杏吧原创

CHALLENGING a multibillion-dollar global industry is bound to be an uncomfortable mission, all the more so if you risk being accused of promoting suffering, being a denialist, or even of culpable ignorance. Few writers who take on the mental health industry can be doing it for the money or in the hopes of sales matching 鈥榮 1990s hit Listening to Prozac.

It was Kramer who coined the phrase 鈥渃osmetic psychopharmacology鈥� to describe a not-too-distant utopia in which drugs such as the selective serotonin reuptake inhibitor Prozac, normally used to treat depression, would be used to enhance or change personality. Kramer did warn of the drug鈥檚 downsides (tremors, loss of libido, suicidal ideation), but the prospect of exchanging shyness, timidity and other social dysfunctions for self-assurance, gregariousness and success ensured the book鈥檚 popularity.

Fast-forward to 2010 and optimism about biochemical aids in the endless pursuit of happiness or as fixes for misery seems to be vanishing like the morning mist. Writers continue to take the mental health industry apart, big genetics still fails to nail 鈥済enes for鈥� mental illness in any important sense, and the deadline for a new edition of the American Psychiatric Association鈥檚 Diagnostic and Statistical Manual of Mental Disorders has slipped a year amid ugly rows and claims that tens of millions of dollars could be spent on unnecessary drugs should new diseases with no clear scientific foundation be included in the DSM.

Gary Greenberg鈥檚 contribution to this melee is thoughtful and well written, though quite different from the scholarly, understated work of Allan Horwitz and Jerome Wakefield, whose (Oxford University Press, 2007) threw down such a powerful marker a few years ago. Greenberg is a psychotherapist and himself suffers from depression. He takes us with him on a journey that starts with the reminder that 鈥渆veryone is against depression, just as everyone is against war and child abuse and global warming鈥�. The issue is that we need to work out what doctors mean when they diagnose depression, and where that meaning came from.

Depression, says Greenberg, is not the result of any dark conspiracy but of the transmutation of unhappiness into a treatable illness. The disease is as much a 鈥渕atter of history as it is of science鈥�, he argues. And history we certainly get in a chapter amusingly entitled 鈥淛ob versus his therapists鈥�. But unlike poor old Job, who was sorely tried as a test of his faith, those who look to science for revelation expect suffering to be cured in a very different way from God鈥檚 restoration of Job鈥檚 wealth. As Greenberg warns, we would do well to recognise that the 鈥渄epression doctors鈥� and drug company sponsors 鈥渄on鈥檛 know any better than you or I what life is for or how we are supposed to feel about it鈥�.

鈥淭hat depression is treated as a disease is as much a matter of history as it is of science鈥�

Manufacturing Depression is full of fascinating stories, such as the time Greenberg, curious to get close to the 鈥渕achinery鈥� of depression, enrolled himself in a drug trial. Expecting a label of minor depression, his comeuppance for trying to exploit the system was a label of major depressive disorder.

Greenberg鈥檚 greatest contribution, though, is insisting on few certainties, and in offering himself to us in messy detail. With Greenberg, you are free to call your sorrow a disease, or not, to take drugs or not 鈥� to see a therapist, or not. All he asks is that you 鈥渄on鈥檛 settle for being sick in the head鈥� you can tell your own story about your discontents鈥�.