On Depression: Drugs, Diagnosis, and Despair in the Modern World

by S. Nassir Ghaemi

Overview

Lasting happiness comes not from chasing the American dream but from living an authentic life—which includes despair.

In a culture obsessed with youth, financial success, and achieving happiness, is it possible to live an authentic, meaningful life? Nassir Ghaemi, director of the Mood Disorder Program at Tufts Medical Center, reflects on our society's current quest for happiness and rejection of any emotion resembling sadness. On Depression asks readers to consider the benefits of despair and the foibles of an unexamined life.

Too often depression as disease is mistreated or not treated at all. Ghaemi warns against the "pretenders" who confuse our understanding of depression—both those who deny disease and those who use psychiatric diagnosis "pragmatically" or unscientifically. But experiencing sadness, even depression, can also have benefits. Ghaemi asserts that we can create a "narrative of ourselves such that we know and accept who we are," leading to a deeper, lasting level of contentment and a more satisfying personal and public life.

Depression is complex, and we need guides to help us understand it, guides who comprehend it existentially as part of normal human experience and clinically as sometimes needing the right kind of treatment, including medications. Ghaemi discusses these guides in detail, thinkers like Viktor Frankl, Rollo May, Karl Jaspers, and Leston Havens, among others.

On Depression combines examples from philosophy and the history of medicine with psychiatric principles informed by the author's clinical experience with people who struggle with mental illness. He has seen great achievements arise from great suffering and feels that understanding depression can provide important insights into happiness.

Product Details

ISBN-13:	9781421409337
Publisher:	Johns Hopkins University Press
Publication date:	07/01/2013
Pages:	232
Sales rank:	584,814
Product dimensions:	5.90(w) x 8.50(h) x 0.90(d)
Age Range:	18 Years

About the Author

Nassir Ghaemi, M.D., M.P.H., is a professor of psychiatry at Tufts University School of Medicine and the director of the Mood Disorders Program at Tufts Medical Center in Boston. He is author of the bestseller A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness, as well as The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry and The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, both published by Johns Hopkins.

Table of Contents

Preface ix

Part I Entrance 1

1 Lives of Quiet Desperation 3

2 The Varieties of Depressive Experience 11

3 Abnormal Happiness 28

4 The Age of Prozac 35

5 The Unknown Hippocrates 44

Part II Pretenders 55

6 Postmodernism Debunked 57

7 Pharmageddon? 65

8 Creating Major Depressive Disorder 75

9 The DSM Wars 80

Part III Guides 91

10 Viktor Frankl: Learning to Suffer 93

11 Rollo May and Elvin Semrad: I Am, We Are 98

12 Leston Havens: Holding Opposed Ideas at Once 112

13 Paul Roazen: Being Honest about the Past 130

14 Karl Jaspers: Keeping Faith 138

Part IV Exit 151

15 The Banality of Normality 153

16 Two O'clock in the Morning 164

Acknowledgments 173

Appendix. Listening to Despair: An Interview by Leston Havens 175

Notes 179

Bibliography 195

Index 207

What People are Saying About This

Edward Shorter

Ghaemi’s distinction between ‘depression disease’ and ‘depression nondisease’ is pioneering and will open the eyes of a number of disease-designers who are currently struggling so mightily to classify the illnesses of psychiatry. But Ghaemi, a distinguished psychiatrist of vast clinical experience, will also open many patients’ eyes: Does my kind of depression need medication? If it isn’t depression I have, what’s going on with me? Even more penetrating: My happiness is abnormal? These are not trivial questions, and Ghaemi’s mastery of literature as well as clinical learning makes the lessons go down mighty easily.

Joshua Wolf Shenk

Nassir Ghaemi blends the wisdom of a seasoned clinician, the hard data of rigorous, original research, and the long view of a scholar steeped in humanities. He is an indispensable voice and with this book—among many others—he has found his place among the eminent ranks of modern writers on depression.

Michael Trimble

Nassir Ghaemi’s quest to make sense of the split between science and the art of psychiatry, pursued brilliantly in his previous writings, gallops ahead in this book, which ransacks the near empty cellars of post-modernism and reinstates common-sense and tradition in a search for meaning in mental health and its disorders in modern life.

Peter D. Kramer

Ghami’s great aptitude is for the provision of context. If the psychiatric encounter sometimes seems routine—paused at decisions about prescribing—still and always, so Ghaemi reminds us, it is grounded in the humane insights of generations of thinkers dedicated to the wellbeing of those who suffer. Ghaemi brings wisdom to bear on the series of challenges inherent in the treatment and understanding of depression.

From the Publisher

Nassir Ghaemi’s quest to make sense of the split between science and the art of psychiatry, pursued brilliantly in his previous writings, gallops ahead in this book, which ransacks the near empty cellars of post-modernism and reinstates common sense and tradition in a search for meaning in mental health and its disorders in modern life.
—Michael Trimble, M.D., Institute of Neurology, London

Ghaemi’s distinction between ‘depression disease’ and ‘depression nondisease’ is pioneering and will open the eyes of a number of disease-designers who are currently struggling so mightily to classify the illnesses of psychiatry. But Ghaemi, a distinguished psychiatrist of vast clinical experience, will also open many patients’ eyes: Does my kind of depression need medication? If it isn’t depression I have, what’s going on with me? Even more penetrating: My happiness is abnormal? These are not trivial questions, and Ghaemi’s mastery of literature as well as clinical learning makes the lessons go down mighty easily.
—Edward Shorter, Ph.D., FRSC, University of Toronto

Ghaemi’s great aptitude is for the provision of context. If the psychiatric encounter sometimes seems routine—paused at decisions about prescribing—still and always, so Ghaemi reminds us, it is grounded in the humane insights of generations of thinkers dedicated to the well-being of those who suffer. Ghaemi brings wisdom to bear on the series of challenges inherent in the treatment and understanding of depression.
—Peter D. Kramer, author of Listening to Prozac and Against Depression

By any measure, this is an important book that goes where thinking about mental illness has never gone. Certainly it will play a role in proving that depression is almost a necessity to actually live and make sense of life. Nassir Ghaemi gives tremendous meaning to my own suffering.
—Andy Behrman, author of Electroboy: A Memoir of Mania

Nassir Ghaemi blends the wisdom of a seasoned clinician, the hard data of rigorous, original research, and the long view of a scholar steeped in humanities. He is an indispensable voice and with this book—among many others—he has found his place among the eminent ranks of modern writers on depression.
—Joshua Wolf Shenk, author of Lincoln's Melancholy

Andy Behrman

By any measure, this is an important book that goes where thinking about mental illness has never gone. Certainly it will play a role in proving that depression is almost a necessity to actually live and make sense of life. Nassir Ghaemi gives tremendous meaning to my own suffering.

Editorial Reviews

The key to happiness might be sadness—or maybe we need to expand our definition of “happiness” to include more introspectively low states, argues Tufts University psychiatry professor Ghaemi (A First-Rate Madness) in this scientific and philosophical treatise on depression. The author blames our culture of widespread discontent on two phenomena: the death of God and postmodernism. The former has made us to feel purposeless, while the latter has undermined psychiatric nosology by blurring the line between physical and existential symptoms. These cultural malaises have combined with overly prescriptive psychiatric practices to disastrous effect. Ghaemi spends the first part of the book outlining the intricacies of this large-scale problem before going on to profile several thinkers, or “guides” (including Austrian psychiatrist and Holocaust survivor Viktor Frankl), whose wisdom he believes can lead individuals toward a clearer understanding of themselves and their experiences of happiness and sadness. Ghaemi acknowledges that drugs do work for some people, and though his ideas about the necessity of pain and sitting through suffering are nothing new, his theory that understanding happiness requires accepting its impossibility—or at least embracing our time in the trenches—presents our darker moods in a more optimistic light. (July)

Publishers Weekly

An informed, challenging, and readable approach to a vital subject. Despair is in the title, but readers will rejoice in the reading.
—Library Journal

Ghaemi is a lucid and eminently reasonable writer.
—Zócalo Public Square

[On Depression] belongs in libraries serving graduate students of psychiatry, psychology, and, perhaps, philosophy.
—Melissa Nasea, Watermark

Clearly written, with mercifully short chapters for the uninitiated reader, Ghaemi's book elucidates how many of us already feel about the current construction of mood disorders, without having been able to articulate our misgivings.
—Alexander Langford, British Journal of Psychiatry

This is a fun and stimulating read for anyone interested in depression and other mood disorders.
—Helga Meier, Metapsychology

From the Publisher

[On Depression] belongs in libraries serving graduate students of psychiatry, psychology, and, perhaps, philosophy.

Watermark - Melissa Nasea

This is a fun and stimulating read for anyone interested in depression and other mood disorders.

Metapsychology - Helga Meier

Clearly written, with mercifully short chapters for the uninitiated reader, Ghaemi's book elucidates how many of us already feel about the current construction of mood disorders, without having been able to articulate our misgivings.

British Journal of Psychiatry - Alexander Langford

After the narrow confines of most psychiatric writing, it is refreshing to read an author who can quote knowingly from both Seymour Kety and William James and who can competently discuss topics as diverse as the mind-body problem and the relevance for psychiatry of Epicurus and Sufism. The book is a reminder of the rich banquet of conceptual and philosophical issues that are of relevance to our field but rarely make it into the standard literature.

Psychological Medicine

Ghaemi is a lucid and eminently reasonable writer.

Zócalo Public Square

"Ghaemi is a lucid and eminently reasonable writer."

Zócalo Public Square

★ 
Ghaemi (director, Mood Disorders Program, Tufts Univ. Sch. of Medicine; A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness) emphasizes the relationship between therapist and patient. His vigorous critique of psychoanalysis, prescription drugs (“Pharmageddon”), and the Diagnostic and Statistical Manual (DSM) stands out among recent books on the decline of psychiatry, a profession that now occupies “the same place scientifically as medicine did at the end of the nineteenth century.” Ghaemi puts to good use his knowledge of the pioneers of medical history, e.g., Hippocrates, Galen, Philippe Pinel, and William Osler. His appreciation of 20th-century therapists Viktor Frankl, Rollo May, and Elvin Semrad, philosopher Karl Jaspers, and his own mentors, psychiatrist Leston Havens and historian Paul Roazen, is heartfelt as well as intellectually rich. In his penultimate chapter, “The Banality of Mental Health,” Ghaemi examines norm, normal, and ideal. Normal is often mediocre, while among the outstanding and creative are many who suffer from mania and depression. “Who can say which is better?”

Verdict An informed, challenging, and readable approach to a vital subject. Despair is in the title, but readers will rejoice in the reading.—E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC
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Library Journal