There is an on-going debate of which many of you will be aware, particularly in light of Giles Fraser-gate, concerning the legitimacy of mental illness as a subject for medical study and treatment. Perhaps the most hackneyed formulation of the anti-medicalization argument is summed up in the phrase 'depression is the medicalization of normal sadness'.
So here's how the argument often goes (in brief):
- We all feel sad sometimes.
- There are many reasons to feel sad.
- Feeling sad can be meaningful, helping us to make changes in our lives, or better, create brilliant artwork.
- Sadness is also a natural human feeling, albeit one that is not valued in and of itself in many cultures, and thereby does not require treating.
- Depression is like feeling really sad.
- Therefore, treating depression is a) treating a perfectly natural condition we should be able to cope with, b) preventing people making the relevant changes in their lives/becoming the next Van Gogh, and, worst of the worst, c) making it legitimate to eradicate a socially disvalued condition.
The fallacies in this argument? 1. Depression is NOT just sadness, it is grief and hopelessness PLUS. It is paralysing, exhausting and all-consuming. 2. Depression is a medical condition, and it can be treated with drugs. Those drugs, like many forms of medication, do not affect all sufferers in the same way, but this does not prevent them being beneficial to the health of some. 3. Treating depression does not inhibit one's ability to tackle those things in life that may contribute to the condition. If anything, it enhances one's ability to do so. And 4. Depression may be natural, but only in the same sense that broken bones, bacteria and hormones are natural, none of which people take issue with treating.*
To condemn these arguments is not to play down the importance of learning to cope with everyday emotions at everyday intensities. Nor is it to ignore anxieties regarding the influence that cultural norms and expectations have on classification of mental illness. Previous editions of the American DSM provide too many examples of attempts to medicalize socially disapproved behaviour, including homosexuality and Drapetomania (a term applied to slaves who attempted to flee their captivity), to pretend psychiatry cannot be misused in such a way.
When it comes to contemplating the legitimacy of mental illness, it is the 'mental' aspect of the term that I think really throws people for a loop, with its entailment of a complex interface between biological and psychosocial factors. Thomas Szasz may have been right to propose that 'brain disease' would make a more appropriate, and less misleading term. But our understanding of the brain, and its mental functions, leaves much to be desired when compared with our understanding of say, the heart and its cardiac functions, or the kidneys and their renal functions. This makes our assumptions, ignorance and value judgements concerning all things 'mental' more obvious and open to dispute.
We will no doubt be kept guessing about our mental lives for many years to come. In the meantime, depression is an easy target for anti-psychiatrists and anti-pharmaceuticals due to its perceived continuity with sadness (no doubt perpetuated by the frivolous use of the term 'I feel depressed' or 'that's so depressing', of which I know I have been guilty in the past). But depression is not mere sadness, and to portray it as such, and subsequently discourage medical treatment for it, is incredibly harmful to those suffering from its effects.
Someone with depression does not need to feel - any more than they probably already do - that they are frauds, simply failing at life. And for all its occasional legitimacy, esoteric debate about the nature of mental illness must never be allowed to impair the recognition and treatment of conditions that are plainly causing individuals harm.
* Similar arguments, and their respective fallacies, are often applied to other common mental illnesses.Suggest a correction