If you’ve been sitting still or lying in bed these past three months, breathing carefully through minutes that each take a year to go by, with anguishing, out-of-control thoughts repeating inside your head, or no thought at all, just a deep, amorphous drear, then you know well enough how to define depression. Doctors would diagnose your state as “severe” or “clinical” depression, to distinguish it from other sorts, but you really don’t need to be told by any flavour of medicine man that there’s a difference between your present condition and feeling a bit low, or blue, sad, unhappy, bad-tempered, stressed or anxious.

Mental diagnosis is remodelled for each era. In our own, drug companies have bet on low levels of serotonin as the root cause of mental unwellness, and the NHS as well as doctors have signed up for the handy pills, and the equally cheap, fast solution of cognitive behavioural therapy. Darian Leader believes that depression is conveniently overdiagnosed, and then treated superficially. Depression is not about brain chemistry, it’s a response by the unconscious to separation and loss and only talk will resolve it, he says. He’s a psychoanalyst, so this is not very startling.

Leader has nothing particularly original to say about depression. The bulk of the book depends on Freud’s view of depression in the 1917 essay Mourning and Melancholia, and later interpretations by Abraham, Klein and Lacan. Freud made mourning into a process that had to be passed through so that the living could separate from the dead. When done correctly, the lack that has been filled by the lost loved-one can be filled by another. The mourner must acknowledge his or her mixed feelings, and learn to give the dead up. Mourning can be blocked for a lifetime, says Freud, while melancholia occurs when, through guilt, the mourner has so introjected the lost one that they have in effect died with them. Loss is broadly defined: not just death or separation, but the failure of all manner of hopes and attachments, even achievements that leave a hole in the rest of life – so it comes to apply to depression.

Leader sonorously reiterates this position and, with an absolutism that makes Richard Dawkins look tentative, insists that depression is the mourning of psychoanalytic theory, much as the behaviourists claim that depression is neuro-chemical imbalance. Why, apart from personal preference, must it be one or the other? It seems likely that the mental and physical aspects of depression are inextricably locked in a grim dance. Yet Leader is adamant that biological explanations empty people of “the complexity of their unconscious mental life”, and only by going through his prescribed four steps of mourning (no more, no less) is it possible satisfactorily to get through depression.

He equates this “unconscious mental life” with “the dimension of truth”, and therefore, on the one hand, dealing with symptoms will stifle truth, while on the other only psychoanalysis can reach that truth. (Leader is given to ghastly generalisations. The arts “exist to allow us to access grief ”, while what artists do is respond to “the experience of frustration, sadness and loss”.) The antiquated dualism in Leader’s writing does no service either to neuroscientific research or to people suffering acute despair. If raising serotonin levels prevents a suicide or enables a person to get to the consulting room, that’s surely a useful precursor to getting to whatever truth you happen to believe exists.

But why, other than that we are culturally steeped in it, and Leader clearly believes it to be axiomatic, should we accept Freud’s view of the unconscious processes, and the psychoanalytic theory that stems from it? Some people have felt better after seeing analysts (or other talk therapists) over extended periods, but Leader’s consulting-room anecdotes offer nothing more than his presumption about what it is that works in analysis. A young woman falls into depression when an affair, previously conducted by flying back and forth across the Atlantic, suddenly becomes settled and sedentary. She finally realises that she needed the repeated goodbyes to her boyfriend because she had not been not allowed properly to mourn for her dead father. This, like much of psychoanalytic theory, is an elegant story, a neat resolution. But perhaps, considering that it comes from hours of work with an analyst who believes depression to be mourning, it’s too neat. It’s nothing like as incoherent as the life we have to deal with while it happens. The psychoanalyst so often uncovers exactly what he is trained to find. Patients, with all that required transference, want to please. And exactly why the young woman’s insight should relieve her of her depression remains at least as unexplained as the reason why people feel better when they take Prozac.

Does it have to be that special understanding that gets the analysts seal of approval or will “the wrong” insight do? Is it the truth just because it makes her feel better? Might not the process of story-making, of turning disappointing life into narrative, count as much as “the personal unconscious truth, which can only emerge through speaking” that Leader speaks of so senten-tiously? Maybe another truth is a less interesting story of habit wearing away love, say, or feeling alien in a new country. Will only the psychoanalyti-cally led story do? Do they live happily ever after, or for a while? Separately or together?

It’s not hard to see that people can benefit from one-on-one attention, a regular chance to speak about their lives. I would.

The new black: Mourning, Melancholia and Depression by Darian Leader
Hamish Hamilton £17.99 pp240

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