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Tuesday, Nov 10, 2009
In some ways Kramer, a subtle and perceptive observer, is the ideal person to consider the many facets of our infatuation with depression. However, his looping and elliptical prose style can make his arguments hard to follow, and sometimes he misses the obvious.
Take language, for example. One reason why we confuse depression with personality is that in common speech people often use the word "depressed" to describe their ordinary, healthy sadness. I might come back from a dysfunctional family weekend complaining that the experience left me "depressed," even though, like Kramer himself, I've never suffered from the disease. Yet until you've been close to someone truly depressed, it can be all too easy to liken a few days in a funk to a whole other order of pain and disability.
This mix-up may look trivial -- it certainly doesn't require a thorough grounding in Cervantes and Kierkegaard to identify it -- but it may hinder our understanding of depression more than all the morose poets of the world combined. Human beings are reflexively empathic; when hearing about someone else's experiences, they tend to seek parallels in their own. They, too, were down in the dumps once, after a bad breakup, but within a few weeks, they'd regained at least some of their energy and ability to enjoy life. So why can't these depressed people just snap out of it?
Only about 16 percent of Americans suffer a major depression during their lifetimes, but many more people erroneously believe they know what it feels like. This confusion of depression with normal sorrow leads to more than just unsympathetic attitudes toward the difficulties depressives have in recovering. When Kramer talks of eradicating depression, what many people hear is that he advocates eliminating sadness -- and that would indeed be dehumanizing. Even those who don't romanticize alienated brooding would object to that.
Another reason why it's so hard to draw the line between healthy sadness and pathological depression is that depression itself often resists the effort. In this way, at least, it's very different from cancer or diabetes. Patients with those diseases might neglect their doctor's orders or even deny that they're sick, but the diseases themselves tend to insist, with ever-increasing physical pain and deterioration, on their own existence. Depression is categorically different from them in that it's a disease that attempts to persuade us that it isn't.
A well-informed, not-too-sick depressive might know how he or she would ordinarily feel, and realize that the absence of those feelings is the result of illness. Many depressives, however, can't achieve this intellectual distance from their pathological mood. They believe that they are correctly perceiving the nature of themselves and the world around them. A man of intelligence, talent and education can be convinced that he has nothing to offer the world; a mother of young children that they'd be much better off if she killed herself.
The depressed will often swear that they have at last perceived the fundamental futility and drudgery of life, a brutal fact that the rest of the world chooses, idiotically, to ignore. Kramer complains that Western culture has made a particular virtue of this type of despair, but it's not just that the depressed are thought to be deeper and more sensitive than the rest of us clods: It's that the depressed claim to have special, unrestricted access to the truth. And much of the time, we've believed them. In this light, you could even say that Western culture is itself depressed.
Furthermore, depression lies. Melodramatic adolescent posturing aside, unalleviated pessimism is as deluded a view of the world as unqualified optimism. It's just a lot easier, particularly if you fancy yourself an intellectual, to deride the optimist. Kramer, who clearly longs to participate in the grand tradition of Western "seriousness," finds himself objecting, conscientiously, on the grounds that the tradition idealizes depression. He stops a little short of accusing it of frankly collaborating with the disease, but the case can definitely be made. One of the most dangerous aspects of depression, now that there are increasingly better ways of treating it, is its ability to persuade us that it is not a disease. To help the devil in his deception is to be complicit in his crimes.
In some aspects, "Against Depression" is just as revolutionary as it pretends not to be; Kramer assures us that he cherishes the best of the Western tradition even as he presents a fairly damning new case for its destructiveness and limitations. In others -- namely, the book's occasional lapses into a self-defeating lack of clarity -- Kramer steps back from the fight. In the final chapter, speculating on a future free of depression, he demonstrates by example just how hard it is to visualize such a thing. "We should have no trouble imagining resilience that contains as much depth as any ever attributed to depression," he writes. After all, so many genocide survivors have shown us just that. And yet still we hesitate; are we throwing out "Starry Night" with the bath water?
The van Gogh question may not be answerable (but if you ask me, we'd surely have more paintings), so Kramer ends with another case study. A woman who had suffered the deaths of family members in a short time was finally able, via medication and therapy, to extract herself from a terrible depression. Then, her house burned down, and "with it went irreplaceable objects, mementos of love ones."
It was the kind of event ready-made to trigger another episode. Instead, "my patient took the loss in stride. Not immediately, not perfectly. There were shaky days. But quickly, ten or twelve weeks down the road, she declared herself out of the woods." It was one of those minor victories that, Kramer writes, "justify the psychiatrist's career. There is no fretting, of this you can be sure, over the imagined benefits of the depressive episode that might have been." It might be as simple as that in the end. If depression were eradicated, we might scarcely notice the absence. We might not miss it at all.
