Reconstructing Mental Health: Depression isn’t the problem, it’s the response.

My name is Aida and I’m a second-year student at King’s College London, currently studying Global Health and Social Medicine BSc. I’d like to give a very brief introduction about myself, to add more context to this piece. As a GHSM student and someone who has also struggled with mental health issues, I bring a personal and academic perspective to the discussion about depression, its causes and potential solutions.


Depression is not always the enemy. It’s not always the cloud that rains over our heads and makes it difficult to function throughout the day. And it’s not the problem we should be pointing our pitchforks at to get rid of. Sometimes, it’s simply a response to our struggles.


It is important I make this clear before continuing, because the way we frame our problems can impact the way we create solutions, and until recently, I have been thinking of depression as an individual problem. I used to view depression as the enemy; the big villain in my life and in some ways it made my depression worse. Because I painted it as another problem I had to deal with, another issue. However, after I changed my perspective, a change inspired by the movie Inside Out and a film essay about it; I gained new insight on the potential solutions and treatment methods for depression!


Let me explain how I now view depression;


Imagine you’re in a forest and you see a bear. You start walking away, but alas the bear has noticed you and has started chasing after you. You, naturally, run for your dear life (at least I hope you do!). To me, depression is the act of running away, it’s not the bear. Let me explain. The running is a natural response to a dangerous situation, which in this case is the bear. The bear is the cause of the depression, which I will get into and discuss in the more technical jargon section and label ‘social determinants’, but for now let’s see them as the cause/s of your depression. If you view it like this, depression isn’t the actual problem, it’s just the response to the problem. It acts as a signal that you’re in a hostile situation and must react. Similar to the body’s fight or flight response.


However, I should specify depression manifests itself in different ways and we all interpret it differently; some describe depression as drowning or feeling lost, some as a numb emptiness. Each interpretation is valid and unique in the way we understand our mental health. Your interpretation and idea of depression may change once, twice, or multiple times. My interpretation may resonate with some, and be completely confusing for others which is perfectly fine!!


Social Determinants of Depression


Michael Marmot, a well-known epidemiologist, discusses the concept of social determinants of health and achieving health equity. He mentions factors such as education, work, money, etc. and how it affects our health. Although he mainly aims it at physical health; the same idea can be applied to our mental health. Aspects such as our education, housing conditions, and our financial situation can affect our mental health and cause/worsen or improve depression.


Research highlights depression is higher in those with financial difficulties and debt. And amongst university students, for example, the main factors associated with depression seem to be grades, family issues, social factors and even political factors. These causes are more so because depression is highly prevalent in late teens. Exposure to new social environments can be overwhelming to teenagers and young adults, especially to those who have not been equipped with the necessary social and emotional skills developed during childhood.


Unstable family dynamics and conflict is also ranked high as a risk factor; children with depressed parents are 60% more likely to develop depression by age 25. Therefore tackling the social determinants can act as a wider treatment and preventative measure for mental health issues such as depression and anxiety.


The use of conventional treatments such as therapy and medication as well as tackling social determinants can increase resources available for those with depression. But, if we already have these treatment methods, why don’t we just send everyone with depression to therapy or give them medication? It’s not that simple.


Therapy is a more inclusive treatment method available for all ages and has shown long-term improvement for those with depression. It’s an option available for individuals to work with a professional and learn healthier thinking habits and improve their mental health, and therefore a great step to take. However, in some cases therapists are limited in the help they can provide to change the individual’s circumstances/environment that cause or worsen their depression, and therefore find it difficult to intervene. This is where being aware of social determinants and building solutions around patterns of social causes can fill in where therapy cannot reach.


Most treatment methods have their pros and cons; with therapy’s cons being limited resources and therapists to see every individual. Certain social determinants such as poverty act as a barrier to treatment. Therapy is not always easily accessible to the public and often leads to long waiting lists with some struggling financially to pay for private treatment which simply isn’t sustainable and can lead to a cycle of worsening depression.


Social Causes and Social Solutions


Individual treatment for depression is important and effective for many with depression, with research highlighting therapy such as CBT and psychotherapy reducing depression long-term; however, tackling the wider social determinants is also equally important in the long-term prevention of depression. The social and cultural stigma surrounding depression can decrease the chances of those with depression seeking help. 60% of young people that attempt suicide never seek medical attention. This means that even if therapy is available, social and cultural barriers prevent those in need from accessing the resources.


Therefore, as well as tackling depression when it is present; we can take actions to prevent depression through early childhood prevention methods by creating safe school environments that allow emotional and social development, stable family dynamics and services that support single-parent households and those struggling with financial issues, to remove or reduce the social risk factors of depression.


Tackling social determinants has many benefits; not only can we simultaneously tackle several other social issues such as poverty but it also helps reduce the strain on conventional methods such as therapy. It helps reach more people that suffer from depression that may be hesitant on reaching out as well as adding another avenue of treatment, that all together tackle different causes of depression whether personal via therapy, chemical imbalances via medication or social causes via tackling social determinants.