“A Disease Like Any Other”: Awareness-Raising and Neuro-tivization of Depression in Poland

Polish and Global Contexts

Discourse on depression in Poland is an example of the global medicalization of distress spanning the entire twentieth century. ¹⁶ The medicalized idiom “depression” gained momentum in the public discourse of the Polish transformation and the advent of capitalism in 1989. During the first decades of systemic change in Poland, depression acquired a twofold meaning, denoting losers and winners of systemic transformation. Sokół ¹⁷ describes how existential anxiety resulting from abrupt economic struggle turned into a pathological state. The term “depression” describes the suffering of those “falling behind,” unfit to become entrepreneurial and face the demands of the free market. However, adaptation to the new conditions also leads to depression: when enthusiasm about promises of the new order morphs into feelings of deception and despair. ¹⁸ Over thirty years after the transformation, depression has lost any connotations in economic and political realms in Polish public discourse. The dominant denotation becomes that of “a disease” which falls under medical/psychiatric scrutiny. ¹⁹

Although local idioms of humanistic, socially oriented psychiatry emerged around the 1970s, contemporary Polish psychiatry aligns mostly with globalized practices of biomedical psychiatry. ²⁰ Legacies of Polish critical psychiatry, represented by Antoni Kępiński and Kazimierz Jankowski, ²¹ are primarily neglected although Polish psychiatry maintains local specificity in certain areas. For example, the diagnosis of attention-deficit/hyperactivity disorder (ADHD) is generally less medicalized in Polish health care, and society in general, than in the United States. ²² However, at institutional levels, Polish psychiatry embraces the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases (ICDs), reflected in the curricula of psychiatric education, as various compendia and manuals present biological aetiological conditions and pharmacological cures. ²³ Strict collaboration with the international pharmaceutical sector shapes diagnostic practices and treatment conceptualization of globalized Polish medicine. ²⁴

The pharmaceutical sector plays a significant role in the social negotiation of depression’s meaning between the lay public and experts. Social campaigns on mental health run by pharmaceutical companies provide action models for other social actors, like children, to run their campaigns (D.presja). However, the industry’s impact is not limited to public awareness-raising, as pharmaceutical companies actively shape the expert psychiatric discourse and treatment practices in Poland. One example of such practice is two online psychiatric conferences held during the COVID-19 pandemic, both sponsored by Polish and international pharmaceutical companies. During these conferences, renowned psychiatrists, including the head of the Polish Psychiatric Association, reported on trends in the pharmacological management of mental health. With diagrams depicting biological mechanisms of diseased nervous systems, psychiatrists (often holding a professorial position) explained the functioning of drugs and discussed questions about adequate dosages of psychopharmaceuticals. For instance, a lecture entitled “Progress in the Treatment of Depression and Phobia” discussed esketamine, recommended in treating drug-resistant depression and pregabalin for general anxiety disorder. Both substances are active ingredients of medications produced by the conference sponsors Janssen and Zentiva.

With a focus on the role of the brain in the development of mental health conditions, the mainstream psychiatric discourse has become a neuronarrative framing depression as a dysfunction of an individual’s neural circuitry. ²⁵ Sokół ²⁶ shows how implementing the World Health Organization’s (WHO) ICD into the Polish health care system in 1997 has led to a certain kind of rupture in the Polish psychiatric practice. Some professionals perceived this as a necessary improvement in closing the gap between “us” and “the West,” thanks to which Polish psychiatry could become a legitimate medical field. ²⁷ However, one part of the psychiatry practitioners criticized the highly formalized character of the newly introduced diagnostic framework. The clinicians felt deprived of part of their agency and articulated the contradictory nature of the ICD diagnoses—“rigid” and “loose” at the same time. ²⁸ The internal “shakiness” of the diagnostic categories stemmed from abolishing the crucial distinction between the states of health and disease in the earlier diagnostic manuals. ICD tenth revision (ICD-10) followed the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, which ultimately divorced mental disorders from their aetiology. Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) stated that mental disorder

must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of the loved one. Whatever its original cause, it must currently be considered a manifestation of behavioural, psychological, or biological dysfunction in the individual. ²⁹

A new, much more accommodating definition of disease emerged: one in which disease ceased to be regarded as an excessive reaction to certain life events. Instead, whether excessive or not, the reaction itself, if it involved specific symptoms, started to be framed as a disease. The DSM and ICD diagnostic classifications, developing along the biological theories of depression, fostered increasingly reified conceptualizations of depression. ³⁰

These changes in Polish psychiatric practice unfold within global processes of psychiatrization. Following the “emergence of health as a significant marketplace,” psychiatric categories, encapsulated in international manuals such as the DSM and ICD, have become part of the global circulation of information and capital, ³¹ contributing to worldwide and local processes of psychiatrization. Beeker et al. propose that psychiatrization embraces material and ideological aspects of psychiatry. Material aspects refer to the overall development of psychiatric infrastructure that encompasses private and public research institutions and technological and pharmaceutical companies; in other words, the institutional expansion of psychiatry—including its practices and forms of knowledge. This materiality of psychiatrization creates “a base” for its ideological expansion that manifests as “an increasing number of individuals being diagnosed as mentally ill, the permeation of psy-knowledge within more and more areas of life, and the furthering of its impact on and its importance in society as a whole.” ³² For Horwitz, ³³ the ideological aspect refers to the domination of symptom-based definitions in diagnostic practice, leading to a growing number of behaviours and mental states being defined as psychiatric conditions. The high prevalence of mental disorders in epidemiological surveys results from lowering diagnostic thresholds. ³⁴ Psychiatrization is far from a homogeneous, top-down process. Instead, it consists of “heterogeneous, not centrally controlled sub-processes, which [are] driven by different agents, for diverse and sometimes even contradicting motives.” ³⁵

While Beeker et al. claim that psychiatrization constitutes a “messy” series of claims and events where it is tricky to discern a leading voice, ³⁶ Dumit ³⁷ points to the existence of an opposing phenomenon—depsychiatrization. Borrowing the term “depsychiatrization” from Robert Castel, ³⁸ Dumit ³⁹ suggests it involves empowering the patient (rather than doctors), mediated by the raising of their awareness. As prospective patients become informed about their suffering, they can demand prescriptions from doctors. Psychiatry loses its unique expertise when diagnoses are broadly marketed and prescriptions are available from general practitioners (GPs). Dumit ⁴⁰ claims that applying symptom checklists results in expanded boundaries of pathology and maximizes drug prescriptions. While it is difficult to reject the claim that the pharmaceutical sector profits from the heightened awareness of any given disease, it is debatable whether depsychiatrization undermines psychiatry’s position. Rather than viewing depsychiatrization as opposed to psychiatrization, this article shows the merging of these processes. The theoretical outlook I propose draws from Lakoff’s ⁴¹ concept of diagnostic liquidity and the related concept of the boundary object. ⁴²

Method

This article draws from ongoing qualitative research framed within a PhD project devoted to the experiences of depression in young adults in Poland. It aims to elucidate the social contexts of depression and juxtapose illness narratives with mediatized and medicalized conceptualizations of depression in public discourse in Poland. This article examines the content of the “Forum Against Depression” awareness campaign. Because the article’s scope does not allow for a detailed analysis of all data on the website, the analyses focus on permanent content and a short film, Disappearing Children, published by the Forum in February 2020. ⁴³ As part of a campaign against teenage depression, the film is available on the Forum’s website and the YouTube channel of its director, introduced as “The Director of Life.”

To understand how the Forum’s discourse frames depression, close attention is given to textual sections devoted to depression symptoms, causes, and treatment. At the same time, an analysis of the movie provides clues about the functioning of awareness campaigns as a “mode of self-identification around illness.” ⁴⁴ The film gathered more than twenty-five thousand comments, many written by children, youth, and parents. ⁴⁵ These comments show that children are asking teachers to watch the movie at school. Recognizing the profound impact that the film exerts on youth, the analysis of comments provides insight into the potential social effects of awareness-raising. Thematic analysis ⁴⁶ identifies some recurrent topics and formulations.

The websites’ textual content was collected using the Web Collector plug-in—offered by MAXQDA analytical software used for coding and analysis. Coding the data enabled the identification of thematic patterns and was followed by critical discourse analysis (CDA). The most frequently used codes were the following: “disease,” “symptoms,” “treatment,” “doctor,” “relapse,” and “risk.” The CDA framework was applied because it is a productive approach to studying cultural idioms of mental illnesses as specific narrative constructs. ⁴⁷ Fairclough ⁴⁸ observes that close attention to “textual analysis is better able than other methods to capture sociocultural processes in the course of their occurrence, in all their complex, contradictory, incomplete and often messy materiality.” However, the method applied here is more open and heuristic-based than in “traditional” CDA literature.

“A Disease Like Any Other”

The Forum is a comprehensive and visually compelling database devoted to depression in Poland. Constantly updated and rich in content, it offers free educational materials for teenagers, parents, and teachers. The Polish Psychiatric Society and different non-governmental institutions collaborate with the Forum. Its campaign, “Faces of Depression,” is supported by public figures such as famous actors, singers, and sportsmen and addressed to youth—casting Polish teenage influencers and celebrities. The campaign’s name suggests that depression is an enemy to be fought, and the Forum “spread[s] knowledge about depression and build[s] social awareness of the fact that depression is not a condition that goes away but a disease that should be treated.” ⁴⁹ The carefully produced film Disappearing Children is an example of the campaign’s broad educational activity.

A pharmaceutical company runs the Forum, and this link is not transparent. The company sponsoring the Forum’s activities produces drugs for major depression in the Polish market. The language used in communication about the campaign’s creators, called “organizers” and “a company,” obscures this affiliation. The Forum’s discourse weaves into complex networks of global international institutions, local medical sectors, media, and governmental and non-governmental institutions. The website has the patronage of the Polish Psychiatric Association and refers to publications of the WHO and renowned Polish psychiatrists. In the section “Treatment,” under the list of drugs, there is a reference to Depression in the Practice of a General Practitioner: a compendium by an editor of popular manuals for psychiatry students. ⁵⁰ In addition, the Forum lists several non-governmental organizations (NGOs) active in the field of education as partners.

The website presents depression as “a disease like any other” related to pathological brain functioning. The tab “About the Disease” divides into subtabs, including “Statistics,” “Relapse of depression,” “Is It Depression Already?,” “I Suffer from Depression,” and “Symptoms of Depression.” ⁵¹ Depression correlates with chronic stress and involves a failure of mechanisms related to the HPA (hypothalamus-pituitary-adrenal) axis and “biological mechanisms taking place in our brain.” ⁵² Faulty stress inhibition increases levels of “many substances released under stress.” ⁵³ Consequently, “the work of many brain centres, including those regulating mood, life force, and emotionality,” becomes disrupted. This explanation does not entirely reject causal models of depression framed as problems of neurotransmitter imbalance. Instead, it emphasizes that the current understanding of depression includes other biological mechanisms related to “chronic stress”: “Currently, the causes of depression are not limited to disorder in the secretion of serotonin and norepinephrine. Research on the biological mechanisms in our brain shows that depression is associated with chronic stress in most (but not all) patients.” The campaign introduces a new paradigm yet without refuting the former. It sounds as if neurotransmitter imbalance was a cause of depression; however, predominantly, it is related to chronic stress and to the “significant role” of the HPA axis. Depression is not easy to cure because of the high risk of relapse: “As much as 75% of those who get sick will fall sick again within two years after the treatment of the last episode.” ⁵⁴ The Forum warns that “symptoms” might occur in subsequent episodes, so prolonged treatment might be needed. Patients should strictly collaborate with a doctor and never independently quit medications or modify dosages. Treatment continues for a minimum of six months; however, due to relapse, it can last for a year or “most often two years.” ⁵⁵ The research the Forum refers to is not specified, and there are no references or studies in the section devoted to causes; nevertheless, the text uses popular scientific vocabulary.

The framing of depression in the Forum’s discourse is split, proving that the marketing of mental disorders moves in two directions. One purports the reification of a disorder by creating an object with stable meaning, eradicating any uncertainty. Those knowing-what-a-disorder-is speak for and represent it. The other is ex-centric and works towards the explosion of the disorder’s meaning, destabilizes it, punctures its borders, and makes it leak. What was inside moves towards the outside. The limits of knowing dissolve as the object becomes dispersed. When symptoms disconnect from subjective immersion in specific cultures and economies, the disorder’s definition turns liquid. “Liquidity” of depression diagnosis means that the category becomes a standardized symptom-based convention. ⁵⁶ Lakoff observes, “in the case of mental illness, the effort to generate a space in which information flows seamlessly between biomedicine and the market is challenged by the difficulty of knowing just what a psychiatric disorder is.” ⁵⁷ In other words, because the status of a psychiatric disorder continues to be highly ambiguous, the biomedical sector (e.g., psychiatrists) cannot synchronize with the market (e.g., the pharma). However, instead of viewing this effort as challenged by epistemic uncertainty, the possibility of uncertainty can be considered the sine qua non of seamless flow between biomedicine and the market.

Only through liquidification, entailing “a reduction and standardization of complexity,” can mental illness acquire potential universality, allowing for its global circulation as information-bound-capital. The “absence of a clear understanding of the biology of psychiatric illnesses” ⁵⁸ ceases to be problematic. ⁵⁹ Lakoff notes that “the thingness of the disorder” could not be identified because of the “biological complexity of the inheritance mechanisms.” ⁶⁰ Regardless of this uncertainty, the Forum presents depression as a problem with the brain, an imbalance of certain chemical substances, stabilizing its meaning as a disease. Such a description of depression’s causes can be interpreted as objectivity-suggesting phrasing, to paraphrase te Meerman et al. ⁶¹

At the “symptom” level, depression can be framed as a collection of vague risks and is widely marketed to invite self-identification by increasing the number of prospective expert-patients. The uncertainty regarding disease’s manifestation punctures the borders of the meaning of depression. In the “Teenager zone,” depression is presented as a “democratic” condition: it “can affect anyone.” ⁶² Nothing like “age, scores at school, popularity, or many friends on Facebook” ensure that one does not fall prey to it. Ultimately, its signs can be just as banal as experiencing frequent “bad days”: “everyone has a bad day once in a while. However, if bad days start to be more frequent, it can be a sign of an illness requiring help from a specialist.” ⁶³ The Forum references the ICD-11 ⁶⁴ to present symptoms of depression and simultaneously reformulate them. This reformulation is not accidental as it expands the pathology’s boundaries. While ICD criteria present a matter-of-fact list of nouns with adjectives, namely, depressed mood, markedly diminished interest or pleasure in activities, reduced ability, or marked indecisiveness, the Forum introduces shifts in grammar and meaning. These linguistic changes consist of a second-person perspective and affective narrativization of symptoms: “You are sad for a major part of the day, almost every day. You often cry,” “You feel agitated and anxious; other people can notice it too.” ⁶⁵

Another significant difference is the replacement of specific, narrow diagnostic criteria from ICD with a phrase unspecific and vague enough to induce fear. Therefore, instead of a “change in psychomotor activity with agitation or retardation,” ⁶⁶ depression manifests when “you feel tension.” ⁶⁷ Tension can be a sign of disease because the reader does not know how much is “normal” and when it is time to see a doctor. While biological causes of depression are known, symptoms of it might be highly unspecific. Such discursive construction creates a dispersed definition of depression. This denotative dispersion can serve to provoke constant (self-)observation and self-diagnosis. ⁶⁸

Framed as an imbalance in neuro-hormonal circuits, depression demands pharmacological treatment as an essential response. ⁶⁹ The Forum lists popular medications, including information about the drug’s generation, mild side effects, and functioning. The description of the last two positions differs significantly from the previous ones ⁷⁰ :

Such formulations suggest that the SSRI and SARI drugs cause disturbing side effects. Although SSRIs are popular and “better tolerated,” they are hardly the best solution because of their side effects. ⁷¹ Their descriptions are not formulated in scientific language, while the descriptions of tianeptine and agomelatine utilize technical neuroscientific vocabulary to describe their mechanisms of functioning. The website provides no information about these drugs’ generation or side effects. This sudden change in the language style suggests, to a casual reader, that agomelatine and tianeptine are innovative drugs free of side effects. For example, according to the Forum, tianeptine targets the HPA axis, and hence the mechanism that causes depression. Both tianeptine and agomelatine are active ingredients of drugs developed by the pharmaceutical company running the campaign. While the website does not mention any side effects, the online pharmacy website doz.pl explicitly states various side effects.

Similarly, PubMed references articles pointing to potential risks related to tianeptine and agomelatine use. For example, there is evidence that tolerance for tianeptine can develop due to its psychostimulant effects, leading to abuse. ⁷² Vadachkoria et al. ⁷³ point to a withdrawal syndrome characterized by high levels of anxiety and depression. Voican et al. ⁷⁴ prove that agomelatine can cause irreversible liver injury independent of intake duration. Other studies conclude that medication might be addictive in patients with a history of opiate abuse. ⁷⁵

The above-mentioned semiotic constructions and ordering of information in the website’s tabs constitute an invitation to self-screening. The threatening unspecificity of definitions is conducive to self-diagnosing the subthreshold condition as a disorder. Introducing a slight departure from the diagnostic criteria of the ICD goes a long way. The basis for diagnosing major depression, according to the ICD, is when several symptoms co-occur for a majority of the day, nearly daily and at least two weeks. While it is debatable whether sadness and anhedonia lasting for two weeks is a disorder, the Forum expands the boundaries of the pathology. Horwitz notes that such framing can be understood as an attempt “to lower the threshold of the diagnostic criteria and define as disorder subthreshold conditions.” ⁷⁶ Awareness-raising ultimately aims at turning readers into prospective expert patients ⁷⁷ and conceals social factors often primary to biological dysregulation. ⁷⁸ In February 2020, the Forum published Disappearing Children, a short film devoted to teenage depression. ⁷⁹ This film provides an example of psychiatrization of stress or a neuronarrative of affliction ⁸⁰ that visibilizes the social origins of distress and immediately frames them as a disease.

Disappearing What?

The film tells a story of a young teenager Ola, her slightly older sister Weronika, and their mother. While her older rebellious pink-haired sister is a troublemaker, Ola is the obedient, well-performing pupil, set as an example of virtue by the girls’ mother. According to their mother, girls “have it all,” yet both sisters are visibly in distress, and the younger one cannot cope. Dreaming of a singing career, Ola listens listlessly as her mother advises her to focus on chemistry: “You have to become a doctor, you understand?”; “One day you will become perfect,” she says, stroking her daughter’s head.

There is an atmosphere of tension and conflict in the family. Emotionally isolated and pressured to drop her dreams, Ola shares her problems with a friend. When she returns from school, she finds her mother busy giggling on the phone with her boyfriend. Reaching out for connection, Ola tells her sister she loves her, but Weronika ignores it and sneaks out for a party. Left alone, the girl logs onto Facebook and posts a dramatic verse from her lyrics. The following scenes suggest her suicide and the grief of her mother, sister, and school. The last minutes show the movie’s director claiming that “depression and emotional problems” are “taboo topics that we are ashamed to talk about, that we often avoid, especially in our country. While it should be different, we should be ready to admit something is wrong with us and not hide our problems.” ⁸¹

In the context of the whole campaign, the film’s message seems obvious: untreated depression is a dangerous disease that might lead to suicide and needs attention from parents and teachers; it needs “talk” and to be treated “like any other disease.” Featuring celebrities was largely successful in capturing the attention of a young audience who accepted the call for participation or the “talk challenge.” The film’s attractiveness can be partly explained by the presence of young amateur actresses and celebrities with millions of followers on Instagram with influencer status among Polish youth. By December 2021, this campaign had been viewed more than 10.5 million times, while the Polish population is around 40 million.

The narrative of misunderstood and depressed children presented in Disappearing Children hooks the audience, providing an example of a “mode of self-identification around the illness.” Numerous comments posted on the film’s YouTube channel testify to the issue’s importance for youths who readily embrace the story and begin talking about their experiences. The common motive of these comments are children’s complaints that parents do not understand them; blame everything on computer games, smartphones, and the Internet; and trivialize their children’s problems, shaming and punishing them for depression: “In the meantime—my parents: children cannot have depression, because they do not have problems”; “It hurts the most when my parents say to me: I cannot bear you anymore”; “Child: /*has depression*/, Parents: THIS IS 100% BECAUSE OF THE PHONE! YOU HAVE A BAN!!”; and so on. Numerous comments mention crying while watching the film and an urge to watch it multiple times. There are many complaints that parents tell youth their depression comes “from boredom,” age, hormones, because it is “fashionable” to have it, and that it is simply impossible that young people suffer if they “have all they could want.” One user put it like this: “A child has depression and parents say: I bought you everything, phone, clothes, so don’t you exaggerate, they will always say that.” Many comments recognize that the film shows “the truth” and “the reality” of feelings and relations. Viewers believe that the movie was an initiative of the Director of Life, showing “the truth.” They are impressed by the film’s professionalism, complimenting the director for showing “what people feel in reality.” One comment captures the essence of this “reality effect”:

This film was so true that I had to cry. I know what it feels like. And this is exactly why I love your films. You show what is happening in reality and what people really feel, not what teachers say. Thank you!”

Some entries are requests, like one which got 6,500 likes: “It would be great to see something about depression in men because it is not much talked about.” ⁸⁴

The viewers’ comments prove that the social creation of meaning is highly complex and cannot be controlled by any institution. Today, knowledge production on health and disease extends well beyond the medical realm. Many actors, namely, doctors, other medical personnel, and the wellness industry, including technological devices and patients’ movements, all compete for cultural authority in the domain of health. According to Epstein and Timmermans, ⁸⁵ cultural authority consists of the ability to shape meanings of health and disease. The campaign creates a space in which depression is simultaneously reified and fluid. ⁸⁶ It signifies a disorder of the nervous system induced by stress, its symptoms are standardized, but at the same time, its nature is fluid and undefined. Depression thus functions as a boundary object—biological and social, “a biological thing” of the medical realm and yet “a social thing” that emerges within social relations and manifests as observable symptoms. The concept of the boundary object introduced by Star and Griesemer ⁸⁷ can help understand how depression as a category, a human-made but non-human artefact, generates “interpretative flexibility” that enables different social actors to act upon it. ⁸⁸ Although these actors can diverge in their aims and interpretations, the boundary object provides them with a frame of reference—solid and fluid enough to accommodate these differences. Boundary objects are thus “both plastic enough to adapt to local needs and the constraints of several parties employing them, yet robust enough to maintain a common identity across sites.” ⁸⁹ In the case of awareness-raising, “depression” refers to the standardized psychiatric diagnosis signifying a biological disorder. At the same time, it also embraces the myriad experiences of those who define their symptoms as “depression.”

In this way, the psychiatric categories cut the boundaries between different social professional and lay groups, allowing them to cooperate and eventually form what Star ⁹⁰ calls a “boundary infrastructure.” Regardless of their internal diversity, boundary objects can thus produce consistent practice. While “depression” as a boundary object can accommodate diverse experiences and meanings, it also possesses an aspect of one-ness. It is a thing: “a disease like any other.” Bechky ⁹¹ observed that objects mediate power relations between professional groups: the status of an expert can only be maintained by a group if the group can understand something that the other ones cannot understand. While the doctors have expertise in the “solid” biological characteristics of depression, the rest of society has “soft” expertise: knowledge about symptoms and treatment. The expansive potential of depression as a boundary object fulfils the market requirements. The awareness-raising thus is driven by the inclusivity principle: the more people talk about their experiences, the more confidently they seek help.

The urgency of overcoming stigmatization and shame to empower people to admit that “there is something wrong” with them is a recurring motif in the campaign. In a spot entitled “Faces of Depression,” published on 1 October 2020, the representative of the pharmaceutical company running the campaign says that for fourteen years, the Forum has been “breaking the taboo of depression.” ⁹² Therefore, the Forum’s activities potentially lead to the “normalization” of depression or “depsychiatrization.” While depression is psychiatrized by emphasizing its biological causes and pharmacological treatment, depsychiatrization is inherent in the call for participation and overcoming shame. Depsychiatrization consists in “breaking through the denial,” as suggested by the title of an article from the Pharmaceutical Executive quoted by Dumit, stating people must admit they have a medical problem. ⁹³ Both Forum and Pharmaceutical Executive claim that the “condition will not go away on its own” and must be treated by doctors who can prescribe psychotropic drugs. Similarly, the company’s representative and the film encourage “breaking through the denial” and taboo by talking about depression. The biological framing of depression as “a disease like any other,” readily embraced in the youth’s comments, mediates the reality of depression as a diagnosis. The more real (biological) it is, the less shame and denial it potentially implies.

Although Disappearing Children points to the failure of the social environment, this failure is individualized and turned into a disease of the brain. Thus the Forum’s discourse on depression constitutes an example of neuro-tivization: narrative construction in which the disease manifests as a failed neural process. Martinez-Hernaez notes that the cerebralization of suffering enhances the consumption of antidepressants. He emphasizes that focus on the brain in the psychiatric explanatory model prioritizes the individual over society as it entails “a rejection of interdependence and a negation of the relational self.” ⁹⁴ The misattunements in the social world disappear, eclipsed by the imbalance in individualized and disconnected brain entities. Disappearing Children shows that “something was wrong” with Ola, and the disease eventually killed her because nobody noticed. However, the film also shows a relational failure within the family system. The family lacks not only a connection but also a father. The implication of this narrative choice is conservative; the children suffer in a “broken” family where the mother is busy with her boyfriend instead of taking care of her children. While evidence shows that emotional misattunement of the caregiver leads to traumatic development that manifests as depressive states, ⁹⁵ Disappearing Children pathologizes this distress, framing it as a disease. The exclusive focus on family as a depressive environment obscures the broader cultural, economic, and political conditions contributing to distress. While it is out of this article’s scope to consider these numerous determinants of depression, described in more detail in works of critical mental health studies, ⁹⁶ it highlights the seamless transition between the relational nature of suffering and the biological framing of causes and treatment of depression.

Raising awareness about mental disorders aligns with the market “logic of potential.” ⁹⁷ Within this logic, lowering risk maximizes the at-risk group and thus the number of potential drug consumers. New ways of calculating the possible market size are not based on the number of prescriptions given but on the number of possible prescriptions. The marketers of pharmaceutical companies are interested in “how many human beings on the planet have specific diseases that can be addressed by our drugs.” ⁹⁸ Raising awareness helps identify not only those with a disease but also those at risk. ⁹⁹

Conclusion

The wide dissemination of biologically modelled categories of depression in the public sphere leads to its normalization. Raising awareness about depression is intimately related to maximizing the number of consumers, empowering them with knowledge, and normalizing or naturalizing the biomedical category of depression. In this narrative, depression is established as a dangerous disease with relapse rates caused by imbalanced neurotransmitters and failure of the neuroendocrine system’s mechanisms related to stress inhibition. Karp writes, “repeated often enough, the mantra of chemical imbalance becomes a kind of unassailable cultural fact.” ¹⁰⁰ Through “marketing of fear,” the number of potential drug consumers can be maximized. ¹⁰¹ Discourse on depression as a psychiatric disease is mitigated by a call to overcome stigma and shame, thereby presenting depression as “a disease like any other.”

By emphasizing that the Forum is entangled with discourses of different global and local actors, the discursive boundaries are blurred and difficult to track. Alliances between the company running the Forum, authoritative institutions, and celebrities lead to the proliferation of voices, making it difficult to assign specific senders to a concrete piece of information and making it impossible to draw boundaries between social actors and their statements. The Forum’s message ultimately rests upon the social authority of psychiatry as medical science and is widely disseminated with help from influencers. The problem of depression becomes “locked into a powerful network” of discourses, ¹⁰² hindering analysis ¹⁰³ and testifying to the “messiness” of psychiatrization processes. ¹⁰⁴

The Forum’s message rests upon the operation of language, which intensifies the unassailability of the narrative on depression, conceals authorship of the message, expands the category of depression, and enhances auto-diagnosis. This occurs through (1) the use of words evoking objectivity and vagueness of the meaning of depression; (2) confusing semantic exchanges including mock-quotations (such as reframing a symptom of depression as “tension” while referencing the WHO) ¹⁰⁵ ; (3) intentional stylistic inconsistencies used to manipulate the message (for instance, sudden changes of style in describing drugs); and (4) inciting fear through inflation of depression data.

Psychiatric diagnostic categories bound with medicalized self-care practices primarily involve the consumption of medications. The website instructs the users to eliminate shame and seek help for a disease “like any other.” Neuro-tivization of depression, expressed with a focus on biology, alleviates shame and blurs the possible social aetiology. When constructed around individual organisms, the relational field falls into pieces, and the interrelatedness of the sufferer with their environment becomes obscured. This unexplored terrain is worth further investigation by medical sociologists and anthropologists as biomedical discourses on mental health gain momentum in Poland.