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Mar 27, 2014

Razer’s Class Warfare: reducing depression’s ‘stigma’ is cheap, stupid policy

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. The Sydney Morning Herald reported 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.

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30 comments

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30 thoughts on “Razer’s Class Warfare: reducing depression’s ‘stigma’ is cheap, stupid policy

  1. Kez

    The other issue with awareness campaigns over decent funding of research and treatments is that rather than reducing stigma, we permit fakers to keep on faking. Just as so many “recovered” memories of childhood sexual abuse in the 90s, now the same type feels entitled to her depressive “illness”.

  2. Draco Houston

    You’ve taken ‘just skip to the comments’ to a new level, Kez.

  3. Shaniq'ua Shardonn'ay

    “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.”
    Nail, Head.
    I’ve experiences of both shoddy public health care and the Rolls-Royce version (In the same hospital as Andrew Robb) after doubling my health insurance and waiting a year (it’s about 2 months now I believe). I’d choose the latter any day.
    I’d rather sponsor someone to have private health cover than give to beyond blue.

  4. Take A Letter Maria

    Kez – all future posts of yours are now in moderation.

  5. ruth elder

    Helen, I think it’s not just the context within which the illness occurs, but the context within which care is provided. Unfortunately, that context includes health professionals who often have little expertise or understanding of serious mental illnesses, neither of which, I agree, are fixed by improved ‘awareness’.

  6. sparky

    Actually guys, Kez has a point (though not all people) and the point is part of the article. Depression has absolutely no biological test that can accurately diagnose people. It is only self report and you can’t be naïve enough to think that people don’t tell mistruths to get some kind of benefit. And it is those kinds of people that are heard about. Killed someone?.. diagnosed with Depression by a magical thinking Psychiatrist who believes that they can go back in time and tell the mental state of someone at a certain point in time. Had an affair?..ditto. Caught with drugs…ditto. Drink driving?…ditto. Embezzled?…ditto. Sexually assaulted a patient…ditto.

  7. Matthew of Canberra

    I don’t know what the problem is – my impression is that beyond blue has been first-rate when it comes to raising awareness about beyond blue.

    Yes, that’s snarky, I know. I suspect I’m not alone here in being at the pointy end of depression, and efforts at awareness raising seem about as useful as … dunno, something not particularly helpful. Consciousness-raising is a diminishing-return exercise because, let’s face it, the problems of the depressed are ultimately their own problems. Nobody else actually HAS to give a damn, and give a damn they most certainly won’t. Make them aware as you want to, but it won’t change self-interest.

    In a weird moment of anguish I chose to “come out” (at 3AM, ill-advisedly) on facebook to all of my friends and many coworkers as a long-term diagnosed and medicated depressee (I glossed over some things). A couple of people who’d “been there” spoke to me personally about it and were worried. A couple wondered if there was, like, anything they should, like, do – but it was nice that they made the effort. Most were “meh” and I haven’t heard from some others since at all. My advice to people who’re wondering if they should do the same is – avoid disappointment, don’t. It probably won’t actually hurt, but a week later you’ll wonder why you bothered.

    I’m not sure that awareness raising is going to achieve very much more than it has. People have their own problems. Most people are just getting by now, without trying to help to untangle the alien, illogical and un-yielding thoughts of somebody who doesn’t want to be around any more. The rational self-interested response to a cry for help is to be hard to find. I honestly suspect that the real first thought that went through the minds of some of my coworkers was whether I’d get their projects finished before I stopped coming to work any more. That’s reality.

    Beyond blue? Yeah. I’m sure they’re lovely people, but they’re nowhere near where the action is.

  8. Matthew of Canberra

    Ah, screw it. Delete that if you want to.

  9. Dave

    You can’t get much lower than low than being homeless.

    I used to walk past a guy who sat on the corner and entrance to a busy shopping mall all day until about dusk, seven days a week. The council eventually found him some appropriate accommodation due to the businesses in the area filing complaints.

    But this guy was always up-tempo and up for a chat. His knowledge of current affairs was outstanding and as with most homeless people he did n’t feel sorry for himself. Perhaps just content that the mill-stone of absurd rents, ridiculous mortgages and obtaining meaningful and fulfilling employment had been lifted from his shoulders.

    So, I agree. There is no single parameter or context to depression. It’s a myriad, but the Black Dog doesn’t distinguish between rich and poor or fat and skinny or even free will or predetermination. Ups and downs are the natural rhythm of life. Beyond that is another issue.

  10. Undiagnosed

    Thanks for that Matthew, shall we all start coming out? Perhaps not.

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