“The World Health Organisation predicts that depression will soon be the second largest public health problem. Has the world become more depressing, or has the pharmaceutical industry simply become better at marketing antidepressants? In the latest exclusive essay from the London Review of Books, Mikkel Borch-Jacobsen examines the new ‘epidemic’.”
The strength of the new biomedical psychiatry doesn’t come, therefore, from the discovery of organic causes, but from placebo-controlled trials in which the effects of molecules are measured and compared. These trials don’t tell us how the medication works, but only if it works, what works best, and on whom. Biomedical psychiatry is a form of rhetoric: it knows how to produce effects without knowing how to treat causes. Pignarre proposes calling it a ‘petite biologie’ to differentiate it from the larger biology that it mimics. When all is said and done, nothing distinguishes it from dynamic psychiatry and the various brands of psychotherapy, which also base themselves in the end on the effects (the changes) observed among patients. The only difference is that the rhetoric of the ‘petite biologie’ is incomparably more persuasive: how, faced with the accumulation of double-blind, randomised trials, could one possibly deny that antidepressants do indeed produce an effect?
The question is, however, on what? It’s a mistake to say they produce an effect on depression, as if the illness existed independently of antidepressants; depression is nothing other than that on which antidepressants act. The reason so many of us are depressed is not because depression is spreading, but because we’ve been persuaded that ‘depression’ exists and can be treated…