Some Australians still think depression is not a disease. But who cares? Instead of trying to change their minds, let’s change our policy and funding, and provide some proper treatment.
On Monday, Beyondblue announced the results of its triennial Depression Monitor. The survey, which interviews around 3000 Australians, seeks to track the public understanding of mental illness; the methodological assumption being that “awareness” of mental illness leads to better management of mental illness.
This truth appears to us manifest: awareness of depressive illness will have positive outcomes. If we talk about it and learn to recognise its symptoms, we are likely to be encouraged ourselves — or to encourage others — to seek treatment. A key aim of Beyondblue is to raise “awareness” of depression by diminishing its “stigma”.
News from Beyondblue that the stigma had been lowered and awareness raised was greeted, as one might expect, uncritically by professional media. TheSydney Morning Heraldreported on the awareness raising. A piece in The Guardian urged for lowering the stigma further. In it, an author previously diagnosed with depressive disorder restated a key goal of Beyondblue, for which she is an ambassador. That is: to change public attitudes toward depression.
Of course, the “you can just get over it” attitude of family, friends and co-workers can be immensely frustrating to the depressive; it may even compromise recovery. But, as the author’s own experience of shoddy short-term care bears out, the real barrier to recovery is a political reluctance to fund it and not a public reluctance to believe in it.
This is not, for a minute, to suggest that people are not arseholes. Everyday impatience with the pathologies or diagnoses of mental illness are as common as prescriptions for Lexapro. But a reading that emphasises the importance of individuals in understanding depression necessarily minimises the role of government in managing it. One could argue that Beyondblue and similar organisations play a “trickle-up” role by accenting the need for personal understanding. One could also argue that redeeming policy is a more efficient use of resources than redeeming people who are, as we have established, arseholes.
Just as Treasurer Joe Hockey overstates the role of the individual flaw of “entitlement” in raising national debt, Beyondblue has been successful in overstating the role of the arsehole in mental illness. Despite clear indications that those in significantly marginalised social and economic groups are the most likely to experience mental health disorders and least likely to be able to access mental health services, this story about the role of individual responsibility is told just as often as national fictions about welfare cheats.
The hazy neo-liberalism that demands so much of individuals and requires so little of government is common. It’s also very cheap. Addressing a question that often has clear social and economic origins with a soft cultural answer like “awareness” is politically cost-effective. Think of the Rudd government’s National Advisory Group on Body Image, which sought to award commercial publications for their “positive” depictions of bodies. The fiscal cost was minimal. The spin benefits, thanks to celebrity appointments including Mia Freedman and Sarah Murdoch, were great. But even as government aimed, half-heartedly at best and cynically at worst, to raise both “awareness” and “self-esteem”, Rudd withdrew funding to a key mental health program that permitted subsidies on visits to psychologists.
“Those with a socially induced depression are in no need less critical than any other mental health patient.”
In “reducing stigma” and raising awareness, we rip both the origin and the treatment for mental illness from any social context.
It’s worth noting that medical orthodoxy is beginning to move away from this model of mental illness as something that most urgently needs better public understanding. Many psychiatrists are impatient to resume a better scientific understanding of depression.
Psychiatry’s reputation as a pseudo-science is perhaps deserved these past decades and not only by its failure to come up with any brain scan or blood test to diagnose the widespread disease of depression. Its emphasis on symptoms and its taxonomic refusal to make any distinction between the kind of depression that arises with cause and the kind that occurs for no reason are seen as an impediment to research.
Last month, the US National Institute of Mental Health made the shocking announcement that it would no longer fund clinical trials that aim to ease patients’ symptoms. Instead, NMIH director Thomas Insel said: “Future trials will follow an experimental medicine approach in which interventions serve not only as potential treatments, but as probes to generate information about the mechanisms underlying a disorder.”
This move follows last year’s controversial rejection by the NIMH of the latest and fifth revision of the Diagnostic and Statistical Manual for Mental Disorders (DSMV), an influential publication now receiving professional criticism for its approach of taking depression in particular out of any social context.
In accounts of medicine going back to Hippocrates, we can see a division between the kind of depression (or “melancholia”) that arises with and without cause. A view of depression as a one-size-fits-most disorder whose origins are fairly irrelevant to its management is a new idea just decades old, and it is an unworkable one that is now being gradually abandoned.
Those with a socially induced depression are in no need less critical than any other mental health patient. But it is not, perhaps, the “stigma” of the illness that is their most pressing concern. It is, perhaps, the stigma of refusing a system of easy diagnosis that has shackled psychiatry these past decades.