Depression gives us so much to reflect upon. Experiences of sadness, lethargy, loss of appetite, sleep disturbances, and withdrawal from everyday life have been reported across the ages, yet there are things that are new about depression. During the 20th century, it became an illness that warranted expert care. It was not transitory and it was scientifically described as a distinct set of symptoms. Depression also came to be experienced by more and more people, not just in the United States, but throughout the world. We might ask them, is depression a disease? Is a disease of modern life? Is it an understandable response to increasing demands of the social world caused by unrealistic expectations for individual success or the fading of collective life? Is it caused by changes in the environment, pollution, crowding, scarce resources? Is it's remarkable proliferation related to the comparably remarkable expansion of pharmaceutical remedies? We cannot reflect on all the questions raised by this amazing ascendancy of this mental health condition. Today, we will focus on one. This question is broad, however, it invites us to critically examine what it means to live life well. Ultimately, and asks whether depression's opposite is happiness and whether 20th century science and culture have generated heightened expectations about personhood. Before proceeding, it's important for us to remember something we discussed in an earlier class. Depression is real, it is a thing, and also some people suffer greatly. Today's reflection will concern not those who are suffering greatly, but the vast majority of other kinds of suffering or feelings of depression. This reflection concerns the ways in which depression came to be understood as a loss of much more than well being. Depression has come to be much more substantial and complex than Kraepelin's definition of the early 20th century. Kraepelin referred to depressive states that were endogenous that is caused by internal, not external factors, and had good progress of prognosis of recovery. Now by that time, many Americans already were engaged in the need to maintain mental health and what constituted mental health was much more than the absence of disturbing mental experiences of depression. According to historian and psychiatrist, Laura Hirshbein, and I quote her, depression as an illness became meaningful to the American public because of the ways in which it addressed pre-existing conflicts and issues within American culture. Issues that can be traced to changes in popular magazine coverage in the first half of the 20th century. Hirshbein ads, depression did not emerge in the second half of the century as a full-blown market phenomenon. It emerged in the context of existing markets for personal and national mental health that had evolved in the first half of the century, end quote. An important note here, until very recently, depression was a matter of concern largely for white Americans of financial means. The market was not available to all. What constituted mental health was to evolve during the 20th century, expanding its vision of what was normal as being successful, vibrant, industrious, engaged, and well, happy. Early evidence of this capacious thriving personhood is seen in a popular book on depression called When Life Loses Its Zest, written by the psychiatrist Abraham Myerson. Depression or the word he coined anhedonia, he explained is the loss of the energy feeling. Yet Myerson described the absence of this loss of energy, this depressive state as something more. It is, and I quote him, pep, zeal, courage, concentration, interest, and pleasure. This was written in 1925. By the 1930s, Myerson was recommending amphetamines not only for depressive, but also for normals as a means to eliminate low moods and hangovers. The ideals of normal mental health started creeping upward. By the 1950s, amidst the era of prescribing tranquilizers for depression, physicians also recommended their use for any number of life's hurdles, aspirations, and dreams. A 1955 article in the Journal Science recommended one of these tranquilizers for, and I quote from the journal, the normal population. A businessman with a demanding and unreasonable supervisor, or a woman with insufficient funds to ride her home according to her ideal standard, end quote. Other medical articles recommended tranquilizers for premarital jitters, complicated work projects, bereavement, and resentment. The mass marketing antidepressants in the 1970s and the arrival of SSRIs like PROzac in the 1980s, evidenced further escalation of what emotions, thinking, and forms of engagement with the world constituted mental health. As seen in the ads presented during the last class, the goal was not simply the alleviation of depression, but also and importantly, the realization of success, power, happiness, and peace. Thus, over the last century, the opposite of being depressed became more than being not depressed. A telling example of the heightened expectations for mental well being is seen as psychiatrist vehement debates over whether grieving the death of a loved one is a mental disorder. Psychiatrists developing the fifth edition of the DSM around 2000 had proposed that grief due to death of a loved one could constitute a depressive disorder. Many psychiatrists who are opposed to this proposed expansion of depressive disorder to include the human experience of bereavement, spoke vehemently. As Allen Frances argued, and I quote Frances, turning bereavement into a major depression would substitute a shallow, Johnny-come-lately medical ritual for the sacred mourning rites that have survived for millenniums. To slap a diagnosis and prescribe a pill would be to reduce the dignity of the life lost and the broken heart left behind, end quote. A similar question can be asked about the ways in which definitions of depressive disorders mark melancholy feelings as undesired, as abnormal, or pathological experiences that warrant treatment. Writer Eric Wilson argues against the corralling of all forms of sadness in a mental disorder of depression. He warns, and I quote him, American culture's overemphasis on happiness at the expense of sadness might be dangerous, a wanton forgetting of an essential part of full life, end quote. Wilson's analysis beckons attention to the fact that suffering is an essential and natural part of life. As witnessed in the lives of artists and thinkers, sadness and low feelings also can be an important precipitator of growth, change, and creativity. Wilson finds that too often we complete sadness and depression, thereby facing sad feelings and canceling their restorative functions. What's more, living by the ideal of stead, positive, happy, and successful state of mental health, we might find that happiness becomes blase and even inauthentic. With a century long expansion of what constitutes depression and modifications of what is expected of normal life, we can launch a project of reflective thinking. While there are individuals who suffer greatly and we should not forget this, is it not possible that the help that many seek in antidepressants and therapy is less about depression. And more about how a growing desire to live without melancholy, without sadness, without loss, and instead to be continually and positively happy. Is unhappiness becoming abnormal? Is there no value in experiencing a range of emotional states, the highs, the lows, responding to life's uncertainties with appropriate emotions? Are we living with what some of call a happiness cult? And importantly, which Americans are privileged to join this cult to seek escape from life's hazards and dangerous and find perpetual fulfillment.
