BRIEFINGS Defeat Depression Campaign Attitudes towards depression: some medical anthropological queries Sushrut Jadhav and Roland Liftlewood The vigorous public profile adopted by the College In the 'Defeat Depression' campaign (Psychiatric Bulletin, 1993. 17, 573-574) is to be welcomed, but the proposed educational pro gramme is premature. The MORI poll is not an adequate basis for understanding how 'depression' is popularly conceived nor how people respond to it. The research report (Royal College of Psychiatrists, 1992) says little about the methods used in the qualitative part of the study: whether the researchers were properly trained in ethnographic field interviewing to elicit illness categorisations, and their ability to elicit the whole complex of ideas and actions, involving nomenclature, causation, agency, recognition and recourse to treatment. The main thrust of the campaign is to popu larise the biomédicalconcept of depression (i.e. 'what depression is': page 573). one which we already know is rather different from lay usage of the term or its cognates (Kleinman & Good. 1985). Yet the College's qualitative and quanti tative studies both use a propositional approach which starts with the presentation of the word 'depression'. Such an approach is inevitably con strained by the elicitation of discrete statements. Critics of this method have argued that such statements are obviously restricted to attitudes that are a product of the item in the proposition as popularly understood, not the patterns understood by professionals as included in the category (White, 1982). More significantly, it has been recognised for some years that simplistic attitudinal surveys also fail to capture the full complexity of local illness conceptualisations which generally involve unstable, heterogenous and contradictory categories dependent on im mediate context, and which deeply overlap with other elicited categories, are explained through multiple causalities, and which may be quite unrelated to actual pragmatic decisions (White, 1982; Littlewood, 1990). Such decisions are themselves oriented, not to a discrete lexical item like 'depression', but to more diffuse socially- embedded patterns of action (Holy & Stuchlik, 1980). For example, if a subject's notions of attribu tion reveal three core constructs for depression - let us say, unemployment, marital difficulties and physical weakness - these may be related causally to each other in quite different non linear modes (Jadhav, 1992). We can only make sense of this in relation to a particular society's core notions of the self, moral agency and intentionality: not only to its elicited lexicon of affect, but to its categorical logic and contingent recourse to therapy. Unless these complex pathways are understood, it is unlikely we will be able to change 'attitudes'. At a basic level, a simple propositional ap proach misses the categorical semantics (White, 1982). We have just analysed the first 1220 responses in a cross-cultural 11 country study on stigmatisation of severe mental illness; this uses a brief clinical vignette (without a named category) developed in three languages (Bengali, English and Sinhalese), through ethnographic pilot studies in five countries (Britain, India, Sri Lanka, South Africa and Trinidad). Respondents were asked to give a name that might best iden tify the illness described in the vignette. Taking the English language responses alone (n=892), we find 140 different terms offered for the pattern of illness described in one vignette alone (and these responses included such diverse suggestions as 'mad', 'normal', 'illumination', 'depression', 'neurosis', 'mental retardation', 'cancer' and 'mania'). The vignette was a lay description of severe mental illness, recognised by most of the psychiatrist respondents as schizophrenia, but which in turn was derived from popular descriptions of illness in Britain, India and Sri Lanka. With a vignette based on 'depression' (which is not only a biomédicaldis ease entity but also a lay account of everyday distress), one would expect even more categories to be elicited. What the MORI poll has not shown is how patterns of distress may be popularly recognised (and perhaps categorised) but are not locally regarded as 'depression' although they would be by biomédicalcategorisation; and the point of the educational programme is 572 Psychiatric Bulletin (1994), 18, 572-573