Medicalising the moral: the case of depression as revealed in internet blogs

Abstract

Depression is regularly declared to be equivalent to a bodily illness, yet critics have long contested this ‘medical’ view of mental disorders. Following the ideas of Szasz and Foucault, we describe an alternative ‘moral’ view of depression, which emphasises the agency of the individual and presents depression as a potentially problematic but meaningful response that can be regarded as an aspect of character. We use popular internet blogs by people with depression to explore these contrasting conceptions, which can also be found in other research and information on depression. In blogs, the medical view is used to challenge what bloggers perceive as a persistently influential moral view, by deflecting criticism and responsibility and disowning unwanted aspects of the self. At the same time, bloggers make positive use of the moral concept of depression when discussing recovery. The moral view enables people to take active steps to address their difficulties and to integrate the experience of depression into their understanding of themselves in a challenging yet rewarding process of personal development. We suggest that the moral view of depression represents an enduring aspect of our understanding of ourselves, which the medical view has been superimposed onto, but has not managed to suppress.

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References

  1. Barr, M., and D. Rose. 2008. The great ambivalence: Factors likely to affect service user and public acceptability of the pharmacogenomics of antidepressant medication. Sociology of Health & Illness 30 (6): 944–958. https://doi.org/10.1111/j.1467-9566.2008.01116.x.

    Article  Google Scholar 

  2. Blumner, K.H., and S.C. Marcus. 2009. Changing perceptions of depression: Ten-year trends from the general social survey. Psychiatric Services 60 (3): 306–312. https://doi.org/10.1176/appi.ps.60.3.306.

    Article  Google Scholar 

  3. Brown, C., D.R. Battista, S.M. Sereika, R.D. Bruehlman, J. Dunbar-Jacob, and M.E. Thase. 2007. Primary care patients' personal illness models for depression: Relationship to coping behavior and functional disability. General Hospital Psychiatry 29 (6): 492–500. https://doi.org/10.1016/j.genhosppsych.2007.07.007.

    Article  Google Scholar 

  4. Cederstrom, C. 2018. The happiness fantasy. Cambridge: Polity Press.

    Google Scholar 

  5. Conrad, P. 2009. Medicalization and social control. Annual Review of Sociology 18: 209–232.

    Article  Google Scholar 

  6. Conrad, P., and D. Potter. 2000. From hyperactive children to ADHD adults: Observations on the expansion of medical categories. Social Problems 47 (4): 559–582.

    Article  Google Scholar 

  7. Correira, T. 2017. Revisiting medicalization: A critique of the assumptions of what counts as medical knowledge image. Frontiers in Sociology 2: 14. https://doi.org/10.3389/fsoc.2017.00014.

    Article  Google Scholar 

  8. Dietrich, S., R. Mergl, P. Freudenberg, D. Althaus, and U. Hegerl. 2010. Impact of a campaign on the public's attitudes towards depression. Health Education Research 25 (1): 135–150. https://doi.org/10.1093/her/cyp050.

    Article  Google Scholar 

  9. Duncan, P. D. N. 2018. Four million people in England are long-term users of antidepressants. The Guardian, 10th August 2018. https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants. Accessed 3 June 2020.

  10. Ferguson, I. 2007. Neoliberalism, happiness and wellbeing. International Socialism 117: 117.

    Google Scholar 

  11. Fischer, J.M. 2006. My way: Essays on moral responsibility. Oxford: Oxford University Press.

    Google Scholar 

  12. Foucault, M. 1965. Madness and civilisation. New York: Random House Inc.

    Google Scholar 

  13. Fullagar, S. 2009. Negotiating the neurochemical self: Anti-depressant consumption in women's recovery from depression. Health 13 (4): 389–406. https://doi.org/10.1177/1363459308101809.

    Article  Google Scholar 

  14. Fullagar, S., and W. O'Brien. 2013. Problematizing the neurochemical subject of anti-depressant treatment: The limits of biomedical responses to women's emotional distress. Health 17 (1): 57–74. https://doi.org/10.1177/1363459312447255.

    Article  Google Scholar 

  15. Fullagar, S., and W. O'Brien. 2014. Social recovery and the move beyond deficit models of depression: A feminist analysis of mid-life women's self-care practices. Social Science and Medicine 117: 116–124. https://doi.org/10.1016/j.socscimed.2014.07.041.

    Article  Google Scholar 

  16. Fullagar, S., and W. O’Brien. 2018. Rethinking women's experiences of depression and recovery as emplacement: Spatiality, care and gender relations in rural Australia. Journal of Rural Studies 58: 12–19.

    Article  Google Scholar 

  17. Gonzalez-Moreno, M., C. Saborido, and D. Teira. 2015. Disease-mongering through clinical trials. Studies in History and Philosophy of Biological and Biomedical Sciences 51: 11–18. https://doi.org/10.1016/j.shpsc.2015.02.007.

    Article  Google Scholar 

  18. Greenberg, G. 2010. Manufacturing depression: The secret history of a modern disease. London: Bloomsbury Publishing.

    Google Scholar 

  19. Hansson, M., J. Chotai, and O. Bodlund. 2010. Patients' beliefs about the cause of their depression. Journal of Affective Disorders 124 (1–2): 54–59. https://doi.org/10.1016/j.jad.2009.10.032.

    Article  Google Scholar 

  20. Health and Social Care Information Centre. 2015. Health survey for England 2014. London: Health and Social Care Information Centre.

    Google Scholar 

  21. Healy, D. 1997. The antidepressant era. New York: Harvard University Press.

    Google Scholar 

  22. Healy, D. 2015. Serotonin and depression. British Medical Journal 350: h1771. https://doi.org/10.1136/bmj.h1771.

    Article  Google Scholar 

  23. Hookway, N. 2008. ‘Entering the blogosphere': Some strategies for using blogs in social research. Qualitative Research 8: 91–113.

    Article  Google Scholar 

  24. Johnstone, L.B.M., J. Cromby, J. Dillon, D. Harper, P. Kinderman, E. Longden, D. Pilgrim, and J. Read. 2018. The power threat meaning framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.

    Google Scholar 

  25. Kangas, I. 2001. Making sense of depression: Perceptions of melancholia in lay narratives. Health 5: 76–92. https://doi.org/10.1177/136345930100500104.

    Article  Google Scholar 

  26. Karp, D.A. 1994. Living with depression: Illness and identity turning points. Qualitative Health Research 4: 6–30.

    Article  Google Scholar 

  27. Kirsch, I. 2010. The emperor's new drugs: Exploding the antidepressant myth. London: Basic Books.

    Google Scholar 

  28. Kokanovic, R., E. Butler, H. Halilovich, V. Palmer, F. Griffiths, C. Dowrick, and J. Gunn. 2013. Maps, models, and narratives: The ways people talk about depression. Qualitative Health Research 23 (1): 114–125. https://doi.org/10.1177/1049732312467231.

    Article  Google Scholar 

  29. Lafrance, M.S.J. 2006. Constructing a non-depressed self: Women's accounts of recovery from depression. Feminism and Psychology 16 (3): 307–325.

    Article  Google Scholar 

  30. Laing, R.D. 1965. The divided self. London: Pelican Books.

    Google Scholar 

  31. Levine, D. 2017. Is depression a disease? US News. https://health.usnews.com/health-care/patient-advice/articles/2017-09-19/is-depression-a-disease. Accessed 19 Sept 2017.

  32. Longden, E., and J. Read. 2016. Social adversity in the etiology of psychosis: A review of the evidence. American Journal of Psychotherapy 70 (1): 5–33. https://doi.org/10.1176/appi.psychotherapy.2016.70.1.5.

    Article  Google Scholar 

  33. Lupton, D. 2014. Digital sociology. London: Routledge.

    Google Scholar 

  34. Malpass, A., A. Shaw, D. Sharp, F. Walter, G. Feder, M. Ridd, and D. Kessler. 2009. "Medication career" or "moral career"? The two sides of managing antidepressants: A meta-ethnography of patients' experience of antidepressants. Social Science and Medicine 68 (1): 154–168.

    Article  Google Scholar 

  35. Martin, M.W. 1999. Depression: Illness, insight and identity Philosophy. Psychiatry & Psychology 6: 271–286.

    Google Scholar 

  36. McLeod, K. 2014. The missing work of collaboration: Using assemblages to rethink antidepressant action. Contemporary Drug Problems 41: 109–142.

    Article  Google Scholar 

  37. McLeod, K. 2017. Wellbeing machine: How health emerges from the assemblages of everyday life. Durham, NC: Carolina Academic Press.

    Google Scholar 

  38. Meyer, A. 1948. The commonsense psychiatry of Dr Adolf Meyer. New York: McGraw Hill.

    Google Scholar 

  39. Moncrieff, J. 2008. The creation of the concept of the antidepressant: An historical analysis. Social Science and Medicine 66: 2346–2355.

    Article  Google Scholar 

  40. Moncrieff, J., and D. Cohen. 2006. Do antidepressants cure or create abnormal brain states? PLoS Medicine 3 (7): e240.

    Article  Google Scholar 

  41. Munizza, C., P. Argentero, A. Coppo, G. Tibaldi, M. Di Giannantonio, R.L. Picci, and P. Rucci. 2013. Public beliefs and attitudes towards depression in Italy: A national survey. PLoS ONE 8 (5): e63806. https://doi.org/10.1371/journal.pone.0063806.

    Article  Google Scholar 

  42. National Institute of Mental Health. 2018. Depression: What you need to know. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml. Accessed 5 Dec 2018.

  43. O’Brien, W.F.S. 2008. Rethinking the relapse cycle of depression and recovery: A qualitative investigation of women's experiences. Social Alternatives 27: 6–13.

    Google Scholar 

  44. Pilgrim, D. 2019. Key concepts in mental health. London: Sage.

    Google Scholar 

  45. Pilkington, P.D., N.J. Reavley, and A.F. Jorm. 2013. The Australian public's beliefs about the causes of depression: Associated factors and changes over 16 years. Journal of Affective Disorders 150 (2): 356–362. https://doi.org/10.1016/j.jad.2013.04.019.

    Article  Google Scholar 

  46. Press Association, P. 2018. Antidepressant prescriptions in England double in a decade. The Guardian, 29th March 2019. https://www.theguardian.com/society/2019/mar/29/antidepressant-prescriptions-in-england-double-in-a-decade. Accessed 3 June 2020.

  47. Prins, M.A., P.F. Verhaak, J.M. Bensing, and K. van der Meer. 2008. Health beliefs and perceived need for mental health care of anxiety and depression—The patients' perspective explored. Clinical Psychology Review 28 (6): 1038–1058. https://doi.org/10.1016/j.cpr.2008.02.009.

    Article  Google Scholar 

  48. Rogers, A., C. May, and D. Oliver. 2001. Experiencing depression, experiencing the depressed: The separate worlds of patients and doctors. Journal of Mental Health 10 (3): 317–333.

    Article  Google Scholar 

  49. Shaw, I., and L. Woodward. 2017. The medicalisation of unhappiness? The management of mental distress in primary care. In Constructions of Health and Illness. European Perspectives, ed. I. Shaw and K. Kaupinnen, 124–136. London: Routledge.

    Google Scholar 

  50. Smardon, R. 2008. 'I'd rather not take Prozac': Stigma and commodification in antidepressant consumer narratives. Health (London) 12 (1): 67–86. https://doi.org/10.1177/1363459307083698.

    Article  Google Scholar 

  51. Stepnisky, J. 2007. The biomedical self: Hermeneutic considerations. Social Theory and Health 5 (3): 187–207.

    Article  Google Scholar 

  52. Stevenson, F., and P. Knudsen. 2008. Discourses of agency and the search for the authentic self: The case of mood-modifying medicines. Social Science & Medicine 66 (1): 170–181.

    Article  Google Scholar 

  53. Szasz, T. 1960. The myth of mental illness. American Psycholgist 15: 113–118.

    Article  Google Scholar 

  54. Szasz, T. 1970. Ideology and insanity; essays on the psychiatric dehumanization of man. New York: Anchor Books.

    Google Scholar 

  55. Szasz, T. 1996. The meaning of mind: Language, morality and neuroscience. Westport, CT: Praeger.

    Google Scholar 

  56. Szasz, T. 2000. Mental disorders are not diseases. https://www.szasz.com/usatoday.html. Accessed 3 July 2019.

  57. Taylor, C. 1989. Sources of the self; the making of the modern identity. Boston: Harvard University Press.

    Google Scholar 

  58. Taylor, S., F. Annand, P. Burkinshaw, F. Greaves, M. Kelleher, J. Knight, C. Perkins, A. Tran, M. White, and J. Marsden. 2019. Dependence and withdrawal associated with some prescribed medicines: an evidence review. London: Public Health England.

    Google Scholar 

  59. van Schaik, D.J., A.F. Klijn, H.P. van Hout, H.W. van Marwijk, A.T. Beekman, M. de Haan, and R. van Dyck. 2004. Patients' preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry 26 (3): 184–189. https://doi.org/10.1016/j.genhosppsych.2003.12.001.

    Article  Google Scholar 

  60. www.nhs.uk. 2018. Overview: Clinical depression. https://www.nhs.uk/conditions/clinical-depression/. Accessed 3 June 2020.

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Correspondence to Joanna Moncrieff.

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Conneely, M., Higgs, P. & Moncrieff, J. Medicalising the moral: the case of depression as revealed in internet blogs. Soc Theory Health (2020). https://doi.org/10.1057/s41285-020-00141-1

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Keywords

  • Depression
  • Blogs
  • Medical model of mental disorder
  • Medical model of depression
  • Lay views of depression
  • Szasz
  • Foucault