Difference-makers in human affective distress: perspectives on causation and recovery gained from qualitative inquiry into lived experience

The biomedical conceptualisation of “depression” as a disease entity stems from biological science rooted in a 17th century paradigm, and is an inappropriately positivist idea which discounts individual agency, disregards social context underscored in the descriptive epidemiology, fails to accommodate inter-subjectivity and process, medicalizes suffering, and serves a managed care model of health administration. A qualitative study using in-depth interviews was undertaken to elicit perspectives from individuals who had lived experience of biomedical (pharmacological) treatment for affective distress and who self-reported having attained satisfactory recovery. Thematic analysis of interview data clustered around three main categories: (1) multifactorial conceptual understandings; (2) context pertinent to the experience of distress and recovery – including a variety of stressors – and (3) trajectories of recovery from acute distress to negotiation of ambivalence toward treatment, enlisting of supports, and reclaiming of agency. Relationships with service providers marked by trust, empathy, and hope were valued as primary difference-makers.