Review of "Speaking of Sadness"

David Karp is a sociologist and he suffers from depression. He felt a divide between these two parts of his life; he found that the fundamental premise of his academic life -- that social structure is vitally important to how people live their lives -- did not fit with his experience that no matter how well his life seemed to be going in terms of success and achievements, he was still depressed most of the time. Furthermore, he saw a huge divide in the main approaches to writing about depression. Either people with depression wrote their own stories, with little attempt to generalize from them, or else professionals wrote about depression from the outside. With his book, Karp attempts to bring together these two different approaches, by systematically studying the way that people with depression described their experience, in order to provide a phenomenology of the condition.

In seven chapters, Karp first gives a brief summary of his long struggle with depression, and then goes on to divide up the accounts of his interviewees into different topics, such as the relation of the illness to their identity, the meanings of medication, coping with the illness, and the reaction of family and friends. He ends with a more theoretical view of how current social structure forms and effects the experience of depression. His writing style is engaging and often informal. In some ways the book is similar to Living With Prozac and Living With Tricyclic Antidepressants, two books that compile short accounts by people on medication and how they view their experience, and also with Rosemarie Dinnage's One to One: Experiences of Psychotherapy, which is a compilation of people's reflections on being in therapy. Karp's book is more wide-ranging and systematic than those. But in some ways the experience of reading these books shares common features; as someone who has also experienced depression, has been in therapy, and has taken antidepressant medication, I find myself in some of the descriptions and find it harder to relate to others. It is interesting to compare the dynamics of my life with those of other people, and such books can provide a way to reflect on one's own experience, especially when one is new to it, and one doesn't know many people who are ready to discuss these issues sympathetically.

Simply reading the personal accounts of others, however, sometimes leaves me feeling "so what?" What is the point of getting a general phenomenology of depression, when I already have my own experience to draw on? Karp certainly wants to go further than mere description. I might also compare Speaking of Sadness to The Hite Report on female sexuality, without meaning to make light of Karp's book. Hite's book was written in a context of new feminist awareness that the personal is political. Using women's answers to questionnaires, it gave a new perspective on their experience of sex; it was importantly different from the Kinsey Report or the studies by Masters and Johnson largely because it was letting women speak for themselves, rather than merely using the measurements of researchers. Of course, Hite was criticized for a lack of objectivity in her conclusions, partly due to the framing of the questions, and also because of the ways she advertised for women to complete the surveys. But in retrospect, her claims do not seem very controversial; she showed that the 'sexual revolution' of the 1960s had served men better than women; women were largely dissatisfied with their sex lives, and men often did not know how to please them. Oh, it was such a long time ago, when sex wasn't quite so public. Of course, Hite's book could also serve as a 'how to' book for people who wanted to know how to improve women's experience.

Unfortunately, we can't use Karp's book for such gratification or relief. But he does point to some ways in which we might take some positive conclusions, in linking the nature of modern society to the rapid rise of depression since World War II. He expresses his theory as follows:

MEDICALIZATION + DISCONNECTION + POSTMODERNIZATION = PERSONAL DISLOCATION

This is not a new thesis; it is hard to think of a mental illness that has not been linked to some aspect of modern society: consider borderline personality disorder, schizophrenia, dissociative disorders, addictions, eating disorders, and panic attacks. Karp is placing depression in the more general nexus of such mental disorders, and although very brief, his discussion of this is plausible enough. What we need is more such work exploring the links between the social and the personal in connection with mental illness. It is easy to give general outlines of the connection between modern life and mental illness; it is far harder to provide a theory that could make solid predictions or tell us how to solve our problems.

Speaking of Sadness does useful work in its intelligent discussions of the thoughts of interviewees. It will be a source of information for writers who are concerned about the widespread use of drugs like Prozac. The chapter on the meanings of medication helps to convey some of the ways that people deliberate about taking antidepressants, reflecting on both the good and bad effects, and the way that it affects their lives. Karp's book might be especially attractive to people who don't like self-help books and who want to get more of a sense of how to think about depression and medication. He writes with the authority of someone who personally knows about depression and so has some insight into the experiences of his interviewees, while at the same time maintaining a sense of objectivity.