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Section 20
Depression and Alienation

Question 20 found at the bottom of this page
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Of course, mental illness can be used metaphorically in fiction; the suicidality of the depressed drug abuser can serve as a dramatic metaphor for the despair and sense of social disconnection that any healthy citizen might, and perhaps should, feel on any given day. But then we would not want to confound the two conditions in daily life.

For Walker Percy, this problem-confusing existential alienation with mental illness-did not exist. Percy valued disease. He had contracted tuberculosis during his medical internship and called it the best thing that had ever happened to him. The enforced rest turned him into a philosopher and novelist. In his fiction, Percy writes of characters who suffer epilepsy and overt psychosis. In each case, the ailment is an indication of special standing. (As regards epilepsy, one might say special falling-Percy makes plays on physical collapse and Adam's moral fall.) To Percy, symptoms are divine mysteries, to be savored. Yes, Percy objects to the medicalization of personality traits, like obsessionality; but he is already further down the road. In effect, he questions the medicalization of standard medical conditions, like epilepsy and tuberculosis. First and foremost, suffering constitutes spiritual news.

This position is perfectly tenable. We can attribute divine meaning to disease. Psychiatrists are reasonably content for depression to be in the same boat as epilepsy and tuberculosis, whatever boat that is. But Percy's position blurs distinctions we might want to make. It overstates the case only slightly to say that for Percy, there is no difference between treating epilepsy and treating alienation. Both are best approached via faith and revelation, not technology.

For Elliott, disease does exist as a distinct entity. He writes, "I do not want to call into question the use of serotonin reuptake inhibitors for major depression." Still, Elliott says, in the case of the accountant, to approach his alienation as a symptom, rather than an indicator of a predicament, is to make a category mistake. He quips that seeing alienation as a psychiatric issue is like seeing Holy Communion as a dietary issue.

But of course, alienation sometimes is a psychiatric issue, or an indicator of one. In my years of immersion, I was obsessed with category mistakes from the other direction. I had seen too many patients who came in complaining of a sudden loss of interest in marriage or career, but who, upon evaluation, turned out to be in the midst of a depressive episode. Category mistakes are generally in that direction-study after study shows that most depression goes undiagnosed.

And then, in the case of the man from Downers Grove, there was the matter of the many identifiers-Midwest, accountant, suburb, lawn mower. They seemed to signal aspects of the culture we are meant to scorn-conformity, pollution, consumerism. I was reminded of the contempt for Carl Rogers. Do we assume that Illinois accountants are mostly blind to the emptiness of their lives, until they are rescued by sudden and intense discomfort?

The Illinois accountant struck me as a figure from existentialist fiction, a literary creation-and so many of those are suicide-bound. It was hardly reassuring that Elliott had begun by selecting patients with diagnosable illness, Sally and Hillary, as exemplars of the alienated. In the case of the Downers Grove accountant, I found I did want assurance that his new disenchantment was not a psychiatric issue.

Speaking in public alongside Elliott, as I did once or twice in those years, I learned something about myself and the medical model. It is true, when you embrace depression as disease altogether, you become more suspicious of alienation. Not contemplative alienation, not joyous alienation, not alienation that leads to vigorous political action, but the anxious or depressive variety, the type that brings a person to a psychiatrist.
- Kramer, Peter D., Against Depression, Penguin Group: New York, 2005.

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Personal Reflection Exercise #8
The preceding section contained information about depression and alienation. Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 20
According to Kramer, when you embrace depression as disease altogether, you become more suspicious of what? Record the letter of the correct answer the Answer Booklet.