Over at Salon.com there is an excellent piece about depression: “Van Gogh on Prozac.”

The piece actually goes into some things I’ve been wanting to post about for quite a while actually, especially based on some recent conversations I’ve had with various people about the nature of depression, the definition of “normal,” the use of prescription medicines to treat mental “illness,” and so on.

First, as a bit of a disclaimer, I am not on any medication. I do not consider myself depressed. At times in my life, I think I probably was (so was it really depression? I don’t know) and considered seeking out therapy and/or medication to help me. That said, I have quite a few friends who are either taking medication, once took medication, or decided not to take medication. I also had a friend in college commit suicide after starting an antidepressant. I also know someone who is a psychology graduate student who seems convinced that I have quite a few psychological problems and is a strong proponent of cognitive behavior therapy.

All that said, I think it’s fair to say that I spend quite a bit of time thinking about mental health issues and have given a lot of thought to the intricacies and whatnot of the issue. Also, the next book I plan to read is Michel Foucault’s Madness and Civilization: A History of Insanity in the Age of Reason (which may not have to do with depression, necessarily, but, I imagine, involves some similar modes of thought).

The most enlightening conversation I had about antidepressants was with a friend of mine who has been taking them for years. I would consider him to be an “artist” (he is currently getting an MFA) and an intellectual. I asked him once whether he felt the antidepressants affected his ability to get in touch with his feelings and produce art. I was, at the time (and maybe still am?), enamored by the idea of the “tortured artist” who is depressed and lonely and all that, sitting alone somewhere creating great works of art that speak to the human existence and the truth of the world and stuff. My friend, however, said that since he started antidepressants, he found he was able to be more prolific because he was more focused and not so blasé about life. He also said that prior to antidepressants, he was more interested in imagery and poetry and that now his poetry isn’t as much like that. (The conversation was a while ago, so I don’t remember many of the specifics.)

Another conversation I remember took place during college. One of my friends was talking to another friend who was on antidepressants, and the friend who wasn’t, but would probably claim that he had some sort of depression, kept talking about how he was glad he wasn’t on antidepressants because he was afraid that they would affect his artistic integrity. As I recall (or maybe this is me being dramatic), my friend, who was on antidepressants, made a comment about how if it weren’t for the antidepressants, she probably wouldn’t be alive and functioning, so he should shut up and stop being pretentious.

Both of these little stories touch on the common belief that somehow equates a depressed person with an artist who is in touch with the truth and brutality of human existence.

The author (Peter Kramer, who wrote Listening to Prozac and Against Depression) interviewed in the Salon.com article strongly disagrees with this point. The article makes his point clear:

Depression, in many people’s minds, is integral to the creative temperament. We might lose some of the triumphs of art and culture if it were wiped away.

This vision of depression [of “the depression was not her fundamental self, or a window into buried feelings”] flies in the face of the common belief that the depressed are deeper and more authentic than the cheerful rabble. Kramer rails against the notion that depression is the only honest, thoughtful response to a cruel world, that we must choose between despair (or a kind of sardonic brooding) and a plastic, smiley-face mask of denial.

The psychology student that I know makes a claim like this. He says that because, he claims, I am so aware of the “cruel world,” that the only way I know how to cope is with “sardonic brooding.” So this example really struck me.

Based on the article, it sounds like Kramer advocates a combination of antidepressants and therapy. I’m willing to bet that the “therapy” involved would be cognitive therapy.

Cognitive therapy, based on my understanding, basically means making the patient self-aware of small things that he or she can do in order to make his or her life more livable. That is, make the patient cognitive of negative behaviors so that the patient can change them.

To me, and based on the psychology guy’s attempt at using cognitive therapy on me, this can be pretty torturous to the patient. Imagine feeling depressed or insecure or anxious and going to a therapist and having him or her tell you that the key to being happier is being more social. Well duh, you probably knew that already… but you don’t feel like being social. So as part of the therapy, the therapist tells you to go to a crowded mall every weekend and spend an hour walking around. Gradually over time, increase that to two hours, three hours, whatever.

As far as I can tell, when cognitive therapy doesn’t work, the blame seems to fall on the patient because he or she wasn’t trying hard enough to change or whatever or worse yet, that the patient “doesn’t really want to change.” This really pisses me off.

Cognitive therapy, in my opinion, is just trying to candy-coat one’s condition (if that metaphor makes sense?). Rather than really treating the underlying issue (anxiety, failure to get over some trauma from the past, etc.), the therapist just tells the patient to “be more happy” and “try harder at life.” If that doesn’t work, the patient is blamed (not explicitly, but rather indirectly) and probably ends up feeling more anxious.

One of the reasons I think I still like psychoanalysis, from some perspective, is that it looks to identify some “core” or “kernel” of a problem (“my mother was distant”, “I saw two dogs fucking when I was three years old”, whatever) and goes to that root in order to deal with your current problems. Yes, a lot of these root problems are ridiculous, so maybe it’s the belief that there is something deep down that can solve (not cover) the problem.

This loops back, again, to my overall theory of therapy. The psychology major I know argues that the goal of psychology is to allow the patient to live a happy life and function in society. I, on the other hand, think that psychology should solve the problem that makes the patient unhappy.

All this said, I’m no expert on any of these topics — like I said, I just think about them a lot. If this ever gets picked up by Google, I’m sure I can expect a barrage of angry psychology students debunking my thoughts. Oh well. That’ll just make me more anxious anyway.