The Valorization of Sadness Alienation and the Melancholic Temperament Author(s): Peter D.

Kramer Source: The Hastings Center Report, Vol. 30, No. 2 (Mar. - Apr., 2000), pp. 13-18 Published by: The Hastings Center Stable URL: http://www.jstor.org/stable/3528307 . Accessed: 24/10/2011 22:11
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The

of Sadness Valorization
and
KRAMER

Alienation
by PETER D.

the

Melancholic Temperament

In the Western aesthetic of melancholy, alienation and authenticity walk hand in hand, and therapies that change affective states-especially drugs like Prozac-are philosophically suspect. This is not a necessary state of affairs. What would be the central philosophicalquestions in a culturewhose aesthetic values rose from the well-springsof optimism?

t the heart of Listeningto Prozacis a thought experiment:Imagine that we have to hand a medication that can move a person from a normal psychologicalstate to another normal psychologicalstate What are that is more desiredor bettersociallyrewarded.1 the moral consequencesof that potential, the one I called "cosmeticpsychopharmacology"? The question would be overgeneralexcept that it occurs in the context of a discussionof psychicconsequences of technologies.Peoplenow experiencethe self in the light of psychotherapeuticmedications as lately they experienced it through psychoanalysis.In the thought experiment, the medication we are to imagine is rather like Prozac,and the less desiredstate is something like melancholy, when that term refersto a personalitystyle rather than an illness. Melancholicsare well describedin literature that stretchesback for centuries.They arepessimistic, self-doubting, moralistic, and obsessive. They have low They are creative energybut use that energyproductively. in the arts.They are prone to depression,especiallyin response to social disappointments. Listeningto Prozacarguesthat the importantaction of new medications may be on the melancholic temperament as much as on depression,althoughthe two arepresumed to be related.The book's assessmentof cosmetic psychopharmacology begins with the observationthat for decades, psychotherapyhas been the technology applied to melancholy. In this account, psychotherapyincludes
"TheValorization Sadness: of Alienationand the MelanPeterD. Kramer, cholicTemperament," Center 30, Hastings Report no. 2 (2000): 13-18.
March-April 2000

approaches,such as supportive or strategictherapies,in which self-understanding is not the means or end of cure-where the goal is change in affectivestate merely. makes us so Asking why cosmetic psychopharmacology I did not neglect to consider the targetsof treatuneasy, ment-in particular, claims that sufferingis an indicator of the human condition; that psychicpain servesan adaptive function; and that melancholy is an element of authentic self. But since the premiseof "cosmesis" moveis ment from normal to normal, the post-treatmentstate as much as the pretreatment should meet the criteriaof Darwinian fitness and human completeness.And those who hope psychotherapysucceeds must be comfortablewith the diminution of melancholy.For these reasons,I came to believe that a criticalelement in a principledobjection to cosmetic psychopharmacology must involve the method of change, namely, medication, more than the goals of intervention. To my delight, moral philosophershave taken up this the thought experiment,particularly medicalethicist Carl Elliott, in a seriesof essaysdistinguishedby their literary to appeal.These discussionsarea continuationof Listening because Prozac,but they are also a form of backtracking, the element that interestsElliott is cosmesis's goal. Elliott is worriedabout the diminution of alienation. I hope here to use Elliott'sessaysto ask, as rule-keeper for a certainsort of game, whether the concept of alienation successfullyidentifies grounds on which cosmetic psychopharmacologymight be morally suspect. At the same time, I will want to reopenthe issueof the legitimate goals of treatment.To preview my conclusion-my imHASTINGS CENTER REPORT 13

pression is that the concern over Prozac, and with imagined medications extrapolated from experience with Prozac,turns almost entirelyon an aestheticvaluationof melancholy.

worry.Their alienation is of a single sort, the sort that is an element of the melancholicpersonality. When I say that the premise "medication diminishes alienation" casts its shadow on questionsof cate* * * gory, I mean that our likely beliefs about category are susceptible to E lliott's central claim is that ad- being altered by our beliefs about dressing alienation as a psychi- how that diminution occurs. We do atric issue is like treating holy com- not expect medication to work dimunion as a dietaryissue-a catego- rectlyon the cognitive component of ry mistake. Included in this claim is alienation,just as we do not imagine the understanding that alienationhas there is a pill for, say, atheism or a particularmoral worth. Neither of chauvinism-that sort of imagining strikesme as obvious. would violate the rule that the drug these assertions In particular, want to say that both we have in mind is a good deal like I are thrown into doubt by a premise Prozac. Presumably,our hypothetic of our discussion, namely that med- medication tones down obsessionaliication can lessen alienation.The na- ty, pessimism, and social anxiety, so ture of the technology may cause us that, secondarily,a person feels less to reassessthe category,and the sig- impelled to resist the ambient culture. It altersaffectiveaspectsof pernificance,of the target. To begin with the question of cat- sonality,where affect extends to such egory: Clearly some alienation is an phenomenaas sense of statusin social aspectof mental illness, indeed alien- groups. ation is an element in schizophrenia. That is to say, our premise brings It is not absurdto imagine that alien- into play the basis of personality.If ation might be "psychiatric." Often we were certain,as many mid-centuElliott equatesalienationwith depres- ry psychoanalysts were, that personalWalker ity is the detailedpsychicencoding of sion, as when he paraphrases a person's experience in the world, Percy to this effect: "Take a look around you; it would take a moron relativelyfixed but responsiveto inThe not to be depressed."2 arguments sight, then the parametersfor a disElliott makes regarding depression cussion of the pharmacologic enand alienation, as worrisome targets hancement of alienation would be for pharmacology,are identical. It is clearer.Equally,if we were to discovnot alwaysclearwhether the depres- er that even minor depressionis in all sion referredto is a stance or a syn- instances caused by a virus that dedrome. forms brain anatomy, the discussion As regards category, then, the would be stableat a differentpoint of question is, alienation of what sort? equilibrium.The rangeof philosophElliott recognizes that alienation ical arguments might remain simicomes in many forms, and he de- lar-one can approach character scribes personal, cultural, and exis- armoras a medicalcondition and one tential alienation.But from a psychi- can define living with microbesas an atric point of view, the people Elliott expectablestate of human life-but suggestsas candidatesfor antidepres- in each instance we would be more ones. sant use are homogeneous. They are inclined to entertainparticular To clarify the interplay of target not primarily mistrustful, in a way that might make us think of a para- and technology:Setting aside Prozac, noid alienation;nor are they socially let us imagine that it is discovered unawareand distancedfrom their fel- that moderatedoses of vitamin C delows in way that might suggest an crease a person's sense of isolation. autistic alienation. Elliott's subjects Would the taking of vitamins seem aresad, obsessive,and questing.They worrisome?The answer depends on

how we "listen"to the medication. We might decide that alienation of that sort was in all probabilitysomething like a vitamin deficiency.We might even decide in retrospectthat our objection to cosmesishad resulted from an aesthetic assessment of the technology employed to achieve it. That is, previously(when it was a matter of using Prozac, rather than vitamins, to the same end) we had objected becausethe technology was artificial,scientificallycomplex, and manufactured and advertised by a large corporation-partaking of the very qualitieswe believeought to lead to alienation,on, say,a politicalbasis. Once vitamin C's effect was discovered, we might come to believe that Prozac had, after all, been repairing medical damage to the self. Starting with the premisethat medicationcan mitigate alienation, it is not hard to imagine evidence in light of which alienation would be most parsimoniously understoodas at least in part a psychiatric issue. I should add that as a clinician, I find the argument by category mistake suspectbecausegenerallycategory mistakesare in the opposite direction from the one that perturbsElliott. Mental illness has too often been too narrowlyunderstood-misunderstood-as a principledresponse to social conditions; this erroris one R. D. Laing made with regard to schizophreniawhen he claimed that psychosisis a responseto the absurd of pressures bourgeoisfamilylife. My own belief is that the conundrum is necessarily playedout at a historical moment, ours, when the categorization of alienation remains ambiguous.

ation is circumstantiallyappropriate and morallyvaluable.Regarding personal and cultural alienation-the mismatchbetweenparticularself and the particulars the soof cial surround-Elliott writesthat you might feel ill at ease among Milwau2000 March-April

Elliott goes on to arguethat alien-

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kee Rotarians.Elliott would disfavor your being offered Prozacin this instance because "Some external circumstancescall for alienation." Now I hope it is the case that no one is dispensingmedicationas an alternativeto dropping membershipin the Milwaukee Rotary.But if Elliott is at some distance from the clinical moment here, he is nonetheless successful in depicting one sort of unease, that of the sensitivepersonstuck in a group of philistines. Walker Percy, in a passage cited by Elliott, works the same vein as regardsdepression: "Consider the only adults who are never depressed: chuckleheads, Californiasurfers,and fundamentalistChristianswho believethey have had a personal encounter with Jesus and are saved once and for all. Would you trade your depressionto become any one of these?"3 These examplesareamusing,but I fear that because they are all of a type, they prejudicethe jury. Elliott's and Percy's comments succeed, on first reading, not because we value everyinstanceof alienation-any sort of fish out of any sort of water-but because of a cultural preferencefor the melancholic over the sanguine. Considerthe alienationor depression of a hockey player(a potential future Rotarian) rooming with poets; we may not want him to resist integration. Or consider the sort of movie, common in recent years, where a man is thrown into the straight-laced of a wild woman and her company friends;the audience's hope is that he will overcome ratherthan sustain his alienation from the kooky subculture. In Listeningto Prozac,I addressed a similar issue-alienation from what?-in regardto mourning rituals. Those who consider the American grieving period too brief and therefore alienating to the sensitive have pointed with admiration to rural Greece, where widows mourn predeceasinghusbandsfor five years. But enforced mourning is restrictive for resilient widows; they are the alienated in a traditionalculture. If
2000 March-April

alienation means a sense of incompatibilitywith the environment,then will people of differingtemperaments be alienatedin differentsettings. Do we honor both the sensitive and the Is resilient? it permissiblefor resilient Greek women to move to a society with shorter grieving periods?More to the point, if the sensitivemove to ruralGreece,will the consequentloss of alienationrob them of an aspectof their humanity?This sort of example might convince us that it is not personal or cultural alienation that we value, but the melancholic temperament or aspectsof it, such as loyalty and sensitivity-and that we honor a suffererin any setting, even one from which she is not personallyor culturally alienated. Effectively, Elliott conflates personal and culturalalienation.The notion of culturalalienationis invisibly buttressedby what I might call the Woody Allen effect.The prominently

onel Trillingand EdmundWilson debatedthe point-they areless appealing than the wounded Dionysian vaThe clusterof personalitytraits riety.4 arising from the melancholic temperament (pessimism,perfectionism, sensitivity,and the rest) overlapsso stronglywith our image of the intellectual that we may have difficulty creditingthinkerswho are differently constituted.The pervasiveness this of valuation came home to me in the course of my writing an essay about the psychologistCarl Rogers;Rogers met all the criteriafor intellectuality save one, pessimism, and on that grounds was dismissed as a lightweight.5 Thus concern over personal or culturalalienationcomes to seem the valuation of one sort of normal person (the melancholic) over another (the sanguine). And just how far would a moralistgo in this preference for alienation?Are those 25 percent

The nature of the technology the category,

may cause

us to reassess of the target.

and the significance,

neurotic today are often political libhas erals,and this correlation more or less held since the Romanticera. Soft left, hard right. But even if this conjunction is real and has an explanation (andwhat sort of explanationdo we have in mind?), it is hardly universal. A sanguine person may be alarmedby apartheid, as a melanjust cholic might attributehis disaffection to the ending of apartheid.If Prozac inducesconformity,it is to an idealof but can assertiveness; assertiveness be in the serviceof social reformof the sort ordinarily understood as nonconformityor rebellion.The political effects of medicating the disaffected will be various. Politics aside, we may find we have an aestheticpreferencefor neurosis. The melancholic temperament is the artistic temperament.Even if hearty Apollonian artists exist-Li-

of humans who lack the purported "Woody Allen gene" morally defective?If so, we might logicallyfavora medicationthat makesthem more ill at ease. It seems less a matterof mistrusting pharmacologythan of valuing melancholy.
* * *

I lliott'sthird categoryis existential the alienation-"questioning very terms on which a life is built," an unease such as one might suffer even on a desertisland, or, as Robert Coles might put it, under any moon. Here we seem to be getting to the heart of the matter, alienation that has nothing to do with distancefrom a particular social surround. We could perhaps obviate this considerationby arguingthat if existential alienation is neither personal
HASTINGS CENTER REPORT 15

Elliott resiststhis sort of reframing nor cultural, it should be part of being human, for all people in all when he assertsthat "thereis no diftimes. If normallife is a project,then ference between the commuter who change qualifies as cosmetic only feels bad without knowing why and when life remainsa project.Even for the same commuterreadinga copy of But to "goodresponders" medication,ex- DSM-IV."6 that is becauseElliott istence remains hedged round by mistrusts the manual. Finding his death, chance, unfairness,and absur- condition delineatedthere, the commuter might decide he had formerly dity. But empirically, we know that made a category mistake, just as, angstgrabsdifferentpeople different- finding himself in a Walker Percy ly. Some people are more constantly novel, a diagnosed depressivemight awareof the universalexistential condition. But what is it to be aware in this ':1. sense? Even existential alienation might be inter- . :i; twined with temperament. Elliott leans toward that *-1`: recognition when he 'L;" -T" writes, "Alienationof any type might go together with depression,of course, ' but I suspect that the two -.. don'tnecessarily hand in go hand."But that is the question at issue:to what extent is affect, such as anxiety or depression, constitutive of existential alienation? To j put the matter differenty: If, medicated, one retains an intellectual unease but with diminishedemotional discomfort, does being in that state constitute existential alienation? Imagine one of Walker Percy'sfamously alienated t characters, a commuter. AlbrechtDurer, Melancolia,1514 say

He might feel bad for two

Fund ia Museumof Art:The LisaNorrisElkins Philadelph

reasons,because life is imperfectand becausehe is predisposed to feel worse than others do in response to that imperfection.If he experiences relief via medication, he which was might come to understand which, his dysthymia versus the alienationcommon to all humans.As a diagnostician,medication is imperfect, but neitheris it simply dismissible. On a quest for authenticity,we must be open to discoveriesof this sort-that what seemed carefullydebiologically veloped self was arbitrary, based idiosyncrasy.
16 HASTINGS CENTER REPORT

draw a concusion in the reversedirection. I once treated a dysthymic had patientwhose formerpsychiatrist commanded her to "Put away your Sylvia Plath!" Whether poetry or medication (or manual-reading)is a better means to self-discoveryis in part an empiricalquestion; a combination might proveoptimal. Another thought experiment: Imaginewe have defined possibleelements of existential alienation: spleen, anomie, angst, accedia,vertigo, malaise, emptiness, and the like.

Now we give a medicationfor depression and find that some factorsdisappear and others remain,so that a hypotheticalsubjectis no longer vertiginous but remainsanomic.Would we have defined "core"alienation?Dissected the existential?Well, perhaps connection to not. Not if alienation's minor depression is especially intimate. The problem of melancholic temperamentcannot be made to disappear,not even by our framing the conundrum in terms of respect for existential alienation. Elliott'sworry is precisely that if a medicationreli5:, places pessimism with optimism, anxietywith assertiveness, diffidencewith gregariousness, it will have robbed us of a tendencyto remainat a critical distance from our own existence.The affective stance is what is of value, worryingthe same old bone, as Percy puts it; not mere awareness of distance but anxietyover it. I have come to believe that much of the discussion of cosmetic psychopharmacology is not about pharmacology at all-that is to say, not about the technology. Rather, "cosmetic pharmacology"is a stand-infor worries over threats to melancholy. That psychotherapy caused less worry may speak to our lack of confidence in its efficacy. We do, as a culture,value melancholy.Some months ago, I attended an exhibition of the paintings of "the young Picasso." Seeing the early canvases,I thought, "Here is a marvelous technician." I turned a corner to confront the works of the Blue Period,Picasso's responseto the suicide of his friend Carlos Casagemas. InstantlyI thought (as I believe the curator intended): "How profound." That pairing-melancholic/deep-is a centraltrope of the culture. Or to allude to another recent museum exhibition, for years
2000 March-April

the rap on Pierre Bonnard was that his paintings were too cheerfulto be important.Here is the corresponding trope:happy/superficial. Surelythe central tenet of literary "I criticismis Kafka's: think we ought to read only the kind of books that wound and stab us. ... [W]e need the books that affectus like a disaster, that grieveus deeply,like the death of someone we loved more than ourselves,like being banishedinto forests far from every one, like a suicide."7 This need may even be pragmatic.In his poetry (I am thinking of "Terence, this is stupid stuff"), A. E. Housman argues that painful literature immunizesus againstthe pain of life'sdisappointments. And here I want to lay down two linked challengesthat areintentionalThe first is to say that ly provocative. the literary aesthetic makes most sense in relation to a particulartemperament(the melancholic,in which one feels great pain in response to culture(one lackloss) in a particular technologiesto preventor dimining ish that pain). What if Mithradates had an antidote, so that he did not require prophylactic arsenic and strychnine? Might poetry appropriate era to the antidepressant be more like And might that new beer-drinking? art still prove authenticto the way of the world? The second challenge is yet more provocative,call it intentionally hyperbolic:to say that there is no neutral venue for this debate over alienation or cosmesis because our sensibility has been largely formed by melancholics.Much of philosophy is written, and much art has been created, by melancholics or the outright depressed,as a responseto their substantial vulnerabilities. To put the matteronly slightlyless provocatively (and to returnto the first challenge), much of philosophyis directedat depression as a threateningelement of the human condition. As MarthaNussbaum'sThe Therapy of Desire demonstrates in detail, classicalmoral philosophy is a means for coping with extremes of affect
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that follow upon loss.8 The ancient Greeks' recommendations for the good life, in the writingsof the Cynics and Stoics and Epicureans and Aristotelians, amount to ways to buffer the vicissitudesof attachment. If loss were less painful, the good life not might be characterized by ataraxia but by gusto. The connection between philosophy and melancholy continues in the medievalwritingson akadie and then in the Enlightenment, through Montaigne, and throughPascalwho writes "Manis so unhappy that he would be bored even if he had no cause for boredom, by the very nature of his temperament."9 In a study of Kierkegaard, Harvie Ferguson writes, "Modern in philosophy,particularly Descartes, Kant, and Hegel, presupposed as a permanentcondition the melancholy

between melancholy and sanguinity, then we will need to worryabout the association between creativity and mood. What if there is a consistent bias in the intellectualassessmentof the good life or the wise perspective on life, an inherent bias againstsanguinity hidden (and apparent)in philosophy and art? An argumentof this sort is worrisome-more worrisomethan the conundrum we began with. And yet can we in good faith ignore the question of who sets the values?I have been in effect proposingstill another thought experiment:Imaginea medication that diminishes the extremes of emotionalresponseto loss, imparting the resiliencealreadyenjoyed by those with an even, sunny disposition. What would be the central philosophical questions in a culture

The concern melancholic

over alienation

is the valuation It seems

of the

over the sanguine. of mistrusting

less a matter than of

pharmacology

valuing melancholy.

of modern life."?1Even those like who chide melancholics Kierkegaard do so from such a decided melancholic position that their writing reinforces the notion that melancholy who is profundity.It is Kierkegaard inspires Walker Percy, Kierkegaard whose body of work implies that to melancholy is appropriate modernity. As for literature,studies indicate that an astonishing percentage,perof haps a vast majority, seriouswriters are depressives. Researchers have speculatedon the cause of that connection-does depressionput one in touch with importantissues,of deterioration and loss? But no one has asked what it means for us as a culture or even as a species that our unacknowledgedlegislatorssuffer from mood disorders,or something like. If there is no inherentmoral distinction

where the use of this medication is widespread? Aesthetic values do change in the light of changingviews of health and illness. Elsewhere,I have asked why we are no longer charmedby suicidal melancholics-Goethe's Werther or Chateaubriand'sRene or Chekov's Ivanov.Becausewe see majordepresdrivenpersonality sion and affectively disorders as medically pathologic, what once exemplified authenticity now looks like immaturity or illness-as if the romanticwritershad made a categoryerror. A final thought experiment: Imagine that the association between melancholy and literary talent is based on a random commonality of cause:the genes for both cluster,say, side by side on a chromosome.And let us further imagine a culture in which melancholy,now clearlysepaHASTINGS CENTER REPORT 17

rate from creativity,is treated pharmacologicallyon a routine basis. In this culture, it is the melancholics manques who write, melancholics rendered sanguine-so that the received notions of beauty and intimacy and nobility of characterrelateto bravado, decisiveness, and connections to social groups, not in the mannerof false cheerleading,but authentically, from the creative wellspringsof the optimistic. What would be the notion of authenticity under such conditions? Perhaps in such a culture "strong evaluation" would find psychic resilience superior to alienation. Even today, many a melancholic looks at Panurgeor Tom Jones with admiration-how marvelous to face the world with appetite!The notion of a sanguineculturehorrifiesthose of us resonantwith an aestheticsof melancholy, but morally,is such a culture inferior,assuming its art corresponds Is to the psychic reality? there a prinbasisfor linking melancholyto cipled authenticity?Is there a moral hierarchy of temperaments?
* * *

an haveoffered extreme version of

an argument that might be more palatable in subtler form. I hope I have been convincing, or at least troubling,in one regard,the assertion that there is no privileged place to stand, no way to get outside the

problem of authenticity as regards temperament. Elliott askswhetherwe do not lose sight of something essential about ourselveswhen we see alienationand guilt as symptomsto be treatedrather than as clues to our condition as human beings. The answeris in part empirical,in part contingent (on the socialconditionsof human life, a culture's technological resources, and such), and altogetheraesthetic.If extremes of alienation are shown to arisefrom neuropathology, and if asof that pathology respond to pects treatment,our notion of the essential will change.And it may be that what remains of the experience and the concept of alienationwill be yet more admirable-alienation morally of compulsion, alienation stripped independent of genetic happenstance,alienationthat arisesfrom free choice. I want to end by saying that, like Percyand Elliott, in my privateaesthetic, I value depressionand alienation, see them as posturesthat have salience for the culture and inherent beauty.But the role of philosophy is to question preferences. The case for and againstalienationseems to me at this moment wide open. It has become easy, in the light of the debate over Prozac,to imagine materialcircumstancesthat might causeus to reassesswhich aspectsof alienationfall into which category. The challengeof Prozac is precisely that it puts in question our tastesand values.

References
1. P.D. Kramer, to (New Listening Prozac York: VikingPress,1993). 2. C. Elliott, "The Tyrannyof Happiness: Ethics and Cosmetic Psychophamain HumanTraits: Ethical cology," Enhancing and Social Implications,ed. E. Parens D.C.: Georgetown Universi(Washington, ty Press,1998), pp. 177-88, at 183. 3. W Percy,Lost in the Cosmos(New York:WashingtonSquarePress, 1983), p. and the 79, quoted in C. Elliott, "Prozac Existential Novel: Two Therapies," The in LastPhysician: Walker and the Moral Percy ed. LifeofMedicine, C. ElliottandJ. Lantos (Durham, N.C.: Duke University Press, 1999), p. 65. 4. E. Wilson, "Philocheles: Wound The and the Bow,"in E. Wilson, The Wound and the Bow: Seven Studiesin Literature Mass.:Riverside Press,1941), (Cambridge, The pp. 272-95; L.Trilling, Liberal Imagination:Essays Literature Society on and (New York: Viking, 1950), pp. 160-80. Introduction On Beto 5. P. D. Kramer, cominga Person,by C. Rogers (Boston: HoughtonMifflin, 1995). 6. See ref.2, Elliott,"Tyranny Happiof ness,"p. 183. 7. E Kafka,letter to OskarPolluck,27 1904. January 8. M. Nussbaum,The Therapy Desire: of Theoryand Practicein HellenisticEthics (Princeton: Princeton University Press, 1994). 9. B. Pascal, quoted in H. Ferguson, and Melancholy the Critiqueof Modernity: Soren Kierkegaard's Religious Psychology (London:Routledge,1995), p. 25. 10. See ref.7, Ferguson, and Melancholy the Critique Modernity, 32. of p. 11. See ref. 1, Kramer,Listening to Prozac,p. 297, and P D. Kramer, "Stage View:What Ivanov NeedsIs anAntidepres21 sant,"New York Times, December1997.

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