(c) 2003 Toomas Karmo and Stephen Roney. Draft of essay for possible publication in a multi-author volume. For permission to circulate this piece more widely, and for more precise particulars on copyright, please ask either the author (Toomas Karmo) or the volume coordinator (Stephen Roney: sroney@shaw.ca). Revision history: 20030221T010053Z/version_0001.1000 (minor improvements in language); 20030220T193158Z/version_0001.0000 (base version).

Depression, the Body Politic,
and Frankelian Freedom-to-Appraise

My complaint: chronic dysthymia, complicated by major depressive episodes in 1977, 1990, and 1999, and further complicated by Obsessive-Compulsive Personality Disorder (OCPD, not to be confused with the better-known OCD). To this straightforward inventory the misguided "Doctor Prozac", to whom I return below, added a more questionable diagnosis, alleging Asperger's syndrome, a currently much-discussed empathy disorder akin to autism.

More revealing, however, than diagnostic vocabulary is the richer conceptual framework of politics. I was born in 1953, in small-town Nova Scotia, nine years after the fighting had officially stopped in Estonia. In that year the last armed resistance, on the part of the "metsavennad", or "Forest Brothers", was itself winding down. Mine was a childhood of ill-defined fear. Only later, when I was about twenty, was it safe for me to be told that I had a half-sister still in Estonia. (She, having survived the various difficulties, is in today's free Estonian republic a clinician of some eminence, practicing and publishing in a field far removed from psychiatry.)

The Estonian exile diaspora from the mid-1940s to the late 1980s provided a universal frame of reference, applicable wherever Estonian was read and spoken outside police control. All was homogeneous and predictable, whether the local Estonian House happened at that moment to be open for weekend lunch on the Sydney or on the Vancouver side of the Pacific, whether the Estonian Evangelical Lutheran Church happened at that moment to be worshipping in Toronto pews or in a Nova Scotia living room. I remember a courtesy visit to the decaying Legation at Queen's Gate in Kensington, London. Legation representative Mrs Taru and I took our simple cup of coffee amid opulent, disintegrating upholstery worthy of Miss Havisham in Great Expectations. Dear, kindly, dutiful old Mrs Taru! I think she had joined the Legation support staff a few years before the London Blitz. She was at the time of our meeting, in the latter half of the 1980s, perhaps the one soul among the few with keys to that vast, deserted mansion who could claim some link to Estonia's 1939 Foreign Ministry. Someone at the United Kingdom Foreign and Commonwealth Office allegedly complained in the 1980s about the remarkable difficulty of dealing with a state that had ceased to exist half a century ago. And yet it was not difficult for us, its citizens: the eeriest part of my quiet chat with Mrs Taru was the realization that the objectively spooky milieu was to the two of us not spooky at all.

It is not the clinical-diagnostic system alone, but this political world (so brilliantly captured in the Cold War novels of John le Carré) that renders half-meaningful my chequered experiences in medicine.

I recall one of my innumerable psychiatrists, a Melbourne-exiled Czech, commenting on my question whether he could by the therapies we were envisaging (they ultimately proved to be invasive, to be in the most crude and revolting sense gymnastic) reverse my homosexual orientation: "Ziss is a very krew-ell kvess-chon. Do not be krew-ell in ziss vey, pleez." Is there not a continuity here with the world of public life - in which our leaders operate, often in desperate, if in misguided, good will, not so much with lies as with evasions?

I recall Doctor Prozac in Toronto, commenting on my worries, as one of Estonia's little band of Catholic converts, about sexual obsession: "Stop masturbating and I'll write a book about you." Is there not here, again, a continuity, this time perhaps comic, with public life, specifically with the willful failure of bourgeois North America to engage effectively with the deeper issues of the day?

Above all, perhaps, I recall, with gratitude, the reaction of the Toronto constabulary - they had applied handcuffs, if I remember accurately, and were transferring me to the waiting ambulance - only a couple of years ago, but nevertheless in the shadow of the Cold War, as I shouted to all bystanders my cheap exit line, "Psychiatry is an instrument of state control." (I had had a panic or rage attack at a meeting of an Estonian community group trying to address some book-publishing issues, notably a complex of issues swirling around a 1941-42 Estonian Nazi concentration-camp officer, deported from the United States in the late 1980s, and dead soon thereafter in Leningrad detention.) When we were on our way to Emergency, the officers assented - "Sure, buddy: psychiatry is an instrument of state control." We had, from that instant onward, a pleasant ride, amicably discoursing, as a group of well-informed subject specialists may, on policing and psychiatric first aid and Toronto ambulance routes. Is there not here an echo of the sense in which North America can, its naivete notwithstanding, offer the wider world sanity and hope? A sort of minuscule, private echo, like some theme from Dvorak's New World tinkling in the foyer Muzak, of a philosophy played out also many times in living memory on the historic, public stage? (The kindness of the constables was in no way negated by my subsequent rough reception at Emergency, where my wrists and ankles were secured to a rectangular metal frame with straps, in a physical arrangement indeed suggesting a Soviet apparatus of state control.)

Politics, then, assists in the articulation of a framework for illuminating initially obscure adventures in our psychiatric institutions.

More usefully still, it is politics that supplies a guiding metaphor as we all seek to define our stand in the ancient debate over hardware and software. The Greeks liked approaching psychiatry through hardware. (Greek medicine wrote of "humours", much as we nowadays write of serotonin.) On the software side, however, there was also in at least one Greek town an actual "talking shop", in which the troubled were welcomed to discuss their troubles.

From Greek times to our own, the debate rages. Do we treat ourselves through hardware - whether through the blunt tools of Prozac, Zoloft, and similar selective serotonin reuptake inhibitors, or through more gentle tactics, such as inexpensive, albeit illegal, sleep-promoting melatonin? Or do we, on the contrary, seek out a talking-shop cure?

Hardware clearly has its place. So much is suggested by my experiences with Doctor Prozac, whose fluoxetene hydrochloride tablets issued in broken sleep, in the angry morning elephant pushing me back into bed after breakfast, in the gently solicitous afternoon elephant proposing a death-plunge from a certain high, sunlit, readily accessible balcony. For, the reasoning runs, if Prozac can work such damage, it may have the corresponding power to work in some different patient some correspondingly enormous healing.

Nevertheless, there is a sense in which the essential issue is independent of hardware. I illustrate that sense in metaphor, with two versions of a story. ("Solitudinem faciunt, pacen appellant" at the end of the first story translates to "They create a desolate wasteland and call it peace.")

On the one hand:

The small republic is in a downturn. Dust blows in the streets. Paint peels on shop facades. The populace is silent, tired, sullen. In the harbour, the cranes stand idle. In the modest industrial precinct, there is no smoke from the smokestacks, no sound in the machine rooms.

The republic makes its way in the world partly through scientific activity, partly through trade. And its civil servants are by no means idle: they sit in grim conclaves, annotating their atlases, running bony fingers down the pages of their ledgers. They await an economic revival - meticulously executing, sharp and hard as the old traders and scholars of Holland or Venice, instructions handed down to them by the Prime Minister and Cabinet from the threadbare Parliament House in the Upper Town.

Today there is more trouble than usual. A noise, dull, low, yet insistent, carries from the streets of the Lower Town to the Parliament. It is the noise of chanting, of smashing. It is the dull, mindless roar of a mob. At Parliament House and in the offices of the civil service, red telephones are lifted from cradles, special-situation screens consulted, safes locked, colonels summoned. The expected, indeed (given the prevailing conditions) the inevitable has begun: it is the first hour of the insurrection.

In a dull city square, under a dull sky, two thousand citizens, armed with little more than gasoline bombs and iron bars, march against a tiny group of armoured personnel carriers. This is not a republic which can reward its military with tanks. So the desperate, almost unarmed poor are pitted against an army itself lacking the proper apparatus of riot control. When the altercation is over, two personnel carriers lie turned on their sides, their interiors smelling sweetly of burned flesh. On the cobblestones are broken bottles, a shoe, jacket sleeves, a crushed bicycle, hair, blood.

With the early November dusk, the mobs regroup. Here and there in the capital rise thickening, blackening columns of oily smoke.

But little by little, the government consolidates its hold, sweeping the loudest elements into police vans, confirming with the judiciary that the courts will function at daybreak.

Applying to his own government the cheerless words of the barbarian chieftain led captive by Caesar through Roman streets, the Prime Minister writes in his private journal, "Solitudinem faciunt, pacem appellant."

But on the other hand:

...confirming with the judiciary that the courts will function at daybreak.

The Prime Minister wavers momentarily. Will he now write in his private diary the cheerless words of the barbarian chieftain led captive by Caesar through Roman streets? He decides instead to walk downhill from the ministerial offices into the Old Town. Coffee with the Bishop, he resolves, shall mark the beginning of sanity.

- And so, the prelate asks (as the restoring vapours rise over the pale Royal Albert saucers; as the biscuit tin bearing, helpfully, the lithographed likeness of John XXIII is borne to the leather armchairs by the tiny anthracite fire): the courts will deliver justice?

- But of course.

- Do have a biscuit.

I interpret my pair of stories thus, that given the usual physiological hardware, there is a residue of free will, capable of coexistence with even violent external or internal compulsion. Our situation may conceivably be so adverse as to make us unfree to modify the evolution of external events, and also, more subtly, unfree to modify the evolution of our feelings. Nevertheless, we are free to take up either an affirming or a negating attitude toward the totality of these facts, external and also, more subtly, internal. In selecting that attitude, we create one or another meaning, and so ultimately select either to die a special kind of death or to have life abundantly - as life may be had abundantly even behind guard towers and barbed wire.

The affirmation of attitudinal freedom that I propose here comes from Freud's Viennese debating opponent, logotherapist Viktor Frankl. Encouragingly, Frankl was himself a survivor of the Nazi camps.