Depression: Should we be rid of it?

Am I as happy as I should be?

We've become so obsessed with that question that it's making us miserable, says psychotherapist Gary Greenberg.

Look at pop culture, says Greenberg, 52, who has worked as a therapist for 26 years: We are beset by messages from positive-thinking hucksters, New Age gurus, self-help authors, and prosperity theologians who tell us we are entitled to wealth and happiness - but only if we think positive. Be negative, and you'll be inviting destruction and ruin.

Greenberg, author of the revelatory polemic Manufacturing Depression: The Secret History of a Modern Disease, says the self-help mania is another aspect of hyper-consumerism that encourages an "irrational exuberance" by promising products that will provide meaning to our lives.

Worse, Greenberg says, more and more doctors, psychiatrists, and therapists are selling us the same lie.

Speaking from his office in New London, Conn., the Swarthmore alumnus says therapy - for those who could afford it - once provided a bulwark against the increasingly unrealistic demands we make on ourselves to reach the fantastical promises fed to us by our culture.

He asserts that recent advances in psychiatry, which have redefined "depression as a medical disease caused by a biochemical imbalance in the brain" and treatable with drugs such as Prozac, have convinced many Americans that there's a "magic bullet" that can make our suffering disappear.

This "Prozac revolution," Greenberg argues, has put the worst aspects of positive thinking "into a white lab coat. . . . And you know what happens when we see a guy in a lab coat on TV: We sit up and pay attention."

And how!

In 1987, when Prozac and other SSRIs (selective serotonin reuptake inhibitors) were coming on the market, 44.6 percent of adults treated for depression were prescribed medication. A decade later, the proportion had grown to 79.4 percent. By 2005, it had become virtually unthinkable to treat depression without drugs.

In 2005, 20.9 million American adults, or 9.5 percent of the adult population, had a mood disorder, a category that includes depression and bipolar disorder. In that same year, 27 million, or 10 percent of the adult population, were on antidepressants. (The drugs also are used to treat other psychiatric disorders, such as anxiety, which explains the disparity between the numbers, Greenberg says.)

Psychiatrist Peter D. Kramer, whose 1997 best-seller Listening to Prozac popularized the medical model of mood disorders, applauds the development of new antidepressants.

"Depression is a quite ordinary multisystem disease" that affects "brain, bone, blood elements, heart [and] endocrine glands," he says in a phone interview. He adds that while "life circumstances can trigger" it, there's overwhelming evidence that depression has a biochemical cause.

Kramer says Greenberg is one in a long line of artists and thinkers, including Sigmund Freud, who romanticize melancholy. This pessimism, he says, has colored our culture for far too long.

"It is the height of hubris to say that everyone with depression is in an alienated . . . relation to the culture," Kramer says. He cites one of his patients who made similar, "stereotyped depressive outcries" about the state of the world. "Really, all she needed to be all right with the world was to have her depression lift."

For his part, Greenberg admits that drugs can help many patients cope with their suffering. He insists he's interested not in debating the causes of depression, but in exploring how the way we talk about human suffering affects our basic values.

"What's at stake here is who we are," he writes in Manufacturing Depression, "what kind of people we want to be, what we think it means to be human."

Suffering, he says passionately, "was once seen as a meaningful aspect of human life which has to do with our life history, our transactions with the universe, and with others in a social context."

Therapists, he asserts, looked at people as if they were an ongoing story and taught them to achieve a certain level of equanimity by cultivating healthier ways to interpret their lives. By contrast, today people "are reduced to biological mechanisms."

Bala Cynwyd psychiatrist Elio Frattaroli agrees. "Our culture has a problematic attitude toward disturbing emotions," he says. "We have this idea that the proper way to be is to be happy and that if you have any variety of unhappiness, you are not right."

Frattaroli, whose 2002 book Healing the Soul in the Age of the Brain criticizes the medical model of mood disorders, says this view of suffering is upside down. "Painful emotions are a part of the healing process," he says. "You shouldn't try to get rid of them, but learn to see them as guideposts, indicators that you are not happy with your life."

Greenberg says the psychiatric establishment's suspicion of negativity has two dangerous consequences.

First, he says, "an increasingly larger area of human experience . . . of human unhappiness has been redefined as illness."

And he takes exception to the belief that we must eradicate depression for good, like cancer or diabetes.

"This attitude puts you in a state of longing" for a life free of depression and unhappiness, he says. "That longing is experienced as inadequacy and doubt, which are frowned upon as an illness."

So how do we escape this vicious cycle?

"Instead of selling false optimism, doctors should be honest," Greenberg says. "They need to own up to the obvious truth - this is a hard world to live in and we are routinely faced with demands that are simply impossible."

Greenberg, no fan of Freud's theories, nonetheless believes the Viennese psychoanalyst has something important to teach us.

"Freud wasn't saying the world is bad in itself," he says. "Freud wanted to instill a carefully cultivated pessimism . . . a willingness to see our lives and our social and political systems with a constant critical vigilance."

Frattaroli accuses the mental health industry of distracting us from the ethical task of attending to our inner lives.

"If you don't pay attention to your inner life," he says, "you lose your bearings, your moral compass, and all sense of meaning."