Depression's Many Faces

When William Styron published his memoir of depression, Darkness Visible, in 1990, psychiatrists were grateful. It criticized doctors, medications and psychotherapy-but never the mind. Styron described the ailment and alluded to ways in which it was beyond description. The book was a resource, something to give to a family member, to explain the

When William Styron published his memoir of depression, Darkness Visible, in 1990, psychiatrists were grateful. It criticized doctors, medications and psychotherapy-but never the mind. Styron described the ailment and alluded to ways in which it was beyond description. The book was a resource, something to give to a family member, to explain the depressed loved one's twin difficulties: the illness and the impossibility of expressing its pain.

But Styron's was an account of depression in an elderly, alcoholic man -- depression as emptiness. Diversity of form is a hallmark of depression. Robert Burton, a 17th-century physician, insisted that among melancholics, "scarce is there one of a thousand that dotes alike." Age and gender make a marked difference.

So I was pleased when the galleys of Prozac Nation crossed my desk in 1994. Elizabeth Wurtzel was grandiose, breathless and self-absorbed, which was all very honest. The memoir displayed depression in a flighty, headstrong, energetic, sexually promiscuous young woman. I endorsed the book, because it filled a need.

After Styron and Wurtzel came the deluge. We have had memoirs of depression by black urban single mothers and white Midwestern family men. Gay and straight, conventional and decadent, scientist and journalist, celebrity and commoner -- the past decade has seen a flood of autopathography. Most authors make the same mistake-presuming that depression is of a single sort. But as a group, the books perform a public health function: They destigmatize. They give voice, in turn, to the variant any patient is likely to suffer. And they form a striking patchwork, forcing us to see how various, how ubiquitous, how influential depression is as an element in contemporary life.

Peter Kramer, M.D., is the author of Listening to Prozac and Spectacular Happiness and a clinical professor of psychiatry at Brown University.