Suffering, Meaning and Hope: Shifting the Focus from Depression in Primary Care

Abstract

The diagnosis of depression is not fit for the purposes of primary care. It is inherently problematic, with regard to both validity and utility, and can be challenged on ethical and evolutionary grounds. It has iatrogenic effects, including reducing the sense of personal agency. These effects are exacerbated by GPs’ deterministic explanatory metaphors, and aggravated in cross-cultural consultations which attempt to integrate experiences of traumatized self-identity within routine technical practices. We need a theory of the person based not on medical assumptions of passivity but on awareness of personal agency. Two key concepts are coherence and engagement. Coherence involves an understanding of ourselves as consistent beings, persons with the capacity to lead our own lives. We make sense of ourselves in terms of our engagement with the world around us: this is crucial in creating and sustaining our sense of identity and well-being. To provide high quality primary care for depressive feelings, we cannot limit ourselves to individualized biomedical perspectives. In our clinical encounters we do well to see depressive feelings through our patients’ eyes. We should acknowledge suffering, explore meaning and offer hope. We need to incorporate concepts of agency and coherence within our dialogues with patients, expand social understandings of distress and encourage engagement at the community level.