The news that cricketer Jonathan Trott is returning from England’s tour of Australia, suffering from what’s been described as a “stress-related illness,” reminds us of how depression can unexpectedly descend on the most unlikely people. In recent years, athletes from across the whole spectrum of sports, have seemed particularly prone to depression. Perhaps there is something peculiar about the intense, competitive environments in which they operate. The 32-year-old Trott endured a torrid time during the first test in Brisbane as he was twice dismissed cheaply by Mitchell Johnson. He was also the victim of insults from David Warner, who accused England of being “scared” of fast bowling and Trott of being “weak”. A few months ago, Ellis Cashmore wrote a blog on depression. Here we repeat that blog.
Is depression really an illness?
It sounds a ridiculous question today. Ten years ago, we would have discussed it. Twenty years ago, we would have been suspicious. And thirty years ago, we wouldn’t have heard of the word depression, at least not in the way we use it today to describe a prolonged feeling of despondency and hopelessness. The way we conceptualize depression is largely a result of medicine.
About 54 million people around the world habitually take Prozac, which is just one of several prescription drugs known collectively as antidepressants. Between 1991 – i.e. four years after the introduction of Prozac – and 2001, depression in the USA more than doubled. It seemed more than a coincidence. Before 1986, people were nervous, glum, moody or felt continually down in the dumps. Depression didn’t begin in the early 1990s, but its official recognition as a sickness that could be clinically diagnosed and treated with medication marked the start its medicalization. This refers to the treatment of something – potentially anything – as a medical problem, even if there is little justification. That little justification is: we can treat it. If we have the ability to address any behaviour pattern or unwelcome emotional state with a medical intervention, it becomes a medical condition. Problem gambling and sex addiction, for example, are accepted as medical conditions. Treating them as such precludes any analysis of the underlying cultural conditions that give rise to complex patterns of behaviour that become, in some senses, unwelcome.
So when I hear the likes of Clarke Carlisle, the ex-pro footballer, chairman of the PFA, and Staffordshire University alumnus – and with whom I align myself in his campaigns against racism in sport – talking about depression in football, I have mixed feelings. On the one hand I appreciate that labelling mental states that interfere with normal functioning as illnesses helps remove the stigma once attached to mood disorders. If you manage the symptoms with therapy and drugs, then it serves to de-stigmatize it. On the other hand, it masks the origins or sources of the condition and painlessly negates its social dimensions. Symptoms are treated; causes are identified as within the individual, not his or her surroundings. Medicalization is a dominant force: today, more people are diagnosed with mental disorders than at any time in history. Are we getting sicker, or less “normal”? Or are we just inventing new kinds of mental disorder? The “bible” of psychiatric disorder is a US manual, The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which is used worldwide as a basis for diagnosis, research and medical education. The 2013 edition contains diagnoses of conditions such as mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder, as well as the more familiar binge eating. Accepting depression as a sickness means subscribing to what’s called a disease model.
Three particularly influential critiques of the disease model emerged in the 1960s and 1970s. They were those of Thomas S. Szasz (1920- ), R.D.Laing (1927-89) and Thomas J. Scheff (1929- ). In his The Myth of Mental Illness (1974), Szasz critiqued both the concept of mental disorder as a disease, or even illness, and the psychiatric profession that perpetrated it. In a different, though complementary way, Laing (1965) located the causes of behaviours that are seen as symptoms of mental disorders in the family, where he saw destructive conflicts disguised as “love” and “care.”
Scheff’s Being Mentally Ill (1966) proposed that mental disorders are the product of social responses to certain kinds of deviant behaviour. Being normal means conforming to an expected standard. Normalcy is a convention: a customary set of protocols and guidelines as to how we should think and act. Deviations are labelled and those who get stuck with a label find themselves unable to shrug them.
In all these and many related arguments, the complexities and diversity of character and content of what is popularly recognized as mental illness meant that it could not be reduced to the status of a disease or straightforward illness. Mental disorder is experienced in the mind, but the implied arena is larger: private conditions are indexed to social processes.
The terms that come under the rubric of mental disorder are, from this perspective, convenient labels. Once someone gets labelled as suffering from a mental disorder and in need of treatment, whether pharmaceutical or psychiatric (or both) the stigma sticks. This makes it difficult for them to be anything but someone who suffers or who has once suffered from a mental disorder and, in this sense, isn’t totally no
While it may serve the purposes of sport to liken, equate or make mental disorders synonymous with physical illness, we should guard against seeing this as the only way to understand mental disorders. According to many scholars, disordered people are often coping with exceptional social predicaments and their symptoms are more reflections of what goes on outside them than inside them.
Depression and associated mental disorders, even those of the most serious nature, have diverse origins and divergent paths of development. Mental disorders should always be understood in context and conceptualizing them as diseases does not necessarily advance this understanding. Even if it does embolden footballers and other athletes to talk about their problems in public.