Conceptualizing depression in the Sierra Nevada

Over the past few days, four of us have been working through the problem of depression at Chris Dowrick's house in the Sierra Nevada (left). Our aim was to explore depression not by reference to the phenomenology of suffering or distress, but by engaging with the work that people need to do as they engage with depression. Our conversations were dominated by the recognition that depression is much more than a biomedical construct, and that it is a deeply embedded artefact of western culture. Our discussions were founded on data - we worked through transcripts, aiming to form our conclusions around a set of analytic propositions that we could then test against new data. This

kind of conceptual work is interesting, but also it's unusual. Most of the research in our field is

driven by data collection - but we're awash with results that reflect old orthodoxies. Now's the time for social and clinical scientists to work towards producing and applying new explanatory frameworks and for rethinking old problems. We had some great conversations - I've not laughed as much for weeks - and some great dinners with good local wine and fresh peasant bread and cheese (bottom photo, left to right: Linda Gask, Anne Rogers, Chris Dowrick, Carl May).

Our way of working through this problem, as I mentioned a couple of weeks ago, has been to use Normalization Process Theory as a framework to think about the work that sick people need to do. Because NPT was developed as a theoretical model to understand socio-technical change in organizational contexts, I had never thought that it might be used to understand individual illness experiences. But there do seem to be interesting opportunities here, because NPT helps us to understand the work that people do as they seek to make sense of their illness, and as they join themselves and others to it, and operationalize the knowledge and practices that surround it. An interesting point here is the way that the sociology of health and illness has so little to say about getting well. The business of sickness is often conceived of as chronic and inevitably degenerative. As I say, we need to rethink old orthodoxies.