Depression is seen by doctors and medical researchers the world over as a real illness. The World Health Organization reckons it affects 120 million people and will soon rank number two in the global disease burden. But do we really think it is just a disease? Or do we still buy into the romantic idea that creativity is somehow linked to this species of suffering?
Peter Kramer takes an uncompromising line. He is a psychiatry professor who made his name with Listening to Prozac, a book that looked at depression, but also at the then-new notion of “tweaking” personality – what happens when you medicate people who may not be mentally ill.
This time, in Against Depression, Kramer has focused more fully on depression – in part because he wants to know what our world would be like without it. One of his motivations was rage against people who equivocate about treating it. What would lead anyone to resist the idea of treatment, when there is ample evidence that depression physically damages the brain? Would the lives of people like Van Gogh have been transformed if they had taken antidepressants? And why are people attracted to depressives – do they mistake unresponsiveness for confidence, or see nobility in despair?
Advertisement
Perhaps depression is the last bastion of the view that there is some aesthetic, moral or intellectual value in experiencing illness rather than being treated. That’s a very dangerous idea, warns Kramer. It’s high time, he tells Michael Bond, to regard depression in the same light as cancer and AIDS. Seen this way, depression saps strength and energy – the very opposite of what creativity requires.
And yet is it really all so cut and dried? Can we hope to treat it without disrupting the whole personality, creativity included?
What is this idea of “heroic” depression?
The tradition of heroic melancholy goes back thousands of years – and in and out of fashion. It was much in vogue during the Renaissance, especially in England. Melancholy covered a host of sins. It was not only what we call major depression: it probably included everything from bipolar disorder to epilepsy. There was a particular interest in the “melancholic malcontent”, a nonconforming, seditious young man, a type admired in Italy. So the notion of rebellious artistic genius going hand in hand with depression entered our culture.
Do you come across this idea in everyday life?
I hear patients speak of themselves both as if they were gravely disabled and as if their illness was some mark of superiority. Outside the consulting room the tendency to attach value to depression is common enough. Depression can appear to embody an aesthetic, moral or even political stance. There is a left-wing viewpoint in which it represents moral distance from society: minimalism versus mercantilism. There is also a right-wing perspective: the view that one should tough out the suffering without resorting to easy remedies like psychotherapeutic support or medication. Both sides see virtue in experiencing illness rather than seeking treatment. These views strike me as misguided – and impediments to prompt treatment.
Do you see these attitudes within medicine?
I see it around the edges. Some people, such as the psychiatrist Thomas Sasz – and he still has a number of followers today – deny that mental illness exists at all. Even to some mainstream psychiatrists, depression can look like an autonomous, brave manifestation of personality. You also see the idea among some psychotherapists that in order to really cope with depression the patient should get more depressed; that to fully face their problems they should go down before they can come up, allowing them to deal with personality issues such as narcissism. The idea is that the self-doubt that is an element of depression makes these patients open to self-examination. I think we would be shocked if doctors allowed any other serious progressive illness to linger before treatment. I think you would need a very solid form of informed consent before considering that risky course. Failing to treat a disease that causes ongoing anatomical damage, in the hope of benefit to personality – would any ethics committee approve?
You say depression can be seductive. How?
One example is men who find themselves attracted to women with depression. A woman whom it is hard for them to attract, hard to arouse, one who is withdrawn and unresponsive to them, appears to have a kind of social confidence, the ability to resist men’s wiles. Why is it that two great novels by men about women, Anna Karenina and Madame Bovary, both end in the heroine’s suicide? And it is not only women. The brooding, unreachable young man, the rebel without a cause – what woman can resist his dark appeal?
Why does it matter if depression is seen this way?
Because depression is disabling and we need to deal with it very straightforwardly. It is a derailing of functions: the regulation of heart rhythm is affected, blood platelets are out of control, and strokes and heart attacks become more likely. These symptoms testify to the pathological nature of depression.
But can depression inspire genius or creativity?
Most of the early studies that link mental illness with creative genius looked at schizophrenia and the paranoia associated with it. Recently, some studies have found a possible link between creativity and manic depression – but people who are prone to mania often accomplish lots of things, not just in the arts. What’s interesting is that studies of what it takes to be creative refer to exactly the traits that are absent in depression. You want energy and intellectual flexibility, whereas depression is a very constraining disorder.
I wonder if the notion that depression is linked to creativity is related to the idea that depression is a lot like passion. I think it is the opposite. It involves very narrow, flattened emotions. It’s true that very often extreme experience informs art and makes a tale interesting. That can go for cancer, or in the novelist John Updike’s case, psoriasis. These diseases give people a strong individual perspective, but that truth is usually an argument against dealing with handicapping conditions. Perhaps the whole question is less interesting than it is made out to be.
Yet can you really separate depression and creativity so neatly?
In my clinical experience, treating people for depression did not seem to affect their creative productivity. With epilepsy, where the case for creativity may be better, no one asks seriously whether something is lost when we treat people. In any case, the view that pathology blends into creativity is suspect. There may be new realisations that arise from sadness, but the emptiness, paralysis and terror of depression have only a modest connection to the sadness of everyday life.
Where did depression come from? Do you think it could have offered any evolutionary advantages?
It is very hard to see any actual benefits of depression. If there were, why isn’t everyone depressed? Evolutionary biologists argue that the advantage could be that it forces you to stop and drop what you are doing. Yet sometimes depressives carry on with what they are doing, making terrible decisions and sticking to the wrong things.
Can you envisage a future without depression?
Eradication is conceivable, though we’re not near it. I use eradication really as a thought experiment to test our resolve in embracing depression as a disease. There are certain lines of research that intrigue me, such as Robert Sapolsky’s work using genetic engineering to moderate the effects of stress hormones on the brain. The goal is to protect vulnerable neurons, not (as may occur with medication or psychotherapy) to change personality. When we treat diseases we aim to isolate the disease and treat that, we don’t want to affect the whole organism. Genetic engineering could work, if you could leave people just the way they are, so that people who were very prone to depression could experience regular stress and all the feelings they usually feel, but not have any progressive damage to the brain and not enter a depressive state. If we could make people more resilient to stress – physically resilient in terms of protection from harm to the brain and other organs – then we’d see less depression. Any objection to that world would be an objection to the scientific enterprise.
“It is very hard to see any actual benefit of depression”
