Accepted Manuscript

Sadness or depression: Making sense of low mood and the medicalization of

everyday life

Christian Bröer, Broos Besseling

PII: S0277-9536(17)30255-1
DOI: 10.1016/j.socscimed.2017.04.025
Reference: SSM 11182

To appear in: Social Science & Medicine

Received Date: 3 June 2016

Revised Date: 11 April 2017
Accepted Date: 13 April 2017

Please cite this article as: Bröer, C., Besseling, B., Sadness or depression: Making sense of low
mood and the medicalization of everyday life, Social Science & Medicine (2017), doi: 10.1016/
j.socscimed.2017.04.025.

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 ACCEPTED MANUSCRIPT

Sadness or depression: making sense of low mood and the medicalization of

everyday life

Christian Bröer* and Broos Besseling**

* University of Amsterdam, department of sociology, **Free University

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Christian Bröer: lead author, designed study and methods, collected and analyzed data.
Broos Besseling collected and analyzed data, co-authored parts of the text. Gail Zuckerwise
and AJE edited the text. We benefitted from comments and collegial support by Patrick R.

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Brown and members of the Political Sociology group at the University of Amsterdam. This
research was performed without external funding.

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Contact detail:

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Christian Bröer
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c.broer@uva.nl
++ 31 20 525 2238
University of Amsterdam
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Department of Sociology
Nieuwe Achtergracht 166
PO Box 15508, 1001 NA Amsterdam
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The Netherlands
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Abstract

This research focusses on low mood as a generic category in everyday social interactions, outside the

clinical realm and among non-patients. We examine if and how a clinical depression label and

treatment are employed when low mood occurs in everyday life, which enables us to analyze the

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extent and content of medicalization and brings to the fore the interactional mechanisms and

cultural concerns that potentially drive medicalization. The analysis is based on 316 observations of

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everyday life in the Netherlands. We observed and recorded interactions in which low mood was

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spontaneously expressed.

Our paper shows that the clinical depression label resonates widely even if low mood is not

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fully medicalized. People de-medicalize low mood, and low mood can be un-medicalized. Our
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analysis thus suggests that dominance is not achieved, which nuances Horwitz and Wakefield’s

(2007) claim that the clinical category of depression has come to encompass all forms of low mood.
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Moreover, uncertainties about the meaning of low mood and about the depression label remain
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pragmatic concerns of everyday life.

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The cultural norm of happiness and active citizenship are very prominent in everyday life

across medicalized and un-medicalized interactions. These norms thus seem to be a necessary but
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insufficient condition for medicalization. While pragmatic concerns do not seem to trigger

medicalization either, one specific type of concern is consistently related to medicalization:

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relational conflicts.
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In sum, the cultural construction of low mood is not dominated by a single medical

approach; however, it mirrors the diversity and uncertainties within the medical field.

Keywords: The Netherlands, medicalization; depression; everyday life; observational methods

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Low mood in everyday life

This article analyzes everyday interactions to determine how low mood is communicatively

addressed and which pragmatic concerns are relevant to it. In this study, low mood designates a

generic and etic category that includes emic expressions such as prolonged depression or mildly

feeling down.

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This article scrutinizes the “medicalization of life” (Conrad, 2007; Crawford; 1980; Szasz,

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2007) hypothesis that the expansion of medical diagnosis and treatment transforms common

understandings of low mood. In particular, it addresses Horwitz and Wakefield’s (2007) claim that

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people have “lost” the ability to experience “normal sadness” and approach low mood largely as

clinical depression. Horwitz and Wakefield convincingly show how the diagnosis and treatment of

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depression have come to include increasing instances of low mood. Decontextualized diagnostic
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criteria were gradually applied to outpatient populations and thereby imported into the community,

according to Horwitz and Wakefield. However, the uptake of medical registers in communities is
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beyond the scope of these authors’ research. Whether “normal sadness” is indeed considered to be
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“clinical depression” must be examined.

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Horwitz and Wakefield urge social scientists to distinguish between normal and pathological

sadness, particularly with the goal of criticizing the overexpansion of diagnostic categories. In this
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research, a different approach is followed: we include all expressions of low mood and attempt to

see if a medicalized “idiom of distress” (Nichter, 2010) is at work and, if so, in which situational
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contexts (A. V. Bell, 2016).

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Medicalization might be limited (Williams & Calnan, 1996), and de-medicalization is studied

(Torres, 2014). However, medicalization research has focused largely on patients, pills and

professionals and neglected whether diagnosis and treatment are relevant among non-patients,

outside the clinical realm, at home, in public or during work. Most medicalization research has

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focused on situations in which medicalization has already taken place. This is a crucial omission

because, for medicalization to occur, it needs to settle in everyday life.

Low mood and depression

Cross-culturally and over time, humans have addressed low mood and the category of depression in

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various ways (Kirmayer, 2001; Kleinman, 1985; McPherson & Armstrong, 2009). Moreover, the

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speed by which depression diagnosis has risen, along with the marketing of anti-depressants and the

lack of bio-genetic explanations of depression, further emphasize the interpretive flexibility of

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diagnosis and treatment. Flexibility, however, seems less pronounced in light of phenomenological

studies that show regularities in illness careers (Kangas, 2001; Westerbeek & Mutsaers, 2008),

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biographical disruption and existential suffering (Karp, 1994; Ratcliffe, 2014).
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We acknowledge that human distress arises in a dialectical relation between nature and

nurture (Kleinman, 1985 p.11). Low mood can become a pragmatic concern in mundane interactions
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which may lead to medicalization, given the availability and dominance of medical categories. In
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interactions, low mood can be considered pathological depression, common sadness or another
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condition entirely.

By focusing on life outside the clinical realm, we can more easily observe whether broader
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cultural concerns enter the medicalization of low mood and whether depression labelling and

treatment become a cultural code. From a cultural perspective, one would expect a gradual fit
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between culture and diagnosis since disease categories can become ways of experiencing illness and,
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over time, “we learned approved ways of being ill“ (Kleinman et al., 1978, p. 252). In Western

countries, suffering might be a partial result of low mood undercutting the norms of active

citizenship and a responsible and happy life (Petersen, 2011; Philip, 2009; Rose, 2007).

In the case studied in this paper, mental health institutions are rife with uncertainties . There

is uncertainty about the meaning and validity of depression diagnosis and treatment (R. C. Fox, 1957;

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Kokanovic, Bendelow, & Philip, 2013). Depression diagnosis and treatment have been critically

assessed publicly, and the medicalization critique, which is half a century old, might have become a

common cultural repertoire by now. By focusing on everyday interactions in which low mood is

relevant, this research illuminates the pragmatic concerns that may drive medicalization, given the

ontological uncertainty surrounding depression labelling.

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Our analysis is based on 316 observations in the Netherlands. We encountered mourning

after loss, joblessness, stress, violence, marginalization, substance abuse, somatic conditions, broken

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dreams and doubts about life choices in relation to low mood. People report themselves or others

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feeling a lack of energy, being unable to get out of bed for days, anxiety, avoiding contact, distrust,

uselessness, suicidal thinking, lack of sleep, panic, lack of an appetite, hypersensitivity and tension or

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anger. Sometimes, only a light reference to one of these phenomena is made, while on other
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occasions, long spells of suffering were reported.

We searched for communicative references to low mood and analyzed if and how medical
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terms and treatments were implied. While the use of the word “depression” might point to
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medicalization, it is also used to refer to bad weather or a lazy morning. Therefore, a large part of
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this research involved the repeated interpretation of the meaning of words in context. As shown

below, this is also what people do themselves: attending to interactions illuminates the shifting
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uncertainties about (medical) categories in everyday life.

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Medicalization between institutions and pragmatic concerns

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In response to the global increase in many (mental) health diagnoses, diversity in prevalence

statistics, a lack of biological explanations and the mega-marketing of pharmaceuticals, social

science scholars have developed theories of ‘medicalization’ (Conrad & Schneider, 1992), ‘bio-

medicalization’ (Clarke, Shim, Mamo, Fosket, & Fishman, 2003) and ‘pharmaceuticalization’

(Abraham, 2010). Medicalization describes a process by which formerly non-medical problems come

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to be defined and treated as medical problems. Studies have focused on the power of medical

professionals, biomedical researchers, pharmaceutical firms, policy-makers and activists to turn

normal behavior into medical conditions.

Research has provided us with manifold insights into the social construction of health

conditions and has often highlighted the downsides of medicalization: the regulation of deviant

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behavior (Scheff, 1970) and unwanted effects, such as stigma (Goffman, 1961), rising costs (Conrad,

Mackie, & Mehrotra, 2010) and damaging treatment (Illich, Cochrane, & Williams, 1975) . Classic

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medicalization studies often followed an institutional approach and were largely based on top-down

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models of social control. In response, scholars influenced by Foucault pointed to the diversity in

clinical practice and the productive side of medical authority (Hacking, 2007; Rose, 2007).

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Nevertheless, Lupton identified a major deficiency in Foucauldian approaches to medicalization,
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which “neglect examination of the ways hegemonic medical discourses and practices are variously

taken up, negotiated or transformed by members of the lay populace” in everyday life (Lupton, 1997
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p.94). Existing bottom-up studies have reported that patients inform their doctors about how to
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interpret symptoms, that activists influence medical practices (Brown et al., 2004; Epstein, 1996) and
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that knowledge of diseases spreads through local networks (Liu, King, & Bearman, 2010). People

seem ‘eager for medicalization’ (Becker & Nachtigall, 1992), claiming institutionally unrecognized
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conditions (B. De Graaff & Bröer, 2012; Dumit, 2006) . Pharmaceuticals in everyday life have been

the subject of recent research (S. E. Bell & Figert, 2012; Coveney, Gabe, & Williams, 2012; Graf,
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Miller, & Nagel, 2014; Hardon, Idrus, & Hymans, 2013). Studies like these show that, while ‘classic’
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medicalization sought to separate the working population from the sick, healthy people are now

additionally encouraged to maximize their physical and emotional well-being through self-

medication.

Nevertheless, most studies conducted to date have focused on patients, professionals and

treatments as the starting point for analysis and theorizing. In these cases, medicalization has

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already taken place to a significant degree. Retrospective interviews offer some access to the

process leading up to the diagnosis or help seeking. However, those who do not seek diagnosis or

treatment are overlooked, which can easily lead to overestimating and misconstruing medicalization.

Recent analyses of self-help books (Barker, 2014; Philip, 2009), for example, suggest addressing

medicalization in everyday life, but they do not address the actual uptake of self-help registers.

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Medicalization must take root in commonly held assumptions among people who have not yet been

exposed to doctors, diagnosis or treatments, and studies in this respect are lacking.

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Therefore, we propose shifting the analytic lens to everyday life and common interactions

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and then ask if and how medical categories and treatments are relevant. In this way, we can address

the extent to which medicalization has affected life outside clinical encounters, include the

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experience of low mood, scrutinize interactional concerns about low mood and avoid top-down
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conceptions of medicalization, which enables us to scrutinize non-medicalization.

Everyday life refers to people’s mundane beliefs and practices (Certeau, 1984; Schutz, 1932;
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Scott, 2009). Following an interactionist perspective (Blumer, 1969; Mead & Morris, 1934), this study
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focuses on concerns and conflicts and people’s attempts to solve them. With regard to health, this
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approach has long been applied fruitfully to chronic conditions, suffering, identity (Bury, 1982;

Charmaz, 1983), everyday health experience (Saltonstall, 1993) and medicalization (Rossol, 2001).
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Lock and Kaufert (1998) proposed studying pragmatic concerns in relation to medicalization and

emphasized the strategic use of medicalization. We build on their research and widen the
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conceptual lens to include any problem-solving attempt, whether strategic or not. It is assumed here
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that humans are inclined to solve the problems they experience and that adverse (mental health)

experiences cannot be reduced to institutional arrangements.

From a conflict perspective, the dominance or hegemony of a medical register is never

uncontested nor absolute and might even produce countervailing tendencies. Therefore, we

interrogate the breadth of medicalization and its content (Brown, de Graaf, Hillen, Smets, & van

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Laarhoven, 2015) and include cases where medicalization does not occur or is contested. We specify

people’s relation to medical diagnosis and treatment according to the ‘resonance model’ developed

earlier (Bröer, 2008; Bröer & Heerings, 2013) . We attend to 1) consonance, where everyday

understandings and practices are fully aligned with medical ones, 2) dissonance, where people in

everyday life oppose or rework medical understandings and practices, 3) autonomy, where no

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medicalization takes root in everyday life, and 4) feedback, where everyday understandings and

practices shape clinical ones (B. M. de Graaff, 2016). Medicalization is thus considered the

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outcome of the dialectical relation between mental health institutions and everyday life concerns.

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We expect that people’s concerns and pragmatic attempts at problem solving are an understudied

micro triggers of medicalization.

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Methods

The observational material for our analysis was gathered in the Netherlands. According to survey
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data and patient registrations, depression is reported yearly by approximately 8 to 10% of Dutch
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people, while approximately 5-6% of are treated medically, usually by a general physician
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administering anti-depressants, slightly more than 1% are treated in specialized care and

approximately 0.03% are hospitalized for depression (Verkenning, 2013; Verweij & Houben-van
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Herten, 2013).

Studying interactions at home, at work or in public, we ask when, where, by whom and how
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low mood is experienced, expressed and dealt with both by the sad person and those in his/her
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immediate social environment outside clinical settings or before diagnosis and treatment. We search

for instances of the medicalization of low mood, the modification of or resistance to depression

diagnosis or treatment and instances where depression diagnosis and treatment are irrelevant.

Additionally, we investigate which interactional concerns are at stake in relation to low mood, how

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these are concerns dealt with, which norms are enacted, and whether these factors push towards

medicalization?

We collected data through focused ethnography (Hammersley & Atkinson, 2007; Knoblauch,

2005) using purpose-built observational logs. The instrument has been tested repeatedly by the first

author and builds on ‘mass observation’ (Danforth & Navarro, 2001; Willcock, 1943), ‘self-recording’

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(Wheeler & Reis, 1991) and experience sampling (Csikszentmihalyi & Larson, 1987). Both authors

participated in the collection and analysis of the data. The first author trained sociology students,

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including the second author, who participated in a course about “citizenship and health” at the

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University of Amsterdam. In five consecutive years, the first authors assigned data collection and

interpretation tasks, and students received an observational form, instruction and multiple feedback

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sessions to fine-tune observation and interpretation.
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Observers were instructed not to ask about or trigger the expressions of low mood.

Observations centered on students’ own lives and the moments when they encountered low mood
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in themselves or others on the street, at home, in schools and at work in any kind of interaction. We
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included observations that referred to low mood broadly defined. Any experience or communicative
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mentioning of feeling down, sad, depressed or somber was included. We also included the media

reports that students encountered; media data are included in the analysis in regard to
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medicalization in general. Students were asked to keep a notebook and take notes as soon as

possible after each occurrence. Students reported on their own lives and consented to sharing these
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reports with fellow students and researchers. Observations were shared on a secure university
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platform and could be uploaded anonymously.

Since the student-observers were part of the interactions, they were asked to collect

contextual information, which facilitated interpretation. Dozens of observation were furthermore

discussed in class, which added to the depth of this contextualization. Students were trained to use

their awareness of the situation and their own emotions for the log and for the analysis. The

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classroom discussions were meant to build an “interpretive zone” (Wasser & Bresler, 1996) in which

differing perspectives on the material could be elaborated and cross checked.

From 2009 to 2013, 137 students posted 479 observations, of which we randomly selected

316 according to time constraints for coding, which lasted about six months full-time. Sampling went

far beyond the point of theoretical saturation to arrive at descriptive statistics. We constructed 168

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codes, 1457 quotations and 5503 codings. In 60% of the observations, low mood related to women,

and in the other 40%, it related to men. The average age of the students was 23.9, with a range from

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20 to 43 (SD: 4.4). Since the students encountered a range of other people, the average age of

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depressed/sad people was 29.5, with a range from 6 to 82 (SD: 14). Below, we report the age, if

available. In approximately 10% of the interactions, we found reference to a person being diagnosed

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with depression, and on a few occasions, we came across a professional. Since the observers were
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students, observations do not represent the general public. However, in the observations, non-

students and a variety of social situations come to the fore.

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Data were analyzed in two ways: deductively, qualitative thematic analysis guidelines were
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followed (focusing on the explicit mentioning of low mood and medical categories and treatments)
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(Hsieh & Shannon, 2005; Mayring, 2000), and we coded for a number of standard variables (gender,

age, and place). Inductively, we noted what participants considered relevant in relation to low
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mood, particularly interactional concerns and norms (Horton-Salway, 2001). The analysis was

assisted by Atlas.ti software.

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During the formal analysis, neither author initially attended to any particular aspect and
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therefore coded openly in combination with extensive memo-writing and collaborative analysis. A

wider group of colleagues participated in two coding sessions to assess the reliability and validity of

emerging codes. In the course of the analysis, theory-driven concepts were fine-tuned and applied to

the material. The collaborative interpretation of observations revealed that the analysts’ uncertainty

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about the meaning of the depression label resembled the uncertainties about low mood and

depression people experience in daily life.

An ethical approval statement was not required due to the ethics procedure of our research school

and university during the time of data collection. Nonetheless, this research has been presented to

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and discussed with the ethics board of the research school. Following their suggestions, the data

collection procedure was changed to offer students the possibility to contribute data anonymously.

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Al students included in the study consented in participation, data sharing and publication.

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Low moods

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As said, we use the term low mood as an etic category to encompass emic terms. The Dutch
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equivalent was not used in the observed interactions. People spoke of low mood in a number of
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ways: as depressed or “depri”, a Dutch shorthand; having no energy or enjoyment; not feeling well;

being down, apathetic, dispassionate, doubtful, or lonely; not getting outside or feeling closed off; or
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reporting tension, misery, burden, obligation, pressure and meaninglessness. In particular, people
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used the following metaphors: experiencing a “dip”; being in a “well”; going through a difficult

phase; not feeling comfortable in one’s skin and a “snap in the brain”. These registers appear to be
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based on spatial imagery (high-low mood) and reasoning in terms of phases, processes, burden and

misery. People also made sense of mood with bodily imageries (tension and discomfort in one’s
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skin). References to “the brain” or neurochemical models (Rose, 2003) were infrequent, appearing in
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13 cases (4%), of which 10 came from media coverage. A wider biomedical “explanatory model”

(Kleinman, Eisenberg, & Good, 1978) – including genetics – appeared in approximately 30% of

references to explanations. In 64% of the explanations, people employed a psychosocial model

(Kangas, 2001; Westerbeek & Mutsaers, 2008) and related low mood to major disruptive life events

such as divorce, unemployment, loss, disease, abuse and violence and mentioned stress, familial

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conflicts, doubts about life choices or monotonous work. Next to medical treatment or counseling,

many people referred to talking, moving to a different house, dressing up, or participating in sports

or leisure activities as remedies. In our sample, people experienced, mentioned or encountered low

mood most often at home (36%), at restaurants and cafés (19%), at work or school/university (15 %),

in mediated conversations (12%) and on the street (10%).

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Asking if and how medical categories and treatments resonate when low mood occurs, peoples

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everyday interactions contained four variants:

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1. Medicalization: people approach low mood consonant with the categorization of medical

depression.

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2. De-medicalization and normalization of low mood: people take a dissonant stance towards
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medical depression categorization and try to normalize low mood against medicalizing

tendencies.
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3. Non-medicalization: people take an autonomous stance towards medical depression

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categorization and do not relate low mood to depression at all.

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4. Normalization of depression labelling and treatment: people seeking doctors’ advice or medical

treatment is presented as normal.

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As a first entry into these variants, we present their numerical occurrence in the sample in figure 1.
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While we are fully aware that the sample does not represent a population, the numbers are part of
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the question if medicalization is dominant in the sample. Dominance includes both a high frequency

of medical categorizations and centrality in the construction of meaning .

=INSERT FIGURE 1 =

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Following this overview, we present two variants in greater detail: medicalization and de-

medicalization. Non-medicalization is not confined to apparently mild cases of low mood and

occurred in relation to prolonged suffering too. Normalization of treatment occurred in few cases.

People sought doctors’ advice and treatment, which is consonant with medicalization. They also

uncoupled treatment from disease and considered it to be similar to dieting or vitamin taking. This

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finding echoes recent research on pharmaceuticalization (N. J. Fox & Ward, 2008).

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“There was just something not right in my head”: medicalization

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The first example of medicalization came from a coffee bar conversation witnessed by our student-

observer. Two old friends inquired about each other’s well-being and reflected on the time when

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Female (F) was depressed.
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P41, small café, M(ale) and F(emale), ages approximately 35
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F: I am lot better recently.

M: Oh, luckily, but it's nice to hear!

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F: I still sometimes think back to the time I told you that I was depressed and I took the
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antidepressants. When I had told you that, it was also a relief that you knew why I sometimes felt so

sad and useless and did not want to do things. There was just something not right in my head. I had
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the idea that the pieces for you were also put into place.

M: Yes, that is correct, yes. I was glad I knew what was wrong with you.
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F: I was also pleased. Especially that there was a drug that I could take. I really felt better because of
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it.

This is an example of the medicalization of low mood: when F felt sad, she sought medical attention,

which, in retrospect, empowered her and alleviated her suffering. M confirmed her description of

the past. We can also observe the pragmatic relevance of medicalization: the diagnosis eased past

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relational tensions. F stressed that she was “relieved” that M received an explanation for the

sadness. Medicalization also enabled M and F to structure the current interaction and to address

current and past feelings.

This example is consonant with (bio)-medicalization, as F referred to “something not right in

my head” and drugs. Here, medicalization occurred in the past and was confirmed in the present.

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Clear-cut examples such as this most often involved retrospection and successful treatment. People

pragmatically point to successful treatment to validate medicalization.

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The second example is a subtle form of incipient medicalization and contains uncertainty.

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P27 M(ale)1, student-observer, age 22, M(ale)2, age 21, in the subway
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M1: Hey, why did you disappear so fast suddenly, at that party?

M2: Yes, I do not know...

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M1: ...

M2: I actually felt like shit. I did not feel like partying at all. And then there was also that issue in the
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street.
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M1: Okay...

M2: ... and as I stood there with my beer while I was not in the mood. Then, I went home. [...] At
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home, I actually felt like shit. I did not sleep so well, and the next day, I stayed home all day. Did not

feel well ... really a bit depressed.

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A pragmatic concern triggered this interaction: M1 could not make sense of M2’s conduct and asked

him about it. M1 remained open to M2’s answers, replying with silence or “okay”. M2 gradually

offered longer replies and more detail. In the last response, he paused twice and summed up his

feelings as “depressed”. We interpret this as incipient medicalization and see potential consonance

with a depression diagnosis in that M2 seems to lists symptoms he then calls depression. M2

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pragmatically used depression to arrive at a conclusion that brought sense and coherence to his

account of troubling interactions and low mood. M2 might also have interpreted the open response

of M1 as a lack of support. In this light, M2 medicalized his mood to achieve legitimacy.

This situation is a form of pragmatic problem solving because the term “depressed” almost

literally answers a question. This exchange also exemplifies that the category of depression is

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employed and made relevant far beyond clinical or professional encounters. It has become so

common that it enables reflexive “self-labeling” (Thoits, 1985). However, this is not equivalent to a

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diagnosis. The label was used hesitantly: the response “really a bit depressed” constructs

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“depression” as somewhere between common sadness and clinical depression, which we interpret

as uncertainty about the label.

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“Case of the winter blues?”: de-medicalization

While the above examples are consonant with medical categorizations, we now turn to dissonant
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relations. The first example of de-medicalization is a conversation between partners that occurred
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when the M(ale) came home from playing sports. They talked about a female friend.
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P226, F(emale), 23 and partner, M(ale) 30, at home

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F: And all is well with J. [sports friend]?

M: Yes, but it’s not going so well with S. [ wife of J. ]

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F: Oh?
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M: Yes, she is not feeling so good, a little glum.

F: Case of the winter blues?

M: Well, you know that S. is always a bit gloomy. Now running (turning) to the doctor. [pause]

But if she would do something more, pick up a hobby and not only a part-time job and hanging out at

home a lot, I think she will feel much better in her skin.

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This part of the conversation again began with a question about someone’s mood. F scrutinized why

an absent friend, S, was “not feeling so good”: first with a probe (“Oh?”) then with an interpretation

(“winter blues”). In response, M emphasized that S’s feelings had existed for a while and that she

was under medical treatment. M thereby assigned S an identity that explained her low mood. The

reference to “the doctor” points to the medicalization of her identity. Then, M paused, questioned

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S’s identity (“But”) and re-interpreted S. M then de-medicalized S’s situation, pointing to a lack of

activity and motivation and suggesting that S should lead a more active life to drive out gloom.

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M thus took a dissonant position toward medical treatment. His remarks were built on an

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active citizenship discourse instead of medicalization (Petersen, 2011). The low mood itself was not

questioned, but the medical solution was. S was made responsible for tackling her low mood. This

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reinstated an active citizenship norm, but it did not separate the normal and the pathological
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through medicalization. This example shows that low mood, when treated by a doctor, is not a

straightforward example of medicalization but is instead doubted. Medical treatment itself does not
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legitimize the depression label.

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In the next example, the patient de-medicalizes low mood: the female student simultaneously seeks

reassurance from her family doctor and criticizes him/her.

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P247, University Library, F(emale)1, 28, student, F(emale)2, student

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F1: Yeah, you still know that I told you a while back that I was at the doctor and I said I didn’t feel
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comfortable in my own skin and didn’t feel like doing things anymore.

F2: Yea…

F1: And that when the doctor, without actually asking further said, yes, perhaps you can try this (anti-

depressant).

F2: Oh yeah, I remember, yes, you said…

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F1: Yeah, I found it so bizarre that it was just prescribed so indiscriminately. And I’m already, it’s not

that I’m eh…quick to want to use medications. I just wanted to tell my story or something.

F2: Yeah, bizarre, huh…

The student sought help from her family doctor but resisted the pharmaceuticalization of her needs.

PT
This marks a dissonant relation (partly accepting and partly rejecting medicalization). The reference,

“I just wanted to tell my story” indicates an attempt to normalize low mood.

RI
This dissonant position of de-medicalizing a doctor is in line with the critique of the over-prescription

SC
of anti-depressants. Critiques of medicalization are common in media framings of low mood,

including newspaper headlines such as “Numerous side effects of antidepressants” and a talk show

U
that ridiculed “just another telephone number” for depression diagnosis.
AN
Pragmatic concerns in interactions
M

In almost all of the interactions, we were able to inductively discern one or more of the following
D

pragmatic concerns:
TE

1. Sense-making: interactions in which the question arises of how to make sense of your own or
another person’s low mood.
2. Responsibility: interactions in which the question arises of who has to do what in cases of low
EP

mood.
3. Rule breaking: interactions in which happiness and active personhood as norms are violated.
C

4. Identity: interactions in which low mood is related to the question of the identity of the sad
AC

person.
5. Relation: interactions in which the question arises of how to address a conflict in a relationship.

Again, as a first approach to these concerns, we present descriptive statistics that show that none of

the concerns is dominant. Moreover, in our sample, all concerns co-occur with medicalization, de-

medicalization and non-medicalization, which indicates that none of these concerns engenders

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medicalization. However, the strength and content of correlations vary, and there is a concern that

almost always co-occurs with medicalization: relational conflict. Below, we report on sense-making

and relational concerns in detail, while the other concerns are briefly mentioned.

PT
= INSERT FIGURE 2 =

RI
Making sense of low mood

SC
The questions “how are you?”, “how am I?” or “how is (s)he?” were fundamental to many

interactions and triggered sense-making once low mood was on the table. Sense-making is often but

U
not always tied to medicalization: of the 165 instances of sense-making, 102 coincided with
AN
medicalization, and in 31 instances, there was no medicalization, while in 32 cases, there was de-

medicalization. Therefore, sense-making does not appear to lead up to medicalization.

M

Depression diagnosis and treatment often aided in making sense of mood, particularly in
D

retrospect (as seen in P41 above). In other cases, invoking a clinical definition merely shifted
TE

concerns about meaning. In the example below, we see that invoking depression helps M but not F

in making sense of the troubles of a third person, D.

EP

P200, At home, F(emale) student-observer (age unknown) and M(other) 63

C

F: Hey, how nice, a postcard from D (our former cleaning lady). Do you ever speak to her?
AC

M: That’s nice that she sent a card. It’s going pretty good with her now, since the past few days, she

may return home.

F: Oh, what was the matter with her?

M: She was really depressed for a while. She checked herself into a center where she was taken care

of internally.

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F: Oh, what for? You couldn’t tell that D was depressed. Well. She marched cheerfully around our

house with a duster.

M: Yeah, but she said she was really all tied up in knots with herself. It’s good that she asked for help.

In this exchange, M framed the troubles of her cleaner as depression, which, for M, addressed the

PT
pragmatic concern of making sense of the cleaning lady’s troubles. However, for F, this produced a

different concern: F had to adjust her image of the cleaning lady. While the depression label

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pragmatically seemed to make sense of the troubles of the cleaner, it also induced questions about

SC
her social identity.

The next example shows how diagnosis and treatment raise even more concerns. Here, two

U
friends tried to make sense of the well-being of A, a friend of F1. F1 knew that A had been
AN
threatened physically while living abroad.
M

P190: Two female students, one is a student-observer (age unknown)

F1: By the way, A’s psychologist has suggested that she should start with anti-depressants.
D

F2 : Anti-depressants? Why?
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F1: He says she is depressed.

F2: What do you think?

EP

F1: I do not know, I think everything she's been through is just very difficult stuff, and yes, she may be

depressed. I do not know, she seems uncomfortable in her skin, but it seems logical.
C
AC

F1 and F2 tried to make sense of the diagnosis and treatment of A. F1 did not embrace the

psychologist’s definitions and treatment of A’s troubles, but did not reject the diagnosis, either,

which presented her with the question of how to make sense of the diagnosis and treatment. In the

last reply, F1 did not reach a conclusion. In this sense, medicalization has not solved the pragmatic

concern of making sense but complicated it instead. Treatment with anti-depressants itself did not

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establish certainty. Cases such as this particularly undermine straightforward assumptions about the

medicalization of everyday life: even taking medication does not constitute an all-out embrace of the

medical model of low mood. The material includes cases in which routine medication use was even

seen as a normal part of everybody’s lives, not a pathology.

PT
Relational conflicts

In 78 instances, people expressed concerns about their relations with spouses, friends or colleagues

RI
in terms of low mood, and 65 of these went hand-in-hand with medicalization. The majority of the

SC
relational concerns were more or less pronounced conflicts (48), which almost always related to

medicalization (47/48). We maintain that these conflicts were leading up to medicalization.

U
In the first example, a young woman visited her friend at home and described an encounter
AN
with another friend:
M

P92, 2 Females, age 23 and 25, at home

F1: You know S, right?

D

F2: Yes, the blonde, I even got her on Hyves (Facebook variant, CB).
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F1: She is really depressed! You know.

F2: Why?
EP

F1: Well just, she's so negative about everything.

F2: About what?

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F1: She dislikes everything and thinks it’s no fun. It's just not nice anymore.
AC

F2: Oh, yeah ...

This brief exchange revolves around the pragmatic problem of how to address a friend’s low mood,

which we interpret as a mild but common relational conflict. F1 medicalized this conflict by referring

to S as “really depressed”, which F2 first questioned (“why”, “about what”) and then confirmed

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(“Oh, yeah”). The conflict was resolved by blaming the “depressed” friend. The depression label

helped F1 to distance herself from her then-former friend.

In our material, we see different ways of expressing the idea that a relation in which low

mood as a concern is “not nice anymore”. Relations were strained when friends or family did not

want to join festive events or pleasurable activities and when get-togethers were not joyful (28 of 78

PT
times). In these cases, a norm of happiness was reinforced when significant others distanced

themselves through medicalization.

RI
In the next example, alongside distancing, we witness empathy. Two students talked about a

SC
fellow student in their student housing who stopped going to class, withdrew from student life and

“looks bad”, according to them. They wondered how to address it and spoke about the possibility of

U
him being depressed prior to this exchange.
AN
P17, Male 24, Female, 24, meeting of student home seniors
M

M: I just do not feel like doing it anymore. I pulled him out of his room during the floor-dinner, well,

reluctantly.
D

F: Yes dear, but you have to see it as a disease. He does not sit all day in his room to bully you.
TE

M: No, I understand that, but I (pull my hand off) don’t bother anymore.
EP

Both M and F acknowledged that there is a relational conflict (“bully you”) and assumed that the
C

fellow student was depressed, but they responded differently: M stopped trying to activate him,
AC

while F, a psychology student, exculpated the fellow student and foregrounded the “disease”. The

depression label helped them both to adjust their approach and ease the relational tension.

Implicitly, we could assume that M also expected the fellow student to act on his situation. We

found a norm of being active and responsible underlying half of the relational concerns.

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While the two former examples concern absent persons’ low moods, the next one

demonstrates how “depressed” persons utilize the depression label to ease pragmatic conflicts. The

following is part of an email conversation between a teacher and a student. The student had left the

room during class, and the teacher emailed her about it as follows:

PT
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M
D
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AC

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P93, Female student, 25, Teacher 42, email from teacher

Good day Sara,

How is it going today?

Sincerely (cordially), Tom

PT
Hey Tom

It is at least better than yesterday. I found it very dismal to walk away from the seminar. In recent

RI
weeks, I have ignored that I am actually still sort of 'recovering’, thus, I have again fallen into old

traps, and the result is that the well-known burnout / depression symptoms somewhat resurface. I

SC
am going to take better care of myself this time around, and hopefully I’ll feel stronger quickly.

Greetings, Sara

U
AN
In her response, the student foregrounded the discomfort, possibly shame, she experienced when

she walked away from class. She apportioned blame on herself (“I have ignored”, “I am going to take
M

better care of myself”) and medicalized the symptoms (“burnout/depression”), resolving the conflict
D

and allowing her to return to class again. The teacher responded by saying, “no problem that you
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walked away”, “take your time” and “adjust your planning”, thereby using both the medical and

responsibility registers that Sara offered.

EP

Medicalization and protracted uncertainty

C

Medicalization research often focuses on (proto)-patients, professionals and pills and thereby
AC

neglects to ask if and how medicalization affects the non-clinical realm. Undoubtedly, a medicalized

approach to low mood is institutionalized in the US (Horwitz & Wakefield, 2007) and beyond, but we

do not know whether this has affected the way people deal with low mood in everyday life. In this

study, using innovative methods, we looked at generic low mood in everyday life interactions in the

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Netherlands to determine if and how low mood is medicalized and which interactional concerns and

cultural norms underpin everyday medicalization.

Outside the clinical realm, among friends, in public, at work or in school, we observed how

people deal with low mood ranging from short-lived gloom to decades of suffering. Medicalized

approaches to low mood resonate widely in the sample. The way low mood is addressed in common

PT
interaction is often consonant with depression diagnostics and treatment, but we also found many

interactions in which low mood was not medicalized. In relation to medicalization, these interactions

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were autonomous. We found dissonance, too: interactions in which medicalization was contested.

SC
This contestation, however, was also structured by medical categories and treatment and added to

the dominance of medicalization.

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In this case, sense-making is largely based on psychodynamic and social explanatory models
AN
(Kleinman et al., 1978) of depression, as Kangas and others have found (2001), while

“Biomedicalization” (Clarke et al., 2003) and “Brain talk” are far less important than Rose (2007)
M

suggests. Moreover, low mood is seldom pharmaceuticalized: the availability and use of anti-
D

depression medication is of limited relevance to everyday life, and pills are particularly controversial.
TE

Therefore, we nuance Horwitz and Wakefields (2007) claim that a medicalized approach to

low mood is so common that it has replaced normal sadness in discourse and experience. Low mood
EP

can be experienced without reference to clinical depression, even though the clinical approach is

widely shared in the sample we studied. Moreover, while we see a cultural shift in that a medicalized
C

idiom (Nichter, 2010) is often common and taken for granted, it is also evident that the medicalized
AC

depression idiom itself is rife with uncertainty. People struggle to make sense of low mood and the

depression label in everyday interactions, similarly to the way analysts attempt to make sense of this

material. The way uncertainty surrounding low mood is dealt with in everyday life is similar to how it

is approached by professionals and patients (R. C. Fox, 1957; Kokanovic et al., 2013; Rafalovich,

2005; Timmermans & Buchbinder, 2012; Weiner & Martin, 2008). The category of depression is

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furthermore reshaped in everyday life. The word “depression” has become normal and can be used

to the extent that “depression” has lost psycho-medical connotations.

Looking at the interactions in greater detail, we consistently find that low mood interrupts

the flow of interactions and triggers sense-making, (re)definitions of responsibilities and concerns

about identities. These concerns are often unresolved by using depression labeling. In cases of

PT
current suffering, the use of the depression label often raises new concerns for the sufferer and

his/her intimate relations (“what is depression?”, “How should we deal with a depressed person?”).

RI
Treating low mood as clinical depression in daily life does not disambiguate responsibilities.

SC
Norms of active citizenship, self-reliance and happiness are widely shared and lead to the

problematizing of low mood but not necessarily to its medicalization. Similarly, everyday concerns

U
and sense-making do not always encourage medicalization. However, interactional conflicts appear
AN
to be consistently tied to medicalization. Annoyance, irritation or doubts about friendship or

collegial contact trigger medicalization, particularly by the non-depressed person. Approaching low
M

mood as a medical problem settles these relational conflicts: The “depression” label and treatment
D

enable either distancing or empathy and provide coherence and legitimacy, which is the classic case
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of micro-controlling deviance.

We interpret the large-scale, though non-encompassing, employment of depression

EP

diagnosis and treatment, the attempts at de-medicalization, the diversity in explanatory models and

prolonged uncertainties as outcomes of the particular institutionalization of depression in care

C

practices. Since contemporary care practices – in the Netherlands and beyond – are diverse and
AC

conflictual in themselves, people have a rather broad array of interpretations at their disposal. In the

Netherlands and elsewhere, de-medicalization is even part of mental health policy. However,

institutionalized diversity as a whole resonates dominantly in everyday life (see: Bröer & Heerings,

2013 for a similar configuration regarding ADHD) . Depression diagnosis and treatment, through

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their pragmatic use, dialectically mediate between everyday attempts to make sense of low mood

and institutions marked by uncertainty.

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AN
M
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References

Abraham, J. (2010). Pharmaceuticalization of society in context: Theoretical, empirical and health

dimensions. Sociology, 44(4), 603-622.

PT
Barker, K. K. (2014). Mindfulness meditation: Do-it-yourself medicalization of every moment. Social

RI
Science & Medicine, 106, 168-176.

SC
Becker, G., & Nachtigall, R. D. (1992). Eager for medicalization - the social production of infertility as

a disease. Sociology of Health & Illness, 14(4), 456-471.

U
Bell, A. V. (2016). The margins of medicalization: Diversity and context through the case of infertility.
AN
Social Science & Medicine, 156, 39-46.
M

Bell, S. E., & Figert, A. E. (2012). Medicalization and pharmaceuticalization at the intersections:
D

Looking backward, sideways and forward. Social Science & Medicine, 75(5), 775-783.
TE

Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs: Prentice-Hall.
EP

Bröer, C. (2008). Private trouble, policy issue, how policy discourses shape our experience of aircraft

sound. Critical Policy Studies, 2(2), 93-117.

C

Bröer, C., & Heerings, M. (2013). Neurobiology in public and private discourse: The case of adults
AC

with ADHD. Sociology of Health & Illness, 35(1), 49-65. doi:10.1111/j.1467-9566.2012.01477.x

Brown, P., de Graaf, S., Hillen, M., Smets, E., & van Laarhoven, H. (2015). The interweaving of

pharmaceutical and medical expectations as dynamics of micro-pharmaceuticalisation:

27
 ACCEPTED MANUSCRIPT
Advanced-stage cancer patients' hope in medicines alongside trust in professionals. Social

Science & Medicine, 131, 313-321.

Brown, P., Zavestoski, S., McCormick, S., Mayer, B., Morello-Frosch, R., & Altman, R. G. (2004).

Embodied health movements: New approaches to social movements in health. Sociology of

PT
Health & Illness, 26(1), 50-80.

Bury, M. (1982). Chronic illness as biographical disruption. Sociology of Health & Illness, 4(2), 167-

RI
182.

SC
Certeau, M. d. (1984). The practice of everyday life. Berkeley: University of California Press.

U
Charmaz, K. (1983). Loss of self: A fundamental form of suffering in the chronically ill. Sociology of
AN
Health & Illness, 5(2), 168-195.
M

Clarke, A. E., Shim, J. K., Mamo, L., Fosket, J. R., & Fishman, J. R. (2003). Biomedicalization:

Technoscientific transformations of health, illness, and US biomedicine. American Sociological

D

Review, 68(2), 161-194.

TE

Conrad, P., Mackie, T., & Mehrotra, A. (2010). Estimating the costs of medicalization. Social Science
EP

& Medicine, 70(12), 1943-1947.

C

Conrad, P., & Schneider, J. W. (1992). Deviance and medicalization : From badness to sickness : With
AC

a new afterword by the authors (Expanded ed.). Philadelphia: Temple University Press.

Coveney, C., Gabe, J., & Williams, S. (2012). Boosting brainpower? from the medicalisation of

cognition to the pharmaceuticalisation of routine mental life. Salute E Società,

28
 ACCEPTED MANUSCRIPT
Csikszentmihalyi, M., & Larson, R. (1987). Validity and reliability of the experience-sampling method.

The Journal of Nervous and Mental Disease, 175(9), 526-536.

Danforth, S., & Navarro, V. (2001). Hyper talk: Sampling the social construction of ADHD in everyday

language. Anthropology & Education Quarterly, 32(2), 167-190.

PT
de Graaff, B. M. (2016). Should I be worried? citizens’ experiences and the risk politics of cell site

deployment

RI
De Graaff, B., & Bröer, C. (2012). ‘We are the canary in a coal mine’, establishing a disease category

SC
and a new health risk. Health Risk & Society,

U
Dumit, J. (2006). Illnesses you have to fight to get: Facts as forces in uncertain, emergent illnesses.
AN
Social Science & Medicine, 62(3), 577-590.
M

Epstein, S. (1996). Impure science : AIDS, activism, and the politics of knowledge. Berkeley: University

of California Press.
D
TE

Fox, N. J., & Ward, K. J. (2008). Pharma in the bedroom... and the kitchen.... the

pharmaceuticalisation of daily life. Sociology of Health & Illness, 30(6), 856-868.

EP

Fox, R. C. (1957). Training for uncertainty. The Student-Physician, , 207-241.

C

Goffman, E. (1961). Asylums; essays on the social situation of mental patients and other inmates
AC

([1st ed.). Garden City, N.Y.,: Anchor Books.

Graf, W. D., Miller, G., & Nagel, S. K. (2014). Addressing the problem of ADHD medication as

neuroenhancements. Expert Review of Neurotherapeutics, (0), 1-13.

29
 ACCEPTED MANUSCRIPT
Hacking, I. (2007). Kinds of people: Moving targets. Proceedings of the British Academy, 151, 285-

318.

Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice Routledge.

Hardon, A., Idrus, N. I., & Hymans, T. D. (2013). Chemical sexualities: The use of pharmaceutical and

PT
cosmetic products by youth in south sulawesi, indonesia. Reproductive Health Matters, 21(41),

214-224.

RI
Horton-Salway, M. (2001). The construction of ME: The discursive action model. Discourse as Data: A

SC
Guide for Analysis, , 147-188.

U
Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness Oxford University Press New York.
AN
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative
M

Health Research, 15(9), 1277-1288. doi:Doi 10.1177/1049732305276687

D

Illich, I., Cochrane, A., & Williams, R. (1975). Medical nemesis Australian Broadcasting Commission,
TE

Science Programmes Unit.

Kangas, I. (2001). Making sense of depression: Perceptions of melancholia in lay narratives. Health,
EP

5(1), 76-92.
C

Karp, D. A. (1994). Living with depression: Illness and identity turning points. Qualitative Health
AC

Research, 4(1), 6-30.

Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety:

Implications for diagnosis and treatment. Journal of Clinical Psychiatry, 62, 22-30.

30
 ACCEPTED MANUSCRIPT
Kleinman, A. (1985). Culture and depression: Studies in the anthropology and cross-cultural

psychiatry of affect and disorder Univ of California Press.

Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from

anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251-258.

PT
Knoblauch, H. (2005). Focused ethnography. Forum: Qualitative Social Research, , 6(3)

RI
Kokanovic, R., Bendelow, G., & Philip, B. (2013). Depression: The ambivalence of diagnosis. Sociology

of Health & Illness, 35(3), 377-390.

SC
Liu, K., King, M., & Bearman, P. S. (2010). Social influence and the autism epidemic. AJS; American

Journal of Sociology, 115(5), 1387.

U
AN
Lupton, D. (1997). Foucault and the medicalisation critique. Foucault, Health and Medicine, , 94-110.
M

Mayring, P. (2000). Qualitative content analysis. Forum Qualitative Social Research, 1(2)
D

McPherson, S., & Armstrong, D. (2009). Negotiating ‘depression’in primary care: A qualitative study.
TE

Social Science & Medicine, 69(8), 1137-1143.

EP

Mead, G. H., & Morris, C. W. (1934). Mind, self & society : From the standpoint of a social

behaviorist. Chicago: University of Chicago Press.

C
AC

Nichter, M. (2010). Idioms of distress revisited. Culture, Medicine, and Psychiatry, 34(2), 401-416.

Petersen, A. (2011). Authentic self-realization and depression. International Sociology, 26(1), 5-24.

Philip, B. (2009). Analysing the politics of self-help books on depression. Journal of Sociology, 45(2),

151-168.

31
 ACCEPTED MANUSCRIPT
Rafalovich, A. (2005). Exploring clinician uncertainty in the diagnosis and treatment of attention

deficit hyperactivity disorder. Sociology of Health & Illness, 27(3), 305-323.

Ratcliffe, M. (2014). The phenomenology of depression and the nature of empathy. Medicine, Health

Care and Philosophy, 17(2), 269-280.

PT
Rose, N. (2003). Neurochemical selves. Society, 41(1), 46-59.

RI
Rose, N. (2007). The politics of life itself : Biomedicine, power, and subjectivity in the twenty-first

century. Princeton, NJ: Princeton University Press.

SC
Rossol, J. (2001). The medicalization of deviance as an interactive achievement: The construction of

U
compulsive gambling. Symbolic Interaction, 24(3), 315-341.
AN
Saltonstall, R. (1993). Healthy bodies, social bodies: Men's and women's concepts and practices of
M

health in everyday life. Social Science & Medicine, 36(1), 7-14.

D

Scheff, T. J. (1970). Being mentally ill: A sociological theory Transaction Books.

TE

Schutz, A. (1932). Der sinnhafte aufbau der sozialen welt; eine einleitung in die verstehende

soziologie. Wien,: J. Springer.

EP

Scott, S. (2009). Making sense of everyday life Polity.

C
AC

Timmermans, S., & Buchbinder, M. (2012). Saving babies?: The consequences of newborn genetic

screening University of Chicago Press.

Torres, J. M. (2014). Medicalizing to demedicalize: Lactation consultants and the (de) medicalization

of breastfeeding. Social Science & Medicine, 100, 159-166.

32
 ACCEPTED MANUSCRIPT
Verkenning, V. T. (2013). Nationaal kompas volksgezondheid. Bilthoven: RIVM, 9

Verweij, G., & Houben-van Herten, M. (2013). Depressiviteit en antidepressiva in nederland.

Wasser, J. D., & Bresler, L. (1996). Working in the interpretive zone: Conceptualizing collaboration in

qualitative research teams. Educational Researcher, , 5-15.

PT
Weiner, K., & Martin, P. (2008). A genetic future for coronary heart disease? Sociology of Health &

RI
Illness, 30(3), 380-395.

SC
Westerbeek, J., & Mutsaers, K. (2008). Depression narratives: How the self became a problem.

Literature and Medicine, 27(1), 25-55.

U
AN
Wheeler, L., & Reis, H. T. (1991). Self‐recording of everyday life events: Origins, types, and uses.

Journal of Personality, 59(3), 339-354.

M

Willcock, H. (1943). Mass-observation. American Journal of Sociology, , 445-456.

D

Williams, S. J., & Calnan, M. (1996). The 'limits' of medicalization?: Modern medicine and the lay
TE

populace in 'late' modernity. Social Science & Medicine, 42(12), 1609-1620.

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FIGURES

Figure 1

Figure 1: Low mood and resonance of medicalization as percentages of codings

(n=335)

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Non-
medicalization
24%

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Medicalization
42%

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AN
De-medicalization
25%
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Normalization
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of
medicalization
9%
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Figure 2

Figure 2: Types of concerns as percentages of all interactional concerns

(n=457)

Identity
8%

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Rule breaking

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14% Sense-making
36%

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Relation 17%

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Responsibility
25%
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Highlights

-The first study on medicalization of low mood in everyday life interactions

-Low mood triggers sense-making but not necessarily medicalization

-Demonstrates that medicalization resonates but is not dominant

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-Uncertainties about depression labelling and treatment resonate in everyday life

-Relational conflicts seem to be triggers of medicalization

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