Customer Reviews

Against Depression

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Dr. Peter Kramer was a general practice psychiatrist and philosopher who became intrigued and troubled by ethical issues proceeding from the introduction of SSRI medications in the 1980's. He cared enough about these concerns to pen "Listening to Prozac" in 1993, a best seller that, by his own exasperated admission, turned his own life upside down in terms of public perception. He was now "America's depression doctor," a position he neither sought nor relished. But, having been pushed up the steps of the bully pulpit, he decided to tackle his nemesis head-on, and the end product is our work at hand.

With his heightened sensitivity to depression, a new wave of depressed clients pounding his door, and countless speaking engagements and seminars, Kramer became aware that the medical condition of depression carried an aura of mystique and superiority that would never be tolerated in other disorders such as diabetes or cancer. Yes, individuals with painful diseases can grow in character through surgeries, chemotherapies, or deprivations. But no one actively cultivates the condition of cancer as an enhancement of the human situation.

Perhaps an irreverent title for this work might have been "A Tale of Two Prozacs," for the author divides his work into the misconceptions and canonizations of depressed mood, on the one hand, and the hard reality of this disease on the other. There is, he contends, a prevailing belief that mental health disorder and/or substance abuse unleashes creative energy and expands the life experience. As a psychotherapist myself, I do not need to revert to stories of Hemingway or Van Gogh. Nearly every teenager on psychotropic medication raises the question of whether "I'll still be myself." My reassurances that this is precisely our treatment goal are heard warily and with skepticism. They would probably agree with a doctor friend of mine who joked that if Prozac had been invented centuries ago, there would be no Irish folk music.

Kramer is fed up with the toleration of depression, particularly among adults, intellectuals, professionals, artists, and particularly some of his own colleagues. He assesses the false faces of depression, such as charm. He takes note of depressive stereotypes, such as the weak and sensitive depressed woman whose vulnerability presents an alluring attraction to men, or literature's subtle and continuous glorification of those who live as if life meant nothing. He decries the intellectuals' distrust of Carl Rogers for embracing enthusiasm instead of worshipping at the altar of alienation [100 ff.]

"Listening to Prozac" had been an excellent overview of the neurobiology of depression as understood in 1993, a time when the exchange of neurotransmitters such as serotonin dominated both conceptual thinking and pharmaceutical investigations. If LTP had been about a pill, AD describes what Prozac's offspring might look like, if they had been born yet. This of course is a major difference in Kramer`s two works: LTP begins with a pill, while AD begins with hypotheses. In this work Kramer examines more recent research that generally has not yet evolved into psychotropic medicine. One new source of depressive theory comes from Grazyna Rajkowska [52 ff.], an anatomist who explored the prefrontal cortex of the brain in autopsies. Under microscopic examination she found the cells of this region of the brain weakened, disorganized, disconnected, possibly but not certainly due to reduced blood flow to the region. Such a syndrome is seen in more intensive form in Huntington's and Alzheimer's Disease, a connection which, if continuously verified, would certainly lead to a paradigmatic shift in approaching the significance and treatment of depression.

Kramer does not discard the neurotransmitter model he described so eloquently in LTP. Present day treatment modalities, including Prozac, will continue to man the fort for the foreseeable future. But he argues persuasively that the theory is more complex than previously thought,. In his reviews of brain deprived neurotropic factor [120 ff.], 5-HTT genes as "stress police [130 ff.], Yvette Sheline's study of the hippocampus, and Fred Gage's theory of neurogenesis or the replacement of diseased neural cells, Kramer exudes less confidence that the secrets of depression will be unpacked soon, or that new generation miracle drugs will reach the corner pharmacy imminently.

Kramer's early concerns about depression medication as cosmetic have been replaced by concern and anger about the double standard regarding attitudes toward depression by the medical profession and the public alike. Kramer depicts depression as a killer, as dangerous as plague and prevalent in epidemic proportions. He argues that the disease must be attacked ruthlessly, and here he takes issue with what he sees as a somewhat casual approach to the disease by those who espouse psychotherapy as the long term answer, or those hesitant to medicate, or even those who consider the depressed state as a creative matrix or Nietzschian pose of alienation. Chapters 17 and 18 are perhaps the highlights of the work, where art, history, and culture come face to face with biology, in the philosophical style that made LTP such a pleasure to read.

LTP was a leisurely thoughtful work. AD is not. For the most part it is more scientific and certainly more polemical. LTP was speculative about the possibilities of psychiatry and medication. AD is acute in its assessment of the present, particularly regarding cultural attitudes toward this disease. I am struck by the impression that after over a decade as "America's depression doctor," the author is sounding more...well, depressed.

This is, hands down, the best book I have ever read about the multifocal and devastating effects of depression. It is extremely well researched, thoughtful, and is exactly the book that is needed to dispel the erroneous notions that persist regarding depression. There is nothing at all charming or intriguing about depression.

Kramer wrote this book after being deluged by stories of depression, depression research, and patients after he wrote Listening to Prozac.
While touring for his previous books, he would often be asked a question, "what if Van Gogh had taken prozac?" The real question he's being asked is whether depression should be cured, or whether curing depression would take away something that is an essential part of being human.
The book is really making the argument "against depression" - there is nothing romantic or especially meaningful about it.
He writes, convicingly, that depression is a disease that has specific physical indications. The physical causes of this disease are close to being understood.
He writes that other diseases - such as tuberculosis (then called consumption) - used to have romantic implications. They are now considered just ordinary diseases that need to be cured.
While making this point, he touches on treatments for depression - some of them incredibly clever - that may be coming out over the next 5 to 20 years.
If you have suffered from depression and are not sure how you think about it - along the lines of the book: "should I be cured, or if I get treatment will I lose 'part of myself'?" then I'd highly recommend this book. Also recommended if the underlying question is interesting to you - maybe you know someone who suffers from depression, or are just curious about the human condition.

The title suggests a political position of sorts, and much of the book deals with the suggestion that many people are for depression as an aid to artistic expression.

The other parts of the book, that deal with new research showing physical damage to the brain and discussing causes of depression were extremely useful. For 40 years I have tried to explain to family members, doctors and psychiatrists that my depression has nothing to do with my mother; it's just an inapproprite reaction to normal stress. It's a physical defect of sorts that needs medication more than understanding. Attacks can be brought on by job stress, a virus, or no identifiable reason. This book is a great exposition on the physical effects of depression.

I just wish the lengthy discussions about some perceived value of this disease had been confined to a page or two.

Against Depression may be the most significant book I've read on the topic of depression, combining new scientific research with cultural and social criticism. The book chronicles new developments in the science of the brain, highlighting the lack of resilience in certain parts of the brain in the depressed.

Using this physical description of depression, Kramer argues persuasively that depression should be considering a disease in the same literal sense as other physical illnesses such as cancer.

Assuming that depression is, in fact, a disease, Kramer wonders why the culture still romanticizes depression in a way that it doesn't for other diseases. In particular he addresses the supposed role of depression in art. He argues that difference, not depression in particular is valuable to writing and art. He believes that certain aspects of both the artistic and the depressive temperament, such as feelings of alienation from society, can still be valuable to art, as long as the feeling of alienation is not simply a product of a depressive illness. Kramer's longstanding interest in literature and the arts was particularly engrossing to this reader.

He argues that depression is one of the most pressing health concerns confronting the world, with major depression being more debilitating than many other, more obviously "physical" illnesses, and often striking much earlier in life. Particularly noteworthy is that Major Depression is a progressive illness in the same sense as cancer; if not treated properly early on, recurrences tend to be more frequent and more severe. Non-treatment can eventually lead to permanent debilitation.

Kramer covers all of this ground in a sparkling prose style that raises Against Depression above other purely academic tracts on the topic. The book includes a wealth of information while being extremely readable and engaging at the same time.

How this debilitating illness ever became romaticiszed is beyond me. But no one who has ever suffered truly suffered from depression could ever look back with nostalgia on the experience. This is why Dr. Kramer's book resonates with such reason and common sense, if not humane-ness and compassion.

We live in an age when it has become fashionable to be content with your suffering; to be the "walking wounded." The gliteratti flaunt their pathology endlessly on the daytime talk shows without shame, and depression is the sickness of choice.

But Peter Kramer has de-legitimized this romantic notion that somehow there is some virtue in suffering and debunks this myth and exposes depression for what it is; an insidious disease that sucks the life out of its victim and, if left untreated, robs the sufferer of his or her joy, health, spirituality, livlihood, friends, romances, family, and, ultimately life.

This work is an important dialogue about an illness that has reached pandemic levels worldwide as a public health crisis. Depression is real, it is measurable, quantifiable, verifiable, and, thankfully, treatable.

Dr. Kramer has performed a valuable public service with this work and clinician and consumer alike should read this book to understand this terrible maladay, especially if you are know or are living with someone who has been diagnosed with depression.

Have some respect for the authors and the people reading what you write, and please review a book on its own terms. The fact that you were mistaken about what sort of book it was when you bought it, or that you would have preferred if the author had written a different book with a different purpose and focus, are not valid criticisms. If it really makes you so angry to spend money and time on a book that isn't what you expect it to be, then perhaps you should spend more time and effort when choosing your reading material.

This is not a self-help book. It doesn't address itself to depressed people in particular. It doesn't advise on treatment alternatives. It is not an alternative to Richard O'Connor's books. What it is is a plea for depression to be treated as the serious, progressive, frequently fatal illness that it is, and treated aggressively. In particular, Kramer discusses and refutes the ideas that depression is romantic, that it makes its sufferers better or deeper people, or that eradicating it would deprive humanity of works of art. This discussion ranges through science, literature, philosophy and biography. Although I have suffered from depression all my life, I don't think you need to have a personal connection with the subject to find it interesting and enlightening, or to be persuaded by its arguments.

With this excellent book, Peter Kramer has done much more than simply provide answers to those who are always smugly asking him (do these people follow him around like Deadheads when he goes out on book tours?)what would have happened had van Gogh/Poe/Kierkegaard taken Prozac. He helps the reader understand exactly what depression is and what it is not. That it can affect a person's heart literally as well as figuratively. He seeks to divorce human emotions, which he celebrates, from the illness of depression, which places such a heavy burden on so many. Anyone who questions depression's status as a disease, celebrates or romanticizes it, would do well to read this book. Even those who have a vast knowledge of depression, personal or otherwise, will find this book a valuable educational tool.

This book is a very thoughtful look at depression in society. Dr Kramer sets himself up as an intellectual warrior against depression and draws a line in the sand, making an argument against anyone who will romanticize, or dismiss this devastating disorder. Although this book is much less reader friendly, than his best selling Listening to Prozac, and for the most part, it is less heartening with good news currently available, it does point to a future, where, at last we can view depression as an insidious disease, and put the resources to its eradication that it deserves.

As I finished Peter Kramer's new book on depression, I read an article about a recent scientific study led by epidemiologist Ronald Kessler of Harvard that concluded that about half of all Americans report at least one symptom of mental illness at some point in their lifetimes. But I suspect that very few people needed Kessler's study to appreciate the ubiquity of depression in particular; we all know people who have suffered from depression. Peter Kramer, a psychiatrist at Brown University and author of the best-seller Listening to Prozac (1993), has written a sort of cultural history of depression that raises an interesting question: if depression is such an insidious disease, as Kramer believes it is, why does our society ennoble it rather than do everything it can to eradicate it?

Advances in science the last decade have confirmed the horrible symptoms and devastating consequences of depression, including abnormal brain anatomy, cellular pathology, chemical imbalances, and clear correlations between depression and coronary disease, early death, and other ailments. Depression destroys families and careers, causes massive economic losses in public health and employment through poor job performance, and robs people of joy. But in both overt and covert ways society can distort, glamorize and romanticize depression. Unlike cancer, malaria, or most any other disease, we suggest depression is a source of "heightened awareness, (justified) social-disaffection, moral insight, and creative genius." In an entire chapter Kramer examines the "charm" that attaches to depression. Depressives can be desperate to please, attractively and even erotically vulnerable, compulsively generous, attuned to life's absurdities, and full of ironic-self-awareness. Kramer considers the role of the tortured artist who is so productive, the melancholic hero, the depressed writer, and so on. After all, he asks rhetorically, what would have become of Kierkegaard or van Gogh if they had been "cured" with Prozac? Would we have lost the legacy of their genius? Their deep insights into our human condition?

Kramer admits he has written a "polemic, an insistent argument for the proposition that depression is a disease, one we would do well to oppose wholeheartedly." He draws on a broad variety of sources, including art, literature, philosophy, recent scientific studies, interactions with readers from his book tours, case studies from his clinical practice, and his own family history ("most psychological theory is veiled autobiography," he admits). I found it hard to argue with the final sentence of his book: "How glorious it will be to free ourselves from depression."