Manufacturing depression

Gary Greenberg is an American psychologist and journalist who lives and practises in Connecticut. He is an excellent writer, and Manufacturing Depression provides a comprehensive, fast-paced, and often mordantly funny overview of the history of modern psychiatry and medicine. In 15 chapters with provocative titles such as “Making Depression Safe for Democracy” and “Diagnosing for Dollars” he provides readers with a look at contemporary medical practice, including the conduct of clinical drug trials, the development of cognitive behavioural therapy, and the use of brain imaging techniques in the diagnosis and treatment of depression. The book is very well referenced with seminal papers in the medical and psychiatric literature.

Greenberg’s book is a thought-provoking critique of what he regards as the pathologizing of sadness, grief, and despair in modern Western society. Furthermore, he views the invention of medications designed to “treat” these feelings as a capitalist conspiracy that aims to convince us that our unhappiness is a chemical problem, not an existential one. He is highly critical of psychopharmacology and even more critical of cognitive behavioural therapy, which he calls “a method of indoctrination into the pieties of American optimism, an ideology as much as a medical treatment.” That statement gives you a pretty good idea of the tone of the writing and the stance of the author!

That said, I found this book challenged many of the ideas about depression and other mental health problems that I was taught as a resident and continue to be taught in my exposure to continuing education and in my discussions with psychiatrist colleagues with whom I share the care of some of my patients. The historical overview of psychiatry that Greenberg provides was certainly lacking in my medical education; reading this book challenged me to go back and explore that history, especially more recent developments in biological psychiatry. I am not convinced by Greenberg’s conspiracy theory, but his book is a valuable contribution to my understanding and thinking about the nature of depression and the way it is viewed and treated in Western medicine.

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