I am posting this essay on ZESTPoets as I remember having a conversation with Vivek about poetry and depression; and on TalkZEST because I think there are a lot more perspectives possible on the issue. S.
The Neurotic Artist: Romanticizing Depression By PETER D. KRAMER http://chronicle.com/temp/reprint.php?id=suuf5a3ynrdzlomxtuwgwmtgiv2aq6li For 10 years or longer, my week-day routine as a psychiatrist had been constant: write mornings, see patients afternoons. With the publication of my book Listening to Prozac in 1993, new elements were added: travel and public appearances. One question followed me from lecture to lecture, from talk show to talk show, bookstore to bookstore. Because the question was so automatic, so predictable, it took me months to appreciate how peculiar it was. At a book signing, I might give a short introduction to this or that aspect of Listening to Prozac, discussing workplace pressures to remain upbeat, say, and the ethics of using medications in response. What I spoke about seemed not to matter. Inevitably someone would ask: "What if so-and-so had taken Prozac?" The candidates for drug treatment were drawn from a short roster of tortured 19th-century artists and writers. Friedrich Nietzsche and Edgar Allan Poe made frequent appearances. My response was perfunctory -- a quick review of theories of art and neurosis. I resented the joking distraction from issues I had raised. I did not treat the what if question as I did others. I did not attend to it, puzzle over it, take it to heart. And then one day I did. The setting was a professional meeting in Copenhagen, in 1995. At home, as the Prozac book's popularity grew, my standing among my colleagues fell -- or so I feared. With a few thousand copies sold, a man is all right. With hundreds of thousands of sales, it is another matter. I was a popularizer, an opportunist who had made his way on the backs of others, the real researchers. This apprehension was a matter of hypersensitivity, of mild paranoia -- although when a book succeeds, there are always belated "debunking" reviews, to feed an author's insecurity. Speaking invitations poured in, and still I thought I heard snickering from the back row. But in Scandinavia! There I was a prophet with honor, like Jerry Lewis in France. The Finns were among the first to translate Listening to Prozac. Now it was being put into Swedish, with an introduction by the most eminent biological psychiatrist in Northern Europe, Marie Åsgard. The Swedes had persuaded the Scandinavian Society for Psychopharmacology to invite me as the keynote speaker at their annual meeting. My hosts had proposed the topic "Myths and Realities" about antidepressants. The core of the talk would concern an orthodoxy I considered mythical, the one that said antidepressants treat only depression. I wanted to review evidence that the drugs might influence personality traits in people with no mental illness at all. I spent a pleasant afternoon in Copenhagen on my own. The morning of my presentation arrived. I was in serious company -- laboratory and clinical researchers. The practicing doctors had seen effects similar to the ones I had described in my book, dramatic responses to medication. I felt myself on solid ground, the honored guest. I launched into my talk. The audience was attentive, applause polite. A hearty fellow stood up to ask the first question. He had a smile that was familiar to me, from other audiences. His question was: "So, Dr. Kramer, what would have happened if Kierkegaard had taken Prozac?" Of course, in Copenhagen the suffering artist would be Søren Kierkegaard. Who else? He is the most famous Dane, give or take Hans Christian Andersen. Certainly Kierkegaard is the Dane best known for his melancholy, if you understand Hamlet to be fiction. Danes know Kierkegaard the way we know Mark Twain or Henry David Thoreau -- perhaps more intimately. I was once told that when Danish children are sullen, parents will scold them, "Don't be such a Søren!" Kierkegaard is part of what had brought me to Copenhagen, what had made the invitation appealing. I read Kierkegaard when I was young. My college roommate and I plowed through Either/Or together, after my roommate's mother died. She had lived with Hodgkin's disease for almost the whole of her son's life and had never told him, for fear of blighting his childhood. That was like something out of Kierkegaard -- self-sacrifice so radical as to be disturbing. On the flight across the Atlantic, I had browsed in a paperback version of Kierkegaard's Diaries. How grim they are. Kierkegaard describes self-loathing, pessimism, dread, isolation, guilt, and anomie. He writes of wanting to shoot himself. Kierkegaard complains of a "primitive melancholy ... a huge dowry of distress." He writes, "My whole past life was in any case so altogether cloaked in the darkest melancholy, and in the most profoundly brooding of misery's fogs, that it is no wonder I was as I was." And then: "How terrible to have to buy each day, each hour -- and the price varies so!" And again: "The sad thing with me is that the crumb of joy and reassurance I slowly distill in the painstakingly dyspeptic process of my thought-life I use up straightaway in just one despairing step." On my arrival in Copenhagen, I had taken a walk to the Kierkegaard statue, in the garden of the Danish Royal Library. For good measure, I sought out Kierkegaard's grave in the old central churchyard. The walks gave time and occasion to take the measure of the man. So when I heard Kierkegaard in the usual question, I was aware of a particular person. What if effective treatment had been available to this man, the one who pays a terrible price for each day and each hour? That was how, standing before a group of friendly faces in a standard hotel conference room, I caught a glimmer of the problem with the what if challenge: The question had nothing to do with my talk and not much to do with my book. I had asked my listeners to consider medication's effects on people who meet no criteria for any illness. How did that presentation suggest Kierkegaard? Addressing my European colleagues, I found myself cutting short the stump speech about the neurotic artist. I restarted at a slower pace, considering the ubiquity of the what if question. We pose it automatically -- but why? Do we have qualms about treating or preventing depression? It is fine to debate "cosmetic psychopharmacology" -- my term for the effort to sculpt normal personality with medication. But for as long as psychiatry has been a profession, its aim has been to conquer mental illness. The what if question, the Kierkegaard question, expresses unease with the psychiatric enterprise, with the life projects of Scandinavian psychopharmacologists. As I spoke, I wondered why the familiar taunt had never before struck me as unusual. What was depression to me, if I could hear the what if question dozens of times before finding it strange? There (which is to say nowhere) the matter might have stood but for a change in the weather. A colleague had invited me for a stay at a family castle in Jutland, Denmark's more rural peninsula. But a storm grounded the ferry, so we settled instead for the usual automobile tour of Zealand, a well-traveled loop of castles and museums. On the way back to Copenhagen, we stopped at the Isak Dinesen homestead. Dinesen, the master short-story writer and diarist, is another Danish icon -- all the more since the appearance of the film version of Out of Africa, based on her accounts of her early married life. I had read Dinesen's work, too, in my teens. I had been taken with the ominous fables. To my family, driven from Nazi Germany, the Old World had two simultaneous meanings, high culture and cruelty. The Dinesen stories captured both. Here we were now, my pharmacologist host and I, walking the grounds of Rungstedlund, Dinesen's farm on the North Sea. My colleague and I were discussing Dinesen's ailments, her recurrent stomach pain and leg weakness. I assumed, as Dinesen had in her lifetime, that the symptoms were late effects of the syphilis she contracted in the first year of her marriage to the feckless Baron Bror Blixen. "What," I asked my host, "if penicillin had been around in Dinesen's day?" My question was by way of teasing -- making light of any annoyance I had betrayed at the conference. The joke (if there was one) was that there was and could be no Dinesen question. Of course, if penicillin had been available in 1915, doctors would have prescribed it. No one would withhold an antibiotic from a wife innocently infected by her husband. Indeed, no one withholds antibiotics from anyone infected in any manner. No moral dilemma attaches to their use. Antibiotics' purpose, to lessen the burden of disease caused by bacteria, is unexceptionable. It is possible to wonder whether Dinesen would have written differently if she had suffered less. Syphilis has shaped our cultural heritage. Gauguin painted his greatest canvases when he was dying of syphilis, in pain and acutely aware of his mortality. The diagnosis has occasionally been disputed, but for more than a hundred years experts have asserted that much of Nietzsche's work was composed while he suffered a mental illness, one caused by the form of syphilis that damages the brain. Still, we have no moral or aesthetic ambivalence about penicillin. We have lived with penicillin for half a century, and no one considers the world of art or ideas to be shallower, at least not for that reason. Infectious disease can be idealized. Tuberculosis once had romantic overtones. Susan Sontag traced the form of that fantasy in her famous essay, "Illness as Metaphor." TB was a disease of recklessness, longing, sensuality, serenity, decadence, sensitivity, glamour, resignation, instinct, and instinctual renunciation, that is to say, of passion or passion repressed, but in any case a disease of emotionally enhanced or refined creatures. Sontag quotes a passage in The Magic Mountain where a character holds that "disease is only love transformed." The cachet attaching to consumption diminished as science clarified the cause of the illness, and as treatment became first possible and then routine. Still, as Sontag points out, there was a lag; scientific explanation did not trump metaphor in any quick or simple manner. When the fashion finally changed, it did so with a vengeance. Tuberculosis became repulsive before it became unremarkable, one pneumonia among many. By and large, we take syphilis this way, merely as infection. Certainly we are neutral about residual manifestations, treated syphilis that shows itself as leg or stomach pain. If syphilis has moral or metaphorical overtones, they are not outsize -- at the least, they are in remission. That is why there is no Dinesen question. In fact, Dinesen may have suffered not from any sequel of infection but from heavy metal poisoning -- she treated her syphilis with arsenic and mercury. Or she may have been hypochondriacal and depressed. If this assumption were commonplace, it would put Dinesen in the same category as Kierkegaard -- the depressed creative genius. And then lecturegoers would ask, "What if Prozac had been available in Dinesen's day?" There would be a Dinesen question after all. This contrast -- no question in the face of infectious disease, but a routine question in the face of mood disorder -- implies a special status for depression. Why? If both illnesses cause the sort of suffering that can alter worldviews or shape art, why do we react to depression and syphilis differently? After the trip to Denmark, I paid closer attention to my audience's beliefs about the nature of depression. If someone posed the what if challenge, I would ask what he had in mind. Often, it seemed, the questioner believed that the amelioration of depression might cloud a person's moral clarity or dampen a divine spark. By this account, depression has a sacred aspect. In Listening to Prozac, I had worried over the use of medication in healthy people to alter personality traits like shyness. Now these concerns were being extended to cover antidepressants' intended recipients, those suffering from mental illness. The questioners seemed to understand mood disorder as a heavy dose of the artistic temperament, so that the symptoms of depression are merely personality traits and any application of antidepressants is finally cosmetic. One confounding concern had to do with depression as a source of creativity. Why is depression different, less than fully worthy of decisive treatment? Is a link to art enough to alter the way we think about a syndrome -- to move it from straightforward disease to disease-in-a-manner-of-speaking? Sometimes I ask my audience to consider epilepsy, the set of disorders characterized by seizures, sometimes alternating with a variety of mental auras and intense experiences of emotion. Chronically, between attacks, patients with a subtype of epilepsy can be afflicted with hypergraphia, the tendency to write compulsively and at length. They may also display a characteristic personality style, one that includes intense enthusiasms, often religious fervor, and an alternation between aggression and emotional clinginess. Dostoyevsky, Flaubert, Tennyson, Swinburne, Byron, de Maupassant, Molière, Pascal, and even Petrarch and Dante have been named as presumptively epileptic in one or another medical treatise. Poe's name often makes the list. Epilepsy is another sacred affliction or was once. And there are medications -- anticonvulsants -- used to prevent or manage epilepsy. But you might give a dozen talks about quirky uses of anticonvulsants and not hear a single joking question about an artist. The vividness of the pathology and the consequent solidity of epilepsy's status as a disease cast their shadows over attempts at humor. To withhold treatment would be cruel. In the context of seizure disorders, a what if question, if asked, might point to the ironies of medical practice -- how necessary interventions have unknowable consequences. But the question would not be funny. To put the matter differently: While we are protective of depression, we would be happy to eradicate epilepsy. For me, the what if question led directly to another: What would it be like for depression to go through the transformation experienced by tuberculosis? Depression might be on the verge of that metamorphosis, from romanticized affliction into ordinary disease. Hard-to-ignore evidence was accumulating, about the bodily harm depression causes, and about the brain pathology that underlies its symptoms. Increasingly, the prevailing scientific myth had it that depression is neither more nor less than illness, but illness merely. I wanted to imagine how our beliefs, our art, our sense of self might change as the medical view became a cultural commonplace. But I had no illusion that the moment was at hand. My work with patients and my conversations with readers reminded me daily that we retain a confused -- partial, anachronistic -- understanding of depression. Peter D. Kramer is a clinical professor of psychiatry at Brown University. This essay is adapted from Against Depression, published in May by Viking. Copyright (c) 2005 by Peter D. Kramer. ________________________________ http://chronicle.com Section: The Chronicle Review Volume 51, Issue 35, Page B11 -- You are encouraged to post poetry, respond critically to the poems circulated and participate in discussions. To post, email your message to [email protected] OR post online at http://groups.yahoo.com/group/ZESTPoets/post/ Tell friends to subscribe to ZESTPoets by sending a blank email to [EMAIL PROTECTED], OR, if they have a Yahoo! 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