Madness as a Social Construct

I was reading an article the other day which expressed a point I’ve often heard:

Depression is an illness.

I’m no mental health expert, but I know I’m supposed to agree with this. And, perhaps, I do. In theory.

Reinforcing depression as an illness is important for a number of reasons:

People shouldn’t feel shame for seeking help. You wouldn’t feel weak for seeing a doctor after a heart attack, for example.

People should know they can’t control depression. You can’t “snap out” of depression the way you might change an outfit. Dedication, determination, effort – these may not make a difference. And that’s no one’s fault.

So it is important to remind people that depression is an illness. An actual issue. It’s far more insidious than a bad day.

Yet, when I read this the other day, it suddenly stuck me as…judgmental.

If depression is an illness, that implies that there is something wrong with people who are depressed.

Someone who is a mental health expert once told me that depression is only a problem for a person who finds it a problem.

That is, every person has the right to be depressed if they choose to be. A person with depression only needs treatment if they feel they need treatment. If they’re not living the life they want to live or being the person they want to be.

I gather this is a contentious idea within the mental health community, and, perhaps, reasonably so.

The right of depression resonates with my support for the unconventional, but this approach raises obvious concerns as well. If someone thinks they don’t deserve to live, is it then their right to act on that belief? Are we obligated to intervene, or should we rather defer to their individual freedom?

If a person feels this way because they are ill – does that change things?

InĀ Madness and Civilization Michel Foucault documents the history of “madness” throughout the modern Western world. Different things have been considered madness at different times, with different explanations, and, of course, different solutions.

The beauty of Foucault’s analysis is that it goes beyond the articulated scientific layer of the day.

Yes, he explores the scientific rational behind the humors, documenting the believed impacts of hard bile or hot blood. But he goes deeper than that, connecting the medical understanding of the day with the moral beliefs that went into it – and the moral implications which come out of the diagnosis.

It is easier and comforting to think of today’s medicinal understanding as pure science, untainted by the bias of morality. But this interplay is perhaps easier to see when looking back at “medicine” which is pure quackery.

Foucault recounts stories of men whose mania was attributed to “excessive intercourse,” and of women who “invent, exaggerate, and repeat all the various absurdities of which a disordered imagination is capable.” This women’s hysteria, one doctor warns, “has sometimes become epidemic and contagious.”

And, lest you laugh this off as the foolishness of the Victorian era, remember that it wasn’t until 1973 that the American Psychiatric Association declassified homosexuality as a mental disorder.

So, there may be some legitimate science to it, but it seems there’s some social construct to it as well.

Is depression an illness? Well, it seems I don’t know.

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