The March 2016 issue of Culture, Medicine & Psychiatry has recently debuted. Over the coming weeks, we will feature article highlights from a selection of the newest research published at our journal. To access the full issue, click here.
This week’s article highlight examines Alex B. Nietzke’s piece “An Illness of Power: Gender and the Social Causes of Depression” (accessible here.) Nietzke argues that a mechanistic and biological model of depression overlooks the extent to which women across the world are frequently diagnosed with the disorder at a higher rate than men. When bioscience and biomedicine fail to attend to underlying social and gendered dimensions of depression as a diagnosis, the author holds, they are “silencing women” and “marginalizing” a discourse surrounding the problematic social power of the biomedical model.
The article opens with a review of the literature on medicalization, which describes the shift from a psychodynamic model (where external factors were typically considered the source of reactive mental distress) to a biopsychiatric one (where, given the development of medications for mental disorders, mental illness was increasing viewed as seated within the patient’s biology.) The DSM-III later “eliminated” the categories for “reactive” mental illness, and placed physical symptoms (like weight loss) alongside psychological ones (like feelings of hopelessness) such that both expressions of illness were physiologically equated to one another.
Upon biologizing symptoms, the causes of depression thus fall wholly within the realm of biomedicine to diagnose and to treat. This leads to a nearly unilateral assumption of control over depression by psychiatrists and clinicians, even if other individuals such as family and friends– and the patient herself– has insights into the social determinants of a psychological condition. Furthermore, when biomedicine interests itself only in the biological and not social basis of women’s mental illness, it delegitimizes the very roots of many women’s distress and reinforces their inability to verbalize forms of oppression. Nietzke thus adds that “what begins to emerge here is that the psychiatric disease model of depression may actually be disempowering women by legitimizing the pathologies of a social system of gender as it delimits one’s expression of suffering and testimony to its causes.”
When biopsychiatry quiets the discussion of social determinants of mental illness, so too does it lend power to the systems of oppression that enable women’s suffering to continue, and limits their ability to express their psychological state. Put another way, by biologizing rather than contextualizing depression, women are inherently marginalized because they may have few other recourses outside of biomedicine for ameliorating the psychological ramifications of social disenfranchisement. The “silencing” Nietzke cues in the early paragraphs of the article returns here, as the author reminds readers that biomedicine’s biologizing of depression may problematically close the conversation around the social situatedness of women’s psychological experience and social status.