Depression as a Failure of Neuroresilience: Thoughts on Peter Kramer's Against Depression

As an individual who has spent some time immersed in the academic environment, I have developed a degree of insight into itsperversionss and pathological tendencies. In fact, as someone with a melancholic, neurotic, cynical temperament, I have all too frequently participated in them.

Nietzsche tells us that it is not suffering itself, but the meaninglessness of unnecessary hardships which humanity finds unbearable. On my most skeptical days, I view the modern academic edifice as a sustained effort to fashion makeshift cloaks of significance for the naked victims of history. And a good academic always recognizes himself as among these victims; the first mask he crafts covers a face wracked in torments that are all too often self-imposed. Under this pale light, all humanistic scholarship is vanity and pretense, a meager palliative to make life bearable.

Happiness is synonymous with ignorance and shallowness, sadness and anxiety are merely the natural response to alienation. To be critical is to be deep, insightful, intelligent. Honors are conferred to those who paint the bleakest picture, the most insoluble dilemma. These artistic endeavors give us at least some small consolation in an absurd universe--and really, this is all we can hope for.

No more! I've had my fill. We think we are so smart merely because we see the ugliest parts of the world to which the supposedly beguiled masses are blinded by ideology. It is easy, too easy, to be critical. This is not to suggest that criticism isn't sorely needed. Nevertheless, it is far more difficult to take a risk and be constructive.

Such is the endeavor that Peter Kramer attempts in his fantastic book Against Depression. Kramer asks us to question the traditional heroic portrait of the melancholic thinker and to abandon the mistaken notion of pharmacotherapy as the mass administration of soma. As a sufferer of depression and an academic philosopher-in-training, I have come to see, with Kramer's aid, the wide gap between melancholia as purported critical insight and the reality of depression as devastating disease.

I will touch on some of the highlights of Kramer's arguments here, but I highly recommend that you read this work in full. It should be of interest not merely to those with an interest in psychological disorders, but also to any with the gut reaction that a world without depression would be some kind of nightmare, best realized only within the confines of dystopic science fiction as a warning of the dangers of "cosmetic psychopharmacology"”.

The key to Kramer's account is a new model of depressive illness. Many are familiar with the account that emphasizes neurotransmitters: depressives are those who lack sufficient amounts of serotonin and norepinephrine. Thus, drugs like Prozac (selective serotonin reuptake inhibitors or SSRIs) are effective because they leave more serotonin available in neural synapses by blocking its reuptake--or something to that effect. Well, Kramer offers another kind of explanation for how these drugs help depressives, in which their function is merely incidental.

Kramer's alternative centers on the notions of neuroresilience, neuroprotection, neuroplasticity, and neurogenesis, in short, the capacity for the brain to maintain its neuronal structure under duress. Citing recent research, Kramer points out the recent discovery that adult human brains are able to regenerate neurons, refuting previous hypotheses to the contrary. As it turns out, some people's neurons are better equipped than others' to respond to the recurrent stresses of human life.

The culprit here is actually the whole system of fight-or-flight response with its production of stress hormones that spread from the adrenal glands through the blood to the brain. While this response is normally adaptive, too many stress hormones can actually kill cells. Those individuals whose neurons are better protected, more flexible, more easily regenerated--i.e., those with more resilient cells--are ones who are best suited to coping with stress. Those on the other end of the spectrum are largely sufferers of depression.

This model makes intuitive sense: those with the most resilient cells and neuronal structures happen to be those who are most resilient on a human scale. It's not that they have fewer sources of suffering than the rest of us, but that they are not so easily deterred by them; depressed individuals become dejected and despair over what many regard as minor setbacks. One might liken the difference to that between James' strenuous and easy-going mood. The neuroresilient can afford to take on additional hardships and maintain the energy of their efforts, while the depressed would be best served to play it safe.

A lack of neuroresilience is not merely correlated with depression: susceptibility to anxiety, heart disease, stroke, and other chronic conditions also crop up. If this model is right, the use of drugs (or gene therapy) that increased the defenses of neurons against stress hormones would have more positive effects than just decreasing susceptibility to depression. Not only that, but they would be likely to have less of an effect on personality, since they would not be altering the levels of neurotransmitters in the brain. (Right now, Kramer believes that SSRIs and other antidepressants derive their benefits from increasing neuroresilience and neurogenesis.)

Many people are uneasy about the prospect of eliminating depression--in ways in which they are not about other diseases like polio, small pox, or AIDS, for instance--because they operate on a mistaken notion of what depression is and how it is treated. They ask, what would happen to the Kierkegaards, Poes, and Van Goghs of a world without depression? Would we lose some great insight into the human condition? This is precisely the kind of prejudice betrayed in academic circles, particularly those of Continental European thought.

This is not to say that their concern is not justified. If it were the case that a drug like soma were being administered on a large scale, I would be every bit as worried. However, depression is not equivalent to alienation, anomie, mourning, or even ordinary sadness. It is a pathological condition characterized by more than just depressed mood: quite often the depressive feels nothing at all, a kind of emptiness and numbness that bears striking resemblance to the misperception of what antidepressants do.

I think a partial contribution to this misunderstanding is an overly narrow understanding of what happiness is. By many (particularly among the remnants of puritanical culture), happiness is seen as a kind of passivity, as mere pleasure (eating chocolate ice cream, having an orgasm, lazing about on a Sunday afternoon, etc.)--i.e., as sinful, to be kept to a minimum. Those who have equated happiness with pleasure, such as Bentham, Mill, and other utilitarians, help to perpetuate this myth. But, if we return to a more classical understanding of happiness, perhaps in the Aristotelian sense of eudaimonia, a kind of activity that is done for its own sake, I think we are much better equipped to understand the reality of human emotional life.

Unsurprisingly to those who know me, I find Spinoza extremely helpful here. For him, human happiness is not the ataraxia or equanimity of the Hellenistic schools, but energetic striving: not mere satisfaction, but desire itself. In so far as we are active, we are joyful; sadness is mere passivity, a diminishment of our power. The joyful individual is one who does more, who is more capable of seeing how the supposed evils of life come about and of dealing with these problems. The joyful are actually more insightful than the saddened. Nietzsche, in his notion of Joyful Science, takes a very similar tack.

And this is the reality for the depressed individual: I may not be blinded by an unthinking optimism, but the stresses that I perceive all around me take a much heavier toll. I am beset on all sides by burdens too onerous to bear, but which seem to the average observer mere trifles. When I am depressed--and I am speaking in my own voice here--I feel less like myself. I have difficulty concentrating, remembering, even getting out of bed. Should I be inspired by my condition, I will nonetheless probably lack the energy to write about it.

Fortunately, I am in the midst of treatment that has proved quite effective: a mixture of pharmacotherapy and counseling. I have never felt better in my life, never more alive, never more energetic and excited. Has my critical capacity suffered as a result? Well, I can't speak with certainty here, but it doesn't seem that way to me. I'm still just as critical of myself and my world, but I feel more hopeful, more capable of doing something about my shortcomings and the defects of our society. I am both a better student and a better teacher. I focus less on myself and more on others. Life isn't perfect, to be sure, but at least I feel like it's definitely worth living now.

I know also how the feeling of profundity can help one get through a depressive episode. To feel as though one knows the world better by being a cynical realist is a means of coping--but not a very effective one. But it is just wrong to see depression as in any way necessary for being critical. The problems of our world are writ just as large for the healthy minded who make an effort to see them. Resilience gives us a means of avoiding despair. Thus, not only is it the case that personal suffering is diminished: it becomes far easier to make a difference in the world when not beset by fear and hopelessness.

Would life be different in a world without depression? Yes, but in a way in which what we lost was more than made up for by what would be gained. We could be a happier, healthier, more active, less self-centered, more resilient people. There would still be those of us who were melancholic by temperament, but without the crippling paralysis and decreased vitality that accompanies depression. Personally, I have made progress in this direction, while I eagerly await the new generation of anti-depressants that may offer a genuine cure.

In any case, I have touched upon but a fraction of Kramer's amazing text. Go to your local library or bookstore and see for yourself. Whether you are depressed or not, I promise you won't be disappointed. (Well, maybe you will be if you're depressed, but it will give you all the more reason to seek more effective treatment!)