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Manufacturing Depression: The Secret History of a Modern Disease

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• Author with professional and personal experience: Psychotherapist Gary Greenberg’s musings on the intersection of science, politics, and ethics have graced the pages of The New Yorker , Wired , and Mother Jones. A longtime sufferer of depression, in 2007 he enrolled himself in a clinical trial for major depression (after his initial application for a minor depression tri • Author with professional and personal experience: Psychotherapist Gary Greenberg’s musings on the intersection of science, politics, and ethics have graced the pages of The New Yorker , Wired , and Mother Jones. A longtime sufferer of depression, in 2007 he enrolled himself in a clinical trial for major depression (after his initial application for a minor depression trial was rejected). He wrote about his experience in a Harper’s magazine piece, which received a tremendous response from readers..• “Am I happy enough?”: This has been a pivotal question since America’s inception. Am I not happy enough because I am depressed? is a more recent version. Greenberg shows how depression has been manufactured—not as an illness, but as an idea about our suffering, its source, and its relief. He challenges us to look at depression in a new way.. • A nation of depressives: In the twenty years since their introduction, antidepressants have become staples of our medicine chests—upwards of 30 million Americans are taking them at an annual cost of more than $10 billion. Even more important, Greenberg argues, it has become common, if not mandatory, to think of our unhappiness as a disease that can, and should, be treated by medication. Manufacturing Depression tells the story of how we got to this peculiar point in our history. .


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• Author with professional and personal experience: Psychotherapist Gary Greenberg’s musings on the intersection of science, politics, and ethics have graced the pages of The New Yorker , Wired , and Mother Jones. A longtime sufferer of depression, in 2007 he enrolled himself in a clinical trial for major depression (after his initial application for a minor depression tri • Author with professional and personal experience: Psychotherapist Gary Greenberg’s musings on the intersection of science, politics, and ethics have graced the pages of The New Yorker , Wired , and Mother Jones. A longtime sufferer of depression, in 2007 he enrolled himself in a clinical trial for major depression (after his initial application for a minor depression trial was rejected). He wrote about his experience in a Harper’s magazine piece, which received a tremendous response from readers..• “Am I happy enough?”: This has been a pivotal question since America’s inception. Am I not happy enough because I am depressed? is a more recent version. Greenberg shows how depression has been manufactured—not as an illness, but as an idea about our suffering, its source, and its relief. He challenges us to look at depression in a new way.. • A nation of depressives: In the twenty years since their introduction, antidepressants have become staples of our medicine chests—upwards of 30 million Americans are taking them at an annual cost of more than $10 billion. Even more important, Greenberg argues, it has become common, if not mandatory, to think of our unhappiness as a disease that can, and should, be treated by medication. Manufacturing Depression tells the story of how we got to this peculiar point in our history. .

30 review for Manufacturing Depression: The Secret History of a Modern Disease

  1. 4 out of 5

    Diane

    Mr. Greenberg's book may not be the most concise or engagingly written on this topic, but he provides a detailed and interesting overview of the cultural evolution of our idea of depression. For that alone, I think it's a book well worth reading. I also have to agree with his view that while it may not be intentional, the big drug companies have and are continuing to take steps, through lobbying and direct-to-consumer advertising, to broaden the definition of depression and other "mental illness Mr. Greenberg's book may not be the most concise or engagingly written on this topic, but he provides a detailed and interesting overview of the cultural evolution of our idea of depression. For that alone, I think it's a book well worth reading. I also have to agree with his view that while it may not be intentional, the big drug companies have and are continuing to take steps, through lobbying and direct-to-consumer advertising, to broaden the definition of depression and other "mental illnesses." That is not to say mental illness does not exist, or that depression is not a true illness, but rather that two things coexist: true mental illness, and the increasing pathologizing of the tail ends of the bell curve of normal human emotion and experience. To me, and Mr. Greenberg, this is a dangerous trend and one that we should be aware of and informed about.

  2. 5 out of 5

    Wanda

    I bought this book because as a mental health academic type I wanted to see what pop psych writers were saying about some of the thorniest issues that we are dealing with in psychiatry. Many of us know that SSRIs and SNRIs are often no more effective than placebo. Many of us know that the DSM is a socially (and politically) constructed document. But the limits of science and the excruciating difficulties in doing research in the area of mental health has many of us stymied. Yes, the drug compani I bought this book because as a mental health academic type I wanted to see what pop psych writers were saying about some of the thorniest issues that we are dealing with in psychiatry. Many of us know that SSRIs and SNRIs are often no more effective than placebo. Many of us know that the DSM is a socially (and politically) constructed document. But the limits of science and the excruciating difficulties in doing research in the area of mental health has many of us stymied. Yes, the drug companies hold physicians and patients in thrall with their promises and sometimes outright distortions of the truth. We know this too. But I am not sure what the answer is with respect to changing matters. The sad truth is that we really have not made great strides in the area of mental illness treatment and none of us really like to talk about it or think about it. To that end, Greenberg does present these difficult questions to the lay public. But he does not present any answers nor pose any solutions. He simply tears the entire house of cards down. Frankly Robyn Dawes did that and did it more elegantly and compellingly in his book written over a decade ago. And Dawes presented solutions. That we have failed to implement them speaks to the strength of marketplace medicine and the industry that it has become. There is nothing new here, and I am puzzled as to why we need another psychiatry bashing book to add to the many that are already on the market. I found it a disjointed re-hash of what others have done and done better.

  3. 5 out of 5

    Gina

    Oh man, as a lover of totally depresso shit and the history of science, this book was GREAT. Basically, psychiatrist Greenberg -- who has spent a lifetime battling various degrees of clinical depression himself -- outlines how it came to be that, like, our entire country is on-the-books depressed. He argues that this is not some sort of mass chemical imbalance so much as a current way of life that just doesn't make people very happy. Power through the early chapter about Job -- a necessary but m Oh man, as a lover of totally depresso shit and the history of science, this book was GREAT. Basically, psychiatrist Greenberg -- who has spent a lifetime battling various degrees of clinical depression himself -- outlines how it came to be that, like, our entire country is on-the-books depressed. He argues that this is not some sort of mass chemical imbalance so much as a current way of life that just doesn't make people very happy. Power through the early chapter about Job -- a necessary but more convoluted part of the book -- and move on to his hilarious accounts of early drug company hijinks and the arguable benefits of illegal drugs (many of which enjoyed a periods of legality specifically for treatment of depression. You can't make this shit up!). Greenberg's own story line involves his enrollment in a clinical trial, which is telling and allows him a nice backboard to be the funny, insightful guy he clearly is. When I put down this book, I have to say, I felt like I was somehow on the right path. I mean, I've always had this pretty fucked view of the world, and haven't really subscribed to certain ubiquitous cultural quirks. I've opted out, I suppose. Greenberg read as a kindred spirit, as that super-smart uncle you have who is totally dour but totally hilarious. Maybe you smoke weed with him now and again, I don't know. At any rate, this was one of my favorite books I read all yeah.

  4. 5 out of 5

    Emily Crow

    I'll start this review with a confession: like the author and millions of other folk, I am prone to depression (along with the occasional bouts of anxiety and insomnia and the attention span of a gnat), but luckily I consider myself more of an old-fashioned garden variety neurotic than someone who is actually ill. I am also a bit distrustful of the antidepressant craze currently in vogue, and in my own personal experience, I have seen that psychotropic medicines are definitely over-prescribed. M I'll start this review with a confession: like the author and millions of other folk, I am prone to depression (along with the occasional bouts of anxiety and insomnia and the attention span of a gnat), but luckily I consider myself more of an old-fashioned garden variety neurotic than someone who is actually ill. I am also a bit distrustful of the antidepressant craze currently in vogue, and in my own personal experience, I have seen that psychotropic medicines are definitely over-prescribed. My own favorite story is the time I asked my doctor for a script for Ambien because I was too stressed out to sleep at night, and he said, "I have a better idea. How about Zyprexa? It makes people sleepy so I like to prescribe it off-label as a sleeping pill." And I was like, "Wait, isn't that an anti-psychotic with hella side effects?" Which he brushed off with, "Oh, mostly weight gain, but you're thin, so you don't need to worry about that." WTF?? Suffice to say: 1. I did not accept his offer of anti-psychotic meds; 2. I refuse to see that doctor ever again; 3. I lost any faith I ever had (which wasn't much) in the common sense of the medical profession; and 4. I enjoy reading books like this one to figure out how we have gotten to this point. Manufacturing Depression is filled with interesting tidbits about the history of psychiatry, written by a psychologist with a definitely contrarian point of view. Unfortunately, I found the author's tone to be consistently annoying and after a while found it hard to take him seriously. Also, I am not necessarily against antidepressants in general (despite their being over-hyped by Big Pharma's ads and prescribed at the drop of a hat by way too many doctors), and honestly, I wish I could tolerate the side effects long enough to see if they would work. Because Greenberg and I really part ways on our experience of depression. He seems to feel that, for him and his patients, being depressed is a normal and completely rational response to their shitty life stories and the general suckiness of the world at large. In the face of that, who wouldn't be depressed, and if a pill makes it go away, you're probably medicating away your unique biography and moral outrage, and that's bad. (Unless you cure your woes with Ecstacy, like he did. Don't even get me started on that one.) Well, I disagree. I have a hard time finding an upside to the times I am really depressed, and I do not feel that those days are noble or existentially significant or conducive to personal change. Maybe it is not really a disease, as he states, but it also certainly does not feel like "myself." I also found his repetition of defending ourselves from the infernal diagnoses of the "depression doctors," for the reason that they will take away some meaningful understanding of the self by reducing "biography to biochemistry," to be, by the end of his ranting, so much hand-wringing. And naive at that. Maybe it is because my own personal philosophy has been heavily influenced by yoga and Buddhism and the belief that we place too much emphasis on our biographies and our ideas of self to start with, and that just makes us miserable. Moreover, in my own life, I have at least one example of being completely waylaid by my biochemistry, when during one of my most sluggish and mournful periods, a lab test found me to be hypothyroid. Which can cause fatigue, constant coldness, hair loss and...depression. A couple months of taking thyroid medication and I felt so much better. If I were of Greenberg's disposition, this would have sent me into an identity crisis, because he spends so much space here defending the ineffable self against the materialist machine. But guess what? My symptoms at that time really didn't mean anything at all about me or my life, and there was little I could have done to fix things, because it really was a chemical imbalance wreaking havoc. Namely, my wonky thyroid. And you know what? I didn't feel betrayed because "my" feelings were just byproducts of a hormone out of whack. I just felt relieved to take a pill and feel better. Finally, there was just too much ranting about the evils of consumer capitalism and all its attendant woes for my tastes (and this is coming from a reader who tends to be quite liberal). I was especially aghast when he stated, at one point, how myopic society is to blame someone for driving drunk instead of pointing to the society that doesn't provide enough public transport and doesn't require car manufacturers to have a mechanism to prevent drunks from driving. Say what? Some drunken asshat gets behind the wheel and hits an innocent party and you want to blame Ford or Honda for letting him do it? Sorry, me and this author just wouldn't get along. Despite that, on occasion, this was an interesting book.

  5. 5 out of 5

    Sharon

    Psychotherapist Gary Greenberg presents a fascinating and in-depth look at the history of depression in the United States, and the role that pharmaceutical companies play in the recent rise in diagnosis. As someone who has been in and out of treatment for depression for 15 years, on a range of medications from older tricyclics to the most modern SSRIs, it was interesting for me to see how physicians themselves acknowledge that for the vast majority of patients any improvement on these medications Psychotherapist Gary Greenberg presents a fascinating and in-depth look at the history of depression in the United States, and the role that pharmaceutical companies play in the recent rise in diagnosis. As someone who has been in and out of treatment for depression for 15 years, on a range of medications from older tricyclics to the most modern SSRIs, it was interesting for me to see how physicians themselves acknowledge that for the vast majority of patients any improvement on these medications is due to the placebo effect. Further, Greenberg describes efforts on the part of Pharma to keep the most dangerous side effects of the medications (e.g., increased suicidality) out of the media. Greenberg shares his own experiences as a patient in clinical trials, being told that he is dramatically improving on the new med (despite lab tests demonstrating that he was on a placebo). He also writes of actors going into see prescribing psychiatrists with a list of symptoms to relate and requesting a specific med they had seen advertised. In this latter example, well over half of those presenting received exactly the prescription they asked for. Having concluded, with the assistance of my physician, that none of the medications currently on the market would be of assistance to me, I have made it my own task to read as much as I can about depression and see what I can learn. The takeaway message I got from Greenberg's outstanding, personal and entertaining book (which is not to say that it lacks scientific basis; the endnotes section and bibliography are extensive) is that the goal of modern pharmapsychology is to medicate people into conformity and to divorce them from the ability to feel concerns for what is an increasingly disconcerting world. This should disturb anyone, and provides excellent food for thought. (Review based on advance readers copy.)

  6. 5 out of 5

    Glenn Cheney

    This book gets off to a good start. The writer explains technical information, from biochemistry to psychology, very clearly, even entertainingly. He uses on-the-scene images and cases to make it all real. I like the way he relates this anti-pharma position to his personal and professional lives. So far I'd have to say that the book is depressing, but in a nice way.

  7. 4 out of 5

    lark benobi

    Glib and messy. It was hard to untangle Greenberg's facts from his theories from his polemical rants--it was all presented in a mosh of sentences, and I ended up not trusting the author, and not liking him too much either. I continue to be fascinated by the difficulty the psychotherapy profession has with justifying its own existence, but I think the more interesting answers about mind/brain theory are to be found in the work of sociologists, some of which are referenced in this book. Because of Glib and messy. It was hard to untangle Greenberg's facts from his theories from his polemical rants--it was all presented in a mosh of sentences, and I ended up not trusting the author, and not liking him too much either. I continue to be fascinated by the difficulty the psychotherapy profession has with justifying its own existence, but I think the more interesting answers about mind/brain theory are to be found in the work of sociologists, some of which are referenced in this book. Because of an off-hand remark Greenberg makes in his book about being influenced by certain sociology books in college, I'm now reading "Stigma" by Erving Goffman and enjoying it very much.

  8. 5 out of 5

    LemontreeLime

    This is so creepy on so many levels... This tells an observant view of the path of psychotherapy from the past until now, and questions the origin of many of the processes used. From Kraepelin's 19th century diagnosis lists still being used today to Big Pharma decisions on how to get a cut of the health insurance $, this book disturbed me on how trusting we are to accept so much without question. The author makes you laugh out loud with his insights, i really appreciated his humor throughout the This is so creepy on so many levels... This tells an observant view of the path of psychotherapy from the past until now, and questions the origin of many of the processes used. From Kraepelin's 19th century diagnosis lists still being used today to Big Pharma decisions on how to get a cut of the health insurance $, this book disturbed me on how trusting we are to accept so much without question. The author makes you laugh out loud with his insights, i really appreciated his humor throughout the whole book. This was a very worthwhile read, because it acts as a reminder that we should never assume that everyone, medical establishment included, looks out for all of our best interests. Don't be afraid to ask questions.

  9. 5 out of 5

    Carmen

    Fantastic read for anyone cynical about Big Pharma, the depression industry, and the "chemical imbalance" theory of depression.

  10. 4 out of 5

    Mark

    I started reading this book because I was interested in the topic. About a hundred pages into it, I forgot all about the topic----I was riding the waves of Greenberg's beautiful prose. To this day I have only a vague idea what his theme was, the writing just overwhelmed me. I wasn't reading anymore; I was listening to music. And because the melody was so enchanting, the lyrics became unimportant. So I can't really comment on the author's subject matter, but I can say this: This book is chock-ful I started reading this book because I was interested in the topic. About a hundred pages into it, I forgot all about the topic----I was riding the waves of Greenberg's beautiful prose. To this day I have only a vague idea what his theme was, the writing just overwhelmed me. I wasn't reading anymore; I was listening to music. And because the melody was so enchanting, the lyrics became unimportant. So I can't really comment on the author's subject matter, but I can say this: This book is chock-full of very fine writing, and if you faithfully follow Greenberg from the start he'll reward you every step of the way. And when you reach his crescendo on pp. 332-335, you'll feel like you've won the reader's lottery! At least, that's how I felt.

  11. 5 out of 5

    Matthew Johnson

    This book started off as devastatingly interesting to me. I really enjoyed his telling of the various religious, historical and scientific topics that intersect with depression. But it didn't build a case for our modern conception of depression as being synthesized by drug companies trying to sell antidepressants, and of psychiatrists trying to bill more hours. Not really. Instead he just talked about everything. By halfway I had given up and dismissed this book as too ambitious, too long, too s This book started off as devastatingly interesting to me. I really enjoyed his telling of the various religious, historical and scientific topics that intersect with depression. But it didn't build a case for our modern conception of depression as being synthesized by drug companies trying to sell antidepressants, and of psychiatrists trying to bill more hours. Not really. Instead he just talked about everything. By halfway I had given up and dismissed this book as too ambitious, too long, too self indulgent, too uncertain, too unstructured. Ill find a different book on the topic Sorry Gary Greenberg

  12. 4 out of 5

    C

    A wonderful mess of a book that asks a million questions and gives v. few answers. In a word, I guess, Manufacturing Depression is eye-opening. I never knew how much I took for granted about depression or mental illness in general. Unlike some recent attempts to weave personal narrative and medical history (ex: "The Pain Chronicles"), the book finds a great balance and I never lost sight of both stories. To boot, though Greenberg's POV is sometimes hopeless, this is probably the funniest book ab A wonderful mess of a book that asks a million questions and gives v. few answers. In a word, I guess, Manufacturing Depression is eye-opening. I never knew how much I took for granted about depression or mental illness in general. Unlike some recent attempts to weave personal narrative and medical history (ex: "The Pain Chronicles"), the book finds a great balance and I never lost sight of both stories. To boot, though Greenberg's POV is sometimes hopeless, this is probably the funniest book about depression that you will ever read.

  13. 5 out of 5

    Rita Varian

    As someone who has lost a loved one to depression, it is very difficult for me to write about this book. In rating books on Goodreads, I find that I tend to be stingier with my stars when it comes to non-fiction. That might be because in fiction, I am only asked to suspend disbelief while reading, something that is normally easy for me. Works of nonfiction have to face my skepticism; whether it's just that I expecting more than entertainment, or if disagreeing IS my entertainment, the result is As someone who has lost a loved one to depression, it is very difficult for me to write about this book. In rating books on Goodreads, I find that I tend to be stingier with my stars when it comes to non-fiction. That might be because in fiction, I am only asked to suspend disbelief while reading, something that is normally easy for me. Works of nonfiction have to face my skepticism; whether it's just that I expecting more than entertainment, or if disagreeing IS my entertainment, the result is the same. So this one gets all 5 stars, that's it.

  14. 4 out of 5

    Linny

    A review in the Nation alerted me to this fascinating book by a psychologist plagued by depression himself who researched the history of depression as developed by the medical and drug industry, turns out also a history of medicine/discovery in general. Fine writing, intelligent and witty - probes the evolution, even creation, of an illness to satisfy the drug industry's needs. Questions the whole approach to depression.

  15. 5 out of 5

    Regan

    A challenging topic. As I think he admitted he really didn't seem to know where he was going when he started the book. His criticisms of the disease of depression were well supported if a bit disjointed. His bias was clear and I was hoping for a better explanation of why do many people are suffering. As a practicing physician I wasn't surprised about the information about SSRIs but he's a bit hard on the "depression doctors" who are for the most part just trying to help.

  16. 5 out of 5

    Diane Brown

    This is a comprehensive and interesting book on the history of depression and how the 'industry' is treating depression. It urges to look beyond the current view of what happiness is and what depression is. I found it insightful and would recommend it to anyone who takes depression medication and to the medical fraternity.

  17. 5 out of 5

    William Adams

    Psychotherapist and medical science writer Gary Greenberg keeps the tone light, even witty, as he weaves the story of his own lifelong struggle with depression around a compact psychiatric and psychological history from Hippocrates to Prozac. He has a strong opinion about depression: except for extreme psychotic cases, depression is not a disease, is not explained by biology, and does not need to be cured, by drugs or anything else. He rejects and even ridicules the medical model of psychopathol Psychotherapist and medical science writer Gary Greenberg keeps the tone light, even witty, as he weaves the story of his own lifelong struggle with depression around a compact psychiatric and psychological history from Hippocrates to Prozac. He has a strong opinion about depression: except for extreme psychotic cases, depression is not a disease, is not explained by biology, and does not need to be cured, by drugs or anything else. He rejects and even ridicules the medical model of psychopathology that labels all suffering as disease. It is a very thought-provoking thesis. Greenberg acknowledges that some people are severely, profoundly depressed. But most so-called depressives, he says, even “major” depressives, are not in the same ballpark as that. At issue is whether depression is a legitimate way of being in the world. Greenberg cites the Biblical story of Job, who suffered waves of devastating misfortune. Job’s life became entirely bleak and he showed signs of depression. Could we say that Job had a condition called depression, showing symptoms of an underlying pathology? Or does it make more sense to say that life treated him cruelly and he responded humanly? It is not wrong to be unhappy and it should not be treated as a disease. Greenburg points out that the DSM (Diagnostic and Statistical Manual of mental disorders) says that after 2 weeks, if you are still sad or pessimistic, that’s a symptom. Two weeks? We can easily imagine grievous losses or afflictions about which one might be unhappy for much longer than two weeks. That qualifier is arbitrary and Greenberg says there is no meaningful psychiatric distinction between unhappiness and mental disease. So why should we assume unhappiness is a disease? Superficially plausible, this argument is nevertheless disingenuous. Nowhere in the book does Greenberg list the clinical criteria for a diagnosis of depression, and as he well knows, there is more to it than feeling unhappy for two weeks. The diagnosis requires concurrent presence of at least five of nine indicators, such as feelings of worthlessness, significant weight loss in the past month, excessive sleeping, recurring suicidal thoughts, and so on. Greenberg seems more interested in whipping up outrage than in evenhanded analysis. But that’s how you sell books. Ultimately, Greenberg sees the medical model of depression as dehumanizing. He says, “If your mental illness isn’t a function of history or culture or geography…but only about whether or not you have the signs of the illness, then...[it is]as stupid and brutal and meaningless as diabetes or cancer” (p. 252). That is a conclusion he cannot accept, and he urges readers not to accept it either. But despite what he would wish, the possibility remains that depression is actually just a stupid disease.

  18. 5 out of 5

    ellen

    This review has been hidden because it contains spoilers. To view it, click here. Possibly overly long, the meat of this book is a philosophical look at what we call depression and if it’s really a disease or a state of being and a part of being. The implications being that if we call something a disease, we may feel there is nothing we can do to fix it but take medication. It’s an interesting addition in a culture that is waking up to the idea that our lifestyles, the food we eat, our lack of social connections, all those hours we sit in front of screens is making us physica Possibly overly long, the meat of this book is a philosophical look at what we call depression and if it’s really a disease or a state of being and a part of being. The implications being that if we call something a disease, we may feel there is nothing we can do to fix it but take medication. It’s an interesting addition in a culture that is waking up to the idea that our lifestyles, the food we eat, our lack of social connections, all those hours we sit in front of screens is making us physically sick. It’s not hard to draw a line from physically ill to mentally ill even as we are also learning how the body is connected to the mind. The author obviously struggles with the idea that he himself has a disease. It’s a question worthy of contemplation. As noted in a book about shyness I recently read - maybe it’s s feature and not a bug. And maybe if we learned to value what depression is telling us, rather than assuming it’s 100% bad - the same way in which I would have avoided years of suffering if someone had told me as a child that it’s ok to be shy - maybe it would also reduce the suffering of those who experience it.

  19. 4 out of 5

    Yaaresse

    Disclaimer: I have to admit I'm granting one star to this rating just because it fits my long-held bias against pharmaceutical marketing and how cavalierly doctors hand out prescription for better living through chemistry. ____________ There are two stories within this book: one is the history of the diagnosis, treatment, and marketing (yes, marketing) of depressive disorders (both major and minor); the other is about the author’s experience as a participant in a clinical trial for a depression t Disclaimer: I have to admit I'm granting one star to this rating just because it fits my long-held bias against pharmaceutical marketing and how cavalierly doctors hand out prescription for better living through chemistry. ____________ There are two stories within this book: one is the history of the diagnosis, treatment, and marketing (yes, marketing) of depressive disorders (both major and minor); the other is about the author’s experience as a participant in a clinical trial for a depression treatment. It is of note that Greenberg is a psychologist and was well aware of his chronic minor depression (or so he thought). He was upfront about his dual agendas, which were to get relief from his symptoms while getting a book out of the experience. Sometimes the back-and-forth between these two tracks works; sometimes they are distracting. At the least, Greenberg's wry observations of his situation and his visceral responses to being on the “patient” end of the equation do provide relief from what could have been long stretches of heavy, dry material. In the historical chapters, Greenberg provides a crash course on prominent psychologists, psychiatrists, and neurologists of the 19th and 20th centuries and their theories about depressive conditions. He delves into the birth and growth of the pharmaceutical industry. He briefly appears to go off-track in that section: pages about the genesis of the synthetic dye industry and the rather intensive chemistry material seem unrelated to the subject, but stick with him through this: he’ll tie it all together, and it is relevant background for later chapters about genesis of psychoactive and anti-psychotic drugs. To round out the historical information, he provides the background on the creation and changes of the almighty DSM (the Bible for psychiatrists...at least for the ones who want insurance codes so they can be paid). In my opinion, how changes are decided for the DSM might be some of the more disturbing material in this book. I recalled much of the history of psychology from my college classes. Nothing about Big Pharm’s maneuvers or marketing methods surprised me. (Seriously, anyone who has noticed the consumer-direct marketing should find any of that surprising. Current ads practically suggest that if you are NOT on a SSRI there’s something obviously wrong with you.) What I didn’t realize, however, was how the language of the DSM skews so many other things. The word “neurosis” has officially disappeared from the medical industry. Neurosis is a psychological mechanism, not a chronic condition, not behavior outside the norm, not a disease, not something so drastic that those who have neurosis can be convinced they are sugaring from disease and that long-term use of (patented!) medications are their only cure. More to the point, it no longer exists. Neurosis has been erased from the books. Quite simply, neurosis isn’t a money-maker. There is a interplay of mutually parasitic interests among medical doctors (as opposed to non-MD therapists, counselors, etc.), drug companies, insurance companies, and marketing agencies to make sure depression is seen as a purely biological disease with a chemical solution. The operative word here is “disease.” The new think is that those with depression are not experiencing temporary emotional or spiritual imbalance, but a chemical one that can be neatly quantified and charted – preferably requiring long-term maintenance medication. To be clear, Greenberg is not saying depression doesn’t exist or is not a serious matter. He does, however, argue that the manipulating of diagnostic terms to make all depression a “disease” rather than a “condition” is a mistake, one from which the pharmaceutical companies are the main benefactors rather than patients, and that mild depressive reactions, neurosis, mild dysthymic states – all of these obsolete terms now per the DSM – should not be pushed toward categorization with psychotic depressive states. In other words, “the blues” is not a disease. Being temporarily off-balance emotionally is not a disease. The emotional lows that come with being alive in this world are not only not a disease, but could well be part of what pushes us to evolve emotionally, to learn compassion and empathy, to become wiser. We’ve all bought into the idea that mental illness – which depression is now classified per the DSM – is strictly a chemical imbalance, yet there is no conclusive proof of that. And antidepressant prescription numbers soar in spite of the fact that no one knows exactly how they work or if they even treat the problem. Causality becomes confused with correlation: just because the pill makes someone feel good doesn’t mean it fixed the cause of the person feeling unwell. Masking a symptom is not curing a condition. Greenberg does not pretend to be objective in his reporting. His discomfort with the industry is particularly strong in the chapters about his experience in the clinical trials when he suddenly finds himself being the one to which the labels and diagnosis are applied. He is downright hostile at some points during his trial when he feels himself reduced to checklists and numbers, a physical machine with a chemical imbalance rather than a whole person with emotional, mental and spiritual dimensions, and a past with relevant experiences that contribute to his state of being. In the end, Manufacturing Depression explodes the economics and politics of a diagnosis created for the profit of the drug industry without offering any answers – but Greenberg admitted up front that he didn’t have any answers, that this was an exploration of the questions. He does offer one solid piece of advice: understand why you're doing what you're doing and who it ultimately will benefit. Be an informed patient.

  20. 5 out of 5

    Judith

    Greenberg's thesis is in the title. He believes that depression can not be reduced to a simple brain disease, amenable to chemicals or cognitive therapy. Certainly there is no proof of a biological basis for depression, hard as scientists have been trying to find such a thing. Even if there were, however, Greenberg would still have to ask (and we should too): what makes the change in the brain? How does it get that way? In this book Greenberg offers us a history of depression, condensed of course Greenberg's thesis is in the title. He believes that depression can not be reduced to a simple brain disease, amenable to chemicals or cognitive therapy. Certainly there is no proof of a biological basis for depression, hard as scientists have been trying to find such a thing. Even if there were, however, Greenberg would still have to ask (and we should too): what makes the change in the brain? How does it get that way? In this book Greenberg offers us a history of depression, condensed of course, its definition and its treatment. He then settles into the last fifty years or so, when scientists seriously started looking for brain dysfunction and magic potions to "fix" it. Even today, although the evidence against it is clear, doctors tell their patients that they have a "chemical imbalance" and will have to be on antidepressants all their lives. Greenberg is no fan of antidepressants, yet he says throughout that they may well help some people and they don't do much physical harm. I beg to differ on this last, and my objection overlaps Greenberg's. He objects to the concept of depression as a disease that can be fixed by tweaking brain chemistry and nothing else. No exploration of personal biography, no compassionate listening, no looking at the real "why" of depression. As I read it, Greenberg prefers that we accept depression as part of living and question why, in each case, it has reared its head. There may well be good cause, external, like the way the world is today, or the way others may treat us. If we give in to the pill or simplistic therapy we avoid looking elsewhere. I agree with this position. But I go farther, into an area Greenberg only touches briefly: victimization. I believe that when a person believes he has a chemical imbalance or some other brain disorder not within his control, he gives in to the diagnosis and accepts his position as victim of this disorder. It's time we regained control of ourselves and questioned these diagnoses. We need to learn that we have more power than depression doctors would have us believe. We can beat it. And here is where I also part ways with Greenberg. He went through a week-long course in cognitive behavioral therapy, a course for therapists. He went in suspicious and came out suspicious. He concluded that it is a form of positive thinking, regardless of what the leaders of the movement say. He believes it is good short-term only, does not address the long term. And he concludes that on balance it is no better than any other type of talk therapy for treating depression. I disagree on at least some of these points. I picked up cognitive therapy from a book given to me by my stepmother when I was in my twenties. I was in and out of therapy at the time, ending in group therapy, where I did learn some skills to deal with depression. I scoffed at the book: A Guide to Rational Living, by Albert Ellis et al.. How could what you tell yourself have anything to do with how you feel? I did read it, however, and before I was much into it I started to become a believer. Ellis was ahead of the game. He didn't call his treatment "cognitive therapy" but that is what it was. The book is still in print (revised) and still getting rave reviews many years after its first printing. With good reason, in my opinion. I believe it changed my life more than any other book or therapy has. What it did was to give me the tools I needed in the long term. I still get depressed but now I know how to work my way out of it. This is what Greenberg failed to understand. It isn't a short-term fix. Its real value is that it gives us the tools we need for the rest of our lives. Greenberg also believes that the current gurus of CBT would not object to depression being labeled a disease. I disagree here, too. One of the most popular books on the subject, Feeling Good, notes that a study concluded that patients actually do better just reading the book than they do with a therapist. Would this be the case if the CBT folks just wanted to rake in the therapy dough? I don't think so. I believe Greenberg went into this training with his mind shut, unfortunately, because he is a therapist of the "old order". I have no objection to his type therapy, but honestly it is a crap shoot, whereas CBT is so standardized that an intern can do it well. Or a book. Many of us like that about it. It does not mean that we are automatons who simply follow little slogans and mindlessly become "resilient". It means we learn to distinguish fantasy from reality. It's a good skill. One many Americans would do well to learn. Obviously I have a bias here, clearly stated. I disagree with Greenberg on the subject of cognitive behavioral therapy. I agree with his assessment of drugs but feel he does not go far enough. He does not mention the disabling side effects that these drugs can have on some patients. Tardive dyskenisia. Dullness. Other types of brain damage, permanent. Let's not forget strange suicidal tendencies (he does mention this in passing). And the cost is not a small matter. It costs all of us, not just those getting the drugs. This book is worth reading for those who would like a little history of depression and an alternative view to the standard one in place today. Read it but don't stop there. Also read books by Healy and Valenstein, at least. Get the real, gritty facts about antidepressants. And learn more about CBT.

  21. 4 out of 5

    Bhuvanesh

    What a load of crap! First of all, the author should try talking to people who are depressed instead of speculating. Secondly, the Bible is old and obsolete. It has no relevance in the modern world.

  22. 5 out of 5

    Carla Barkman

    "The depression doctors" though? Who are they? Also why do I want nothing and love nothing and do nothing when I'm not on an SSRI?

  23. 5 out of 5

    May

    what happens when the author trips on LSD in a holiday inn in pennsylvania and a maid walks in is beautiful. rest is boring as hell.

  24. 4 out of 5

    Douglas Larson

    I found the amount of detail the author gives on various aspects of depression, psychotherapy and psychiatry to be a bit too much at times. But I stuck with it to the end and I am glad I did. Greenberg covers the entire history of psychotherapy and psychiatry as they delt with depression from the 18th to 21st centuries. Despite its title, the book, in my opinion, is Not an expose or condemnation of psyciatric handling of this condition. Greenberg does raise however, very good questions and shows I found the amount of detail the author gives on various aspects of depression, psychotherapy and psychiatry to be a bit too much at times. But I stuck with it to the end and I am glad I did. Greenberg covers the entire history of psychotherapy and psychiatry as they delt with depression from the 18th to 21st centuries. Despite its title, the book, in my opinion, is Not an expose or condemnation of psyciatric handling of this condition. Greenberg does raise however, very good questions and shows the power of medical practice, drug companies, marketing and how they all intertwine and contribute to the result we have today. Doctors and psychologists who question the mainstream thinking on depression have a difficult time being heard. A real eye opener for me was his discussion of elctro-shock therapy. My perception is that it is widely regarded today as extreme, inhumane and dangerous. But Greenberg points out two very intersting facts - 1) the practice of electro-shock therapy was far more effective for treating depression (around 70%) than All other therapies (drug or otherwise) at any time in the history of psychiatry and psychotherapy. The best drug therapy in history comes in around 30% effective; and 2) The medical community did not understand why electro-shock therapy worked so well during its heyday in the 1950's and still don't today. There are a few practitioners who use it today but they keep a very low profile, don't advertise and are difficult to find. It makes one wonder, why a medical practice that is now almost completely reviled by both the general public and the professional community, was the most effective and long lasting treatment ever devised for depression and without significant side effects, especially when compared to the numerous drugs that have been used for the same illness. I am not particularly inclined to try elctro-shock therapy for myself nor do I beleive that Greenberg is advocating it for anyone, but his discussion of depression and all its treatment methods asks some very interesting questions. Questions I doubt we will see the answers to anytime soon. In addition I enjoyed getting a new perspective of Sigmund Freud, who is just one of the many professionals that Greenberg discusses in this book. Up until I read this book, I believed that Freud's methods had value, but as a long time user of psychotherapy I have always held a certain amount of dislike for his methods. I preferred and used other methodologies. But Greenberg's discussion of Freud (who Greenberg portrays as one of the lesser players in the history of depression) shows that he was one of the few professionals of his day whose voice called for reason, restraint and careful consideration. This was in contrast to many of Freud's colleagues who were loudly proclaiming this therapy or that therapy as being THE solution and who had a much greater influence than Freud on the shaping of the professional image that depression has today. Well worth reading if the subject is of interest to you and if you are able to wade through the sometimes tedious detail he gives. The chapters on the 18th and 19th centuries were, to me, especially tiresome though they did indeed deliver important information in this discussion of the history of depression.

  25. 4 out of 5

    The Angry Lawn Gnome

    An easy book for me to read -- perhaps too easy. Which means this review would be a bitch to write if I were to attempt anything so coherent. But I'm not. I'm simply going to plop down some random impressions and perhaps someday return to clean up this mess. Though I wouldn't bet on that. I suppose lists are the last refuge of the incompetent, much as patriotism is the last refuge of the scoundrel. But, alas, I can do no better. Ick. The Neo-Kraepelinian DSMs: Amazing how willfully ignorant thera An easy book for me to read -- perhaps too easy. Which means this review would be a bitch to write if I were to attempt anything so coherent. But I'm not. I'm simply going to plop down some random impressions and perhaps someday return to clean up this mess. Though I wouldn't bet on that. I suppose lists are the last refuge of the incompetent, much as patriotism is the last refuge of the scoundrel. But, alas, I can do no better. Ick. The Neo-Kraepelinian DSMs: Amazing how willfully ignorant therapists of all stripes are over this beauty. And me, too. Somehow I'd completely missed that the term "neurosis" has been consigned to the ash heap of history, and had been sent off quite some time ago. Makes the kerfuffle over Asperger's going out in DSM-V seem like small beer in comparison. Drugs, drugs, and more drugs: What an absolute nightmare the sordid history of antidepressants is. And Greenberg lays it all out from clinical trials through "diagnosing for dollars" to desire to stamp out anyone actually getting high from the stuff...Though, curiously, Greenberg cites Andrew Solomon's The Noonday Demon as a memoir worth reading, while ignoring all of Solomon's cautions regarding the use of MDMA (Ecstacy). Cognitive Therapy: Curiously, I've always been rather a fan of this approach, but I can't rebut Greenberg's critique here either. The Becks (father and daughter) come across like a very strange pair, and their therapy as something of a bait and switch con. Ouch. And the last chapter was amazing. A modern day Augustine, save that this one announced that while the others have no answers, he really doesn't, either. And that we all need to muddle through this vale of tears, disease model or no disease model, modern day phrenologists or no. The only place I really parted company with him was his thought that somebody depressed (or pessimistic) might see something as wrong and try to change it. My personal experience has been to think something is wrong and that there's nothing to be done, or that can be done. But, that's me personally. Perhaps the way my thought run is not at all typical? I honestly don't know.

  26. 5 out of 5

    Scott

    I was prompted to read on the subject of depression because in the past decade or so, I have known or known of many children that have been diagnosed as such. I have also gone through a personal experience of a loved one whom I never really felt had clinical depression, yet was being medicated for such. Sure the child had some issues, but I just felt the soul of that child was gone under the influence of. To not go into this too deeply, this was a process I witnessed for several years, and it wa I was prompted to read on the subject of depression because in the past decade or so, I have known or known of many children that have been diagnosed as such. I have also gone through a personal experience of a loved one whom I never really felt had clinical depression, yet was being medicated for such. Sure the child had some issues, but I just felt the soul of that child was gone under the influence of. To not go into this too deeply, this was a process I witnessed for several years, and it wasn't until a serious suicide attempt and going through the withdrawal of the medication, did the process of reclaiming this now young adult's life truly begin. During this time it seems to have become more common that we know or know of several youth who have committed suicide. Several I have known of were receiving an anti-depressant. As we are being bombarded with ads about these "miracle cures", have we become immune to the disclaimers........."suicidal thoughts"? Now I'm even seeing ads for meds that supplement the anti-depressants, with the same disclaimers. Although I found much of Greenberg's work laborious reading, there is depth in his research. He offers the reader a great over view of how depression has been manufactured as a "disease" and the industries that have sprung up to capitalize on this. Not to say depression doesn't exist, but I've always felt that if you truly know someone, your powers of observation and common sense might help you realize if someone is truly inflicted with deep depression. After all, as Greenberg often points out, it is part of life for us all to experience sadness. Also from a Buddhist perspective, we all need suffering to more deeply appreciate the good. What is good about books such as this and the works of say Pollan, is that we gain knowledge that empowers us as individuals to make better choices for ourselves. This is important to realize. For when I make these types of recommendations, I often hear, "I don't want to read about doom and gloom". In this complicated world, books such as this don't make me an expert, but I do have greater independence on making a choice that serves my better interest.

  27. 5 out of 5

    thewestchestarian

    Everything you could want to know about depression. In this exhaustively researched history of the ”disease” and every researcher who ever studied it, every pharmacist who concocted potions to treat it and every psychiatrist who ever commented on it, Greenberg reveals what must have been years on end among the psychiatric book stacks. But no mere spectator is Greenberg, he also participates having suffered debilitating depression after divorcing his first wife. Perhaps the depth of study represe Everything you could want to know about depression. In this exhaustively researched history of the ”disease” and every researcher who ever studied it, every pharmacist who concocted potions to treat it and every psychiatrist who ever commented on it, Greenberg reveals what must have been years on end among the psychiatric book stacks. But no mere spectator is Greenberg, he also participates having suffered debilitating depression after divorcing his first wife. Perhaps the depth of study represents a type of therapy or perhaps evidence of obsessive compulsive disorder. In either case, if you want to know something about depression, it must be in here somewhere. Disappointing is the title’s implicit promise of the ”secret history” unless buried in musty, obscure references connotes mystery. Only a limited amount of the presented information was unavailable to a determined researcher. The lack of evidence of a clandestine cabal of Big Pharma execs to ”manufacture” depression as a lucrative psychiatric illness also disappoints. Certainly, the Pfizers and Merck’s of the world marketed the hell out of their latest dubious drug convincing some folks with the common blues they actually had major depression, but, hey, that’s called business. Anyway, Greenberg’s interest leans far more to such topics as the historical development of depression diagnosis taxonomies and comparisons of historical diagnosis approaches (e.g., patient-center psychotherapeutic approaches vs. checklist-center approaches that actively discount patient differences). In short, the book appeals mainly to those studying to be psychiatrists, those studying psychiatrists and depressed people who are really, really into the affliction. For a general audience the fathoms of depth here are overkill.

  28. 4 out of 5

    Bob

    Let me simply quote from chapter one, "what I will do in this book is to show you how we arrived here, how we got to a point in our history where it is common, if not mandatory, to think of our unhappiness as a disease...to convince you that what is at stake w/antidepressants and the disease they treat isn't only a question of whether or not to take drugs for our unhappiness, or even whether or not it's really a good ide to call our unhappiness clinical depression. What's at stake is who we are, Let me simply quote from chapter one, "what I will do in this book is to show you how we arrived here, how we got to a point in our history where it is common, if not mandatory, to think of our unhappiness as a disease...to convince you that what is at stake w/antidepressants and the disease they treat isn't only a question of whether or not to take drugs for our unhappiness, or even whether or not it's really a good ide to call our unhappiness clinical depression. What's at stake is who we are, what kind of people we want to be, what we think it means to be human." The writer hits his target, he will reveal how clinical depression and it's treatment is an invention of people rather than something discobvered in nature. That is contived and not the result of science or medicine. He reminds us of something, it seems that researchers have forgotton, the symptoms of a disease are only signs of the disease, not the disease itself. the exception is psychiarty where the symptoms constitute the disease and the disease comprises the symptoms. The book is informative raise many questions, answers most and forces us to ask many more. Thought provoking and in todays' climate it will make many, maybe most very uncomfortable.

  29. 4 out of 5

    ury949

    This book was about the author's thesis that depression as an illness is questionable and arguably made up by doctors and drug companies who benefit from it. But also it's a in-depth look at the history of depression and depression treatments, as well as some other, related mental illnesses and treatments. That part of the book was interesting. Aside from the history and explanations of how different drugs work, and different ways the brain works, I wasn't too impressed with the author's approac This book was about the author's thesis that depression as an illness is questionable and arguably made up by doctors and drug companies who benefit from it. But also it's a in-depth look at the history of depression and depression treatments, as well as some other, related mental illnesses and treatments. That part of the book was interesting. Aside from the history and explanations of how different drugs work, and different ways the brain works, I wasn't too impressed with the author's approach to his topic. It's a topic that demands argument and is subject to opinion, but the author attempts to be as gentle and neutral as possible - to exhaustion. His writing is too suggestive, repetitive, with lots of maybe this and maybe that. But that's just my taste. I read the whole thing because of the subject matter, and would recommend it to anyone who wants to learn more about depression and the industry that surrounds it. Just breeze over the parts where he tries to explain why he wrote the book.

  30. 5 out of 5

    Andres

    This is quite an epic read about depression, set amid a ton of historical background on the discovery of medicinal drugs, how doctors and the medical field changed because of them, how drug companies learned to sell these drugs, and how doctors and patients alike are influenced by these companies. The author provides plenty of history, humor, commentary, digressions, meditations, and more about himself, depression, and the depression 'industry'. The reading can be extremely fun and informative b This is quite an epic read about depression, set amid a ton of historical background on the discovery of medicinal drugs, how doctors and the medical field changed because of them, how drug companies learned to sell these drugs, and how doctors and patients alike are influenced by these companies. The author provides plenty of history, humor, commentary, digressions, meditations, and more about himself, depression, and the depression 'industry'. The reading can be extremely fun and informative but at times a bit too much, rhetorically and semantically---he offers nuanced analyses about various topics that sometimes seems to drag a little too long, but it may just be me. My brain wasn't quite with the book at all times but I learned much more than I expected, and anyone with an interest in the topic, and a little patience with the style of the book, will be rewarded. It has definitely piqued my interest on the subject.

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