“I’ve been through a lot, good and bad, I’ve seen government rise and fall and scientific theories rise and fall, and I think there’s a breadth of mind which, provided the brain is healthy comes with age.”
— Oliver Sacks
Eli Lilly got FDA approval to market Prozac in December 1988. The company’s marketing genius, Ed West, had a brilliant strategy for making it a blockbuster: Market not the drug but the disorder “Clinical Depression” —a supposedly widespread “mental illness” that, by the way, Lilly’s new “Selective Serotonin-Reuptake Inhibitor” could supposedly treat.
Lilly’s peer-reviewed publicists determined that shame was preventing millions of Americans from getting a Depression diagnosis (and proper medication). ‘Overcome your shame’ worked as a sales pitch then and it’s working still —witness the publication in the New York Times August 5 of “The Great God of Depression,” an article about the novelist William Styron by a woman named Pagan Kennedy. It begins:
Nearly 30 years ago, the author William Styron outed himself in these pages as mentally ill. “My days were pervaded by a gray drizzle of unrelenting horror,” he wrote in a New York Times Op-Ed article, describing the deep depression that had landed him in the psych ward. He compared the agony of mental illness to that of a heart attack. Pain is pain, whether it’s in the mind or the body. So why, he asked, were depressed people treated as pariahs?
A confession of mental illness might not seem like a big deal now, but it was back then…
That’s Big PhRMA’s line and it’s false. Discussion of melancholy has always been acceptable among those who could afford to discuss it. The reason people didn’t make “a confession of mental illness” until Prozac came along is that they didn’t define their sadness as mental illness.
In the 1990s I reported on the marketing of Prozac for the Anderson Valley Advertiser, and with Alexander Cockburn, wrote a comprehensive piece on the subject that was rejected by the Los Angeles Times. Based on 100 phone interviews (in response to a classified ad in the San Francisco Bay Guardian), we concluded that “Clinical Depression is invariably a function of loneliness and/or insecurity —plain words that suggest social rather than chemical causation.”
We noted that William Styron and Mike Wallace filled an important niche in Lilly’s marketing campaign, being prime examples of men who were famous and respected and well-to-do… and yet prone to Clinical Depression! We knew that both Styron and Wallace were suffering from loneliness, broadly defined. Styron’s beloved mother died when he was 13 after a many-years-long ordeal with cancer. Boys who watch their mothers suffer and then lose them can feel the loss forever. That’s not an illness, it’s lifelong grief. Mike Wallace’s handsome, talented son Peter died at age 19 in a mountain climbing accident. Was his enduring grief an illness?
Psychiatrist Frederick Goodwin, former head of the National Institute of Mental Health explained in a phone interview that an episode of major depression is one of “relentless duration —week after week. You can have a grief reaction that can be every bit as intense as a clinical depression. But it doesn’t last. Depressions stick around…” A key to defining depression, Goodwin reiterated, was “duration, measured in weeks and months rather than days.”
Cockburn and I wrote: “Weeks and months? Is that ‘relentless duration? We don’t know about you and your friends and patients in Washington D.C., doctor, but in our circles grief reactions last for years, decades, lifetimes, generations!”
Reading Darkness Visible: a Memoir of Madness I was surprised to learn that William Styron didn’t see himself as a man who had been through years of an anguish that lasts. His first novel, Lie Down in Darkness, is excruciating. His most famous, Sophie’s Choice was grim, to put it mildly. My favorite, Set This House on Fire, is the lightest but it’s pretty heavy. His memoir Darkness Visible is stylishly written and almost light in tone until page 83 when Styron describes the death of his mother and the tone changes and he expresses unresolvable loss, grief, and rage.
I met Styron and his wife Rose in the mid-60s through their neighbor on Martha’s Vineyard, Lillian Hellman, who I was interviewing for a possible biography. From my glimpse of the Styrons’ social circle, I doubt they had many friends who were cynical about Psychiatry. Bill needed a friend and he got a Brain Scientist.
Pagan Kennedy writes:
“His famous memoir of depression, ‘Darkness Visible,’ came out in October 1990. It… demonstrated that patients could be the owners and describers of their mental disorders, upending centuries of medical tradition in which the mentally ill were discredited and shamed. The brain scientist Alice Flaherty, who was Mr. Styron’s close friend and doctor, has called him “the great god of depression” because his influence on her field was so profound. His book became required reading in some medical schools, where physicians were finally being trained to listen to their patients…
This past year, I have been working on an audio documentary about Mr. Styron and Dr. Flaherty (a longtime friend of mine).
Pagan Kennedy(@Pagankennedy) is the co-producer of “The Great God of Depression,” a serial podcast from PRX’s Radiotopia; the author of “Inventology: How We Dream Up Things That Change the World”; and a contributing opinion writer..
Darkness Visible played and evidently will continue to play a big role in the marketing of Depression. Styron makes the diagnosis classier.
The Anti-Depressant Epidemic
We tend to think of the 1990s as the Prozac Decade, but sales have continued soaring ever since. Between 1999 and 2014 antidepressant use in the US rose by 65%, according to a US Center for Disease Control and Prevention study.
By 2014 about one in eight Americans over age 12 reported recent antidepressant use. Women were about twice as likely as men to be using. A quarter of the people who had used in the past month had been on anti-depressants for 10 years or more.
When the CDC report came out, CBS news asked a New York psychiatrist named Ami Baxi to explain the steep, steady rise in anti-depressant use. Baxi credited FDA approvals for more indications and “a sign of decreasing mental health stigma,” where more people feel comfortable asking for help against depression and anxiety.