Against Depression (Hardcover)

~ (Author) "SHORTLY AFTER THE PUBLICATION OF Listening to Prozac, twelve years ago, I became immersed in depression..." (more)
Key Phrases: heroic melancholy, stuck switch, vascular depression, Ken Kendler, Walker Percy, Altogether Again (more...)

Editorial Reviews

Amazon.com Review

Written as an answer to the question, "What if van Gogh had been on anti-depressants," Against Depression manages to be more of an exploration than a polemic, regardless of its title. While author Peter Kramer (Listening to Prozac) expresses a definite opinion--that disease of any sort should be treated as effectively as possible--he manages to express sympathy along with frustration about the recurring idea that soulful creativity often goes hand-in-hand with depression. Without ever being dismissive or particularly angry, his writing makes his point abundantly clear after the first chapter: The pervasive idea of depression serving a creative purpose is preposterous, as well as highly damaging.

While he draws from a number of recent studies on depression, the book is not meant to assist in the diagnosis or treatment of individuals, except in a very general sense. Instead, Kramer adds the findings of those studies into his thoughts on how patients modify medication doses for depression as they wouldn't for purely physical diseases, and looks into future possibilities of genetically modified stress hormone transmitters that could work to prevent a slide into chronic depression. In the arts, he examines the work of philosophers, painters and writers in relation to the reputation their personal lives have earned (critics and consumers alike believe that pain equals genius and lack of pain equals lack of depth). Adding Dineson, Bellow, Updike and Kierkegaard to the list headed by van Gogh, Kramer shows a variety of ways we live with the assumption that creative genius does not function without severe emotional strain.

While he does include a few stories from a patient to illustrate specific treatments, most of the book is slow and thoughtful, without ever being dry or pedantic. Useful to families or individuals who have encountered depression, this book offers excellent support for anyone--creative genius or otherwise--who struggle to define their talents as existing separately from their illness. Jill Lightner

From Publishers Weekly

Starred Review. What is depression really, and how does society define it? Kramer, a famed psychiatrist and author of the 1993 bestseller Listening to Prozac, says he has written "an insistent argument that depression is a disease, one we would do well to oppose wholeheartedly." In making his argument, Kramer examines the cultural roots of notions about depression and underscores the gap between what we know scientifically and what we feel about the illness. Kramer traces depression from Hippocrates through the Renaissance and Romantic "cult of melancholy" to advances in medicine, psychiatry and psychotherapy, and at last to the disease we now know it to be. Kramer's curiosity drives the book forward as he ponders why we value artwork and literature built on despair: "certain of our aesthetic and intellectual preferences have been set by those who suffer... deeply." The book maintains the perfect balance between science and human interest, as the author details both psychiatric studies and personal experience. A comparison of the biochemical workings of depression with the physical and observable symptoms serves as an intellectual trip for readers and provides a thorough exploration of what Kramer dubs "the most devastating disease known to humankind." The book is rich with questions that engage the reader in an active dialogue: Why is society captive to depression's charm? And will this infatuation change with the emergence of more evidence regarding depression's severely disabling effects? Kramer leaves off with these questions to ponder. Resolute but not preachy, this book is an important addition to the growing public health campaign against depression. As for how we should define depression—perhaps it's best understood by its opposite: "A resilient mind, sustained by a resilient brain and body." One Spirit and Discover Book Club selections. (May 9)
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Product Details

• Hardcover: 368 pages
• Publisher: Viking Adult; First Printing edition (May 9, 2005)
• Language: English
• ISBN-10: 0670034053
• ISBN-13: 978-0670034055
• Product Dimensions: 9 x 6.4 x 1.3 inches
• Shipping Weight: 1.3 pounds
• Average Customer Review: 3.9 out of 5 stars  See all reviews (39 customer reviews)
• Amazon.com Sales Rank: #382,561 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

51 of 55 people found the following review helpful:

5.0 out of 5 stars Listening To Pathology, February 15, 2006

By	Thomas J. Burns (Apopka, Florida USA) - See all my reviews (REAL NAME)

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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.

16 of 17 people found the following review helpful:

4.0 out of 5 stars Against Depression -- Of course!, July 6, 2005

By	A. Moeller - See all my reviews (REAL NAME)

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.

16 of 17 people found the following review helpful:

5.0 out of 5 stars Captures the true experience of depression., May 26, 2005

By	A. Miller (Boston, MA) - See all my reviews (REAL NAME)

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.