Debunking depression

Unfortunately, we are swimming upstream against a psychobabble epidemic, in which all negative feelings tend to be lumped under depression. I suspect that, in part, this is because depression is increasingly viewed as neurochemical and beyond our control. If we are depressed, it is our chemicals mistreating us. If we are resentful, there is a hint of a character defect, and, God forbid we should have any personality flaws.

Frustration, resentment, bitterness imply an inability to take life's lumps; they imply some personal weakness. So why admit to frustration when you can blame your serotonin receptors?

Check out Webster's unabridged dictionary; its definition of depression includes a sense of humiliation. Humiliation is a feeling, but it also is attached to an idea of self. It is not of the same category as depression or elation; it comes from a different area of our psyche. Embarrassment is not the same as despondency.

I haven't had the privilege of hearing Woody Allen on the couch, but the public manifestations of his depressive persona are tinged with humor, irony and a variety of intellectual posturings. In fact his protestations of depression are a bit wearisome, precisely because they do not evoke true empathy. They are attention-getting devices. Allen's self-aggrandizing self-mockery is not the same as the sinking sensation of true despair. (Another definition of depression is a hollowing out of the landscape.)

We can watch a Beckett figure and sense alienation, but as we watch, we are uplifted, filled with a sense of wonder at the very life we are mocking. Sit in the audience of "Waiting for Godot" and hear the laughter generated by the recognition of the humor of our pitiful existences. People leave the theater exhilarated. Again, we have the trappings of depression -- moping, shuffling, mumbling static figures -- but we do not have the mood of depression.

Recently, in the New York Times, there was a photo of a young woman from Brooklyn in shorts and T-shirt walking three frisky dogs through Prospect Park. The woman said she suffered from lifelong depression and that she had failed all forms of treatment. Perhaps, but the picture didn't ring true. My mind, cynical as it is, wondered about disability checks. She probably has a loving spouse back home doing the dishes, sweeping out the yard, carrying out the garbage for her, because she's too "depressed" to handle life's mundane details.

So what is this disorder than can be anxiety, irritability, humiliation or lack of self-esteem; that may create sadness, or may not? Is this a single psychiatric disease? When is it biological and when, if ever, is it within our control? Can we tell? Or is this all seat-of-the-pants, low-tech medicine?

Yes and no.

A good psychiatrist might answer the same way a Supreme Court justice once defined pornography: I may not know how to define it, but I know it when I see it.

We have all had some degree of true depression, some more than others. Imagine a time when nothing is going right. After a few horrible sleepless nights you awaken with a sensation of -- pick your own word -- doom, dread, hopelessness. But it is a sensation, a sick feeling that rattles you to your bones.

Depression is not about ideas and postures. It isn't about laziness and a languorous desire to spend the day in bed. It is a feeling of sickness. It is brain chemistry gone awry. In someone who is clinically depressed, functional MRI scans would show areas of altered brain metabolism. The spinal fluid might show decreased levels of vital neurotransmitters; there would be alterations in hormonal levels.

But, having said that, we still haven't solved the chicken-and-egg dilemma. Did some psychological malfunction trigger bad feelings that, in turn, triggered the biological response, or was the chemical aberration primary?

If you believe the biochemistry came first, then you opt for anti-depressants. If you think that some psychological malfunction triggered the chemical response, you opt for therapy. Already you can sense the problem of treatment. The patient immediately is subject to his own bias for/against the psychological. Ditto the doctor.

One possible answer is to look for biological markers -- like a strongly positive family history, or a pattern that suggests one of the classical mood disorders, such as a history of manic behavior pointing to a true bipolar (manic-depressive) disorder. Soon there will be more precise genetic markers, maybe even nice neat lab tests that indicate predisposition.

But even if there were such lab tests, would we really understand the triggering mechanisms beyond saying that someone was predisposed? If you knew you had a tendency toward depression, could you control it with therapy, exercise, meditation, mind control, willpower? Or would you opt for the latest serotonin modulator?

There is no easy answer. Not to recognize depression is to misdiagnose a wide variety of chronic complaints (headaches, back pain). To diagnose depression when the problem is based in character is to create a drug-dependent nation. Pretty soon Prozac will be added to public drinking water. To not acknowledge the complex interplay between psyche and chemistry is to abandon any sense of personal responsibility, and create a generation of victims.

At the same time, we must recognize that depression may be beyond a person's control, can be a serious medical problem.

At bottom we are struggling with the very notion of how to define our sense of self. We see our chemicals as not being a part of us; only our psyche counts, is responsible. But this line of reasoning reduces each of us to a machine with a superimposed little man or woman sitting at the top, wearing the driver's hat but not really having a grip on the wheel. It's not a very healthy self-image. It's even a bit depressing.

• View blog reactions