HEALTH: Manufacturing Depression: The Secret History of a Modern DiseaseBy Gary Greenberg, Bloomsbury, 432pp, £20
IF YOU’VE been treated for depression in the last few decades, you might recognise this perplexing epiphany. Some weeks into your treatment, as the drugs and – if you’re lucky, and budgets permit – talking start to take effect, it seems your grim private microclimate starts to clear and you’re suddenly not so given to “pathetically manipulative self-excoriation”. (The phrase belongs to David Foster Wallace, who knew a thing or two about toxic misery.)
It’s during this grey dawn that the questions surface. Where are “you” in the delicate web of chemical interventions and therapeutic encounters? Is your self – the one you were eager to be shot of so recently, the one that now looks almost worth preserving – just a function of pharmacology and diagnostic questionnaires? What’s become of the world of pain, loss, fear and loneliness that you’d contrived, then tended for so long? And this character that medical science wants you to be, all realistic optimism and resilience: does that really sound like you?
As both therapist and patient, Gary Greenberg is well acquainted with the existential void that yawns (professionally unplumbed) beneath current treatments for depression. Dogged by psychic crises for 25 years, he was finally diagnosed with “major depression” in 2006 and joined in the popular modern dance with those twin partners, drugs and cognitive-behavioural therapy. His book is an eloquent and uneasily enlightening prehistory of contemporary melancholia, and a timely polemic about what we lose when we submit our anxieties and dolours to the medical gaze.
Greenbery contends, ultimately, that what we have come to know as depression is an ambiguous and hugely lucrative artefact of medicine itself. For sure, this is a deeply unsettling message for those of us who've been there just like the author, huddled and useless on the bedroom floor, but it's hard to resist the force of his logic and the breadth of research in Manufacturing Depression.
The history of medicalised unhappiness has been exhaustively told before. Stanley Jackson's masterful Melancholia and Depressionwas published in 1986, and tracked the malign reputation of the disease from its humoural origins in classical times, through the rise of modern psychiatry in the 19th century, to the competing opinions of physicians and Freudians in the 20th.
In 2001, Andrew Solomon – like Greenberg, a readably erudite New Yorker writer – wove together memoir and medical reportage in his suave, essential study The Noonday Demon.Greenberg takes a different tack; starting with historical theories of disease, he considers one Emil Kraepelin, a 19th-century German psychiatrist whose typology of mental afflictions still haunts the practices of doctors today, as also their allies (if that's what they are) in the drugs industry.
Much of our present faith in the pharmacopeia, Greenberg argues, can be traced to Kraepelin’s insistence that the hapless patient’s reported experience – grief, despair, exhaustion and self-hate – was strictly irrelevant to the curative process. (His contemporaries must have felt some relief, for listening to the depressive’s litany is a thankless, dispiriting task: a fact the guilty patient knows too well.) The disease existed elsewhere, in the dysfunctional brain into which science could not yet see; all that was left to doctors was description, incarceration and ensuring the afflicted did not breed. According to Greenberg, modern psychiatry is Kraepelinian by default: we may have got better at picturing the brain and its neurochemical weather, but drug therapies still proceed as if the suffering self were not really there.
Greenberg is tireless in his pursuit of the fallacies and, at times, outright frauds that have been effected in the name of a scientific cure for depression. A good deal of the book is given over to the complex (and more fascinating, even comic, than it sounds) search for a biochemical target that could be linked to symptoms and a “magic bullet” that would reach it. Since the second World War, pharmaceutical corporations have time and again sought to redefine the illness to suit the cures they have patented.
Such has been their success that most readers will recognize the pharmacological family tree that flourishes here: from Valium and Librium to Zoloft, Paxil and Prozac – all of them in their time miraculous, even glamorous (one of the curious, and shameful, effects of taking Prozac in the 1990s was that through your fatigue and anxiety you still felt oddly zeitgeisty.)
In recent decades of course, it is serotonin – the accidental discovery of a researcher working on mussels – that has led us to think of the illness as a mere “chemical imbalance”. But statistics, Greenberg persuasively demonstrates, have been consistently massaged – it’s not that the drugs don’t work, rather that we still don’t know how or why they might work, and the currently vast global (though, predictably, mostly American) expenditure on antidepressants may be no more than the keenest proof ever of the placebo effect.
None of this should be taken to imply that Greenberg thinks depression is not genuine, or even that patients should quit the pills. When you shiver awake at four in the morning and gawp helplessly at the blackness of the day to come, you know you’re in the realm of the all-too-real.
The value of Manufacturing Depressionis in showing how such suffering has been needlessly exploited, and asking where human experience has gone in our rush to medicate ourselves away.
Brian Dillon is the author of Tormented Hope: Nine Hypochondriac Lives(Penguin, 2009) and UK editor of Cabinet,a quarterly of art and culture
