more bioenvironmental than really biopsychosocial), presentation of the main chemotherapeutics and psychological treatments, referring first to a general practitioner, importance of reducing stigmatisation, and presentation of depression as a disease. However, the French campaign differs from other campaigns in its use of an organising concept for the symptoms (slowing down) and a more precise description of the frontiers between normal and pathological functioning. Furthermore, beyond the usual biological and environmental elements, greater importance is given to the psychological mechanisms and to phenomena that are not only in the "real world", such as symbolic losses. Nevertheless, it does not explicitly recommend any psychotherapy "brand". This "specificity" reflects the compromise found between the different French professional positions and the opposing paradigms that govern them. The campaign led by the French Institut national de prévention et d'éducation à la Santé (Inpes) on depression is a first step of prevention and heath promotion of mental health in France. The analyses presented in this paper highlight the present orientations in this domain, its underlying tensions and the importance of respecting and preserving the multiple aspects of this domain, which are many different ways to explore the complex object that is mental health. This paper also replaces those campaigns in the complexity of their logic and their context, in an attempt to provide elements for a dispassionate reflection for all of the actors concerned by these questions.