Monday, May 23, 2005

Against Depression.

There's an interesting review of Peter Kramer's new book, Against Depression, in today's Salon.

I know that in the past I've fallen into the easy and stupid mistake of romanticizing depression, ignoring the horrible impact that it has on people and trivializing what can be a very debilitating disease.

I think the problem is that people confuse art that is generated by actual emotions, many of which are unpleasant, with a neurological imbalance. Depression isn't feeling bad over losing someone and then writing a poem about it. Depression is no longer taking joy in anything you do. It's losing interest in friends, music, art, books, or whatever else fascinates you. It's wanting to lay in bed all day, forever, and never wanting to do anything. It's nights of insomnia, obsessing over the pointlessness of why you're alive.
If you unpack the glibness of the van Gogh question, the implications are obvious. The painter suffered greatly from (probably) both depression and epilepsy, and his art strikes us as intimately concerned with those two, intertwined afflictions. Would the paintings be less revelatory if van Gogh himself were not so miserable? Would they even exist at all? Depression, in many people's minds, is integral to the creative temperament. We might lose some of the triumphs of art and culture if it were wiped away.

Yet as Kramer points out, in a book full of similarly provocative thought experiments, no one would hesitate to treat van Gogh's epilepsy. The idea of allowing those torments to continue with the hope that they might somehow lead to more or better pictures strikes us as coldblooded, inhuman. So why does the idea of treating the painter's depression make many people at least slightly uncomfortable, for exactly the opposite reason? Why do we still harbor a residual fear that eliminating someone's -- and especially a great artist's -- depression might be a betrayal of our humanity?
We don't think twice about treating illness when it's physical, so why are we so hung up about treatment of mental illness? Maybe it's because it's something that we can't directly and intuitively observe. Sure, we can see the horrible symptoms that may tear someone's life apart, but the biochemical processes are locked in the mysterious realm of the brain and we often assume that the illness is part of a person's personality. That's why we tend to blame and stigmatize people for mental illness, while we'd never think of doing the same for glaucoma. It's somehow their fault, in spite of all of the experimental evidence about mental illness's roots in things like genes, chemical imbalances in the brain, environmental factors, and so on. We can tell when someone is sneezing because they have a cold, but have a harder time feeling the same way about a mental illness because it seems so tied up in factors that people are supposed to be able to control, such as how they speak and behave.

And of course, that also has the exact opposite effect when people assume that anti-depressants will cure those everyday emotions. If you're having personal problems or are in a bad mood, maybe a happy pill will make it all better:
Although he once would have regarded the psychoanalyst's strategy as a valid way to prompt a patient to go deeper, now Kramer found himself "seething." "Listening to Prozac," contrary to popular conception, was not about depression at all, but about the implications of the then-new trend of prescribing antidepressants to people who weren't suffering from mental illness: personality tweaking, if you will. Nevertheless, the book's success drew depressed patients to Kramer's practice, and his growing understanding of mood disorders, both as a psychotherapist and as a follower of clinical research on the subject, has convinced him of just how dangerous the disease can be, and how incompletely we realize the threat.
So we're simultaneously underestimating and overestimating depression by assuming that it's just another personality problem, ignoring its source in actual chemical problems in the brain. The wrong people get drugs and the one's who need them get told to just suck it up when they're no more able to do that than someone who has cancer.
According to Kramer, research in the past decade (since "Listening to Prozac" was published) suggests that serotonin and similar neurochemicals may instead serve a protective function. They help shield the brain from the negative effects of the stress hormones that prompt the body to respond to threats. Certain brains are rendered particularly vulnerable to stress hormones by genetics and sometimes, in addition, early childhood trauma. This kind of brain loses the ability to protect and heal itself from the effects of those hormones, and also loses the ability to turn off the production of the hormones. The stress response system can get stuck in the "on" position, eventually weakening and diminishing nerve cells and further eroding the brain's capacity to cope with the hormones. This vicious circle results in clinical depression.

The manifestations of the disease include "low mood, apathy, diminished energy, poor sleep and appetite, suicidality, loss of the capacity to experience pleasure, feelings of worthlessness," and so on. Some depressed people can't sleep; others sleep way too much. Some feel misery; most feel something closer to emptiness. But the cause, Kramer maintains, is measurable organic damage to the brain, damage that prevents the brain from repairing itself and leaves it ever more susceptible to further damage. This is why often very slight stressors can incapacitate a depressed person or trigger an episode of depression, and why a third or fourth episode is harder to treat than the first.
Mental illnesses aren't personality traits or negative emotions. They're illnesses. Maybe we should treat them that way and give up this stupid, patronizing cliche that they're somehow wonderful and responsible for the greatest artistic achievements in human history. Try telling someone who actually has to suffer with paranoid schizophrenia or bipolar disorder how edgy and hip you think it is. I certainly don't presume to be able to speak on behalf of such people, but we should definitely be wary of thinking that we can appropriate their suffering as an aesthetic lifestyle feature in the same manner as the latest Hilary Duff CD when we can't even come close to knowing what they may be going through.

1 comment:

farnsworth said...

You make quite a few good points. The naive romanticization of mental illness is one of the worst aspects of literature and art, and the vapid embrace of "emo" culture as a hip thing speaks poorly of the mainstream as well. I don't think anyone should be forced to deal with that kind of thing for any reason.

On the other hand, when I had some problems last year, I never felt like what was happening was an illness. It was real, it just was. It was a part of what I was. Even if it was horrible, would I want to be someone else? My answer was no, and that's why pills frightened and still make me cautious. It's disgusting to play down or somehow lionize the real avoidable suffering that the disease has caused, but at the same time I'm not really upset that it happened. This is far too muddled to make any sense, but bah. I think there needs to be a different orientation in the discussion than exists now.