In the past decade, Australians have seen a sharp increase in the amount of government funding for mental health programs. The three most significant programs are beyondblue, the Better access initiativeand headspace. With the exception of headspace, these programs are based in an individualised model of the cause and treatment of depression that emphasises biological factors and, to a lesser extent, psychological contributors to distress.
Depression and anxiety are the leading causeof non-fatal burden of disease in Australia. The prevalence of these conditions is also high, with the Australian Bureau of Statisticsfinding that 6% of respondents reported having experienced symptoms consistent with severe, moderate or mild depression in the previous 12 months, with a self-reported lifetime prevalence of 15%. Despite being less widely acknowledged, anxiety disorders were found to have a significantly higher prevalence rate of 14% in the past year and 26% over the lifetime. The symptomsof these conditions are variable, but commonly include despair, difficulty eating, poor sleep and reduced decision making capacities. Social isolationand suicideare some of the more devastating consequences of these conditions.
The experience of having depression, anxiety or bipolar (know collectively as affective disorders) is profoundly affected by how people think about their condition. For example, feelings of guilt or shame may be more extreme if a person believes that they should be able to 'snap out of it'. In addition, whether people seek professional help, who they seek that help from and how willing they are to adhere to their treatment regime depends on what they believethey are experiencing.
Consistent with other researchers,my research has shown that Australians generally understand affective disorders as illnesses. While this categorisation is correct, when Australians say that 'depression is an illness' they tend to be referring to a type of illness that affective disorders are not. For instance, the very popular sentiment that 'depression is just like diabetes'is often presented in a way that indicates that depression is a lifelong physical illness that requires regular medication and which is primarily caused by genetics.
While research indicates some genetic factorsthat increase the risk of depression, they are not the whole story. Nor is there evidence of a singular biological cause. While medical interventions are helpful, their 'helpfulness' is not solely biological. Instead, studies which show that antidepressants have almost the same effectiveness as placebossuggest that the effects of antidepressants are medical, psychological(relief that something is being done) and temporal(most depression is episodic, so sometimes 'waiting it out' is an effective treatment). (Anti-anxiety and mood stabilisers have more evidence to support their effectiveness, however they are appropriate for a smaller number of people.)
One of the main reasonspeople use the 'just like diabetes' argument is that it provides a reason why they are not weak or a bad person but rather are experiencing an illness. However, this explanation may not help with the stigma that they are afraid of, with researchindicating that in some instances, this explanation may actually increase the discriminatory beliefs held by the general population.
In many ways, this emphasis on depression as illness is the most humane option we have. It encourages people to see their doctors, and while the treatments are not ideal, they seem to be the best we have. However, this emphasis has some unfortunate consequences.
An acceptance of the medical model may result in individuals being less likely to take non-medical treatments (e.g., counselling, exercise, meditation, improved diet) seriously. In addition, when people think that 'the problem' is an illness, they may be less likely to act on situational factors that may be contributing to their distress (e.g., depressed women who stay in abusive relationships). Moreover, when an individual's experience and the expected medical narrative do not align, they may feel as if their experience is invalid and thus be more distressed.
There are also several consequences at a societal level. Where in the mid to late 20th century individual distress was seen as indicative of social problems (sexism, racism, homophobia etc.), the medical model encourages people to think of distress as 'my' (or 'their') problem and not as a symptom of systemic social injustice. This in turn, may reduce efforts to address such injustice. In addition, acceptance of the medical model is likely to result in government funding going to medical treatments. While such treatments are essential, focus must also be given to the situational factors that make people miserable.
Although the individualised model has some problems, I am not suggesting we get rid of it. Rather, we need to value and support alternative understandings as well as the medical model, thereby enabling greater acknowledgement of the variety of factors that affect mental health. For many people, that could involve embracing a model of distress that places equal weight on biological, psychological and social contributors (this model has a lot of empirical backing). For others, more radical social engagements may be desirable. These alternative understandings, while certainly not for everyone, are useful because they continually question the dominant model and ensure that its dangers are considered and, hopefully, mitigated.
Alternative understandings are less common in Australia than most other western countries. Perhaps because of the obvious power of big pharmaceutical companies, in the US there is far more questioningof why emotional suffering should be treated by a doctor and not by community inclusion and support. Australia is also behind much of Europe as we are less inclined to think of suffering as a meaningful part of life (as is encouraged by psychoanalysis and other, typically continental, treatments) and we have a less robust anti-psychiatry and psychiatric survivors movement.
If you squint, you can see a range of alternative understandings of affective disorders in Australia. Australia does have a small survivor movement. Organisations like GROWprovide community support to individuals willing to identify as having a mental illness and make significant changes to their lives. Some religious communities provide non-medical ways of understanding emotional distress, however these tend to wrapped up with judgements about how people should behave that are particularly damaging to individuals who are already experiencing distress and/or oppression. One of the most encouraging models is that used by headspace, through their provision of holistic early interventionfor young people. Such a program is likely to be difficult for adults who are well schooled in the medical model to embrace, however it may provide a beginning for generational change.
Overall, we need to be aware that while the medical model is often helpful, it is not a magic bullet. Rather, much like the cane toad, while the biomedical model is meant to address problem, it is also a problem in and of itself.