D.A. Karp, Speaking of Sadness (New York City and Oxford, UK: Oxford University Press, 1996)

CM writes: I have included this title to acknowledge that the starting point of good therapy is understanding, and that its proper focus is the person not the disease. This seemed to me a thoughtful, original, honourable and eminently sensible book - if not an easy read, probably as easy as any serious book on this subject could be. The following verbatim abstracts explain the author's perspective; the interviewees speak for themselves:

"Given the pervasiveness of depression, it is not surprising that both medical and social scientists have tried to understand its causes and suggest ways of dealing with it. When I first considered writing about depression I did a computer search that turned up nearly 500 social science studies done in just the last few years. Researchers have tried to link the incidence of depression to every imaginable social factor. For example, since the rate of depression is twice as great for women than for men, studies have been conducted seeking to relate depression with gender roles, family structure, powerlessness, child rearing, and the like. Studies can also be found trying to link depression with, among other things, age (especially during adolescence and old age unemployment, physical illness, disability, child abuse, ethnicity, race, and social class. Another focus of the literature is on the efficacy of different social programs or intervention strategies for reducing the impact of depression. Of course, the medical literature alone contains hundreds of studies on the use of different drugs for treating depression.

"As valuable as these studies might be" something crucial is missing. My view is that to really understand a human experience, it must be appreciated from the subjective point of view of the person undergoing it. To use the language of social psychology, it is necessary to 'take the role" of those whose behaviors and feelings we want to fathom. Underneath the rates, correlations, and presumed causes of behavior are real human beings who are trying to make sense of their lives.

"The essential problem with nearly all studies of depression is that we hear the voices of a battalion of mental health experts (doctors, nurses, social workers, sociologists, psychologists, therapists) and never the voices of depressed people themselves. We do not hear what depression feels like, what it means to receive an "Official" diagnosis, or what depressed individuals think of therapeutic experts. Nor do we learn the meanings that patients attach to psychotropic medications, whether they accept illness metaphors in assessing their condition, how they establish coping mechanisms, how they understand depression to affect their intimate relationships, or how depression influences their occupational strategies and career aspirations.

"The absurdity of this omission was dramatically called to my attention when I came across a periodical called The Journal of Affective Disorders that has been in been in the Boston College library since 1987. In all twelve volumes available there is not one word spoken by a person who lives with depression. Someone once described social statistics as human beings with the tears washed away. Nowhere is such a characterization more apt than in trying to grasp what depression is all about. There is something dehumanizing and distorting about social "scientists" reducing an extraordinarily difficult human experience to indices, causal models, and statistical correlations. Certainly such research has its place, but an empathetic understanding of depression can only be accomplished by bringing human beings back into the picture. Research about a feeling disorder that does not get at people's feeling seems, to put in kindly, incomplete." …

"Some readers will feel let down by this book because I am simply not interested in providing The Theory that finally explains the cause(s) of depression and a sure-fire way to get rid of it. This book is not focused on causes and cures. As already indicated, I feel that the scores of books on emotional dilemmas found in the self-help sections of bookstores do a disservice by offering ridiculously simple injunctions for solving enormously complex problems. I doubt that there will be a solution to the enigma of depression; that we will ever flatly sort out the interplay of nature and nurture that makes people desperately unhappy. In this book, centered as it is on the consciousnesses of those interviewed, cause and cure enter into the analysis only in so far as they have theories about this."

Many thanks to Dr. Bruce Lambert for recommending this book.

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