1/29/2006

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!)

8 comments:

Jeff said...

Dom,

Thanks for this piece. You blend philosophy, pharmacology, psychology, politics, and personal anecdote here with great insight. This is pluralistic philosophy at its best.

For those of us happier souls, it's all too easy to talk about the "positive" side of depression. I think that the critical capacity is often misconstrued as negativity, and hence its correlation with melancholy and depression. But in order for criticism to be progressive and not merely reactive and full of ressentiment, it must be affirmative. In this sense the common phrase "constructive criticism" is a redundancy which shows how deeply ingrained the correlation between criticism and negativity is today.

This correlation has an effect which you did not mention--it makes it easy to trace the criticism which the critic offers to his or her psychological health. The common connection between criticism and melancholy allows those being criticised an easy ad hominem counter: "They are just taking out their sadness and depression on us "healthy" members of society." In this sense the correlation between criticism and depression is a tool that serves conservative interests.

Dewey and Nietzsche make a kind of positive, affirmative criticism the centerpiece of their philosophies. The distinction you elaborate here between criticism and depression will benefit not only the depressed (in that we will stop making excuses not to treat them), but also those of us critics who are not depressed, only hopeful for a better world.

specter_of_spinoza said...

Jeff,

Thank you for your kind words and thoughtful comments. I'm sorry I didn't offer a response sooner, but I am largely in agreement with what you say.

As you know, this is an issue I feel quite strongly about, and one on which I'm willing to take a stand.

I am probably a little too quick to praise technological advances (consider for instance, Lasch's comments about the connection between narcissism and technology), but since so many in the humanities are practically Luddites too eager to highlight possible abuses, I'm willing to overstate my case.

Quite frankly, despite my more positive mood, I remain cynical about our species' future prospects. There are too many of us, and we mess with powers far beyond our understanding and control.

Sometimes, I just find myself hoping armageddon will be held off for just a few more decades so I can live as full a life as possible.

However, I see great promise in biotechnology, and a sliver of a greater hope. Perhaps we cannot genetically engineer perfect human beings, but we may be able to give more people the means to withstand hardship and invoke a strenuous mood.

One things for sure, at least in my mind: things are going to get worse before they get better (that is, if they ever do). We'll surely need all the moral courage we can get.

Anonymous said...

I am intrigued by the parallels that spring to mind in reading two of your recent postings, the above and that of 1/13. There is a general social and discursive commentary that you pursue and elucidate in the comparison of eudaimonnia and ataraxia in the one and the duality of belief and theory in the other (and both via Spinoza). That both comparisons are at the root of such contemporary concerns brings me to wonder if you haven't put your finger on a significant shift (still very much in progress) in the inherent duality of our western political and cultural sphere. The traditional political labels of the right and the left are gradually becoming devoid, via what passes for discourse in our society, of meaning, to be replaced or redefined with some as-yet-unaccepted terminology (the fundamental and the ...).

The attacks of the right on the "liberal press" are a forceful illustration of this shift, as it has been shown time and again that the bias of the press cannot be easily categorized as leftist in the 20th century sense. Instead, the fundamental attacks atrike at the nature of journalism to be actively inquisitive, to develop feasible narratives from available facts, to theorize. The new rightist desire is that the press accept belief as a tool of public discourse; this desire was temporarily actualized in the western media for a sustained period following September 11, 2001, much to the glee (Rove, et. al.) of the new right.

The spoon feeding of passive enjoyment and the utilitarian justification that suports it as a social policy is a foundation of new rightist thinking. The problem for a new left (an entity of sorts that includes, for example, an active environemntal interest, whether from traditional lefty groups or from hunters and ranchers) is to offer a vision of hope (a cure for our collective depression) that counters the easy pleasure of passivity and belief.


This is not the first time that the terms of our political duality have changed, but I do think that this shift, resonating as strongly as it does in the broader fields of technology and medicine and religion, as well as the traditional politics and law, indicates a deeper shift in our cultural sphere than we might have otherwise anticipated.

Thank you for your thorough tracings of the philosophical underpinnings of contemporary cultural issues.

specter_of_spinoza said...

Anonymous Reader,

Thank you for sharing your thoughts. I find them quite intriguing but I don't have time at the moment to respond with the care they deserve. I will reflect on what you say, and hopefully address some of these points in a future post.

I might add, I'm glad that I'm not just talking to myself here! I think all great philosophers at least since Socrates have recognized that philosophy is most effective when a dialogue.

anotherpanacea said...

I've been meaning to pick up this book, because I've been interested in the connection between nootropics lke hydergine and the new crop of anti-depressants that are looking for the serontonin precursors.

Anyway, I do worry that there might be a form of macro-neuroresilience at stake in the experience of a shattered psyche, unable to handle the stress of an environment, that rebuilds itself anew and differently. Compare this to the resilience of a psyche capable of managing the challenges to its worldview through incorporation or rejection alone: this person will be happier but will probably reject those traditions that require significant slogging through the mire of depressive and cynical texts. It's not a -complete- mistake to associate this easy comfort with jocks and stockbrokers, right? Adolescent depression, at least, seems required to produce humanists and philosophers rather than simply doctors. But yeah, as an adult, depression just seems like a real downer. :-)

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