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A Depressing Diagnosis – Social Amplification and Mental Health

Keep Calm And Carry On

Will only get you so far...

Doctors should recognise the range of symptoms that signify depression in their primary care patients and should intervene appropriately, according to the results of a study reported recently in the Journal of General Internal Medicine.

RM Epstein and colleagues, from Rochester University Medical Center in New York, continue “…families, friends and the media can prompt people who have depressive symptoms to seek care by adopting a multi-faceted understanding of the experience of depression from the patient’s perspective — and helping them find the words to bring their experiences and concerns to the attention of [a] physician.”

Two things strike me here.

One is that this varied range of symptoms might, if considered analytically, using the Hamilton, Edinburgh or other rating scale, lead a clinician to an accurate mental health diagnosis. In the hands of others, the same information could lead the friends, family and the media to variously consider the potential patient as ‘just being himself’, ‘a bit down since John died’ or ‘dangerously psychotic’.

The point being that ‘families, friends and the media’ remain woefully ill-informed about the range of mental health conditions, their comparative severity and implications for patients’ lives.

Part of the solution to the above comes in the second feature.

Social amplification – the means by which the media press a concept or information into the public consciousness (for good or ill) – means that what is hyped in the press is expanded on talk shows until a proper sense of proportion can be lost.

Worries can be contagious, and mass media help to rapidly infect people within a social group. Family and friends – usually a solid source of support that keeps us alive through life’s ups and downs – are not immune. A year ago, pandemic influenza fed another misleading, damaging media feeding frenzy and, today, what quiet but sad middle-aged singleton would want to rely on a balanced diagnosis from friends or family, in the aftermath of the Cumbria shootings?

But this can surely be harnessed for good as well as ill, can’t it?

Where Epstein and his colleagues are right is that the social actors around a patient need to know more about key features which point to a visit to the local surgery. This is easy with a broken arm. There is, usually, a clear cause and an obvious injury. Less so with mental health conditions like depression. Mental health conditions are complex, they overlap and they blur at the edges. Worst of all, they can be extremely hard to treat.

So what can we do to make sure that social amplification works for not against patients.

Increasingly, there is a need for a substantial, proactive and ongoing campaign of public information and education about the more common mental health conditions. In the UK, we never really accepted the mental part of health, preferring, perhaps, the philosophy of ‘Keep Calm and Carry On’. But that only carries you so far.

In many ways, we have only just come out of the Dark Ages in our treatment of mental health here and we desperately need to widen public understanding with responsible and considerate reporting and discussion.

In this time of spending cuts, this is one area in which to stay the hand of the axeman.

Epstein RM, Duberstein PR, Feldman MD, Rochlen AB, Bell RA, Kravitz RL, Cipri C, Becker JD, Bamonti PM, Paterniti DA. (2010); “I Didn’t Know What Was Wrong”: How People With Undiagnosed Depression Recognize, Name and Explain Their Distress; J Gen Intern Med. 15/05/10 [epub ahead of print].

From → Crime, Health, Research

  1. Certainly, doctors should know the signs of depression. But I do think the psychiatric aspect of depression is overrated, and the lifestyle issue are not seen most of the time: If one does not move, sits in front of computer and TV all day, does not relate to people, eats processed food, etc. depression is not far away.

    Alexa Fleckenstein M.D., physician, author.

    • Hi Alexa,
      I agree – the origins of depression are certainly not ‘All in the Mind’: environmental factors are more important than previously allowed. What I wanted to challenge was the idea that a union of ‘friends, family and the media’ (in this country, at least) has the information or the education to be a reliable sounding board and support for those with mental health problems. I wasn’t criticising GPs: most know what the combinant risk factors and symptoms of the more common mental health difficulties look like. After all, that’s their job.

  2. Oh, Neil,

    DO critisise GPs – please!!


  3. Well, I have just been advised by two very good and kind GPs, so I’m all out of criticism for today!!

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