Manufacturing depression Read online

  Poor Job! Pillar of Uz and patriarch of a large family, a God-fearing, evil-shunning “mark among all the people of the East,” he’s just minding his own business—which is considerable, according to the Bible’s detailed list, including “seven thousand sheep, three thousand camels, five hundred yoke of oxen and five hundred she-donkeys, and many servants besides”—when Satan challenges Yahweh to a duel over Job’s righteousness.

  Job is not God-fearing for nothing, is he? Have you not put a wall round him and his house and all his domain? You have blessed all he undertakes and his flocks throng the countryside. But stretch out your hand and lay a finger on his possessions: I warrant you, he will curse you to your face.

  Rabbis and priests have long argued about what role Yahweh plays in the mayhem that follows, whether he commissions the hit like a godfather or just turns a blind eye while Satan does his mischief, but from Job’s point of view this doesn’t really matter. Either way Yahweh’s wager spells disaster for Job. In one day, nomads swipe the oxen and donkeys and slay the servants, lightning strikes dead the sheep and shepherds, the camels are carried off by Chaldeans, and then, as Job discovers from the last in a line of bad-news messengers, his children are killed by a sudden storm.

  To Satan’s dismay, Job maintains his faith. But the Prince of Darkness prevails upon Yahweh’s insecurity one more time, and Job is inflicted with “malignant ulcers from the sole of his foot to the top of his head.” Job’s wife nudges him toward the dark side. “Curse God,” she says, “and die,” but Job will have none of it. “If we take happiness from God’s hand, must we not take sorrow too?”

  The story would end with Job’s impressive forbearance were it not for the arrival of three old friends—Eliphaz, Bildad, and Zophar—who ostensibly show up to console him. They weep and tear their clothes and then sit down silently with Job for seven days, turning their visit into the ritual week of mourning. And in that week, something happens to Job—perhaps the extent of his catastrophes sets in or the pain and disfigurement of his ulcers take their toll, or maybe he recognizes that in some way his comforters are sitting shiva for him rather than with him, that stripped of his wealth, family, and dignity he is as good as dead. Whatever the occasion for his change of heart, Job finally confesses the nearly unspeakable truth: he has lost his desire to live.

  May the day perish when I was born,

  And the night that told of a boy conceived.

  May that day be darkness,

  May God on high have no thought for it,

  May no light shine on it.

  Not only that, he tells them, he actually longs for what he is sure awaits him in death.

  I should now be lying in peace,

  Wrapped in a restful slumber,

  With the kings and high viziers of earth . . .

  Down there, bad men bustle no more,

  There the weary rest.

  Not all suicidal people are depressed. Sometimes they’re angry or trapped in desperate circumstances, or, in the case of the terminally ill, already dying and ready to take matters into their own hands. But Job is also irritable and implacable, uninterested in food or prayer or any of the things that once brought him pleasure. And like Evelyn—and nearly every depressed person I’ve ever met—he’s tortured by the bright light of day, sees it as a mockery of itself. “Why give light to a man of grief?” he asks his friends. “Why make this gift of light to a man who does not see his way?” It’s no coincidence that the two most famous recent memoirs of depression—William Styron’s Darkness Visible and Andrew Solomon’s The Noonday Demon (a metaphor he borrowed from Psalm 91, which Job also cites)—invoke this image. This total dejection, the demoralization that turns light into reproach and darkness into anguish is what makes Job’s wish to be dead a mark of what we call depression.

  I wouldn’t want to blame Job’s pitiful psychological state on his therapists. It’s nearly impossible, I think, to get used to being in the presence of someone whose “only food is sighs and [whose] groans pour out like water,” as Job puts it, who is both looking to you for comfort and yet ready to tell you why the comfort you offer just makes things worse. You fight off your impatience and fear and search for the words that will shine through what Hawthorne called “the black veil” and into whatever corner of his psyche is not shrouded in gloom, and you hope you come up with something more helpful than what these men offer to Job in his anguish. But still you have to wonder how they think it will help Job to level accusations disguised as questions like these:

  Can you recall a guiltless man that perished,

  Or have you ever seen good men brought to nothing? . . .

  Was ever any man found blameless in the presence of God,

  or faultless in the presence of his maker?

  Or this:

  And now your turn has come, and you lose patience too;

  Now it touches you, and you are overwhelmed,

  Does not your piety give you confidence,

  Your blameless life not give you hope?

  With comforters like these, who needs ulcers? That’s certainly what Job is wondering when he calls them “charlatans, physicians in your own estimation” and wishes that “someone would teach you to be quiet,” or when he asks, “Will you never stop tormenting me and shattering me with speeches?” But then again, he doesn’t order them to be quiet or to leave his house and take their sanctimony with them. Undoubtedly this is in part because they’ve cast doubt on his integrity, forcing him to defend himself, but we might also imagine that Job listens to them in hopes that he will hear something that will actually comfort him—if not a cure, then at least an explanation of what has happened to him, one that can restore his faith that life is fair and God is just or, by providing a reason for his suffering, assuage his grief.

  Job isn’t buying his self-appointed physicians’ answers, however. Indeed, their attempts to console him just seem to egg him on. With growing stridency and in agonizing detail, Job argues his case: if this could happen to him, then life itself is so unfair as to be cruel and meaningless.

  Is not man’s life on earth nothing more than pressed service,

  His time no better than hired drudgery,

  Like the slave, sighing for the shade

  Or the workman with no thought but his wages,

  Months of delusion I have assigned to me,

  Nothing for my own but nights of grief.

  Lying in bed I wonder, “When will it be day?”

  Risen, I think, “How slowly evening comes.”

  Slowly, inexorably, the personal becomes the universal, Job’s wish to be dead in order to escape his pain escalating into an indictment of life’s injustices:

  Why do the wicked still live on,

  Their power increasing with their age?

  They see their posterity ensured,

  And their offspring grow before their eyes.

  And from there into the most profound pessimism—a rejection of the very terms of existence:

  But man? He dies and lifeless he remains;

  Man breathes his last, and then where is he?

  The waters of the seas may disappear,

  All the rivers may run dry or drain away;

  But man, once in his resting place, will never rise again.

  And, finally, into blasphemy: he will take his complaint all the way to the top. “I mean to remonstrate with God,” says the man who started his mourning week demanding nothing of the sort.

  Now you have to admire Job’s chutzpah here: he is going to call God to account. If he knew what you know—that he has indeed gotten the royal shaft from the king of the universe—he’d also know that he has Him dead to rights. It’s a little perverse, of course, the way Job is betting against himself, as if being correct that life is not worth the candle—and pressing this case with its creator—is consolation for how bad he feels. But depressed patients sometimes do just this—make such a compelling case for the pointlessness of their lives and of life in general
that you don’t know whether to agree with them or to assert that their pessimism, as William James once said of Arthur Schopenhauer’s, is like “that of a dog who would rather see the world ten times worse than it is, than lose his chance of barking at it.”

  You don’t know, in other words, whether to read bleakness as symptom, which is exactly what Eliphaz does.

  Does a wise man answer with airy reasonings,

  Or feed himself on an east wind?

  Does he defend himself with empty talk

  And ineffectual wordiness?

  You do worse: you flout piety . . .

  A guilty conscience prompts your words,

  You adopt the language of the cunning

  Your own mouth condemns you, and not I

  Your own lips bear witness against you.

  Or as a latter-day Eliphaz might put it, Job is in denial and cannot see that disorder in his inner world has led to his view of the outer world, that “it is man who breeds trouble for himself as surely as eagles fly to the height.”

  Job’s inner life has been the subject of this story from the beginning, when God and Satan squared off about whether his piety was authentic or God-bought; Eliphaz is only taking this scrutiny one further step. Confronted with Job’s abjection, he does exactly what a depression doctor does: first, he invokes an idea about what a human being is supposed to be—someone who can take these blows and still maintain his faith and piety—and then he claims that Job’s problem is a failure to be that way. If Job were healthy, a modern Eliphaz would say, he wouldn’t be so distraught but instead would be able to see how he had bred trouble for himself (if not in the catastrophes themselves, then in his response to them). He would be able to roll with the punches and then move on to the rosier future, where, according to Eliphaz,

  You shall be safe from the lash of the tongue,

  And see the approach of the brigand without fear.

  You shall laugh at drought and frost,

  And have no fear of the beasts of the earth . . .

  In ripe age you shall go to the grave,

  Like a wheatsheaf stacked in due season.

  If only he were sufficiently pious, Job would have the ability to live through setbacks without losing heart.

  With all of this anticipation of the modern world, it’s tempting to say that Job was suffering from an undiagnosed case of depression, and that, had his comforters had prescription pads and an acquaintance with the techniques of cognitive-behavioral therapy, they could have relieved his suffering. But this misses a much more important way in which Job anticipates our modern understanding of depression: at the dawn of history, when confronted by the bewilderments of loss and by the human capacity for deep despair, self-appointed physicians sought to diagnose pessimism as a pathology within the suffering person. By the time the story leaves the comforters behind, when Yahweh thunders his answer “from the heart of the tempest,” informing Job of his insignificance and impertinence, of the absolute irrelevance of his puny notion of justice to the raw majesty of creation, the fix is in: the fault lies not with creation, not with a god who would sell out his best customer or, for that matter, who would send a man with a sense of justice into a world in which the gods roll us like dice, but with the man himself. Job’s desolation is an affront to the convictions of his therapists, and they desolation back with a diagnosis.

  “In its commonest form,” Peter Kramer wrote in Against Depression, “depression is a disorder of emotional assessment of experience.” People, struck by the inevitable misfortune of life, lose the ability to bounce back, which Kramer calls “resilience.” The result is what he describes as “a fixed tragic view of the human condition” that prevents people from moving “toward assertiveness and optimism.” This is Job’s problem from a psychiatrist’s point of view: he fails to see not only that he is mired in negativity, but also that his attitude itself is the problem. He mistakes his pathological view of things for an apprehension of the truth about his pain and the world in which he suffers.

  This misunderstanding, Kramer says, is a hidden wellspring of Western civilization, a culture that he says valorizes depression because it has been shaped by depressives. “Our aesthetic and intellectual preferences have been set by those who suffer…deeply,” he wrote. “If the unacknowledged legislators of mankind…are depressives, then we might want to examine the source of our value judgments when it comes to pessimistic views of the human condition.” Those judgments are flawed, Kramer believes; affronted by their victory, by the history they have written, he strikes back with a diagnosis.

  Not all the depression doctors are as articulate and forthcoming as Kramer, but I think he has spoken for them here, or at least accounted for one of the reasons that so much of our psychic suffering has come under the rubric of their disease. Your sadness doesn’t become depression until it has settled in for a while—officially, according to the DSM, for two weeks. So what happens on that fifteenth day? The depression doctors will tell you that the threshold is derived from statistics, but like so much about depression, it’s based on circular logic: the number was derived from the experience of people the doctors already considered depressed. So it’s left to us to figure out that what’s at stake is persistence. After two weeks, it seems, your dejection is at risk of becoming a fixed and tragic view that is not only unpleasant but also nearly taboo in a society dedicated to the pursuit of happiness—and that was, for different reasons, taboo in the land of Uz. Your sadness becomes depression, in other words, when it turns into pessimism.

  The arbitrary nature of fortune, the near certainty that unbidden catastrophe will visit each of our lives, the inevitability of mortality, a nature that is more generous with pain than with pleasure, in short, all the stacked-deck calculus of human existence—these are challenges to optimism if not outright invitations to pessimism, and that’s before we even consider what a hash we’ve made of both civilization and nature. But I don’t wish to mount a broadside against optimism or, Kramer forbid, more legislation for pessimism. Instead, I want to point out that the depression doctors have done exactly what Eliphaz and company did. Psychology may have replaced theology, but pathology is still the point: for Kramer no less than for Eliphaz, pessimism is evidence of interior disturbance.

  “On this medication, I am myself at last”: this is what Kramer tells us his patients say when their depression lifts. This may indeed mean that they have become healthy, that to be able to “laugh at drought and frost” is to feel the way nature intends them to feel. But it may also be that the self they have become can, thanks to the drug, give up the fixed and tragic view and live comfortably in an unchanged world. The usual—and, as we will see later, justified—rap against medicalized depression is that it doesn’t really distinguish between ordinary sorrow and pathology. But it may be, indeed I think it is the case, that the diagnosis also can’t distinguish adequately between disease and demoralization any more than the cure can distinguish between making people well and making them feel better about their lives. The depression doctors, in other words, may not be able to avoid the errors of Eliphaz.

  I don’t want to overstate this. I’m not worried that antidepressants will turn us into mind-numbed, smiley-faced zombies. The drugs aren’t that effective, at least not yet. But I do think we need to pay attention to our feelings of demoralization. Pessimism can be an ally at a time of crisis, and I think we’re living in one right now. Regardless of whether or not the drugs work, to call pessimism the symptom of an illness and then to turn our discontents over to the medical industry is to surrender perhaps the most important portion of our autonomy: the ability to look around and say, as Job might have said, “This is outrageous. Something must be done.”