How Everyone Became Depressed

The rise and fall of the nervous breakdown

Adam Gopnik Blots His Copybook

There is a huge area of neuroscientific research that has made a difference

Adam Gopnik at the New Yorker is one of my favorite writers, especially when he goes on about how wonderful Paris is. But he’s blotted his copybook recently (New Yorker, Sept 9) with a piece about “neuroscience” that pretends to be skeptical about the skeptics.

Neuroscience is hot right now. No doubt about it. The psychoanalytic explanations of behavior so popular in the 1960s and -70s have given way to explanations favoring pieces of the brain as the center of action. One early 19th century writer, riffing on phrenology, referred to this kind of cerebral localization as “bumpology,” and Gopnik leaps on the phrase with glee as a way of ridiculing both those who criticize neuroscientific explanations and those who favor them. A pox on everybody, cries Gopnik, who yearns for good-old-fashioned Humanism, and Erasmus didn’t need to know about his amygdala, thank you very much.

Find a Therapist

Search for a mental health professional near you.

Hmmm. We have to be careful not to throw the baby out with the bathwater here. Some of the recent crop of books criticizing neuroscience are actually quite good: psychiatrist Sally Satel and psychologist Scott Lilienfeld’s recent Brainwashed: The Seductive Appeal of Mindless Neuroscience (Basic Books) warns that perps may go free because they can now blame their brains for their misdeeds rather than their characters. We see this with every new edition of the Diagnostic and Statistical Manual of the American Psychiatric Association: that some new diagnosis provides potential exculpation for criminal acts. The changes that DSM-5 makes, for example, in “Dissociative Identity Disorder” (formerly called Multiple Personality Disorder) stipulate that the existence of the various personality states within the individual may be self-reported, as opposed to reported by others. This opens a wide portal for pleas that “my personality as Jim made me rob the bank.” So, yeah, these fears that neuroscientific findings may have forensic consequences are not unrealistic.

But I suspect that Gopnik is not really interested in the courts. He wants to put the shiv into Sally Satel, who is a prominent conservative media intellectual based at the even more conservative American Enterprise Institute in Washington DC.

Yet my beef isn’t really with Gopnik’s politics. It’s that he seems unaware of a huge area where neuroscientific research really has made a difference in human welfare, and that’s psychopharmacology, the study of drugs that affect the brain and mind.

I know, I know. Some aspects of psychopharm have been seized by the pharmaceutical industry and converted into pseudoscience as a way of selling drugs. The whole neurotransmitter play, for example, claims that too little serotonin makes you depressed but the remedy is Prozac. Nobody in neuroscience believes this anymore, but it’s what doctors tell their patients every day (because they feel they have to tell them something).

But on the whole the historic record of psychopharmacology, including convulsive therapy, is stunning. The suicides prevented by the timely prescription of tricyclic antidepressants such as imipramine; the patients lifted from the depths of despair by electroconvulsive therapy; the manic agitation stabilized by lithium; the back wards of the old asylums emptied out by the first antipsychotic drug chlorpromazine: These are accomplishments comparable to the introduction of penicillin in internal medicine.

And they have given rise to modern neuroscience. Neuroscience set out to explain how these drugs worked, and soared from there.

I am not faulting Gopnik because he failed to write about imipramine. The problem is that he acts as though current neuroscience is mainly focused on the localization of things within the brain. But localization is secondary to the discovery of mechanisms. Because once we discover the brain mechanism of something like melancholia we can treat it more effectively. And much of the research in neuroimaging, neuropsychopharmacology, and the rest of it aims to do just that.

What’s the problem here, Adam? It’s like criticizing the Atomic Table or Boyle’s Law: This is mainline science, man. It’s not scientism (phony science), and it’s not an assault on your precious Humanism. No one wants to do away with the classics, and figuring out exactly why Shakespeare appeals seems pointless.

But why melancholic patients kill themselves: That’s not so pointless.

 

Edward Shorter, Ph.D., is the Jason A. Hannah Professor in the History of Medicine at the University of Toronto.

more...

Subscribe to How Everyone Became Depressed

Current Issue

Love & Lust

Who says marriage is where desire goes to die?