Abstract
Depression: Integrating Science, Culture, and Humanities is a thin volume that accomplishes a great deal. In just 120 pages, Bradley Lewis summarizes psychiatric models of depression, reviews the alternative frameworks suggested by historical and cross-cultural research, and advocates for narrative theory as a way to make sense of and utilize divergent approaches. His argument is straightforward, pragmatic, and quintessentially postmodern: Despite the ascendance of scientific psychiatry, the disease model of depression does not capture the complexity or totality of people’s experiences. No single model can. Since there are countless, equally valuable frameworks for understanding depression, the best orientation to treatment helps sufferers to choose among various courses of action. Narrative theory, Lewis argues, offers a useful set of concepts for practitioners wishing to adopt this humble “recovery” approach to providing care.
For a short book that covers so much ground, Depression: Integrating Science, Culture, and Humanities is surprisingly rich with detail. Lewis’s careful account of what doctors learn in psychiatric textbooks is followed by an excellent summary of scientific controversy regarding diagnostic expansion, the efficacy of antidepressants, and the “broken brain” analogy. His 19-page chapter on Western history somehow manages to avoid superficiality, even though it begins with The Epic of Gilgamesh and ends with psychiatry’s turn away from psychoanalysis and psychotherapy in the 1980s. Lewis’s discussion of cultural contexts is particularly compelling. In addition to conveying the central role of culture in shaping experiences and expressions of sadness, he sharply critiques the American pharmaceutical industry as an agent of cultural change. Focusing on the transformation of the Japanese market for antidepressants in the 1990s, Lewis reveals the industry’s calculated efforts to export a disease model of sadness, thereby increasing demand for the drugs they sell.
Despite such incisive analyses, Depression: Integrating Science, Culture, and Humanities has some blind spots. Lewis mischaracterizes David Karp’s (1997) Speaking of Sadness as a “memoir.” A qualitative study of 50 people with depression, Karp’s work is considered a seminal contribution to the sociologies of emotion and mental health and can hardly be considered autobiographical. Lewis’s failure to mention Is It Me or My Meds?, Karp’s (2007) study of how people manage and make sense of taking antidepressant medications, is even more puzzling, given how nicely it dovetails with Lewis’s own assertion that clinical decisions should align with a person’s “life choices, life goals, and narrative identity” (Lewis 2012:88).
By leaving sociological accounts like Karp’s out of the picture, Lewis downplays how much social scientists already know about people’s active and complicated relationships with psychiatric models of sadness in the contemporary United States. It seems, in fact, that the only people in the academy who remain stubbornly unaware of depression’s multidimensionality are scientific psychiatrists and other purveyors of the disease model. Here I think that Lewis’s analysis could be much more to the point. He has little to say about medical scientists’ complicity in the rise of “big pharma,” and he writes only a sentence or two about the legitimacy that psychiatrists sought to gain by turning toward a biomedical framework in the 1980s. Although Lewis highlights the shortcomings of the disease model, he only hints at the potential harm that can result from biological reductionism and the widespread medicalization of human sadness. By positioning the disease model as one among many potentially useful frameworks, he largely neglects the dynamics of power and inequality that shape the availability of particular discourses.
Somewhat paradoxically, these gaps make the text a good supplement for sociology courses, which are apt to focus on some of the social and political dimensions of depression that Lewis overlooks. Not only is the book’s brevity ideal for undergraduate instruction, but Lewis’s writing is engaging and highly accessible. Appropriate for courses such as Self and Society, Medical Sociology, and the Sociology of Mental Health, Depression: Integrating Science, Culture, and Humanities offers a short but well-grounded introduction to key perspectives on depression. If Lewis’s work is any indication, Routledge’s series on Integrating Science and Culture will be a fruitful source of other cross-disciplinary texts in the future.