[Paleopsych] NYTBR: 'Against Depression': Anatomy of Severe Melancholy
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Sun May 22 01:14:01 UTC 2005
'Against Depression': Anatomy of Severe Melancholy
By Peter D. Kramer.
353 pp. Viking. $25.95.
By NATALIE ANGIER
PETER D. KRAMER, author of the phenomenally successful ''Listening to
Prozac,'' may be thought of as America's Dr. Depression, and he may
have done more than anybody else to illuminate the clawing, scabrous,
catastrophic monotony that is depressive illness. But he has never
suffered from the mental disorder himself. Not that he's a chipper bon
''I am easily upset,'' he writes in ''Against Depression.'' ''I brood
over failures. I require solitude. . . . In medieval or Renaissance
terms, I am melancholic as regards my preponderant humor.'' Still, he
has never qualified for a diagnosis of even low-level depression. My
first reaction to that biographical detail was to question Kramer's
authority on the subject. How can you really understand what pain is,
I wondered, if you've never felt the Cuisinart inside?
I quickly dropped my objections, however, when I realized I was doing
for depression precisely what Kramer warns against in this eloquent,
absorbing and largely persuasive book. I was lifting it to the status
of the metaphysical, or at least the meta-medical. I was granting to
its specific pain the presumed reimbursement of revelation, the power
to ennoble, instruct and certify the sufferer. By contrast, I'd never
insist that my endocrinologist suffer my autoimmune disorder before
treating me or talking publicly about autoimmunity; or that my
endodontist, before extracting my infected dental pulp, first be
''enlightened'' with a few root canals of his own.
That Kramer has not been depressed may in fact allow him to resist
doing what depressives, and those who love them, too readily do, which
is romanticize and totemize and finally trivialize the illness.
Instead, Kramer, who is a clinical professor of psychiatry at Brown
University, sees depression for what it is. ''It is fragility,
brittleness, lack of resilience, a failure to heal,'' he writes. It is
sadness, hopelessness, chronic exhaustion allied with corrosive
anxiety, a loss of any emotion but guilt, of any desire but to stop,
please stop, and to stay stopped, forever. ''Depression is a disease
of extraordinary magnitude,'' he says, and ''the major scourge of
Found by the World Health Organization to be the single most disabling
disease, depression afflicts people of every age, class, race, creed
and calling: as many as 25 percent of us will be caught in its vise at
least once in our lives. The disease blights careers, shatters
families and costs billions of dollars in lost workdays a year. Kramer
cites studies putting the annual workplace cost in this country alone
at $40 billion -- the+equivalent of 3 percent of the gross national
Depression also kills, through suicide, heart disease, pneumonia,
accidents. Forget the persistent myth of depression as a source of
artistry, soulfulness and rebellion. Depression doesn't fan creative
flames. It is photophobic and anhedonic and would rather just drool in
Kramer wrote ''Against Depression'' to dispel what he sees as the
lingering charisma of the disease. And yes, people talk about it now
as a biological disease rather than a moral or spiritual failing. The
stigma of mental illness has mainly faded, and antidepressants are
among the most widely prescribed of all medications. Nevertheless, in
the dozen years since the publication of ''Listening to Prozac,''
Kramer has seen plenty of resistance to the idea that depression, like
cancer, AIDS or malaria, is a disease without redeeming value, best
annihilated entirely. He has read stacks of depression memoirs, and
though most have parroted the party line that depression is a disease
like any other, ''hints of pride almost invariably showed through, as
if affliction with depression might after all be more enriching than,
say . . . kidney failure.'' The writers couldn't help conveying the
message: ''Depression gave me my soul.''
Moreover, whenever Kramer gives a talk, sooner or later an audience
member invariably asks The Question. So, Dr. Kramer, what would have
happened if van Gogh had taken Prozac? Or Kierkegaard? Or Virginia
Woolf? The implication of the question is obvious. Throw out the
depression bath water and, whoops, there go ''Starry Night'' and
''Mrs. Dalloway'' with it.
Kramer presents a sustained case that depression, far from enhancing
cognitive or emotional powers, essentially pokes holes in the brain,
killing neurons and causing key regions of the prefrontal cortex --
the advanced part of the brain, located just behind the forehead -- to
shrink measurably in size. He lucidly explains a wealth of recent
research on the disease, citing work in genetics, biochemistry, brain
imaging, the biology of stress, studies of identical twins. He
compares the brain damage from depression with that caused by strokes.
As a result of diminished blood flow to the brain, he says, many
elderly stroke patients suffer crippling depressions. Is
stroke-induced depression a form of ''heroic melancholy''? If not,
then why pin merit badges on any expression of the disease?
Rallying his extensive familiarity with art and literature, Kramer
argues that history's depressive luminaries were creative not because
of but despite their struggles with mental illness -- as a result of
their underlying resilience, a quality he admires. Kramer envisions a
utopian future in which neuro-resilience and neuro-regeneration may be
easily induced with drugs or gene therapy. How much more
intellectually and emotionally courageous might we be, he asks, how
much more readily might we venture out on limbs and high wires, if we
knew a private trampoline would always break our fall?
KRAMER'S narrative is not seamless. He argues that depression has long
been very much among us, and he rightly discounts pat evolutionary
hypotheses about the disease's ''adaptive value,'' but he doesn't
offer much of an explanation himself for how a condition so
devastating+has come to be so common. Kramer can also sound defensive
and willfully dour. To counter possible charges of superficiality or a
fondness for smiley-face fixes, he presents his ''bona fides as a
person who can appreciate alienation, both the social and existential
varieties,'' among them being a New York-born German Jew who lost many
relatives in the Holocaust. He rejects our habitual conflation of
tragedy with depth and joy with shallowness, yet when A. L. Kennedy,
author of the memoir ''On Bullfighting,'' struggles to find some
lightness by recalling how her suicidal fantasies clashed with her
fear of public embarrassment, Kramer dismisses her attempts as an
author's version of ''meeting cute.''
Ah, but self-mockery can be a small source of joy, even redemption,
which is why, whenever I lapse into hand-wringing, I recall Ezra
Pound's ode to misery, a parody of A. E. Housman: ''O woe, woe, /
People are born and die, / We also shall be dead pretty soon /
Therefore let us act as if we were dead already.''
Now that's what I call cute.
Natalie Angier, who contributes science articles to The Times, is
completing a book about the scientific canon.
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