Overcoming Depression by Demitri F. Papolos MD and Janice Papolos (Harper & Row: $18.95; 319 pages)
A lively debate rages nowadays between psychiatrists who treat depression with medication and those who treat it with traditional psychoanalysis--the talking cure.
At the moment, the psychopharmacologists have the upper hand. They surmise that the cause of depression is biological and that it is therefore susceptible to treatment with drugs just as other bodily disorders are.
But the traditionalists have not given up. They argue that drugs frequently have unfortunate and debilitating side effects and that, in any case, drugs at best only mask the symptoms of depression without curing the underlying causes.
In fact, nobody knows which of these approaches (if either) is correct, as Demitri F. and Janice Papolos concede in "Overcoming Depression," a book that seeks to explain what is known about the causes and treatment of depression and offers helpful and practical information for depressed persons and their families. The Papoloses lean toward the drug therapies, but they acknowledge that some combination of drugs and talking may be the best course.
Demitri Papolos is a psychiatrist in New York and Janice Papolos is a science writer, and they present the current state of knowledge. The trouble is that the current state of knowledge isn't much knowledge at all. A century after Freud invented psychoanalysis, psychiatrists are still stumbling in the dark.
The Papoloses put it succinctly: "There is still no answer to the question: what causes these disorders?"
Moreover, psychiatrists are unable to demonstrate that any of the treatments has any therapeutic benefit, though they and some patients insist that it does. The Papoloses, of course, are among the adherents of psychiatry, but their dizzying litany of drugs and dosages and provisos and howevers makes one wonder about the efficacy of these nostrums.
Some people do well on lithium; others do not. Some people respond to tricyclic antidepressants such as Elavil; others do not. Some people respond to other antidepressants such as Desyrel; others do not. Some people benefit from monoamine oxidase inhibitors such as Marplan; others do not. The list goes on and on, long enough to make sure that the patients keep coming back for yet another try. Desperate people keep hoping that something will work.
An unspoken assumption of the Papoloses book is that depression is pathological and should be treated one way or another in an effort to effect a cure.
But they never seriously consider the idea that depressed people may be rightly depressed, that life has dealt some people an unplayable hand and they recognize that there is no way to throw in the cards and get a new deal.
It does no good to tell such people that other people are worse off than they are and yet remain happy. So what? they say. The other people are Pollyannas who do not see the world clearly and cannot understand or refuse to understand the hopelessness of the situation.
To be sure, some people who say this may be wrong. But some may be right. The nexus of their lives may indeed doom them to unhappiness. Isn't it appropriate for such people to be depressed? Isn't it the rational, logical and inevitable conclusion of a lifetime of unhappy experiences from which there is no escape? Such people would be crazy if they were not depressed.
The Papoloses never address these questions. They take it as a given that depression is a disorder that should be treated, and they proceed from there. But few depressed people are ever permanently cured, and the reason is that life continues to depress them.
No psychiatrist has yet been born who can change the world with or without drugs, and the world is governed by the three laws of thermodynamics, which have been summarized as follows:
1--You can't win.
2--You can't break even.
3--You can't get out of the game.