Manufacturing depression (5 page)

It is customary
for histories of depression to start with Hippocrates, the ancient Greek physician.
*
There are good reasons for this. In addition to originating the oath by which physicians pledge not to harm or kill or seduce their patients, Hippocrates set Western medicine on its current course by insisting that the doctor’s job was to use his own senses to acquire the actual details of his patients’ suffering. When he told his disciples to seek the truth by examining the phenomenon of the illness itself, Hippocrates was urging them to kick the gods out of the clinic; as Hippocrates said of epilepsy, known in his time as the
sacred disease,
“
it appears to me to be no more divine
nor more sacred than other disease, but has a cause from which it originates.” This idea—that illnesses exist in nature and that it is the doctor’s job to find and, if possible, to heal them—is exactly the idea behind most medicine today, including the treatment of depression.

One of the conditions that Hippocrates took note of looks something like our depression. “
Fear and sadness
that is prolonged means
melancholia
,” he wrote, and the melancholic patient, who suffers from an excess of black bile (which is how
melancholia
translates from the Greek) has an “aversion to food, sleeplessness, irritability, and restlessness.”
He is rumored to have cured
the king of Macedonia’s melancholia by deducing that he was secretly in love with his recently deceased father’s concubine and prescribing a consummation of his desire (which makes you wonder if Hippocrates had heard about Oedipus).

It’s easy to understand the depression doctors’ eagerness to enlist the father of medicine in support of their contention that depression is a disease. The winners get to write history, after all, so why wouldn’t they claim this patrimony? But even leaving aside for the moment the fact that so much of what Hippocrates and his followers wrote is fanciful at best—for instance, that “
it is a deadly symptom
…when the patient sleeps constantly with his mouth open” or that lying “with the hands, neck, and legs tossed about in a disorderly manner and naked…indicates aberration of intellect”—you have to wonder why, if depression is such a common disease and Hippocrates such a voluble commentator on a vast range of human suffering, his work on melancholia is so scant. His notes on the subject are scattered throughout his works, and he doesn’t tell us much about it, not even how the problem was related to the other black bile disorders, which ranged from hypersexuality to hemorrhoids (a condition that, unlike melancholia,
he devoted an entire book
to).

Hippocrates’ lack of attention to melancholia doesn’t mean that depression isn’t an illness. But to cite Hippocrates as an authority for its existence is a little like citing George Washington as an authority on wooden teeth or cherry tree removal: just because he was a great man who had some interest in the matter, we shouldn’t necessarily privilege his opinion about it. There is, however, an ancient account of depression that is much more robust than Hippocrates’—and much more like our current version of the malady. It’s also much
older. In fact,
according to one scholar
, as soon as people started taking enough notice of themselves to put stylus to clay tablet—in around 5000 B.C., 4,500 years before Hippocrates, in the Mesopotamian society known as Sumer—they wrote down a story about a whopping case. (It would be a mistake to conclude from this ancient lineage that depression, like, say, the common cold, has been with us from the beginning. After all, we know virtually nothing of the inner lives of
Homo sapiens
for the 200,000 or so years prior to the advent of writing, so its appearance at the dawn of history could just mean that people became despondent as soon as they started paying enough attention to themselves to take notes.) The Sumerian version of this story is in fragments, but the Hebrews eventually incorporated it into their Bible. It has since become one of the Western world’s best-known, if not best-loved, stories.

Poor Job! Pillar of Uz and patriarch of a large family, a God-fearing, evil-shunning “
mark among all the people
of the East,” he’s just minding his own business—which is considerable, according to the Bible’s detailed list, including “seven thousand sheep, three thousand camels, five hundred yoke of oxen and five hundred she-donkeys, and many servants besides”—when Satan challenges Yahweh to a duel over Job’s righteousness.

Job is not God-fearing
for nothing, is he? Have you not put a wall round him and his house and all his domain? You have blessed all he undertakes and his flocks throng the countryside. But stretch out your hand and lay a finger on his possessions: I warrant you, he will curse you to your face.

Rabbis and priests have long argued about what role Yahweh plays in the mayhem that follows, whether he commissions the hit like a godfather or just turns a blind eye while Satan does his mischief, but from Job’s point of view this doesn’t really matter. Either way Yahweh’s wager spells disaster for Job. In one day, nomads swipe the oxen and donkeys and slay the servants, lightning strikes dead
the sheep and shepherds, the camels are carried off by Chaldeans, and then, as Job discovers from the last in a line of bad-news messengers, his children are killed by a sudden storm.

To Satan’s dismay, Job maintains his faith. But the Prince of Darkness prevails upon Yahweh’s insecurity one more time, and Job is inflicted with “
malignant ulcers
from the sole of his foot to the top of his head.” Job’s wife nudges him toward the dark side. “
Curse God,
” she says, “and die,” but Job will have none of it. “If we take happiness from God’s hand, must we not take sorrow too?”

The story would end with Job’s impressive forbearance were it not for the arrival of three old friends—Eliphaz, Bildad, and Zophar—who ostensibly show up to console him. They weep and tear their clothes and then sit down silently with Job for seven days, turning their visit into the ritual week of mourning. And in that week, something happens to Job—perhaps the extent of his catastrophes sets in or the pain and disfigurement of his ulcers take their toll, or maybe he recognizes that in some way his comforters are sitting shiva
for
him rather than with him, that stripped of his wealth, family, and dignity he is as good as dead. Whatever the occasion for his change of heart, Job finally confesses the nearly unspeakable truth: he has lost his desire to live.

May the day perish
when I was born,

And the night that told of a boy conceived.

May that day be darkness,

May God on high have no thought for it,

May no light shine on it.

Not only that, he tells them, he actually longs for what he is sure awaits him in death.

I should now
be lying in peace,

Wrapped in a restful slumber,

With the kings and high viziers of earth . . .

Down there, bad men bustle no more,

There the weary rest.

Not all suicidal people are depressed. Sometimes they’re angry or trapped in desperate circumstances, or, in the case of the terminally ill, already dying and ready to take matters into their own hands. But Job is also irritable and implacable, uninterested in food or prayer or any of the things that once brought him pleasure. And like Evelyn—and nearly every depressed person I’ve ever met—he’s tortured by the bright light of day, sees it as a mockery of itself. “
Why give light
to a man of grief?” he asks his friends. “
Why make this gift
of light to a man who does not see his way?” It’s no coincidence that the two most famous recent memoirs of depression—William Styron’s
Darkness Visible
and Andrew Solomon’s
The Noonday Demon
(a metaphor he borrowed from Psalm 91, which Job also cites)—invoke this image. This total dejection, the demoralization that turns light into reproach and darkness into anguish is what makes Job’s wish to be dead a mark of what we call depression.

I wouldn’t want to blame Job’s pitiful psychological state on his therapists. It’s nearly impossible, I think, to get used to being in the presence of someone whose “
only food is sighs
and [whose] groans pour out like water,” as Job puts it, who is both looking to you for comfort and yet ready to tell you why the comfort you offer just makes things worse. You fight off your impatience and fear and search for the words that will shine through what Hawthorne called “the black veil” and into whatever corner of his psyche is not shrouded in gloom, and you hope you come up with something more helpful than what these men offer to Job in his anguish. But still you have to wonder how they think it will help Job to level accusations disguised as questions like these:

Can you recall
a guiltless man that perished,

Or have you ever seen good men brought to nothing? . . .

Was ever any man
found blameless in the presence of God,

or faultless in the presence of his maker?

Or this:

And now your turn
has come, and you lose patience too;

Now it touches you, and you are overwhelmed,

Does not your piety give you confidence,

Your blameless life not give you hope?

With comforters like these, who needs ulcers? That’s certainly what Job is wondering when he calls them “
charlatans, physicians
in your own estimation” and wishes that “someone would teach you to be quiet,” or when he asks, “Will you never stop tormenting me and shattering me with speeches?” But then again, he doesn’t order them to be quiet or to leave his house and take their sanctimony with them. Undoubtedly this is in part because they’ve cast doubt on his integrity, forcing him to defend himself, but we might also imagine that Job listens to them in hopes that he will hear something that will actually comfort him—if not a cure, then at least an explanation of what has happened to him, one that can restore his faith that life is fair and God is just or, by providing a reason for his suffering, assuage his grief.

Job isn’t buying his self-appointed physicians’ answers, however. Indeed, their attempts to console him just seem to egg him on. With growing stridency and in agonizing detail, Job argues his case: if this could happen to him, then life itself is so unfair as to be cruel and meaningless.

Is not man’s life
on earth nothing more than pressed service,

His time no better than hired drudgery,

Like the slave, sighing for the shade

Or the workman with no thought but his wages,

Months of delusion I have assigned to me,

Nothing for my own but nights of grief.

Lying in bed I wonder, “When will it be day?”

Risen, I think, “How slowly evening comes.”

Slowly, inexorably, the personal becomes the universal, Job’s wish to be dead in order to escape his pain escalating into an indictment of life’s injustices:

Why do the wicked
still live on,

Their power increasing with their age?

They see their posterity ensured,

And their offspring grow before their eyes.

And from there into the most profound pessimism—a rejection of the very terms of existence:

But man?
He dies and lifeless he remains;

Man breathes his last, and then where is he?

The waters of the seas may disappear,

All the rivers may run dry or drain away;

But man, once in his resting place, will never rise again.

And, finally, into blasphemy: he will take his complaint all the way to the top. “
I mean to remonstrate
with God,” says the man who started his mourning week demanding nothing of the sort.

Now you have to admire Job’s chutzpah here: he is going to call God to account. If he knew what you know—that he has indeed gotten the royal shaft from the king of the universe—he’d also know that he has Him dead to rights. It’s a little perverse, of course, the way Job is betting against himself, as if being correct that life is not worth the candle—and pressing this case with its creator—is consolation for how bad he feels. But depressed patients sometimes do just this—make such a compelling case for the pointlessness of their lives and of life in general that you don’t know whether to agree with them or to assert that their pessimism, as William James once said of Arthur Schopenhauer’s, is like “
that of a dog
who would rather see the world ten times worse than it is, than lose his chance of barking at it.”