Manufacturing depression

by Gary Greenberg

  I didn’t intend to treat my depression by building a house—which, by the way, is a very expensive and time-consuming cure. But had I considered myself diseased, would I have stumbled on this cure for my unhappiness? Had I taken antidepressants, would my recovery have gone down in my biography as a lesson about the value of losing myself or just as another illness cured by a drug? And would I have noticed that this was the same lesson that I had learned from my MDMA experience: that the redemption of despair lies in involvement in the world and engagement with others—to put it briefly, in love?

  I don’t think I’m done with being depressed. I don’t think it’s going to be all that much fun to get older, and as hopeful as the recent regime change has made me, I think we might have fouled our nests irretrievably. My tragic view is getting pretty fixed, and not in the sense of repaired. So I am sure that I’ll have all sorts of opportunities to deploy this lesson. But I doubt I would have learned it if I thought my problem was a chemical imbalance, and if I believed that Princeton researcher—or, for that matter, if I believed Daniel Amen and George Papakostas, both of whom told me that my MDMA cure was the result of unleashing a flood of serotonin, as if the rest of it—Angel and Grace and my wife’s bottomless blue eyes—didn’t matter.

  I suppose I’ll never know whose story is the right one. But I know what mine is, and I’m sticking to it for now. The greatest injustice that Eliphaz and his friends inflicted on Job was that they refused to let him have his version of events. That’s what the depression doctors want to do to you.

  Call your sorrow a disease or don’t. Take drugs or don’t. See a therapist or don’t. But whatever you do, when life drives you to your knees, which it is bound to do, which maybe it is meant to do, don’t settle for being sick in the brain. Remember that’s just a story. You can tell your own story about your discontents, and my guess is that it will be better than the one that the depression doctors have manufactured.

  NOTES

  CHAPTER 1

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  2 a question first posed: Smith, “Pavlov and Integrative Physiology,” R747.

  3 On Easter night: Loewi, From the Workshop of Discoveries, 30–34. See also Finger, Minds Behind the Brain, 268–73.

  5 Twarog’s first paper: Twarog, “Responses of a Molluscan Smooth Muscle.”

  5 Her paper with Irvine Page: Twarog and Page, “Serotonin Content of Some Mammalian Tissues.”

  6 27 million Americans: These figures are notoriously hard to pin down. However, for a good analysis of both the numbers and their meaning, see Barber, “The Medicated Americans.” For raw numbers, see Olfson and Marcus, “National Patterns in Antidepressant Medication Treatment,” and the Pharmacy Facts and Figures pages on the Drug Topics website, http://drugtopics.modernmedicine.com/drugtopics/article/articleList.jsp?categoryId=7604.

  8 no more effective at treating depression: Geddes et al., “Selective Serotonin Reuptake Inhibitors.”

  8 the drugs fail to outperform placebos: Kirsch et al., “The Emperor’s New Drugs,” http://journals.apa.org/prevention/volume5/pre0050023a.html.

  8 “remake the self”: Kramer, Listening to Prozac, t.p.

  9 By now, asking about the virtue: Ibid., 300.

  9 W. H. Auden’s elegy: Auden, Collected Poems, 271.

  10 “the common cold of mental illness”: Centers for Disease Control and Prevention, “Understanding Depression,” http://www.cdc.gov/nasd/docs/d001201-d001300/d001247/d001247.html.

  10 “the leading cause of disability”: World Health Organization, “Depression,” http://www.who.int/mental_health/management/depression/definition/en/.

  10 his drug was the first SSRI: Wong, Bymaster, and Engleman, “Prozac (Fluoxetine, Lilly 110140), the First Selective Serotonin Reuptake Inhibitor”; Carlsson and Wong, “Correction: A Note on the Discovery of Selective Serotonin Reuptake Inhibitors,” 1203.

  11 “seven preeminent medical, advocacy, and civic groups”: Depression Is Real Coalition, “Link to Us,” http://www.depressionisreal.org/depression-link.html..

  12 Some say depression is all in your head: Depression Is Real Coalition, “Right and Wrong,” http://www.depressionisreal.org/depression-dr-greengard.html.

  14 the 1980 release of the third edition: American Psychiatric Association, Diagnostic and Statistical Manual, 3rd ed.

  19 manic-depressive illness: American Psychiatric Association, Diagnostic and Statistical Manual, 2nd ed., 36.

  19 involutional psychotic reaction: American Psychiatric Association, Diagnostic and Statistical Manual, 24.

  20 depressive neurosis: American Psychiatric Association, Diagnostic and Statistical Manual, 2nd ed., 40.

  20 “Depression is neither more nor less”: Kramer, Against Depression, 41.

  20 “an occupying government”: Ibid., 25.

  21 “the eradication of depression”: Ibid., 111.

  22 depressionisreal.org is quietly funded: In particular, by Wyeth. See Depression Is Real Coalition, “What Is,” http://www.depressionisreal.org/depression-about-coalition.html

  CHAPTER 2

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  25 It is customary: See, for example, Jackson, Melancholia & Depression, 7–8; Horwitz and Wakefield, The Loss of Sadness, 57–61.

  25 “it appears to me to be no more divine”: Hippocrates, Hippocratic Writings, 154.

  25 “Fear and sadness”: Schmidt, Melancholy and the Care of the Soul, 32.

  26 He is rumored to have cured: Roccoatagliata, History of Ancient Psychiatry, 163–64.

  26 “it is a deadly symptom”: Hippocrates, Hippocratic Writings, 20.

  26 he devoted an entire book: Ibid., 152–54.

  26 according to one scholar: Kramer, History Begins at Sumer, 105–15.

  27 “mark among all the people”: Job 1:3, Jerusalem Bible.

  27 Job is not God-fearing: Ibid., 1:9–11.

  28 “malignant ulcers”: Ibid., 2:7.

  28 “Curse God,” she says: Ibid., 2:9–10.

  28 May the day perish: Ibid., 3:3–4.

  28 I should now: Ibid., 3:13–17.

  29 “Why give light”: Ibid., 3:20.

  29 “Why make this gift”: Ibid., 3:24.

  29 “only food is sighs”: Ibid.

  29 Can you recall: Ibid., 4:7.

  29 Was ever any man: Ibid., 4:17.

  29 And now your turn: Ibid., 4:3.

  30 “charlatans, physicians”: Ibid., 13:4–5.

  30 Is not man’s life: Ibid., 7:1–4.

  31 Why do the wicked: Ibid., 21:7–8.

  31 But man?: Ibid., 14:10–12.

  31 “I mean to remonstrate”: Ibid., 3:13.

  31 “that of a dog”: Richardson, William James, 14.

  32 Does a wise man: Job 15:2–6.

  32 “it is man who breeds”: Ibid., 5:7.

  32 You shall be safe: Ibid., 5:21–26.

  33 “In its commonest form”: Kramer, Against Depression, 44.

  33 “a fixed tragic view”: Ibid.

  33 “toward assertiveness”: Ibid., 4.

  34 “Our aesthetic and intellectual preferences”: Ibid., 106.

  35 “On this medication”: Ibid., 4.

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  38 Prozac, or Sarafem: Daw, “Is PMDD Real?” http://www.apa.org/monitor/oct02/pmdd.html.

  39 the diagnosis ran into stiff opposition: Caplan, They Say You’re Crazy, 122–67.

  39 the nine depression criteria: For diagnostic criteria, see American Psychiatric Association, Diagnostic and Statistical Manual, 4th ed., text revision, 775–77.

  39 The normal process of life: James, The Varieties of Religious Experience, 136.

  40 “uncontrollable urge”: GlaxoSmithKline, “New Survey Reveals,” www.gsk.com/press_archive/press2003/press_06102003.htm.

  41 a study by David Rosenhan: Rosenhan, “On Being Sane in Insane Places.”

  41 A cottage industry: See, for example, the “Letters” section of Science 180: 356–65. Also Spitzer, “On Pseudoscience in Science.”


  42 So when I found out: Information about most government-funded clinical trials can be found at the U.S. National Institutes of Health website www.ClinicalTrials.gov. The National Institute of Mental Health (NIMH) minor depression study can be found at http://www.clinicaltrials.gov/ct2/show/NCT00048815?term=minor+depression&rank=1. The Massachusetts General Hospital trial I eventually entered is described at http://www.clinicaltrials.gov/ct2/show/NCT00361374?term=major+depression+Omega&rank=1.

  44 M. trunculus looks like: For good pictures of these two snails, see Monfils, “Murex Shells,” http://www.manandmollusc.net/Shell_photos/dye-murex.html.

  44 according to legend: Told by the Alexandrian mythographer Julius Pollux. See Garfield, Mauve: How One Man Invented a Color, 39; Hazel, Who’s Who in the Greek World, 197.

  44 “exactly the colour”: Pliny, Natural History, 447.

  44 “Mauve Measles”: Garfield, Mauve, 60–62.

  44 bat guano and from certain lichens: Travis, “Perkin’s Mauve,” 62–64.

  45 By the time William Perkin: Garfield, Mauve, 19–20; Travis, “Perkin’s Mauve,” 53–54.

  45 recruited from Germany: Garfield, Mauve, 21.

  45 Hofmann had an interest: Garfield, Mauve, 26; Travis, “Perkin’s Mauve,” 54.

  46 An enterprising Scotsman, Charles Macintosh: Garfield, Mauve, 24.

  46 Hofmann, however, thought he could extract value: Travis, “Perkin’s Mauve,” 55; Garfield, Mauve, 33.

  46 Malaria was not only a scourge: Garfield, Mauve, 31–34.

  46 Cinchona bark: Shapiro and Shapiro, The Powerful Placebo, 20–22.

  46 a pair of Frenchmen isolated quinine: Garfield, Mauve, 31; Sherman, Twelve Diseases, 139.

  47 enough to hinder the business of empire: Garfield, Mauve, 30–33.

  47 “happy experiment”: Ibid., 34.

  47 Perkin soon determined: Travis, “Perkin’s Mauve,” 55.

  47 a powder with a reddish tint: Garfield, Mauve, 35–39; Travis, “Perkin’s Mauve,” 55–56.

  47 “Perfectly black”: Garfield, Mauve, 36.

  48 Perkin’s invention proved: Travis, “Perkin’s Mauve.”

  48 “When I felt…miserable and forsaken”: Marquardt, Paul Ehrlich, 159.

  48 Ehrlich had been introduced: Bäumler, Paul Ehrlich, 5–6.

  49 “They cared so little”: Marquardt, Paul Ehrlich, 73.

  49 “I can see the structural formula”: Bäumler, Paul Ehrlich, 6.

  49 “Substances act only when they are linked”: Ibid., 10.

  49 “brilliant eccentric”: Ibid., 13.

  50 “minute creatures that live [there]”: Quoted in Amici, “The History of Italian Parasitology,” 4.

  51 Theriac, for instance: Watson, Theriac and Mithridatium, 71–82; Bartisch, Theriac.

  51 George Washington: Shapiro and Shapiro, The Powerful Placebo, 25.

  51 “If the whole materia medica”: Holmes, “Currents and Countercurrents,” 108.

  51 They even had a theory: Arikha, Passions and Tempers, 3–37.

  51 time-proven, if poorly understood, remedies: Jouanna, Hippocrates, 205–6.

  52 “If we were once to admit”: Quetel, History of Syphilis, 79.

  52 Koch announced that he had discovered: Bäumler, Paul Ehrlich, 14–16; Ullmann, “Pasteur-Koch.”

  53 Ehrlich had found that methylene violet: Bäumler, Paul Ehrlich, 16.

  53 Pasteur came to focus on: Ullmann, “Pasteur-Koch.”

  53 It should be possible: Marquardt, Paul Ehrlich, 91.

  53 “straight onward”: Ibid., 93.

  53 “learn how to take aim”: Bäumler, Paul Ehrlich, 143.

  54 “There must be”: Marquardt, Paul Ehrlich, 94.

  54 In 1903, one of Ehrlich’s dyes: Mann, Elusive Magic Bullet, 7.

  54 he had discovered something significant: Marquardt, Paul Ehrlich, 142–45.

  54 he determined that the test animals: Bäumler, Paul Ehrlich, 128.

  54 The first three years: Ibid., 129–30.

  55 a colleague of Ehrlich’s: Quetel, History of Syphilis, 139–40.

  55 “putrid liquid”: Sherman, Twelve Diseases, 83.

  55 he injected some of that liquid: Nuland, Doctors, 183–86.

  55 “gonorrhea and the chancre”: Quetel, History of Syphilis, 82.

  55 when his aorta burst: Sherman, Twelve Diseases, 90.

  55 Hunter treated himself: Ibid., 184.

  56 Mercury had been the treatment of choice: Quetel, History of Syphilis, 86–87.

  56 “A night with Venus”: Marquardt, Paul Ehrlich, 48.

  56 doctors’ ability to publicize: Quetel, History of Syphilis, 114–20.

  56 Public health measures: Ibid., 120–23.

  56 Nineteenth century man: Ibid., 119.

  56 a French scientist gave even more reason: Ibid., 162–64.

  57 word about 606 got out: Marquardt, Paul Ehrlich, 163–66, 175.

  57 “remarkable effect”: Mann, Elusive Magic Bullet, 10.

  57 Patients showed up: Ibid., 156–60.

  57 Hoechst had distributed 65,500 free doses: Mann, Elusive Magic Bullet, 10–12.

  58 375,000 doses: Bäumler, Paul Ehrlich, 167–69.

  58 There’s hardly a child: Ibid., 167.

  58 “long, slow, painful and expensive grind”: Benedek and Erlen, “The Scientific Environment of the Tuskegee Study.” See also Berdin and Flavin, “The Least of My Brothers,” http://web.archive.org/web/20080124141121/http://wisdomtools.com/poynter/syphilis.html.

  CHAPTER 4

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  62 Diagnostic trends varied: See, for example, Sandifer et al., “Psychiatric Diagnosis,” and Beck et al., “Reliability of Psychiatric Diagnoses.”

  64 “The name hysteria”: Richardson, William James, 336.

  64 His doctoral dissertation: Shorter, History of Psychiatry, 101.

  65 “we cannot afford to pay”: Kraepelin, “Manifestations of Insanity,” 512.

  65 an analysis of his dreams: Ibid.

  65 “from the medical point of view”: Kraepelin, Lectures on Clinical Psychiatry, 1.

  66 Julien Offray de La Mettrie: For biographical information on La Mettrie, see Frederick the Great, “Eulogy on La Mettrie,” and Wellman, La Mettrie: Medicine, Philosophy and Enlightenment.

  66 “it possesses muscles”: La Mettrie, Machine Man, 28.

  66 a “machine that winds itself up”: Ibid., 7.