Depression is a Choice: Winning the Battle Without Drugs
by A. B. Curtiss
Hyperion, New York. 2001.
Reviewed by Christopher Dowrick, Professor of Primary Medical Care, University of Liverpool, Liverpool L69 3GB, United Kingdom.

Curtiss is a family therapist and cognitive behavioural therapist. She also has long personal experience of the condition now known by psychiatrists as bipolar affective disorder - formerly called manic-depression - in which periods of intense despair and misery are interspersed with episodes of highly charged energy and excitement. This book is a detailed, honest and at times alarming account of her ongoing struggle with depression, which makes good use of historical, philosophical, professional and some very personal perspectives.

The book’s central message concerns the importance of what Curtiss calls ‘Directed Thinking’. She has found that it is not necessary to become a victim of depressed mood. She argues that although we cannot get rid of it directly, we do have some element of choice in the matter. It is possible for us to think our way out of the depths of despair.

She explains the technique of ‘conscious neutral thinking’, whereby we can learn to use simple repetitive thoughts - such as nursery rhymes - to counter and replace depressive thinking that can so easily hampers and cripple us. She also explains some of the cognitive-behavioural techniques used to challenge negative thinking, which are aimed to help us to see ourselves as not as failures but as ‘works in progress’. In place of the complex biochemical formulae developed by pharmaceutical companies to derive antidepressant medication such as Prozac, she presents us with her own much simpler formula for the cure of depression:

D + (cnt)c = e

Depression + conscious neutral thinking x concentration = equanimity

Curtiss describes valuable role models from history and from literature. At the age of twenty-two Benjamin Franklin decided to embark on a regimen of acquiring what he considered to be the thirteen important virtues (including temperance, resolution, chastity and humility) and kept a diary to record his progress. She finds him a helpful example of how it is possible deliberately and explicitly to work on our health and well-being. Greater than this is the importance of locating ourselves in our life, our roles and responsibilities, and not seeing our immediate feelings as the arbiters of our fate. Ishmael, in Melville’s Moby Dick, said that ‘in all cases man must eventually lower, or at least shift, his conceit of attainable felicity; not placing it anywhere in the intellect or the fancy; but in the wife, the heart, the bed, the table, the saddle, the fire-side, the country’.

She has devised a morning meditation to use if she wakes and finds herself depressed. This includes singing children’s songs and nursery rhymes, fast counting, laughing silently (or out loud if there is nobody else around), praying for three other people, and remembering that life can have meaning without the necessity of happiness. ‘If you can’t do it for yourself, do it for the others’.

Curtiss is strongly anti-medication, particularly antidepressants such as Prozac, which she sees as taking away our responsibility and our ability to work things out for ourselves. While I agree with her concerns about the medicalisation of misery, and the relentless drive for profit maximisation of major pharmaceutical companies, I think her position here is unnecessarily antagonistic. In my experience as a general practitioner - and as the father of a child who has experienced bipolar affective disorder - I have found that medication can be a very useful support to the approaches and techniques that she is advocating in this book. I do not think that we need to make an either-or choice, but can do best with a judicious use of all relevant approaches.