Western ‘Depression’ is Not Universal

Derek Summerfield critiques study on global prevalence and undertreatment of depression


Derek Summerfield, consultant psychiatrist at South London and Maudsley National Health Service Foundation Trust, challenges the assumption that Western depression is a universal condition. In a recent commentary, published in The British Journal of Psychiatry, Summerfield responds to a study led by Graham Thornicroft on the undertreatment of Major Depressive Disorder globally. Summerfield argues that the Western construct of depression is not valid in many countries.

“Biologically triumphalist studies like this simply have to be challenged, because once something—in this case, depression as a unitary pathological entity arising naturalistically anywhere in the world—is declared real, it becomes real in its consequences,” writes Summerfield.

Derek Summerfield – Why Export Mental Health? from McGill Transcultural Psychiatry on Vimeo.

Thornicroft and colleagues investigated the prevalence of Major Depressive Disorder, as defined by the DSM-IV, in 21 countries of varying income-level. The researchers found an average of 4.6% of study respondents met criteria for Major Depressive Disorder within the past year. They also argued that only a minority of people are receiving “minimally adequate treatment” for depression, which they identified as (a) at least one month of pharmacotherapy with at least four visits to a medical doctor, or (b) at least eight psychotherapy sessions.

Summerfield writes:

“Thornicroft et al assume that ‘mental disorder’ is an entity essentially lying outside situation, society, and culture, which is identifiable anywhere using a common (Western) methodology.”

He challenges the World Health Organization’s claim, cited by Thornicroft and colleagues, that Major Depressive Disorder is the second leading cause of years lived with disability (DALY) worldwide, describing the DALY measurement as “epistemologically lamentable.”

Summerfield states, “diagnoses are merely descriptive constructions, conceptual devices, and are drawn up by us, not by nature.”

He argues that ‘depression’ often does not have an equivalent in non-Western cultures because the notion of emotions—experiences that are internal, biologically-driven, and separate from thoughts—is not a universal concept.

Thornicroft and colleagues acknowledged the limitations of their survey instruments’ validity across cultures. However, Summerfield argues that the researchers’ conclusions did not take these limitations into account.

He writes, “Invalid approaches cannot be redeemed by ‘reliability’—using a standard, reproducible method—since the very ground they stand on is unsound.”

In light of the recent call to implement routine screening for depression internationally, Summerfield’s reminder that the Western understanding of depression is not universal is critical. Summerfield concludes by reflecting on his own home country, Zimbabwe. He writes:

“Does Africa need the category of Western depression at all, and does it need the marketing of antidepressants which will ride on the back of papers like this in international psychiatric journals? I think not.”



Summerfield, D. A. (2017). Western depression is not a universal condition. The British Journal of Psychiatry211(1), 52. doi: 10.1192/bjp.211.1.52 (Link)


    • Sian Whitehead who filmed Jean, wrote this in the comments:

      “This lady’s name is Jean Cozens. In May 2014 I attended the inquest into her death and the Coroner declared it an open verdict not suicide. Jean’s psychiatrists was at the inquest and her evidence was that she put Jean on the medication with her welfare in mind. When the verdict was announced she smiled as it meant she did not have to worry that she had a suicide on her record. The inquest was more of a cover up as to how Jean died. She was found hanging but the psychiatrist and the mental health Trust South London and Maudsley did what they could to persuade the coroner that she did not mean to take her own life. I was disgusted with what I heard at the inquest and I have sent a complaint to S.L.A.M. They did not bother to reply to my complaint after the inquest. Yet.”

      Report comment

      • I knew Jean. I think she killed herself for a variety of reasons. One big one was that she hated psychiatric drugs that she was forced to take and she hated the ward she was put on when she had breakdowns. She saw no escape.

        The doctors knew she hated the drugs but could not imagine any other way of treating her.

        I feel slighly guilty as I started Speak Out Against Psychiatry and I think that raised her hopes of getting off the drugs and freeing herself of psychiatry. I am no longer involved in anti-psychiatry campaigning but if I was I would make sure that setting up good advocacy, drug withdrawal help and social support was at the heart of it.

        Report comment

        • You are also a victim, we all are apart from the psychiatrists, pharma and their marketing machine. They had a choice, they chose to destroy for money and when they were faced with their own abuse they chose to blame the victim. These people lack the strength of character to do the decent thing – admit the harm they have been involved in, move out of their destructive behaviour and get another job. We are stuck for life with the labels they gave us, and in-turn they bear the label of psychiatrist. In the future that word will increasingly be associated with human destruction. As they die, their name and the word next to it: psychiatrist, will live on, along with the knowledge of the horrors they put into peoples brains. It is up to us to make that knowledge known.

          Report comment

          • “They had a choice, they chose to destroy for money and when they were faced with their own abuse they chose to blame the victim. These people lack the strength of character to do the decent thing – admit the harm they have been involved in, move out of their destructive behaviour and get another job”


            Report comment

        • ” … good advocacy, drug withdrawal help and social support … ”

          These are absolutely crucial and I’m glad you identified them so clearly. I never used to take drug withdrawal seriously – I would just stop cold turkey and then launch into rebound psychosis within weeks.

          This time, I’m tapering responsibly, with the help of my treatment team. I’m still on a shitload of meds but I can see light at the end of the tunnel.

          Report comment

          • Glad you have a non-virtual support team, Francesca.

            I moved with my parents when they retired to a remote place in the country. No shrinks in almost 100 miles.

            They know I don’t lie (but what can I do if my loved ones are brain washed?) I flushed my drugs down the toilet. Those I didn’t take–SA has helped me greatly in my tapering–and I took a small amount of Effexor till I left for HUD housing in a nearby city.

            Doing okay if I weren’t sick and broke. As a born introvert I get my social needs met pretty easily. No mental illness services!

            I continue to lie about my “awesome treatments” because of the placebo effect on Mom.

            She worries at how inactive I am. My housekeeping never has been stellar, but it showed improvement till my withdrawal symptoms worsened. I told her I think I have FM but she still talks about putting me in a “home” when the mood hits her.

            Report comment

        • John,

          It is possible to withdraw from these injections but it can be a very difficult. I experienced 4 hospitalizations in 5 months a suicide attempt and 2 aborted suicide attempts – in the process.

          In the end I was diagnosed as a hopeless psychiatric revolving door. But I never returned. Recovery was made as a result of quitting the psychiatric ‘medication’.

          My former (Research) Psychiatrist in Southern Ireland kept all the safety information regarding these injections off my Records ; while producing promotional Resarch Papers on the efficacy of the drug in question. He was a Psychiatric Dr Shipman.

          Report comment

  1. If you sell “mental health treatment” for the “mental illness” “depression”, you must also sell the “mental illness” “depression”. Here they come up with a percentage, and this percentage justifies claiming a great need and urgency for more treatment. Then you’ve got the WHO claiming depression the up and coming leading cause of disability worldwide, offsetting heart disease. Seriously, someone needs to say, “Get a grip, guys.”

    Any emotional depression on a large scale, just like economic depression, is a man-made phenomenon. If people are unhappy and discontent in the countries where they live, often there are social and economic reasons for this sadness and discontent. Work your butt off for what’s not having in the first place, and you might begin to get my drift. There is no manual for survival in today’s world, and if there were, it would certainly be in short supply. There are reasonable ways to do things, one of those reasonable ways is not to make profiteering the be all, end all, of existence.

    Now we’ve got this little problem. What happens when the source of your income is other peoples’ “mental disorder” so-called? What happens when your business is profiteering from confusion, misunderstanding, and unhappiness? Job security becomes a matter of projecting a percentage of “un” or “under treated” “illness”. You can’t clean this mess up entirely, not and keep your job at the same time. The “human condition” is worse than it might be, chiefly because it pays to have an atrocious “human condition”. Clean it up, and corporations take a dive. Well being and contentment don’t maximize profits for a few individuals at the expense of the vast majority. On the other hands, maximizing the profits of the few, means much business for those who make a living from the system’s casualties.

    Report comment

    • I like your comment and want to add that the majority of us “ex patients” have had our earning capacity permanently lowered as a result of missing prime wage growth years and suffering difficulty functioning as a result of psychiatric injury in “normal” jobs. These psychiatrist people are making an absurd amount of money per year. They should try living on $12k per year two years in a row like I did. Psychiatrists act like if they make less than $150k per year that they will be suffering severe poverty and thus must continue to find new victims, er patients to “treat”. Wtf? Either these people have expensive lifestyles that require an assembly line of new people to label or they are really that out of touch. People who make $150k are extremely out of touch. Try telling psychiatrists to get some roommates and take the bus! Watch them diagnose you with Reasonable Budget Lifestyle Disorder.

      Report comment

      • Yep. No wonder Tim Murphy made a seamless career change from psychiatrist to congressman. Both jobs waste tax payers’ money.

        If the public weren’t hopelessly gullible and naive, we might try convincing them that “mental health” costs tens of thousands of dollars per year per “consumer” and forces the victim to live at tax payer expense, preventing them from paying their share of taxes. Psychiatry is ruing the economy of the Western World. Forcing or tricking 20% of the population into lives as junkies is despicable! And ultimately unsustainable.

        Report comment

        • Tim Murphy was a *psychologist*, not a psychiatrist. I was actually *helped* by a small group of licensed clinical psychologists, who were NOT connected to psychiatry & the local “Community Mental Health Center”. They actually helped me get off (most) psych drugs, too. So i will always give psychology *some* credit. But psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21st century Phrenology with potent neuro-toxins.
          But as for the psychologist Tim Murphy, he did so much damage, that he may as well be a psychiatrist….

          Report comment

  2. Since “depression” is really just another word for sad feelings, and everybody gets sad at times since everyone experiences losses, disappointments, failures, etc. at times, then I would think that the “depression” rate around the world would be exactly the same everywhere, at 100%. So watch psychiatry steadily broaden the criteria and increase the rate of “depression”, until it reaches its goal of “treating” 100% of all people in the world.

    Report comment

  3. Japanese society and culture had no concept of “depression” until the drug companies and western psychiatry say a new and untouched group to suck money from. And so, at the instigation of the drug companies and western psychiatry, key opinion leaders in psychiatry were sent over to convince the Japanese people that they were “depressed”. They colonized Japanese culture just as white Europeans colonized the New World at the expense of the indigenous peoples that they found there.

    So now, the Japanese people believe that they are “depressed” and swill the so-called “antidepressants” like we do here in the United States. When are people finally going to realize that we’ve been sold a plot of swamp land in Florida and rise up against the drug companies and psychiatry? If we don’t do it soon there won’t be anyone left that isn’t drugged to the gills. Like the doctor in the video stated, the claim that one in every five persons suffers from “depression” is nothing but quackery and bull feces.

    Report comment

    • Just wait until the Japanese disability figures rise and rise – and then the heads will roll. I know plenty of people that started with SSRIs and are now genuine mental health cases that will (probably) never function economically again (no matter how hard they try).

      Report comment

    • Traditionally suicide has not been viewed by the Japanese as something “insane” people do but rather an act of honor. If you were mortally insulted by a high ranking official you could save face by thrusting a knife in your chest.

      Here’s a question. Since a “diagnosis” of hopeless insanity is a disgrace, how many people in that type of culture will choose suicide immediately after being told they’re officially “bipolar” or “schizophrenic?”

      Report comment

      • Thank you for pointing out a very important point and I think you’ve asked a very good question here. I corresponded with a Japanese woman who was contemplating suicide and we talked about this very thing. Americans have a difficult time understanding this but many Japanese still hold this as an honorable way to settle issues. How would one go about investigating this to find the answer to your question? Unfortunately, now the Japanese seem to be as “depressed” as Americans these days. The drug companies and western psychiatry did a great job of colonization in Japan.

        Report comment

  4. Sometimes the claim is “one in five persons has a mental illness.” Sometimes the claim is one in four or even one in three. A lot of wishful thinking in the psych industry!

    I remember hearing of a psychiatrist who said he personally knew millions of people whose lives had been saved through the drugs he prescribed. What a memory that guy had! Even the ability to know 2,000,000+ people by name would be remarkable, yet he not only knew these people as more than casual acquaintances but was so sure of alternative outcomes and all possible scenarios that he could guarantee FOR A FACT they would have killed themselves without the “life-saving medicines” he dished out.

    Report comment

  5. How can we get Derek Summerfield to actually READ these comments, and respond to them? I want to make explicit, what Summerfield comes close to, but just doesn’t see. He’s basically saying that so-called “depression” is an invented, “Western” intellectual concept, that is claimed to be a real, live, actual “disease”.
    Psychiatry has no more global validity that we *imagine* it to! And, to whatever extent we *believe*, or claim that it has some kind of global validity, it only has that validity IN OUR MINDS, simply because we CHOOSE to BELIEVE it! So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but not more real. I’m pretty sure there’s no Santa Claus in Mongolia.

    Report comment