Abstract
This paper is an analysis of three elements of which depression as the primary target of current Western psychiatry and mental health care is made: the quest of psychiatrists to identify a depressive disease proper; the category of ‘major depression’ as defined by the diagnostic manuals; and the epidemiological view emphasising risk factors of depression. These elements are pivotal to the present understanding and experience of what depression is since they delineate the space of reasoning in which claims about depression are presented, problematised, and disputed. The paper presents how these elements have historically evolved and coalesced, and how depression has been formed and transformed as an object of knowledge and treatment in psychiatry and how the claims about depressive disorders acquire objectivity in the current mental health discussions. The paper also demonstrates how the quest of depression as a neurophysiological disease, consolidation of Major Depression as the diagnostic core of mood disorders, and the central role of the epidemiological notion of risk are both interlocked and discordant with each other in the current depression paradigm. In addition, tendencies of subversion of the depression paradigm are discussed.
Highlights
Depressive illness has acquired a paradigmatic position in Western mental health thinking and practice during the past quarter of a century
I analyze an ’applied’ discourse that creates a framework of thought in which depression becomes conceivable and its treatment gains a reasonable basis in current mental health care, disseminated in numerous contexts and institutions of health care, social services and education in which plethora of mental problems are encountered
My discussion in these sections is based on the analysis of the discussion on definition and classification of depression in Anglo-Saxon psychiatry, mainly in Britain, from the 1920s to 1980s, and I situate my analysis in the historical context by reviewing research literature on the topic
Summary
Definitions of what depression is and the objectivity of them are essentially formed and tested in practices and institutions for treatment of people suffering from depressive illness For this reason, my analysis is focused on reasoning relevant for the public health and clinical practices, instead of manifold psychiatric theories of depression and mood disorders. In the first two sections of my paper, I focus on the psychiatric discussion of endogenous depression that is a historical attempt and problem to define depressive illness as a clear-cut disease with definite physiological cause and course, in a manner similar to modern medicine My discussion in these sections is based on the analysis of the discussion on definition and classification of depression in Anglo-Saxon psychiatry, mainly in Britain, from the 1920s to 1980s, and I situate my analysis in the historical context by reviewing research literature on the topic. My argument is that at the core of the both merits and perils of the current depression paradigm is the tendency to think of depression as well as other mood disorders as objects instead of as an experience with a specific context; and, as Emily Martin (2007: 220) says, ‘movement toward thing-like status makes mania and depression seem possible to identify, manipulate, and optimize through the technology of psychotropic drugs and through taxonomic apparatuses.’
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