Excerpt of Against Depression by Peter D. Kramer
(Page 3 of 5)
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Many psychiatric practices have this quality as they mature.
is depression in young adults; those patients were the ones ward
chiefs favored. Suicide is always a risk; we worry over it and guard
against it. Still, most patients in their twenties and early
thirties do well.
Often, a trigger for the acute episode is apparent, so there is
to discussthe "precipitating event" and its relationship to
Psychotherapy plays a central role in treatment. The doctor
feels of use. But as the patient ages, bouts of depression recur
greater frequency. Later episodes can appear spontaneously,
reason. They last longer, respond more poorly to any
remit (when they do) more briefly. Certain functions may remain
impairedconcentration, confidence, the sense of self-worth.
Even with first episodes, there will be patients who respond
or incompletely. These hard-to-treat depressives linger in a
will refer them for outside opinions. I will consider new and
interventions. Often, nothing worksor else, relapse follows
hard upon recovery. These patients struggle. I knew them whenor
just after, when life's promise was still evident.
For the psychiatrist, then, depression becomes an intimate. It
company. Depression destroys families. It ruins careers. It ages
prematurely. It attacks their memories and their general health.
for methe truth that depression is a disease is unqualified.
is debilitating, progressive and relentless in its downhill
course, as tough
and worthy an opponent as any a doctor might choose to combat.
In an important respect, my clinical practice stood at a
the testimony of the memoirs: I had never treated a seriously
patient who, on recovery, said anything favorable about
Yes, in the grip of mood disorder, a patient may allude to a
sense of superiority.
The resilient are missing something; they do not get it. This
belief brings comfort in a time of suffering. But the
outlasts the depression. When she feels better, the patient will
her own prior thought process. What was that about? She mistook
for insight. She had been, quite literally, making a virtue of
In retrospect, depression has no saving grace.
Outside the consulting room, the tendency to attach value to
is common enough. Depression can appear to embody an aesthetic
or moral or even political stance. There is a left-wing
which depression represents moral distance from the culture,
self-abnegation, minimalism in contrast to mercantilism. There
right-wing perspective on depression as wellthe notion that one
should "tough out" the suffering, without resort to "easy"
psychotherapeutic support or medication. From either angle, left
right, there is virtue in experiencing illness rather than
and thorough treatment. At least, it seemed to me that I heard,
claims of these sorts, claims that would sound peculiar in
to any other disease.
They outraged me. I discovered in myself a protectiveness toward
depressed, a wish for clarity on their behalf. I would have said
had intended, on setting up my office, to conduct a broad
practice, extending to anxiety disorders, attention deficits,
retardation, schizophrenia, marital discord, you name it. But if
teaches anything, it is that, more than we are at first
inclined to acknowledge, we are responsible for our
Chance plays its part, but we collaborate. As a child, I had
to transient, low-level depression in relatives. I may have set
in wandering fashion, to protect those I loved. This passion
evidentI could imagine as muchin my writing. Perhaps my
had placed me where I belonged.
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.