Alex Riley’s A Cure for Darkness begins with a stand-alone paragraph stating that an estimated 322 million people have depression. According to the World Bank, mental health problems are responsible for over 8% of all healthy years lost, more than cancer, heart disease, or malaria. What can humanity do in response to such a staggering tragedy, and what has been done already?
Riley is not a psychologist but an intelligent person with a history of depression who became fascinated by the demon that tormented him. Riley had been a promising Ph.D. student in paleontology at the University of Sheffield and a researcher at the Natural History Museum in London, but he was beset by feelings of inadequacy: “Like the fossils that I pored over, I felt delicate and brittle, capable of breaking at the slightest drop.” After unemployment and a breakup exacerbated his distress, Riley began studying depression, and his research developed into this book.
The story, aside from a brief interlude about antiquity and the Middle Ages, begins with the psychologists Sigmund Freud and Emil Kraepelin, who were born within three months of each other in 1856 and developed competing approaches to depression. Freud’s main contribution was psychoanalytic talk therapy, which supposedly helped unburden patients of traumatic memories. But his first effort to treat depression was a chapter in his career that he might have later preferred to forget. He was an evangelist for the use of cocaine, which he frequently took himself for over a decade (he didn’t sniff lines; he mixed the stuff with water and drank it).
Some contemporaries blamed Freud for the epidemic of cocaine addiction that spread across Europe in the late 1880s, and his advocacy does seem to have been unscrupulous, especially his unwillingness to revise his views in light of evidence that cocaine was dangerous and addictive. But the early attempt to treat depression with drugs was a scientific landmark nonetheless. Freud’s misadventure with the substance is also an example of a reoccurring motif in the history of depression: researchers becoming enthusiastic about some miraculous new treatment and turning a blind eye to its downsides.
The lesser-known Kraepelin saw depression through a biological lens. Like Freud, he used drugs in his research, though mostly more mundane ones such as alcohol and caffeine, and for the purpose of quantifying their effects. (Kraepelin invented control groups, which are now standard in pharmaceutical research.) Later, when he became interested in mental illness, Kraepelin used thousands of cards to document details of individual cases that he monitored over years, which allowed him to distinguish different types of depression. Like Gregor Mendel, the so-called father of genetics, who discovered rules of hereditary transmission by meticulously observing the pea plants that he grew, Kraepelin had a detail-oriented mind.
Freudian psychoanalysis fell out of favor by the late 20th century, and today, Kraepelin’s rigorously empirical method of classifying psychological ailments reigns supreme. But as Riley shows, seeing depression exclusively as a physical or biological problem has its own limitations.
Exhibit A is the physician Walter Freeman, a charismatic advocate for lobotomy, a procedure that intentionally damages the frontal cortex of the brain in order to treat depression and other psychological ailments. Freeman did thousands of lobotomies in his career, often using ice picks, and even went on tour performing them in the 1940s, aided by a credulous media. Lobotomies sometimes delivered immediate results — indeed, some patients woke up smiling. But relatives frequently reported that their lobotomized loved ones were shadows of their former selves, content but devoid of personality. One of Freeman’s lobotomies permanently reduced Rosemary Kennedy, President John F. Kennedy’s younger sister, to having the mental life of a 2-year-old. Many didn’t survive at all.
Fortunately, the history of psychiatric treatment is more than a gallery of horrors. Although electroconvulsive therapy was initially pretty shocking, it’s now one of the most effective treatments for severely depressed patients. Progress has been made on other fronts, too. Antidepressant drugs have gradually improved, and cognitive-behavioral talk therapy, which emphasizes practical coping skills, has provided relief for many. Riley also introduces us to a number of colorful unsung heroes, including Helen Skipper, formerly homeless and addicted to crack, now a “peer supervisor” at a New York nonprofit group serving those involved in the criminal justice system.
Riley juxtaposes his history with details about his own personal battle with depression. We hear about his travails as he improves his diet, starts exercising, begins taking antidepressants, and even experiments with psychedelic mushrooms. At the end, Riley faces an especially tough challenge: attempting to quit the drug sertraline during the COVID-19 lockdowns with a baby girl on the way. This proves too much to handle, and Riley returns to the antidepressants to alleviate his symptoms. At first, I thought this was a disappointing note on which to end. On further reflection, it seems appropriate. Riley’s condition at the end is more or less a reflection of the human condition: There’s reason for hope in the fight against depression, but tribulations lay ahead. We still haven’t found our miracle cure.
One of the virtues of A Cure for Darkness is that it sheds light on scientific progress. There is a popular bias toward thinking of scientific progress as moving in great leaps: A genius has a flash of insight and dramatically overturns the existing paradigm. As Riley shows, however, scientific progress is more like a gently rising tide. People with diverse backgrounds and interests make small contributions to our knowledge by examining the same phenomenon from many different angles. No one has the whole picture, and quite a lot remains unknown.
One minor criticism is that Riley’s discussion of theories of depression before the 19th century is cursory and unsatisfying. He discusses Hippocrates’s theory that depression is caused by excessive black bile in the body — the word “melancholy” derives from the Greek melan khole, meaning “black bile” — but there’s only a fleeting acknowledgment of the fact that ancient Greek and Roman stoic philosophers anticipated much of modern cognitive-behavioral therapy. The writer and therapist Donald Robertson has drawn attention to these continuities in his books, including How to Think like a Roman Emperor and The Philosophy of Cognitive-Behavioural Therapy (CBT). Riley should have either expanded his discussion of ancient and medieval medicine or omitted it entirely.
Nevertheless, A Cure for Darkness is recommended reading for anyone with even a peripheral interest in depression. The book offers no easy lessons and cautions against solutions that seem too good to be true. We’ll probably never find a cure for darkness, but we can learn from those who have helped make it easier to bear.
Spencer Case is an international research fellow in the school of philosophy at Wuhan University.
