I was interested to read an article published today by a journalist called Mary Kenny on the BBC News website that refers to a longstanding argument about modern-day conceptualisations of sadness and depression. In it, she argues that as the stigma surrounding depression has decreased and it is more ‘acceptable’ as a condition than it was, say, 50 years ago, the idea that periods of sadness, bereavement and loss are part and parcel of normal fluctuations of human experience has been lost.
Increasing openness about personal distress and suffering marks a departure from a time when such things were kept behind closed doors, leaving the individual to suffer alone and in silence. The marked shift in attitudes towards mental health is no doubt a good thing (though there’s still a long way to go), but Kenny fears that the vocabulary now used to describe human experiences of loss and sadness is reductive and the use of medical terms implies that the experiences are indicative of disorder, of something having gone wrong, and therefore not a normal part of human life. She cites increasing use of the technical-sounding term ‘trauma’ in place of grief or mourning: when someone suffers a loss or experiences a particularly emotionally turbulent time they are described as going through a ‘traumatic experience’ for example. Yet bereavement, loss and mourning clearly are part of normal human experience, and thus her argument runs that we are losing touch with old rituals and rich, varied ways of describing such sadness as these experiences are increasingly brought out of the dark recesses of human nature and into the light.
I see Kenny’s point and agree fully that the rich varieties and subtleties of human experience cannot and ought not to be reduced in the way she describes. But I feel that actually, her argument has nothing whatsoever to do with the stigma of depression and mental illness.
Firstly, she has identified the wrong target. Her suggestion is that reductions in stigma, accompanied by increasing frankness and openness about the prevalence and nature of depression have led to the loss of the “dark poetry of the human condition”. Yet I see no reason why in and of itself, wider knowledge of depressive mental illness should have this effect: if anything, it might enrich our understanding of such experiences.
The problem as I see it is that she is not actually talking about depression. Kenny appears to have conflated ordinary, normal kinds of experience such as bereavement, nostalgia and loss – which she views through a somewhat romantic lens – with the far more debilitating condition we have come to call ‘depression’. The very reason depression is considered an illness is that it marks a significant, distressing and impairing, departure from the vagaries of normal life (though the DSM-IV somewhat clumsily differentiates depression and bereavement through a seemingly arbitrary distinction regarding the duration of symptoms). It can disrupt or destroy a person’s life, relationships and ability to function in the world- it is not a nostalgic yearning for past loves, wistful sorrow or romantic melancholy as Kenny seems to think.
Here we come to the crux of the issue. Whilst it is still an open question as to quite how depression (as a mental illness) ought to be classified and diagnosed, it is certainly true that today certain kinds of normal human experience are overmedicalised and pathologised. Any period of sadness or social withdrawal may be instantly viewed through a medical lens, either by the person or by others around them. We are quick to judge that any deviation from our normal routines and moods is inherently pathological. Such feelings may of course signal the onset of something sinister but at the same time they may simply be, as Kenny is keen to emphasise, normal variations that we should accept as part of the human condition. It is the ‘illness’ label that is problematic here- the domain of ‘symptoms’ has perhaps spread too far and encroached on “normal” fluctuations in experience, but this is an issue to do with how we label and understand those troublesome and distressing periods of life that we all experience, not an issue about the stigma of what can be a devastating mental illness.