Is demoralisation an illness? Illnesses by definition are our creations. In other words they are ‘social constructs’. The International Journal of Social Psychiatry publishes papers on the social aspects of psychiatry. In a 2006 paper by Briggs and MacLeod, a ‘demoralisation syndrome’ definition was used to assess its probable existence in a group of refugees in New Zealand. The authors describe a syndrome ranging from disheartenment through to despair and demoralisation.
The study which I would consider a pilot study involved looking at the psychiatric casenotes of 64 refugees. The people had answered questions about other conditions (e.g. depression) and the researchers looked at these answers to see if their responses met the criterion for demoralisation syndrome. In 86% of cases, there were sufficient responses to meet a probable diagnosis of demoralisation syndrome. They also looked at whether this was related to diagnosed illnesses in this group including depression and PTSD. They found that there was no significant association between the occurrence of probable ‘demoralisation syndrome’ and PTSD or depression, thus supporting this as a separate entity.
We might expect that there would be a greater degree of demoralisation in refugees depending on the reasons that they had moved. Locating to another country, leaving one’s life behind and starting again in a position of uncertainty (although we don’t know the specifics) might be expected to create demoralisation. However there are some problems. Firstly demoralisation may be a symptom rather than a syndrome. For example, if someone said that they were feeling tired we wouldn’t say that they had an illness. This may just be their experience for a limited period of time – part of the range of ‘healthy experiences’. The next point is that only the case notes were examined. The patients weren’t seen during the research and asked questions directly. There was also no comparison group and the sample size was relatively small.
Having said that, this was a creative study, using previously acquired data to investigate the existence of a demoralisation syndrome. The authors have raised questions that can be investigated in subsequent studies. Will we ever be able to say we have an illness when we are feeling despondent? Time will tell
Briggs L and MacLeod A. Demoralisation – A useful conceptualisation of non-specific psychological distress among refugees attending mental health services. International journal of Social Psychiatry. 2006. 52(6). 512-524.
The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor.