Monday, February 22, 2010

A NEW YORKER Recent essay on depression and how badly it is diagnosed and treated

Louis Menand reviews two recent books about psychiatry and its difficulty diagnosing and treating depression. Kirsch, in The emperor's new drugs : exploding the antidepressant myth
maintains that the underlying thesis that mood disorders result from the imbalances of serotonin and dopamine. I do believe that PURSOR has proven this contention to be wrong. Furthermore, according to Menand, Kirsch argues that depression results from the sorry state of our world and our personal conditions and shouldn't be treated.  This is what Greenberg states in response.

The decision to handle mental conditions biologically is as moral a decision as any other. It is a time-honored one, too. Human beings have always tried to cure psychological disorders through the body. In the Hippocratic tradition, melancholics were advised to drink white wine, in order to counteract the black bile. (This remains an option.) Some people feel an instinctive aversion to treating psychological states with pills, but no one would think it inappropriate to advise a depressed or anxious person to try exercise or meditation.
The recommendation from people who have written about their own depression is, overwhelmingly, Take the meds! It’s the position of Andrew Solomon, in “The Noonday Demon” (2001), a wise and humane book. It’s the position of many of the contributors to “Unholy Ghost” (2001) and “Poets on Prozac” (2008), anthologies of essays by writers about depression. The ones who took medication say that they write much better than they did when they were depressed. William Styron, in his widely read memoir “Darkness Visible” (1990), says that his experience in talk therapy was a damaging waste of time, and that he wishes he had gone straight to the hospital when his depression became severe.
What if your sadness was grief, though? And what if there were a pill that relieved you of the physical pain of bereavement—sleeplessness, weeping, loss of appetite—without diluting your love for or memory of the dead? Assuming that bereavement “naturally” remits after six months, would you take a pill today that will allow you to feel the way you will be feeling six months from now anyway? Probably most people would say no.
Is this because of what the psychiatrist Gerald Klerman once called “pharmacological Calvinism”? Klerman was describing the view, which he thought many Americans hold, that shortcuts to happiness are sinful, that happiness is not worth anything unless you have worked for it. (Klerman misunderstood Calvinist theology, but never mind.) We are proud of our children when they learn to manage their fears and perform in public, and we feel that we would not be so proud of them if they took a pill instead, even though the desired outcome is the same. We think that sucking it up, mastering our fears, is a sign of character. But do we think that people who are naturally fearless lack character? We usually think the opposite. Yet those people are just born lucky. Why should the rest of us have to pay a price in dread, shame, and stomach aches to achieve a state of being that they enjoy for nothing?
I do not believe that pain, whether it is psychic or somatic, has any virtue at all. I, therefore, applaud his ultimate paragraph.
Or do we resist the grief pill because we believe that bereavement is doing some work for us? Maybe we think that since we appear to have been naturally selected as creatures that mourn, we shouldn’t short-circuit the process. Or is it that we don’t want to be the kind of person who does not experience profound sorrow when someone we love dies? Questions like these are the reason we have literature and philosophy. No science will ever answer them.

He also reviews Gary Greenberg's Manufacturing Depression: The Secret History of a Modern Disease an indictment of Pharma.

Read more:

No comments: