Ghaemi, Nassir. “On Depression. Drugs, Diagnosis, and Despair in the Modern World.” Baltimore: The Johns Hopkins University Press. 2013.

10/9/13.

My review of Dr. Ghaemi's new book.

 

Ghaemi, Nassir. “On Depression. Drugs, Diagnosis, and Despair in the Modern World.” Baltimore: The Johns Hopkins University Press. 2013.

Book Review.

To some intelligent consumers, mental health clinicians come in two varieties:  muddleheaded or simpleminded. In the mind of too many, either you go for help with your mental troubles for years in psychotherapy, or you get a pill after a fifteen minute conversation listing your symptoms.

Of course these stereotypes are silly --- but may illustrate the stigma and fear still associated with mental illness.

The recent slew of critical articles in the national press covering the roll-out of the fifth-edition of the “Psychiatric Bible” no doubt adds to this confusion and misunderstanding of mental maladies in the general public.  The DSM-V runs amok with poorly understood psychiatric diagnoses, consisting of a list of ingredients for many psychological disorders with no recipes for the causes or etiology of any of the increasing number of mental maladies. To ask what mental illness is, is to often get a story along the lines of some theory.

An expert in mood disorders, steeped in philosophy, existential biology (his term), statistics, rigorous research, psychiatric diagnoses, and psychotherapy --- Dr. Nassir Ghaemi brings his knowledge of science and the humanities in his new book to look at the complexity of depression. He has written books on concepts in psychiatry, statistics, and the psychology of leadership and mental illness.

Dr. Ghaemi asks what it means to experience despair or happiness in a post-modern world he defines as “the notion that the ‘modernist’ goal of discovering the truth, through reason and science has failed; our claims to the truth and knowledge, whether through science or democracy or other ideologies, are merely culturally relative opinions, with economic and political sources…” (1).

He says many people now live as if God is dead because hope has died, meaning has been sucked out of the world, and the ideals of the Enlightenment have perished in the nightmare of the gas chambers. Even if we don’t know it, he says, we are drenched in a culture where nothing is true or false so that a rational response to the world is cynicism and despair.  We spend endless time and money getting the world to bend to the desires of the self.

Dr. Ghaemi discusses the big lies of postmodern thinking and steers a course of adherence to scientific principles and existential understanding of the human condition – focusing on depression. He takes a dim view of the mental health clinicians he calls “pretenders” who only see the pharmaceutical companies as evil profiteers, selling snake oil for nonexistent conditions. Other “pretenders”, he says, embrace all views as true, producing an eclecticism which leaves patients on their own. Ghaemi says that critics of psychiatric drugs often ignore evidence of their benefits. His approach is to advocate a biological existentialism, which means that science and humanism are not in conflict.  

He describes depression as many things---not all requiring medication, and not all consisting of twisted thoughts tied to twisted neurons. Sometimes depression is a disease such as manic-depression, where episodes of despair and flights into disorganized exuberance come and go, and in severe episodes require the right medications to stop the horrors of a shattered soul, and block the nightmare of suicide. Sometimes depression reflects personality traits, such as a tendency to be anxious or sad all the time, with brief periods of more severe symptoms. Sometimes depression is a reflection of life, death, and existential despair --- that Freud characterized as, “The terrors of nature,…the cruelty of Fate, particularly as it is shown in death,…the sufferings and privations which a civilized life…has imposed,…the perplexity and helplessness of the human race,…the suffering which men inflict on one another.”  (2).

Dr. Ghaemi devotes chapters describing the work of some existentially oriented psychologists and psychiatrists who have deeply influenced his  clinical work and world view.

The following are some of these clinical guides along with their chapter headings and quotes:

Viktor Frankl, M.D., Ph.D. (1905 – 1997):  Learning to Suffer

He was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. He founded Logotherapy, a form of existential therapy.

·       “The most horrible psychiatric outcome isn’t suffering – it’s apathy.”

·       “We shouldn’t fear suffering; we should fear not caring about whether or not we suffer.”

·       “The goal of existential psychotherapy is to try to help us learn to suffer.”

Rollo May, Ph.D. (1909 – 1994) and Elvin Semrad, M.D. (1909  - 1976): I Am, We Are

Rollo May was an American existential psychologist. He sought to analyze the structure of human existence with the aim of understanding the reality underlying all situations of humans in crises.

·       “I don’t think I’m either pessimistic or optimistic; I’m realistic. I don’t disparage your joy, but I think true joy only arises from acknowledging our despair.”

Elvin Semrad was an American psychiatrist who was an influential teacher of psychotherapy at Harvard’s Massachusetts Mental Health Center.  His approach was difficult to classify but he had an uncanny ability to empathically focus on the patient’s experiences. He would say that no one is psychotic in his presence.

·       “I’ve always thought that some of the things people suffer most from are the things they tell themselves that are not true.” 

·       “The psychiatrist’s job is to acknowledge, bear, and put into perspective suffering.”

Leston Havens, M.D. (1924 – 2011):  Holding Opposed Ideas at Once

An American psychiatrist known for his work on biological psychiatry, and his existential approach to psychotherapy.

·       “I teach the philosophy that we don’t know.”

·       “Experience is a comb you get when you’re bald.” 

·       “Creativity meant holding two apparently irreconcilable positions at once.”

·       “The goal of psychotherapy: personal liberation.”

·       “The goal of empathy is enough safety to begin to find out the painful truth.”

·       “Psychic health requires the ability to connect and disconnect, to connect with others and to leave and protect oneself from others.”

 Paul Roazen, Ph.D. (1936 – 2005):  Being Honest about the Past

Dr. Roazen was a political scientist who became a historian of psychoanalysis. Roazen was the first non-psychoanalyst whom Anna Freud allowed access to the archives of the British Psychoanalytical Institute. He interviewed surviving friends, relatives, colleagues and patients of Sigmund Freud.

·       “Freud used to quote the line from Schiller or somebody, to the effect that a person who does not lose his mind under certain circumstances has no mind to lose. Put that in your DSM pipe and smoke it – I do not think anything that DSM does or does not say is of any intellectual relevance…DSM is a question of what insurance needs require – period. In my view nothing to do with ‘science,’ certainly not the life of the mind.”

·       Dr. Ghaemi: “What can we learn about psychiatry today from Paul Roazen? Psychoanalysis as a dogma should be rejected. Freud as a thinker can be embraced. Biology as a dogma should be rejected. Medications, carefully used, can be accepted. Not all symptoms are diagnoses; not all diagnoses are very symptomatic. The concept of neurosis should be resuscitated:  it tells us much about the many people who have psychological symptoms but no psychiatric diseases.”

Alfred North Whitehead, a famous mathematician and philosopher, urged us to remember that knowledge keeps no better than fish. Therefore, throughout our lives,  we are all in the learning game, not the authorities’ game.

Dr. Ghaemi offers much fresh knowledge in his elegant new book.  

I think Dr. Ghaemi would agree with Anna Freud  who when she was eighty-five offered the following succinct statement of her credo to a depressed young man who sent her a lament about the chaotic state of the world:

“I agree with you wholeheartedly that things are not as well as you would like them to be. However, my feeling is that there is only one way to deal with it, namely to try and be all right with oneself, and to create around one at least a small circle where matters are arranged as one wants them to be.” (3)

References:

(1)  Ghaemi, Nassir. On Depression. Drugs, Diagnosis, and Despair in the Modern World. Baltimore, The Johns Hopkins University Press, 2013.

(2)  Schur, M. Freud: Living and Dying. New York:  International Universities Press, 1972.

(3)  Young-Bruehl, Elizabeth. “Anna Freud: A Biography. Second Edition.”  Ann Arbor: Sheridan Books, 2008.