La Fatigue d'être soi: Dépression et société

by Alain Ehrenberg

Troisième volet d'une série qui s'attache à dessiner les contours de l'individu contemporain. En confrontant, depuis le XIXe siècle, l'évolution de la psychiatrie et les mutations de la société, ce livre montre que l'effondrement intérieur de la dépression est le symbole de la culture d'impuissance qui est la nôtre. Le déprimé ne se sent pas à la hauteur des exigences qu'il s'impose.

Genres: Psychology, Nonfiction, Philosophy, Sociology, History, Self Help, Science

414 pages, Paperback

First published October 1, 1998

Reviews

[Ed · Rating 3 out of 5]

It appears that we live in the midst of an epidemic of an illness that we call Depression. Looking back to my training as a psychiatrist in the early 1970s, the diagnosis of Depression was usually limited to states that were so disabling that a person could not work, was at risk of suicide, often needed hospitalization and was usually treated with tricyclic antidepressants or ECT. There was a diagnosis of Neurotic Depression that was milder and was always treated with psychotherapy. Our current epidemic is usually explained by two factors: first, the Diagnostic and Statistical Manual of 1980 which eliminated Neurotic Depression and created a vaguely defined category called Major Depression and second, the advent of Prozac, an easy to take medication that was effective for a broad range of symptoms.
Ehrenberg takes a different tack. He traces the history of depression focusing on two models. The conflict model, initiated by Freud, sees people as whole, but divided by conflict. Transgression and guilt are the forces that drive it, especially in France where Lacan's version of psychoanalysis is dominant and about which Ehrenberg is writing. The key term in the second model is deficiency. Following the social and cultural changes of the 1960s, he argues, transgression and guilt were no longer dominant concerns. She, and Ehrenberg is religious about using that pronoun, can do anything she wants. Now what matters is feeling inadequate, that is to say deficient. Depression is no longer about conflict and guilt, but about feeling inadequate and deficient. Medications like Prozac help with this by allowing people to feel more capable. Ehrenberg seems nostalgic for the old days when conflict reigned and psychoanalysis was popular. He seems to hold the view that feeling better because of a chemical effect is not authentic. Nonetheless, because he sees the changes as cultural, and social he does not make case for going back to the old days.
What to make of a book like this. It was certainly confusing at times, especially because most of his references are to twentieth century French psychiatry about which I am not very familiar. The broad idealistic/Foucauldian perspective where cultures change without clearly marked material causes is hard to follow. Nonetheless, posing a contrast between a view of human nature centered on the idea of conflict and one centered on a notion of deficiency is quite refreshing. It isn't a matter of a biologica/psychological dichotomy. Ehrenberg is clear psychotherapies, going back to Janet, can be based on a deficiency model. Indeed as I think about discussions of psychotherapy in recent years it seems to me that these were often based on the premis that the patient was somehow injured and in need of repair, not that 'she' was in conflict about how to live. The medications and the psychotherapies that we use are consistent with one another in how they view human nature. In this regard it seems to me that Ehrenberg is onto something and that this book was worth reading.

[Barak]

People seem to be too depressed to actually read it.

[Bruce Campbell · Rating 4 out of 5]

Ehrenberg has the French disease of writing obscurely enough that it is fatiguing to read, particularly on the Subway going to work. I will probably enjoy it more on re-reading. Generally some great ideas about the way Neurosis and Anxiety lost to Depression in the last quarter century. I suggest beginning with the concluding chapter, which puts us here with some sense of how we got here.

[Jonathan · Rating 3 out of 5]

Smart and ambitious, but filled with highly speculative claims.

[Elari · Rating 4 out of 5]

Ehrenberg attributes the rise of the diagnosis of depression to a shift in governance practices after World War II, and a transition from politically imposed restrictions on personal freedom to the social urge for personal initiative and the cult of individual entrepreneurialism. He calls depression an ‘illness of responsibility’ which is both the manifestation and embodiment of feelings of inadequacy and helplessness. The medicalization of individual failure as a diversion from systemic failure, so to speak, acts as a powerful pacifier in the face of political injustice.

[Sandrine · Rating 2 out of 5]

Une réflexion très intéressante … mais noyée - délayée ? - dans un style pas assez percutant, voire lénifiant, et des apports dont on ne voit pas toujours le rapport avec le sujet.
Tout le débat sur les médicaments et l’évolution de la psychiatrie aurait gagné à être résumé pour ne pas tenir les 3/4 du livre.
Les notions sociologiques sont par conséquent moins explorées .
En résumé : un fond intéressant mais noyé dans des propos pas toujours pertinents ou trop repris

[Marc ZEIMET · Rating 5 out of 5]

Alain Ehrenbergs "Das erschöpfte Selbst“ kam zu mir durch die Empfehlung eines Freundes – eine jener Buchempfehlungen, die zu einer intensiven Auseinandersetzung führen. Der Titel des französischen Soziologen versprach Einblicke in ein Phänomen, das unsere Zeit prägt wie kaum ein anderes: die Depression als Signatur der Moderne.
Ehrenberg zeichnet historische Entwicklungen nach und zeigt, wie sich die psychiatrische und gesellschaftliche Aufmerksamkeit verschiebt. Entstanden ist ein sozialphilosophischer Panoramablick auf die „Krankheit der Freiheit“. Das Werk vereint Psychiatrie-, Pharmakologie- und Sozialgeschichte und macht die Grenzen medizinischen Verstehens sichtbar: Medikamente wirken oft nach dem Prinzip „Trial and Error“, ihre Wirksamkeit bleibt vielfach unvorhersehbar.

Die Lektüre verlangt einiges an Ausdauer. Komplexe Theorien werden oft nur in knapper Form referiert, sodass ohne Vorwissen der Zugang schwerfällt. Auch die deutsche Übersetzung nimmt nicht alle Hürden. Dennoch lohnt die Mühe, denn gerade die dichten Passagen eröffnen wertvolle Einsichten.

Besonders erhellend ist Ehrenbergs These, dass die Depression „die Krankheit der Freiheit“ sei. Sie markiert den Wandel von der Neurose als Ausdruck einer repressiven Gesellschaft hin zur Depression als Leiden einer Kultur, die unablässig Verantwortung und Initiative verlangt. Menschen werden depressiv, weil sie die Illusion ertragen müssen, dass ihnen alles möglich sei. Damit verknüpft er auch demokratietheoretische Fragen: "Der Verlust des Konflikts als gesellschaftlicher Bezugspunkt gefährdet die kulturellen Grundlagen einer zivilen Demokratie" – war so ein prägender Satz im Essay.

"Das erschöpfte Selbst" ist mehr als ein Essay oder eine Dissertation – es ist eine vielschichtige Analyse des modernen Menschen. Trotz seiner Komplexität gilt es zu Recht als Standardwerk zur Depression. Ehrenberg macht sichtbar, wie individuelle Pathologie und gesellschaftliche Struktur ineinandergreifen. Ein herausforderndes, aber lohnendes Buch für alle, die verstehen wollen, warum Erschöpfung zur Signatur unserer Zeit geworden ist.

[Germana Paolella · Rating 2 out of 5]

Il libro fa un excursus storico su alcune teorie riguardanti la depressione, concentrandosi in particolare sulle cure farmacologiche, inserendole nel contesto socio-culturale francese. Unisce poi alla depressione il concetto di dipendenza patologica (senza citare studi che la correlino direttamente). Il libro è stato scritto quasi 30 anni fa, non è stato aggiornato e risente gravemente del tempo trascorso. Le idee originali espresse dall'autore sono poche e ripetute, in maniera identica, più volte nei vari capitoli del libro. In conclusione, a meno di avere uno specifico interesse storico, questo libro è di scarso valore

[Till · Rating 4 out of 5]

erschöpfend

[E. · Rating 4 out of 5]

Why in the last fifty years has depression become such a widespread illness? Ehrenberg explores that question. While much of the book details changing understandings in psychiatry and psychoanalysis, particularly with the advent of anti-depressants, his question is much broader. He determines that the rise of depression is a result in a changed understanding of the self. We have emerged from traditional societies where our roles were often defined for us. Now we have almost complete freedom to create our own lives. He argues this has caused the rise in depression, as many struggle with that freedom and the social impulse to keep up. Depression results from feeling of inadequacy and leads to an inability to function.

This book was referenced in a book I read in December, and I was so intrigued by these ideas that I ordered this to read for myself. I found it illuminating and thought provoking. I feel it advanced my understanding of some of the people in my life and myself.

[Emmanouil · Rating 4 out of 5]

Πολιτικό βιβλίο, που προσπαθεί να πάρει ίσες αποστάσεις από την νοσταλγία του παρελθόντος και την αισιοδοξία του μέλλοντος. Μέσα από την ιστορία της κατάθλιψης αναδίδει νέες κοινωνικές μορφές, δράσεις και λειτουργικότητα του υποκείμενου. Περνώντας από το 1800 και το δίπολο τρέλα -παραλήρημα στο 1900 τη νεύρωση, τον συγκρουσιακό άνθρωπο και τα διλήμματα ενοχής καταλήγει στο 2000 σε μια κουλτούρα της αποδοτικότητας και της ατομικής δράσης όπου τα πάντα είναι εφικτά και οδηγούν στην κατάθλιψη και τον εθισμό.

[Claude · Rating 3 out of 5]

Ça demeure un livre de sociologie, donc ce n'est pas un roman. Par contre, j'ai vraiment apprécié pouvoir mieux comprendre l'évolution de la maladie de la dépression.

[Shujath · Rating 5 out of 5]

Worth read on depression. It has given me new insights into depression. I found it interesting that there are social and cultural reasons behind it and not pathological as generally understood.

In his conclusion he writes:
"Worth read on depression. It has given me new insights into depression. I found it interesting that there are social and cultural reasons behind it and not pathological as generally understood.

In his conclusion he writes:
"Depression and addiction are names given to the uncontrollable,
which we encounter when we stop talking about winning our freedom
and start working on becoming ourselves and taking the initiative
for action. They remind us that the unknown is part of every person
– and that it always has been. It can change but never disappear: that
is why we never leave the human realm. That is depression’s lesson.
The impossibility of completely reducing the distance between us
and ourselves is inherent to any human experience in which the
person owns herself and the individual origin of her action."

[Ruo Jia · Rating 4 out of 5]

A history of depression or the construct of the psyche/being, feels like reading Cusset’s history of French theory. Almost disillusion of philosophy and being comes back in the end brushing the stability of the emptiness that is unchanged human condition, which demands much more work and reflection unpacking their relations.
Individualism and identity/diversity and politics rightfully connected to this social-construction of psyche.

[David · Rating 4 out of 5]

Ehrenberg beschreibt über einen großen Teil des Buches die Geschichte der Depression und verwandter kritischer Störungen. Die Geschichte ist sehr vielseitig, sei es bezüglich der Ursachen (endogen, psychogen, exogen), Defizit-/Konfliktmodell, Chronizität (die heute sehr stark ist), der Mechanismen (-> Neurowissenschaften), Behandelbarkeit ("Entdeckungen" der Elektroschocks und Psychopharmaka) oder der Umwelt (Gesellschafts-/Wertewandel). Diese Faktoren haben sich "bunt" auf die Definition und das Bild der Depression niedergeschlagen - während früher sie oft definiert wurde über ihre Ursachen bzw. Auslöser, gab es auch Definitionsversuche über ihre Behandelbarkeit (Depression ist das, wo Behandlung XY hilft), während heute die Definition über die Symptomatik herrschend ist. Diese hat wiederum gewisse Schwächen, insbesondere, dass der Rückgriff zur Ursache fehlt.

Das Buch ist sehr historisch aufgebaut und recht "französisch". Erst am Ende geht der Autor tiefer auf Schlussfolgerungen über die Natur und heutigen Ursachen der Depression ein.