The social problem of depression: a multi-theoretical analysis

Journal of Sociology and Social Welfare, Sept, 2003 by Rich Furman, Kimberly Bender

The purpose of this paper is to discuss the social problem of depression from a multi-theoretical perspective. It explores depression through the lens of two psychologically based theories of human behavior, existential theory and cognitive theory, as well as through the vehicle of two sociological theories, Marxist theory and the theory of oppression. By understanding how each of these theories explains depression, social workers may be helped to see the complexity of treating the problem. It is the belief of the authors that social work literature, which is often dominated by reductionist, quantitatively-based research studies, has increasingly ignored theoretical explorations of key social problems such as depression, to the determent of the profession and the disciplines which inform it.

Introduction

The purpose of this paper is to discuss the social problem of depression from a multi-theoretical. This work has been undertaken for several reasons. First, each of the four theories presented in this article form a piece of the puzzle for understanding depression as a psychosocial phenomenon. By understanding how each of these theories explains depression, social workers may be helped to see the complexity of treating the problem. Second, the increasing hegemony of psychiatry and privatization in the United States, through the vehicle of managed care, has led to the medicalization of many problems that often have psychosocial etiologies. Thus, other explanations to depression have received little recent interest or articulation. Third, it is the belief of these authors that social work literature, which is often dominated by reductionist, quantitatively- based research studies, has increasingly ignored theoretical explorations of key social problems. This is lamentable, as theoretical scholarship has had an important place in the building of a social work knowledge base.

The problem of depression

Depression is so prevalent that it has been referred to as the "common cold" of mental illness (Turnbull, 1991). However, unlike the common cold, depression can be fatal, and has been referred to as the world's number one public health problem (Burns, 1980). Social awareness and concern regarding depression can be evidenced by the proliferation of self-help books written on the subject over the past decade (Carrigan, 1997; Greenberger & Padesky, 1995; Larsen, 1989; Katzenstein, 1998; Kramer, 1993; Rosen & Amador, 1996). Since depression is so prevalent, all social workers, regardless of their practice setting and specialization, must be familiar with various aspects of the syndrome.

Depression has been a social problem throughout history. The biblical tale of King Saul, and Homer's suicidal character of Ajax depict examples of major depressive disorders (Kaplan & Sadock, 1998). Depression is seen throughout history in literary and medical arenas (Goodwin & Guze, 1996).

Freud's conception of depression prevailed for the first half of the twentieth century. While the psychoanalytic view of depression is far more complex and detailed than can be presented here, the perspective stresses unresolved conflicts from the past, locked away in the unconscious, as the main determinant of the disorder. Social workers working from this perspective, the diagnostic school, sought to treat depression by helping their clients uncover and resolve repressed conflicts.

The work of Jesse Taft (1933) and the functional school of social work represented a major shift in how depressive moods and other emotional experiences were seen. Taft and the functionalists rejected the notion that emotional problems were the result of unresolved conflicts and intrapsychic pathology. For Taft (1939), emotions were to be accepted and experienced, not changed or blunted. In Taft's conception of maturity and health, the highly functioning individual is able to tolerate a high degree of emotion without reactivity, without the need to "act them out." Ideally, emotions are to be tolerated and processed through our consciousness prior to any action.

Challenging the dominance of the diagnostic and the functional schools in the interpretation of depression was the developing medical model. With the advent of modern psychiatric medication, depression began to be seen as a medical disease. Today, the medical model stands as the dominant model for understanding and treating depression. Psychopharmacological developments, through the study of antidepressant medications and their effects on depressive symptoms, have supported the biomedical view of depression and other mental disorders. Medical research has sought to demonstrate that depression is caused by fluctuations in levels of neurotransmitters, which lead to the subjective experience of depression. The medical model seeks to increase levels of these neurotransmitters in an effort to decrease depressive mood. (Kaplan & Sadock, 1998).

For the general United States population, Boyd and Weissman (1983) report that at some point in their lives, 8-12 percent of men and 20-24 percent of women will meet the diagnostic criteria for major depression. Prevalence of depression varies greatly within the population however. Egeland & Hostetter (1993) found the incidence for all types of depression within the Amish community to be less than 1 percent. This variance across populations points to the importance of social and cultural influences in the definition and expression of depression.