From “Manufacturing Depression,” which appeared in the May 2007 issue of Harper’s Magazine. The complete article—along with the magazine’s entire 175-year archive—is available online at harpers.org/archive.
Once upon a time, the scientific explanation for depression sounded something like this:
If one listens patiently to a melancholiac’s many and various self-accusations one cannot in the end avoid the impression that often the most violent of them . . . fit someone else, someone whom the patient loves, has loved or should love. . . . The self-reproaches are reproaches against a loved object which have been shifted away from it on to the patient’s ego.
For a modernist like Sigmund Freud, who wrote “Mourning and Melancholia” in 1917, depression was embedded in history, personal and cultural, and untangling that history, rescuing it from the oblivion of the unconscious by turning it into a coherent story, was the key to a cure. But his fascinating and tragic notion—that we carry within us an other whom we can never fully know, but whom we must try to know—is now headed for the dustbin of history. Freud, with his extravagant hermeneutics, his because-I-said-so epistemology, his unfalsifiable claims—not to mention the sheer inefficiency of psychoanalysis—has given way to the doctors of the world, with their inventories and brain scans and pills. They have replaced Freud’s unconscious, the repository of that which is too much to bear and which will stop tormenting us only to the extent that we give it language, with an unconscious populated by carbon and hydrogen and nitrogen and oxygen, the basic building blocks of the material world, essential but forever dumb. Still, I’m not exactly pining for Freud at the Depression Clinical and Research Program of the Massachusetts General.
This is the heart of the magic factory, where I have met the criteria for a study that the hospital is running on pharmaceutical treatments for major depression—and where medicine is infused with the miracles of science. Except I never use the term “magic factory” with the doctors (you wouldn’t want to seem paranoid in a place like this), though I had my suspicions of the drug industry. Not that diseases care whether you believe in them. What matters is the evidence, how much insulin is in the blood or how much sugar in the urine, and all the other ways nature has of telling you something is wrong. And yet there is no lab to send my bodily fluids to in order to assay my level of depression.
Out on the street, blinking in the noonday sun, I peer into the brown paper bag they have given me. The “study medicine” comes in a pair of plastic bottles stuffed with two weeks’ worth of glistening amber gel caps. They look just like regular prescription drugs but for the sticker that says drug limited by federal law to investigational use. That seems a little dramatic for fish oil, something I can get at any health-food store or by eating however much salmon it would take to provide two grams of omega-3s per day. But under the agreement we’ve made—that they are doctors, I am sick, and must turn myself over to them so they can cure me—the medicine must be treated with the reverence due a Communion wafer.
I make a sudden decision: to duck into a restaurant, to order a glass of water with my meal, to start the trial not tomorrow morning, as I’m meant to, but now. I cannot resist the temptation to lay down my pessimism at this altar, to put myself in the hands of these doctors, to take their investigational drug and let them cure me of myself. I gulp down my six golden pills.
