Thursday, September 29, 2005

Notes from the Prozac Nation, Vol. 1, No. 6

  • Male Melancholy=Genius: Lance Mannion blogged here about his friend’s refusal of the diagnosis “clinically depressed”:

    “What he is, most likely, is clinically depressed. But he won't accept that when I've tried to suggest it to him. "For one thing," he says, "Depressed people don't move at all. They don't get out of the house. They don't get anything done. They just sit there or they don't even get out of bed."

    However, he will admit:

    "I'm not depressed," he insists. "I'm just prone to melancholy, like Abraham Lincoln."

    This anecdote illustrates well the gendering of melancholia: men are melancholic geniuses, while women are plain mad and diseased. I wrote about this in “Why Mad Melancholic Feminista?” To be affilicted with the dark moods of melancholia is to also be compensated with intellectual greatness. That is, only if you are male. If you are female, you are depressed and thereby deprived of this heightened creativity (this is according to the history of medicine and traditional writings on melancholia).

    Lance also discusses Joshua Wolf Shenk’s book, Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness, and relays its central thesis: melancholia is a source of genius. In the course of Shenk’s essay in the Atlantic he mentions William Styron’s bout with depression, which he describes in Darkness Visible. I want to emphasize a different aspect of Styron’s book that resonates with Lance’s post. Styron also refuses to call his suffering depression:

    “When I was first aware that I had been laid low by the disease, I felt a need, among other things, to register a strong protest against the word ‘depression.’ Depression, most people know, used to be termed ‘melancholia,’ a word which appears in English as early as the year 1303 and crops up more than once in Chaucer, who in his usage seemed to be aware of its pathological nuances. ‘Melancholia’ would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun with bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness.”

    Depression is just plain wimpy, it’s a girlie man disease. Real men are melancholic.

  • What if the Cure is Worse than the Disease?: Shakespeare’s Sister also has an excellent post on creativity and depression, inspired by Lance’s post. Her writer friend is concerned that any treatment he may get for his black moods will deprive him of his creativity:
    “The thing is, he’s a writer, and there is, of course, a rich tradition of thought (as alluded to with the reference to Styron in Mannion’s post) that depression, and indeed other afflictions and the addictions appropriated to mask them, are the very things that drive an artist’s artistry, and that seriously addressing something like depression may stifle the muse. Would I be as interesting, as thoughtful, as creative, if I weren’t afflicted? It’s a terrible thing to be scared of one’s potential cure, to worry that the cure might be worse than the disease.”

    A discussion ensued in after this post over whether or not the belief that melancholy moods were also wellsprings for creativity was a rational belief or mere romanticization of the illness. Peter Kramer’s new book, Against Depression, was mentioned.

    Kramer wrote Against Depression after years of speaking to various audiences about his earlier book, Listening to Prozac. The earlier explores the ethical permissibility of giving SSRI drugs such as Prozac to patients who are not clinically depressed, but who respond well to the drug and feel “better than well.” However, in the course of giving talks on Prozac and “cosmetic psychopharmacology (see this entry),” he discovered repeatedly that his audience had an aversion to treating even clincal depression with SSRIs, arguing that it would rob the patients of some special perspective gained through depressive episodes. This led him to debunk any claim that clincial depression is an artist’s illness. In a short piece in the Chronicle of Higher Education, Kramer compares depression to illnesses such as epilepsy or tuberculosis.

    “Infectious disease can be idealized. Tuberculosis once had romantic overtones. Susan Sontag traced the form of that fantasy in her famous essay, "Illness as Metaphor." TB was a disease of recklessness, longing, sensuality, serenity, decadence, sensitivity, glamour, resignation, instinct, and instinctual renunciation, that is to say, of passion or passion repressed, but in any case a disease of emotionally enhanced or refined creatures. Sontag quotes a passage in The Magic Mountain where a character holds that "disease is only love transformed."

    This romanticization follows from an incomplete scientific understanding of the illness. Once we discover the pathogen responsible for the suffering, we recognize that this illness descends upon its sufferer independently of broken hearts of magical powers, or so Kramer’s argument goes.

    “One confounding concern had to do with depression as a source of creativity. Why is depression different, less than fully worthy of decisive treatment? Is a link to art enough to alter the way we think about a syndrome -- to move it from straightforward disease to disease-in-a-manner-of-speaking?

    Sometimes I ask my audience to consider epilepsy, the set of disorders characterized by seizures, sometimes alternating with a variety of mental auras and intense experiences of emotion. Chronically, between attacks, patients with a subtype of epilepsy can be afflicted with hypergraphia, the tendency to write compulsively and at length. They may also display a characteristic personality style, one that includes intense enthusiasms, often religious fervor, and an alternation between aggression and emotional clinginess. Dostoyevsky, Flaubert, Tennyson, Swinburne, Byron, de Maupassant, Molière, Pascal, and even Petrarch and Dante have been named as presumptively epileptic in one or another medical treatise. Poe's name often makes the list.

    Epilepsy is another sacred affliction or was once. And there are medications -- anticonvulsants -- used to prevent or manage epilepsy. But you might give a dozen talks about quirky uses of anticonvulsants and not hear a single joking question about an artist. The vividness of the pathology and the consequent solidity of epilepsy's status as a disease cast their shadows over attempts at humor. To withhold treatment would be cruel. In the context of seizure disorders, a what if question, if asked, might point to the ironies of medical practice -- how necessary interventions have unknowable consequences. But the question would not be funny. To put the matter differently: While we are protective of depression, we would be happy to eradicate epilepsy.

    For me, the what if question led directly to another: What would it be like for depression to go through the transformation experienced by tuberculosis? Depression might be on the verge of that metamorphosis, from romanticized affliction into ordinary disease. Hard-to-ignore evidence was accumulating, about the bodily harm depression causes, and about the brain pathology that underlies its symptoms. Increasingly, the prevailing scientific myth had it that depression is neither more nor less than illness, but illness merely. I wanted to imagine how our beliefs, our art, our sense of self might change as the medical view became a cultural commonplace. But I had no illusion that the moment was at hand. My work with patients and my conversations with readers reminded me daily that we retain a confused -- partial, anachronistic -- understanding of depression.”

    I am not sure that Kramer is comparing apples to apples by drawing analogies between consumption, TB, epilepsy and depression. It is less clear in the case of depression that we are dealing with something that has a disease structure. It is unclear what causes depression, what enables us to recover from depression, and what it does to us if we live with chronic depression. I am not arguing against medical intervention, nor am I arguing against a medical model, if it is helpful in treating suffering.

    I do think that depression, in many cases, has made its sufferers more empathetic and sensitive to human frailty. John Stuart Mill’s descent into depression is the classic example. In his autobiography, Mill recounts that when he asked himself if he would be happy if he could bring about all the social reforms he wanted, he instantly realized that he would not. Ask yourself if you are happy and you cease to be so. Mill recovered from his depression by reading Wordsworth’s poetry, which taught him to find more happiness in the “higher pleasures” (Better to be an unhappy Socrates than a contented pig). Mill’s rethinking of pleasure in terms of the base and higher pleasures was a rejection of Jeremy Bentham’s hedonism and perhaps we are all the better for it.