After reading literature on the social construction of illness and medical knowledge, I have come to understand more of my personal experience as an individual suffering from mental illness. Since February 2020, I have been diagnosed with Major Depressive Disorder (MDD) or commonly known as clinical depression. My condition is a mood disorder characterized by excessive and recurrent feelings of loneliness and a general loss of interest. Moreover, I have also experienced physical symptoms such as insomnia, a decrease in appetite, and significant weight loss. These manifestations of clinical depression gradually developed since I was in high school and reached its culmination after the death of my Aunt Marissa — who I dearly loved like a mother — in December 2019. Hence, I sought medical professional help and have been under antidepressant medication for more than a year.
However, I have come to notice how my experience of mental illness is different from other illnesses. For example, people suffering from anemia are not burdened with negative moral connotations compared to people like me who have depression. In order to elaborate on these nuances, I think it is necessary to understand my disorder through two paradigms in the social construction of illness and health: the medical and social models.
Depression through the Medical Model
The medical model presents illness as a fact within the context of the natural sciences methodology. Under this framework, diseases are conceived to be universal and immutable to time and place. In addition, there are different features that define the medical model of illness and health. Nonetheless, I personally find two features relevant to the biomedical treatment of my depression: technological imperative and reductionism. Moreover, I also have criticisms towards them.
The technological imperative of the medical model puts precedence on the importance of medical intervention. In the case of my depression, my psychiatrist has decided to put me under antidepressants. However, I have noticed that this approach does not consider its burden to me in terms of costs and also its lack of recognition of the social environment I am in. Firstly, I find it difficult to diligently drink my medication because I can’t afford them. Furthermore, my parents are not willing to spend on my medication because they perceive my depression merely as a “weakness” that I can “snap out of.” Even if I try to earn money from my part time job, it’s still insufficient to cover the costs. On the other hand, I also realized that even if I drink my medication, the social environment I am in is the very trigger that exacerbates my condition. For example, my parents would constantly fight even in my presence and it would trigger some traumatic experiences that would make me feel more sad and lonely. These personal experiences point out to the insufficiency of technological imperatives to address external constraints such as my financial circumstances and family relations that contribute to the inaccessibility and inefficaciousness of medical intervention.
On the other hand, reductionism posits that explanations to illness tend to be simplified as the physical workings of the body. For my depression, a reductionist view on mental illness would simply attribute my disorder to hormonal imbalances and genetic predispositions. This approach tends to neglect some of the root causes of depression that are rooted in its social context. In my case, the triggers that worsen my depression are rooted in society. Ever since I was a child, I have been bullied and harassed for being feminine. Thus, homophobia has largely contributed to my feelings of worthlessness and lack of self-esteem. This social context of depression is commonly excluded from mainstream discourse of mental health that is reduced to physiology.
A Social Model of Depression
In contrast to the medical model, the social model of illness and health emphasizes how the meaning and experience of illness in society is shaped by social and cultural systems. This highlights how specific social, political, and economic processes shape the construction of illness in different societies. There is a diverse set of concepts and ideas that are related to the social construction of illness. Nonetheless, I have found two concepts to be salient in understanding my depression: stigmatization of illness and medicalization.
Stigmatization has been a defining experience for my mental illness. Culture significantly dictates which illnesses are to be stigmatized and not. Ever since I have been diagnosed with clinical depression, I have received negative reactions from society. Unlike other diseases such as anemia or measles, having clinical depression is associated with “weakness”, “lack of faith”, “craziness” and even “over sensitivity”. A clear instance of experiencing stigma for my depression is the invalidation of my parents on mental illness. Up until now, my parents refuse to recognize that I am legitimately ill. They would usually attribute my conditions as simply being “sad” due to my “lack of faith” to God and “laziness.” However, I have been clinically diagnosed according to a strict criteria administered by a psychiatrist. Moreover, the symptoms that I have been experiencing have hindered me from normal functioning in my daily activities especially if I abruptly stop drinking my medication. This experience made me realize that the construction of illness is relative to the social context it is located in.
Next, medicalization is another pertinent concept in the social model. This refers to the process where nonmedical problems in society are subsequently considered to be pathologies that require medical intervention. One realization from this concept that I have encountered is that it can potentially overemphasize the medical solutions to the illness without recognizing its root cause. For example, medicalization does not recognize how social structures in my life such as unrealistic beauty standards can reinforce my feelings of inferiority and lack of self-esteem. Even if I undergo therapy and medication, the constant bombardment of unrealistic beauty standards in the media can still make me loathe my own body.
Although the medical model provides a coherent framework to understand illness, it tends to decontextualize the existence of health from society. It is inadequate to address the social dimensions of illness. Hence, it is equally important to examine social constructs and knowledge claims under the social model. Integrating these two models allows me to understand that although I need to continue medication and therapy, I must also actively be aware and critical of how external forces affect my depression. With these ideas that I learned, I can have a better and healthier mind.