Excerpt of Against Depression by Peter D. Kramer
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As with a book, so with its author: where his readers locate him
is
where he finds himself. The book's career made me an authority
on
depression.
One unnerving development was my exposure to memoirs of mood
disorder.
The bedside table groaned under the weight of typescripts and
bound galleys. There were accounts by sexually depleted
depressives,
promiscuous depressives, urban single mothers, small-town family
men,
femmes fatales, gay lotharios, celebrities, journalists,
ministers, and psychologists.
The collection represented an outpouring of autopathography
such as no prior generation had known. I was asked to endorse
these books, to review them, to vet them for publishing houses,
to assess
their worth in the midst of a bidding war.
A psychiatrist is pleased—overjoyed—to see a mental illness shed
some of its stigma. But as a reader, I became ever less
enthralled. Despite
the superficial variety, the memoirs of depression struck me as
distressingly
uniform. Their constant theme, their justification, was
confirmation of the new reality, that depression is a disease
like any
other. The authors' self-exposure was an act of witness,
converting former
private shame into current openness about an unexceptional and
unexceptionable handicap. This much was welcome—a testimonial
for
the public health view of depression, often accompanied by
advice to
readers to seek evaluation and, if needed, treatment. But then
more often
than not, in these memoirs, hints of pride showed through, as if
affliction with depression might after all be more enriching than, say, a
painful and discouraging encounter with kidney failure.
Expressions of
value would emerge:
Depression gave me my soul.
The spiritual gift was
not the insight that might arise in the face of any adversity.
Despite
their insistence on its ordinariness, the memoirs made
depression seem
ennobling.
I had admired the first handful of these books, not least for
their
courage. But the tenth confession is not so brave as the first.
Soon I
reached my limit. Awash in memoir, I told myself that I should
complete
the set. The memoir to end all memoirs. The final
autopathography.
A personal account of depression by someone who has never (this
would be my claim) actually suffered the ailment.
If this project moved beyond the level of private joke, it was
because depression
had, in fact, perturbed me, as disease and suffering always
perturb
those who grapple with them. In my case, the point of confusion
was this issue of romance—the glamour of depression. For the
practicing
psychiatrist, depression is grim enough.
It is true that among the major mental disorders, depression can
have
a deceptive lightness, especially in the early stages. Depending
on the
prevailing symptoms, the depressive may be able to laugh,
support others,
act responsibly. Depressed patients participate actively, even
compulsively,
in their own treatment. And depression, especially a first
episode in a young adult, is likely to respond to almost any
intervention:
psychotherapy, medication, the passage of time. In my medical
school days, if an inpatient psychiatry ward had spun out of
control, a
cagey chief would hold off on admissions until a good-prognosis
depressive
was referred. The hope was that the new arrival's recovery
would restore morale, for staff and patients alike.
But the depression I dealt with in my practice had settled in to
stay.
The unrelenting darkness was a function of the length of my
tenure
here. I have seen patients in Providence, Rhode Island, for over
twenty
years. In a small practice, failure accumulates. As I wrote
more, I let my
clinical hours dwindle. The result was that patients who were
not yet
better filled many slots, along with those returning to
treatment. And
the popularity of
Listening to Prozac
meant that the loudest knocks
on
the office door were from families with a depressed member who
had
faltered elsewhere. Circumstance made me a specialist in
unresponsive
mood disorder. I worked amid chronic despair.
Excerpted from Against Depressionby Peter Kramer. Copyright 2005 by Peter Kramer. Reproduced by permission of Penguin Publishing. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
