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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 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.

  11. sparky

    Thank you so much for that Matthew, you describe the space with humanity.Yes they did wonder about the projects but they’re only projects.

  12. Take A Letter Maria

    That was awesome, Matthew. Can’t stop thinking about it. So contrite, helpful and informative.

  13. Matthew of Canberra

    Thanks guys. I wasn’t trying to be deep, just realistic. I’ll be quiet now – I’ve switched back to trying to work out how to get the outlook 2010 API to convert the stoopie internal X400 format that exchange uses into an SMTP email address using visual basic. I love my work 🙂

  14. 64magpies

    Yes Matthew, don’t tell. Last person I confided in advised me to get a book on spirituality which would help. I bought it (OK I’m stupid,of course). The first chapter explained that depressed people are on the lowest level of consciousness, along with psychopaths. Yeah! He could have just told me to fuck off.

  15. Henry

    this article has no merit whatsoever. The author’s oblique and pathetic 3rd person reference to their own experience, (oh what a telling comment, oh how it raised my awareness so)is just annoying. There is no depth here, no meaningful analysis, nothing worthy, no insight, just a wanna be hack having to file something. pathetic.

  16. BookishMisfit

    ‘Depression’, in my experience, is often a natural personal response to environmental concerns. If you have unresolved trauma, if you are unemployed, if you struggle financially, if you are or have been a victim of violence, if you have a physical illness or disability, if you are lonely (etc) then you are likely to be ‘depressed’.

    People can be helped through these problems in a number of practical and emotional ways before being given the diagnosis of depression and, often, medication of some kind. Just being able to ‘tell the story’, to be helped to access supportive networks, recreation and the like, to feel valued – all can help relieve ‘depression’.

    I don’t know whether depression is an illness or not, remembering the 70s and 80s when women in particular were often prescribed benzodiazepines (minor tranquillisers) for supposed anxiety arising from social isolation and unsupported parenting responsibilities. Social problems were medicalised and we ended up with many women who were addicted to things like valium. Doctors just made the problems worse.

    I think the same could easily happen with ‘depression’.

    We also have a whole industry of medical, health and social workers waiting to ‘help’ us. Their livelihood depends on the ‘sickness’ of others. Sorry if I sound a little cynical.

    As for Jeff Kennett and Beyond Blue, please don’t get me started. Kennett unleashed all sorts of social problems through his unfettered encouragement of the free market (including pokie gambling) in the Victorian community. Thousands of people lost their jobs during his tenure as Victorian Premier and Victorians lost many of their capital assets.

    Beyond Blue, with its awareness raising about depression is little more than a free market token response to social and economic woes that are, partially at least, a consequence of the slow abolition of social democracy.

    If you really want to look at class warfare, Helen, you could go a little deeper than you have.

  17. Liamj

    Well spotted, Helen.
    “The hazy neo-liberalism that demands so much of individuals and requires so little of government is common.”
    Its beyond common, its the default, someone needs to coin a buzzword for the now bog-standard pattern… atomised responsibility? Apathetic governance? Its not we its you?

    Re underwhelming responses to disclosure of depression, i think its simple fear of the needy disolving precarious coping mechanisms. Just as the truthful frighten liars, the 10% (voluntarily or not) feeling/facing their despair or ‘craziness’, scare the 89% busy running away from same.

  18. Matthew of Canberra

    Bookish …

    I’m with you on the Kennett thing, but not the sickness industry thing or the erosion of society thing.

    You’re partly right about the external factors thing, though. I could write lots of words about this, but I decided that the guy in the following link says it better.


    His mileage differs from mine a bit but his description of effects at their worst is so astute.

  19. Dave, David..whatever.

    ” The first chapter explained that depressed people are on the lowest level of consciousness, along with psychopaths.” 64Magpies

    I would throw that book away immediately.

    Every ancient script I have ever studied, every apochraphyl item and manuscript and even NDE experiences would say the opposite.

    The evidence is in. Depressed people are at the highest level of consciousness.

    Some of the greatest literary works, all forms of art, physical and spiritual achievements were all reached during the subjects most lowest point.

    I have to disappear at the moment, but would love to explain what I know in this field at a later time.

    “What Father/Mother would not stricken their son/daughter if they hath no love for them. ”

    “But on this one I will look. On him/her who is humble and of a contrite spirit and who trembles at My word.”

  20. Dave, David..whatever.

    What’s with the moderation? Lift your game guys.

  21. hj_murphy

    Yes – can the moderators please remove the first comment as it is highly offensive.

    I am consistently disappointed with BeyondBlue’s policy tinkering-around-the-edges. Awareness raising is so important but it goes much further than getting you to visit your GP, hand-on-your-heart, asking for salvation. Counselling, therapy and medication doesn’t come cheap and everyone squirms when you realise it might take years for “recovery”. It’s not like tinea where you can apply cream for 6 weeks.

  22. BookishMisfit

    Thanks for your response, Matthew of Canberra.

    I think I was a little ‘over the top’ with my comments about the ‘sickness industry’. I remember a remark once that John Patterson made when he was head of the Department of Human Services in Victoria in the mid 90’s. He asked whether a woman living in poverty would prefer assistance from a social worker or the $40,000 which was the cost of a social worker. It was perhaps a rhetorical question but his point was clear.

    “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.”

    I basically agree with the above statement from Helen Razer. It is too easy to blame individuals for their various predicaments instead of looking at social and other contexts. It is similar to medicalising a social or economic problem.

    We have to look at empowering people in their own lives and there are myriad ways of doing that. Thanks for the TED reference as well.

    I understand our reticence about disclosing personal pain. I think one has to think very carefully about this and to do it in a supportive environment. You are always going to get a mixed reception. Even friends don’t often don’t understand.

    The reality is that good counselling is costly these days. There is research, however, which shows that nobody knows that counselling really works, unless perhaps it is CBT. Sometimes it s simply telling the story and being heard that is the most healing thing.

    And it is sometimes the oddest thing that can empower.

    All the best 🙂

  23. michelle.smith

    Isn’t depression a rational response to having consciousness of death? The reality is that most people self-medicate; either through alcohol, drugs or religion.

    Both myself and my husband have been on a variety of anti-depressants, seen psychiatrists, psychologists, undertaken CBT, practiced mindfulness and meditation, and discussed our ‘issues’ ad infinitim.

    What might work at the individual level, often doesn’t work at the relationship level (eg, anorgasmia – a common side effect of anti-depressants), weight gain, not to mention the personality changes, often undetectable in the medicated.

    I am inclined to agree that it must be a neurological disorder which serotonin seems to help but not really ‘fix’, and creates its own set of problems. Counselling appears to work for some, I suspect they are the ‘depressed for a reason’ rather than those whose depression and it’s sibling; anxiety, lives inside them waiting to erupt at seemingly random times.

    Personally, I don’t give a shit about ‘awareness’ – to me, the depression is a bit like menstruation – an internal process that knocks me around for a few days a month. I don’t feel the need to broadcast it to the world.

  24. Matthew of Canberra

    Realistically, one social worker is not working with a single person in need. Given the option of the actual money spent on that one case, the decision might be altered somewhat.

    Something that the speaker in the at TED talk observes: For somebody with a basically good life, a job, money, security, friends, depression is somethign that appears to be strange, something that needs to be fixed. To somebody whose life is rubbish anyway, who hasn’t seen an alternative and who hasn’t been surrounded by contrasting examples, depression can easily be mistaken for being just how things are.

    Seriously guys – watch the TED talk. I think he missed a few aspects, but he says what he does so much better than I ever could.

  25. Shaniq'ua Shardonn'ay

    Matthew of Canberra +1 (by the way, I’m also a VB programmer as well – maybe that’s it)

  26. Piers Gooding

    Another key issue here is the discriminatory nature of mental health law, which is underpinned by false notions of dangerousness associated with mental illness and false notions that doctors can predict when a person will harm themselves or others. While state governments like Victoria link arms with Kennett and sing the song of anti-stigma, they simultaneously ignore directives by the UN Committee on the Rights of Persons with Disabilities and the UN Special Rapporteur on Torture that involuntary treatment under current discriminatory mental health laws is in breach of international human rights law. Coercive care is costly and saps funds from voluntary services designed around people’s wishes and preferences.

  27. Matthew of Canberra

    In summary, I’m with Helen. I think “awareness raising” exercises are fine, let’s not NOT do them, but it isn’t going to solve any problems. We can all know about mental illness, depression, poverty and addiction all we like … now, what do we do about it?

    That said, I’m still cynical about the real political foundations of beyond blue. I’m sure they’re lovely people, almost every single one.

  28. Tyger Tyger

    Unless and until you can adduce any evidence that such things exist, can we leave the “levels of consciousness” stuff out of this debate, Dave@19. It’s patronising to say the least to characterise people with mental illness as merely representative of a particular “level of consciousness”, whether high or low. I’ve had my run-ins with the psych industry but I’d take their sometimes fumbling ministrations over “spiritual”, new-age, ancient text-based drivel any day. (I’m always staggered by people’s obsession with “ancient wisdom”. Before the advent of the scientific method, pretty much everything everyone believed about everything was rubbish – purblind attempts at explaining natural phenomena. Why the fascination with dead-end, demonstrably false thinking?)
    As for NDEs, as this article argues, you don’t need a “spiritual” explanation for what is far more likely the brain doing its thing “in extremis”:


    BM@16, no doubt there are cases where people who are a bit down identify or are diagnosed as clinically depressed. However, if you’d ever had months-long bouts of can’t-get-out-of-bed depression, you wouldn’t question “whether depression is an illness or not”. It leads to countless suicides and episodes of self-harm and self-sabotage both acute and chronic, so its pathology should be evident. That it involves the least understood organ in the body and often defies all attempts at treatment doesn’t make that any less true, though it does encourage people to speculate.
    I began to experience anxiety from the age of about 9 or 10 and full-blown depression by the age of 12, yet I come from a loving, secure, violence-free family, had abundant friends and social contact and, while we were far from rich – and far from perfect! – I didn’t want for much.
    You seem well-meaning, but what you’re saying echoes the “just get over it” line that has caused so much harm and led to years of victim-blaming and subsequent inaction on depression.

    Matthew@7, not to question your experience for one second, but I too “came out” about my depression at work – didn’t have much choice given my downward spiral was so bleeding obvious – and my experience was overwhelmingly positive, so it might be more a problem with your workplace than anything. One thing in my favour is that I work in a somewhat dangerous trade where teamwork is essential, so you tend to form strong bonds with your workmates and look out for each other’s backs. I tried office work once – for a very brief time! – but I found it the most toxic, pettily political environment I’d ever been in. Not recommended for someone with my condition!

    Finally, I see where Helen is coming from and agree 100% that more funding is required for both treatment and research, also with the posters who think it’s a joke that beyondblue is led by someone as divisive and abrasive as Kennett, but why are these things always either/or arguments? Greater awareness that depression is not something you can “just get over” has had a significant effect on my life in making those around me more sympathetic.
    For mine, the important point in this article can be found in the references Helen makes to the sort of rampantly individualistic, devil-take-the-hindmost society we’re becoming. In such a society “those in significantly marginalised social and economic groups” cop it every which way.

  29. 64magpies

    Thanks for the support D d whatever. I regret that post now, because having got over my ego spack attack, I’m finding the book quite helpful.

  30. Shaniq'ua Shardonn'ay

    @Tyger Tyger – thanks for that. I’ve learnt to politely ignore the ‘spiritualists’ but they do drive me nuts. They are about as helpful as those who post “Depression Is Not a Sign of Weakness It Is a Sign That You Have Been Trying to Be Strong for Too Long” on their facebook wall. FFS, just because I’m depressed doesn’t mean I’m some sort of hero. I have the right to be a lazy nasty arseh@le just like anyone else.
    By the way I ‘came out’ at work several years ago after disappearing off to have ECT. The response was interesting but overall ok. I figure some people just don’t know how to deal with it but that’s ok. I have things I have trouble dealing with.

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