Manufacturing Depression: The Secret History of a Modern Disease

by Gary Greenberg

• Author with professional and personal 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 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. .

Genres: Psychology, Nonfiction, Science, Mental Health, History, Health, Medicine

432 pages, Hardcover

First published January 1, 2010

About the author

Librarian Note: There is more than one author by this name in the goodreads data base.

Reviews

[Wanda · Rating 2 out of 5]

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.

[Diane · Rating 3 out of 5]

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.

[Gina · Rating 4 out of 5]

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.

[♑︎♑︎♑︎ ♑︎♑︎♑︎ · Rating 2 out of 5]

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.

[Emily Kestrel · Rating 3 out of 5]

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.

[Sharon · Rating 5 out of 5]

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.)

[Glenn Cheney · Rating 5 out of 5]

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.

[Laila · Rating 3 out of 5]

I'm reading this for a book review assignment for a sociology paper on mental health.
Given the seriousness of the topic, notably the history of depression from its conceptualization into "illness" and the evolution of drugs as the magic bullet to cure it (Prozac being the climax of it all), however, the narrated-style of writing reduced its effectiveness. Certain statements got me to pause and wonder if it was factual or contained the author's biases. I suppose a good starting point in learning about the history of modern disease and its cures. Or the whole thing is nothing more than the commercialization of unnecessary drugs by the big Pharmas profiting from what we human beings crave and desire the most in life--happiness. Perhaps, we should tell ourselves: I am happy enough (even when shit really hit the fan at times). In my humble opinion, keeping moving the ideal state of happiness in our lives is the root cause of many problems. Food for thought there.

[Sherif Gerges · Rating 2 out of 5]

Greenberg’s argument, while erudite and well-intentioned, fails to convince and in retrospect, has not aged well. As a psychotherapist, his affinity for psychodynamic theory and his skepticism toward biological models of depression are evident throughout. He’s not wrong in noting that, at the time of writing, no definitive chemical biomarker for depression had been identified.

But a lot has since this book was published. Genetic markers and genes associated with depression have been found, and this is precisely why his shortsightedness is confusing. Greenberg overlooks a central constraint of science: our current understanding of the brain is shaped—and limited—by the granularity of our scientific tools. He fails to acknowledge that neuroscience is an evolving discipline, and that the absence of biomarkers may reflect the immaturity of our methods rather than the absence of biology. Greenberg does not engage with this dimension of psychiatric science, strange.

That said, I do share his concerns about the pharmaceutical industry’s marketing apparatus, which has arguably outpaced its scientific rigor. His observations about the medicalization of normal human variation are not without merit; the expansion of diagnostic categories, and the pathologizing of every dimension of human behavior is a legitimate problem.

Still, depression is real, and many individuals derive meaningful relief from psychiatric medication. In this context, Greenberg’s casts doubt where nuance is needed, and substitutes ideology for scientific openness.

[LemontreeLime · Rating 4 out of 5]

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.

[Carmen von Rohr · Rating 3 out of 5]

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

[Michelle · Rating 2 out of 5]

Manufacturing Depression is part history of depression and psych meds, and part impassioned plea in defense of Freudian psychoanalysis. Gary Greenberg aims to show us "how we got to a point in our history where it is common, if not mandatory, to think of our unhappiness as a disease." Greenberg argues that whether we decide to take a pill for unhappiness has high stakes: "What's at stake is who we are, what kind of people we want to be, what we think it means to be human." So far, so good - I think those are very compelling questions.

We start with a somewhat muddled chapter about the supposed OG of depression: Job from the Bible. The problem is that the story of Job is more about answering the question, "If an all-powerful and all-good God exists, then why do bad things happen to good people?" rather than a story about a man who is depressed. I don't see Job as depressed, just rightfully shocked and demoralized by his string of extreme misfortune. If Gary is making the point that modern day therapists would misdiagnose Job as depressed when he's very rationally and understandably upset, the point is confused when Gary makes the analogy that Eliphaz is like Job's therapist and is blaming him for being depressed, saying he brought his troubles on to himself. According to Gary, Eliphaz telling this to Job is similar to how modern day therapists tell their patients they have biological imbalances which require them to be medicated. The analogy is very poor though as you can probably already see. Eliphaz isn't casting judgment on Job for Job’s poor mental state, he's casting judgment on Job for all of the bad things that have happened to him. And furthermore when modern-day therapists tell patients their issues are biochemical, they’re doing to opposite of casting judgment: they’re absolving the patient of personal responsibility.

After his tortured Job analogy, Gary launches into a brief history of modern pharmaceuticals. This part of the book was probably the best part overall. Manufacturing Depression fills in the gaps of depression medication history that the Noonday Demon leaves. The Noonday Demon had a more philosophical focus in its recap of the history of depression (which is a bit strange considering how hard it promoted antidepressants). Manufacturing Depression actually gives a respectable and insightful review of the history of antidepressants, starting with the discovery of “silver bullet” medications, and how they quickly led (in some cases very directly, like in the case of iproniazid) to the discovery of the first psych drugs.

Tied in closely with the question of how to treat depression is the question of what causes depression. The historical figures who addressed this in one way or another fall on a chart which contains at the far left, the idea that depression is an illness of the mind/philosophy, and at the far right, the idea that depression is an illness of the brain/biology. On this chart, we can place Freud on the far left, Kraepelin (symptoms = disease) and Sakel (insulin shock therapy) on the far right, and Adolf Meyer (look at the patients life story to treat them, but don’t get mired in philosophy) near the center. Just for fun, if pull out our copy of the Noonday Demon and go back further in history, we can put Plato and Socrates on the far left of our chart (mental disorders can be treated through the study of philosophy), Hippocrates on the far right (treat mental disorders by rebalancing the four humors), and Aristotle somewhere in the center (body affects the soul, and vice versa). This was fun to read about because the debate about what causes depression is still on-going (though biological explanations are most favored these days, more and more people are realizing medical treatments of depression do not actually treat the root cause), so maybe we'll a continued swing back and forth on the chart in the future.

Whether or not to treat depression as a malady with mental or physical roots leads very quickly to the question of whether we as human beings have free will or bounded free will (potentially implied if depression has only mental causes, and IMHO implying a solipsistic, dualist, or dualist-adjacent worldview), or whether the free will we think we have is an illusion and we are instead controlled by the laws of physics which govern the rest of the universe (potentially implied if depression has only physical causes). Falling under the umbrella of the latter view, a deterministic and mechanical view of consciousness is not new: “The Parisian doctor Julien Offray de La Mettrie, for instance, had proposed in 1745 that the brain was a machine that produced consciousness, and that it was in this respect no different from the rest of the body” (66). Gary’s own views about free will, though, are strongly opposite Julien’s. Greenberg continually butts heads against the idea of a materialistic, free-will-lacking universe, calling it “neurochemical reductionism” (254). Part of this seems to be from an existential uneasiness with the idea that we are all only just cells, but part of it seems to be because he has a stake here, as he practices psychoanalysis, which has fallen to the wayside a bit in the modern day compared to other therapies like CBT. Gary muses during one of his annoying, smarmy and self-righteous run-on sentences: “…I’m wondering if I’ve failed my patients and myself, if I’ve frittered away twenty-five years of my life and millions of their dollars by focusing on the tractors and the strawberries and all their possible meanings, by the inescapable and sometimes intentional inefficiencies of this method, by my nearly willful avoidance of anything resembling accomplishing work, by my possibly blind and certainly unscientific belief that the best that we can do is integrate all that we can of ourselves into a good story, even the thoughts that don’t make sense and the desires that are horrifying or the feelings that shock.” (297) First of all, get an editor. And to answer Gary’s question if he’s wasted his time and his patients’ money: I don’t think his patients got any special benefit from the psychoanalysis part of his therapy, though I’m sure they benefited from having someone listen to them tell their stories.

Gary gets himself worked up into a frenzy again and again over the idea that the mind might be rooted in the physical brain: “The raw material out of which depression is manufactured— the idea that this pageant of selfhood, the stories we cobble together out of our lives, and the epic of history that all those stories together make is all just a byproduct, an illusion manufactured by our molecules, something to keep use busy while they go about their business of dividing and replicating — is repellant to me. It’s demoralizing. It’s nearly intolerable. Who wants to be the tail of some electrochemical comet?” (315, but also see 329 and 334 for similar rants). Unfortunately, while he is frothing at the mouth, Gary misses the best argument against psych drugs: that these drugs cause serious long term harm. We do get a mention of antidepressant discontinuation syndrome, and how it is a drug withdrawal effect, on page 356, “The depression doctors are familiar enough with this phenomenon to give it a name: adverse events related to antidepressant discontinuation. But back in your ninth grade health class, your teacher probably gave a different name to the malaise that occurs when you stop taking a drug and disappears when you start again: withdrawal syndrome…” (356) but only about one page is devoted to it. Another book which came out around the same time, covers similar themes and content but with more of a focus on the destruction that psych meds can cause, and that ended up making more of a cultural impact is called "Anatomy of an Epidemic" by Robert Whittaker. I am reading that book next!

Another complaint I have: one of the central events in this book is the depression medication trial that Gary participates in. Gary brings it up throughout the book, wondering if he’ll notice a huge difference in mood from his treatment, etc. However we find out mid book that the medical trial is testing the efficacy of Omega-3 fatty acids in treating depression, not an actual prescription medication. It's weird because on page 42 it seemed like he was going to participate in a trial for Celexa, but then later he talks about not knowing if he’s taking Omega-3s or the soybean oil placebo. This was a huge letdown to me and feels like a weird copout, given the large portions of the rest of the book devoted to discussing actual depression medication.

Overall I was pretty disappointed by this book, but I did appreciate (and learn a lot from) the discussions of the history of depression and depression meds.

Miscellaneous thoughts:

- American nervousness epidemic in the late 1800s, “The cause of all this trouble, Beard said, was a failure of the nervous system to keep up with the demands of ‘modern civilization,’ which he listed as: ‘steam power, the periodical press, the telegraph, the sciences, [and] the mental activity of women’” (91) Love this.

- The power of the placebo effect: “You can, for instance, give people fake alcohol (without, of course, telling them that it only tastes like the real thing) and put them in a crowd of socializing drinkers and watch them get ‘drunk’. You can give them fake morphine and hear them sigh in relief as their pain goes away. You can tell one group of subjects that caffeine will impede their coordination, another group that it will improve it, give both groups decaf, and observe as both groups behave accordingly” (256) And people say stereotype threat isn’t real.

- Another case of the author becoming even less likable on page 171, where he mentions in his younger years taking LSD, then driving his car a few blocks. He seems to defend his actions in the book, and seems put off by the idea that the doctors in the depression study he is in seem to be judging him. If you are going to take a drug for the first time, no matter how small the dose, it’s your own responsibility to make sure that you won’t be in a position where you need to drive a car home. The fact that Gary didn’t do this makes him look like a total creep, and his attempts to defend himself just dig the hole deeper.

- “Like many people who went to college in the 1970s, I had read Erving Goffman and Michel Foucault, sociologists who had pointed out the inescapable ideological dimension of diagnostic labeling. Identifying people as depressives or schizophrenics, they suggested, was a way to exert power over them, to stifle dissent and impose conformity to a particular way of being human. Sometimes, as in the case of a person shut up in a mental hospital or forced to undergo a lobotomy, the exercise of power was obvious and brutal.” (228)

[Rubber Duck Ry · Rating 4 out of 5]

This one waddled right into my brain and fluffed up a nest of thoughts I’m still sitting on.

Part history, part science, and part “quack, I’ve lived this”—Greenberg dives into the murky waters of depression not just as a researcher, but as someone who’s been caught in the rip current himself. It’s more of a thoughtful paddle through psychiatry’s backwaters than a structured academic lap.

He doesn’t pretend to be objective (thank duckness), and that’s what makes it compelling. His feather-ruffling mix of memoir and investigation makes you wonder how much of what we call depression was diagnosed by scientists—and how much was manufactured in the labs of Big Pharma and bureaucratic beaks.

Not so much a how-to manual as it is a "what-the-duck-is-going-on" kind of read. If you're after clear answers, maybe swim elsewhere. But if you like your nonfiction with a splash of scepticism and a philosophical tailfeather shake, this one’s worth the plunge.

Mood: Pensive duck staring into reflective pond
Current Thoughts: Somewhere between “Am I sad or just self-aware?” and “Time to cancel my therapist and start a duck cult.”

[Yaaresse · Rating 4 out of 5]

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.

[Judith · Rating 3 out of 5]

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.

[Mark · Rating 5 out of 5]

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.

[Matthew Johnson · Rating 2 out of 5]

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

[C · Rating 5 out of 5]

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.

[Rita Varian · Rating 5 out of 5]

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.

[Linny · Rating 4 out of 5]

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.

[Regan · Rating 3 out of 5]

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.

[Diane Brown · Rating 5 out of 5]

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.

[William Adams · Rating 4 out of 5]

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.

[Avery · Rating 1 out of 5]

On premise I agree with this book: the ways we discuss and treat depression are manufactured and how we discuss it and treat it feed into each other to seek prescription. Beyond that he loses.

I believe he uses weak evidence and is so convinced of his own arguement that you’ll find yourself doubting if a passage is just fact and not his biased shining through. I take this most issue with how to support his argument that treatments of depression are based on quackery he uses evidence from extremes, the true wackjobs of psychiatry and often used example of treatment of SCHIZOPHRENIA and MANIC DEPRESSION (BIPOLAR) to support his argument and NOT depression. Obviously if you argue that psychiatry is based on something abstract and use the most controversial doctors using the most unethical practices who were often treating the most SEVERE illnesses. It’s almost like Greenberg was not confident that a discussion that focused explicitly on depression and any nuance when discussing the history of treatment would have severely weakened his argument. What about the sincere efforts of doctors to treated depressed people Mr. Greenberg? What about the real lived experience of severely depressed people Mr. Greenberg. Unfortunately I don’t think he is skilled or intelligent enough to answer this question.

My most controversial opinion is that most of what gets diagnosed ant depression disorder isn’t depression but if I wasn’t already convinced of this, a book like this would NOT convince me.

Other negative reviews have mentioned more thoughtful books to read that explore this new topic and I will be checking this out.

[Sara · Rating 5 out of 5]

Gary Greenberg is a psychiatrist and someone who has struggled with depression for over two decades. I first read his book "Book of Woe" which I would recommend reading first. Most of the book focuses on how mental illnesses in the DSM such as depression are nothing more than a group of symptoms that psychiatrists have observed. Having depression is surely suffering, but it does not mean you are sick. Gary discusses how placebos work just as well as antidepressants in clinical trials. What does that mean for how "hope" can help with depression? He questions why drugs are created first by pharmaceutical companies and then a "disease" is created in order to sell these drugs. He talks about how easily psychiatrists prescribe drugs, mostly based on what the client is saying they need verses anything else. He discusses the side effects and the addictive nature of antidepressants. If antidepressants are mostly mood drugs why must we see a psychiatrist and get a prescription to get them? He discusses depression along with grief and how psychiatrists have never agreed on what is a disease verses what is just human suffering. He also discusses how DSM criteria continue to be added to diagnoses, at some point everyone will have a "mental illness". Overall, both books have caused me to evaluate why psychiatry is the only medical field that pushes drugs based on symptoms verses identifying any true pathology or biophysical root cause.

[ellen · Rating 4 out of 5]

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.

[Elizabeth]

Skimmed this one. Interesting premise but sooooooo long. I like the way he frames the discussion, rightly recognizing that manufacturers are telling us a story about our suffering and its relief. If you don’t mind a rambling memoir mixed with intellectual history and expose, you might enjoy this.

Personally, I’d recommend Mike Emlet’s short book, “Descriptions and Prescriptions” for a more concise work that quickly gets to the point.

[Pathila Singh · Rating 3 out of 5]

He asked more questions than he provided answers. Basically the summary of this book is that there's no quantifiable way to measure depression. You are the only one who can know if you're depressed or not. Don't let anyone sell you a bunch of BS to get you to buy drugs not even if they're a doctor or psychiatrist.

[Paul · Rating 3 out of 5]

I no longer know who is fooling who anymore. It's charlatans all around. Probably doesn't help that the author is writing with his mind made up from the start that only paying psychoanalysts like him a lot of money will cure you of depression which on one page is and on another isn't a disease.

[Josh · Rating 5 out of 5]

Excellent. Greenberg's writing is crisp, clear, ironic and yet sympathetic to the human condition. His evaluation of the depression industry - its roots, historical development, and deeply troubling current manifestations - is important reading for all who care about people.