Depressed Losers on the Verge of Destruction
The depressive’s neurons are appropriately withering, along with the possibility of a human future.
The psychiatrist Peter Kramer used to see patients, and he still remembers why. When a young woman visits him complaining of being unable to do the laundry, he’s nearly lovestruck: “Betty is terribly likable…. She is subtle, generous, self-effacing. In her presence, I feel coarse and overbearing. Betty understands the intricacies of relationships better than I do, has a wider tolerance for others’ foibles. How lucky I am to be having this conversation.” But it doesn’t take long for Kramer to come back to his senses: “when I am charmed, I think depression.” And by depression, he means not the characteristics of depressive behavior but rather “glial cells retreating…, neurons withering, [a] shrunken hippocampus and disordered prefrontal cortex.” This is because Kramer, knowing that depression is a brain disease, a problem of neuronal resilience, has trained himself to see beyond the person and into the brain. “No need to look forward to the face,” he proudly claims. Just as a “cardiologist sees blocked arteries” when “hearing of chest pain,” so too does Kramer see “fragility, brittleness, lack of resilience, [and] a failure to heal” in Betty’s brain whilst being charmed by Betty’s self-deprecating persona.
Kramer is the guy, if you’re wondering, who insinuated that we ought to be putting Prozac in public drinking water, but let me be clear from the outset: though I disagree with his practical conclusions, I find most of his assertions about depression to be true in an admittedly flat and narrow way. His genealogy of heroic melancholy, dating back to Romanticism, forces us to confront the debilitating features of depression even in the tradition of thought that saw it as an anchor of creative individuality. His conception of depression as brain disease strikes me as generally correct: though I’ve never seen the fMRIs, it sounds pretty reasonable that “depression in the brain looks eerily like depression in the person.” And though his predictable emphasis on genetic predisposition as the cause of depression is misguided, his understanding of the relationship between predisposition and environment is not objectionable. Indeed, if we replace “genes” with the more general “predisposition” in what follows, his etiology of depression is easily reconcilable with psychoanalysis:
The genes create adverse environments, as when they lead to a temperament that the culture fails to reward. Ordinary environments become adverse when interpreted through the personality shaped by the genes, as when someone needs more social stability and predictability than the culture tends to provide.
In what follows, I will take as roughly accurate Kramer’s assertion that depression is a disease evident in withering and disordered brain function that is traceable more to predisposition than environmental factors. One can agree with all of this, however, while still wondering about the nature of the purportedly “ordinary environment” in the previous passage. What social stability and predictability does contemporary culture provide? Or better, what in our ordinary environment is destabilizing to people whom we call depressed?
