Fibromyangela

doomhamster:

discoursedrome:

I was staying out of it but since it keeps coming up on my dash: the “depression is caused by social circumstances” thing is stupid, not least because it’s clearly trying to sell you ideology as hard as pharma is trying to sell you drugs. (I’m assuming people in this orbit know what post I’m talking about because I’ve seen it 25 times in the past two weeks.)

Many, many, many medical syndromes only become problems when combined with specific environmental factors. That’s the norm. This argument against the “biomedical model of depression” (gag) is like saying that we need to stop medicalizing hemophilia because the real problem is that society is causing people to get cut, and besides, everyone recognizes that some factors will cause anyone to bleed to death, and we don’t call that a medical disorder! Of course you would suplex anyone who said that, but the only actual difference here is that a) we currently know less about the physiological etiology of depression and b) we’re predisposed to view mood disorders as non-medical because they interact weirdly with our model of agency.

The piece in question is just one more variation on the evergreen “social degeneracy causes malaise” trope; it’s working a leftist angle in this case but it’s basically the same gimmick as “ADHD is caused by bad parenting”. It’s a disreputable line of argument used in service of a disreputable agenda, and it’s important to develop antibodies against that entire genus of arguments because they mutate rapidly.

Here’s the kernel of truth: when a negative symptom depends on both an environmental and medical factor, you should investigate both and begin by tackling whichever is easiest. It’s usually easier to stop mixing raw sewage with drinking water than it is to cure cholera and parasites, for instance (though absolutely you want to do both). On the other hand, it’s usually easier to give vitamin supplements to people living on shitty diets long-term than to deal with whatever is requiring them to do that. The age of sail was basically terrible from a social and ethical standpoint, but even still we’d laugh at anyone who complained about giving sailors vitamin C because it wasn’t addressing the oppressive social regime that caused scurvy. If there’s a lot of weight and investment behind social systems that harm people, you are never going to build a stack of victims high enough to dissolve those systems out of shame.

It is an actual fact that most antidepressants – most mood disorder drugs overall – are really shitty, and that they are overprescribed in spite of this because of sleazy marketing. We don’t know that much about how this shit works and it’s seemingly pretty difficult to alter someone’s baseline long-term without also rendering them nonfunctional or causing massive organ failure. There is a hell of a lot of work left to be done in this area. But it’s virtually certain that we’ll have a pharmaceutical solution before we have a social one, and even right now I’d say that drugs are a better prospect than lifestyle changes for most people with chronic depression. You can, of course, try both at the same time. But the kind of person who advocates a treatment before all others on the grounds that it’s the “real” or “root” treatment, rather than on the basis of how easy it is or how likely it is to produce immediate improvements, is someone who cares less about how your problems affect you than about what they symbolize.

Much of this is so true. Especially the part about tackling what is easiest. And about not knowing enough – for ex, some professionals theorize that there may not BE a single biological cause/mechanism for depression, so much as there are half a dozen or more conditions with similar symptoms, some of which are trauma- or stress-triggered, others mainly or purely biochemical.

Though as a pharmacist, I’d like to point out that mood disorder drugs aren’t generally any shittier than any other drugs. Medicinal treatment of ANY kind is a careful balance of “okay, how much of what drugs can we give this particular patient before the side-effects start outweighing the benefits?” And that’s a hell of a lot more subjective and individual with antidepressants than with most other stuff.

(Oh, and “overpriced”? Not in countries with socialized healthcare. Speaking of social factors we should attack, in the long term, to help ease depression-inducing stresses!)