Jonathan Barkat for The Chronicle Review
In his controversial book American Nervousness: Its Causes and Consequences (1881), the neurologist George M. Beard proclaimed that Americans in the 19th century led all civilized nations in their susceptibility to nervous, anxious, and depressive disorders. Beard named the mixture of negative emotions "neurasthenia" and attributed it to five developments in "modern civilization"—steam power, the periodical press, the telegraph, the sciences, and the mental activity of women. In those major signs of modernity—and dozens of related ones, such as buying stocks on margin—the United States, he argued, was both "peculiar and pre-eminent" among advanced societies.
Beard claimed that American nervousness "is the product of American civilization," and that this "distinguished malady" was seen most often among the cultural elite and the "brain-workers." (Indeed, he had suffered from it as a student at Yale University.) Neurasthenia was strongly gendered, but it was an acceptable, even prestigious disease for male intellectuals, professionals, writers, and artists.
The physician Silas Weir Mitchell famously prescribed a "rest cure" for female neurasthenics, to slow down their dangerous mental activity and forcibly restore them to a traditionally passive feminine role. Neurasthenic men, however, were encouraged to steel their nerves and recover their masculine self-control through rugged exercise—ideally the "West cure," of horseback riding, hunting, and camping in California or Colorado. Beard, like many of his contemporaries, was interested in solutions to the malady of modern civilization, which offered its most advanced form in the United States. As he concluded, "He who has solved the problem of nervousness as it appears in America shall find its problems in other lands already solved for him."
Neurasthenia peaked in the early 1900s, according to the literary critic Tom Lutz's fascinating cultural study, American Nervousness, 1903 (Cornell University Press, 1991). But a century later, we are in the midst of a new epidemic. Depression, angst, panic, stress—whatever you choose to call it, there is clearly a lot of it going around.
"It has not escaped many observers that today we are drenched in anxiety," says the medical historian Edward Shorter in his new book, How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (Oxford University Press). "Depression has become a mass illness." Shorter cites statistical evidence: "Within a given year, one in 10 Americans today will have a mood disorder, the great majority of them major depression." The psychiatrist Jeffrey P. Kahn sees an even worse trend in his recent Angst: Origins of Anxiety and Depression (Oxford), with "the commonplace anxiety and depressive disorders" affecting at least 20 percent of Americans. That's some 60 million people.
The New York Times even has an online series dedicated to anxiety (submissions to email@example.com), with regular posts on such cheering topics as the dire residential options for the elderly ("You Are Going to Die," January 20, 2013), as well as regular apocalyptic updates on poverty, guns, violence, terrorism, antibiotic-resistant superbugs, climate change, and the inexorable decline of all the professions, occupations, and institutions we thought were eternal. A report from the World Health Organization says that, despite its wealth, the United States is the most anxious nation. "America's precocious levels of anxiety are not just happening in spite of the great national happiness rat race but also, perhaps, because of it," suggests Ruth Whippman in "America the Anxious" (the Times blog, September 22, 2012). Hollywood, too, is cashing in on the age of anxiety, with noir thrillers like Side Effects, about the opportunities and risks of antidepressant medications.
Not surprisingly, the rise of American angst is also the subject of a flood of new books, including memoirs, literary criticism, and medical and historical studies. Looking at several of them suggests that the search for solutions has also created some of the problems, through publicizing a category of distress.
In Angst, Kahn, who is a clinical associate professor of psychiatry at New York-Presbyterian Hospital/Weill Cornell Medical Center, sees depression and anxiety as the contemporary forms of primeval instincts of self- and social preservation. He looks at five major syndromes of depressive disorders—panic anxiety, social anxiety, obsessive-compulsive disorder, atypical depression, and melancholic (or suicidal) depression—suggesting how each one could have evolved from some Darwinian drive to help organisms survive. Melancholic depression, for example, "kept us from using scarce resources when no longer useful to the group"—in other words, it led to the aged and infirm stepping onto the ice floe.
Kahn locates himself in the field of evolutionary psychopathology, a subset of the evolutionary biology that has seeped into much of our thinking about our maladies, our family patterns, even our literature. He believes the symptoms of angst are so common and widespread that they "must have served some kind of purpose for us in our evolutionary past." He readily admits that there is not much hard scientific evidence for his ideas, let alone a "smoking gene" for disorders like panic anxiety.
But Kahn is writing for general readers who need to be told that Shakespeare was a "British playwright, 1564-1616," rather than for scientists or other brain workers. While he is casual about evidence, he is good on common sense. After all, researchers have shown that a disease like schizophrenia has a strong genetic component, and that depression and OCD may also be hard-wired into our evolutionary process. Kahn punctuates his explanations with corny jokes ("It's not easy being blue"), and illustrates his themes with quotations from rock and folk lyrics (such as Jerry Garcia's "Old and in the Way").
He is a pragmatic and reassuring guide to angst, suggesting at the end of each chapter "how to fix it." As he writes, "You've gotta ask yourself one question: Do you feel yucky?" If your angst is "intense" or "prolonged," he suggests, it is worth seeking professional counsel from pastors or physicians—and even getting some psychotherapy, a move Kahn recommends for "an accurate diagnosis and good suggestions," including medication, an option that he clearly thinks will alarm many of his readers. "You can still take a pass," he says.
We are in the midst of a new epidemic: Depression, angst, panic, stress—whatever you choose to call it, there is clearly a lot of it going around.
Where Kahn's book is a genial guide to American angst, Shorter's How Everyone Became Depressed is a polemical, alarmist complaint about the psychiatric profession, the big pharmaceutical companies, and the changes within medicine about diagnosis and terminology. Shorter, a professor of history at the University of Toronto, who went down this road in Before Prozac (Oxford, 2008), argues that the overelaboration of symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the updated fifth edition of which will appear in May, has led to the multiplication of nervous syndromes. "Most clinicians, in their heart of hearts, thought anxiety and depression were really the same illness: It was only the DSM drafters who wanted to keep them apart," he says.
Between 1860 and World War I, during what Shorter sees as the heyday of nervous illnesses and the golden age of treating them, physicians traced connections between body and mind. But after Freud, he says, "the spotlight shifted from nerves, a diagnosis that implicated the whole body, to mood, a diagnosis that implicated mainly the mind. Mental illness triumphed over nervous illness."
From the 1920s to the 1960s, the "mixed disorder" of depression and anxiety became the commonest psychiatric illness. The next big shift occurred in the 1960s, with the availability of effective, albeit risky, antidepressant medications. In 1988, Prozac was launched, and drug companies, Shorter tells us, proclaimed a quick serotonin cure for depression. "Is it any wonder that depression spread epidemically within the medical profession as a diagnosis and within the public as a supposed disorder?" he asks.
Shorter believes that the increase in depression is more a problem of an expanding diagnosis and a surge in self-labeling than a genuine epidemic. Serious mental illness certainly exists, but is often misdiagnosed and ineffectively treated with Prozac-type drugs. He indignantly concludes that "psychiatry's inability to stop the depression epidemic is an appalling story of the collective failure of a scientific discipline to ward off a public-health disaster." Abdication to Big Pharma "means that poorly diagnosed patients are denied the benefit of proper treatment." Ironically, however, Shorter's solution to the disaster is not a return to the holistic concept of nerves, but the development of new and better drugs.
While Shorter crusades against the drug companies and the DSM, the Bryn Mawr College professor of social work Dana Becker, in her new One Nation Under Stress: The Trouble With Stress as an Idea (Oxford), is a social constructionist. She sees the discourse of depression as a reflection of "traditional American values of individualism and capitalism." Like Shorter, she is skeptical about the insistent marketing of antidepressant medication, but in her view the real source of the epidemic is "stressism." Popular books about stress and life events, stress and the heart, stress and the Type A personality, as well as products and therapies marketed to relieve stress, have made the disorder the default diagnosis for millions of Americans. Too many academic experts, as well as the mass media, send the message that the way to deal with stress is through individual adjustment to competition and ambition.
But stress and anxiety are also "tied to social, economic, and political processes in ways that many contemporary perspectives rarely touch," Becker concludes, "Now stress gives us a way to talk about unsettling transformations in American life: growing income inequality, tectonic shifts in gender arrangements, war in the age of terrorism. We call the plunge into poverty during recession 'financial stress'; we call the sometimes crushing responsibility for equal investment in work and family the stress of 'work-family conflict'; we call suicidal reactions to the unnameable horrors of war 'post-traumatic stress.'" She believes that we should accept our "universal vulnerability" to life's risks and dangers but work together to change "inequalities in our society." To contend with our "all-American stress," Becker argues, we need to face the real problems of our country in the 21st century.
In last fall's Depression: A Public Feeling (Duke University Press, 2012), Ann Cvetkovich, a professor of English and women's studies and gender studies at the University of Texas at Austin, looks at "the culture of depression" in academic life. Academe, she writes, "breeds particular forms of panic and anxiety leading to what gets called depression—the fear that you have nothing to say, or that you can't say what you want to say, or that you have something to say but it's not important enough or smart enough."
Like Beard, Cvetkovich views brain workers as especially susceptible to depression. Some of the key stages of professorial life are fraught with anxiety. First is the ordeal of the dissertation, with "perfectly capable people who fall apart in the process of writing a first chapter or who wallow in partial dissertation drafts unable to put it all together," she writes. Then they can fall apart from being on the job market, adjusting to a new job, and facing the hurdles of publication.
Of course, most professional careers proceed through similar stages of uncertainty and apprenticeship. But Cvetkovich believes that they are especially intense for academics. Indeed, melancholy has been the fashionable disease of scholars and intellectuals since Hamlet, at least, and there are many modern variants, like the Nordic noir of Henrik Ibsen and Ingmar Bergman and the anhedonia of Woody Allen. Then, too, the news these days for higher education, especially the humanities, could scarcely be gloomier, especially the plight of non-tenure-track faculty members.
In addition, for academics, as for other Americans, default anxiety was exacerbated by the catastrophic events of 9/11, the Iraq war, and Hurricane Katrina, when, Becker says, "many of us admitted to feeling exhausted and overwhelmed by our professional obligations."
Along with their personal sense of trauma, some left-wing academic activists experienced "political depression" or "left melancholy," which Cvetkovich defines as "nostalgia for a past socialism that prevents action in the present." She describes a loosely affiliated group of academics and artists calling itself "Public Feelings," which started in Chicago with a mission to replace collective depression with a new political activism. The group organized a conference, "Depression: What Is It Good For?," at the University of Chicago and a series of demonstrations called "International Parades of the Politically Depressed," in which participants were encouraged to show up in their bathrobes. (In a new production of Hamlet at the Yale Repertory Theatre, Paul Giamatti plays the melancholy Dane as a depressed dropout in a bathrobe. Perhaps the ratty bathrobe is the new tweed jacket, updated for today's world of unemployment and underemployment.)
Cvetkovich esteems such alternative public events as providing spaces for discussion and community, as well as going a therapeutic step beyond the empty slogans of political protest. In terms of her own anxiety, however, she wryly notes, "Saying that capitalism (or colonialism or racism) is the problem does not help me get up in the morning."
What does help her get up in the morning? She has a number of private incentives, including keeping dental appointments and swimming. She also recommends communal forums like the knitting circle, which takes private activities to a public level and counteracts the tendency of depressed people to withdraw. Indeed, she suggests that "the knitting store has now joined the feminist bookstore of the 1970s and the sex-toy store of the 1990s as a public space for feminist thinking and activity." Like the 19th-century quilting bee, which brought women together to combat loneliness and to discuss feminist issues like suffrage, knitting can be a site of public feeling.
Cvetkovich locates herself in a new field of depression studies, a subset of the "affective turn" of literary criticism, which focuses on emotions. Naming the field in a way that parallels the "linguistic turn" of poststructuralism and deconstruction, she describes her cohort of literary critics as attracted to the "emotional genres," such as the gothic, sentimental, sensational, and melodramatic.
Her book is an experiment in connecting personal feelings with social conditions and critical analysis. She divides it into "The Depression Journals," an engaging memoir of her own lengthy depression 20 years ago as a young graduate student and beginning assistant professor, and three heavily theoretical critical essays: on historical models of melancholy and spiritual crisis, the relationship between depression and racism, and the uses of crafting and creative work, including "new forms of writing that are 'essays' in the literal sense of an experiment," as antidotes to despair. Cvetkovich speculates that academic anxiety might be relieved by changes in self-expression: "If depression is conceived of as blockage or impasse or being stuck, then its cure might lie in forms of flexibility or creativity more than in pills or a different genetic structure."
The academic conference is another antidote to depression. In her critical-essay mode, Cvetkovich notes that "live events with their performative energies have been a crucial forum" of resistance and recuperation. In her vivid memoir, she describes the first Lesbian and Gay Studies Conference she attended, at Yale, starring Judith Butler, Eve Sedgwick, and Douglas Crimp: "The rooms and halls were pulsing with energy—Act Up activists mingled with academics, and everybody looked sexy and cool; long before the mainstream media reported on it, lesbian chic had already arrived. Even though I was barely present emotionally, I could feel it enough to be able to save the experience for later use." In other words, Cvetkovich finds a variety of ways to utilize the tools of academe to build a shelter from the traumas of academe.
It's both funny and oddly endearing to see an academic response to depression that turns it into a field, organizes conferences and protests with special and entertaining dress requirements, recommends cures for writing blocks, and appropriates American anxiety in the interest of getting academic work published. I feel the pain. And I, too, worry about the many problems that beset the labor market and threaten the future of higher education. But how does focusing on academic anxiety bring light to the discussion in general?
As Tom Lutz shows in American Nervousness, 1903, the discourse of neurasthenia, exemplified by writers like Henry James and intellectuals like Charlotte Perkins Gilman, "helped people negotiate the large-scale changes in culture and structure which radically changed the face of social life in America between the Civil War and World War I." American anxiety may be serving a similar purpose today, and academics may once more become the cultural vanguard—if we can come together to confront some of the structural, epistemological, and financial issues facing higher education.
But reading all these books leaves too many questions unanswered. They don't agree on much, except to insist on the prevalence of American anxiety in a way that sounds like competitive humblebragging. Is anxiety getting worse in the United States, or is that just a matter of terminology and a popular diagnosis? Would anxiety disappear in a social utopia? Or is it an indelible part of the human condition? Are Americans anxious because we are so successful, because we are the richest country in the world? Are academics so depressed because we are so damn smart, and, like Hamlet, paralyzed by the dilemmas and conflicts we face?
Perhaps we can get a little perspective by asking ourselves whether Americans are more anxious than Syrians, or more depressed than the British during the Blitz. Or whether academics are more depressed than unemployed factory workers or phased-out journalists.
American anxiety seems like a cultural chimera created by, yes, social and economic problems, and by personal crises, but also by media attention. Perhaps too much attention to feelings creates a self-fulfilling prophecy and risks making us a "solipsistic, self-consumed, bottomless emotional vacuum and sponge," like the "The Depressed Person" in David Foster Wallace's wickedly funny 1998 short story.
Maybe if we are really feeling yucky, with or without medications, we need to organize rather than somatize, and to act rather than brood.