In Sai Mhok, the number of those diagnosed with depression was below average until 2023, when it experienced an unprecedented spike as the village saw the presence of psychiatrists for the first time.
Previously, physicians assisted instead due to a shortage of medical staff in remote areas. Today, following an exodus of working-age adults, only youths and seniors live in the community.
At the time, Poramin Tangopasvilaisakul, a lecturer at the Faculty of Social Sciences, Srinakharinwirot University, was conducting research for his PhD. He met Tha, who felt jai jep (heart pain), which was diagnosed as depression. Studies show that many in the Northeast experience this symptom. Soon, he learned that their vulnerable background had forced them to work hard and care for their families.
“It is unlikely that they suffered from depression, but doctors said otherwise. The DSM [Diagnostic And Statistical Manual Of Mental Disorders] can’t be used to explain the situation — it must be contextualised. Tha told me that they all experienced jai jep, especially leftover youth [a term for uneducated and unproductive youth]. It was the beginning of my research,” he said.
Speaking at a seminar at Kasetsart University, Poramin explained that depression can be expressed in many ways. Whereas psychiatrists regard it as an illness, social scientists read it as an idiom of distress. Meanwhile, those in Sai Mhok feel jai jep. This inspired Poramin to study how depression can be understood in a specific context and a local hospital permitted him to observe clinical cases.
“Should depression be seen in a different light? Imagine you were poor and abused. Why don’t you run away? In my hypothesis, depression is moral subjectivity that pieces fragments of yourself together,” he said.
Poramin explained how depression took a medical turn due to Emil Kraepelin in the 19th century. Pushed further by an advance in neurology in the 1970s, depression is understood to result from a chemical imbalance in the brain. New studies, however, challenge this theory. The growth in diagnosis of depression is also associated with capitalism and the pharmaceutical industry.
“DSM-5 is a victory for biopsychiatry in being able to explain depression as a universal phenomenon,” he said.
In general, there are two systems for classifying mental disorders. The first is the DSM, a manual by the American Psychiatric Association for diagnosing of mental health disorders. The second is the ICD (International Classification of Diseases) by the World Health Organization, which is a standard tool used by health professionals to catalogue diseases, health conditions and causes of death.
Depression is psychologically understood to involve experiencing loss of interest in activities, feeling tired and having low self-worth and suicidal thoughts due to social, psychological and biological factors.
However, Poramin said depression cannot be entirely understood from a pathological perspective. It can be an expression of bodily suffering, according to social science. His research seeks to move beyond the first paradigm.
“Many take drugs but are not cured of depression. For social scientists, it is how the body communicates pain. Parents often complain that it was harder in their generation and wonder why youth get depressed today. But it is a different hardship. In their days, they reaped the rewards of hard work, but it is no longer true. That is why depression is rising,” he said.
Fieldwork led Poramin to get involved with youths who dealt with depression in multiple ways. Some find a safe zone in hospitals. For example, Nid, an only child, sent him a suicidal message in the middle of the night. Poramin rushed to the hospital in the morning. A psychiatrist joked that she had made several suicide attempts. Nid funnily told him that she had taken pills and driven a motorcycle to hospital. On the one hand, she pitied her father who was abandoned by her mother and turned to alcohol. On the other hand, she hated him for abusing her.
“How was Nid supposed to tackle this moral predicament? I think hospitalisation is an escape for her. It defuses her stress and makes her father more conscientious. It allows her to live with it,” Poramin said.
Some take antidepressant drugs to numb themselves. For instance, a teenager took pills for many years to make herself get used to pain. Like Nid, she looked after a bedridden mother who vented her frustration at her. Depression would persist as long as she took care of her mother. Still, she could not run away.
“Taking drugs helps her cope with this moral dilemma — being a good daughter or a human with dignity. She is trapped in domestic violence due to moral obligation to a dependent mother. As a result, drugs perform more than what their labels show — they numb her pain,” Poramin said.
While suicide is negatively viewed as a short-sighted decision, some with depression choose that path. For example, a teenager helped assist his stepfather at a farm, however, after seven years, the stepfather had his own son manage the durian plantation instead. On the one hand, the teenager invested a lot at the expense of his health, yet his mother wanted to be with her new husband. The boy thought it through and hung himself from a durian tree to take himself out of the equation. However, a worker thwarted the suicide in time.
“This incident made the stepfather feel guilty. It shows that suicide may open up possibilities for repairing a broken relationship,” he said.
Last but far from least, some girls from the Sai Mhok area work in bars. While psychiatrists interpret their behaviour in a pathological sense, they view life decisions as management of resources for survival. For example, one depressed teenager made 2 million baht from sex work to take care of her father. She then left the night life behind and opened a salon.
“A psychiatrist attributes her behaviour to insecurity, but I think she is entrepreneurial. There are many ways to live a good life,” Poramin said.
His research enables a shift in the status of the human from an individual to being in a web of relationships. Pathologically speaking, depression is viewed as a static entity. His study, however, regards depression as moral subjectivity that emerges from suffering. It helps shed light on the complexity of lives.
“Suffering is more than medical terms. Why do you stay in a toxic relationship? It is all about an unreasonable choice,” Poramin said.
“Being a good child is good. Being a human with dignity is good. Making money is good. How can you choose? I think it is better to let people live the way they want. That is why depression is an ethical pedagogy that varies from person to person, whether it be jai jep or other idioms of distress.
“It is a moral project that pieces together fragmented selves.”