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Subjectivity

, Volume 11, Issue 2, pp 144–160 | Cite as

Making sense of the evolving nature of depression narratives and their inherent conflicts

  • Damien Ridge
Original Article

Abstract

Originally a psychiatric diagnosis fashioned by Western psychiatry in the twentieth century, depression evolved to encompass varying lineages of discourse and care. This article elucidates some of the current challenges—as well as emerging discourses—influencing the category of depression. Depression-like experiences are shaped by (at times conflicting) subjectivities, claims to knowledge, material realities, social contexts and access to resources. With no unified understanding of the category of ‘depression’ available, lay people, social scientists and neuroscientists, GPs, psychiatrists, talking therapists and pharmaceutical companies all attempt to shape narratives of depression. The current paper focuses on patient narratives about depression—in the context of these wider debates—to better elucidate the ways in which depression discourses are publicly developing along varying lines. In conclusion, the paper suggests that we could better conceptualise the resulting ‘depression(s)’ with concepts such as ‘society of mind’ and notions of subjectivity unbounded by individuals.

Keywords

Depression Narrative Patient experience Psychiatry 

Notes

Acknowledgements

I would like to sincerely thank all those participants who shared with us their intimate stories so generously (see healthtalk.org for more details of credits); the reviewers for their thought-provoking commentary; and Renata Kokanovic and the editors for their patience and encouragement. I would like to thank Alex Broom and Volker Scheid, discussions and exchanges with whom helped to shape the original paper, along with Renata Kokanovic and the organisers of the excellent Broken Narratives and the Lived Body conference held at the Monash Prato Centre in Italy in 2016, where this paper was first presented. The feedback from the anonymous reviewers was valuable in further developing the arguments in the paper, and critical readings of the manuscript by Petra Makela and Alison Fixsen helped to clarify the final paper.

Compliance with ethical standards

Conflict of interest

The author declares no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

  1. Anderson, C., S. Kirkpatrick, D. Ridge, R. Kokanovic, and C. Tanner. 2015. Commencing antidepressant use: A qualitative synthesis of UK and Australian data. British Medical Journal Open 5 (12): e008636.Google Scholar
  2. Berrios, G.E. 1988. Melancholia and depression during the 19th century: A conceptual history. The British Journal of Psychiatry 153 (3): 298–304.CrossRefGoogle Scholar
  3. Blackman, L. 2014. Affect and automaticy: Towards an analytics of experimentation. Subjectivity 7 (4): 362–384.CrossRefGoogle Scholar
  4. Blatt, S.J. 1998. Contributions of psychoanalysis to the understanding and treatment of depression. Journal of the American Psychoanalytic Association 46 (3): 723–752.CrossRefGoogle Scholar
  5. Braslow, J.T. 2013. The manufacture of recovery. Annual Review of Clinical Psychology 9 (1): 781–809.CrossRefGoogle Scholar
  6. Braun, V., and V. Clarke. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3 (2): 77–101.CrossRefGoogle Scholar
  7. Buus, N. 2014. Adherence to anti-depressant medication: A medicine-taking career. Social Science and Medicine 123: 105–113.CrossRefGoogle Scholar
  8. Cipriani, A., T. Furukawa, G. Salanti, A. Chaimani, L. Atkinson, Y. Ogawa, et al. 2018. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet 391 (10128): 1357–1366.CrossRefGoogle Scholar
  9. Clark, D.M. 2011. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry 23 (4): 318–327.CrossRefGoogle Scholar
  10. Cooksey, E.C., and P. Brown. 1998. Spinning on its axes: DSM and the social construction of psychiatric diagnosis. International Journal of Health Services 28 (3): 525–554.CrossRefGoogle Scholar
  11. Cooper, M. 2004. Towards a relationally-orientated approach to therapy: Empirical support and analysis. British Journal of Guidance and Counselling 32 (4): 451–460.CrossRefGoogle Scholar
  12. Cosgrove, L., S. Krimsky, M. Vijayaraghavan, and L. Schneider. 2006. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics 75 (3): 154–160.CrossRefGoogle Scholar
  13. Cromby, J. 2016. Developing schizophrenia. Theory & Psychology 26 (5): 607–619.CrossRefGoogle Scholar
  14. Cuthbert, B.N., and T. Insel. 2013. Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine 11 (1): 126.CrossRefGoogle Scholar
  15. Davidson, L., M. O’Connell, J. Tondora, M. Lawless, and A. Evans. 2005. Recovery in serious mental illness: A new wine or just a new bottle? Professional Psychology: Research and Practice 36 (5): 480–487.CrossRefGoogle Scholar
  16. Davis, S.C. 2014. Annual report of the chief medical officer 2013: Public mental health priorities-investing in the evidence. London: Department of Health.Google Scholar
  17. Dowrick, C. 2004. Beyond depression: A new approach to understanding and management. Oxford: Oxford University Press.Google Scholar
  18. Dowrick, C., and A. Frances. 2013. Medicalising unhappiness: New classification of depression risks more patients being put on drug treatment from which they will not benefit. BMJ.  https://doi.org/10.1136/bmj.f7140.Google Scholar
  19. Driessen, E., P. Pim Cuijpers, S. de Maat, A. Abbass, F. de Jonghe, and J. Dekker. 2010. The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis. Clinical Psychology Review 30 (1): 25–36.CrossRefGoogle Scholar
  20. Dye, J.F., I. Schatz, B. Rosenberg, and S. Coleman. 2000. Constant comparison method: A kaleidoscope of data. The Qualitative Report 4 (1): 1–10.Google Scholar
  21. Emslie, C., D. Ridge, S. Ziebland, and K. Hunt. 2006. Men’s accounts of depression: Reconstructing or resisting hegemonic masculinity? Social Science and Medicine 62: 2246–2257.CrossRefGoogle Scholar
  22. Epstein, R.M., P.R. Duberstein, M.D. Feldman, A.B. Rochlen, R.A. Bell, et al. 2010. “I Didn’t Know What Was Wrong:” How people with undiagnosed depression recognize, name and explain their distress. Journal of General Internal Medicine 25 (9): 954–961.CrossRefGoogle Scholar
  23. Fava, M., A. Memisoglu, M.E. Thase, J.A. Bodkin, M.H. Trivedi, et al. 2016. Opioid modulation with buprenorphine/samidorphan as adjunctive treatment for inadequate response to antidepressants: A randomized double-blind placebo-controlled trial. American Journal of Psychiatry 173 (5): 499–508.CrossRefGoogle Scholar
  24. Fonagy, P., F. Rost, J.A. Carlyle, S. McPherson, R. Thomas, et al. 2015. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: The Tavistock Adult Depression Study (TADS). World Psychiatry 14 (3): 312–321.CrossRefGoogle Scholar
  25. Foot, D., and D. Ridge. 2012. Constructing the placebo effect in the placebo wars: What is the way ahead? Health Sociology Review 21 (3): 355–368.CrossRefGoogle Scholar
  26. Fraser, M. 2001. The nature of Prozac. History of the Human Sciences 14 (3): 56–84.CrossRefGoogle Scholar
  27. Gabbard, G.O. 2010. Long-term psychodynamic psychotherapy: A basic text. Arlington, VA: American Psychiatric Publications.Google Scholar
  28. Gallagher, J., Buchanan, R., and Luck-Baker, A. 2016. Depression: A revolution in treatment? In BBC News. London: BBC.Google Scholar
  29. Gordon, S.E. 2013. Recovery constructs and the continued debate that limits consumer recovery. Psychiatric Services 64 (3): 270–271.CrossRefGoogle Scholar
  30. Healy, D. 2015. Serotonin and depression. British Medical Journal 350: h1771.CrossRefGoogle Scholar
  31. Hermans, H. 2013. The dialogical self in education. Journal of Constructivist Psychology 26 (2): 81–89.CrossRefGoogle Scholar
  32. Hollway, W., and T. Jefferson. 1997. Eliciting narrative through the in-depth interview. Qualitative Inquiry 3 (1): 53–70.CrossRefGoogle Scholar
  33. Janssen, I., L. Krabbendam, M. Bak, M. Hanssen, W. Vollebergh, R. de Graaf, and J. van Os. 2004. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109 (1): 38–45.CrossRefGoogle Scholar
  34. Johnsen, T.J., and O. Friborg. 2015. The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychological Bulletin 141 (4): 747–768.CrossRefGoogle Scholar
  35. Kendrick, T. 2015. Long-term antidepressant treatment: Time for a review? Prescriber 26 (19): 7–10.CrossRefGoogle Scholar
  36. Kessler, R.C., C.B. Nelson, K.A. McGonagle, J. Liu, et al. 1996. Comorbidity of DSM-III—R major depressive disorder in the general population: Results from the US National Comorbidity Survey. The British Journal of Psychiatry 168 (Suppl 30): 17–30.Google Scholar
  37. Kinderman, P., P. Pini, and S. Wooley. 2017. Mental Health Europe’s “Beyond the Bio-medical Paradigm Task Gorce” issues on ICD-10. European Psychiatry 41 (Supplement): S460.CrossRefGoogle Scholar
  38. Kirsch, I., B.J. Deacon, T.B. Huedo-Medina, A. Scoboria, T.J. Moore, and B.T. Johnson. 2008. Initial severity and antidepressant benefits: A meta-analysis of data submitted to the food and drug administration. PLoS Medicine 5 (2): e45.CrossRefGoogle Scholar
  39. Kleinman, A., and B. Good. 1985. Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder. Berkley: University of California Press.Google Scholar
  40. Knekt, P., O. Lindfors, T. Härkänen, M. Välikoski, E. Virtala, et al. 2008. Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine 38 (05): 689–703.CrossRefGoogle Scholar
  41. Knight, F., D. Ridge, R. McShane, S. Ryan, and L. Griffith. 2017. Care, control, and the electroconvulsive therapy ritual: Making sense of polarized patient narratives. Qualitative Health Research 27 (11): 1675–1685.CrossRefGoogle Scholar
  42. Kokanovic, R., C. May, C. Dowrick, J. Furler, D. Newton, and J. Gunn. 2010. Negotiating distress between East Timorese and Vietnamese migrants in Melbourne and their family doctors. Sociology of Health & Illness 32 (4): 511–527.CrossRefGoogle Scholar
  43. Körner, H., C.E. Newman, L. Mao, M.R. Kidd, D.C. Saltman, and S. Kippax. 2011. Discourses of depression of Australian general practitioners working with gay men. Qualitative Health Research 21 (8): 1051–1064.CrossRefGoogle Scholar
  44. Kua, E.H., P.H. Chew, and S.M. Ko. 1993. Spirit possession and healing among Chinese psychiatric patients. Acta Psychiatrica Scandinavica 88 (6): 447–450.CrossRefGoogle Scholar
  45. Lacasse, J.R., and J. Leo. 2005. Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Med 2 (12): e392.CrossRefGoogle Scholar
  46. Lacasse, J.R., and J. Leo. 2015. Antidepressants and the chemical imbalance theory of depression: A reflection and update on the discourse. The Behavior Therapist 38 (7): 206–213.Google Scholar
  47. Latour, B. 2004. How to talk about the body? The normative dimension of science studies. Body & Society 10 (2–3): 205–229.CrossRefGoogle Scholar
  48. Lebowitz, M.S., and W. Ahn. 2015. Emphasizing malleability in the biology of depression: Durable effects on perceived agency and prognostic pessimism. Behaviour Research and Therapy 71: 125–130.CrossRefGoogle Scholar
  49. Lebowitz, M.S., and W. Ahn. 2017. Testing positive for a genetic predisposition to depression magnifies retrospective memory for depressive symptoms. Journal of Consulting and Clinical Psychology 85(11): 1052–1063.CrossRefGoogle Scholar
  50. Leo, J., and Lacasse JR. 2008. The media and the chemical imbalance theory of depression. Society 45 (1): 35–45.CrossRefGoogle Scholar
  51. Lewis, S.E. 1995. A search for meaning: Making sense of depression. Journal of Mental Health 4 (4): 369–382.CrossRefGoogle Scholar
  52. Lomas, T., T. Cartwright, T. Edginton, and D. Ridge. 2013. ‘I was so done in that I just recognized it very plainly, You need to do something”’: Men’s narratives of struggle, distress and turning to meditation. Health 17 (2): 191–208.CrossRefGoogle Scholar
  53. McCarthy, M. 2013. Antidepressant use has doubled in rich nations in past 10 years. British Medical Journal 347: f7261.CrossRefGoogle Scholar
  54. McInnes, I. 2014. Fight against rheumatoid arthritis may unlock secrets to heart disease and depression. The Australian Journal of Pharmacy 95 (1129): 12.Google Scholar
  55. McMullen, L.M., and K.J. Sigurdson. 2014. Depression is to diabetes as antidepressants are to insulin: The unraveling of an analogy? Health Communication 29 (3): 309–317.CrossRefGoogle Scholar
  56. McPherson, S., and D. Armstrong. 2006. Social determinants of diagnostic labels in depression. Social Science and Medicine 62 (1): 50–58.CrossRefGoogle Scholar
  57. McPherson, S., and D. Armstrong. 2009. Negotiating ‘depression’ in primary care: A qualitative study. Social Science and Medicine 69 (8): 1137–1143.CrossRefGoogle Scholar
  58. Middleton, H., and J. Moncrieff. 2011. ‘They won’t do any harm and might do some good’: Time to think again on the use of antidepressants? British Journal of General Practice 61 (582): 47–49.CrossRefGoogle Scholar
  59. Milton, J. 2001. Psychoanalysis and cognitive behavioural therapy—Rival paradigms or common ground. The International Journal of Psychoanalysis 82 (3): 431–447.CrossRefGoogle Scholar
  60. Moncrieff, J., and I. Kirsch. 2005. Efficacy of antidepressants in adults. British Medical Journal 331 (7509): 155–157.CrossRefGoogle Scholar
  61. Morgan, J. 2017. If other ways don’t work, try the immune system? The Lancet Neurology 16 (2): 109.CrossRefGoogle Scholar
  62. NICE. 2009. Depression in Adults: The treatment and management of depression in adults. In NICE clinical guideline 90: National Institute for Health and Clinical Excellence.Google Scholar
  63. Pilgrim, D. 2007. The survival of psychiatric diagnosis. Social Science and Medicine 65 (3): 536–547.CrossRefGoogle Scholar
  64. Pilgrim, D., A. Rogers, and R. Bentall. 2009. The centrality of personal relationships in the creation and amelioration of mental health problems: The current interdisciplinary case. Health 13 (2): 235–254.CrossRefGoogle Scholar
  65. Priebe, S., T. Burns, and T.K.J. Craig. 2013. The future of academic psychiatry may be social. The British Journal of Psychiatry 202 (5): 319–320.CrossRefGoogle Scholar
  66. Ridge, D. 2009. Recovery from depression using the narrative approach. London: Jessica Kingsley Publishers.Google Scholar
  67. Ridge, D., R. Kokanovic, A. Broom, S. Kirkpatrick, C. Anderson, and C. Tanner. 2015. ‘My dirty little habit’: Patient constructions of antidepressant use and the ‘crisis’ of legitimacy. Social Science and Medicine 146: 53–61.CrossRefGoogle Scholar
  68. Ridge, D., and S. Ziebland. 2006. ‘The Old Me Could Never Have Done That’: How people give meaning to recovery following depression. Qualitative Health Research 16 (8): 1038–1053.CrossRefGoogle Scholar
  69. Ridge, D., and S. Ziebland. 2012. Understanding depression through a ‘coming out’ framework. Sociology of Health & Illness 34 (5): 730–745.CrossRefGoogle Scholar
  70. Rizq, R. 2012. The perversion of care: Psychological therapies in a time of IAPT. Psychodynamic Practice 18 (1): 7–24.CrossRefGoogle Scholar
  71. Rogers, A., and D. Pilgrim. 2014. A sociology of mental health and illness. Maidenhead: Open University Press.Google Scholar
  72. Ryan, A., and S. Wilson. 2008. Internet healthcare: Do self-diagnosis sites do more harm than good? Expert Opinion on Drug Safety 7 (3): 227–229.CrossRefGoogle Scholar
  73. Shariatmadari, D. 2015. What is depression? You asked Google—Here’s the answer. In The Guardian. London: The Guardian.Google Scholar
  74. Shepherd, G., J. Boardman, and M. Slade. 2008. Making recovery a reality. London: Sainsbury Centre for Mental Health.Google Scholar
  75. Spence, R., A. Roberts, C. Ariti, and M. Bardsley. 2014. Focus on: Antidepressant prescribing. London: Nuffield Trust.Google Scholar
  76. Stern, M., and A. Brown. 2016. ‘It’s 5:30. I’m exhausted. And I have to go all the way to f*%#ing Fishtown’.: Educator depression, activism, and finding (armed) love in a hopeless (neoliberal) place. The Urban Review 48 (2): 333–354.CrossRefGoogle Scholar
  77. Tamam, L., and N. Ozpoyraz. 2002. Selective serotonin reuptake inhibitor discontinuation syndrome: A review. Advances in Therapy 19 (1): 17–26.CrossRefGoogle Scholar
  78. Trivelli, E. 2014. Depression, performativity and the conflicted body: An auto-ethnography of self-medication. Subjectivity 7 (2): 151–170.CrossRefGoogle Scholar
  79. Victora, C.G., J.P. Habicht, and J. Bryce. 2004. Evidence-based public health: Moving beyond randomized trials. American Journal of Public Health 94 (3): 400–405.CrossRefGoogle Scholar
  80. Wakefield, J.C., and M.B. First. 2012. Validity of the bereavement exclusion to major depression: Does the empirical evidence support the proposal to eliminate the exclusion in DSM-5? World Psychiatry 11 (1): 3–10.CrossRefGoogle Scholar
  81. WHO. 2012. WHO Fact Sheet—Depression. Geneva: World Health Organisation.Google Scholar
  82. Ziebland, S., and K. Hunt. 2014. Using secondary analysis of qualitative data of patient experiences of health care to inform health services research and policy. Journal of Health Services Research & Policy 19 (3): 177–182.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of WestminsterLondonUK

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