Manufacturing depression (52 page)

Writing in 1840 in America, Tocqueville would of course have
been worried about slavery, just as writing in 5000 B.C. a Sumerian poet would have worried about the wrath of the gods. But slavery is gone, at least in most of the world, and the gods have been replaced by science. Now that we are responsible for our own destinies, the danger we face is one that the manufactured version of depression can only deepen: not that a hand will bind us or that a god will destroy us, but that we will bind and destroy ourselves, that we will mistake our anguish and our rage and our terror of what we have become for the symptoms of a disease and dismiss them, that we will find our solace in the privacy of our own medicine chests and seek normalcy as our most magnificent aspiration.

Science is not a democracy. We cannot choose whether molecules interact in our brains to give us our experience, including our experience of the suffering we call depression, any more than we can choose whether the planets circle the sun or whether gravity pulls us to the earth. Neither can we determine the particulars of those interactions. But we can choose what we make of these facts, and what, if anything, to do about them. Now that I’ve told you this story, we both know that we don’t have to put our discontents into the hands of the drug companies and their doctors. When it comes to understanding and alleviating the suffering now known as depression, we don’t have to give up biography for biochemistry. We don’t have to give up the ghost for the machine.

And then we will be free to fashion our own stories about our unhappiness. Maybe yours will follow the disease model. Maybe it will include taking antidepressants (or other drugs) or entering psychotherapy. Or maybe you will find options that involve neither. That happened to me once—when, four years after my Holiday Inn miracle cure, I fell into another depression. There was a reason for this one too. My wife and I were trying to have a baby. We had made the sacrifices to the great gods of medicine required of would-be parents of a certain age—endless doctors’ visits and bodily indignities and the transformation of our sex life into a factory job—but without success. Not only that, but my inexhaustible penchant for
dithering had led me not to know which side I was on, whether our failure was a blessing or a curse, whether I should be relieved or devastated when the monthly bad news came. In the midst of it, we decided to build a house, on the assumption, I suppose, that if we built it, the child would come. I threw myself into the project, and by the time we were putting up the downstairs walls, I was just as childless, and just as frustrated about that, but no longer depressed. I was, I suppose, resilient.

A few years later, a researcher at Princeton University suggested to me that because large muscle movement is known to increase serotonin metabolism, all that hammering was what had cured me. I didn’t disagree entirely. The hammer was surely important to the cure. I had swung it with a redemptive fury, and as the house took shape, I found reason to hope that I could indeed bring something, if not a human life, into being. Maybe the serotonin explanation is correct, but I choose to believe that giving my burning anger a place to go, vanquishing my helplessness, and losing myself in a task as I had once lost myself in my then future wife’s eyes are what cured me.

I didn’t intend to treat my depression by building a house—which, by the way, is a very expensive and time-consuming cure. But had I considered myself diseased, would I have stumbled on this cure for my unhappiness? Had I taken antidepressants, would my recovery have gone down in my biography as a lesson about the value of losing myself or just as another illness cured by a drug? And would I have noticed that this was the same lesson that I had learned from my MDMA experience: that the redemption of despair lies in involvement in the world and engagement with others—to put it briefly, in love?

I don’t think I’m done with being depressed. I don’t think it’s going to be all that much fun to get older, and as hopeful as the recent regime change has made me, I think we might have fouled our nests irretrievably. My tragic view is getting pretty fixed, and not in the sense of repaired. So I am sure that I’ll have all sorts of opportunities to deploy this lesson. But I doubt I would have learned it if
I thought my problem was a chemical imbalance, and if I believed that Princeton researcher—or, for that matter, if I believed Daniel Amen and George Papakostas, both of whom told me that my MDMA cure was the result of unleashing a flood of serotonin, as if the rest of it—Angel and Grace and my wife’s bottomless blue eyes—didn’t matter.

I suppose I’ll never know whose story is the right one. But I know what mine is, and I’m sticking to it for now. The greatest injustice that Eliphaz and his friends inflicted on Job was that they refused to let him have his version of events. That’s what the depression doctors want to do to you.

Call your sorrow a disease or don’t. Take drugs or don’t. See a therapist or don’t. But whatever you do, when life drives you to your knees, which it is bound to do, which maybe it is meant to do, don’t settle for being sick in the brain. Remember that’s just a story. You can tell your own story about your discontents, and my guess is that it will be better than the one that the depression doctors have manufactured.

CHAPTER 1

Page

2
   
a question first posed:
Smith, “Pavlov and Integrative Physiology,” R747.

3
   
On Easter night:
Loewi,
From the Workshop of Discoveries
, 30–34. See also Finger,
Minds Behind the Brain,
268–73.

5
   
Twarog’s first paper:
Twarog, “Responses of a Molluscan Smooth Muscle.”

5
   
Her paper with Irvine Page:
Twarog and Page, “Serotonin Content of Some Mammalian Tissues.”

6
   
27 million Americans:
These figures are notoriously hard to pin down. However, for a good analysis of both the numbers and their meaning, see Barber, “The Medicated Americans.” For raw numbers, see Olfson and Marcus, “National Patterns in Antidepressant Medication Treatment,” and the Pharmacy Facts and Figures pages on the Drug Topics website,
http://drugtopics.modernmedicine.com/drugtopics/article/articleList.jsp?categoryId=7604
.

8
   
no more effective at treating depression:
Geddes et al., “Selective Serotonin Reuptake Inhibitors.”

8
   
the drugs fail to outperform placebos:
Kirsch et al., “The Emperor’s New Drugs,”
http://journals.apa.org/prevention/volume5/pre0050023a.html
.

8
   
“remake the self”:
Kramer,
Listening to Prozac
, t.p.

9
   
By now, asking about the virtue:
Ibid., 300.

9
   
W. H. Auden’s elegy:
Auden,
Collected Poems,
271.

10
   
“the common cold of mental illness”:
Centers for Disease Control and Prevention, “Understanding Depression,”
http://www.cdc.gov/nasd/docs/d001201-d001300/d001247/d001247.html
.

10
   
“the leading cause of disability”:
World Health Organization, “Depression,”
http://www.who.int/mental_health/management/depression/definition/en/
.

10
   
his drug was the first SSRI:
Wong, Bymaster, and Engleman, “Prozac (Fluoxetine, Lilly 110140), the First Selective Serotonin Reuptake Inhibitor”; Carlsson and Wong, “Correction: A Note on the Discovery of Selective Serotonin Reuptake Inhibitors,” 1203.

11
   
“seven preeminent medical, advocacy, and civic groups”:
Depression Is Real Coalition, “Link to Us,”
http://www.depressionisreal.org/depression-link.html.
.

12
   
Some say depression is all in your head:
Depression Is Real Coalition, “Right and Wrong,”
http://www.depressionisreal.org/depression-dr-greengard.html.

14
   
the 1980 release of the third edition:
American Psychiatric Association,
Diagnostic and Statistical Manual,
3rd ed.

19
   
manic-depressive illness:
American Psychiatric Association,
Diagnostic and Statistical Manual,
2nd ed., 36.

19
   
involutional psychotic reaction:
American Psychiatric Association,
Diagnostic and Statistical Manual,
24.

20
   
depressive neurosis:
American Psychiatric Association,
Diagnostic and Statistical Manual,
2nd ed., 40.

20
   
“Depression is neither more nor less”:
Kramer,
Against Depression
, 41.

20
   
“an occupying government”:
Ibid., 25.

21
   
“the eradication of depression”:
Ibid., 111.

22
   
depressionisreal.org is quietly funded:
In particular, by Wyeth. See Depression Is Real Coalition, “What Is,”
http://www.depressionisreal.org/depression-about-coalition.html

CHAPTER 2

Page

25
   
It is customary:
See, for example, Jackson,
Melancholia & Depression
, 7–8; Horwitz and Wakefield,
The Loss of Sadness
, 57–61.

25
   
“it appears to me to be no more divine”:
Hippocrates,
Hippocratic Writings
, 154.

25
   
“Fear and sadness”:
Schmidt,
Melancholy and the Care of the Soul,
32.

26
   
He is rumored to have cured:
Roccoatagliata,
History of Ancient Psychiatry
, 163–64.

26
   
“it is a deadly symptom”:
Hippocrates,
Hippocratic Writings
, 20.

26
   
he devoted an entire book:
Ibid., 152–54.

26
   
according to one scholar:
Kramer,
History Begins at Sumer,
105–15.

27
   
“mark among all the people”:
Job 1:3, Jerusalem Bible.

27
   
Job is not God-fearing:
Ibid., 1:9–11.

28
   
“malignant ulcers”:
Ibid., 2:7.

28
   
“Curse God,” she says:
Ibid., 2:9–10.

28
   
May the day perish:
Ibid., 3:3–4.

28
   
I should now:
Ibid., 3:13–17.

29
   
“Why give light”:
Ibid., 3:20.

29
   
“Why make this gift”:
Ibid., 3:24.

29
   
“only food is sighs”:
Ibid.

29
   
Can you recall:
Ibid., 4:7.

29
   
Was ever any man:
Ibid., 4:17.

29
   
And now your turn:
Ibid., 4:3.

30
   
“charlatans, physicians”:
Ibid., 13:4–5.

30
   
Is not man’s life:
Ibid., 7:1–4.

31
   
Why do the wicked:
Ibid., 21:7–8.

31
   
But man?:
Ibid., 14:10–12.

31
   
“I mean to remonstrate”:
Ibid., 3:13.

31
   
“that of a dog”:
Richardson,
William James
, 14.

32
   
Does a wise man:
Job 15:2–6.