Site Presented By
Tuesday, Nov 10, 2009
The most commonplace notion of depression is that it arises from a deficiency, or an inability to make use of, certain mood-stabilizing chemicals in the brain, particularly serotonin. The most widely prescribed antidepressants today, the selective serotonin reuptake inhibitors (SSRIs) are frequently seen as increasing the brain's supply of those chemicals, correcting the "chemical imbalance," or, as one friend of mine put it, filling the brain with "happy juice."
According to Kramer, research in the past decade (since "Listening to Prozac" was published) suggests that serotonin and similar neurochemicals may instead serve a protective function. They help shield the brain from the negative effects of the stress hormones that prompt the body to respond to threats. Certain brains are rendered particularly vulnerable to stress hormones by genetics and sometimes, in addition, early childhood trauma. This kind of brain loses the ability to protect and heal itself from the effects of those hormones, and also loses the ability to turn off the production of the hormones. The stress response system can get stuck in the "on" position, eventually weakening and diminishing nerve cells and further eroding the brain's capacity to cope with the hormones. This vicious circle results in clinical depression.
The manifestations of the disease include "low mood, apathy, diminished energy, poor sleep and appetite, suicidality, loss of the capacity to experience pleasure, feelings of worthlessness," and so on. Some depressed people can't sleep; others sleep way too much. Some feel misery; most feel something closer to emptiness. But the cause, Kramer maintains, is measurable organic damage to the brain, damage that prevents the brain from repairing itself and leaves it ever more susceptible to further damage. This is why often very slight stressors can incapacitate a depressed person or trigger an episode of depression, and why a third or fourth episode is harder to treat than the first.
Rather than seeing depression as arising from a lack of certain chemicals, Kramer defines it as a deficit in resilience, the ability to bounce back -- neurologically and emotionally -- from stress. To treat depression you don't pump the afflicted full of artificial happiness, you restore their ability to absorb and recover from the unavoidable bumps, knocks and tragedies of life. That's why, Kramer feels, doctors should vigorously treat depression (using a combination of medication and psychotherapy), as soon as possible. Delayed or insufficient treatment risks further weakening of the brain itself, although depressions will sometimes spontaneously evaporate.
This happened to one of Kramer's patients, Margaret, a no-nonsense woman with a difficult past who suddenly discovered one afternoon (despite no change in her medication) that she was better. After her recovery, she scolded Kramer for suggesting that the apathy and pessimism she had felt about her husband and daughter while depressed reflected some real ambivalence on her part. Like another patient of Kramer's who burnt the diary he kept during his depression because "I was like a torture victim confessing to fantastic crimes he never committed," she had felt possessed by a foreign entity. The depression was "an imposter" and Kramer "had been negotiating with an occupying government, of Margaret's mind, while the legitimate ruler was in exile."
Kramer leads "Against Depression" with Margaret's case because it demonstrates that treating depression doesn't consist of changing someone's personality, but of restoring it. Genetics and early trauma might have set Margaret up for depression, by making her brain more vulnerable to stress, but the depression was not her fundamental self, or a window into buried feelings -- in fact, it was quite the opposite.
This vision of depression flies in the face of the common belief that the depressed are deeper and more authentic than the cheerful rabble. Kramer rails against the notion that depression is the only honest, thoughtful response to a cruel world, that we must choose between despair (or a kind of sardonic brooding) and a plastic, smiley-face mask of denial.
Citing an undergraduate favorite, Albert Camus, Kramer counters with the existential model of the mythic Sisyphus, condemned by the gods for eternity to push a huge stone up a hill, whereupon it rolls down again and the process starts over. "His rebellion, his fidelity to self," Kramer writes of Sisyphus, "rests on the refusal to be worn down ... he faces endless futility without succumbing to despair." Camus himself wrote, "The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy."
Kramer complains about museum curators who treat an artist's gloomier works as more important than those celebrating "exuberance, appetite, an appreciation of the exquisite in the ordinary," using the vaunting of Picasso's "blue period" over his erotic drawings as an example. Likewise -- and to escape for a moment Kramer's manifold references to the mandarin works of classical and high modernist art and literature -- consider that the Academy Award for best picture rarely goes to a comedy. While scientists, historians and anyone with direct experience of depression's crippling listlessness can make pretty short work of the canard that depressives are unusually creative, it's undeniable that we usually consider bleak and somber art more significant than pieces that are vital and joyous.
