Sociologist Alain Ehrenberg's detailed and challenging account of depression is the first English translation of La fatigue d'être soi: Dépression et société (1998). Offering a valuable addition to the body of Anglophone writing on that subject, its virtues lie in three distinct directions: its historical references and citations are refreshingly different from those invoked by most writing about depression in English today; it contains a self-conscious reflection on the cultural and epistemological assumptions separating European from English-speaking psychiatric ideas; and it puts forward a provocative, original thesis about the way depression is to be understood at this point in history.
Ehrenberg's writing is well known in Europe, we are told in the helpful foreword to this book written by the McGill University medical anthropologist Allan Young. And as Young emphasizes, the comparative aspect of the work, stressing the very different sources and meanings surrounding how depression is understood in each culture provide Anglophone readers with an opportunity to discern what otherwise might go unnoticed – their "taken-for-granted beliefs about the normal and the pathological" (Young xii). This remains to my mind the most important benefit of Ehrenberg's book. Despite the parallel course of French psychiatry vis à vis treatment innovations during the twentieth century, he does not assume that (again in Young's words), depression is objectively given – an unchanging medical, rather than an evolving cultural category.
In his own preface written for this edition, the author offers his account of what he calls a tale of two continents, citing a literature that includes English language sociological and philosophical works such as Horwitz and Wakefield's Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (2007). For the most part though, the history of the self as depression sufferer during the long course of twentieth century treatments, from electroconvulsive therapy to Prozac, is told using citations and passages from French sources rarely encountered in the Anglophone literature. At times, these seem to echo and even acknowledge what was said on this side of the Atlantic (about persistant struggles to parse depression into endogenous and reactive forms, for example). At other times, they diverge – reflecting, on the author's analysis, a utilitarian approach inimical to Gallic metaphysics. And, from the similarities as much as the differences, there is much to learn here.
Ehrenberg's original thesis concerns depression and the self, as the book's title indicates. The case is built through an in-depth look at treatment responses, first electroconvulsive therapy, followed by imipramine and its companions, and finally the SSRIs. The thesis involves a transformation, in his words, of the meaning of depression, prompted in part by changes in the goal, and effects, of anti-depressant medicine. Stimulants to action replaced the older idea of a cure for pathology. Broader cultural shifts and traditions are also invoked to explain these changes. At the turn of the twentieth century, the depressed self was one of inner conflicts giving rise to depressive suffering; by the turn of the twenty-first century, with unbounded freedom of action "end-of-the-century individuality" had produced a sovereign self, who "believes herself the author of her own life." Now depression lay outside the realm of privacy in issues of inhibition over outer action, making it the twin of addiction. The pathologies of the individual had come to involve "the responsibility of a person who has freed herself from ... the old systems of obedience and conformity" (page 232) No longer a curable illness, depression had become - and was by our contemporary psychopharmacology treated as - a chronic, incurable personality trait of dysthymia. And depression is a "state of mind inherent to individualism" (Preface page xiv).
This brief sketch does not do justice to all the strands of Ehrenberg's substantive thesis, but should suffice to introduce his positive claims and the flavor of the writing - for which a warning is in order. To the Anglophone reader these claims are at times bothersome in their vagueness and generality. They are unconstrained by any hint of phenomenological support, let alone research data, for example, and give little attention to questions of definition or conceptual clarification, even with terms as loose as 'self.' (That the term 'depression' eludes definition today is a point developed persuasively in its own chapter, and stems from the central hypothesis. This indefinability in turn gives rise to a paradox: "although we do not know what we are treating, we are treating it better" (page 73). Nonetheless, given its centrality, allowing 'depression' as what patients claim, psychiatrists diagnose, and anti-depressants treat, leaves the reader in uncomfortable waters.) At times the writing also takes on the turgid style that is anathema to analytic approaches. Consider, for example, the following randomly chosen passage from the conclusion:
The major fact of individuality during the second half of the twentieth century was the confrontation between the notion of limitless possibility and the notion of the uncontrolled. The rise of depression set off the tensions produced by this confrontation, as the realm of the permitted crumbled before the onslaught of the possible. (page 230)
Some of the fault may lie with the translation. Yet the style also reminds us of the very real differences between French and Anglophone theorizing.
English-speaking readers must persevere. Rather than dismissing Ehrenberg's ideas as over-reaching, I suggest we might remember Alan Young's admonition that we use these differences to reflect on our taken-for-granted beliefs about the normal and the pathological. Possessed of this new translation, moreover, we might hope that the plethora of important recent Anglophone research about depression and the self can be enriched by Ehrenberg's insights, ideas and challenges.
© 2015 Jennifer Radden
Jennifer Radden, University of Massachusetts, Boston