Academic journal article Ethical Human Psychology and Psychiatry

Is Social Anxiety Making Us Depressed?: A Social Evolutionary Hypothesis for Why SSRIs Work

Academic journal article Ethical Human Psychology and Psychiatry

Is Social Anxiety Making Us Depressed?: A Social Evolutionary Hypothesis for Why SSRIs Work

Article excerpt

In the developed world, the use of selective serotonin reuptake inhibitors (SSRIs) has skyrocketed since 1988, when Prozac was first released in the United States. Biomedical psychiatry's explanation for their success is an unsubstantiated hypothesis that claims SSRIs treat a chemical imbalance in people who suffer from low levels of the neurotransmitter serotonin. Using social evolutionary theory, this article provides an alternative hypothesis for why SSRIs work for some people. SSRIs' success is attributed to their capacity to adapt people to the increased status anxiety occurring in developed nations grappling with the effects of unprecedented global competition. Biomedical psychiatry is depicted as adjusting patients to prevailing social norms rather than contributing to mental health.

Keywords: SSRIs; serotonin; depression; human evolution; status; globalization

In Nikolai Gogol's short story "The Overcoat," first published in 1842, the protagonist Akakiy Akakievitch, an impoverished clerk, saves his meager government wages to buy an impressive overcoat, thus replacing the thread-worn jacket that his coworkers once ridiculed for its shabbiness. The new coat garners Akakiy complements and attention. He begins to increase his expectations for success, and his self-esteem rises-all because of his possession of the attractive garment. But Akakiy's hopes are quickly cut short when the coat is stolen and he finds himself without protection from the elements or the cruelty of a status-driven society that perceives him as inconsequential because of his low social rank. Eventually, Akakiy dies from exposure, but not before going insane (Gogol, 1998).

Rarely today are associations made between low social status and insanity as Gogol did in his 19th-century tale. Explanations for the cause of mental disorders more often look to genetic underpinnings and other endogenous origins, with little regard for the inequalities that throughout the millennia have challenged humankind. In today's biomedical climate, even "insanity" has lost its usefulness. It is far too vague a term to facilitate assigning medications geared to treat the symptoms of disorders-rather than grapple with the nature of human suffering (Horwitz, Wakefield, & Spitzer, 2007).

The loss of social status is one type of suffering that plagues all of humanity. Economic crises are particularly revealing of its profound effect. During the Great Depression in America, the suicide rate increased from 14 to 17 per 100,000 people (Black & Hopkins, 2003). In South Korea, the suicide rate increased by 50% in 1998 following the financial collapse that ensnared Asia during the 1990s (Klein, 2007). More recently, India's cotton belt has been renamed the "suicide belt" as crushing debt and falling cotton prices has led thousands of farmers to take their own lives (WNET/Thirteen, 2007).

Despite such emotional devastation that sharp financial declines can create-and with it, declines in social standing-the significance of status for emotional well-being is all but silenced. Alain de Botton, in his book Status Anxiety (2004), characterizes status as one of our greatest, albeit shameful loves:

Every adult life could be said to be defined by two great love stories. The first-the story of our quest for sexual love-is well known and well charted, its vagaries form the staple of music and literature, it is socially accepted and celebrated. The second-the story of our quest for love in the world-is a more secret and shameful tale. . . . And yet this second love story is no less intense than the first, it is no less complicated, important or universal, and its setbacks are no less painful. (p. 5)

The loss of status, or the threat of losing status, is just as likely a cause of mental disorders as difficulties with interpersonal relationships. For example, studies that examine the effect of poverty on poor health show that rather than the result of lack of health care access, failure to utilize health care, or increased exposure to risk-conditions that often characterize life in poverty-it is the psychosocial consequences of poverty that cause poor health, including depression (Marmot, 2004). …

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