Sunday, Jul 6, 2008
Why has a cultural cottage industry sprung up around the most isolating of illnesses?
Jun 27, 2001 | Despite a decade of efforts by public figures such as Tipper Gore and Mike Wallace, as well as by countless health journalists, depression remains a baffling and controversial illness. Its manifestations seem to run the gamut from extreme and destructive dementia to what strikes some observers as not much more than a prolonged bad mood. Take two recent developments: In the case of Andrea Yates, who allegedly murdered her five children, Americans were told that she acted in the throes of an ongoing, severe postpartum depression. A few days later, the publishers of Psychology Today announced that they are launching a new magazine, called Blues Busters, aimed at depression sufferers and billed as "a new antidote to the blues." Within the course of a single week, we've been presented with depression as the cause of homicidal psychosis and as the premise for a lifestyle.
When it comes to the prevalence of the illness, improbably large numbers get thrown around: According to Andrew Solomon, author of the new book "The Noonday Demon: An Atlas of Depression," chronic depression afflicts more than 19 million Americans. If you're not among that group, it's easy to be skeptical; the seemingly functional relative, friend or acquaintance seeking treatment for depression is still often viewed as a self-absorbed, neurotic malingerer or morally weak pill popper. According to Solomon, 60 million prescriptions for antidepressants were written in 1998 alone. Are the people who take these pills dupes of the pharmaceutical industry, or genuine sufferers looking for relief?
Part of depression's public relations problem stems from the fact that it's an exaggerated form of common experiences -- grief, hopelessness and fear about the future. The line between ordinary depression, which is part of being human, and what's now called "clinical depression," which if left untreated can ravage a life in big and small ways, isn't always a clear one.
The widespread perception of depression as a "disease of affluence" doesn't help either. Many see it as a sickness that only seems to afflict the well-off and whiny. What used to be called "melancholia" has always been with us, but "depression" in its present form only appeared on the scene, after all, in the middle of the 20th century, after life became cushy and stoicism (or what some would call moral backbone) went out of fashion. Is there perhaps something about our godless, impersonal, materialistic society that has caused middle-class people's brains to short-circuit somehow? Or perhaps depression is the equivalent of the "neurasthenia" that afflicted wealthy women at the turn of the 20th century but has since disappeared as a medical diagnosis: A sort of mass hysteria through which the idle and self-indulgent convince themselves that they are "sick" and need special attention.
One thing that Solomon's exhaustive and eloquent book makes abundantly clear is that, despite depression's well-to-do and lily-white public image, it's not true that serious depression is largely a province of the privileged. The rise of antidepressants may be a phenomenon of affluence, but depression itself is not. In fact, Solomon argues, since clinical depression is often the brain's response to trauma, physical hardship and a persistent lack of self-determination in one's everyday life, we shouldn't be surprised that poor people actually suffer from it more often than do the middle class and rich. The overwhelming obstacles encountered during a life spent in poverty can breed passivity, and passivity, or "learned helplessness," is "a precursor state of depression."
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