This question is central to Becker’s analysis. She coins the term stressism to describe “the current belief that the tensions of contemporary life are primarily individual lifestyle problems to be solved through managing stress, as opposed to the belief that these tensions are linked to social forces and need to be resolved primarily through social and political means.” Here’s just one example of stressism: the idea that working mothers must learn to juggle their multiple roles and the stress that results from dealing with the responsibilities of work life, childcare, and family life. This stereotype is so widely accepted that it’s easy to forget the assumption that lies behind it: juggling is a woman’s problem, not that of a man, a family, or society. It’s an assumption that favors the status quo. Yes, stressed out working moms who take up yoga and follow a Mediterranean diet may indeed feel calmer, more “balanced,” and in the moment. But unless their companies institute family-friendly policies, the stress inherent in the pressure to juggle so many activities will remain constant.
This isn’t the only way that the idea of stress becomes a dodge from facing up to and acting on its underlying or systemic causes. Becker applies this reasoning to other social ills that remain invisible when stress becomes the focus, especially when discussing the impact of poverty. It’s too easy for social and political scientists to gloss over poverty as merely one of many “stressors” affecting the mental health of people stuck in dire economic circumstances, she says, rather than addressing poverty directly and looking at issues of inequality, affordable housing, and better wages.
She further argues—less persuasively—that diagnosing post-traumatic stress disorder in soldiers returning from combat medicalizes responses to horror, neutralizes the reality of the contact horror experienced by those who didn’t serve in combat, and distances lawmakers and civilians from the political responsibility of going to war. But this perspective misses the ways in which this diagnosis has contributed to much greater public and professional understanding of the aftermath of trauma. Nor does Becker propose a better way of approaching and treating the severe psychological distress, discomfort, and pain resulting from combat trauma.
Becker’s book is densely detailed and filled with footnotes, which can make for slow going, but she’s outspoken, proactive, and provocative—which keeps you reading. Depending on your political views and the particular issue under discussion, you may find yourself agreeing with her, becoming impatient with her, or alternating between the two, as I did. Ultimately, her book is as much a call for social action as it is for psychological clarity.
In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, the noted historian of psychiatry Edward Shorter similarly demonstrates how we’ve come to misunderstand and misuse the concept of depression. Shorter focuses on the ascent of antidepressants and, especially, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as the main culprits. His book thus serves as a scholarly, history-focused companion to two other recent polemics criticizing the newly published DSM-5: psychotherapist Gary Greenberg’s The Book of Woe: The DSM and the Unmaking of Psychiatry and Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life by psychiatrist Allen Frances.
From Shorter’s viewpoint, the constant rewriting and reinterpreting of depression from one edition of the DSM to the next has mangled its meaning. He chronicles how the political infighting and compromises among different factions writing the DSM over the decades have transformed a real illness of body and mind into an amorphous compilation of mood disorders that wrongly lumps together potentially suicidal depression with passing bouts of sadness. In his view, this mislabeling in the ongoing DSM editions has had disastrous consequences, leading to misdiagnosis and ineffective treatment.
In his scathing critique, he argues that we’d be better off dividing depression into two separate disorders and using an older terminology to distinguish them. He advocates using melancholia to define the severe depression that affects body and mind. While the malady of melancholia may include symptomatic mood disturbances, it goes beyond fluctuating moods and “may lead to despair, hopelessness, a complete lack of pleasure in one’s life and suicide.” He adds, “Melancholia means a dejection that appears to observers as sadness but that the patients themselves often interpret as pain,” numbness, and the inability to experience joy. Readers of Shakespeare will recognize in this the melancholia that Hamlet describes.