[Paleopsych] NYTBR: 'Against Depression': Anatomy of Severe Melancholy

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'Against Depression': Anatomy of Severe Melancholy
http://www.nytimes.com/2005/05/22/books/review/22ANGIERL.html

AGAINST DEPRESSION
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
    vivant.

    ''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
    humankind.''

    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
    product.

    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
    the dark.

    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.