Healthy Skepticism Library item: 7365

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Levine BE.
Book reviews: Lincoln’s Melancholy by JW Shenk and Against Depression by PD Kramer
Z Magazine Online 2007 Jan
http://zmagsite.zmag.org/Jan2007/levine0107.html

Full text:

If we declare depression to be nothing but a disease, as Peter Kramer demands in Against Depression, then billions of dollars will continue to pour into biotech research and treatment and we will continue to ignore the societal and cultural causes of depression. If instead, we see strengths in those with depressive temperaments, as does Joshua Wolf Shenk in Lincoln’s Melancholy, then we become uneasy about handing over our despair to profit-hungry biotech corporations.

It may surprise those Americans who believe that modernity is synonymous with progress that in 1860 the U.S. public and press had compassion-and even respect-for Abraham Lincoln’s depression. According to Shenk, Lincoln’s depression may have actually helped him politically more than it hurt him, as it gained him sympathy and drew people toward him. Shenk discovered that Lincoln’s depression “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature.”

Public compassion for Lincoln’s depression in 1860 stands in clear contrast to 1972 when George McGovern’s vice presidential running mate Thomas Eagleton was shoved off the ticket because of his history of depression. Today it continues to be unlikely that anyone with Lincoln’s temperament would receive a presidential nomination. One wonders whether the medicalization of depression-which the psychiatric establishment claimed would eliminate the stigma of “character defect”-instead created the stigma of “biochemical defect.”

The aim of Shenk, a writer with a penchant for both history and psychology, is not to pull the rug out from under the psycho-pharmaceutical industrial, but rather to (1) show that Lincoln would today be diagnosed with depression; (2) describe the strategies that Lincoln used “to heal and help himself;” and (3) explain how Lincoln’s depression was a meaningful part of his character that contributed positively to his work. Lincoln’s Melancholy accomplishes those goals- which does in fact pull the rug out from under the psycho-pharmaceutical industrial complex.

Shenk’s evidence that today Lincoln would be diagnosed with clinical depression is quite convincing: Lincoln’s friends’ “suicide watch” over him; two major breakdowns replete with many of the official symptoms of depression; dark Lincoln quotes such as “I am now the most miserable man living”; and observations by friends and acquaintances, including William Herndon, Lincoln’s law partner from 1844 to 1861, who said, “Gloom and sadness were his predominant state.”

Then how did Lincoln, without antidepressants or electroconvulsive treatment, not only live a meaningful and productive life, but become for many the most admired president in U.S. history? Lincoln hung in there with commonsense selfhelp therapies such as humor and poetry and, ultimately, Lincoln’s depression, rather than being an unfortunate disease, actually “fueled his greatness.”

Shenk concludes: “From a place of trouble, he looked for meaning. He looked at imperfection and sought redemption.” Though Lincoln shared with other politicians the trait of ambition, he also wanted his life to have genuine meaning, which he found first in attempting to stop the spread of slavery and then, when the political climate changed, in his Emancipation Proclamation.

“In Lincoln’s time, people understood the obvious point that [current] research bears out: every cognitive style has assets and defects,” Shenk notes, “This seems surprising today because, by some quirk of culture, some cognitive styles are held to be superior and others inferior.” The research does in fact support Shenk’s contention that while depressives such as Lincoln are often more gloomy, they are also more capable of discerning painful truths than are nondepressives. Lincoln’s superior grasp of reality, Shenk contends, was vital to his political wisdom. I also agree with Shenk’s conclusion that depressives, because of their own suffering, often have great compassion for the suffering of others.

Shenk’s attributing the current American intolerance of some cognitive styles to a “quirk of culture” is generous to psychiatry. In the early 20th century, much of American psychiatry embraced the eugenics movement. Eugenics declared those cognitive styles and temperaments that are monkey wrenches for industrial society to be diseases that should be weeded out from the gene pool. In the early 1930s the Nazis were actually concerned that American psychiatry might be ahead of them in the race to eliminate mental defectives. After the word eugenics became associated with the Nazis, American psychiatry dropped the word, but not the goal of identifying biochemical and genetic markers for defective cognitive styles and temperaments. Nowadays, psychiatrists who seek these biochemical and genetic markers are called biopsychiatrists.

In opposition to Shenk’s doubleedged view of depression, bio-psychiatrist Peter Kramer sees nothing good about it and he begins Against Depression by stating, “I have written a polemic, an insistent argument for the proposition that depression is a disease, one we would do well to oppose wholeheartedly.” Kramer gained fame in 1993 for his Listening to Prozac, which was for Prozac manufacturer Eli Lilly what “Diamonds Are a Girl’s Best Friend” was for De Beers.

Against Depression argues that to view depression as fuel for greatness-or anything other than a disease to be eradicated-is romantic hogwash. While Kramer’s view of depression has already achieved pharmaceutical industry backing and corporate media acceptance, he tells us there remains a need for his book: “But I think we do not own it, not in the sense that we own the belief that cancer is a disease…. We associate depression with a heroic artistic stance, one we think humankind might be worse off without.”

Kramer offers several rationales for why depression should be seen as a disease to be opposed with as much gusto as is cancer. He reports that science has discovered “biological markers”-the sine qua non of disease-for depression. Kramer tells us that brain scanning techniques focusing on the size of the hippocampus and amygdala can differentiate the depressed from the nondepressed. However, on October 18, 2005, five months after Kramer’s Against Depression was published, the New York Times (“Can Brain Scans See Depression?”) concluded: “After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies.”

Kramer also attempts to revive the chemical imbalance theory of depression, specifically the serotonin-deficit theory, an idea that much of mainstream medicine now rejects. He tells us, “Deplete serotonin, and depression is unmasked.” But researchers have depleted serotonin and it did not cause depression in nondepressed subjects nor did it worsen the depressive symptoms of those already depressed. By 1998 the American Medical Association Essential Guide to Depression was telling us that there is no clear link between levels of serotonin and depression, “as some depressed people have too much serotonin.”

Genetics is also a major component of Kramer’s argument: “By the mid-1990s, scientists had identified genes that might lead to both conditions, neuroticism and depression.” A hero of Against Depression is behavioral geneticist Kenneth Kendler, whose work Kramer adduces to document depression’s genetic roots. Kramer tells us that Kendler has been a close colleague ever since both had done their Yale psychiatry residency together and that “Ken was the genius of our residency group.” However, two months after the publication of Against Depression, Kendler reviewed the evidence for “gene action in psychiatric disorders” in the American Journal of Psychiatry in July 2005 where he concluded: “Although we may wish it to be true, we do not have and are not likely to ever discover ‘genes for’ psychiatric illness.”

Kramer also tells us that depression must be a disease because of how devastating it is. He is certainly correct that depression can result not only in suicide, but can also ruin careers, destroy families, and jeopardize physical health. However, such non-diseases as war and poverty also have a devastating impact; and there is a long list of noncontroversial illnesses, including the common cold, that do not have such a devastating impact. Making “devastating impact” one criteria for classifying a phenomenon as a disease akin to cancer is but another of Kramer’s many stumbles.

Today in the U.S., Native Americans have the highest suicide rate among all ethnic groups and suicide is the second leading cause of death among Native American adolescents. Prior to the subjugation of Native Americans, suicide was a rare event, restricted to the sick or elderly who felt they could no longer contribute. In a similar vein, during the years of intensive removal of German Jews to concentration camps, their rate of suicide is estimated to have been at least 50 times higher than the rate for non-Jewish Germans who were not forced into concentration camps. Does anyone seriously believe that the epidemic of depression and suicide among modern-era Native Americans or Hitler-era Jews is genetically caused?

Depressed people for whom the drugs and other treatments of modern psychiatry have been nonproductive or counterproductive-no small population-will certainly be interested in how Lincoln dealt with his depression. Although Shenk accepts without critical analysis some of biopsychiatry’s beliefs about depression, he deserves credit for helping to revive the democratic idea that all temperaments have assets and defects.