This book, written by Carl Walker (a senior lecturer in psychology at the school of applied social science, university of Brighton) within a critical psychology perspective, aims mainly at defending the following thesis: "depression is a political and economic problem" (p. 157). More precisely, it features the social production of mental illness, i.e. too much underestimated links he said between political economy, social structures and prevalence of depression. The general and theoretical problem to solve is well-known, but disputed: what is the etiology of mental illness?
The response of Carl Walker runs as follows. Basically, the book is organized in three parts. At first glance, the first two parts seem to be juxtaposed, the third party being the true place of the argument. In fact, the thesis is developing all along the book at three levels: as a clinician practitioner ("depression"), as a kind of altermondialist activist ("Globalization") and as public health expert ("Mental health"):
The first section is devoted to a critical overview of the definitions of depression. The aim is to disconnect sharply two kinds of depression ("reactive" and "endogenous") and to defend one against the other: Etiology is more important than symptomatology (DSM) in order to delineate and reinvest "reactive depression" in response to a given set of circumstances (p.6, p.41). Environment and psychosocial circumstances (stress and life events), is more important than biology and psychology. Depression is real and disabling, but neglected and under-diagnosed, treatable but as a stigma (in the social representations) is still very strong.
The second section deals with the social change and its bad impact on our environment. It has been a critical history of political economy in United State and United Kingdom since the late 70s, becoming globalization today. The author is not anticapitalist (p. 98 et p.102), but he opposes the social cost (distress, social inequalities, social disintegration) of this "rapacious Anglo-American form" of capitalism and individualism (religious, psychiatric, economic and politic) as ethic of responsibility. "Social capital" (p. 125) is destroyed by neoliberalism.
The third section provides with a broader functionalist analysis of the consequence of "the structural factors that create a conducive environment to the development of mental distress and, particularly, depression" (p. 135). And this reactive depression is preventable if we solve poverty problem and social inequality... This reactive depression is treatable with collective action and case management. We find there another critic of psychotherapy (and the drug industry) as a support of a pathogenic individualism and the psychologization of social problem (chapter. 6).
This book is not only weak as it is mostly built from a series of sum-ups, but as it is not critical at all:
First, the number of manual of sociology or social work defending this thesis (the stressful theory of mental illness and the critic of medical model) can be counted even more. The author emphasizes and synthesizes a well-known literature from sociologists and psychiatrists about distress (the new word and a core contemporary concern for reactive depression).
Second, as Georges Rosen had shown it in a famous article (1959), social psychiatry held an old conservative thesis against social change (urbanization, industrialization, individualization). What the leftists don't see is that the "neo liberals" has successfully domesticated the discourse of progress and modernity! The need for a new relevant critical discourse is thus the more important point.
Third, Carl Walker doesn't notice from his functionalist point of view that individualism is a vector of freedom as well. Freedom is not always compatible with well-being. In France, for instance, the psychoanalysts are developing a radical critic of neoliberalism and propose to treat the "social suffering" (from worker to homeless) on behalf of freedom because psychoanalysis is considered as emancipative therapy and not as adaptive.
Four, neoliberalism promotes today a new humanism around the concepts of "psychosocial risk management" and "well-being", so much cherished by Carl walker. The moral consensus that he highlights between mental health politics and liberalism is right, but certainly not as psychologization and eclipse of social structures. The concern over the possible pathogenic environment and traumatism has never been greater. It's the reason why the links between social structures and mental health is certainly not underestimated. Rather social epidemiology flourished and most contemporary international conference of psychiatric epidemiology focuses precisely on this topic (for instance, "Global Recession: Psychiatric Illness, Violence and Addiction in Population under Stress" at the 13th International Congress of International Federation of Psychiatric Epidemiology, in Taiwan, the next 30th March – 2nd April, 2011).
The need for mental health, and in particular, of mental healthy workers is in the heart of the message conveyed by international health organizations on mental health (as WHO) stresses very well on a new scourge that must be a priority for every national health policy in twenty-first century : the fight against distress, depression and suicide. Indeed, the economic cost and the impact on international economy are at the core argument for the implementation and dissemination of public health campaign. Observing social inequality, distress and poverty remains a powerful mean to anticipate social critics and social disorders.
© 2010 Samuel Lézé
Samuel Lézé is social anthropologist, postdoctoral research fellow at the CNRS and member of IRIS, EHESS, Paris, France. His research interests focus on contemporary mental health issues in France within political and moral anthropology. He recently completed The authority of psychoanalysts (Puf, 2010). Website: www.sleze.fr