I.
A psychiatrist from NewYork–Presbyterian visited my seminar on depression and shared a case study. His subject: a politically astute college student, recently undone by the 2024 U.S. presidential election. The student, anxious but articulate, declined a formal diagnosis. If you knew as much as I do, he told the psychiatrist, you’d be depressed too.
Nonetheless, the student accepted a brief course of antidepressants. When he returned to Dr. F’s office, he reported an improvement in mood. His world, still bearing the same threats, had not changed. Dr. F noted the distinction: the object of despair remained intact; only the student’s ability to endure it had shifted.
At first glance, this encounter affirms psychiatry’s most foundational claim: that psychic distress, whatever its cause, deserves relief. That to feel better is a sufficient good. The student’s capacity to function returned, and with it, a feeling of balance and an ability to function again as a student. No legislative bill had been passed, no political tide reversed, and yet the intolerable became palatable. The implicit message here seems to be this: when the world cannot be fixed, there is something noble and good in being able to “fix” the person.
But the exchange also unsettles. The student resisted treatment not because he denied his own pain, but because he saw it as an appropriate response to injustice. Are we helping people suffer less—or adapt to what once felt unbearable? What are we treating: the brain, or the relationship between person and world? As a pre-med student invested in the future of psychiatric care, I approach these questions not as a practicing clinician but as a concerned observer and participant in medical education.
This essay asks what we risk, what we gain, when we treat politically induced depression—and whether care must mean accommodation.
II.
The idea that depression could be generative forces a rethinking of how psychiatry interprets suffering. If we—clinicians, researchers, patients, and advocates alike—take seriously the possibility that psychic pain emerges from a precise awareness of structural disorder, then current diagnostic paradigms risk mislabeling dissent as disease.
This fear comes from historical precedents of pathologizing dissent to preserve social order. In 1851, American physician Samuel A. Cartwright coined the term drapetomania to describe a supposed mental illness afflicting enslaved Black people who attempted to escape captivity (Bynum). Writing in De Bow’s Review, a pro-slavery Southern journal, Cartwright proposed that the desire for freedom in enslaved persons was not a rational response to violence and degradation, but a form of psychiatric deviance, a rebellion against what he construed as their “natural” condition. Since, according to Cartwright, slavery was divinely ordained and inherently benevolent, any effort to flee it could only be explained by mental disease. The act of running away—what he called “absconding from service”—thus became a medical symptom. As treatment, he advocated “whipping the devil out of them,” combining the lexicon of theology, violence, and medicine into a unified logic of subjugation (Cartwright).
The significance of drapetomania lies not in its scientific falsity, which is now universally acknowledged, but in its enduring template. It illustrates how psychiatric discourse can be marshaled to translate political dissent into individual pathology—how social conflict is depoliticized through diagnosis. In this respect, drapetomania belongs to a longer genealogy of what we might call disciplinary psychiatry: the use of medical language to pathologize noncompliance, to treat power as health and opposition as illness.
The history of women’s mental health further illuminates how clinical categories have functioned as instruments of containment. Across centuries, women’s suffering has been interpreted less as evidence of their environments than as confirmation of their deficiencies. In ancient medicine, women were imagined to suffer from a literal “wandering womb,” a source of internal chaos (King, 1993). Medieval theology reframed that chaos as a moral threat, casting female illness as demonic possession or spiritual weakness (Showalter). Freud refined the definitions of depression in “Mourning and Melancholia” (1917), where he distinguishes between mourning, a time-bound, object-directed grief, and melancholia, a more pervasive, structureless despair (Freud). Robert Burton, in The Anatomy of Melancholy, reads melancholy as a condition of excess, not deficiency: of intellect, imagination, moral attunement (Burton). The melancholic is not unfeeling but too feeling, not disengaged but overwhelmed.
Which brings us to the literary record of modern female depression. Consider Play It As It Lays (1970), Joan Didion’s novel following Hollywood actress Maria Wyeth as she drifts through a landscape of moral vacancy and personal loss. Maria’s “numbness” is less absence of affect than saturation with it: she has absorbed too much. “I know what ‘nothing’ means,” she tells us—not melodramatic, but diagnostic (Didion). Her depression is her devastating clarity about the incoherence of the Hollywood excess she’s expected to revel in.
A similar dynamic animates Charlotte Perkins Gilman’s “The Yellow Wallpaper,” now widely considered a foundational feminist text. The narrator, confined to an upstairs room under her physician husband’s care, undergoes a psychological breakdown. What she suffers is enforced deprivation. Her descent into hallucination begins not with a rupture from reality, but with a command to withdraw from it: to rest, to obey, to relinquish writing, movement, thought (Gilman).
In both cases, what looks like a breakdown may be testimony. The shift from hysteria to depression in the postwar period mirrors broader ideological shifts in how subjectivity is understood. As feminist scholars note, the decline of hysteria as a diagnosis coincides with the rise of individualist psychology, biomedical psychiatry, and the valorization of autonomy (Ussher; Showalter). Depression, unlike hysteria, is inward-facing: coded as cognitive, neurochemical, private. Hysteria was performative, often dramatizing a misfit between the individual and the role she was asked to play. Depression is increasingly interpreted as failure without referent.
Then, what if antidepressants had been widely available in the 19th century? Would yellow wallpaper hallucinations have been dulled before they became legible as critique? And would Maria Wyeth, in the 1960s, have been prescribed Prozac and returned to the Hollywood sets?
III.
Some forms of depression may register reality more faithfully than the anesthetized calm we often mistake for health. But there is danger in romanticizing suffering into something morally or epistemically sacred. This is one risk of politicizing depression too fully: turning it into a badge of insight. Supposing that if you’re not depressed, you must be ignorant or unaware of the realities around you.
Depression rarely energizes or indicts. Political scientist Christopher Ojeda, in a 2015 longitudinal study published in American Politics Research, examined the relationship between depression and political participation in the U.S. His findings showed depression to be politically disabling. Individuals experiencing depressive symptoms were significantly less likely to vote, engage in political discussion, or believe in their own political efficacy (Ojeda). Far from sharpening critique, depression corroded the very foundations of democratic agency. What if, instead of illuminating injustice, depression merely makes action feel irrelevant? What if the person who sees clearly also comes to believe that nothing can change? When theorists extract “insight” from depression, they often ignore the physiological cost. Depression may begin in lucidity, but it does not sustain it. The clarity it provides is real—but so is the exhaustion.
An alternative framing emerges in “The Political Is Personal” (2023), a paper by Brett Ford et al. published in Perspectives on Psychological Science. Rather than asking whether depression interferes with political life, they ask whether political life itself might cause depression. Ford et al. identify a critical trade-off: people who regulate their emotional responses through strategies like distraction or cognitive reappraisal tend to report better mental health, but lower political motivation (Ford et al.). Those who allow themselves to fully feel injustice may be more willing to act—but they are also more emotionally depleted. In other words, there is no clean line between feeling better and acting better. The very affects that motivate resistance can also immobilize it (Ford et al.).
This is the bind psychiatry now faces. If it does nothing, it leaves people drowning in despair. If it intervenes too bluntly, through medication or therapy, it risks dulling the affective charge that makes resistance possible. The question is how to treat without extracting the politics from pain.
One possible solution is to distinguish between two forms of clarity. First, the clarity of recognition—the ability to see that the world is broken. Second, the clarity of strategy—the ability to move, think, act within that brokenness. Depression may sometimes yield the first. But it rarely provides the second.
This is where pharmacology reenters the picture. Insight, to be usable, must be metabolized, held by a body that can endure it, translated by a psyche that can still speak.
IV.
So then what are we to do with the figure of the Didion or Gilman heroine, the student who refuses to “get better” because the world has not changed? Antidepressants inhibit the reuptake of serotonin, or norepinephrine, or dopamine, yes; they do not explain why some people feel more alienated under late capitalism than others. They do not distinguish between someone crushed by neurochemical depletion and someone crushed by meaninglessness. If we are going to intervene pharmacologically in states of political despair, we should be precise about what, exactly, we are dampening.
What might such precision look like? It means doing better science into diagnosis and treatment. Not more symptom checklists, but longitudinal studies that ask how political beliefs evolve or erode after pharmacological treatment. We need clinical models that incorporate political context into psychiatric assessment—not just family history, but housing precarity, labor alienation, racialized violence. We need more research into what antidepressants actually do—not just at the level of symptom scores, but at the level of ideology, affect, agency. Whether people still feel outraged, moved to act, connected to a moral horizon larger than their serotonin levels.
In addition, we need psychiatry that is structurally self-aware. Psychiatry that is capable of saying: this antidepressant may help you get out of bed, but it will not make your job more humane. It may return appetite, but not autonomy. Such a psychiatry would not reject medication, but embed it in a broader project of material analysis. It would refuse the fantasy of personal recovery without political change.
The goal cannot be to make people well-adjusted to a broken order. The goal must be to make people capable. To me, capability is living with one foot rooted deep in the joy of presence—the laughter of friends, the comfort of family, the small marvels of everyday life—while the other foot stays planted in awareness—politics, injustice, the world as it is. It is only by balancing these two contradictory truths that we can move forward without our feet freezing in one place. Forward is the act of witnessing pain without being consumed by it, loving life while staying wide awake to its cruelties, and remaining human in a world that often asks us to forget both presence and awareness. Let the goal be to make people capable of critique, capable of connection, capable of imagining a life that is not organized entirely around survival.
Until then, we are not treating depression. We are teaching people to endure what should be intolerable and calling that health.
Works Cited
Burton, Robert. The Anatomy of Melancholy. Edited by T. C. Faulkner, N. K. Kiessling, and R. L. Blair, Oxford UP, 2001. Original work published 1621.
Bynum, Bill. “Discarded Diagnoses: Drapetomania.” The Lancet 356, no. 9241, 2000, n.p.
Cartwright, Samuel A. “Diseases and Peculiarities of the Negro Race.” DeBow’s Review of the Southern and Western States 11, 1851, pp. 331-36.
Didion, Joan. Play It As It Lays. Farrar, Straus and Giroux, 1970.
Ford, Brett, et al. “The political is personal: the costs of emotionally engaging with politics.” Perspectives on Psychological Science 18, no. 2, 2023, pp. 403–421.
Freud, Sigmund. “Mourning and Melancholia.” In The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 14, edited and translated by James Strachey. Hogarth Press, 1957, pp. 243-258. Original work published 1917.
Gilman, Charlotte Perkins. “The Yellow Wallpaper.” Feminist Press, 1996. Original work published 1892.
Ojeda, Christopher. “Depression and Political Participation.” American Politics Research 43, no. 2, 2015, pp. 275-306.
Image
The Sick Child I, Edvard Munch, 1896. The Munch Museum. Wikimedia Commons.
