We are always most comfortable when the events of our lives fit into a clear and meaningful narrative, when we can assign significance to the inexplicable. When the facts are lacking, imagination steps in. The ancient Greeks explained natural disasters as a kind of collateral damage caused by the ongoing squabbles of the gods. Even today it’s religion, not science, that for most people provides answers about the meaning of life and the mystery of death.
Depression is another thing–over the years it’s been regarded as almost anything but a disease. In the 19th century, melancholy (like tuberculosis) seemed positively romantic. “A fitful strain of melancholy,” Edgar Allan Poe wrote, “will ever be found inseparable from the perfection of the beautiful.” Today the mythology of depression is different, despite some lingering romanticism and sentimentality. “Depression,” Sontag observes, “is melancholy minus its charms.”
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William Styron attempted to convey the experience of depression in Darkness Visible, a harrowing account of his own plunge into and painful recovery from the disease. He describes an endless succession of sleepless nights and “days . . . pervaded by a gray drizzle of unrelenting horror.” This gifted novelist, who in Sophie’s Choice had given voice to the ultimate horror of the Holocaust, finds himself for once at a loss for words. “This horror is virtually indescribable,” Styron writes, “since it bears no relation to ordinary suffering. In depression, a kind of biochemical meltdown, it is the brain as well as the mind that becomes ill–as ill as any other besieged organ. The sick brain plays tricks on its inhabiting spirit. Slowly overwhelmed by the struggle, the intellect blurs into stupidity. All capacity for pleasure disappears, and despair maintains a merciless daily drumming. The smallest commonplace of daily life, so amenable to the healthy mind, lacerates like a blade.”
To an outsider, depression may be almost indistinguishable from feelings of sadness and grief. But even the early psychologists recognized that there was something different about depression, that it was more mysterious and more intractable than “normal” neuroses. It can come without warning, and it resists not only the sufferer’s efforts but also traditional “talking therapies.” Freud recognized early on that his psychology of insight had little to offer those he called “melancholics.”
But despite their dangers these drugs can be lifesavers, rescuing patients from suicide, from lives of misery and pain. But there has always been a cost; doctors and patients have spent as much time monitoring the unintended effects of treatment as they have watching the progress of the illness. Recently, though, new antidepressants have appeared–Prozac, Zoloft, and Welbutrin–that provide many of the benefits of the earlier medications without, it seems, the side effects.
Despite some lingering notoriety–and a few recent studies indicating that a small but noticeable percentage of men taking the drug have had problems with impotence–Prozac has once again become the drug of choice for many kinds of depression, particularly the milder varieties. Nearly ten million people–half of them in the United States–have taken the medication. And it has improved its public image as well, at least among those whove benefited from it themselves or know someone who has. Indeed, the positive response to Kramer’s gently enthusiastic paean to the medication suggests that Prozac has begun to lose its Jekyll and Hyde image.
Those who are suspicious of psychiatry span the political spectrum. In conservative polemicist Charles Sykes’s recent book A Nation of Victims, he describes modern psychiatry as little more than an elaborate con job, a “new legal/therapeutic/sick-making industry” created by money-hungry psychiatrists and self-pitying patients. Eager to cast the ordinary problems of life as medical disorders, psychologists “define as symptoms traits that are not exceptionally unusual, create . . . anxiety about them, and promise . . . help. That formula, repeated over and over, is the mark of the therapeutic culture and the foundation of the addiction-recovery industry.” Sykes seems particularly perturbed that many recently discovered disorders are relatively common; this seems to him a mark of illegitimacy, as if diseases were only real when rare.
