Listening to Chekhov: Narrative Approaches to Depression

We live in an era of depression. According to the World Health Organization, depression affects 121 million people across the globe; it is the fourth leading contributor to the global burden of disease and, by the year 2020, will be the second.¹ At its worst, depression leads to suicide, killing approximately 850,000 persons every year worldwide.² In the United States alone, the Journal of the American Medical Association reports, about 16 percent of the population, roughly 35 million people, suffer from severe depression in their lifetime.³ In any one period, 13 to 14 million Americans are thought to experience the illness.⁴

Numbers tell us the pervasiveness of depression; they do not tell us about the intensity of individual suffering. Andrew Solomon, in his memoir, The Noonday Demon: An Atlas of Depression, compares his experience of depression to that of a strong and dignified oak tree being persistently and maliciously attacked by a parasitic vine. Melancholia wrapped itself around him, ugly and sure, until his life was gradually asphyxiated: "I knew that the sun was rising and setting, but little of its light reached me. I felt myself sagging under what was much stronger than I."⁵ Solomon felt that the tendril of depression "threatened to pulverize my mind and my courage and my stomach, and crack my bones and desiccate my body. It went on glutting itself on me when there seemed nothing left to feed it."⁶ In this state of utter desperation, he believed that the melancholia was so intertwined with his life that any attempt to destroy the malignant vine would destroy his own self in the process. All he could do was helplessly wish that somehow he would die and be relieved of his misery.

Philosopher Julia Kristeva describes the experience of melancholia as an abyss of sorrow, a noncommunicable grief, that leaves its victims all but mute.⁷ Melancholia lays claim on its sufferers and sucks out all of their interest in words, actions, and even life itself. The initial despair can be triggered by a setback in love or in life, perhaps a betrayal, an illness, or an accident, that wrests people away from what they know and expect. But when melancholia sinks in, people do not snap back; they are thrown into another life, one that is out of proportion with their setbacks. Kristeva describes this other life of depression as "unlivable, heavy with daily sorrows, tears held back or shed, a total despair, scorching at times then wan and empty. In short, a devitalized existence that, although occasionally fired by the effort I make to prolong it, is ready at any moment for a plunge into death."⁸ Depression is "a living death, my flesh is wounded, bleeding, cadaverized, my rhythm slowed down or interrupted, time has been erased or bloated, absorbed into sorrow."⁹ Kristeva likens depression to a "black sun" whose eerie, lethargic rays have the power to pin its victims down to the bed, to the ground, and leave them compelled to silence and renunciation.¹⁰

Despite the seriousness of depression today—both its pervasiveness and the extensive suffering it causes—this is an era that seems naïve and unsophisticated about the multiple dimensions of depression. The vast majority of clinical discourse embraces a biological model that describes depression as a medical disease involving neurological pathology. Using disease logics, like the commonly held notion of a "neurochemical imbalance," the expected solution lies in pharmaceutical interventions.¹¹ Eli Lilly's blockbuster medication Prozac provides a useful benchmark for how pervasive this solution has become. Between 1987 and 2002 (the year Prozac came off patent), new prescriptions for the drug reached over 27 million.¹² Combined with the multiple "me too" drugs it inspired—the class of antidepressants known as "selective serotonin reuptake inhibitors" (SSRI)—that total reached 67.5 million in the United States alone.¹³ These numbers suggest that almost one in four people in the United States began taking a Prozac-type drug between 1987 and 2002.

Simultaneous with this epidemic of prescriptions, there has been a significant public...