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Depression and Popular Fiction

What do novels, like The Woman in Cabin 10, teach us about depression?

Key points

  • As the chemical imbalance theory of depression has become controversial, questions arise about where people get this idea.
  • Ruth Ware’s best-selling novel, The Woman in Cabin 10, provides a revealing didactic example.
  • Ware's story conveys lessons also found in clinical and commercial sources of information.

“The depression I fell into after university wasn’t about exams and self-worth. It was something stranger, more chemical, something that no talking cure was going to fix.”

These words come not from an interview or the clinical or social science literature, or even from a “pathography,” that special confessional genre written by people reflecting on their struggles with mental disorder and efforts to get well. They come from a novel spoken by the protagonist, nicknamed “Lo,” who took antidepressants for many years.

The general public has increasingly accepted the notion that a chemical imbalance causes depression in recent decades. But as the lack of scientific support for the theory has become better known, it has also become increasingly controversial. So, where are people being led to believe what is at best a dubious notion? In a recent article, The Explanation You Have Been Looking For, I explored communications by doctors and studies of mass media representations and direct-to-consumer drug advertisements. But there is another source, to my knowledge, unstudied but perhaps just as important: popular fiction.

Lo’s lament appears at the opening of a chapter in Ruth Ware’s 2016 best-selling novel, The Woman in Cabin 10. Its purpose is purely didactic. Depression, we discover, plays no actual role in the story (we also learn toward the end of the book that the medication is not for depression but anxiety). Here’s more of Lo's story:

There’s no reason, on paper at least, why I need these pills [antidepressants] to get through life. I had a great childhood, loving parents, the whole package. I wasn’t beaten, abused, or expected to get anything but As. I had nothing but love and support, but that wasn’t enough somehow.

My friend Erin says we all have demons inside us, voices that whisper we’re no good, that if we don’t make this promotion or ace that exam, we’ll reveal to the world exactly what kind of worthless sacks of skin and sinew we really are. Maybe that’s true. Maybe mine just have louder voices.

But I don’t think it’s as simple as that. The depression I fell into after university wasn’t about exams and self-worth. It was something stranger, more chemical, something that no talking cure was going to fix.

Cognitive-behavioral therapy, counseling, psychotherapy—none of it really worked in the way the pills did.

Lo concluded that while her best friend Lissie found the prospect of “chemically rebalancing your mood scary,” Lo saw it was “like wearing makeup—not a disguise, but a way of making myself more how I really am, less raw. The best me I can be.”

This little monologue, stated with the authority of the first-person experience, resonates with three things you might hear from physicians or see in drug ads promoting the chemical imbalance idea.

Lesson 1: Depression, being chemical, comes about independent of the sufferer herself or her situation. It’s not like the ordinary experience, which can be understood in a language of reasons and intentions.

In the protagonist's case, Lo, the fact that her family life as a child involved “nothing but love and support” adds to the conviction of meaninglessness. She wanted a cause-and-effect explanation, and, among potential causes, none of the low-hanging possibilities—parental abuse and excessive demands, performative failure—is applicable.

She was out of college and had a good job. The other option, “demons” doing distressing things “inside us,” might also work as a cause, if only that explanation seemed plausible. Needing a causal mechanism, Lo attributed her experience to “something stranger, more chemical.” Stranger? Stranger would be the old belief that “we can prove incomprehensible to ourselves.”

Lesson 2: “No talking cure” is “going to fix” depression, so conceived. This lesson follows from the first. If the suffering has no reasons, context, or meaning, what is there to talk about? All that needs to be known—the chemical malfunction—is known. Almost by definition, none of the talk options, “cognitive behavioral therapy, counseling, psychotherapy,” will really work “in the way that the pills did.” Only problems conceived mechanistically can be “fixed.” Therapies that deal with thoughts, interpretations, understandings, and social context proceed fundamentally differently.

Lesson 3: Depression is a kind of “third condition,” somewhere beyond normal but short of a mental illness. Admittedly, this lesson is implicit rather than explicit. Lo was suffering. She needed the “pills to get through life,” yet, when describing their effect as “chemically rebalancing your mood,” she compared the treatment to make-up.

Medical and advocacy groups often emphasize that depression is a “real” medical condition by saying depression is “just like diabetes.” But none compare taking insulin to applying cosmetics. The talk here is not of mental illness or getting well but of an enhanced presentation of self to others—“less raw,” a “best me”—brought about by pills.

In exploring the clinical, commercial, and popular uses of the chemical imbalance idea, I found that its rhetorical promise and personal appeal are largely explanations. It accounts for troubles in a way that eases the burden of selfhood and enhances a sense of self-determination. And judging by Ruth Ware’s novel, at least some popular fiction is conveying the same message.