Centre for Biomedicine, Self and Society

Depression, Self and Society: My Research in Edinburgh and Beyond

Hiroto Shimizu, a medical sociologist, reflects on his two-year research journey in Edinburgh, exploring narratives of depression in Japan, UK, and the US, aiming to enrich the understanding of mental health.

Written by Hiroto Shimizu | PhD in Human Sciences | JSPS Overseas Research Fellow (February 2022–February 2024)

I am an early-career medical sociologist, and my research interest lies at the intersection of medicalisation and narrative studies in the contexts of depression in particular and mental health and illness more generally. I had a fruitful two-year research stay in Edinburgh based at the Centre for Biomedicine, Self and Society (CBSS) as a Japan Society for the Promotion of Science (JSPS) Overseas Research Fellow which included the publication of a paper in Social Science & Medicine. I want to thank Professor Martyn Pickersgill and all who supported me during my stay in Edinburgh.

In recent years, there has been renewed interest in diversifying the discussion about the causes and nature of depression against the backdrop of the global rise of the diagnosis and treatment of depression since the 1980s. There is increasing interest in moving beyond biomedical determinism — a view that biomedical factors are the ultimate cause of an individual’s depression. On one hand, there is growing emphasis on diversity in how people seek to articulate the causes of depression to incorporate non-biomedical dimensions. On the other, the biomedical understanding of depression has been increasingly questioned, mainly due to emerging limitations in pharmacotherapy. These shifts encourage social analyses that explore what narratives as to the causes of depression are constructed and presented with relative plausibility in different contexts and why and how.

A collection of illness memoirs in a private library in Japan
A collection of illness memoirs in a private library in Japan

My paper aimed to contribute to this diversification by analysing published memoirs in Japan by individuals who have experienced depression. The paper demonstrates how Japanese narratives portray depression and its perceived causes in characteristic ways in a nation that adopts Western diagnostic systems, biomedical therapeutics and other relevant technologies. The paper shows that ‘burnout’ is the dominant theme in the Japanese data, diverging from the predominantly biomedical narrative in Western societies. This burnout narrative depicts depression as the somewhat unfortunate but unsurprising result of overwork arising from individual active adaptations to structural features of the Japanese work culture. The paper argues that reasons, rather than causes, articulate the making of the burnout narrative by revealing the interplay between the structural and individual and ultimately enrich the understanding of depression. The paper concludes with a call for further exploring how the boundaries between normalcy and illness are enacted and re-enacted and to what avail through public discourse and through shifting diagnostic schemata in the context of different national norms and practices.

My ongoing project extends the data used to depression memoirs published in the United Kingdom and the United States to pursue cross-cultural analyses further. The project will reveal how these public-facing narratives frame depression in terms of what the medicalisation literature refers to as ‘normal responses to problematic environments’ and ‘abnormal functioning’. By analysing how individuals diagnosed with depression seek to articulate the causes and nature of their depression differently or similarly across cultures, I aim to gain new insights into the interface between depression, self and society.

The intellectual culture in the UK has helped me articulate the arguments I made in the paper and future directions for research. I benefited particularly from how broadly bottom-up (or empirical, grassroots, experiential, and so on) approaches are deeply valued and embedded in scholarly research as well as everyday communications. Emphases on individual narratives and experiences in medical sociology are a case in point. UK journals embodying these approaches, including the Sociology of Health & Illness (SHI) and Health, have been a significant source of inspiration to me as a qualitative researcher interested in complementing quantitative and sometimes universalising discourses in health and illness. Papers in these journals sensitised me to the richness of health and illness narratives, including their historical variation and cross-cultural diversity. My analyses of the perceived aetiology of depression and my suggestion for further research to relativise causality are heavily informed by these papers, which also involve the explicit influence of Classic and Enlightenment writings, including David Hume’s discussion on causality. (The SHI paper ‘The genesis of chronic illness: narrative re-construction’ (Williams 1984) illustrates this influence.)

My stay in Edinburgh facilitated my academic growth greatly. I was able to engage in a range of research activities thanks to the freedom and support I had throughout the two years. Writing up my paper manuscript was the central pursuit during this period. Martyn’s comments were of great help in improving the earlier drafts in both language and content. I learned much about how to interweave the literature, cultural narratives and data excerpts effectively to hopefully develop as a medical sociologist conducting qualitative research in particular and to be a good author more generally. Conversations I had with colleagues on medicalisation and narrative were vital for my self-reflections on the strengths and limitations of my research. I would also like to thank the opportunities to present my work in the CBSS seminar and the British Sociological Association’s Critical Mental Health seminar series—thank you for the comments and critical reflections. Additionally, I was able to collect UK and US memoirs and learn how to collect such data generally, with the help of the University Library and other public library staff and resources.

I look forward to making the most of my experience in Edinburgh to advance medical sociology and qualitative research in the anglophone and Japanese academia. I also hope to continue contributing to CBSS and related activities.

Further information

Read Hiro's paper, produced during his fellowship period, in Social Science & Medicine

Cite as

Shimizu, H (2024) Explaining depression in the language of burnout: Normative reasons for depression in place of deterministic causes, Social Science & Medicine, 2024, 116703, ISSN 0277-9536. https://doi.org/10.1016/j.socscimed.2024.116703