Manufacturing depression (18 page)

Even as he formed these dour theories, however, Freud retained some optimism that the war, and the truths about human nature that it seemed to reveal, would be the occasion for mourning more than for melancholia:

Once mourning is overcome
it will be apparent that the high esteem in which we hold our cultural goods has not suffered from our experience of their fragility. We will once again build up everything that the war has destroyed, perhaps on firmer foundations and more lastingly than before.

By 1930, however, even this pale optimism—which biographer Peter Gay describes as “
far more a matter
of duty than conviction”—had nearly disappeared. “I can no longer get along without the assumption of this [death] drive,” he wrote to a fellow analyst. And he was deeply worried about its implications for a people in possession of even the prenuclear version of weapons of mass destruction:

The fateful question
for the human race seems to be whether, and to what extent, the development of its civilization will manage to overcome the disturbance of communal life caused by the human drive for aggression and self-destruction…Human beings have made such strides in controlling the forces of nature that, with the help of these forces, they
will have no difficulty in exterminating one another, down to the last man…And now it is to be expected that the other of the two “heavenly powers,” immortal Eros, will try to assert himself in the struggle with his equally immortal adversary.

These were the final sentences of
Civilization and Its Discontents
when Freud sent it to the printer on October 29, 1929, the day that the New York Stock Exchange collapsed. The following year nearly one hundred Nazis were elected to the Reichstag, and in 1931 Freud added a new last line, one that made it clear he no longer considered a victory for Eros a safe bet: “But who can foresee the outcome?”

As much as the book (whose German title,
Das Unbehagen in der Kultur
Freud once proposed translating as
Unhappiness in Culture
) keeps returning to the large scale, it also considers the fate of individuals, and here Freud is, as Peter Gay puts it, “pitiless” about our prospects. “
The life imposed on us
is too hard for us to bear,” Freud wrote. “It brings too much pain, too many disappointments, too many insoluble problems.” The worst by far of those insoluble problems is what Freud calls the “sense of guilt,” which he says differs from guilt itself in that we, rather than some external authority, inflict it upon ourselves. Developing a conscience, we control our instincts and use the channeled energy to erect a civilization; keeping ourselves in line, we can dispense with the dictators in favor of modern nation states and all the liberties they bring. But the price of freedom is high: “
the threat of external unhappiness
…has been exchanged for an enduring inner unhappiness.” Modern civilization requires a mutilation of the self, less barbaric than circumcision or ritual scarification, but still leaving a permanent mark.

Your mum and dad, whatever trauma they inflict upon you, are only determining the particulars of how the conflict between your boundless instinct and the demands of civilization is going to make you suffer. The garrison of the ego is under constant assault from within and without; how and where the shells penetrate its walls is
a matter of your personal history, but in the war between Eros and Thanatos you are mere collateral damage.

Our existential condition, then, is one in which both Job and his comforters are correct. The game is rigged against us, as Job complained, but our misery is a function of how we have played the game, as Eliphaz insists. Which means that a very peculiar form of comfort is available: psychoanalysis, which is not a technique for correcting those negative thoughts and achieving happiness, but merely the crucible, some would say the ordeal, from which the patient emerges with the strength and courage to face the truth about himself, to resist what he must resist and enact what he can enact, to live without the illusion that he is not guilty of what he accuses himself of and yet to stop accusing himself. You don’t have to surrender to the whirlwind. If you face it, which is to say if you are an assiduous patient, you can trade in your neurotic misery for normal human unhappiness and carry on with a better story, one in which self-knowledge is your only consolation.

You have to marvel at the fact that this unrelentingly bleak philosophy, and its expensive, inefficient, and not terribly warm and fuzzy therapy, ever caught on in the United States. The full story of how this happened is too long and complex for my purposes, but Eli Zaretsky has done a very good job of telling it in
Secrets of the Soul
, and Joel Kovel has given an alternate account in
The Age of Desire.
What you have to know is that some things did change—notably Freud’s conviction that the ego would never do better than to hunker down behind some imaginary green line while civilization and instinct relentlessly lobbed their mortars. Within a decade of his death in 1939, Freud’s followers, including his daughter Anna, having left a broken Germany for England and the United States, saw to this, decreeing that the ego was at least potentially a commander-in-chief capable of leading the psyche beyond discontent. By the 1950s, psychoanalysis was dominated by the ego psychologists,
whose job was no longer to acquaint people with the source of their discontents, to clue them in to the endless conflict that raged in their psyches, and to console them as they faced their inescapable suffering, but to help them manage their impulses and adjust successfully to civilization. And by the 1950s, psychoanalysis had become what Kovel sneeringly called a “
psychology for winners
,” which of course made it a much easier sell in the land of opportunity.

Even before this transformation, however, psychoanalysis had made deep inroads into American popular culture. Zaretsky is among the historians who argue that Freud came along at just the right time: in the first half of the twentieth century, when “personal life”—the interior world that had once been the province of philosophers and priests—became a sphere in which everyone had a stake. “
Freudianism helped construct
a new object—personal experience,” Zaretsky says. “It gave [people] a new sense, according to which individuality was rooted in one’s unconscious, one’s desire, and, above all, one’s childhood.” As John Calvin had done for an earlier generation, Freud provided the template for the new story that Americans were telling themselves about themselves, their mental hardships, and the means for overcoming them.

Those hardships were substantial, the discontents widespread. Leaving America after an eight-month lecture tour in 1927, Sandor Ferenczi, a Hungarian analyst and close colleague of Freud, told a
New York Times
reporter that “
life in America
is so strenuous that the people are naturally driven into neurotic conditions.” Criminality and insanity and “incorrigible children” demanded our attention, Ferenczi added, but “another issue…is the psychological readjustment that thousands upon thousands need in their relation to family, profession and society in general.” Which meant that the whole world could be put on the couch.

But that didn’t mean that the whole world was insane—or, for that matter, that it needed doctoring at all. Ferenczi may have sounded like George Beard in flagging the dislocations of modernity
as a widespread pathogen, but the Freudian diagnosis was at once more universal and less medical than Beard’s—not neurasthenia but neurosis, not the rest cure but restless exploration of the incurable human condition. This difference helps to explain something remarkable about
Civilization and Its Discontents:
that in this sometimes bitter, often mournful, and always melancholy lament about who we are, what kind of world we have created, and where we are headed, Freud never once mentions melancholia.

My doctors at Mass General would no doubt have interpreted the absence of melancholia from Freud’s book as yet more historical evidence that depression is not unhappiness itself but an illness that has unhappiness among its symptoms, and that Freud himself was trying to make that distinction. They would claim that now that they have returned to a Kraepelinian diagnostic scheme, they are able to sort out the diseased from the merely discontented. Far from indicating a flaw in that logic, or at least that their diagnostic net was cast too wide, my presence in their study meant that their science worked. It told them something about me that I didn’t know: that if I thought I was only suffering from
das Unbehagen,
that was my depression talking.

But Freud would have had a different explanation.
Civilization and Its Discontents
may not have been an account of a medical condition—his own or anyone else’s. (“
I believe that I have not given
expression to any of my constitutional temperament or acquired dispositions,” he wrote, perhaps forgetting how this denial would sound to a Freudian.) But that didn’t mean it wasn’t scientific. The book’s gloomy conclusions were the only ending that the evidence allowed: “
My pessimism appears
to me as a result,” he wrote, “the optimism of my adversaries as a presupposition.” Science, after all, sometimes tells us what we would prefer not to hear.

But what kind of science was psychoanalysis? Ferenczi’s interview with the
Times
ended with a coded message that answered this question. All that psychological readjustment, he said, “opens a tremendous field for the analytically trained social worker.” The general
reader might have heard the good news that help was on the way for the discontent he evidently was bound to suffer; young people looking for career opportunities may have heard a different encouraging message. But to doctors, especially those with a professional interest in psychoanalysis, Ferenczi’s words had another meaning: social workers, not doctors, were going to reap this bounty. Medical science was one thing, psychoanalytic science another.

Ferenczi was in fact firing a salvo in a battle that had already been raging in his profession for a few years and that had just recently surfaced in a
Times
article that had run just a couple of weeks before the interview. An American doctor by the name of Newton Murphy, the story went, had gone to Vienna for analysis with Freud. The master was too busy to see him and referred him to a student analyst, Theodor Reik. After several weeks of treatment, Murphy, according to the
Times,
“
declared that his health
was worse rather than better.” He complained to Freud but evidently received no satisfaction, because he then approached the Austrian authorities, claiming that because Reik was not a physician, he was guilty of quackery.

The trial was attended by the elite of medicine and psychoanalysis in Vienna, among them Julius Wagner-Jauregg, a Nobel Prize–winning psychiatrist. Testifying on behalf of thirty-one of his colleagues, Wagner-Jauregg warned that psychoanalysis was “dangerous when practiced by a man not educated in medical science.” Freud countered that medical science was not only irrelevant to his treatment, it might actually get in the way. “A medical man cannot practice psychoanalysis because he always has medicine in his mind,” he told the court. The judge decided that Freud knew what he was talking about when it came to psychoanalysis and dismissed the case against Reik.

But a court in Vienna couldn’t stop what had already happened in America. In 1926, the New York Psychoanalytic Society declared that only physicians could practice analysis. Freud’s response came in
The Question of Lay Analysis,
in which he spelled out why doctors
were ill-suited to psychoanalysis: their education was exactly the wrong preparation for the job. “
It burdens [a doctor]
with too much…of which he can never make use, and there is a danger of its diverting his interest and his whole mode of thought from the understanding of psychical phenomena.” Doctors are subject to the “temptation to flirt with endocrinology and the autonomic nervous system,” as if psychic suffering was just another illness whose cause and cure were organic.

Some mental suffering may indeed be organic in origin. A few cases of melancholia, Freud wrote in “Mourning and Melancholia,”
“suggest somatic rather than psychogenetic diseases
,” but his own interest lay in the “cases whose psychogenetic nature was beyond a doubt.” These maladies—the neuroses—were the proper object of his therapy, and because the mind was shaped by history and culture, the education of analysts must “
include elements from the mental sciences
, from psychology, the history of civilization and sociology, as well as from anatomy, biology, and the study of evolution.” There was no time to teach medical students these subjects in addition to all they had to learn about medicine. But without this breadth of knowledge, doctors would make poor analysts. Perhaps even more important to Freud—whose “
self knowledge,” he wrote
, “tells me that I have never been a doctor in the proper sense”—their ignorance would lead them to turn psychoanalysis into a “
specialized branch of medicine
, like radiology.”

That was the last thing Freud wanted. “
As long as I live
,” he declared, “I shall balk at having psychoanalysis swallowed by medicine.” But even Sigmund Freud could not control the fate of psychoanalysis. The New York Psychoanalytic Society continued the policy that Freud, his already rabid anti-Americanism inflamed by his quarrel with American doctors, called “
an attempt at repression
.” Mental suffering may have been democratized, but it was still an illness, its understanding and treatment still firmly in the hands of the medical elite. The social workers would have to find some other way to save the world.

Staking the territory of
das Unbehagen
for medicine, the renegade analysts opened the way for the depression doctors eventually to corner the vast unhappiness market—a debt of which my doctors at Mass General were most likely unaware. But the New York psychoanalysts left their future colleagues with a problem that would only deepen as more and more of the mysteries of the human organism fell to the microscope and the scalpel: the diseases the psychiatrists were claiming as their own were problems of the mind, their origins in culture and history, their treatment in the refashioning of biography. But the authority behind the doctors’ claim derived from treating diseases that were biochemical in origin for people who, as Freud grumbled, “
expect nervous disorders
…to be removed.” It was only a matter of time before the obvious contradiction between form and content became an embarrassment.