When Alfred Adler, one of Freud’s early followers, saw a patient for an initial consultation, he would take a history and ask the patient to give an account of what he was suffering from, in the traditional medical way, and then, right at the end, he would say to the patient, "What would you do if you were cured?" The patient would answer, and Adler would say, "Well, go and do it then." The patient is assumed to know what he wants, to know what his preferred life is, and his illness is the way he has inhibited himself. The problem, in this sense, is a pragmatic one: the patient knows what he wants; the only problem is how to get it, how to successfully negotiate the obstacle course of desire. The patient’s symptoms are self-imposed obstacles. The patient assumes that were he to get what he wants, he would feel better, but he has made himself into an incompetent hedonist. In this deprivation model of so-called mental illness, life is about doing what you can to get whatever you feel is lacking in your life. We are ill either when we are unable to do this or, worse, when we no longer believe in it. People who are depressed, as Gary Greenberg makes abundantly clear in his lucid and unusually revealing book Manufacturing Depression, are the casualties or critics (or both) of this modern view that life is there for the taking, if only we can find a way—that unhappiness is a form of inefficiency.
This is, of course, a very upbeat view of mental illness, because it presumes, first, that what we want, what will make us feel better, is there (i.e., there’s no scarcity); and second, that wanting works, that the ways we have evolved of getting what we want are competent (i.e., there’s nothing intrinsically difficult, nothing essentially conflictual about wanting); and third, that we are good at knowing what we want, good at knowing what’s best for us (i.e., because we know who and what we are, we know what makes us happy). Each of these presumptions that masquerade as assumptions is obviously contentious. But the many people who discuss these issues—and they are discussed both implicitly and explicitly with shrewd tact by Greenberg in this book—don’t always know that people who are depressed live as if none of this is even plausible. Is there something wrong with them? Is there perhaps something wrong with someone if he is suffering at all? And what are we trying to do to suffering when we redescribe it as illness, rather than as something else? Is something an illness, for example, if there is a drug for it? And if there is a drug for something, does that make it an illness? Is all suffering an illness now, and is all illness defined as something we want a drug for? Science has been one of the very few things that have helped us believe in progress, but, not surprisingly, it hasn’t exactly made a breakthrough with mental illness.
"A good science story," Greenberg writes, "can make you feel even better about progress and the prospects for humankind," but it has become increasingly obvious that the story of antidepressants, not to mention many other wonder drugs of the pharmaceutical industry, may be a bad science story that will make us feel even worse about progress and the prospects for humankind than we do already. Depression, as Greenberg’s title indicates, may have been manufactured, by which he means described in a way that made it the "target" for certain kinds of treatment. Depression was "an enormous market opportunity," he writes, "for an industry that would aim its magic bullets at insanity." As Greenberg knows, a lot is at stake, and not only money, in the medical treatment of depression; around 30 million Americans take antidepressants, and the World Health Organization has claimed that depression is "the leading cause of disability" and the fourth "leading contributor to the global burden of disease." We may not be able to stave off for much longer a catastrophic disillusionment about what science can do for what it insists on calling mental illness for its own good and bad reasons. What is at stake, Greenberg writes, when we begin to think of our unhappiness as a disease is "who we are, what kind of people we want to be, what we think it means to be human."