Blank space on the map

Xavier Briffault, La fabrique de la dépression (The manufacture of depression; Paris: Armand Colin, 2010), is a useful book. It compensates for the individualism of DSM-style psychological symptomatology by devoting chapters to the social conditions that contribute to people experiencing depression; on the other end, it lays out evidence of the bio-chemical underpinnings of the thing. Both the social and the chemical angle bring relief from the self and from the insistence on thought reform, what I might call the orthopedic bias of the psychiatric trade. But here’s something one can’t help noticing in Briffault’s chapter on personality disorders. It includes a table pointing to an 80% lifetime prevalence of depression among people with a diagnosis of avoidant personality disorder — the highest rate of prevalence, the runner-up being borderline personality disorder with 61%. You might think, then, that a book entitled “the manufacture of depression” would spill some ink on those unfortunate people cursed with a Cluster C avoidant makeup. But no! Briffault goes into a detailed discussion of the more colorful borderline and bipolar patients, forgetting completely the population with the highest prevalence. A keyword search shows a similar feast-vs.-famine pattern in psychological research generally. Is Avoidant Personality Disorder simply not interesting, or does its symptomatology too closely track that of depression in general? Or have psychologists figured out that the avoidant aren’t going to make a big fuss if they’re ignored, but will just shrink back into the curtains? I wonder why the experts are so quick to avoid the avoidant.

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