Manufacturing depression (47 page)

A few weeks later, the woman agreed to try it again. This time, the doctors took pictures, which they published with the article. The first photo shows a relaxed woman with a Mona Lisa smile. Within thirty seconds, her right hand is gripping the lower part of her face, pushing her mouth into a pout; her eyes are downcast, and she looks thoughtful and worried. Four minutes later, she is weeping, her eyes squeezed shut against the feeling that, as she puts it, her “body is being sucked into a black hole.” Five minutes after that, she is smiling again, this time broadly, as if in celebration. “The neural networks involved in this particular case have not been clearly identified,” the doctors wrote, although it may have involved the
ventral nuclei
of the thalamus or perhaps the activation of the left
pallidum
. Whatever the specifics, they wrote, the important thing is that the stimulation affected only “a few cubic millimeters of neural tissue,” which means that “the depression probably resulted from the stimulation of afferent, efferent, or passing fibers within the substantia nigra or from the inhibition of those fibers.”

If you don’t understand any of this brain talk, don’t worry too much. I don’t really understand it either, any more than Walt Whitman really understood the Fowlers when they went on about his philoprogenitiveness or his inhabitiveness or than I fully understand what Daniel Amen means when he tells me about my
cingulate-basal ganglia-thalamus
triad. I mean, I know where those regions are, more or less, and I have some idea about what goes on, electro-chemically speaking, in them—and so could you if you spent just a little time with a basic neurobiology textbook—but I really don’t understand how they bring about my experience of depression. Even more important, I’m not entirely sure that they do, at least not all by themselves. I’m not sure what makes the depression doctors so certain that they do know, but when they write about depression as a disease that is the result of pathophysiological processes, when they say that the circuitry of depression, whatever it is exactly, gets turned on by stress—“kindling,” they call it—and then in some unlucky segment of the population stays on even when the stress
is over, creating its own stress, which creates its own depression, the brain consuming itself like a serpent eating its tail, depression an exercise in meaningless suffering, they sure sound as if they do.

But maybe we—those of us not equipped with scanners and advanced medical educations and prescription pads—are not supposed to understand. Maybe the point isn’t to help us gain self-knowledge, at least not in the sense that that term usually carries, but rather to help us realize that we’re way too complicated for ourselves, and so we might as well turn that work over to the only people who are qualified to understand the mumbo-jumbo, to the new phrenologists, who have used the SPECTs and PETs and MRIs to look inside our skulls and figure out what has gone wrong to make us suffer, and what will cure us. Maybe the point is to help us see that there’s no point in looking elsewhere.

Because what else explains the fact that the French doctors never even considered in their article the possibility that the patient’s sudden sadness isn’t merely an artifact, a random by-product of their treatment, but that she is actually very, very sad about something—like maybe the fact that she has a debilitating and degenerative illness that will eventually ruin her—and that they somehow released a cascade of pent-up feeling, that her experience was not just a random electrical storm but real and potentially important and meaningful? Or that they had simply stumbled on one way in which the brain provides intense sadness, activated it in the same way that a tap on the knee activates a kick reflex, thus proving only the highly unremarkable fact that brain events are necessary for conscious experience? For that matter, what else but a conviction that the explanation for our suffering can be found in our molecular biology accounts for the total absence in the
Nature
article of any consideration of the actual lived experience of depression—not even a gesture at the possibility that what they are describing is the
result
and not the
cause
of a person’s troubles, the
how
of our suffering and not the
why
, that our lives as we live them actually matter, and that the conviction that this is so is not a mere illusion (itself no doubt arising
from some neurochemical trick) but is as real and as significant as any bit of grey matter? To write about depression without ever even mentioning what it feels like, or how it might be related to the actual circumstances of a person’s life, seems nearly willful, as if
subjectivity is a forbidden topic
.

Which makes sense. All religions need taboos, and in the church of clinical neuroscience, subjectivity must be off-limits. To talk about a self as something that exceeds the sum of its parts is to challenge the notion, central to materialism and the scientism behind it, that we are nothing more or less than what our brains do. This idea has always been latent in the attempt to turn magic-bullet medicine toward our psychological suffering, but it has only become manifest recently, as scientists’ ability to monitor and measure the brain has grown—and with it their belief that they have found the reality behind the illusion of self.

The conviction that biochemistry is more important than biography is as faith-based today as it was when Julien Offray de La Mettrie first proposed it. Psychoanalyst-turned-neuropsychiatrist (and Nobel laureate) Eric Kandel has no more scientific proof when he claims that “
the mind is a set of operations
carried out by the brain much as walking is a set of operations carried out by the legs” than La Mettrie did when he declared that the brain “possesses muscles for thinking as the legs do for walking.” Kandel does, of course, have much more certainty about what is actually going on in those “muscles,” but he doesn’t know that that’s all there is to it. Daniel Amen might be correct to say that he is seeing my depression in my hypoactive cingulate, but he can’t tell me why it feels the way it does, how the ebb and flow of neurotransmitters through my brain turns into a pit in my stomach, how it nails me to the floor of my study. He can tell me everything about my brain and he still will have told me nothing about my self.

Or so I believe. And I may be a majorly depressed abuser of illegal substances, but I do have some sober company here. Carl Woese, for instance. He’s one of America’s most prominent molecular
biologists and has been trying to alert his colleagues to the fact that to reduce mental life to its molecular correlates is one thing, and to claim that it is nothing more than whatever is happening in that chunk of neural tissue is quite another. This is the difference that Woese had in mind when he wrote:

Empirical reductionism
is in essence methodological; it is simply a mode of analysis, the dissection of a biological entity or system into its constituent parts in order to better understand it. Empirical reductionism makes no assumptions about the fundamental nature… of living things. Fundamentalist reductionism… on the other hand, is in essence metaphysical. It is ipso facto a statement about the nature of the world: living systems (like all else) can be completely understood in terms of the properties of their constituent parts.

Materialism may arise out of the wish to be rid of metaphysics, of something that simply can’t be explained by science, of a doubt that can only be resolved by faith, but when it crosses the line into fundamentalism, it turns into a metaphysics of its own.

And when that metaphysics purports to explain our inner lives—as it most surely does when doctors tell us our depression is a disease of the brain—it has profound implications. Philosopher Karl Popper outlined them in 1977:

With the progress
of brain research, the language of the physiologists is likely to penetrate more and more into ordinary language and to change our picture of the universe, including that of common sense. So we shall be talking less and less about experiences, perceptions, thoughts, beliefs, purposes and aims; and more and more about brain processes, about dispositions to behave, and about overt behaviour. In this way, mentalist language will go out of fashion
and be used only in historical reports, or metaphorically, or ironically. When this stage has been reached, mentalism will be stone dead, and the problem of mind and body will have solved itself.

Repeat the fiction about the legs and the brain often enough over two hundred and fifty years, and eventually it comes true. Recite the gospel of brain chemistry, invoke your authority to see inside us and show us the miraculous pictures of our despair, name the secret regions of our brains in a language as incantatory, as mysterious and incomprehensible as a Latinate Mass, and then offer the sacramental pills that will absolve us of our original sin, of the imbalances that are in us but not of us, promise us the salvation of mental health in the form of the ability to meet whatever sorrow we encounter with resilience—illness and loss and the death of loved ones (after two months, of course), our own limitations and failures and those of our leaders, the creeping awareness that we’re suffocating the planet, that living high on the hog requires billions of people to be our fodder, troubles both personal and political adding up to a world broken beyond repair: do all that, and we will line up for communion, we will take the sacrament, and we will be transformed into neurochemical selves, reinvented as the people of the pill. Not only because the drug changes our brain chemistry, although it undoubtedly does, but because it changes our idea of who we are. It’s the biggest placebo effect of all.

So let’s say you’re writing a book about the way the medical industry has manufactured depression as a brain disease, how it has assembled the magic-bullet hopes and the yearning for self-improvement in a time of diminishing prospects, the Age of Enlightenment and the march of progress and the pursuit of happiness, the doctors and the ad men and the government regulators into a sleek and gleaming product. And let’s say your best evidence that this invention
is not all it’s cracked up to be is the fact that for all the scientific language and scholarly discourse, for all the doctors’ claims that they’ve found the wellsprings of demoralization, there’s still no actual biochemical glitch that lies behind the symptoms, which means that the targets are only targets of opportunity and that the depression doctors are still working off a century-old promissory note. And then let’s say you get to the part where the captains of this industry finally acknowledge this, although only by way of saying that they are on the verge of solving the problem, that soon, very soon, they will be able to take snapshots of depression right there in the brain, which will give us not only the true targets but also the final proof that the problem is not in our selves but in our molecules. Whereupon, let’s also say, you find a doctor who insists that these days have already arrived, who has a book full of Technicolor brain pictures to prove it, and who shows you one of them (a teenage boy’s, he says, who wanted to murder his mother), points out the “huge dent” in his amygdala (“dark evil thoughts here”) and the hole in his interior prefrontal cortex (“and there the inability to control them”) and adds for good measure that if only the boy “had good frontal lobes, he would just have those horrible thoughts but he’d have a brake; he doesn’t have a brake in his head.” And then let’s say this conversation takes place in Southern California in late 2008, in one of the few office parks with cars in the lots and tenants in the suites, where building after building is festooned with tattered signs bearing futile messages about lease and sale opportunities, where the shuttle driver who ferries you to your deserted hotel from the equally deserted airport used to be a computer programmer, where the waitresses in the half-dark restaurants eye you like lions who haven’t seen prey in a month (but where just down the road in Newport Beach, people are buying handmade dog biscuits at The Barkery and snapping canvas covers over the teak decks on their luxury yachts), and the doctor tells you that he can
see
your depression and your ADHD (and your mother too) in your head, and you think that now, more than in your clinical trial or your cognitive
therapy workshop, now you’re finally seeing what’s dark and Satanic about the depression mills, that it’s not just the arrogant scientism of the Harvard doctors or the slick corporate shine of the cognitive therapists, but the ambition, the hubris, the greed, from which this effort grows, the nearly desperate desire to reduce us to what can be grasped with the hand or glimpsed with the SPECT-aided eye, to make our suffering into a need that can be satisfied with a product, to
fix
us so that the outside world no longer really matters—even if it means robbing us of our tragedy, denying us our rage, playing Eliphaz to our Job, and in the bargain rendering each of us as an electromolecular stew just a dash short of this or that crucial salt. And then let’s say it dawns on you that, when the doctors tell you that the reason you can’t sleep in your nearly empty hotel and are worried and sad when you walk in the deserted streets is that there is something wrong with your brain, they are also telling you that you are nothing more than the output of the inputs, a cloaca through which chemicals pass, a mere residue that can be scraped and polished and recast. Which makes you a perfect customer, someone who will buy the illness to get the cure, who will take heart at the news that your brain is mostly healthy and that all it needs is a few grains of this or that, and who is ready to believe that a whole society of resilient people with chemically balanced brains would make for a better world, that this desiccated self is the paragon of health, and that none of this is a matter of conviction, but of fact, not a climate of opinion that arose from the hurly-burly of history and desire, but truth that has descended from the scientific heavens. And, finally, let’s say the guy with the brain pictures turns out to be a shamelessly entrepreneurial, dyed-in-the-wool American optimist who is also a fundamentalist Christian graduate of a medical school founded by a faith healer, a man named Amen no less, who is faintly ridiculous and whose ridiculousness gives you an opportunity to compare the brain scanning frenzy to a long-discredited nineteenth-century fad that is a powerful reminder of just how easy it is for doctors to claim that they know more than
they know and how willing we are to believe them, an opportunity, that is, to point out that there’s
still
no there there, that they really can’t claim to have found what lies behind the symptom without a leap of faith about how we get from the depression triad to depression itself, that they have not gone beyond metaphysics, but only replaced one metaphysics with another. Well, if all that happened to you, you could be forgiven for thinking that you’d gotten the perfect slam-dunk, wrench-in-the-works, really long one-paragraph ending for your book, the final Amen.