This book began from a simple premise: that depression should be viewed as a social and cultural phenomenon, not a biological or medi- cal one. Within cultural studies, this statement is absolutely unob- jectionable, so much so that a book that makes this argument might seem utterly predictable. It would no doubt proceed via a historical or genealogical inquiry in order to show how the category of depression changes over time and is constructed in relation to shifting social and ideological demands. But this is not that book. Instead the very banality of that premise is part of my subject here. As valuable as the histori- cal critique of medical discourse can be, it is not my ultimate goal, in part because it has been done (and done well) by others but, more im- portantly, because what is taken for granted in cultural studies is not the commonsense view elsewhere, and that disconnect is my real inter- est. Within medical and scientific circles that construct depression as a treatable disease, the premise that depression is social and cultural can seem not so much suspect as irrelevant, especially in the context of the practical urgencies of treatment and new pharmacological discoveries. Within the popular imaginary, the medical model also holds power- ful sway, especially the rhetoric that depression, pervasive though it might be, is manageable because it is a disease that can be detected, diagnosed, and treated. Although significantly bolstered by powerful economic and institutional interests, this commonsense understanding has widespread popular appeal particularly because a medical model based on biology relieves people of individual blame or responsibility
and makes for a tangible set of solutions that contrast with the over- whelming, diffuse, and messy tendencies of social or cultural analysis. At stake here are not just different understandings of depression but questions of cultural authority. Who are depression’s public intellectu- als? Is it the doctors and scientists? Ordinary people who are experi- encing depression? The historians and humanists who can tell us about the cultural and social record? Artists whose attention to form and genre might create new ways of representing depression? Monks in the desert? Depression is an interdisciplinary phenomenon not only in the academy but in popular culture, where doctors, journalists, patients, and self- help experts weigh in through a variety of genres and media, including talk shows, memoirs, advice books, journalism, and middle- brow historical and medical surveys. Like many academics, I am moti- vated by a desire to see cultural studies approaches play a more promi- nent role in public discourse and to provide an alternative to scientific expertise as the primary authority on depression. But my archive— which includes not only early Christian monks but indigenous spiritu- alities, political burnout, and queer subcultures—is far outside the orbit of medical science.
Yet medical science remains the central point of reference for many discussions, even critical ones. Beginning a discussion of depression with an account of acedia, for example, differs sharply from the fre- quent use of statistics as a starting point for underscoring the serious- ness of depression as a problem, even when it’s viewed as a socially con- structed problem rather than a real one. Whether popular or academic, and whether medical or cultural in orientation, a remarkable number of studies use as a touchstone statistics about the rising rates of diagno- sis and pharmaceutical treatment that make depression a global public health epidemic. Andrew Solomon offers the following enumeration, for example:
According to recent research, about 3 percent of Americans—some 19 mil- lion—suffer from chronic depression. More than 2 million of those are children. . . . Depression as described in dsm- iv [Diagnostic and Statistical
Manual of Mental Disorders] is the leading cause of disability in the United
States and abroad for persons over the age of five. Worldwide, including the developing world, depression accounts for more of the disease burden, as calculated by premature death plus healthy life- years lost to disability,
than anything else but heart disease. Depression claims more years than war, cancer, and Aids put together. Other illnesses, from alcoholism to heart disease, mask depression when it causes them; if one takes that into consideration, depression may be the biggest killer on earth.9
Although he also notes that “it is a mistake to confuse numbers with truth,” Solomon lets the “figures tell an alarming story” of depression’s pervasive reach (25). Such statistics are often attached to accounts of the need for medical treatment. Along with offering statistics on de- pression as a leading cause of disability worldwide, for example, the World Health Organization’s (who) website notes that it can be “reli- ably diagnosed and treated with primary care” that consists of “antide- pressant medications and brief, structured forms of psychotherapy.”10 Even for those who aim to tackle depression in more qualitative ways or to critique the medical model, statistics provide incontrovertible evi- dence of an unprecedented problem.11
Although popular books about depression are easy to critique, their formidable cultural power is nonetheless compelling, and I have been unable to ignore them when pondering what it would mean to write about depression differently. They offer instructive models for why other nonmedical approaches and topics fall off the radar in the main- stream media—historical critique is too cranky; acedia is irrelevant; new age therapies have an air of quackery. Sustained by persistent de- bates about the pros and cons of drugs (and the implications for conven- tional psychotherapy), books about depression have become a main- stay of public discourse. Solomon’s The Noonday Demon, where I first encountered the concept of acedia, is only one of an ongoing flood of books that have emerged since the marketing of the new generation of ssri (selective serotonin reuptake inhibitor) antidepressants in the late 1980s. One of the best known, Peter Kramer’s Listening to Prozac (1993), responded to the Prozac revolution by considering whether antidepres- sants could be used cosmetically to change personality and created a public discourse around pharmaceutical treatment that is as much a part of the culture of depression as the medical science itself. Combin- ing medical and scientific research with the case history (which gives depression a human face), popular medical books on depression are often very compelling rhetorically; they are rigorous but accessible, seemingly balanced in their consideration of both cultural and scien-
tific theories, and affectively sympathetic.12 Like Solomon, the authors often use their own case histories to provide the forms of expertise that come from patients. (Kay Redfield Jamison’s An Unquiet Mind, al- though about manic- depression, is probably the most well known of this genre in which the doctor’s professional authority is bolstered by a first- person account of her experience as a patient.)13 There are some glimpses of what Public Feelings would call “political depression,” as when Solomon, perhaps because he is a writer, not a doctor, suggests that a culture of disconnection is largely responsible for the current high incidence of depression and that love and community would be the antidote. But even when, as Solomon does, these writers combine both scientific and cultural understandings and both personal narrative and scholarly research, in order to present a “balanced” or pluralistic view, they ultimately operate within the framework of a medical model of depression as a disease.
Indeed, with its many firsthand accounts, the work generated by medical experts is strongly connected to the other crucial genre of popular discourse about depression, the memoir. Although memoir might seem to offer an alternative to medical expertise, it frequently confirms it since its equally vast proliferation has also been catalyzed by the antidepressant revolution and, like many subgenres of memoir, can be quite homogeneous in its vision. Published in 2001, Solomon’s
Noonday Demon builds on a steady stream of titles spawned by the mar-
keting of Prozac in the late 1980s, of which some of the most popular and most significant include William Styron’s Darkness Visible (1990), in which the famous writer demonstrates how depression can strike even those who appear to be successful and productive; Elizabeth Wurtzel’s
Prozac Nation (1994), in which the infamously whiny twenty- something
describes the woes of her generation in terms of depression; and Lauren Slater’s Prozac Diary (1998), in which the psychologist turned writer applies her considerable skill as a memoirist to the dramatic effects of Prozac on her life.14
These memoirs and others like them are largely structured around some version of a drugs- saved- my- life narrative and hence consolidate a medical model. As a writer suddenly felled by depression at the peak of his career, Styron captures the feel of depression as something that cuts him off from normal relations and work, but he presents it as a largely mysterious visitation, and the process by which drugs and ther-
apy alleviate it remains vague. Drawing on Styron’s stature as a writer, this approach renders depression poetically powerful but ultimately opaque, and it has limited value for cultural explanations for depres- sion. Wurtzel and Slater are both among the first generation of people to be treated by Prozac in the late 1980s and thus grew up with psychic distress that seemed utterly untreatable. Wurtzel shares all the lurid details of her emotionally chaotic childhood, adolescence, and college years, and Prozac comes in to save the day in her conclusion. Slater starts with Prozac, structuring her narrative as a detailed account of how it transformed her personality, a version of a conversion narrative in which she takes stock of the sick person she left behind and grieves, and the world she comes into after medication. Written more recently, Solomon’s book reflects both the wider range of antidepressants now available and increasing doubts about their efficiency. He adopts the balanced view that drugs must be combined with other approaches to depression but also that “to take medication as part of the battle is to battle fiercely, and to refuse it would be as ludicrously self- destructive as entering a modern war on horseback.”15
In addition to being marketable because they link their stories to pub- lic debate about pharmaceuticals, these books are also produced by and for a very privileged demographic; their authors are not just white and middle class but have the cultural capital that comes with an Ivy League education and access to publishing networks based in New York, as well as, in Slater’s case, the authority of being a medical professional or expert, and they often presume a readership with the same profile. They are also written in the idiom of professional creative writing, with the eye for detail encouraged by mfA programs and venues such as
The New Yorker (where the essay that became Solomon’s book was first
published). The results are well- polished documents that have none of the rough edges and messiness of the queer writing and performance art that have been my touchstones for memoir. The medical literature often gets its start in publications such as The New Yorker as well, which, along with other middlebrow intellectual publications such as the New
York Times Magazine, Atlantic, and Harper’s, serves as the place where
science and humanities meet in order to produce popular accounts of research questions.16 The relations between medical research and mem- oir, and between case history and literature, are fluid; the case history, for example, spans the spectrum from the scientific to the creative (and
is thus an important genre for this project because it suggests the pos- sibility of combining them).17 All of these books about depression are part of a larger category of writing about science that is central to its operation and epistemological and cultural power.
If writing is integral to scientific thinking, though, it can also produce something other than the medical or scientific model of depression. Furthermore, depression might be capable of producing other kinds of writing and knowledge besides science.