If one believes that
words can heal, or that language--and specifically, narratives--can empower a
person, then David Allen Karp's goal will be realized in his book, Is It Me or My Meds? This, Karp's latest
book on depression, could be seen as the third in a trilogy. In his first book,
Speaking of Silence, published in
1996, Karp endeavors to understand how those with depression make sense of
their illness. His second book on depression, The Burden of Sympathy, published in 2001, reflects on what causes
caregivers to continue to care in spite of overwhelming odds. Underlying the
foundation of all three books is Karp's reliance on narrative language and his
subsequent ethnographic work carried out through individual interviews. In Is It Me or My Meds? it is easy to see
his continuing attempt at meaning making through his examination of the
treatment of depressive disorders with the use of psychotropic drugs. This is a
complex and complicating issue, both to those who deal with depression
personally and to caregivers of those disabled by depression as they work
through the ongoing process.
meaning making, and the authenticity of the self are not new ideas, especially to
writers. The promise of thoughts brought to life, the ability to name one's
feelings, and the continuing attempts to put words to one's imaginations are at
the heart of writing. As writers, we are constantly attempting to maintain our
own individuality while trying to find a comfortable place, or space, in
society. Many of us with disabilities write because of, or through, our
emotional pain. Karp is troubled by what he sees as the increased use of
psychiatric drugs as a result of "a culturally induced readiness to view
emotional pain as a disease requiring medical intervention" (15). This
issue prompts several questions: Is emotional pain a disease to be treated, or
is it 'normal?' Are we, as humans, meant to experience suffering? What is
'normal life pain?' Should spirituality or religion be enough to work through
depression, without the use of medication? And perhaps most important, who
decides the answers to these questions?
The voices in this
book, those of the fifty individuals (forty adults and ten teenagers) who were
interviewed, are those who deal with such questions daily. These are people who
continue to ask themselves such questions. These are also voices that we would
not hear, were it not for the 'spokesperson' role that Karp takes on. His readers
may know of their own experiences, yet rarely, if ever, get to hear others who
have similar experiences. His readers may be caretakers who are striving to
understand depression from a more global aspect. Either way, the fact remains that depression is often an
invisible disability. Karp's statement that "[d]epression's pain is
significantly multiplied when it is disbelieved by others" (52) can be
understood by everyone who has ever tried to explain this kind of suffering.
Therefore, the idea of "Giving Voice," the title of chapter one, is
an apt reference for the desire to help others understand the experience of
depression and the complexities of taking medications.
Our society rarely
depicts those with depressive conditions as functional, valuable, or valued.
"Despite the popularity of biological explanations for mental-illness, as
a society we expect people to manage their emotions, and we have very little
tolerance for those who cannot" (Karp 104). In addition to inner
expectations of the depressed individual are the hopes of caregivers, family
and friends, who desire, and sometimes demand, the depressed individual to
adjust to social 'normalcy.' In other words, the social view of mental illness
impacts the depressed individual's choice to take (and stay on) or abstain from
psychotropic drugs. The path to medication acceptance, according to Karp,
includes four stages an individual will go through: desperation,
experimentation, engagement, and marriage. 'Success' stories involve such
criteria as working with an understanding and caring physician, finding a drug
that works (hopefully with few side effects), adjustment to or acceptance of
loss of creativity, and, perhaps most importantly, the understanding that there
is no easy and perfect answer: this is an ongoing process. Consequently, we can
'define' depression as a chronic disability: one that is not always physically
evident but, nonetheless, never really ceases to exist.
To discuss whether a depressed individual
should take medicine is a moot point at times. There are many for whom there is
no choice, and for these, the questions and struggles usually take a back seat.
Karp shares the voice of one individual, a twenty year-old female sociology
student who states "Instead of thinking I was becoming inauthentic by
taking medication, I realized that I was totally inauthentic when I wasn't
taking medication..." (125). Put this way, we could doubt how anyone could
question the value of anti-depressant medications. However, it is exactly at
this point where Karp's book makes so much sense: disability is individual.
What is unbearable by one is manageable by another. What is uncomfortable for
one may become an occupation for another. In addition, it is just this struggle
to balance and make choices--to take or not to take medications--that is a
palpable current throughout this book.
Karp, as a well-read
sociologist, professor, and writer who suffers from depression, struggles with
these same issues of taking medications in his own life, and he makes no claims
to categorize or cure depression. Reading this book is somewhat like sitting
outside a door--listening: to participants discussing their experiences,
convictions, and struggles. Other 'people' enter (through footnote references):
Arthur Kleinman who wrote the very interesting book Illness Narratives; Milan Kundera, author of the beautiful novel The Unbearable Lightness of Being; L.
Slater who wrote Prozac Diary; A.
Solomon, author of intriguing book, The
Noonday Demon: An Atlas of Depression; T.M. Luhrmann, who authored Of Two Minds: The Growing Disorder in
American Psychiatry; and many more. Some familiar faces show up for further
reading: Sylvia Plath, William Styron, Kay Redfield Jamison, Virginia Woolf,
Elaine Showalter, J. D. Salinger, and others. Amidst all of this is Karp's
clearly understood voice, talking, sharing, sometimes referring to more
scholarly or professional journals, for those who want such readings.
As a holistic and
narrative view of some of the troubling ramifications of integrating
psychotropic drugs into the lives of depressed individuals, Karp's book
symbolizes the spokes of a wheel: a variety of paths, which lead to informative
sources that are narrative, poetic, academic, or medical. For those who are
looking for 'more,' the references should be referred to. Problematic, with
regard to this book, is the omission of an alphabetical bibliography. In order
to garner the wealth of references that Karp offers, the reader would have to
highlight or write out any interesting authors for further reading. Since his
two previous books on this subject contain bibliographic listings, this must be
an oversight by the publisher.
One strength of Karp's
book is also a weakness. His willingness to approach the question of the
construction of mental illness interferes with his "sample [that] is
skewed toward those who are more severely ill than would be the case for all
Americans treated with psychiatric medications" (17). In a sense, he is
dealing with two incongruent issues: that of arguing the value of the self
within society's mandate of 'normalcy' and learning about those who need to
take psychotropic drugs yet struggle with control, identity, and their own
comfort level. 'Cultural conceptions of normalcy' (211) might better be
relegated to those who have more choices than Karp says his participants own.
Authors who write about their own disabilities,
especially mental or emotional, are often severely criticized by an objective
public. How much personal information is enough? Too much? Has the issue been
beaten about enough already? In this area, Karp should receive no complaints.
Although his short (eight page) prologue depicts his own story of disability by
depression and his desire and failure to be free of medication, his voice holds
no self-pity. On the contrary, Karp's voice is one we can rely on to show us
more than we know, to offer other, informative and intriguing views, and
through it all, to hold onto a clear and calm sociological view that neither
falsely comforts nor causes despair.
© 2006 Jo Doran
Jo Doran, M.F.A., is a second-year Ph.D. student in
Rhetoric and Composition at Purdue University, where she teaches composition,
professional writing, and works as a tutor in the Purdue Writing Lab. Her main
research is in the area of language and grief. She has also published poetry in