That moment 17 years ago was a turning point for Karp, who a few years earlier had been diagnosed with clinical depression. Determined to come to grips with his condition, Karp became a self-described "mental health explorer," looking into various kinds of therapies while sorting through the available research on clinical depression. But over this time, he found that little of what he read presented insights from those coping with depression.
Karp's recent book, Speaking of Sadness: Depression, Disconnection and the Meanings of Illness, combines many of his concerns and interests regarding depression. Besides relating his own story, he draws upon his interviews with 50 people about their experiences with depression and its place in their lives. But Karp also offers his perspective as a sociologist in discussing what he says has been a problem inappropriately defined as exclusively psychological or biological.
"To understand depression, you have to look not only at the chemistry of the person, but at the chemistry of his or her culture," he said. "We live in an age and a culture where the medical version of reality is tremendously powerful. I am not trying to attack psychiatry or medicine, but defining depression in purely biological terms deflects attention away from the role of society. The fact is, this is a society which is disconnecting people, at work and at home, and I don't see how we can ignore this in examining depression."
Some 11 million Americans are said to be suffering from some form of depression and the economic losses - ranging from lost work days to health costs - amount to $43.7 billion a year. The growing body of writing on depression, and an increase in public awareness, indicate "an incredible hunger" for materials that describe depression, Karp said. But, "for all the studies, we have not heard what depression feels like."
As a sociologist, Karp examines America's perceptions of what constitutes health, illness and disease, and the overwhelming tendency in American medicine to focus on biological dysfunctions as the root of a patient's problem.
Karp goes on to discuss the "disconnection" in both home and work environments, and its relationship to depression. The trend toward "downsizing" or "reengineering," for instance, has proved as devastating for middle to upper-middle class workers as dim employment prospects have for persons with low incomes. The erosion of traditional family bonds and Americans' general ambivalence toward social attachments, meanwhile, also contribute to stress, he said.
Part of what makes depression so difficult to deal with is its ambiguity, Karp says. Everyone feels "depressed" periodically, but statistics indicate that only about one in four clinically depressed people are diagnosed.
"The ability to say 'I am a depressed person' is often the product of a long journey aimed at discovering the kind of self one is," Karp said. "Acquiring this identity has some critical implications for how individuals respond to their pain. Accepting a biomedical definition of depression's cause is, for example, a two-sided coin: There's a sort of relief because you are absolved from the struggle, the responsibility to act or appear normal; but it also makes you into a victim who can do little on your own to 'get better.'"
Publishing Speaking of Sadness is not an act of catharsis, Karp says, nor does he feel courageous for discussing in print his own depression - unlike many others, he said, it has never seriously threatened his life or career. Neither should the book be construed as a guide to overcome depression.
"In a way, I wish I could have written something more optimistic," Karp said. Depression, he added, is not as easily "cured" as some recent media stories claim. "But people do find ways to live with depression, through exercise, meditation, medication and spiritual means. Self-help groups are also very useful - to be with people who speak the same language as you and have successfully incorporated depression into their lives is often reassuring."
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