Interacting with colleagues, submitting to interviews, treating patients, I became increasingly aware of a gap between two aspects of depression: what it is, insofar as we can put together recent research findings, and what it is to us, depression as we approach it informally. Our habits of mind lag. They have roots in traditions that take depression, or its distant cousin melancholy, as a sign of heightened awareness, social disaffection, moral insight, and creative genius.
I grew up in that tradition. In my college years, traits that resemble (and sometimes just are) symptoms of mood disorder were in vogue, alienation especially. I read widely in the literature that takes a journey through the slough of despond to be a prerequisite for full humanity. I saw bravery in the melancholic postures of my classmates, anhedonic, self-destructive young men and women who wore their depression with panache. Even now, in my years of close contact with depression, I was not immune to being charmedexcept that when I caught myself in this attitude, it seemed utterly mistaken.
When I spoke in public, I began to challenge audiences about our double-mindedness. I used a test question: We say that depression is a disease. Does that mean that we want to eradicate it as we have eradicated smallpox, so that no human being need ever suffer depression again?
In posing this challenge, I tried to make it clear that mere sadness was not at issue. Take major depression, however you define it. Are you content to be rid of that condition?
It did not matter whether I was addressing physicians or pharmacology researchers or relatives of patients gravely affected by mental illnessall proponents of the "medical model of depression." Invariably, the response was hedged. Just what do we mean by depression? What level of severity? Are we speaking about changing human nature? I took those protective worries as expressions of what depression is to us. Asked whether we are content to eradicate arthritis, no one says, well, the end-stage deformation, yes, but let's hang on to tennis elbow, housemaid's knee, and the early stages of rheumatoid disease. Multiple sclerosis, high blood pressure, acne, schizophrenia, psoriasis, bulimia, malariathere is no other disease we consider preserving. But eradicating depression calls out the caveats.
To oppose depression too directly or completely is to be coarse and reductionisticto miss the inherent tragedy of the human condition. And here it is not only the minor variantsthe psychiatric equivalents of tennis elbowthat bear protecting. Asked about eliminating depression, an audience member may answer with reference to a novel that ends in suicide. Or it may be an artist who is held forth, a self destructive poet. To be depressedeven quite gravelyis to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness. To be depressed is to adopt the posture of rebel and social critic. Depression is to our culture what tuberculosis was eighty or a hundred years ago: an illness that signifies refinement. Major depression can be characterized as more than illness, or lessa disease with spiritual overtones, or a necessary phase of a quest whose medical aspects are incidental.
I retained sympathy with these claims, but in decreasing degree. It took only a year or two of immersion for me to discover that I had moved a fair distance toward philistinism.
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.
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