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How Western Psychology Needs To Rethink Depression
Quick: Think of 10 people you know.
Surprising fact: One of those 10 people is likely to have experienced depression in the last two weeks (based on CDC data).
But that's just the surface. Consider the role of employment — someone without a job is three times more likely to be depressed than someone working. As for education — those who didn't graduate from high school are 2.5 times more likely to be depressed than those with some college or greater. (For more statistics fun, check out this CDC table.)
The take home lesson is that we have to understand context in order to understand depression. Jerome Kagan, a pioneer in the field of psychology, argued this point powerfully in a Radio Boston interview late last week. His new book, "Psychology's Ghosts," challenges psychology and psychiatry to approach their patients in a radically different way.
What The Psychologist Says...
Here are some of my favorite Kagan sound bites from his interview with host Meghna Chakrabarti. (To listen to the full interview or read the transcript, visit Radio Boston.)
- Reasons over symptoms: "It [the way that we classify and even diagnose mental illness] is inadequate because, if you think about all the physical diseases, they are diagnosed not by the symptoms you tell your doctor, but by the cause. Malaria means not that you have a fever but that you have the malarial parasite. Psychiatry is the only sub-discipline in medicine where the diagnoses are only based on the symptoms. You tell your doctor you can’t sleep and you have no energy and he says that you’re depressed. You’re treated for depression on the basis of your symptoms when your depression could come on for a half a dozen different reasons, and the reasons are important in how you treat the patient."
- It's all about causes and context: "There is very little research going on on the role of class, on the role of life history, on the role of who you identified with, your religious identification, your ethnic identification. In other words, there’s a whole complex set of causes; they are not being studied."
- The importance of inequality: "The best predictor today in Europe or North America of who will be depressed is not a gene and it’s not a measure of your brain — it’s whether you’re poor. And that makes sense. If, in a country like ours with an enormous range of income, you’re poor and you’ve been poor since you were a child, which means that your medical care is less adequate, your diet’s less adequate, you’re probably fighting some low level infections and you’re poor — that’s a pretty good reason to be depressed."
- How the English language falls short: "Let’s take the field of personality. Right now we have terms like introvert, extrovert, shy, anxious. Notice those words are naked. They don’t say with whom you’re introverted, when you’re introverted, in what settings you’re introverted. In other languages — take Japanese for example. There’s no word for “leader” in Japanese. There’s only a word for leader of a corporation, leader of a radio station, leader of a platoon. Because they understand that a person who’s a good leader of a radio station might be a lousy leader of a platoon. And the same thing for extroversion, introversion, shyness. And that’s a problem with the English language. And the problem is that 80 percent of research on personality is done by Americans using the English language. The English language is a very bad language for talking about personality because it doesn’t tell you the context, the setting."
What The Storyteller Says...
Though Jerome Kagan brought up some pretty compelling points, there's nothing like a good story to make the lesson stick.
Andrew Solomon is the author of The Noonday Demon: An Atlas of Depression, which won the National Book Award in 2001 and was a finalist for the Pulitzer Prize in 2002. In 2008, Solomon shared part of his story on The Moth live stage — in the video below, he offers a darkly comic recount of how he was "exorcised" of depression in rural Senegal. It involved a ram, being tied up with intestines, getting spat upon, and lots of cheering:
If you don't have 17 minutes, here's the very last part — which was what really struck me. Years after his Senegalese depression exorcism, Solomon found himself in Rwanda. One Rwandan man explained how they had similar rituals and how Western psychology didn't exactly jibe there:
"You know, we had a lot of trouble with Western mental health workers who came here immediately after the genocide, and we had to ask some of them to leave...They came and their practice did not involve being outside in the sun like what you’re describing – which is, after all, where you begin to feel better. There was no music or drumming to get your blood flowing again when you’re depressed and you’re low and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement of the depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to get them to leave the country."
Where Worlds Collide
Jerome Kagan's arguments and African exorcism rituals are worlds apart, but they do have something in common: acknowledgement of the external.
For Kagan, the "external" is circumstantial context. "Biology says you’re likely to be vulnerable to this envelope of illnesses," he explained. "Your environment, your setting, your class, your culture, where you live disposes and selects from that envelope the symptoms you might develop."
For the Senegalese and Rwandan exorcists, the "external" is not only the bad spirit or unresolved issue that can be cast out but also the strong sense of community that accompanies the ritual.
In both instances, the notion of an external element acts as a glimmer of hope, a chance at wider change. With depressive symptoms as common as they are in our country, we are now challenged not to blame the individual so much as to examine his/her place in society and rethink what can be done to address the underlying structural problems — like poverty, lack of education, limited access to health care. As Kagan reminds us that these bigger problems are the real causes, the African exorcists remind us that only as a community can we work toward the solution.
This program aired on April 2, 2012. The audio for this program is not available.