Reviewed by: On Depression: Drugs, Diagnosis, and Despair in the Modern World by Nassir Ghaemi David Herzberg Nassir Ghaemi. On Depression: Drugs, Diagnosis, and Despair in the Modern World. Baltimore: Johns Hopkins University Press, 2013. ix + 215 pp. $24.95 (978-1-4214-0933-7). Nassir Ghaemi’s primer on existentialist psychiatry, On Depression: Drugs, Diagnosis, and Despair in the Modern World, is a thoughtful, ambitious, and flawed effort to persuade Americans (and their psychiatrists) that suffering is an important element of a meaningful life. The book begins in familiar territory with a critique of today’s expansive definitions of depression as illness. Ghaemi, a professor of psychiatry, director of a mood disorder program, and author of previous best sellers on madness and psychiatry, acknowledges that true depression (“depression disease”) is biological and should therefore be treated with medication. But, he argues, most depression—the kind that “is not episodic, that is chronic and admixed with anxiety”—does not have biological causes and is therefore not a disease (“depression nondisease”; p. 14). Moreover, he points out in a welcome (if brief) chapter on “Abnormal Happiness,” not all happiness is desirable either. Mania can be debilitating, and psychiatrists, he fears, may be fostering it by prescribing Prozac to people with nondisease depression (p. 41). Ghaemi prefers a skeptical approach that he frames as Hippocratic by way of Osler: prescribe “for diseases, not symptoms, and not even for all diseases” (p. 54). If most depression is not disease, what then should be done about it? Ghaemi answers this in the book’s best and most heartfelt section, called “Guides,” which offers a series of paeans to his intellectual heroes. Viktor Frankl taught him the importance of suffering, and of learning to suffer. Existential psychologist Rollo May translated this cosmic truth into the therapeutic encounter, which, he argued, should encourage awareness of suffering but also affirm existence in spite of it. Ghaemi’s former mentor Leston Havens and historian of psychoanalysis Paul Roazen demonstrated how to acknowledge both biology and “problems of living” in patients despite the apparent contradiction. And, finally, Karl Jaspers showed the necessity to “accept science as true” while recognizing its limits and thinking rigorously and seriously about the territory of faith that lies beyond it. Together, this mix of canonical intellectuals and personal figures is both affecting and effective at conveying Ghaemi’s argument that most depression is not biological disease but an existential challenge to which we must rise. Suffering and eventual death are real for all of us, and so are the anxieties and depression that they quite reasonably cause. “The only way out,” he concludes, “is to choose to live ... to find a way to decide that life is worth living” (p. 167). Many historians of medicine would likely be sympathetic to this reasoning, but Ghaemi alienates at least some such potential allies with a sustained but simplistic polemic against what he sees as the truth-denying, relativistic “postmodernists” who have “taken hold of all academia” (p. 63). This section of the book, called “Pretenders,” offers such un-illuminating jabs as the suggestion that postmodernists should “stop taking their antibiotics and avoid their vaccines” (p. 142), and the more serious charge that postmodernists’ “moral relativism” allowed “space [End Page 628] for the banality of evil that led to the Jewish genocide” (p. 60). He spends a whole chapter vilifying historian David Healy—a controversial figure to be sure, but hardly one lacking moral convictions or respect for empirical evidence. It is, frankly, depressing to read someone as smart as Ghaemi dismissing nearly a whole generation of humanistic scholarship because it does not share his proudly Whiggish faith in science. Interestingly, Ghaemi is able to preserve that Whiggish faith only by defining developments he dislikes as unscientific. The recent increase in use of ECT for depression, for example, does not count as science because it has happened “for ideological and economic reasons” (p. 78). The DSM-IV also represents a departure from science because it was shaped by “pragmatic, professional, economic, social considerations” (p. 84). And despite the wonders of modern science, on the all-important question of depression, Ghaemi, like many of the people he denounces...
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Jan 1, 2023
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