A Frustrating Mess

Gary Greenberg opens his new history of depression with a riveting tale of scientific ingenuity. A young, unknown marine biologist with an interest in mussels happens to discover the neurotransmitter serotonin and helps spur the antidepressant revolution. Lest we get too excited, though, Greenberg deflates our hopes just a few pages in.  Great science stories involve chance discoveries that change our everyday lives, he says—but this is not the kind of story he is going to tell.

Instead, the story that dominates Manufacturing Depression: The Secret History of a Disease is of scientific exuberance run amok, of coincidences and hasty conclusions, of a lust for money and for control over what Greenberg aptly describes as the landscape of mental suffering. Greenberg is outraged that “the depression doctors,” as he ominously terms them, have cornered the market on Americans’ internal anguish and have managed to convince millions of people that their unhappiness is actually a disease with a simple cause—a chemical imbalance—and a magic-bullet cure. It’s especially infuriating because this notion isn’t based in fact; it’s just a story we have allowed the medical establishment to tell us. There is no biochemical marker for depression, no good way to tell who is and who isn’t depressed. The tools doctors use to diagnose depression, as well as the other varieties of mental illness, are based on symptoms alone—whether someone is eating or sleeping more or less than usual, for example, or suffering from excessive guilt, or engaging in too much self-criticism.  Most of what’s diagnosed as depression is, in other words, nothing more than the name our society gives to a particular kind of emotional and mental suffering considered worthy of fixing.

Greenberg, a practicing psychotherapist, is quite clear about his biases going into this affair. He believes ardently in the redemptive power of self-exploration, the process of fashioning one’s past and present into a coherent narrative that tries to make sense of the misfortunes, dashed aspirations, betrayals, and losses that inevitably make up human experience. Manufacturing Depression is his attempt to wrest control of the story back from “the depression doctors.”

In one sense, Greenberg has reclaimed the narrative very effectively. He has produced a tightly woven history showing that the medical establishment, despite claims to the contrary, knows almost nothing about the causes of depression from a scientific, biochemical, or neurological perspective. Along the way, the book explains the influence of germ theory, the transformation of German companies that made synthetic dye companies into titans of the pharmaceutical industry, and the endless warring between psychiatrists, psychologists and neurologists over what constitutes mental illness and who is qualified to diagnose and treat it. In a particularly revealing section, the book also demonstrates that street drugs such as LSD and Ecstasy are far more closely related to antidepressants and other psychiatric medications than we, doctors, or the pharmaceutical industry, would like to admit.

Given the whirlwind fashion in which all this information is presented, though, it’s not clear who the book is aimed at. Greenberg sprinkles in cheeky references to people and psychiatric catchphrases previously mentioned 30, 50, or 100 pages back. Maybe I have a bad memory, but even reading very carefully and taking notes, I couldn’t keep track of all the players in this depression-myth saga. Had Greenberg produced a book for scholars, the lack of clarity would be more understandable, but he seems to be aiming for the masses. Addressing the reader in the second person, the book keeps assuring us that if only we can follow the story—which, frankly, is a big if, given all the abrupt twists and turns—we’ll be better informed when our doctors try to sell us a load of crap in the form of a depression diagnosis and a pill. To anyone who can distill Manufacturing Depression’s more than 350 densely written pages into “news you can use” during a 15-minute doctor’s appointment, well, hats off.

If the history gets bogged down at times, though, Greenberg’s prose is truly lyrical when discussing big, abstract, philosophical themes like human frailty and the nature of identity. He’s terrific with metaphor. If we adopt a biochemical notion of depression, he asks in one such passage, then is consciousness merely the steam rising off “the amino-acid-rich neurochemical soup that roils in dumb silence in your head?” Too often, though, the scornful, snarky tone he takes toward psychiatrists and their medicalized version of mental illness sours the lyricism of these passages.

With good reason, Greenberg tried to temper the dense history of science stuff with an account of his own depression and of his participation in clinical trials of a fish-oil treatment. Yet, his self-doubt (are his pills working? Are the depression doctors right? Or is it just a placebo effect?) feels unconvincing, even a little manipulative, as though Greenberg is employing it for the sake of a good story. Or, if I can play armchair psychologist for a minute, perhaps it’s the authorial version of a classic depressive’s tactic—undermining himself before anyone else can.

As hard as he is on himself and the depression doctors, Greenberg lets the rest of us unhappy souls off gently. Although he complains about a depression diagnosis that renders “the whole world insane,” he seems to consider us all worthy of tragic-hero status, with our flaw being the awareness of the inevitable gap between what we aspire to and what we can actually accomplish in the course of our short lives.

Rather than turning inward and attending to our unhappiness with a pill that promotes complacency, or a therapy that teaches only positive thinking, Greenberg argues, we should focus our energies on the massive societal problems that cause so much suffering in the first place. We should, in short, engage with the world and with each other. So, all you need is love? Surely, Greenberg, who has spent most of the book excoriating psychiatrists for professing simple solutions, can’t think this is the answer.

At one point, Greenberg briefly mentions his standard explanation for why self-exploration still matters, even in an age of brain scans and biochemical wizardry. “[T]o learn about the pipes and wires of the brain is to discover the necessary but not the sufficient conditions for our selves and our suffering, only the infrastructure and not the edifice.” It is, he says, “like cataloguing the pigments of the Mona Lisa and claiming that you’ve said something important.” Greenberg dismisses this response as inadequate. Perhaps it is, but I rather wish he’d left it at that.