From damaged nerves to masked depression: inevitability and hope in Latvian psychiatric narratives.

Psychiatric language in Latvia has been invaded by the diagnosis of depression and masked depression. Depression has been promoted by the translation into Latvian of the International Classification of Diseases and by conferences organized by pharmaceutical companies and aimed at educating psychiatrists and family doctors about the new diagnostic categories. The language of depression represents a radical departure from older languages of somatic distress that were central both to Soviet Psychiatry and to lay conceptualizations of distress. However, the new practitioners who favour the diagnosis of depression have a highly atomistic and culture blind approach to patients' problems. In order to selectively cleanse the presentation of distress, various strategies for eliminating social context and suppressing patients' narratives are used during psychiatric consultations. Alongside these imported psychiatric languages, recognition of the physically and socially embedded nature of human experience and its historicity persist. Not all psychiatrists eliminate subjective narrative from the consultation dialogue. However, prioritizing mental over physical states is not linked in a straightforward way to other dualisms such as the intentional versus the accidental and the voluntary versus the involuntary. For many depressed patients autonomy is restricted to being a good patient and learning about their condition. Conversely, psychiatrists who start out by addressing their patients' physical discomfort may move on to open up a range of narrative possibilities.