Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care

Conclusion: Toward a Rhetorical Care of the Self

As a rhetorical analysis of the symptoms quiz for depression shows, what often passes for “care” in the discourse of depression is, in fact, self-doctoring. Texts that appear to promote personal autonomy and dialogue turn out to have gendered identities embedded within them. As individuals take such texts for granted, they cease to question the authority or validity of their uses of them; like the women who spoke with me, they begin to feel reassured by the familiarity of the selves they encounter through the stories and genres that help construct depression as a common mental illness. The discourse of depression constantly evolves, and it reflects the interests of the powerful social and biomedical institutions that generate many of the now familiar texts. Strategies that may have begun as attempts to promote self-care (for example, the government informational brochures produced by NIMH) are likely to be co-opted and redirected toward these institutions’ narrow biomedical disease models. Nevertheless, a critical reading of texts about depression might help individuals live under health and illness descriptions with more consciousness and therefore more flexibility in their personal responses. Such rhetorical self-care originates in a fundamental curiosity about the self and its relationship with the social and physical worlds. It works within circulating discourses to seek opportunities for tactical responses to those discourses, responses that bring personally meaningful experiences to individuals . It cannot operate outside of the coercive discourses that instill the selfdoctoring drive, so it must remain dynamic in order to make tactical use of opportunities as they appear. Because the strategies that compel individuals to doctor themselves are deployed by powerful institutions such as pharmaceutical companies, counterstrategies that create opportunities for self-care must also be fostered among powerful social entities (which may, perhaps, even include those same pharmaceutical companies). Such sites include educational 180 bbbbbbbbbbbbbbbbbbbbbbbb Conclusion Toward a Rhetorical Care of the Self and medical institutions, which can nurture the habits of critical reading and dialogic engagement with the discourses of health and illness. Such engagement promises to bridge the previously uncrossable divides between literary analysis and clinical practice, between subjective description and objective classification, and between patient and doctor. This humanistic impulse is particularly necessary in an era of increased abstractions away from the self, an era exemplified by faith in biology, genetics, and brain chemistry, rather than social exchange and inquiry. Rediscovering the Narratives in Medicine Within the discourse of depression, a loss of storytelling represents a loss of self-care. For author and psychologist Lauren Slater, faith in pure science at the expense of human interaction characterizes contemporary psychopharmacology . She describes this branch of treatment as the one place “where there is no need for intimacy; neither knives nor stories are an essential part of its practice . And in its understandable glee that it might finally move psychiatry into a position as respectable as surgery, it risks forgetting, or maybe never learning, what even many a surgeon knows: that you must smooth the skin, that you must stop by the bedside in your blue scrub suit, that language is the kiss of life.”1 For Slater, the physical intimacy of language brings humanity to medicine ; it connects doctors with patients and patients with their own storied lives. Knowing that there is a variety of cultural narratives about Prozac, Slater begins her memoir by refuting their easy solutions that tell only the master narrative of the triumph of biomedicine: “No. For me the story of Prozac lies . . . in a place my doctor was not taught to get to—the difficulty and compromise of cure, the grief and light of illness passing, the fear as the walls of the hospital wash away and you have before you this—this strange planet, pressing in.”2 Her story is thus one of interpretation rather than one of restitution; it is also an individual , precise story of selfhood. Slater writes of learning how to read “this strange planet” (i.e., the landscape of health) through the focalization of Prozac; she writes of her alienation from the Prozac Doctor, who becomes a caricature of biomedicine. It is the alienation of having been stripped of her own narrative. She writes that “[the Prozac Doctor] had all the right gestures. His knowledge was impeccable. He made eye contact with the subject, meaning me. But still, there was something about the way the Prozac Doctor looked at me, and the very technical way he spoke to me, that made me feel...