The Problems with the Medicalization of Depression in Developed Countries

Overview

According to the World Health Organization, "depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease."

Clinical depression is categorized as mild, moderate or severe, depending on the episode. In a mild episode the individual may show symptoms but be functioning, while in a severe case the individual is unlikely to continue with regular activities and may experience suicidal feelings. Though more likely to be experienced by those with a family history of depression, it can be triggered by life-changing events such as bereavement or giving birth, or it can come on for no reason at all. According to the World Health Organization there are two prominent forms of Depression: Recurrent Depressive Disorder (Chronic Depression) and Bipolar Affective Disorder (Manic Depression). Individuals with the latter experience both depressed episodes and manic episodes.

Since the full medicalization of depression and other mental illnesses there have been thousands of life-saving breakthroughs in developed countries. However, as these capitalist medical and pharmaceutical industries have developed away from the authority of the doctor, significant limitations have arisen. Examples of these relate to misdiagnosis, profit-driven action and the impact on social justice and minority groups. Researchers now question the medicalization of depression in countries such as Canada, the US and the UK, and compare results to underdeveloped countries which do not even view it as an illness but which, for example, have higher rates of people with religious faith.

Treatment

Common treatments vary between a mixture of lifestyle changes, psychological treatments and medication.

• Psychological Treatments include Behavioural activation, cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT).

• Pharmacological Treatments include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

History

Prior to the 18th century, the word melancholia was used in reference to the medical condition now known as depression, and it was considered a spiritual condition brought on by demonic possession. this view was shared by many cultures such as the Greeks, Romans, Babylonians, Chinese and Egyptians. Methods of treatment by priests generally included beating, starvation, exorcisms and executions.

The term depression first originated in the works of Samuel Johnson in the 18th century, describing low spirits. Examples of treatments around this time were: water immersion, dizziness, electroshock therapy and changes in diet.

In the late 19th century and throughout the 20th century further research was conducted, distinguishing different forms of depression from normal emotion. Before medical explanations there were psychoanalytic explanations (that it was a response for physical or symbolic loss), behavioural explanations (that it was learned behaviour from others), and then cognitive explanations (that it was due to errors interpreting information, causing automatic negative thoughts). Though these theories were largely incorrect in encompassing depression as an illness, they played an important part in discovering non-pharmacological treatment.

In the 1970s the first medical and biological models of depression emerged, relating it to genetics, chemical imbalance and hormones.

Issues

Misdiagnosis

As mental illnesses such as depression are often physically invisible, a problem with the introduction of medical treatment will always be the risk of misdiagnosis. Furthermore, profit maximisation as an agenda can lead to overdiagnosis (too many people being diagnosed) and result in misinformed statistics. There is a school of thought that in the process of diagnosis there is not enough differentiation between normal sadness (an appropriate intensity of sadness linked to a clear cause) and abnormal sadness (depression). The distinction between sadness as a part of normal human emotion, and clinical depression, is increasingly unidentifiable yet exceedingly important due to the involvement of chemical treatment and healthcare funding. In the diagnostic criteria for depression in the UK, for example, there is the exemption clause that people showing symptoms after bereavement should not be diagnosed with depression. Researchers Allan V Horowitz and Jerome C Wakefield in their book "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder" argue that there are many other triggers of sadness which should also be taken into account to avoid misdiagnosis. Misdiagnosis can result in a placebo effect, and cause health problems or at the very least cause the individual to have heightened psychological distress.

Profit

The medicalization of depression and other mental illnesses began with doctors, but the power is now in the hands of pharmaceutical industries, biotechnologies, and mass media. In capitalist societies there is little restraint or regulation on these profit-generating corporations. Among the developed nations, the US now has the most expensive healthcare system, despite having the technology to mass-produce and reduce costs. Many researchers now claim pharmaceutical companies in the US spend more on marketing than on research and development. Marketing treatment for mental illnesses such as anxiety and depression is especially detrimental because the suffering individuals are already psychologically vulnerable and susceptible to advertising and false promises made by campaigns. This method of broadening the boundaries of illness in order to expand the market and create profit is called disease mongering. As a group, the world's largest publicly traded pharmaceutical companies are referred to as Big Pharma. These include, Pfizer (US), Hoffman-La Roche (Switzerland), Novartis (Switzerland), Merck & Co. (US), GlaxoSmithKlein (UK) and many more. As the cost of healthcare rises, by 2021 Big Pharma profits from prescription medication are expected to reach US$610 billion.

Increasing the Problem

As well as a focus on profit maximisation through disease mongering, Big Pharma have been accused of attempting to increase revenue by producing prescription drugs which worsen conditions or have adverse side effects, ultimately leading to people purchasing more of their product. Since mass medicalization, there have been multiple Big Pharma lawsuits on cases such as marketing fraud. That is to say that, as well as being expensive, pharmaceutical treatments for depression such as SSRIs and TCAs can be as damaging to health as they are healing. Some of the known possible side effects of TCAs, for example, include: increased heart rate, tremors, sexual difficulties, constipation, headache, insomnia and nausea. Corporations in Big Pharma know that these side effects may cause people to turn to more medication. Additionally, studies have shown the medicalization of depression to be detrimental because it increases medical help-seeking behaviours as a substitute for social resources and the ability to self-soothe and work through normal emotions.

Social Justice and Minority Groups

The Meyer (2003) minority stress model proposes that difficult social situations cause disproportionate stress for minority groups (such as ethnic, religious, and the LGBTQ+ community), and over time this can result in mental health issues like depression. A study on LGBQ university students supports this as they had the highest rate of depression, mainly due to underlying expectations of rejection and internalized heterosexism among other things informed by past experiences. This becomes an even greater issue when other factors are considered. Minority groups typically have a lower standard of health due to lower quality care or avoidance of the health service because of discrimination, and they also typically earn less because of social barriers in education and the workplace. This, alongside the rising health costs due to the actions of Big Pharma, results in minority groups struggling disproportionately with depression since its medicalization. In summary, because of factors caused by medicalization, the people who are most affected by depression are also the ones who struggle to afford the treatment.