[Paleopsych] NYTDBR: That 'Prozac' Man Defends the Gravity of a Disease

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That 'Prozac' Man Defends the Gravity of a Disease
New York Times Daily Book Review, 5.5.9
http://www.nytimes.com/2005/05/09/books/09masl.html

    By [2]JANET MASLIN

    In his new book, Peter D. Kramer tells a story about traveling to
    promote the best-known of his earlier books, "Listening to Prozac,"
    and regularly encountering the same kind of wiseguy in lecture
    audiences. Wherever he went, somebody would ask him whether the world
    would be shorter on Impressionist masterpieces if Prozac had been
    prescribed for Vincent van Gogh.

    Sunflowers and starry nights aside, this anecdote is revealing. It
    conveys both the facts that "Listening to Prozac" made a mental health
    celebrity out of Dr. Kramer (who is a clinical professor of psychiatry
    at Brown University) and that the book's success left him uneasy. He
    became a target, not only of New Yorker cartoons (one of which
    featured a Prozac-enhanced Edgar Allan Poe being nice to a raven) but
    of condescension from his professional peers. He found out that there
    was no intellectual advantage to be gained from pointing the way to
    sunnier moods.

    "Against Depression" is a defensive maneuver against such
    vulnerability. With both a title and an argument that summon Susan
    Sontag (in "Against Interpretation" and "Illness as Metaphor"), the
    author argues against the idea that depression connotes romance or
    creativity. While fully acknowledging depression's seductiveness
    (Marlene Dietrich is one of his prototypes of glamorous apathy), and
    grasping how readily the connection between gloom and spiritual depth
    has been made, Dr. Kramer argues for a change in priorities. He
    maintains that depression's physiology and pathology matter more than
    its cachet.

    Dr. Kramer makes this same point over and over in "Against
    Depression." It may be self-evident, but it's not an idea that easily
    sinks in. As this book points out, the tacit glorification of
    depression inspires entire art forms: "romantic poetry, religious
    memoir, inspirational tracts, the novel of youthful self-development,
    grand opera, the blues." There isn't much comparable magnetism in the
    realms of resilience, happiness and hope.

    What's more, he says, our cultural embrace of despair has a respected
    pedigree. Depression is the new tuberculosis: "an illness that
    signifies refinement," as opposed to one that signifies unpleasantness
    and pain. In a book that mixes medical theory, case histories and the
    occasional flash of autobiography, Dr. Kramer speaks of having been
    immersed in depression - "not my own" - when inundated with memoirs
    about the depressed and their pharmacological adventures. He finds
    there is a lot more confessional writing of this sort than there is
    about suffering from, say, kidney disease.

    But depression, in his view, is as dangerous and deserving of
    treatment as any other long-term affliction. When regarded in purely
    medical terms, evaluated as a quantifiable form of degeneration,
    depression loses its stylishness in a hurry. Here, matters grow
    touchy: the author is careful to avoid any remedial thoughts that
    might appear to promote the interests of drug companies. So there are
    no miracle cures here; there is just the hope that an embrace of
    strength and regeneration can supplant the temptation to equate
    despair with depth.

    "Against Depression" returns repeatedly to this central, overriding
    premise. Perhaps Dr. Kramer's talk-show-ready scare tactics are
    essential to his objectives. "The time to interrupt the illness is
    yesterday," he writes, building the case for why even seemingly brief
    interludes of depression can signal a relentless pattern of
    deterioration in a patient's future. For anyone who has spent even two
    straight weeks feeling, for instance, sad, lethargic, guilty,
    alienated and obsessed with trifles, "Against Depression" has unhappy
    news.

    The author does not stop short of declaring that "depression is the
    most devastating disease known to humankind." But this claim, like
    much of the medical data discussed here, is open to interpretation and
    heavily dependent on the ways in which individual factors are defined.
    How far do the incapacitating properties of depression extend? Do they
    lead only to sadness and paralysis, or also to self-destructive
    behavior, addictions, failures, job losses and patterns passed down to
    subsequent generations? Whatever the case, Dr. Kramer is clearly well
    armed for the debate he will incite.

    While its medical information, particularly about depression-related
    damage to the brain, is comparatively clear-cut, it is in the realm of
    culture that "Against Depression" makes its strongest case. In these
    matters, Dr. Kramer is angry and defensive: he finds it outrageous
    that William Styron's "Darkness Visible" endows depression with such
    vague witchcraft ("a toxic and unnamable tide," "this curious
    alteration of consciousness") or that Cynthia Ozick can complain that
    John Updike's "fictive world is poor in the sorrows of history." He
    himself finds Updike's world rich in life-affirming attributes that
    tend to be underrated.

    He wonders how much of the uniformly acknowledged greatness of
    Picasso's blue period has to do with its connection with the suicide
    of one of Picasso's friends. By the same token, he is amazed by a
    museum curator's emphasis on the bleakest work of Bonnard, though this
    painter strikes Dr. Kramer as "a man for whom fruit is always ripe."
    Similar material, with the potential to illustrate the high status of
    low moods, is endless. There is a whole chapter on Sylvia Plath that
    the author didn't even bother to write.

    There is more breadth of evidence than innovative thinking in "Against
    Depression." Nonetheless, this book successfully advances the
    cartography of a (quite literally) gray area between physical and
    mental illness. And in the process it settles a few scores for the
    author, whose last book was a novel about a radical blowing up trophy
    houses on Cape Cod. Here is his chance to assert that he wrote his
    senior thesis on death in Dickens's writing; he listened to a lot of
    Mozart and Schubert in college; that he, too, has succumbed to the
    erotic power of bored, affectless, emotionally unavailable women in
    candlelit rooms.

    But he wrote this book in a state of reasonable contentment. He finds
    life well worth living. He's tired - in ways that have potent
    ramifications for all of us - of being treated as a lightweight for
    that.