De-Stigmatizing Mental Illness: An Inquiry into Depression

'Nature vs. Nurture' vs. 'Nature and Nature'

Here at IU, we have a lot of campaigns directed towards the de-stigmatization of mental illness. Last year, the Hutton Honors College hosted a discussion about issues with Autism in Pop Culture. Though the discussion mostly consisted of sharing personal stories of those with the disease and speaking of our desire to let them know that it is okay to have it, there wasn't much critical thought put into the assumptions upon which our views toward mental health are built. We were too intimate with a desire to accept one another for who we are that we didn't try to understand what autism, or any disease, really is.

As a science enthusiast, I believe it's important for us to realize how our biological frameworks of disease affect the stigma of mental illness. One might adopt a view of mental illness in which everyone (not just those who suffer from mental illnesses) has different genetic mutations, and some of those mutations are caused by diseases. With this in mind, despite the way biology affects who we are, everyone still has responsibility, personhood, goodwill, etc. This will reduce stigma as we understand disease as something that does not detract from who we are, but, rather, something "natural" that comes about through the same biological processes that make up everyone. These mutations may have affects on proteins, cells, etc., and give rise to various phenomena., etc. At first glance, it seems as though this mentality would reduce stigma of mental disease. But how effective is it?

A recent article in the Hedgehog Review suggested that emphasizing biological roots of disease actually causes us to view mental illness more negatively:
Over the past two decades, both the general public and patients themselves—historically quite resistant to disease models of emotional and psychological problems—have become relatively more biologically minded. This change correlates with an increased endorsement of seeking professional help and using prescription medicine, as well as some reduction in attributions of blame: three of the central goals of the public anti-stigma campaigns (and pharmaceutical advertising). The change, however, also correlates with more intensely negative attitudes toward those with mental health problems, attitudes that are shared even by sufferers themselves.
Joseph E. Davis explains that a "trade-off" between responsibility and medical roots causes this negative attitude. I believe the issue is that there is a misconception that the existence of a disease/illness creates a trade-off between nature and nurture, when, in reality, the disease/illness do not detract an individual's rational ability to make decisions for him/herself. It only means that a person's ability to make decisions and his/her personhood are now in a different "context," and that the person still has the same control over what he/she chooses to do. "Nature vs. Nurture" implies a tug-of-war between which the existence of forces on one side diminishes the other, so it might be better for us to adopt a more accurate phrase: "Nature and Nurture."

A Different Kind of Disease? 

Is mental illness really as "natural" as other types of diseases? Mental illness not only affects our physical body (most notably through neurological changes), but affects the very way we think. Through our inquiry into mental health, we must approach disease with a critical look at morals, values, and humanism in what we do. This separates mental diseases from others, and, for this reason, we might be inclined to view them as, frankly, different kinds of diseases.

Depression, a common disease of the mind, has been seen as both a mark of honor and as a stain of shame, with ethical challenges to both viewpoints. Freud noticed that the melancholic “has a keener eye for the truth than other people who are not melancholic. When in his heightened self-criticism..., it may be...that he has come pretty near to understanding himself.” The romantic genius burdened by age-old questions of existence and the unsocial artist obsessed in his craft may both be seen as filled with woe in light of their gifts. Isaac Newton, David Foster Wallace, and Montaigne have battled with feelings and perceptions inherent to depression, yet we still highly regard their mentalities as though they were heroes. Maybe depression is a different kind of disease in the sense that we may sometimes glorify it? Despite any intellectual value, our society still generally sees depression as something that should be abolished as we have put forth tremendous amounts of effort to help people overcome depression. But positing depression as something that should fight may conflict with our belief that it is "okay to have depression." More generally, our motives of de-stigmatization vs. treatment are often at ends with one another. Simultaneously, we should also be skeptical of the way we glorify the melancholy as those who are truly in-tune with the harsh reality of the world. The way I see it, it's very dangerous to view depression as "accept yourself the way you are because that's what you are." Though we want more people to realize the reality of depression, image and stigma of depression are still too harsh for us to use depression as our identities. And these challenges in our approach to the disease are similar to be found in any mental disease.

Is Mental Illness at odds with Reason?

We are in love with our ability to think rationally. We want to accept ourselves as creatures most closely defined by reason, and we closely associate our argumentation, rhetoric, and similar abilities with our identities. But how does mental health affect this identification? Kant would say depression is "the weakness of abandoning ourselves to morbid feelings," and, since, according to Kant, this detracts us from our ability to reason, it means that Kant would have viewed depression as something connected to reason. This might explain why, despite our anti-stigma campaigns, it is difficult for us to swallow the idea that mental illnesses are just like other diseases. One might argue that, as a result of this account, we ironically have identified, not as masters of reason, but slaves to it.

Depression is not an emotion like other emotions, and, if one believes emotions are adversarial to reason, depression might just be the manifestation of undesirable thoughts that result from pushing reason to the extreme. But one might, in addition, declare that depression should still be avoided at all costs as, while it might not be a weakness in and of itself, its potential to create further weaknesses makes it too unreliable as a means of reasoning. This may compromise our view as depression as a beneficial, acceptable characteristic while avoiding the consequences of blindly praising it. 

And, though there may be similarities between depression and other mental disorders, it would be an oversimplification to paint the entire category of mental illness with a broad brush. Rather, we should embrace a more nuanced approach to different types of mental health issues with science, philosophy, and humanism leading the way.