On the Value of Depression

One evening, after our workshop let out, four of us from my MFA fiction cohort crammed into a car to drive through the Caldecott tunnel. We were discussing class, probably discussing our classmates and their work--I don't remember the specifics. What I do remember, however, is one of us saying that a particular classmate was neurotic. "Of course he is," someone else said, indignant. "We all are. We're writers."

I would be lying if I said that there weren't times when I've wondered whether being mentally healthy is a liability in my chosen path, that maybe I've gotten myself to a point where I'm too sane for greatness. In the middle of these thoughts, I do recognize how ridiculous they are, but I can also see, quite clearly, where they come from.

I don't think it's just that we expect extremes to go together, whether extremes of talent, personality, behavior, or whatever, even though that's clearly part of it. Culturally we are far more likely to forgive, or at least overlook, eccentricities if they come packaged along with incredible talent. (What, Mr. Jobs? You want a genetic background of that sushi you just ate? You got it.) I think we've come to demand it as a method of artistic authentication. And when I talk about writers, I'm not talking about the Malcolm Gladstones or Michael Pollans or Jonah Lehrers of the world, although that group's clearly been having its own problems lately, problems indicative of a whole other batch of fallacies about writing and ideas and public personas (but that's another post). I'm talking about the fiction writers, the painters, the singers, the actors--David Foster Wallace,  Amy Winehouse, Heath Ledger. Go back a little further and there's Sylvia Plath, Virginia Woolf, Vincent VanGogh. And so on. I could go on for quite awhile.

And it's dangerous. While I won't shy away from a discussion of the possibility that sensitive artistic types necessarily feel things more strongly, or in a more nuanced manner, or at least with a better ability to parse what those feelings are, the idea that despair or madness or manic moments or depression is somehow necessary to being an artist is flat out dangerous. And I think we do both established and aspiring artists a huge disservice when we act like this is the case.

I think a large part of the problem is that major depression is often conflated with feeling melancholy. One means that you might get a little teary at a song on the radio, at a book, at a painting, that you might spend an afternoon, a day, or even a week existing down in that part of the spectrum of normal human emotions. The other means you can't get out of the fucking bed. 

This is all on my mind in a glorious mismash thanks to an article over at The Rumpus, "In Praise of Depression." Katherine Sharpe starts her essay off by going straight for the jugular of a contemporary sacred cow, the idea that depression in the body is physically akin to diabetes--that is, a chemical imbalance that it's perfectly natural to want to medicate. She describes a conversation she had with a woman "fifteen to twenty years older than myself, who told me that she thinks of Prozac as 'the penicillin of my generation.'" After Sharpe confirms that, no, she really doesn't think the depression is "a disease like diabetes," the conversation ends with the woman's silence invoking "a touch of disgust we reserve for the wrong ideas."

Let me say here that I have not read Sharpe's book, and I can't presume to speak for her experience on anti-depressants. Let me also say that I'm not advocating an uncritical approach to what we are so often told is the trend in modern medicine, at least for middle class Americans with access to health care--simply throw pills at mental health problems that we don't fully understand and hope that they'll stick. Our system is set up so that it's far easier for a patient, insured or otherwise, to see a sympathetic family physician with a script pad, rather than a psychiatrist or psychologist. There's way less stigma, even these days. It's also far, far cheaper. 

Does this lead to situations where people are prescribed powerful, mood-altering drugs for minor problems that might have been worked out with a few weeks of cognitive behavioral therapy? Of course. I don't know how it couldn't. But I don't see the solution to this problem in attacking medication itself, nor in attacking the very concept of major depression as a disease. Personally, I think that addressing this issue on an individual level is doomed to failure; until comprehensive mental health care is accessible, affordable, destigmatized, and de-linked from pharmaceutical interests, we are simply not going to get it right on a societal level. Once we've done that, the outcome for individuals is going to be a whole lot better than it currently is.

Much of Sharpe's essay examines various historical conceptions of depression, and here again, I'm with her. It doesn't take much poking around online or in a library to discover that disease, as much as we like to think of it as a fixed state of being, is hugely affected by our cultural constructs that surround it. (The Spirit Catches You and You Fall Down, anyone?) And the more complex the disease, the more open it is to these types of interpretations--a broken leg is quite obviously a broken leg, but get a little more internal with your ailment and all bets are off. We do like to think that we have the truth over here in the 21st century western world, and maybe we are closer to understanding the movements of molecules than those who came before us. But that doesn't exempt us from the innately-human trait of making up stories about what happens to us. 

There's something at the end of her essay, however, that does not sit right, that gets back to the problem of conflating a minor bout of melancholia with full-blown depression. It's this parting paragraph that is responsible for this entire post: 

"With equal veracity, we could say that depression is fundamentally human. We could argue that a touch of it, however unpleasant, is a fitting response to some of life’s enduring questions and society’s intractable problems. We could look back and say that there’s something in each of those strange old accounts of it that makes sense. We could believe that our tendency toward it is tangled irrevocably with the things that make us creative, spiritual, capable of love and vulnerable to loss—and that as such it deserves, if not open-armed welcome, then at least the respect that is due to an old and worthy foe. We could even say that a world without depression would be, alternately, a place we wouldn’t recognize, or a nice place to visit, but not one we’d want to live in for very long."

And that last sentence, the sentence that comes out in favor of keeping depression in this world--that's where I have a problem. Because I've heard that one before. It's a nice sign-off, granted, the idea that we have in front of us something that is a fundamental part of the human condition and that to eradicate it would make us less than human. It ties the essay into a neat bow. And it immediately had me Googling, looking for an essay from 2005, by Peter Kramer.

Kramer is a psychiatrist and the author of Against Depression, which does tell you a lot about where he stands. And in his New York Times Magazine article "There's Nothing Deep About Depression" (adapted from his book) he describes giving a series of talks to a variety of audiences, an extremely typical reaction, and a question he began to ask in response:

"Invariably, as soon as I had finished my remarks, a hand would shoot up. A hearty, jovial man would rise and ask -- always the same question -- ''What if Prozac had been available in van Gogh's time?''

I understood what was intended, a joke about a pill that makes people blandly chipper. The New Yorker had run cartoons along these lines -- Edgar Allan Poe, on Prozac, making nice to a raven. Below the surface humor were issues I had raised in my own writing. Might a widened use of medication deprive us of insight about our condition? But with repetition, the van Gogh question came to sound strange. Facing a man in great pain, headed for self-mutilation and death, who would withhold a potentially helpful treatment?

...

"I began to pose 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? I made 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?

Always, the response was hedged: aren't we meant to be depressed? Are we talking about changing human nature?

...

"To this way of thinking, to oppose depression too completely is to be coarse and reductionist -- to miss the inherent tragedy of the human condition. To be depressed, even gravely, is to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness."

But Kramer doesn't buy it, and he has a laundry list of reasons why:

"Depression destroys families. It ruins careers. It ages patients prematurely...Depression is associated with brain disorganization and nerve-cell atrophy. Depression appears to be progressive -- the longer the episode, the greater the anatomical disorder. To work with depression is to combat a disease that harms patients' nerve pathways day by day...Depression has been linked with harm to the heart, to endocrine glands, to bones. Depressives die young -- not only of suicide, but also of heart attacks and strokes. Depression is a multisystem disease, one we would consider dangerous to health even if we lacked the concept 'mental illness.'" 

Still sound like something worth romanticizing? 

Depression's demise is not imminent, no matter what those commercials with the wind-up woman would have you think. We are not yet a society in danger of being medicated out of our emotions--unless, that is, you include self-medication with food, drink, and drugs (prescription and otherwise), and even that's only successful for a limited amount of time. And given that, I think it's dangerous to posit that a world without a debilitating disease, one that is exacerbated by social conditions that we are seeing in ever-increasing amounts (joblessness, poverty, you name it), is something we should be glad we don't have. It's dangerous to argue that the problem is over treatment when it's clear that there is an even larger problem with access to the right types of treatment, or indeed any treatment at all for those who fall out of the middle-to-upper-middle-class white world that is so often used as a stand-in for society at large. 

And it's dangerous to suggest to a group of creative people that their depression makes them better artists. Maybe the traits are linked; maybe they travel together in the genetic code somehow. But I see the work of someone like David Foster Wallace as a triumph in spite of his depression, not because of it. It was coming off of a drug regime that had controlled his condition that sent him spiraling into what would be the final depressive bout of his life (all this reportedly due to side-effects). Debating the importance of research into better chemical treatments for mental illness, and the importance of access to what we currently have, is only reasonable up until the point where the mental illness becomes incapacitating. Depression so deep that the sufferer cannot shower, much less pull up a word processing program, might be a part of the human experience, but, like tuberculosis, smallpox, and polio, it's a part I am grateful that I am not required to have. And I do not consider myself to be unschooled in human emotions for missing out on it.

We had this extremely talented writer and thinker as long as we did because of the treatments we currently have, because they lifted his depression and allowed him to work. To argue, even indirectly, that we would lose our humanity in a world without depression ignores the casualties of the world we do have. Among them, from a literary standpoint: the end of The Pale King, and whatever else would have come next from a writer healthy enough to experience the joy of creation.