Transcript – Dr Neel Burton discusses The Anatomy of Melancholy: Can Depression Be Good For You? at TEDxMaribor.
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Dr Neel Burton – Psychiatrist, philosopher, writer,
Hello everyone. I mostly live in an attic in Oxford, so you’ll forgive me for being completely outside my environment tonight. I am afraid I am not going to be terribly funny like the previous speakers. That’s partly because psychiatrists aren’t very funny people. Freud famously said that there’s no such thing as a joke.
But, no, actually it’s because that my topic tonight doesn’t lend itself very well to jokes and my topic is actually a very serious topic. It’s depression. Now, most people think of depression as a mental disorder that is a biological illness of the brain. Today, I’m going to argue that the concept of depression as a mental disorder has been over extended, has been unhelpfully over extended to include all manner of human suffering.
And, more controversially, that depression or “depression” as broadly understood, can actually be good for us, an idea that I explored, that I developed in my recent book “The Meaning of Madness.”
Now let us begin by thinking very broadly about depression. There are important geographical variations in the prevalence of depression. And these can in large part be accounted for by socio-cultural rather than biological factors. In traditional societies, human distress is more likely to be seen as an indicator of the need to address important life problems than as a mental disorder requiring professional treatment. For this reason, the diagnosis of depression is correspondingly less common.
Some linguistic communities do not have a word, or even a concept with which to talk or think about depression. And many people in traditional societies with what may be construed as depression present instead with physical symptoms, such as fatigue, or headache, or chest pain. So, for example, Punjabi women, who have recently emigrated to the United Kingdom and given birth find it baffling that a health visitor should pop around to make sure that they haven’t developed post-natal depression. I mean, not only had they never conceived of giving birth as anything but a joyous event but they don’t even have a word with which to translate the concept of depression into Punjabi.
Now, in modern societies such as the UK and the USA, people talk about depression very freely, very readily, very openly. As a result, they are far more likely to interpret their distress in terms of depression and also far more likely to seek out a diagnosis of the illness. At the same time, groups with vested interests, such as pharmaceutical companies or indeed, so called mental health experts promote the notion of ‘saccharin happiness’ as a natural, default state and of human misery, of human distress as a mental disorder.
The concept of depression as a mental disorder can be useful – can be useful for some of the more severe intractible cases that are treated by hospital psychiatrists. But probably not for the vast majority of cases which are relatively mild and short-lived and easily understood in terms of life problems, human nature or the human condition.
Another non-mutually exclusive explanation for the important geographical variations in the prevalence of depression may lie in the nature of modern societies themselves which have become increasingly individualistic and divorced from traditional values. For many people living in our society today, life can seem both suffocating and far removed, lonely even and especially amongst the multitudes. And not only meaningless but absurd. By encoding their distress in terms of a mental disorder our society may be subtly implying that the problem lies not with itself, but with them, fragile and failing individuals that they are.
Now, of course, many people prefer to buy into this reductionist, physicalist explanation rather than, I suppose, confront their existential angst. However, thinking of human distress in terms of a mental disorder can be counterproductive because it can prevent people from identifying and addressing the important psychological or life problems that are at the root of their distress.
Now, all this is not to say that the concept of depression as a mental disorder is bogus, not at all, but only that the diagnosis of depression has been overextended to include far more than just depression, the mental disorder. If like the majority of medical conditions depression could be diagnosed according to its etiology or pathology, that is, according to its cause or effect, then such a situation, such a problem would never have arisen. Unfortunately, depression cannot as yet be diagnosed according to its etiology or pathology but only according to its clinical manifestations or symptoms.
Given this, a doctor cannot base a diagnosis of depression on anything so objective as, for example, a blood test as in malaria, or a brain scan as in stroke but only on his subjective interpretation of the nature and severity of the patient’s symptoms. If some of these symptoms happen to tally with a diagnostic criteria for depression, then, you know, bingo, the doctor is justified in making a diagnosis of depression.
Now, the problem here is that the definition of depression is circular, the concept of depression is based on the symptoms of depression, and the symptoms of depression, in turn, are based on the concept of depression. Thus, it is impossible to be certain that the concept of depression maps onto any distinct disease entity.
And, particularly since a diagnosis of depression can apply to anything from mild depression to depressive psychosis, and depressive stupor and overlap with a number of other mental disorders, including anxiety disorders, dysthymia, and adjustment disorder. One of the consequences of our menu of symptoms approach to diagnosing depression is that two people with absolutely no symptoms in common – absolutely no symptoms in common, not even depressed moods, can both end up with the same diagnosis of depression. For this reason especially the concept of depression has been attacked for being little more than a socially constructed dustbin for all manner of human suffering.
Now, let us grant – let us grant as the orthodoxy has it that every person inherits a certain compliment of genes that make him or her more or less vulnerable to developing depression or a state that may be diagnosed as depression during his or her lifetime. And let us also begin to refer to this state rather than depression as the depressive position to include both clinical depression and milder forms of depressed moods.