Cannot Understand Depression without Considering Poverty

Cape Times (South Africa), May 29, 2014 | Go to article overview

Cannot Understand Depression without Considering Poverty


BYLINE: Carla Dukas

Depression is the single most commonly occurring mood disorder and is believed to affect twice as many women as men.

The World Health Organisation has projected that by 2030, depression will be the number one cause of disability worldwide, ahead of HIV/Aids and cardiovascular and chronic pulmonary diseases.

Despite the magnitude of this global mental health problem, depression remains poorly understood. Part of the problem may lie in the way it is diagnosed and described in the medical literature.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is an international reference book that lists the symptoms and diagnostic criteria for various mental disorders, such as depression.

Used by mental healthcare professionals throughout the world, the DSM-5 provides the foundational understanding that informs the diagnosis of various mental disorders and, ultimately, their corresponding treatment.

In other words, understanding informs diagnosis, which informs treatment.

This raises the question: is the DSM-5 really the best route to understanding, diagnosing and treating depression?

Some mental healthcare professionals argue that the medical model adopted by the DSM-5 might work well for physical diseases (where one assumes the cause - the pathogen - resides within the individual) but not for mental illnesses.

Critics contest that applying this view to depression (for example, to assume that a "hormonal", "personality" or "chemical" problem within the individual has caused their depression) is parochial and therefore inappropriate.

They argue that this approach obscures any consideration of the interpersonal, political or otherwise external factors that can cause emotional distress.

That is, some women will continue to suffer from depression because "expert" healthcare professionals and diagnostic manuals alike do not always adequately consider their experiences of distress, and specifically the possible impact of socio-economic and political contexts on their mental health.

A recently conducted study in the Western Cape involved in-depth, one-on-one interviews with a small group of low-income adult women who had been diagnosed with depression. Results showed that the women's subjective experiences, understanding and descriptions were far more complex than the stark and clinical picture of this condition currently on offer in mainstream medical literature.

Findings suggest that the mainstream medical literature, which forms a substantial part of the foundation of our understanding of all known mental disorders, captures only a small part of these women's experience of depression. …

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