Sometimes, the narrow outlook of what I’ll call “brain-focused psychiatry” exasperates me. Is depression just a matter of a few loose wires in the computer within our head? Do our feelings really got stuck just because of some faulty connection, some clog in the brain?
Sure, I won’t deny something like that can play a role, sometimes. In specific cases, a kind of malfunction in our head – something with synapses, hormones, chemicals, whatever – might be one part of a wider, complex set of problems. But there are still psychiatrists who entirely limit themselves to frantically trying to reconnect the wires, to locate that one special little button that will reboot the brain as if it were just a crashed computer.
They remind me of medieval alchemists – you know, those bearded eccentrics who stubbornly kept searching for the one magic formula that would turn stone into gold.
They also remind me of the old philosophers who, in the tradition of 17th century philosopher René Descartes (above), tried to understand and analyze and chart the human body and brain as some kind of complicated machine, with virtual cogs and wheels. Most philosophers have since long abandoned such a limited view, but some psychiatrists still seem to adhere to it.
They keep searching for that one broken cog, for that one loose wire that needs to be repaired. Maybe we should mint a new name for this kind of old-fashioned, narrow-minded psychiatry. Maybe we should call it “Steampunk Psychiatry” (if you don’t know what Steampunk is, see this Wikipedia page).
The most extreme example of Steampunk Psychiatry is of course ECT (electroshock therapy). What this amounts to, it is like taking your grandfather’s broken old pocket watch, and shaking it violently in the hope it will start running again. Actually this can work in a few cases. When I got ECT myself several years ago, perhaps it did help me a little. But it may cause only more damage just as well. (Let me prevent misunderstandings: this image here does not show ECT. It’s more Steampunk…)
Two things got me thinking about Steampunk Psychiatry today.
The first one is a research paper in the March 2012 issue of the British Journal of Psychiatry, about an experiment by Australian psychiatrists trying to treat depression with tDCS, Transcranial Direct Current Stimulation. For a readable review of the experiment, see here.
This tDCS can be considered a milder, more modern form of ECT. Unlike ECT, it is not based on the effect of electricity-induced convulsions: rather, it uses the effects of electricity itself. It involves stimulating specific parts of the brain with currents that are weak enough to make anesthesia unnecessary. As you can see here, tDCS equipment almost looks like iPod earplugs put in the wrong places. This is Steampunk Psychiatry taken to a new level of hi-tech.
According to the researchers, after a six weeks trial with 64 patients (where some got fake treatment to see the difference) they established that tDCS “is a safe and effective treatment for depression”. I’ll be no judge of that. But if ECT was like violently shaking your grandfather’s watch, we might say this is more like carefully poking into the broken watch with a tiny screwdriver. Perhaps it can indeed help some of us. What bothers me, is the complete lack of any wider perspective on the causes and nature of depression. Would an electric “screwdriver” really be the first thing we need?
This brings me to my second reason for thinking about Steampunk Psychiatry. My personal reason. Over the last weeks, my own depression has become much worse again. I won’t bother you with the nasty details. I know that I’ve been vulnerable to depression relapses for the last fifteen years anyway: I cannot pinpoint exactly why I’ve been so badly depressed several times. But I do also know that this time, clearly some external factors contribute to my depression.
To mention a few. My present network of friends may be too small for my emotional needs. I also face unexpected financial problems (an old mortgage loan I’m saddled with, has suddenly changed into a burden). For practical reasons, I’m also not happy with the place where I live today. And exactly because I had been getting better last year, I’ve now begun to miss the rewarding challenges of the university job I had to give up because of my depressions eight years ago. Also, I’ve still not been able to cut short my smoking habit, even though I know very well (cough, cough) that I really ought to quit smoking. Need I go on?
In short, my life is not what I would like it to be, I’m not at all happy with myself. And although I do of course try changing things, it’s unlikely that I can change everything to the better right now. Taken together, all these things add considerable weight to my already present (possibly innate) depression tendencies.
Would poking around in my brain, in the Steampunk way, be a solution here? Even if it might help a little, I doubt this would be a full and definitive solution. Any psychiatrist who would want to help me, would need to look at my life in a wider perspective: taking into account my inclinations, my habits, my practical problems, my mood swings, my family background, my activities, my environment and so on.
This does perhaps not apply to each of us, but I do think it applies to many of us.
The problem with Steampunk psychiatrists is not what they do. Maybe some of it can turn out useful. The problem with Steampunk psychiatrists is what they don’t do. Their narrow idea of depression is to just look into it as some kind of mechanical failure, and they forget too easily about all the rest.
Other psychiatrists, all those who have locked up themselves in different theoretical cages, often from their own perspectives make the same kind of mistake. The mistake of limitedness. The mistake of not looking beyond their own walls-of-theory, the cells that happen to confine them. This makes them too partial, too one-sided. Seeking the definitive solution in changing external circumstances. Or in adjusting the patient’s habits. In reprogramming emotional reactions. In furthering self-insight. You name it.
Those well-meaning therapists who think they can cure serious depression with the right pills, or with a long series of probing analytical talks, or with a program of healthy walks and a natural diet, or with some form of daily-life counseling, or with some form of meditative self-relaxation, are in fact all trying to give us their own kind of short-sighted Steampunk Psychiatry.
What I would like, is for psychiatrists to come out of their limited theoretical cells and for once take a look at the rest of the world. I would like them to stop viewing their otherwise oriented colleagues as marginal idiots, and to finally begin to work all together – systematically – to create a more integrated perspective on fighting depression. To recognize that each one of them, from the Steampunk tinkerer to the Freudian listener to the Socio-counselor to the Mindful type, may be a little bit right. And, sometimes, a little bit wrong.
Now if you’ll excuse me, I need to go. I need to do some urgent repairs. No I’m not thinking of my brain right now, that’s been taken care of already. If you want to know, I was thinking more of my heart. Who can tell me what’s broken in there?
May 22, 1859 –
