Structural violence has become a central concept in critical medical anthropology. It emphasises the importance of structural health determinants such as poverty, political violence and other collateral aspects of globalization. Diseases and epidemics are viewed as being pathologies of power. The goal of anthropology is no longer to analyse the influence of culture on illness and disease, but rather to engage in pragmatic efforts to remedy social inequalities that express themselves through ill-health. Such opposition between culture and politics may not be consistent with the need for a comprehensive anthropology that emphasizes the subtle and complex articulations between the multiple dimensions of health. Based on an analysis of depression and social suffering in postcolonial Martinique (French Caribbean), a plea is made for a new understanding of the relationship between local idioms of distress on the one hand and intermediate social, political and economical factors on the other. There is also a discussion of some of the pitfalls related to an exclusive focus on the political economy of health.