Review: Manufacturing Depression by Gary Greenberg

By Lewis Wolpert for The Guardian

Gary Greenberg is a psychotherapist who joined a clinical trial for an antidepressant at a time when he was mildly depressed. He was diagnosed as severely depressed, got better, and found that his pill was a placebo. His book contains a major attack on antidepressants, and he blames the drug companies for the false advertising of their positive effects. He is also very critical of the concept of depression itself.

He is right that quite a lot of random clinical trials have failed to demonstrate the effectiveness of antidepressants – as opposed to placebos – in curing depression. However, he ignores the evidence that, for severe depression, they really can help. He accuses the drug industry of downplaying the numerous side-effects, such as the 774 papers showing their effect on sexual performance. In addition, he argues that the industry has successfully campaigned to persuade doctors and the public that they suffer in enormous numbers from a disease called depression when in fact they might not. Only someone who has not been seriously depressed could accept that. He suggests that those who benefit from antidepressants that raise serotonin levels might instead be thought of as suffering from Prozac-deficit disorder.

His main thesis seems to be that depression is not a disease or an illness. When a doctor says to a patient that he has depression, “He couches his judgments in the language of sickness and health rather than sin and virtue, which means he is cloaking his morality, even from himself, in science.” Impenetrable.

Greenberg devotes much space to tracing the history of ideas about depression, going back to Hippocrates, who identified melancholia as a distinct disease. He gives much attention to Emil Kraepelin, who believed the chief origin of psychiatric diseases to be biological and genetic malfunction. These are not ideas that he accepts: he views them as neurological tautologies. Psychiatry, he thinks, has been led astray by attaching itself to science, thus losing sight of humanity.

He is very critical of the Diagnostic and Statistical Manual of Mental Disorders, which is intended to help diagnosis by listing key symptoms, or scoring the answers to questions. This, he says, is “a way for the doctor to keep his eye on his notebook and not on the patient”. He is right that there is no unequivocal diagnosis of depression, and psychiatrists may quite often give a different diagnosis for the same patient. However, he does not point out how being depressed can in many cases render people unable to work, and ignores the fact that severe depression can result in self-harm, plunging the individual into a world unrelated to anything in everyday life. Nor does he mention research showing that almost all people who end their life by suicide have a mental illness, most commonly depression.

Severe depression is a terrible experience, as I know. William Styron, in Darkness Visible, describes his thought processes “being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world”. Greenberg’s advice to those who think they are depressed is to stop looking for a cause in their brain, which is just a story, but “to tell your own story about your discontents”.

There is no mention of sadness in the book, or the possibility that depression is an extreme form of sadness. Sadness is a universal human emotion, programmed by our genes, and its evolutionary function is to restore loss of some kind. This loss can be in a child left alone, break-up of a relationship, loss of a job, loss of money. It has been argued that mild depression is useful as it makes individuals reconsider their problems and perhaps give up certain goals that they are having great difficulty achieving. Mourning is clearly triggered by a serious loss, but is not necessarily depression.

It is clear that depression results from changes in the brain, because it can be induced by chemical means such as high concentrations of the hormone cortisol, or the drugs reserpine or alpha-interferon.

Depression can be thought of as sadness becoming malignant for a variety of reasons, not least genetic factors. Heritability of depression is more than 50%. Greenberg is very suspicious of ideas about the cell biology of depression, such as its being due to low levels of the neurotransmitter serotonin. He also ignores the evidence that a gene that lowers serotonin has been linked to depression.

He is not keen on psychoanalysis because it is not possible to verify its ideas, but he seems to accept the virtues of cognitive therapy, developed by the psychoanalyst Aaron Beck in the 1960s. The essence of this is to discuss with the patient their negative thoughts and to see if they are valid, then train them out of negative behaviours. Yet he attributes its success largely to the placebo effect. He is also very sceptical about the explanations that brain imaging have offered – but to take these seriously you have to believe that depression actually exists.

I found the book most unsatisfactory. While Greenberg writes very well and has a nice sense of humour, the arguments are often far too long and discursive, even though there is a lot of information buried in the text. Finally, I remain unclear as to what he thinks depression is, and how and if it should be treated. This book will not help either those who suffer from it or those who wish to understand it.

Lewis Wolpert’s books include Malignant Sadness (Faber).

NY Times Mulls Plan to Charge for Website Access: Will Murdoch Turn around and Smack the Gray Lady?

The Financial Times and the Guardian (UK) are reporting that the New York Times will soon decide whether to begin charging for access to its popular NYTimes.com website.

Quoting the Guardian:

The New York Times could reportedly take the decision to start charging for online news “within three to four weeks”.

Readers who subscribe to the print version of the New York Times could be charged $30 a year to gain access to its website, whereas nonsubscribers could be charged $60 a year, according to the Financial Times.

Considering that the Times had to abandon a similar plan in 2007 due to disappointing revenues, the current scheme may be a desperation move by the financially ailing newspaper to stay alive in an increasingly grim environment for print media of all kinds.

Again quoting the Guardian: “As revenues from print advertising continue to fall in tandem with newspapers‘ readership figures in the US and UK, and consumers increasingly turn to the internet to seek out news, moving to an online pay system would put the New York Times at the forefront of attempts by the industry to find alternative business models.”

To date,  only The Financial Times and NewsCorp’s Wall Street Journal have found the internet subscription model financially viable.

Although Rupert Murdoch has recently indicated that he would consider extending the subscription model to other NewsCorp online properties, the pending move by the Times makes one wonder if Murdoch might not use his deep pockets instead to turn the Wall Street Journal site into a completely free access news hub — or at least for long enough to put the Times out of business.

It would be an audacious move, but one expects no less from Murdoch. And if the gambit were to succeed, Murdoch would end up with the Wall Street Journal online as the undisputed newspaper of record for the entire globe.

Vibe Magazine Shutting Down

Jeff Bercovici / DailyFinance.com

Vibe magazine, the urban-music magazine founded in 1993 by Quincy Jones, is the latest victim of the media recession. Multiple sources both within and outside the magazine confirmed that it is shutting down. 

Reached for comment, chief financial officer Angela Zucconi said, “We will be making a statement by the end of the day. That’s all I can say at this point.” She referred further questions to CEO Steve Aaron, who was not immediately available. Messages left for editor in chief Danyel Smith and publishers Edgar Hernandez were not immediately returned. [Update: Media Decoder has official confirmation.]

Vibe enjoyed significant success in the late ’90s and early part of this decade as hip hop and R&B became the nation’s predominant forms of pop music. But in recent years the title has fallen on hard times under its new owner, the Wicks Group, which bought it in 2006. In February, it reduced its circulation and publishing frequency, cut salaries and moved employees to a four-day workweek to save money.

Current Trends in Art Book Publishing

Perhaps it says something about our era: The three headlining art books of the season are as much about commerce as they are about art.

  • Old Masters, New World, by Cynthia Saltzman, examines the acquisition of art by western oligarchs;
  • Jonathan Lopez’s The Man Who Made Vermeers looks at a master-forger seduced by the Nazis and by the opportunity to fake-for-a-buck;
  • Edward Dolnick takes on the same topic in The Forger’s Spell, which, according to the New Yorker’s Peter Schjeldahl, is just a lesser version of the Lopez book. (Incidentally: Gawker noticed that the NYTimes seems to be shamelessly boosting Dolnick, who is a Times insider.)IrwinWeschler2.jpgThe Saltzman book is about the market in a fairly direct way and the other two less so. But I think there’s a pretty common theme running through a lot of art-related journalism and publishing: It’s about the market first, and art last. If the art world decides that’s an unfortunate focus, it’s going to have to do something to change it.

    University press to the rescue: The University of California press is releasing an updated version of Lawrence Weschler’s classic book on Robert Irwin, complete with a new cover picture that seems to be from Irwin’s recent MCASD exhibition. [via] The hardcover will retail for $50 (!), but you can pre-order the paperback for under $17. (Also from UC Press: A quarter-century of Weschler’s conversations with David Hockney.)

    From Tyler Green’s Modern Art Notes

  • ‘Surrender’ by Bruce Bawer Reviewed in Washington Post

    Paul Barrett / Washington Post

    Bruce Bawer’s latest book comes wrapped in the American flag or, more precisely, wrapped in a jacket depicting the Statue of Liberty gagged with an American flag. It’s an arresting image meant to convey an alarming message: Muslims on a “cultural jihad” intend to stifle free speech in the United States and destroy our liberty. They may succeed, Bawer warns, because they receive aid and comfort from liberal dupes flying the banner of “multiculturalism.”

    Bawer, an accomplished literary critic, has addressed this subject before, in a book published in 2006 called “While Europe Slept: How Radical Islam Is Destroying the West from Within.” There he wrote about the increasing tension between majority populations in cities such as London, Paris and Amsterdam and their often alienated Muslim immigrant neighbors. Bawer stirred controversy by painting Muslims with crude brushstrokes suggesting ubiquitous and intrinsic Islamic extremism.

    Much of “Surrender” merely updates that earlier volume. In his new book, Bawer indulges in such unsubstantiated declarations as: “While there are such things as moderate and liberal Christianity, there is no such thing as a moderate or liberal Islam.” And: “To put it briefly and nakedly, the West is on the road to sharia,” or the rule of Islamic religious law.

    Forgoing the temptation to dismiss Bawer’s latest work as a polemical retread (because most of it actually deals, again, with events in Europe), one might focus on his depiction of Muslims in America. “Surrender” ‘s cover, after all, advertises a book about the United States, and the author expends considerable energy extolling the First Amendment in contrast to less tolerant-sounding words from the Koran. Training his gaze on the United States, Bawer produces a muddled picture. He neglects to take note of the fact that, on average, the American Muslim population is better educated, better off economically and better integrated socially than its Western European counterparts. Not surprisingly, American Muslims have been implicated in far fewer terrorist plots since 9/11 — and no successful ones.

    This is not to say that the toxic mixture of religious zealotry and anti-Western ideology that poisons some European Muslim enclaves is altogether absent from the United States. Bawer could have looked at the tiny minority of American Muslims who harbor real hostility to the mainstream: men like the three Muslim brothers from Albania who were sentenced to life in prison in April for conspiring to kill American soldiers at the Fort Dix, N.J., military base or the four men arrested in New York last month in an alleged plot to bomb two synagogues in the Bronx.

    Instead, he implies that innocuous Muslim social and spiritual organizations favor religiously inspired violence. One he singles out for condemnation as an extremist “front group” is the Islamic Society of North America. I happen to have interviewed numerous members of ISNA and attended their gatherings. Bawer provides no evidence that he has first-hand experience with the group, but, in any event, his attack seems wildly misleading. ISNA has tens of thousands of members who are led by middle-class immigrant engineers, physicians, academics and entrepreneurs. Its current president is Ingrid Mattson, a moderate-minded scholar born in Canada who years ago converted to Islam. Most ISNA members, it’s fair to say, disagree with most American Jews on relations with Israel. But by and large, these are Muslims seeking a constructive role in American society. They adhere to various strains of Islam: some orthodox, some less so. They are increasingly engaged politically. Many supported George W. Bush in 2000; in 2008, they rallied to Barack Obama.

    Bawer veers into self-parody when he asserts that Muslims have cowed skeptics into self-censorship and inaction: “Artists and writers avoid Islamic themes and settings; police officers avoid Muslim neighborhoods.” His own work shows that critics of Islam have no trouble publishing. I counted references in “Surrender” to more than 15 of his allies: prominent columnists, bloggers and authors. As for the notion that the police, FBI and immigration authorities steer clear of Muslim neighborhoods, one need only consider the thousands of Muslims who have been arrested and deported from the United States since 9/11 — some justly, some unjustly — to verify that Bawer has lost his bearings on this topic.

    Paul M. Barrett is a journalist in New York and the author, most recently, of “American Islam: The Struggle for the Soul of a Religion.”