A new article published in Social Theory and Health examines how depression is understood and discussed online through an analysis of internet blogs by depression sufferers. The authors find that self-identified depressed individuals tend to medicalize the causes of depression, while simultaneously adopting a moral view of depression when talking about their recovery.
The study was led by Maev Conneely of the Queen Mary University of London. The authors note that the medical view of depression, which considers the symptoms to be a result of biological illness, is prevalent in official literature and among the general public. This view contrasts with the “old-fashioned moral view of depression,” which treats the depressed person as having control over their emotions and behavior, and depression as a distressing but meaningful response to difficult circumstances. Despite the popularity of the medical view, the authors maintain that the moral view of depression continues to have relevance and influences cultural understandings of mental health. They write:
“The moral view of depression represents an enduring aspect of our understanding of ourselves, which the medical view has been superimposed onto, but has not managed to suppress.”
Depression remains one of the most commonly diagnosed mental disorders, and antidepressants are often turned to as the first line of treatment. However, the medicalization of distress and mood has been the subject of frequent and sustained critique. Research shows that there are numerous socio-cultural factors connected with the experience of depression and that the chemical imbalance theory is both incomplete and misleading.
In this article, the authors explore a tension between the moral and the medical view of depression as observed in the internet blogs of depression sufferers. The moral view, which suggests people have some control and agency over their depression, has been repeatedly criticized by the medical perspective. It has been suggested that the moral view amounts to victim-blaming and creates stigma, but research indicates that the medical view is linked to increased pessimism and stigma.
The modern medical view of depression, broadly defined, views the depression as a medical illness of biological origin, and suggests that people cannot recover themselves since this set of behaviors and emotions is outside the normal range of responses. The authors rely on the writings of Michel Foucault and Thomas Szasz to question this view. Szasz was heavily critical of the concept of mental illness, which he equated to a myth, and insisted that mental illness was essentially a label for behaviors that the society considered unethical and immoral. According to Foucault, the medicalization of madness is connected to a broader cultural strategy that pathologizes actions and thoughts that are a threat to productivity and efficiency.
According to the moral view, people are moral agents responsible for their actions that have a certain amount of control over their depression, which is seen is a part of their self. While this appears to fault the individual, in this view, depression is also considered a meaningful response to life’s circumstances, and one is not simply to be blamed for it. This view suggests that depression can be changed with support and help, and is not out of one’s control.
For this study, the Conneely and colleagues conducted a thematic analysis of ten influential blogs written by people who self-identify as being depressed. They found evidence for both the medical and the moral view of depression in all the blogs.
The medical/biological view was used when the bloggers tried to explain their depression, with one blogger attributing the “illness” to the lack of “happy chemicals” in the brain. This allowed them to emphasize the severity of their condition, with one likening it to a brain tumor. Antidepressants were touted as a form of treatment that normalized this brain chemistry. The authors note that the medical view depends on medication to validate its claims, and for bloggers, “medication becomes the currency of distress… that needs to be increased to reflect the severity of their symptoms.”
The bloggers pitted the medical and the moral view against each other, often noting how they initially ascribed to the moral view and thought of themselves as a failure or incompetent. Later they found the medical view and realized that they had an illness that was beyond their control. This helped many to decrease negative feelings of guilt and shame. The authors claim that the repetitive denunciation of the moral view shows the prevalence, insistence, and intuitiveness of this view.
The bloggers used the medical view to create a separation between their “self” and the “disease.” This helped to avert blame and to control one’s identity and image. Depression was often externalized and personified as a predator, and thus wholly separated from the self. The constant struggle to do this leads the authors to suggest that the bloggers themselves had difficulty in believing and executing it.
The moral view of depression, despite being criticized by the bloggers, was ever-present in their narratives, mainly when they spoke about recovery. They repeatedly contradicted their earlier assertions that depression was a sickness out of one’s control. The authors write:
“While describing the process of recovery, the bloggers make statements about how individuals are ultimately in ‘control’ of their ‘mental health,’ that it is their responsibility to get better and that trying to recover is a choice that people can make… recovery as a personally-driven, active process that requires hard work, determination, and ‘will-power’ on the part of the individual.”
The bloggers insisted that recovery required a change in the character and the perspective of the individual. It involved the transformation of self through the adaptation of new outlooks, new priorities, and new values – a new self. For one blogger choosing to be grateful was essential to recovery, and this included being in control of one’s life instead of letting depression take control. These claims were in contradiction to earlier medicalized beliefs of depression being out of one’s power and having nothing to do with personal characteristics.
Further contradictions were seen as the bloggers’ considered depression, which was earlier disowned and separated from the self, as an “integral and valued” part of their character and essential to becoming the new transformed “me.” Here they contrasted their new self/life with the old self/life, which was problematized for its face pace and superficial priorities.
Thus, it became evident that these bloggers considered depression to be a meaningful response to old forms of being and living, forms that were unhealthy and not conducive to happiness. This included the demands of modern life, which focuses on work and material success as opposed to relational and community priorities. Here they contradicted their earlier understanding of depression as a disease of the brain and instead adhered to a moral view — depression became a result of, and a meaningful reaction to, stress-inducing modern living, unrealistic expectations, and past trauma and grief.
While the moral view may open people to judgment from others, it also allows them to view themselves as open to change and is a part of their understanding of their recovery. Further, the authors note that as Foucault had written, a moral view allows people to question the ethical standards and norms of the society instead of merely looking to the individual for the source of mental distress. For example, the moral view can be useful in criticizing the dangers of prevailing economic conditions.
Conneely, M, Higgs, P. & Moncrieff, J. (2020). Medicalizing the moral: the case of depression as revealed in internet blogs. Social Theory and Health, Published online first: June 4, 2020. DOI: https://doi.org/10.1057/s41285-020-00141-1. (Link)
I don’t understand why the bloggers were not given credit for their writing, the basis for a whole research study, while Michel Foucault and Thomas Szasz are mentioned and linked to. and “The study was led by Maev Conneely” and this blog itself has a named author. Even “Social Theory and Health” was named. and the image has a credit. Does this bother anyone else?
Like a past therapist quoting directly from my emails to his twitter without any name attached, but he was quick to make sure I knew to credit him if quoting his work. You can tell if someone respects you by the way they use your name, or not.
Why the double standard?
Blogging is what these people do. This is their work, an income based on views. Why is it okay to use their writing without credit? Where are the links to the blogs?
Why isn’t this an outrage essay about inequality? About appropriation? About using the vulnerable for personal gain?
By the time we hear voices with lived experience they have been filtered through multiple paid professionals like a giant game of telephone. It is oppressive. The only people unpaid and not credited are the “diagnosed”. Like being a patient trying to get help. By the time your words get to the electronic record it is something else entirely. And again the only person unpaid is the patient.
I imagine these ten blogs are the very inner war each person goes through after diagnosis. These are real people, but this research takes all the human out of it. Sterilizes it. Hard not to draw comparisons. Until the credentialed authors begin respecting people with lived experience enough to tell their own stories, be named as co-authors, and be paid, then why would anyone else?
Maybe I should take this opportunity to reverse credit the therapist and MIA author who used my own words for personal gain multiple times without crediting or compensating me.
I’m sure it’s possible to improve life without taking a moral perspective!
Is this a true contradiction though? Depression, anxiety, and even schizophrenia don’t disable the person’s free will so absolutely that they loose all responsibility for their actions. It makes sense for someone to treat depression as an illness and separate their moral self from it, because there is so much of it left. I doubt people would say the same about victims of brain damage, who are unrecognizable from their former self, don’t remember anyone and react aggressively to everyone, including loved ones, because the parts that made them who they were no longer function and will likely never function again. It’s hard to say that a person in such a state has any responsibility for anything.. but it’s also hard to say if they are still a person. I think our definition of a person involves some level of moral responsibility, and our sense of hope depends on it. If moral responsibility is gone, the person is gone. It might sound harsh, but I only speak from personal experience. I always felt that my grandfather died before his body did – the latter kept going a month longer, terrorizing the family.