Speaking of Sadness: David Karp

Speaking of Sadness, authored by David Karp, provides an in-depth and personal view into an individual battling depression. In this book, Karp relates his own personal experience, as well as fifty case studies completed with voluntary interviewees. The cause of depression is often a rather controversial subject for intense debate. In relating biological and sociological factors as an intertwined cause, Karp provides a compelling and credible argument for the cause and potential solution of depression. This paper will highlight the book's subject matters, such as diagnosis, cause, treatment and lifestyle of depression.

Living with Depression

Author Karp begins his book by sharing his twenty year personal experience with depression. In this chapter, he lays the foundation of his book and establishes his credibility by detailing that he did not begin to analyze this until a business trip to Montreal in 1974. At this time, he experienced unexplainable symptoms of physical illness, combined with feelings of lowness, despite having the "perfect" personal life. He was prescribed Amitriptyline in 1978, with distrastrous results. Initially, he began his treatment with self-diagnosed discussions, reasoning, "It's my stressful job as an assistant sociology professor that must be causing these symptoms." Then, he sought counseling, participated in drug studies and was prescribed more drugs, all to little avail. Then, Karp began writing, as a therapeutic avenue. Karp notes that the American Psychiatric Association asserted that over 10 million Americans suffer from this often debilitating disorder. Karp emphasizes that, in order to thoroughly assimilate all that depression entails, one must understand it from a personal perspective. Often we see the medical experts voice their perspective but rarely is the patient's perspective allowed.

This chapter concluded by outlining Karp's research method in writing this book. He completed 50 exhaustive interviews, wherein the interviewees ranged in age between early twenties and late sixties. Karp spent one and a half to three hours, per interview, per subject. Karp mentions that he is surprised by his subjects' overall openness and candor, despite the prevalence of seclusion surrounding this disease. The research referenced in this book is based on both individuals and theory, providing a more balanced, effective perspective. It is important to note that the purpose of this book is not to "solve the depression riddle" but to provide a more extensive view of existing with depression.

Dialectics of Depression

This chapter begins with the case study of businesswoman "Nina," a businesswoman who discussed her experience with a genetic condition that compromises her immune system, resulting in various types of cancers requiring constant medical monitoring, as well as various surgeries. Often, these surgeries left physical deformities. She believed her depression was due to a prior sexual assault and not her medical problems. She believed that her professional difficulties, which included being laid off, was the reason or definition of her existence. She relayed that, without it, she felt invisible. For "Nina," the depression was so overwhelming that it blocked any positive thinking of past, present and future aspirations she may have had. She recounted that the difficulty for her lay in maintaining a balance and attempting to avoid a deep, paralyzing depression from reoccurring. She was unsure as to how to do that. She concurred with the author in reflecting that very little literature authored on this topic provided real life glimpses into the actual issues or experience of depression.

The author continues in the chapter by building on Nina's reflections regarding society's failure to include the realistic perspective of depression, tying in Durkheim's sociological perspective of a society creating one's connection to culture. Karp focuses on the "description" of depression, from a patient's perspective, not a sociological one. A patient describes it as a color, dark or black, or as the absence of color. Society describes it as a feeling of inadequacy, a failing to actively pursue daily activities. To a patient seeking help, the author surmises that a patient perspective is likely more helpful than a sterile, sociological one.

Karp also discusses the "paradox of depression," the idea that many emotions are experienced concurrently, rather than one at a time. He points out that, despite the immense feelings of loneliness of depression, these patients seek out seclusion not company. They disengage from the world, opting out to share how they feel. Two plausible reasons for this include the inability of others to understand the communication or fear of the impending "stigma" from this communication. Karp finds that the majority of these emotions experienced by these depressed individuals are often centered on a poor self-esteem or self concept.

Illness and Identity

Karp begins this chapter by reviewing the case study of "Karen," whose depression began in childhood and continued through her twenties. Her treatment included therapy and psychiatric hospitals. "Karen" expressed anger and distaste for these options.

This chapter discusses how patients, based on their interactions with and perceptions of society, determine that they were "depressed." With respect to "career," society dictates that there is a proper timeline for where an adult should reasonably expect to be on that career path. Therefore, if an individual's progress does not match the perceived status quo, they experience feelings of inadequacy, failure - depression. Many of these interviewees related "unhappy childhood stories," again, in contrast to society's perception of status quo as being a happy, healthy home environment. Those who did relate these negative experiences related that they thought those experiences were their fault. Again, the presence of poor self imaged was based on perceived status quo.

In addition to society's career time line, an individual also struggles with the debate of disclosing or retaining the presence of these often debilitating inner struggles. The fear of repercussion of stigma is very real for these patients. At some point, however, disclosure often becomes involuntary, perhaps, or likely due to a "crisis," that is easily perceived and can no longer be hidden.

Once a patient is labeled as "depressed," a new identity is automatically become associated with them. With knowledge comes awareness. Many, though, align themselves with the biological rather than the mental cause perspective. This seems to be a more acceptable identity than stating they suffer from a mental illness.

Meanings of Medication

The author admits that his discussion of medications for treating depression is likely be skewed by his own biases. Karp did continue to take medications, despite his reticence to do so, fearing his situation might uncontrollably and intolerably intensify without their presence. If the root cause of depression is biochemical, than, perhaps, medications are a necessary evil. Society indeed promotes medicating as the foremost, proper treatment for depression. Our society projects the view of the expert, the doctor, who surely must be in a better position to know how to effectively treat this condition, than the non-expert, or patient. Who really is the expert here? Karp argues that it should be the patient, more so, as he or she lives with it every day, over the doctor who treats that patient once a month.

The chapter continues by reflecting on the case study of thirty year old salesman "Randall." "Randall" shared with Karp how the death of his younger brother, when "Randall" was twelve, invariably taught him society's perspective of denying the presence of any such "depression." No one acknowledged the intense feelings he experienced related to losing his brother. For years, he turned to alcohol and drugs. He tried a few counseling sessions during high school, with little relief. "Randall" believed that the relief that therapy and medications could provide eventually plateaued, leaving the patient to figure out how to deal with the continuing existence of depression. He believed the root of depression was within, from the "inability to cope with everyday feelings."

Karp also believes that many of his interviewees began to align themselves with the biomedical explanation for the cause of depression, when they agree to take any medication for treatment. Because of this, many of the interviewees expressed an extreme hostility to the psychiatric and medication process in general, despite many of them eventually finding a better match of doctor for their needs. Perhaps this is due to the invariable negative side effects to the drugs themselves. Perhaps it is due to the perceived bargaining process each patient relates when first approached by the doctor concerning a suggested medication. Another factor is likely the difficulty in ceasing to take these medications, given the often-addictive facet of many of these drugs.

Coping and Adapting

Karp relays that the difficulty of the process of coping with depression is magnified in that one rarely forgets one is diagnosed with depression. Compare it to having a broken bone - you could rarely forget the presence of the cast. That inability to escape just from the diagnosis itself is difficult indeed. This is compounded by the inability of others to comprehend the pace this individual might be moving in the path toward recovery. This non-comprehension unfairly leads to impatience and frustration with that individual, thereby adding to the already difficult process of coping. Often added to this is the perception that it must just simply be in the patient's head. Perhaps it is simply imagined, as after physical examination, they were normal. The diagnosis of depression did not correlate to an automatic solution. Diagnosis did not equate to problem solved. There are a myriad of causes for depression. When that individual could not come to terms with that unknown, they then begin to use events and other distractions, which keep them from focusing on this dilemma. Often, by seeking these distractions, these individuals are desperately trying to "fix" what is perceived as wrong with them. However, when that distraction fails to prevent another severe round of depression, the result is often more devastating than the original depression they are seeking to resolve.

Karp concludes this chapter by discussing the concept of symbolic interactionism. He reflects how our society frequently, directly determines our perceptions of the un/acceptableness of an activity or illness. This directly plays a role in how the individual coped with depression. Devoid of those negative perceptions of depression and the individual will likely seek out and receive the appropriate treatment. Coping skills would also likely be enhanced.

Family and Friends

As this chapter relates, this is often the most difficult area for an individual coping with depression. It appears that those who knew and loved us best mean well but often appear more critical, judgmental or overbearing. Establishing and maintaining that fine line in the relationship wherein the family member is appropriately sympathetic but not completely consumed by the other's experience is a daunting challenge for his interviewees. Often, family members and significant others felt they must stay in order to "help them through it," almost as a sense of or type of obligation. Often, through caring for or becoming intimately involved on a daily basis with the individual's depressed behavior, that individual could break down momentarily as well. Perhaps, in some way, that provides a small measure of comfort to that individual, a sense of someone else truly understanding their daily experiences. However, it does not help treat the depression. To be an effective "caregiver" in the home, understanding that you cannot fix their depression is key and vital.

Often, Karp found, the parents of the depressed individual struggled the hardest with this new reality. Again, courtesy of our interactions in society dictating our perceptions, parents take this as a deformity, as a failure on their part to properly raise their child. This is absolutely not true. While many of the interviewees relate difficult childhoods, it likely is not the cause of depression. Rather it is more apt to be the inability to cope with these various emotions resulting from these experiences. Therefore, it is not due to parental failure as the sole cause.

In the same turn, often, children of depressed individuals feel the same burden. While it can make that child feel more "important" or "adult-like," it often results in obscuring symptoms that child experience themselves. Often, these children tend to easily fall into or submerge themselves into a "fixer" role as adults. Perhaps there is a different dilemma in friendships. "Boundaries" are not always clearly established. Sometimes, the fear of disclosing and or being disclosed too is too great. This must also be addressed.

Sickness, Self and Society

What is the cause of depression? Why is the occurrence rating increasing rather than decreasing? Is it that direct correlation between society's structure and our perceptions? Are we socialized to stifle our emotions so much so that this might cause depression? We are socialized to believe that if the illness was not caused by physical symptoms, then, in the alternative, mental illness as the cause was surely to blame but a less favorable option. Are we overly socialized to accept medication as the reasonable, acceptable and logical solution? Might this contribute to the overwhelming rates of depression? In that never-ending "search for ourselves," within the boundaries as set by society, if not found, depression might occur. That need to match status quo adds to the stress and pressure and may demonstrate itself in depression. The notion of completely "eradicating" depression from our existence is simply unrealistic and unattainable. Suffering is a natural part of life - how we are socialized to deal with it is not.

Analysis and Conclusion

Overall, I was impressed with author Karp's approach to this difficult subject. One cannot discuss this illness without acknowledging the taboo and stigma surrounding this topic. Karp's approach to this topic was very realistic, sensitive and human. His discussion was not pretentious, ostentatious nor simplistic. This is a topic I could relate to, in two dimensions, both personal. My mother suffered from episodes of deep depression likely since I was a young child. Unfortunately, I cannot interview her concerning her medical history or experience with depression due to her unexpected passing five months ago. However, I do have distinct memories, both as a child and as an adult, of watching her grapple with this emotionally painful issue. Frequently, I would watch her rocking in her rocking chair by the den window, just aimlessly but sorrowfully staring out the window. By nature, biological connection aside, I am a compassionate individual who seeks to help ease another's pain. Somehow, though, despite anything I did, I never felt as if I were able to give her any measure of comfort, whether through simplistic, idealistic childhood expressions or competent motherhood utterances. Through reading Karp's book, I was able to gain some understanding about my mother's experiences and it gave me some comfort in knowing that there probably really was little I could do. She never really shared an extensive medical history with me, as to exact medications, and, after her passing, I cried upon discovering the extensive list of anti-depressant medications she had been prescribed in her lifetime, including her current dosage of Prosac. I identified with Karp's section in the book that dealt with the child's perspective of a parent with depression and wanting to be the fixer.

Upon losing my 55 year old mother so unexpectedly, at the age of 30, with an eight year old daughter of my own, and becoming suddenly thrust into the role of the adult child supporting the surviving parent, I have recently experienced depression as well. Unlike my mother, I am cognizant of my personal depths of depression, enough to know when to get help. Enough to reach for solutions. Resolutions. It is a difficult and daily journey, to be sure. I am optimistic by nature and reading this book helped provide insight. Like Karp, I am also opting to utilize the therapeutic vessel of writing, in that I have begun writing a book chronicling my own experiences with death and dying.

Karp's suggestion of the connection between society's pressure to conform by not expressing emotions and specific individuals' inability to handle the suffocation of those emotions, resulting in depression is credible and should be reviewed more extensively. I would recommend this book to others experiencing depression, either personally or a family member or friend.

Bibliography

Karp, David A. Speaking of Sadness: Depression, Disconnection and the Meanings of Illness. 1996. Oxford University Press. NY/Oxford. 240 pp.