BOOK REVIEWS

The colonizing of existential space

Ryan Botha

Department of Psychology, Midrand Graduate Institute. East London

Greenberg, Gary (2010) Manufacturing depression: The secret history of a modern disease. London: Bloomsbury Publications. ISBN 978-1-4088-0190-1pbk. Pages 432.

"Depression" is a ubiquitous term within professional and lay discourses on mental health. As a psychiatric meta-signifier, the term encompasses the vast expanses of existential malaise that characterize the human condition. But what exactly is depression and to what extent does its ontological integrity stand up to critical interrogation? Manufacturing depression represents a deeply insightful engagement with this very issue. Part memoir, part history, part axe to grind, the book critically examines the rapid expansion of the depression industry with a view to its implications for how modern society has come to understand its existential anguish. Its author, Gary Greenberg, as both a psychotherapist and individual sufferer of depression proves a dependable guide through this deeply personal and political terrain.

As an intellectual history, the book unfolds rather like a mystery novel, carefully unraveling a series of bold and fortuitous scientific discoveries. Our journey begins with Betty Twarog's research in 1952, a little known biologist whose interest with molluscs culminated in potentially the single most significant discovery in understandings of the etiology of depression, namely, the neurotransmitter serotonin. Following Twarog's discovery, subsequent research unearthed a robust association between serotonin and mood. Translated into a theoretical model, "the permissive hypothesis" was formally introduced into psychiatry, implicating chemical imbalances in serotonin as the major cause of depression. These findings quickly caught the attention of pharmaceutical industries that in turn developed a class of psychotropic medications known as selective serotonin reuptake inhibitors (SSRIs), or more popularly, Prozac. In 2005, Greenberg notes that more the 27 million Americans (10% of the adult population) were taking SSRIs, at an annual cost of more than ten billion dollars. The depression industry was here to stay. Throughout the book, Greenberg continues to sketch important historical developments contributing to this rapid rise of the depression industry. We learn about Emil Kraeplin's categorical classification system of mental illness, which would become a cornerstone of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Greenberg, somewhat tongue in cheek, heralds the DSM as marvellous piece of literary alchemy, capable of mapping out the full terrain of our existential discontents without any solid notion of where they come from or what they mean. In this sense, the DSM reads like an oncology textbook would prior to the discovery of carcinogens and oncogenes, completely devoid of an empirical basis for aetiology. Building on this flimsy science, other important figures are brought into the discussion, from the "the shock doctors" advocating electroconvulsive therapy (ECT) to "the new phrenologists" such as the renowned Dr Daniel Amen. The latter's claims to target specific regions of the brain responsible for depression through modern technologies such as single photon emission computed tomography (SPECT) draws considerable derision from the author. Greenberg is scathing of the charlatanism characteristic of many of these latest developments in the depression industry and particularly the false hope that they cultivate.

As a philosophical rant and memoir on madness, Greenberg combines humour, pathos and rage to advance a powerful case against the depression hegemony and its powerful control over our existential space. He unveils industry ties between the DSM contributors and pharmaceutical companies. He critically examines the pharmaceutical profits informing the DSM diagnosticians lowering of the symptom threshold for depression and other mental maladies. At times bordering on the conspiratorial, the author is also careful to pull back and provide a somewhat more balanced assessment of the situation. For instance, his acknowledgment of the value of psychotropic intervention in curtailing the symptomatology of severe depression is clear. The book's true value derives from the author's invitation to examine our own existential agonies and question the merit of framing them within the hegemonic metanarrative of "suffering as illness". In this sense, he compels us to reflect on whether we retain the richness of our life journey and valuable lessons therein by subjecting it to the homogenizing force that is "depression".

On the whole, Manufacturing depression possesses immense reading value. The book achieves the rare feat of being able to sensitively capture the very real and frighteningly personal existential trauma accompanying "depression" while simultaneously dismantling the disorder within the context of modern capitalism. It is an unsettling text but a deeply empowering one.