Tuesday, August 21, 2007

No Depression

How is depression defined (and, thus, how should it be treated?)? Two nice pieces today worth your while.

Philosopher's Playground: "Matters of Semantics"
As I have learned from reading Aspazia's research over the years, the way that mental illnesses in the DSM (the psychiatrist's Chilton guide) are defined is not the clean neuro-anatomical sort of process you might think at the outset. For the most part, a group of psychiatrists chosen by a larger group of psychiatrists sit in a room and negotiate (a) whether the behavior pattern is outside the norm enough, debilitating or dangerous enough to the person or others with whom he may come in contact with, or in some other way sufficiently undesirable to warrant classification as a mental illness, (b) if so, which symptoms, thought patterns, emotions, or behaviors that tend to be associated with those diagnosed with the problem are the ones that ought to be the defining characteristics and which are mere accidental regularities. These are renegotiated every few years and change with advances in understanding of the causal mechanisms, advances in treatment, cultural norms, and "informational seminars" given by drug companies.
3 Quarks Daily: "Is Depression a Medical Condition?"
Why is the experience of antidepressants so variable? Medical anthropologists have known for a long time that medicines are not just taken by bodies; they are incorporated into cultures, that is to say into preexisting cosmologies that permit certain reponses to things ingested, encourage some, and exclude others. There may be a single, context-neutral fact about what St. John's Wort does in the body (as it happens, probably nothing); but there is no such fact about the role that said wort will play in a culture. In our bodies, it brings about its minor effects and passes through; in our culture's fantasies --and in our culture's economy-- it does a good deal more: it contributes to that nebulous condition we call 'wellness'; it cleanses its consumer of vaguely defined toxins; it purges 'free radicals', whatever the hell those might be; it signals 'consciousness' to other consumers. It is not to be mixed with gin or Diet Dr. Pepper. Now of course consumers of St. John's Wort are likely to be suspicious of chemical antidepressants, but many of the same considerations may be brought to bear in the one case as in the other. For both, success in our culture depends upon the substance's symbolic role in a system of oppositions. Better living through mere chemistry is never enough; the pharmaceutical companies understand that it is principally through marketing --that is, positioning some chemical or other in the desired social role-- that that chemical comes to be perceived as a means to better living.

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