Myths Of the Blues
Why it's a bad idea to romanticize depression
Peter Kramer has been called "America's best-known psychiatrist," and for good reason. The Brown University professor has written five popular books, including the 1993 bestseller Listening to Prozac , and he hosts the public radio series The Infinite Mind. He arguably deserves his fame simply for coining the phrase "cosmetic psychopharmacology," by which he meant the power of antidepressants like Prozac to make people feel "better than well." Kramer describes his new book, Against Depression, as a "polemic" that seeks to finally separate the painful and life-threatening illness of depression from appealing traits like sensitivity and creativity. Kramer attempts to distinguish depression as a personal medical affliction from depression as a cultural idea and argues emphatically that the world's No. 2 killer cannot be allowed to be romanticized despite its artistic and historical link to creative genius. He spoke with U.S. News:
You call your book Against Depression . Who could possibly be for depression?
Over time, I picked up a subtle, protective feeling toward depression, like when someone in an audience would ask me, "What if Van Gogh had been depressed?" Or when people would come into my office and be worried that they would lose their "self" or their creativity if their depression were treated. Like everyone in this culture, I can feel its attractions. Someone comes into your office, is bashful and ambivalent, is troubled over things that don't trouble other people, and we think that there are some moral or socially attractive qualities to that.
How do we misperceive depression?
Today I think that we believe depression is a failure of resilience and that the opposite of depression is happiness. But the opposite of depression isn't happiness. The opposite of depression is emotional flexibility, an ability to appropriately respond to what is happening, to feel something and move on and then feel something else. We can't say that depression is this disease that erodes the brain and endangers the heart and puts you at risk for stroke and brittle bones. Almost everyone would agree that if we could give a pregnant woman a vitamin so that her child would never suffer from schizophrenia, we would do it. It would be shameful to bring up creativity as a reason not to treat schizophrenia. But with depression, that would be more controversial.
Still, depression was always considered a pretty serious illness, wasn't it?
During my medical school days at Harvard, during the tail end of its most psychoanalytic phase, it was considered that a lack of skills as a psychotherapist would lead you finally to have to resort to medication. As a result, we saw some really serious end-stage depression--much more than you do today. It's much rarer to see someone sitting in a chair with poor memory, ruminating, saying the same phrases over and over again. We don't see the kind of depression that you see depicted in medieval engravings. That was, in the past, an ordinary part of training, even on general medical wards. And that just makes me think that the medicines really work.
You explore depression through recovery.
When you see someone get better they just don't own the kind of thoughts that they seemed to own when they were depressed: the self-blame, the guilt. It seems entirely obvious to a doctor that they look different; the pace of their speech and their physical pace are different. They are alive and present.
What are the consequences of our romanticizing depression?
Clearly we haven't treated it as aggressively as we should. We have been laboring in the shadow of this illness, and we might have different tastes and values if we really had made headway against the disease. We might have different tastes in art and different romantic lives and a different sense of what is essential and fulfilling about ourselves. This is a disease that has changed the way that we look at the world. This book takes seriously the notion that the melancholics write philosophy. But then it asks, well, shouldn't we have a different philosophy?
This story appears in the May 23, 2005 print edition of U.S. News & World Report.