The Problem

The Western scientific focus on defining and solving problems coupled with an emphasis on resistance to suffering results in a particularly Western way of viewing the world, and therefore viewing depression. That depression is considered a problem is virtually an a priori position from which the orientations to how depression is interpreted in the contemporary West have their genesis. From this

starting point, the different orientations to depression result in specific interpretations of how to define the problem of depression and how to solve it.

Depression is perhaps the ubiquitous disease of the modern age, with medical sources citing it as “the largest determinant of disability in the world” (Andrews 2001: 419), with major depression alone forecast to “become the second leading cause of disability worldwide by 2020” (Glass 2003: 3169). It is widely considered that “timely diagnosis and treatment of depressive disorders ... is imperative” (Moussavi et al. 2007: 857). However, while there may be agreement from most, though not all (Hawthorne et al. 2008), regarding its prevalence and continuing increase as a major health problem, there is anything but consensus regarding how to deal with the problem.

Medical responses to depression are almost exclusively concerned with scientific diagnosis and treatment while the sociological responses, often bemoaning the dominance of medical science, emphasise such issues as the centrality and importance of social demographic variables, the problems caused by medicalization and professionalization, or ways that the medical approaches could be improved. Nevertheless, sociological responses, with some exceptions (e.g., Horwitz & Wakefield 2005, 2007), often begin from an almost unquestioning acceptance of the medical position on depression, merely adding emphases or aspects (such as gender or work) or specific criticisms (such as lack of attention to socio-economic class or ethnicity) of a sociological nature rather than investigating and assessing the medical interpretative approach in its entirety.

Even a cursory look at leading medical journals leaves one feeling rather dismayed and bewildered about the contested state of opinion regarding depression, despite how well such discussions are argued within each article. This is symptomatic of a Rousseauistic Interpretation in that within each perspective the arguments make sense, only disintegrating when viewed from another perspective. This situation stems from what Weber describes as an inherited belief in a total world-view, which promises mastery and clarity, uncomfortably existing in the plurality of disparate opinion that characterizes secular modernity. In medicine, there is disagreement about how to define depression, about diagnosis, about treatments, and about the

efficacy and risks of various treatments; there is concern about the medicalization of depression itself and the power of the drug companies; and there is uncertainty about the causes of depression and the implications of wider issues. Some opinion considers depression is over-diagnosed and over-treated (e.g., Summerfield 2006c, Parker 2007) while other opinion considers effective management of the problem of depression is hampered by under-diagnosis and under-treatment (e.g., Kessler et al.

2003, J. Scott 2006). However, a variety of medical opinion reveals not only disagreement regarding depression but also awareness of how framing affects illness diagnosis and treatment (Aronowitz 2008a), of the “need to reject the ‘one-size fits all model” (Parker on Williams 2007b), and of the importance of social factors and issues in psychiatric approaches to depression (Blazer 2005). A number of these, such as poverty and gender, are the focus of sociological studies of depression.

The conclusion drawn from reviewing such literature is that there is a great deal of information about depression, but considerable contestation beyond a recognition that an increasing number of people in Western societies are believed to be emotionally suffering. Pilgrim and Bentall (1999: 271) describe the Western medical concept of depression as “confused, woolly and inadequate”, while Rey and Dudley’s (2005: 378) comment regarding depression in adolescents applies equally to depression generally: “If experts disagree, it is little wonder that the public and clinicians are confused”. There is not a single, unified medical or sociological position regarding depression. Rather, there are various positions that are premised on different interpretations, and these can be highly critical of each other. While such difference is a positive sign of plurality of opinion, such difference does not translate into the existence of respectful dialogue that could facilitate the coexistence of difference. Instead, it heralds discord between parties struggling to exert their position as correct over other positions deemed incorrect or deficient in some way.

This discord, I suggest, is symptomatic of a broader problem, stemming not from contestation between differing interpretative positions but from an inherent problem with the problem and solution approach itself. Such an approach inevitably leads to disputation about defining and solving the problem because the focus is on the what

of the problem and not the why of the problem. Weber wrote positively about the advantages of the Enlightenment ideal based on a life of reason, but he also saw that

the way this developed into an emphasis in Western rationalism on scientific rationality was problematic (Schluchter 1989). This is not because Western rationalism is not useful and beneficial, but because it is “specific and peculiar” (Weber 2001: xxxviii), resulting in a “narrowly restricted sense” of “the word ‘rational’” (Brubaker 1984: 44). Unfortunately, when combined with aspects of the Protestant ethic (rejection of anything perceived as irrational and emphasis on the cultivation of the rational) and religious antecedents (belief in a total world-view and world-mastery), this has resulted in interpretative orientations focussed on resistance through a problem and solution approach. This is believed to be the only correct way of approaching the world, and differences of opinion stem from failures or shortcomings of the ‘other’, not from the restricted ability of this approach to deliver definitions and solutions. The ‘problem’, then, is not that the solution to depression cannot be seen (indeed, many solutions are proffered) but that the problem of depression cannot be seen for what it is. Nor is the problem that some facts, in opposing certain deductions, invariable prove capable of an alternative interpretation because there may be many alternative interpretations, depending how matters are interpreted in the first place and from which perspective such interpretations are made. Rather, it is that, because “the interpreter does not approach his subject as a

tabula rasa ... [but] brings with it... beliefs and practices, concepts and norms”, no one interpretation can viewed as the correct one (Dallmayr & McCarthy 1977: 288).

In a Weberian sense the ‘problem’ is not Western rationalism itself but the reduction of the world to ‘problems to be defined’ and ‘problems to be solved’ in a scientifically rational way. Similarly, in a Derridean sense the problem is not that interpretations are centred in a Rousseauistic Interpretation but that they are not seen as being centred, or in a Levinasian sense it is not that the faces of the Other are made into Same in order to control them but that this propensity and intent is not recognized and acknowledged. The Western framing of depression is both enhanced and restricted by the Western view of the world: enhanced because scientifically rationalist, centred, and controlling interpretative orientations ensure resistance through definition and solution, but also restricted because they ensure non- acceptance of plurality and rejection of inclusivity. I explore these potent characteristics of the interpretative orientations to depression by focussing on their primary twin traits of ‘defining the problem’ and ‘solving the problem’.