the still sad music of humanity

The whole point of crying is to stop before you corny it up.
(Richard Yates, Revolutionary Road)

The publication in 1994 of Listening to Prozac by Peter Kramer, in which he suggested anyone with too little "joy juice" might give themselves a dose of the "mood brightener" Prozac , lifted sales into the stratosphere. (Independent, 26/2/08)

Today, a major new study shows that Prozac, taken by 40 million people worldwide, does not work and nor do similar types of drugs. For a profession normally diplomatic, the words today of one of study's authors are damning. "Given these results", Professor Kirsch of Hull University says, "there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients." (Guardian, 26/2/08)

The problem with depression is that people are generally disinclined to believe that it exists. Not that people disbelieve melancholy. Chaucer believed in it, and so did Durer. But they disbelieve, instead, that depression could be a condition worthy of medical attention. Never mind that an excess of melancholy was treated by emetics and blood-letting, before they got the circulatory system was figured out. The problem is that, having stopped treating it because the grounds for treatment were found to be faulty, which is fair enough, the treatment itself resurged because the condition was still endemic. Whether it's electroshock therapy, or some kind of analysis, or cognitive behavioural therapy, or anti-depressants, the past hundred years have (I guess) a pretty consistent theme of reworking and treating the Black Knight's complaint, assuaging his unhappiness as the dream is unable to do.

What I'm getting at is this: irrespective of whether anti-depressants work, or of whether blood-letting and leeches worked; we have been turning to doctors, asking for treatment for a pain we can't place but which saps the very life out of us for as long as there have been doctors.

Maybe anti-depressants don't 'work', however that functionality is calibrated. Maybe no anti-depressant treatment has truly 'worked' - for example, exercise is just a stimulated deferral - but perhaps it's more telling that we feel compelled to be treated. So what if the pills are placebos? To all intents and purposes I find it impossible to distinguish between a psychological medicine that works because it works, and one that works because you think it works. Any takers for that one?

I don't really mind if my antidepressants are placebos. And I am as hostile to Big Pharma as anyone else. It seems to me that antidepressants are just a heavily industrialised extension of an old solution to an old, old phenomenon: that we need institutions (and the very institution in particular that is the guardian and guarantor of our health) to recognise that we have interiority. Paradoxically, maybe we need an institutional recognition that there is something about consciousness that is indivisible?

In a way, that the latest treatment for depression is unmasked as a kind of quackery isn't a victory for the scientist who've produced this report, or the anti-Pharma activists, or for the people who say that depression is a self-constructing, self-perpetuating phenomenon. This is because we don't really know what depression is, beyond an ever more minute catalogue of its symptoms. We don't really know how to cure it, either. And we certainly don't know why it is that we keep taking cures that, though they work, demonstrably don't work. (Phrenology, anyone?)

it seems that there's a blind-leading-the-blind element here. Scientists devise fake treatments that work for a non-existent condition that is described by one analyst and philosopher as 'like death-in-life'. Other scientists then expose these treatments as bogus (although they too are wrong). New treatments are designed simply to meet demand. Lather, rinse, repeat.

We don't know what our antic disposition is (or why so many accounts of depression sound a lot like Hamlet's 'seeming' rather than 'being') but soon there'll be another cure for it. People will re-engineer SSRIs, perhaps, but there'll be something else, something new. It'll be wonderfully effective, too - it'll be the new wonder treatment for depression, until we figure out that in fact, it doesn't work at all. All this makes me think of that wonderful Simon Armitage poem, To his Lost Lover;

Now they are no longer
any trouble to each other

he can turn things over, get down to that list
of things that never happened, all of the lost

unfinishable business.
For instance… for instance,

how he never clipped and kept her hair, or drew a hairbrush
through that style of hers, and never knew how not to blush

at the fall of her name in close company.
How they never slept like buried cutlery –

two spoons or forks cupped perfectly together,
or made the most of some heavy weather –

walked out into hard rain under sheet lightning,
or did the gears while the other was driving.

How he never raised his fingertips
to stop the segments of her lips

from breaking the news,
or tasted the fruit

or picked for himself the pear of her heart,
or lifted her hand to where his own heart

was a small, dark, terrified bird
in her grip. Where it hurt.

Or said the right thing,
or put it in writing.

And never fled the black mile back to his house
before midnight, or coaxed another button of her blouse,

the another,
or knew her

favourite colour,
her taste, her flavour,

and never ran a bath or held a towel for her,
or soft-soaped her, or whipped her hair

into an ice-cream cornet or a beehive
of lather, or acted out of turn, or misbehaved

when he might have, or worked a comb
where no comb had been, or walked back home

through a black mile hugging a punctured heart,
where it hurt, where it hurt, or helped her hand

to his butterfly heart
in its two blue halves.

And never almost cried,
and never once described

an attack of the heart,
or under a silk shirt

nursed in his hand her breast,
her left, like a tear of flesh

wept by the heart,
where it hurts,

or brushed with his thumb the nut of her nipple,
or drank intoxicating liquors from her navel.

Or christened the Pole Star in her name,
or shielded the mask of her face like a flame,

a pilot light,
or stayed the night,

or steered her back to that house of his,
or said “Don’t ask me how it is

I like you.
I just might do.”

How he never figured out a fireproof plan,
or unravelled her hand, as if her hand

were a solid ball
of silver foil

and discovered a lifeline hiding inside it,
and measured the trace of his own alongside it.

But said some things and never meant them –
sweet nothings anybody could have mentioned.

And left unsaid some things he should have spoken,
about the heart, where it hurt exactly, and how often.