Excerpt from Against Depression by Peter D. Kramer, plus links to reviews, author biography & more

What It Is to Us
One
The Final Memoir

SHORTLY AFTER THE PUBLICATION OF Listening to Prozac, twelve years ago, I became immersed in depression. Not my own. I was in my forties and contented enough in the slog through midlife. But mood disorder surrounded me, in my contacts with patients and readers. Messages from parents with depressed children and husbands with depressed wives filled my telephone answering machine; letters dense with personal history crammed the mail slot. In their volume, in their particularity, these contacts were sobering, overwhelming, disorienting. Less intimate overtures came my way. Reporters and talk show wranglers approached me about the significance of drug company initiatives, antidepressant-related lawsuits, and mental health legislation. Colleagues invited me to join colloquia on particular therapies. Advocates of partisan views of mood disorder e-mailed me with propaganda, asking me to sign on.

Immersion has a passive sound to it. I experienced my relationship to depression in that way, being swamped by a tide. I would have denied that I had brought this condition on myself. Yes, in my book I had discussed depression—but only en route to raising issues that stood at some distance from the treatment of mental illness. Listening to Prozac grew out of a claim that certain of my patients had made: On this medication, I am myself at last. These men and women had taken an antidepressant and experienced a dramatic response. Their episode of depression ended—and they reported another change as well. Temperamentally cautious and pessimistic, even before their first encounter with depression, these patients moved, on medication, toward assertiveness and optimism. This self-assured state, so they believed, represented their identity, themselves as they were meant to be.

I had used this report—myself at last—as a jumping-off point for speculation. What if future, similar medications had the potential to modify temperament in people who had never experienced mood disorder? There were reasons to believe that even current antidepressants might sometimes alter personality traits, making the hesitant decisive. Given access to such drugs, how should doctors prescribe? The inquiry moved from medical ethics to social criticism: What does our culture demand of us, in the way of assertiveness? Assessing my patients' attitude toward antidepressants required, I thought, attention to grand, perennial questions. How do we identify true self? Does the path matter, in the journey to contentment?

It was the medications' extra effects—on personality, rather than frank disease—that provoked this line of thought. After all, for centuries, doctors have treated depressed patients, using medication and psychological strategies. When those efforts succeed, restoring health, we are grateful. The ethical dilemmas that interested me lay elsewhere. Strange though it may sound, I never imagined that I had written a book about depression.

But authors cannot predict or control the fate of their books, any more than parents can determine the direction of their children's lives. Listening to Prozac emerged into an era of marked interest in depression. Everything about it had the power to fascinate: diagnosis, treatment, health care politics, gender issues, intimate experience. When Listening to Prozac found readers, it became the best-selling book about depression. In stores, it was shelved beside how-to manuals on recovering from mood disorder or living with those afflicted by it. I had never intended for my book to be useful. But readers wrote to say that Listening to Prozac had guided them to one or another resolution of their depression—through taking medication or steering clear.

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.