Monday, April 18, 2005

PETER D. KRAMER has an essay in the magazine section of the New York Times about the peculiar way that depression is viewed in our culture: as a form of deeper vision. People who suffer from depression are thought more likely to be writers, painters, creative visionaries. Depressed individuals are sensitive souls who feel -- just a little bit more than those who don't experience depression -- the pain and suffering that comes with being human.

I agree with Kramer that depression is often viewed this way -- that in some way depression is seen as conferring a deeper connection with the sacred mysteries of life -- but I also think this coin has a flip side. In my experience, people who have never dealt on a personal level with major or chronic depression are just as likely to dismiss the seriousness and "realness" of the feelings associated with it (a sensation of total bleakness, emptiness, hopelessness; difficulty concentrating; having to exert enormous effort to do the smallest tasks) as they are to romanticize it. Far too many people think that depression is mere self-indulgence, mental laziness, something a person could "snap out of" just by deciding to do so.

These attitudes about depression are wrong. There is nothing romantic or self-indulgent about depression. It's a disease, and it has serious consequences.

Depression is associated with brain disorganization and nerve-cell atrophy. Depression appears to be progressive -- the longer the episode, the greater the anatomical disorder. To work with depression is to combat a disease that harms patients' nerve pathways day by day.

Nor is the damage merely to mind and brain. Depression has been linked with harm to the heart, to endocrine glands, to bones. Depressives die young -- not only of suicide, but also of heart attacks and strokes. Depression is a multisystem disease, one we would consider dangerous to health even if we lacked the concept ''mental illness.''

Depression is not a special way of viewing the world and it is not an automatic response to tragedy and horror.

Depression is not a perspective. It is a disease. Resisting that claim, we may ask: Seeing cruelty, suffering and death -- shouldn't a person be depressed? There are circumstances, like the Holocaust, in which depression might seem justified for every victim or observer. Awareness of the ubiquity of horror is the modern condition, our condition.

But then, depression is not universal, even in terrible times. Though prone to mood disorder, the great Italian writer Primo Levi was not depressed in his months at Auschwitz. I have treated a handful of patients who survived horrors arising from war or political repression. They came to depression years after enduring extreme privation. Typically, such a person will say: ''I don't understand it. I went through -- '' and here he will name one of the shameful events of our time. ''I lived through that, and in all those months, I never felt this.'' This refers to the relentless bleakness of depression, the self as hollow shell. To see the worst things a person can see is one experience; to suffer mood disorder is another. It is depression -- and not resistance to it or recovery from it -- that diminishes the self.

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