Depression Narratives: How the Self Became a Problem
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“A scholar of Melancholy am I Chastised By Sorrow Forced to ceaseless learning Till the end of my life”
Charles d’Orleans (1394–1465)2
Many people afflicted with a serious disease ask themselves why they in particular have been afflicted, and this nagging question soon generates a negative picture of their identity.3 In her famous essay, Illness as Metaphor, and in its sequel, AIDS and Its Metaphors, Sontag argues that diseases with unknown causes give rise to personality-focused interpretations and to a variety of damaging metaphors, and illustrates her thesis with myths about tuberculosis and cancer. For a long time, there was no clear medical-biological explanation for these diseases, which made them puzzling and mysterious; this in turn gave rise to interpretations that sought causes within patients’ personalities and behaviors. However, the moment an organic origin was discovered for a disease, such interpretations came to a halt. At that point, physicians and patients regarded the disease as curable and thus not representative of the sufferer’s character. These shifts in understanding tuberculosis and cancer led Sontag to oppose all metaphorical interpretations of diseases: “My point is that illness is not a metaphor, and that the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking.”4
Depression is a disease surrounded by the unknown. Despite extensive research, there is still no theory to explain conclusively the origin of depression on exclusively somatic grounds, since both internal and external causes can disturb serotonin metabolism. Although modern antidepressants (selective serotonin reuptake inhibitors, SSRIs) can reduce major symptoms in about two-thirds of the cases, full recovery [End Page 25] still remains impossible. It is possible that this has helped alter the negative image of depression in the general public’s understanding of the disease: if it could be cured with a pill, then it is a disease and not a sign of personal shortcomings. One-third of patients, however, are resistant to antidepressants.5 Hence, there is ample room for personal blame.
In this article, we will present a picture of how, in the “age of Prozac,”6 people suffering from depression think about their illness and their selves.
Popular Narratives and Depression: Stigma
We approach depression from patients’ perspectives as written down in published illness narratives. By reading these stories, we get a glimpse of how the authors’ wider social circles perceive people in “low spirits.” We look at the relationship between illness and identity as a matter of labeling, prejudice, internalization, and particularly, stigma. Stigma is not an easy concept to define because it is a constantly changing reflection of cultural and social contexts. However, Goffman’s definition is still regarded as the most adequate one: stigma is a deeply discrediting attribute, and the stigmatized are viewed as less than fully human because of it. He states that every human quality (physical and mental, as well as social) is potentially stigmatizable.7 Stigma can be understood as the social rejection of a person or a group of people for being different in a negative way, for deviating from the norm, which, in Western culture, is generally to be an optimistic and a vigorously ambitious striver for success. The concept of stigma is loaded with moral overtones. In the eyes of the non-stigmatized (“normal people”), the principal question is that of responsibility: “More often than not, the blame for the stigma’s existence is attributed, at least in part, to the personality of the stigmatized person himself or herself. It is assumed that the person has committed some immoral act and that the stigma is punishment for this moral transgression.”8 As Wolpert says, the discrediting stigma of mental disturbances, such as depression, is so compelling because it is not localized in the external world or in any other specifiable organ, such as the lungs or heart, but rather in the core of someone’s self.9
Since the nineteenth century, two views on depression prevail in the general population: a romantic version of depression “as a...
