Times Article

'Against Depression'
That 'Prozac' Man Defends the Gravity of a Disease



By JANET MASLIN

Published: May 9, 2005

In his new book, Peter D. Kramer tells a story about traveling to promote the best-known of his earlier books, "Listening to Prozac," and regularly encountering the same kind of wiseguy in lecture audiences. Wherever he went, somebody would ask him whether the world would be shorter on Impressionist masterpieces if Prozac had been prescribed for Vincent van Gogh

Sunflowers and starry nights aside, this anecdote is revealing. It conveys both the facts that "Listening to Prozac" made a mental health celebrity out of Dr. Kramer (who is a clinical professor of psychiatry at Brown University) and that the book's success left him uneasy. He became a target, not only of New Yorker cartoons (one of which featured a Prozac-enhanced Edgar Allan Poe being nice to a raven) but of condescension from his professional peers. He found out that there was no intellectual advantage to be gained from pointing the way to sunnier moods.

"Against Depression" is a defensive maneuver against such vulnerability. With both a title and an argument that summon Susan Sontag (in "Against Interpretation" and "Illness as Metaphor"), the author argues against the idea that depression connotes romance or creativity. While fully acknowledging depression's seductiveness (Marlene Dietrich is one of his prototypes of glamorous apathy), and grasping how readily the connection between gloom and spiritual depth has been made, Dr. Kramer argues for a change in priorities. He maintains that depression's physiology and pathology matter more than its cachet.

Dr. Kramer makes this same point over and over in "Against Depression." It may be self-evident, but it's not an idea that easily sinks in. As this book points out, the tacit glorification of depression inspires entire art forms: "romantic poetry, religious memoir, inspirational tracts, the novel of youthful self-development, grand opera, the blues." There isn't much comparable magnetism in the realms of resilience, happiness and hope.

What's more, he says, our cultural embrace of despair has a respected pedigree. Depression is the new tuberculosis: "an illness that signifies refinement," as opposed to one that signifies unpleasantness and pain. In a book that mixes medical theory, case histories and the occasional flash of autobiography, Dr. Kramer speaks of having been immersed in depression - "not my own" - when inundated with memoirs about the depressed and their pharmacological adventures. He finds there is a lot more confessional writing of this sort than there is about suffering from, say, kidney disease.

But depression, in his view, is as dangerous and deserving of treatment as any other long-term affliction. When regarded in purely medical terms, evaluated as a quantifiable form of degeneration, depression loses its stylishness in a hurry. Here, matters grow touchy: the author is careful to avoid any remedial thoughts that might appear to promote the interests of drug companies. So there are no miracle cures here; there is just the hope that an embrace of strength and regeneration can supplant the temptation to equate despair with depth.

"Against Depression" returns repeatedly to this central, overriding premise. Perhaps Dr. Kramer's talk-show-ready scare tactics are essential to his objectives. "The time to interrupt the illness is yesterday," he writes, building the case for why even seemingly brief interludes of depression can signal a relentless pattern of deterioration in a patient's future. For anyone who has spent even two straight weeks feeling, for instance, sad, lethargic, guilty, alienated and obsessed with trifles, "Against Depression" has unhappy news.

The author does not stop short of declaring that "depression is the most devastating disease known to humankind." But this claim, like much of the medical data discussed here, is open to interpretation and heavily dependent on the ways in which individual factors are defined. How far do the incapacitating properties of depression extend? Do they lead only to sadness and paralysis, or also to self-destructive behavior, addictions, failures, job losses and patterns passed down to subsequent generations? Whatever the case, Dr. Kramer is clearly well armed for the debate he will incite.

While its medical information, particularly about depression-related damage to the brain, is comparatively clear-cut, it is in the realm of culture that "Against Depression" makes its strongest case. In these matters, Dr. Kramer is angry and defensive: he finds it outrageous that William Styron's "Darkness Visible" endows depression with such vague witchcraft ("a toxic and unnamable tide," "this curious alteration of consciousness") or that Cynthia Ozick can complain that John Updike's "fictive world is poor in the sorrows of history." He himself finds Updike's world rich in life-affirming attributes that tend to be underrated.

He wonders how much of the uniformly acknowledged greatness of Picasso's blue period has to do with its connection with the suicide of one of Picasso's friends. By the same token, he is amazed by a museum curator's emphasis on the bleakest work of Bonnard, though this painter strikes Dr. Kramer as "a man for whom fruit is always ripe." Similar material, with the potential to illustrate the high status of low moods, is endless. There is a whole chapter on Sylvia Plath that the author didn't even bother to write.

There is more breadth of evidence than innovative thinking in "Against Depression." Nonetheless, this book successfully advances the cartography of a (quite literally) gray area between physical and mental illness. And in the process it settles a few scores for the author, whose last book was a novel about a radical blowing up trophy houses on Cape Cod. Here is his chance to assert that he wrote his senior thesis on death in Dickens's writing; he listened to a lot of Mozart and Schubert in college; that he, too, has succumbed to the erotic power of bored, affectless, emotionally unavailable women in candlelit rooms.

But he wrote this book in a state of reasonable contentment. He finds life well worth living. He's tired - in ways that have potent ramifications for all of us - of being treated as a lightweight for that.