Professor Peter Kinderman, referred to as a prominent British psychologist, is reported to say (link to the article here) that it’s time “we should change the way we talk about depression, anxiety, and other forms of psychological distress.” I find the report on what he says not much more than irritating. Here is a response (though I doubt Prof. Kinderman will read it, but others might).
Let me start with an ironic statement. Kinderman is quoted to say:
These can be very distressing human experiences — it’s very distressing to be depressed, and people who are depressed absolutely need help — but that doesn’t mean they’re suffering from a disease or illness.
And I wonder how different what he says is from what others say. There is still the dreaded label ‘depressed’ which is used to describe a person as if it enveloped their entirety in depression. The quote clearly borrows the label from the ‘language of the disorder’ he opposes. And so, I have an impression that nothing changes except that he seems to be saying that when he says ‘depressed’ it doesn’t mean an illness. Riiiiight…..
He further says that psychiatrists and psychologists should
drop the language of disorder which “reifies” diagnostic labels and categories, and unhelpfully mischaracterizes as illnesses what should properly be viewed as natural responses to life’s challenges.
Obviously, when he says ‘depressed’ or ‘depression’, it doesn’t. Not at all. More importantly, however, Prof. Kinderman keeps using the silly phrase ‘language of the disorder’. It’s a phrase that was invented by like-minded scholars, but when you look at it carefully (I did it in a blog – link here), it doesn’t merit serious attention.
This is because medicine uses many commonly used words. For example, if you take ICD-10’s account of the depressive episode (commonly referred to as depression), you will see words such as
confidence, self-esteem, guilt, self-reproach, thoughts, indecisiveness, change in appetite, weight change, ability to concentrate.
Surely, such vocabulary can hardly be considered medical. Indeed, you can add words such as ‘emotion’, ‘personality’, ‘suicide’, ‘paranoid’ and also those are hardly medical. So, are words like ‘emotion’ or ‘suicide’ indicative of the language of disorder? An argument to drop them must surely be considered nonsense. So, what exactly should be dropped, I wonder.
Moreover, I find it quite problematic (it’s a euphemism here, but there we are) that Kinderman continues to suggest that there is an obvious definition of disease/illness and that depression doesn’t fit into it. Not only is it not true, but I suspect Peter Kinderman knows it very well. If so, the argument is not only problematic, it’s very problematic (I continue not to want to go beyond euphemisms).
Indeed, Mildred Blaxter tells us in her book on health that, even within the biomedical model, understanding of what disease is has been a matter for much debate and medicine’s views have been changing. When we get to more holistic views on health and illness, illness can be viewed as a series of losses, as bodily transformation, as being towards death (see Havi Carel’s books). Michael Bury sees illness in terms of a biographical disruption, Kathy Charmaz talks about the loss of self. When you look at such views, they can describe depression very well.
Unfortunately, Prof. Kinderman doesn’t offer even a hint of such debates. Depression is not an illness, full stop. And I would like not to be treated like an oik who is supposed to just inhale the prominent professor’s wisdom. In other words, Peter, can you stop insulting my (and others’) intelligence with these crude and unnuanced statements which are hardly arguments.
But then Kinderman says this:
People walk away thinking the problem is with them.
and I wonder even more. There are a few studies which show that people diagnosed with depression talk about it as if it were outside them. In other words, there is an illness (out there, much like a cold or flu) which made them ill. It’s nothing to do with them, so to say. Time and again, men I interviewed in my study of men’s discourses of depression narratively externalised depression (there is even a chapter on this in my book on men’s depression). Of course, I understand that I refer to studies using qualitative methods, so they are not generalisable, yet, the consistency with which the narrative appeared would be quite puzzling if it all were just an accident.
But there is more. Kinderman never offers any evidence that people think that the problem is with them, he never discusses the nature of the evidence. Is it his clinical expertise? Were there any studies? No matter, let’s assume that he is right. The studies I refer to notwithstanding, people do think that when they have depression, the problem is with them. In such a case the question that should be asked, in my view, is the source of that conviction. You see, I don’t think that people simply think that ‘naturally’. The reason might be because they have had the misfortune to see psychiatrists who have hurt them (or offered poor service, if that’s your preference). And they are legion! Or perhaps people have been attending the ‘drop the disorder’ events when they are being persuaded that what the disorder means is that the problem is with them. We’ll never know, Peter Kinderman is uninterested.
You see, I have high cholesterol (it’s a chemical imbalance proper) and I have been taking medication for it for longer than I care to remember. And, surprisingly, I continue not to blame myself for this. I continue to think that it’s bad luck, it’s likely to be genetic (my father also had hypercholesterolemia), much like the fact that I have blue eyes. Although I accept that depression (and mental illness) is different, I find it difficult to accept that everybody Kinderman refers to thinks that ‘the problem is with them’ because they had a crap shrink or because someone called their depression an illness. Surely, such statements need to be unpicked and interrogated.
And so, the final, dramatically well-trodden argument. Kinderman is quoted:
Depression is a real problem. (…) But it’s not an illness. My contention is if we were to get away from these disastrous labels and stop pathologizing normal human experiences as dysfunctions of the brain, we could start to get a better handle on why people are depressed and how best to help them.
Let’s just repeat. Peter, you are using the bloody label yourself!! It’s really not good enough to say: it’s depression, but I mean it differently. Yes, depression is a problem, but it’s not an illness. If you think that the bloody label is so disastrous, as you are quoted to say explicitly, then, for pity’s sake, why do you use it yourself?! Is it because the ‘label’ is useful to describe a particular group of people whose experiences are similar in many ways (just a suggestion)?
But then there is the small issue of evidence…..As Prof. Kinderman continues to say, the labels are pathologising and disastrous, I, on the other hand, would like to ask the question: “How do you know, Peter”? What kind of disasters happen when people are called ‘depressed’ (which, let me stress again, Prof. Kinderman is happy to do himself)? And, please, don’t talk about the stigma. The (in-)famous social-medical experiment in Japan suggests that label change doesn’t reduce the stigma at all (I describe what happened in this blogpost).
And so, the only experiment (at least as I am aware) which does exactly what Peter Kinderman wants us to do, failed. Indeed, I keep repeating that history of psychiatry is, at least partly, a history of label change. I keep repeating that any word change which is not underpinned by society, will fall on deaf ears. Indeed, words such as ‘moron’, ‘idiot’ or ‘cretin’ used to be medical terms! Psychiatry changed them, but what exactly have we achieved? So far as I can see, we only came up with a new set of words which now apparently need to be changed. The stigma, the suffering, the humiliation seems to remain the same.
This incessant banging on about language has no grounding in any evidence, let alone in how language works. No, people will not suddenly start thinking differently, because Peter Kinderman’s wish that the word ‘depression’ is replaced who knows with what. By way of analogy, it’s an argument which suggests that those of us who are against Brexit will all of a sudden start loving it because someone will call it ‘freedom’. Such arguments are not only simplistic, they’re plain stupid.
Instead of focusing on the reality of mental health/illness, Peter Kinderman offers reducing it to a word or two. Instead of focusing on the complexity of experience and its social anchoring, instead of explaining it, the language argument does away with all those difficult things. No longer do you have to wonder about models, diagnoses, let alone social contexts. You just need to change the words. Indeed, if all fails, Peter Kinderman will always have language to complain about. Always offering the happiness which is just round the corner. If only we changed that word, and then this one. As ‘we’ persuaded people that ‘language matters’, we also offered them something to be bitter about, as they can continue to look for the pot of gold at the rainbow’s end.
Yes, language matters, but do let’s stop telling people that changing one word for another will transform their lives. It will not. They will still have to see a shrink they hate, a psychologist that will patronise them. They will still be unheard, unlistened to, mistreated, and will not get support they need. They will still need a doctor’s note when they are too unwell to go to work.
But here is the alternative scenario. They will hear that they are not really ill and it’s all about the label. Change the label and the horrific compulsions will go away, the next suicide attempt will never materialise, the fear that makes you want to jump out of the window will simply dissipate. Can we at least try to get real?