[NYTr] Bk Rvws: Lincoln's Melancholy; Against Depression

[nytr at olm.blythe-systems.com]

sent by Bill Koehnlein

Book Reviews: Lincoln's Melancholy; Against Depression

Z Magazine online - January 2007
http://zmagsite.zmag.org/Jan2007/levine0107.html

Lincoln's Melancholy:
How Depression Challenged a President and Fueled His Greatness
(Joshua Wolf Shenk, Boston: Houghton Mifflin, 2005, 350 pp.)

Against Depression (Peter D. Kramer, New York: Viking, 2005, 353 pp.)

reviewed by Bruce E. Levine

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.

[Bruce E. Levine is a clinical psychologist and author of Commonsense
Rebellion: Taking Back Your Life from Drugs, Shrinks, Corporations, and
a World Gone Crazy (Continuum).]

-- 
Bill Koehnlein
bill at toplab.org