The concept of depression

At the same time as the evidence for a biological basis for depression appears to be strengthening, the Western concept of depression has been criticized by transcultural researchers. Obeyesekere (18> considers that each culture has developed its own methods for dealing with painful emotions. The Bhuddists of Sri Lanka cope with the loss of a loved person by meditating on the illusory nature of the world of sense, pleasure, and domesticity. Among the Kaluli of New Guinea, the response to loss is anger and the expectation of being adequately compensated by society. Blame is externalized and society is expected to provide social support for the aggrieved individual. (19> In Iran most children learn to grieve in the context of religious ceremonies for Iranian martyrs. The response to personal loss is assimilated into the wider communal experience of historical tragedy. (2°) Obeyesekere1.» refers to these coping measures as 'the work of culture' and views the construction of a disease known as depression as a Western cultural resource. Its incorporation into international classifications of diseases could be viewed as 'the imposition of Western cultural standards that are presented as universal and inseparable parts of an emerging new world order'. (21) If a biological basis for the neuroses was firmly established such a formulation could be readily dismissed, but the efficacy of non-biological treatments for depression and anxiety, such as cognitive therapy, marital therapy, and behaviour therapy, indicates that Obeyesekere's view deserves serious consideration. It represents a specific example of the general premise that Western biomedicine is itself a cultural construction and needs to be seen as one of many different ways of dealing with the experience of illness and distress.(22) The achievement of biomedicine in ridding the world of smallpox and other fatal diseases is undeniable, but in the field of psychiatry in particular we need to remain open to the ways other cultures have developed for helping people with what we would term psychiatric illness.

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