I never intended to write book reviews when I began this blog.  However, since the book deals specifically with depression, I felt that it is pertinent to my intent, which is to help others with their depression.

The title, Manufacturing Depression: The Secret History of a Modern Disease, by Gary Greenberg intrigued me.

I believed, based on the title, that I was going to get a thoughtful, well-researched study on the pharmaceutical industry's avarice.  A study that exposed the industry's penchant to put profits above all other concerns, even if it meant millions of Americans taking anti-depressants for a disease (depression) which they really did not have--that they only believed that they had  because they were inundated by slick advertising campaigns telling them that any form of sadness  lasting longer then "normal" is depression.    I am writing in the United States.  One of only two countries in the world that allows television advertisement of drugs.  The other country being Australia.

I cannot say that I was totally disappointed with the book.  Yet, this was a book with an agenda(s) that trumps all else.  Greenberg  has a bone to pic with the pharmaceutical companies that created anti-depressants, the doctors that prescribe them, and with  author Peter D. Kramer. The gist of the book, is that depression is not a disease and it is not something that can be diagnosed with with the American Psychiatric Association's Diagnostic and Statistical Manual. Good intention, perhaps.  The problem is that this book is more of a diatribe than a well researched argument against what is wrong with the treatment of depression.

Early on in the book Greenberg notes that a definitive definition of what constitutes a disease is elusive. Yet, he does not provide his own definition, which would have done validate his thesis that depression is not a disease.  His argument for depression not being at the same level as an ailment such as heart disease, is that pharmaceutical companies discovered, often haphazardly, that some drugs individuals suffering from depression feel better, therefore their must be a disease that the drug is curing.  He, I believe, is right in stating that this  is not a valid method of determining whether or not a malady of the brain is a disease or not. Yet, just because the method used to determine the validity of a disease is not valid itself, it does not fallow that the malady being tested is not a disease.  It just means that another method should be employed.

Greenberg offers some evidence to support his argument.  He argues that  anti-depressants are not that effective in "curing" patients, which they are not.  And, he also offer his own experience in a anti-depressant study.  In this study, Greenberg drove to Boston weekly to check in with the doctors.  In the end he was declared healed.  After the study was completed, Greenberg sent one of his extra pills out for analysis.  Turns out he was taking a placebo.  Yet, this evidence only proves that anti-depressants are not all that the slick commercials claim--they are not magic bullets.

However, again, proving that anti-depressants are not that good at treating depression does not prove that depression is not a disease.  Greenberg argues that depression is nothing more than life.  If you live, you will get depressed.  There is a lot of truth to this argument.  But, why are so people unable to get better own there own, why are some people so much better with dealing with what life throws at them.

Greenberg told of his own experience of being in what he described as a two year depression which included an inability to commit to his long-time girlfriend who moved across the country to be with him.  After one night of an Ecstasy induced euphoria Greenberg saw everything clearly--that life was good.  And, according to him this episode ended his battle with depression, and he proposed to his girlfriend.  Pharmaceutical drugs, bad.  Illegal drugs, good.  I believe that the point of telling this story is that the drugs that are concocted in the labs of large pharmaceutical companies are no better than the drugs created in the makeshift labs of drug dealers.  And, based on his own accounts he seems to enjoy the latter much more than the ones with gatekeepers (doctors and pharmacists).

The author does not direct all of his animosity toward the drug companies.  Much of it is reserved for Emil Kraeplin and all of the evil that he has spawned, with the Diagnostic and Statistical Manual (DSM) taking most of the punches.  Kraeplin was the first to create lists of symptoms for determining the mental disorder that a patient had or did not have. This way of viewing mental disorders eventually lead to the DSM.   If you are not familiar with the DSM, it is the manual that those in the mental health profession use determine if someone has a mental disorder.  It has easy to use checklists. This may be bit of a simplistic description of the DSM.  However, how it works is the mental health professional  is provided with list of possible symptoms for a  mental disorder, and if the person meets the minimum required number of symptoms, then presto, that person has a mental disorder.

The author, in an attempt to show how the inherent flaws of the DSM, discusses homosexuality.  The DSM, and thus its creators the APA, use to define homosexuality as a mental disorder.  This was until the gay and lesbian community got wind of their new distinction.  The APA had a rethink, and took homosexuality off the list of mental disorders.  I agree that a checklist is not the best method of determining if someone has a mental disorder.  And I hope that any professional in the field will not solely use a DSM checklist to determine if someone has a mental disorder.  However, I have a real problem with the author using homosexuality as an example of how flawed the DSM is in determining mental disorders.  The author never delves into the reasons that homosexuality may have been originally listed as a mental disorder, which perhaps had a lot to do with society's view toward homosexuality.  That they were individuals that needed to be fixed, and if they had a mental disorder they could be fixed.  Nor, does he discuss the issue of  DNA's role in homosexuality, which may have led to a discussion on how the APA decision to place homosexuality on the list of mental disorders preceded the science of DNA mapping.  As far as I know DNA mapping has not found a depression gene.

Finally there is the vituperation that he directs towards Peter Kramer.  It is ubiquitous in the early pages, and it then reappears toward the end of the book.   I  have read Kramer's Against Depression, which I found to be a great book.  Kramer argues that depression is very real and those that are afflicted with it really suffer a lot. And it is time to stop suggesting that despression can be good for such things as creativity.  Greenberg seems to be more upset by Kramer's book Listening to Prozac.  I have not read the book, so I am not going to try to provide a synopsis.   But, as the title suggests, and as Greenberg discussion on Kramer's book reveals, it seems to make an argument for anti-depressant drugs.    Greenberg does not provide a very overwhelming case against Kramer and anti-depressants drugs except that he really does not like them. More real substance, empirical evidence against the drugs, would have greatly improved this study.

And, this is the problem that I have with most of the book. There is too much anger and not enough of a researched based argument against the onslaught of anti-depressant drugs, which is what I thought that I was going to get when I read this book.  I learned the basics, that anti-depressants have not been shown to work that well in comparison to a placebo.  Yet, I did not learn that anti-depressants  alter the way that  a brain functions, so that if and when someone come off of the drug you may be worse than you were before taking the drug.  I learned this from reading Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Metal Illness in America.  I have not finished this book, but I am enjoying if more,  and learning a lot more, than I did reading Manufacturing Depression.

Perhaps I will write a review of Anatomy of an Epidemic after I have finished reading it.

Enjoy life,

Peter