There's Nothing Deep About Depression

Recent research has made the fight against depression especially compelling. Depression is associated with brain disorganization and nerve-cell atrophy. Depression appears to be progressive -- the longer the episode, the greater the anatomical disorder. To work with depression is to combat a disease that harms patients' nerve pathways day by day.

Nor is the damage merely to mind and brain. Depression has been linked with harm to the heart, to endocrine glands, to bones. Depressives die young -- not only of suicide, but also of heart attacks and strokes. Depression is a multisystem disease, one we would consider dangerous to health even if we lacked the concept ''mental illness.''

Audiences seemed to be aware of the medical perspective, even to endorse it -- but not to have adopted it as a habit of mind. To underscore this inconsistency, I began to pose a test question: We say that depression is a disease. Does that mean that we want to eradicate it as we have eradicated smallpox, so that no human being need ever suffer depression again? I made it clear that mere sadness was not at issue. Take major depression, however you define it. Are you content to be rid of that condition?

Always, the response was hedged: aren't we meant to be depressed? Are we talking about changing human nature?

I took those protective worries as expressions of what depression is to us. Asked whether we are content to eradicate arthritis, no one says, ''Well, the end-stage deformation, yes, but let's hang on to tennis elbow, housemaid's knee and the early stages of rheumatoid disease.'' Multiple sclerosis, acne, schizophrenia, psoriasis, bulimia, malaria -- there is no other disease we consider preserving. But eradicating depression calls out the caveats.

To this way of thinking, to oppose depression too completely is to be coarse and reductionist -- to miss the inherent tragedy of the human condition. To be depressed, even gravely, is to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness. To be depressed is to occupy the role of rebel and social critic. Depression, in our culture, is what tuberculosis was 100 years ago: illness that signifies refinement.

What stands in the way of our embracing the notion that depression is disease, nothing more?

This question has any number of answers. We idealize depression, associating it with perceptiveness, interpersonal sensitivity and other virtues. Like tuberculosis in its day, depression is a form of vulnerability that even contains a measure of erotic appeal.

The cachet attaching to tuberculosis diminished as science clarified the cause of the illness, and as treatment became first possible and then routine. Depression may follow the same path. As it does, we may find that heroic melancholy is no more.

In time, I came to think of the van Gogh question in a different light, merging it with the eradication question. What sort of art would be meaningful or moving in a society free of depression? Boldness and humor -- broad or sly -- might gain in status. Or not. A society that could guarantee the resilience of mind and brain might favor operatic art and literature. Freedom from depression would make the world safe for high neurotics, virtuosi of empathy, emotional bungee-jumpers. It would make the world safe for van Gogh.

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