Medicalization and ideology

I’m often struck by how deeply affected our common discourse has been by the language psychology. Nowhere is this clearer than in the absolutely pervasive use of the term “depressed” to refer to virtually any negative emotional state. One rarely hears the word “sad” anymore — everything that was previously “sad” is now “depressing.”

What changes with the shift to “depressing”? The negative affect is subtly pathologized, as the vocabulary for talking about the natural response to bad events is collapsed into the terminology used to talk about a general disposition — a distinction that we might previously have made by contrasting momentary and understandable sadness with a broadly melancholy disposition. There is of course a distinction between situational depression and “clinical” depression, but the pervasive use of depression leads toward a sense that all depression is, at bottom, clinical depression. The result is a tendency to want to treat depression “directly” rather than, for instance, making life less depressing. If people are more depressed nowadays, maybe it’s because life sucks more for people and seems to be on a path toward ever-greater suckiness — less job security leads to more worry, for instance, which has cascading effects on family relationships, etc. But since changing that is supposedly impossible, we must simply face up to reality and learn to love it, or else take some psychotropic drugs to rewire our brains until we can tolerate it better. (That latter solution couldn’t possibly have any negative side-effects, of course. On the other hand, it could. And even more – making life much less easy, like in the case of Taxotere lawsuit).

One can see a similar pattern in the widespread diagnosis of AD/HD. Doubtless many people do have some kind of persistent problem concentrating, such that medical intervention is justified and necessary (yet the case of Xarelto lawsuit settlement shows people should be conscious about any kind of treatment). It seldom seems to occur to people that maybe kids have trouble concentrating in school because school is unengaging. Again, the symptom is pathologized and worked on “directly,” while the overall situation doesn’t come into question — leading to the strange circumstance where a whole generation of younger people seems to be mysteriously afflicted with the inability to concentrate. Kids these days, huh? Must be something in the water! It couldn’t be, for example, the fact that funding for art and music is always the first thing to do, or that kids are increasingly being “taught the test,” etc.

Examples could be multiplied, and I’m pretty sure the same pattern would emerge in each case: pathologizing individual emotional states provides an alternative to any broader systemic critique. The problem is never with the social system — the problem is that you are not able to adapt to it adequately. The question of whether some things shouldn’t be adapted to never comes up.

6 thoughts on “Medicalization and ideology

  1. Adam, have you ever read Lou Marinoff’s work– Plato, Not Prozac or Philosophical Practice? One of his critiques of psychology is that inexact emotive terminology has become systematically integrated into the practice of psychology.

  2. I think that psychology has done a decent job differentiating between depression and major depressive disorder. There’s a large distance separating those two clinical presentations. A diagnosis of dysthymia (which is a low-grade depression) is something more akin to a ‘depressive’ personality.

    I think you’re on target and I have a thought regarding psychotherapy and groups. Currently, I’m co-leading a psychotherapy group. Time and time again, I’m reminded how easy it is for a certain member to become pathologized and scapegoated. It is so much easier for everyone to recognize that the problem resides in that individual while failing to understand how the group is contributing to the problem. Trying to recognize how the group as a whole is unconsciously “activating” a certain member to act out is a very difficult and trying task. It is much easier to pathologize the singular individual.

    Many studies have found that there is a consistent racial bias in diagnostics. For example, African Americans are generally given more severe diagnoses. Psychologists continue to bemoans this fact and feel bad for this over-pathologization, which is of course awful. What everyone seems to not acknowledge is that the way society structures encourage the expression of these more pathological symptoms. It is well known that the identical twin of someone who suffers from schizophrenia only has a 50% chance of developing chronic schizophrenia. Hence, the stress and contingencies of one’s environment does have a great effect on the expression of pathology. I recognize a racial bias exists in diagnostics, but what I find more disturbing is that society structures itself in such a way that encourages certain marginalized population to develop severer psychopathology because of awful health care and unjust economic opportunities. Not to mention, this racial diagnostic bias only further serves to deflect the attention away from societal injustices and to locate the pathology in the individual.

  3. Dunno if you’ve read it yet, but Mark Fisher makes a very similar point in Capitalist Realism. In a joking, but interesting way he asks for a Marxist Super-Nanny (Super-Nanny is a programme on TV whereby a highly trained nanny basically sorts out disobedient often ADHD children) that examines the causes of pathology rather than simply treats their effects.

  4. Yes, amongst some anthropologists it has been remarked that, in medicine, the object of diagnosing the individual is never to heal the individual as such but instead to heal (maintain) society.

  5. I think Perls or Berne said:

    Depression is the id cringing under attacks from the superego; or the child cringing before the punishing parent; or suffering guilt under accepted authority.

    Which leads to an interpretation of unemployment or deflationary “depressions” and what dbarber said. People starve while bankers thrive. Why?

    I forget the contrast made with despair (superego beating on ego?) but intelligence had sociopathic possibilities of liberation that are not available to the depressed.

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