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I started reading Gary Greenberg’s Manufacturing Depression with a good deal of interest. The first few chapters certainly intrigued me (as noted here). Greenberg laid out his idea that depression is an “invented” disease and that the medical diagnosis of depression rewrites the narrative of human suffering as a medical problem rather than an existential problem. He proposed to explore the history of the “invention” of depression throughout the rest of the book.

And he did. He wrote of the history of the “disease” called depression. He wrote of the creation of the nomenclature for depression. He wrote of how depression is not identified based on empirical evidence of pathology but upon a collection of symptoms somewhat arbitrarily assigned based on the effects of psychoactive drugs. He wrote of how drug companies marketed depression to consumers at the same time as they marketed their drugs to “fix” it.

Greenberg uses this information to mount a case against the modern medical model of depression. His main argument against the model is that it doesn’t have as much scientific support as it has been advertised to have. However, Greenberg offers no evidence that proves (or even suggests) that the medical model to be incorrect. His sole argument is that the model is “not as proven as some might claim”.

The history of the medical model of depression is fascinating–but I had a hard time with Greenberg’s obvious bias against the medical model, because I felt like he had no viable alternative model to offer.

Greenberg is a therapist. He uses the medical nomenclature of the DSM to get paid. The fact that he has clients visiting him implies that something is wrong with their lives–something they need help with. But if this is not a medical problem, what is it? It’s not a coping problem, says Greenberg–he disapproves of cognitive therapy that teaches coping skills.

So what is it? How is human suffering, particularly the chronic kind that seems unresponsive to changed circumstances, to be understood? What causes it? What can be done to change it?

Greenberg offers no solutions. Sure, he puts in a plug for his own free-form Freudian version of therapy–but he correctly notes that his own version of therapy really has no theoretical, philosophical, OR empirical underpinnings. He simply asks what he feels like asking, explores what he feels like exploring, goes with his gut in therapy. Ultimately, he offers no alternative narrative to the medical one.

While Greenberg rightly points out misuse of the scientific method in the development and marketing of both depression and its cures, he appears to conclude that this invalidates any scientific inquiry into suffering. I object.

Perhaps this is simply the difference between my ideology and his. I am trained in a science, in a field where scientific inquiry is admired, where we want to make sure that any theories we form are scientifically validated. I am a health-care provider who thinks highly of evidence-based medicine.

I’m also in a field that has a thousand self-proclaimed experts with a thousand different theories and recommendations, few of which are supported by ANY science, much less the preponderance of evidence.

So I tend to have a low view of pseudo-medical professions that base their practice off of ideology rather than testable, provable facts.

Basically, I felt like Greenberg’s main reason for writing this book was to discredit depression since his own brand of Freudian talk therapy has fallen out of vogue. Much of what Greenberg said may have been true–but I doubt his motives in sharing, especially because he offers no evidence to support his own version of depression and its treatment (in fact, he derides the very idea of evidence-based practice.)

I found Manufacturing Depression to be interesting, but ultimately unsatisfying.

Greenberg ends his exploration of depression with a word of advice to readers. He urges them to write their own narrative about suffering–not to let the medical “experts” write their story for them. But what he fails to do is offer any better alternative narrative. Even if the medical model of depression is full of flaws (and I have no doubt that it is), it’s still the best explanation so far.

I’m a scientist–and I’m not going to throw out an explanatory theory unless I have good evidence against it or a better theory to replace it with. Greenberg offers neither.

Rating: 2 stars
Category: Medical History, Depression
Synopsis: Greenberg tells the history of depression as a modern disease.
Recommendation: Interesting but unsatisfying, as Greenberg attempts to discredit a model without offering any better alternative.

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