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Wednesday, Nov 25, 2009
Treating depression doesn't quell our humanity and creativity but restores them, argues "Listening to Prozac" author Peter Kramer. So, please, let's stop making a virtue out of despair.
May 23, 2005 | "What if Prozac had been available in van Gogh's time?" That's the question Peter Kramer, a professor of psychiatry known for his bestselling book "Listening to Prozac," hears whenever he makes a public appearance, and he's sick of it. The people who ask it, he observes, are all the same: "hearty men trying to win standing with the audience about them, as if we were all complicit in a good joke." In other words, it's a stupid question masquerading as a clever one, posed by the kind of person who is unshakably -- and mistakenly -- convinced of his own originality.
You can't blame Kramer for being so irritated by these dumb smart alecks that it took him a while to look behind the question. A good therapist, however, knows that a persistent preoccupation, however superficially banal, suggests a significant underlying problem. If it's society -- rather than an individual patient -- that keeps picking away at "the van Gogh question," then Kramer, who has a sideline in writing about the intersection of biology, psychology and culture, is the man to figure out why.
Are we really ready, Kramer asks in his new book, "Against Depression," to accept that depression is a disease? Though most informed Westerners would probably agree that it is, we aren't as unambivalent about the matter as we might think. We'd have no compunction about enthusiastically endorsing a plan to wipe out diabetes, cancer or malaria, but when Kramer began asking people if they'd support the "eradication" of depression, "invariably, the response was hedged." They asked for precise definitions and expressed "protective worries" about utopian plans to change "human nature."
If you unpack the glibness of the van Gogh question, the implications are obvious. The painter suffered greatly from (probably) both depression and epilepsy, and his art strikes us as intimately concerned with those two, intertwined afflictions. Would the paintings be less revelatory if van Gogh himself were not so miserable? Would they even exist at all? Depression, in many people's minds, is integral to the creative temperament. We might lose some of the triumphs of art and culture if it were wiped away.
Yet as Kramer points out, in a book full of similarly provocative thought experiments, no one would hesitate to treat van Gogh's epilepsy. The idea of allowing those torments to continue with the hope that they might somehow lead to more or better pictures strikes us as coldblooded, inhuman. So why does the idea of treating the painter's depression make many people at least slightly uncomfortable, for exactly the opposite reason? Why do we still harbor a residual fear that eliminating someone's -- and especially a great artist's -- depression might be a betrayal of our humanity?
Kramer finds a similar reluctance in other situations, as well. He recalls attending a conference on mood disorders at which one speaker, a psychoanalyst, talked of a patient whose depression he was not treating very vigorously. "The analyst had the impression that for the whole of his life, the patient has been self-centered, blandly confident and lacking in insight ... He hoped that the loss of confidence [caused by the depression] in particular would motivate the patient to engage in a psychotherapy that would make inroads against the narcissism."
Although he once would have regarded the psychoanalyst's strategy as a valid way to prompt a patient to go deeper, now Kramer found himself "seething." "Listening to Prozac," contrary to popular conception, was not about depression at all, but about the implications of the then-new trend of prescribing antidepressants to people who weren't suffering from mental illness: personality tweaking, if you will. Nevertheless, the book's success drew depressed patients to Kramer's practice, and his growing understanding of mood disorders, both as a psychotherapist and as a follower of clinical research on the subject, has convinced him of just how dangerous the disease can be, and how incompletely we realize the threat.
"Against Depression" is partly a critique of the West's propensity for romanticizing depression, partly a survey of the latest research on the illness and its possible causes and cures, and partly a meditation on what our culture would look like if we stopped equating depression with refinement, profundity, insight and intelligence. "Our beliefs, our art, our sense of self might change as the medical view became a cultural commonplace," he writes. "If we could treat depression reliably, we would have different artists, different subjects, different stories, different needs, different tastes." And the way he sees it, that doesn't have to be cause for alarm.
Nevertheless, it's a lot to ask that an entire culture change a significant part of its orientation and values. A case must be made for the shift. First, there are the facts. The science of depression, Kramer feels, is way ahead of the layperson's image of the disease, and to make matters worse, we're not properly aware of the discrepancy. "We retain," he writes, "a confused -- partial, anachronistic -- understanding of depression." "Against Depression" represents Kramer's effort to tease out some of the contradictions and befuddlements we still cling to, and to supply us with a sense of how the medical establishment now views the illness. If we have a better grasp on this, the change might seem less ominous. Kramer's book is a nudge in the direction of a depression-free world.
