I wish I could say that for the past few weeks nothing happened here on this blog because I was away on a wonderful vacation in sunny France. The truth, I’m afraid, is that I’ve been far too depressed to write a single word. Luckily, I’m recovering now.
So how to celebrate my return to the land of the living?
Well, to go a little easy on myself, here is another image from my collection of old pharmaceutical advertisements. Showing how in the good old days, pharmaceutical companies tried to convince psychiatrists of the magical qualities of their newly-invented medicines.
Often, what strikes us today in these old ads is that they demonstrated little respect for the patients for whom the medication was intended. In many cases, these ads tried to visualize mental illness in ways that we nowadays would find crude or even disturbing. For another example, see the Nembutal ad here.
Below is a circa 1960 advertisement for Thorazine (American brand name; known in Europe as Largactil). Based on chlorpromazine hydrochloride, it was introduced in the 1950s as a calming antipsychotic drug and quickly became very popular. Psychiatrists were happy to prescribe it to patients with psychotic tendencies.
I will let the ad speak for itself:
With this frightening ad, the people of “Smith Kline & French Laboratories, leaders in psychopharmaceutical research”, wanted to show what they thought psychosis did look like.
Shall we try to find a musical equivalent? How would it sound?
Maybe the Finnish rock band Poets of the Fall has something that comes close to an answer. If you want to know more about them and hear more of their fascinating music, please go to their official Poets of the Fall website.
This is just their song Psychosis from their 2008 album Revolution Roulette – and if you feel inclined to complain that it doesn’t sound soft and sweet, the answer is of course that this really shouldn’t sound soft and sweet:
Please don’t worry. This is not going to be some kind of dumb rant against pills or the pharmaceutical industry. I just want to show you how what was considered normal in psychiatric health care 50 years ago, is seen a very different light by us today.
And by implication, how what we now think is normal, may be considered weird 50 years from now.
50 years ago, a popular tranquilizer was the drug Nembutal. It is based on pentobarbital, which as a barbiturate is rather dangerous. It’s not only addictive, easily creating drug-dependency. An actual overdose will simply be lethal. It has long remained in use as a strong tranquilizer, for example to reduce anxiety. But in modern psychiatry it has largely been replaced by other, hopefully less dangerous drugs. It is now mainly being used by veterinarians: for euthanizing animals.
In the USA, it has recently also been used as a simple way to carry out executions, replacing more complex mixtures of lethal drugs. In March 2011, Ohio prison inmate Johnnie Baston was the first to be executed by a single-drug dose of pentobarbital (see this Washington Post article). In July 2011, when already 18 people had been executed in this way, the Danish pentobarbital producer Lundbeck announced that it would no longer accept the use of its drug for execution purposes (see this Guardian article).
Flashback to 50 years ago. Here is an old advertisement that shows how back then, this same drug was promoted (and used) for psychiatric treatment of children:
For us today, this advertisement looks just weird. Not just because it presents the use of Nembutal to tranquilize children as something normal. It also looks weird by itself.
It shows a friendly slogan “when gentleness is important”. But this strangely conflicts with the crude, caricatural, in modern eyes almost disrespectful and disturbing way the child is depicted in the image. The kid looks like a little Frankenstein, a little monster. One look at him and we’re supposed to understand immediately why, yes of course, this boy does need a gentle Nembutal treatment, real quick, before he… (fill in your darkest Dracula fantasies here).
I’ll happily leave all other interpretations of this weird advertisement to you.
Now, instead of flashing back 50 years, flash forward, to 50 years from now. To 2062. How will people then look back to today’s practices of easily diagnosing unruly, not-concentrated children as “ADHD” and sedating them with medication, instead of taking adequate educational steps?
Frankly – Frankensteinly – I think those people in the future will find this way of treating children just as unbelievable and weird, as we find this old Nembutal advertisement.
We can repeat this same time-travel thought experiment for many other primitive practices within psychiatry, such as the still far too easy and liberal use of electroshocks. What will people in 2062 think of the fact that I, a depression patient, got electroshocks even after I got a heart failure during one of those treatments?
There are many more examples of still-existing psychiatric primitiveness: again, I’ll leave this little bit of thinking to you.
The point is: if we can clearly guess how 50 years from now people will find us weird, then why should we wait those 50 more years before making some simple, obvious improvements in psychiatry? Let’s be a little more critical about what we’re doing today! Let’s work a little harder! Let that future begin now!
• note: OK. I admit, maybe this whole demonstration here was a little on the demagogic side. But in essence, I don’t think it’s untrue.
Maybe I’m just too impatient? And now I come to think of that, would this impatience be one more cause of depression?
This portrait here is not Emily Autumn, who is filling the rest of this post.
First, here is my daughter Sophie (portrayed by my friend Frans-the-painter). She is a nearly-graduated expert on medieval literature and manuscripts. She also writes, she makes beautiful drawings, she moderates a sci-fi/fantasy role playing game, she sings in a choir that brings everything from Yiddishe folk songs to Haydn church masses, she worked in a leather shop, she’s into custom-built computers, she cooks great meals, and she is a keen follower of alternative music and culture.
Don’t tell me I should be proud of my daughter: she does it all on her own power.
She’s the one who told me about Emily Autumn.
Emily Autumn is a unique, very flamboyant, punky-style American singer who has many dedicated followers. Having bipolar depression, she was hospitalized after a suicide attempt some years ago, and one of the recurring themes in her music is psychiatry, or maybe I should say anti-psychiatry. You can find Emily Autumn’s website here: The Asylum.
Last month Sophie was at one of Emily Autumn’s live concerts, and she was very impressed by its atmosphere, Autumn’s performance, the crazily dressed fans and the music itself. One of the songs Sophie told me about was Take the Pill, a kind of anti-psychiatric pamphlet translated into a bitter, sarcastic song. After listening to it, I felt compelled to comment on the actual text Autumn is singing here.
As you know my own stance is not rigidly anti-psychiatry, but not pro-psychiatry either: I would describe myself as “a fair critic”. I will never state that all psychiatry is by definition Evil: in some cases, professional therapy (including pills) can perhaps do some good, or even be needed – temporarily – to prevent a disaster. But I also do know very well that psychiatry is way too much commercialized, pushing extreme solutions onto people who might do better without, often resulting in a kind of counter-productive overkill.
I am convinced that in today’s situation, let’s say 80% of all habitual antidepressant users would do better without. The remaining 20% might benefit from them.
In my own past, pills and electroshocks may have helped me incidentally (perhaps preventing more suicide attempts than the two I survived). But they never helped me in a structural way. Against the advice of some psychiatrists, I stopped having electroshocks five years ago, and last year stopped taking pills altogether. On the whole, I feel better for it. But I know that what applies to me, is not necessarily true for anyone else: we’re all different.
I will use my own experiences here as a base for commenting on Emily Autumn’s Take the Pill song: giving you the complete lyrics, mixed with my own comments where I see fit. But first, here is my unique patented Depression Music Player so you can listen to Emily herself. Click the “Play” button to hear her singing Take the Pill:
take the pill that makes you weaker
take the pill that makes you sick
comment: Taken literally, this is sometimes true. Nasty side effects can hit some of us. But there also are people who don’t really notice any side effects.
…take the pill or you’ll be sorry
comment: Yes, this is what psychiatrists often suggest. What they mean is (if you’re in very bad shape at least, if you are suicidal) that if you don’t take medication you may not live to regret your decision to refuse them.
Maybe some psychiatrists do indeed use this suggestion as a kind of threat, to persuade you with force. But the same suggestion can of course also mean they are genuinely worried about you.
…take this bloody pill and make it quick
take the pill that kills your sex drive
comment: Yes, this is one of the most frequent side effects, experienced by many of us. Losing sexual urges and satisfaction affects not only yourself but also your relations with others; this can make your depression much worse.
Somehow, psychiatrists tend to grossly underestimate the importance of this. They keep prescribing medication that has this effect even when there are alternative pills that do not have this effect.
One other thing: in some cases, it’s not the medication that killed the sex. Sometimes, it’s the depression itself that has this effect.
…take the pill that makes you cry
take the pill that burns your insides
take the pill that makes you want to die
comment: Yes, there are known cases of antidepressants generating suicidal impulses instead of reducing them. This does not happen often, but it is a potential danger. This is one of the many reasons why you should never take those pills without regular checks with a qualified psychiatrist, for as long as you use them.
…be careful what you say
today could be your day
you no longer rule your body
comment: Yes, sometimes this is how it feels: medication-induced numbness resulting in the feeling you no longer have control over yourself. For example, you are moving but it does not feel like you are moving: more like a zombie.
This does not happen to all of us but it does happen fairly often: and equally often, you will become fully aware of this effect only after you’ve stopped taking antidepressants.
…you no longer own those rights
you will wake up when we say so
you will sleep when we shut out the lights
enjoy your stay
‘cause you can’t run away
comment: I’ve been hospitalized in a locked ward a few times myself, and of course this is certainly not a pleasant experience. But I want to add a few footnotes here.
It’s obvious that personnel in such a ward want to sleep you regularly, in their own practical interest, and so you won’t disturb other patients, and also because regular sleep can give you more energy to fight your own depression. But I myself have never encountered a regimen of brutally enforced sleep.
In fact, some of the most nice and personal conversations I ever had with psychiatric nurses did occur when I got wandering through the ward in the middle of the night, ran into a night-shift nurse who had little to do at that time, and got into a long talk with her before going back to my bed.
The interesting background dilemma of using locked psychiatric wards is of course that two things conflict here: the patient’s right of freedom, and the patient’s right to be protected against his own self-destructive urges. These two things have to balanced against each other somehow.
I’ll admit that this balancing may not always happen properly or with enough care. On the other hand, if psychiatrists think there’s a serious risk you will run off and impulsively jump from a bridge, can you always blame them for temporarily locking you up rather than taking the risk?
As for the constant supervision, the control and lack of privacy in some institutions: my first suicide attempt was by hanging myself while hospitalized. If they hadn’t discovered me in time, I wouldn’t have been around now. Yes yes, I know, you don’t need to tell me you wouldn’t have missed me, either… ;-)
…get back in line, get back in line, get back in line
get back in line, get back in line, get back in line
comment: I’m not sure what exactly Emily means here. If “get back in line” means that people try to force psychiatric patients into some predefined mold, in standard “normal” behavior patterns, that is indeed wrong. To a slight extent, I’ve sometimes experienced that myself: when it happens, it’s usually because psychiatrists and nurses (out of lack-of-time, laziness or lack-of-involvement) try to go the quick and easy way. When your behavior in some way is just irritating to them.
But I must say I’ve also found often enough that people tried to accept and respect my own peculiarities. And believe me, I sometimes can be a little strange or oversensitive…
On the other hand if “get back in line” simply means making your behavior a little more social again, then I would say there’s little wrong with that. For example, if ward personnel try to involve you in some activities with fellow patients again, then in the long run that might make you feel better.
…you’ll be just fine
take the pill that keeps you quiet
take the pill that keeps you blind
comment: Yes. Sure. Blind. I really must agree here. The first time I was able to fully, candidly, clearly overview and analyze my own situation and my depression, was after I quit taking antidepressants. Not during the years I took them.
…take the pill that wipes your memory
comment: I agree again. And this is even more true when it comes to electroshocks: in my case, they wiped out and destroyed important parts of the hard disk within my head. I can, for example, since those shocks not remember a thing about the difficult birth of my daughter Sophie. And with those parts of my memory, parts of my life, parts of my former personality were also wiped out forever.
This is another very important side effect that may not happen to everyone, but once again an effect that when it happens has a huge impact, and that psychiatrists tend to grossly underestimate.
…take the pill that’s f*cking with your mind
that’s all you have to lose
best that you’re not procreating
best that you don’t multiply
better still, let’s sterilize you
comment: Come on Emily. Are you serious? This is something that only the Nazis did, back in the 1930s and 1940s. As far as I know, no one in psychiatry advocates or tries to sterilize psychiatric patients today. Maybe I’m naive, but I just can not believe this. Please correct me if I’m wrong. If this really happens somewhere, there’s reason for worldwide action and protest.
…take this pill, the doctor’s standing by
pull up your skirt
and yes, it’s going to hurt
comment: Taken literally: yes. Sometimes. A needle, for instance. That can be very unpleasant, but it does not always mean it is just bad. Last year I had to have a gall bladder operation; that did hurt more than anything psychiatrists ever did to me – more than electroshocks.
But the other side is, after a few months I had overcome the feverish and painful side effects of my gall bladder operation. After five years, the nasty side effects of the electroshocks are still bothering me: that damage will probably last forever.
…get back in line, get back in line, get back in line
get back in line, get back in line, get back in line
you’ll be just fine
don’t you wanna be sedated
don’t you want to ease this pain
if the pills are not effective
then we will electroshock your brain
comment: I’ve had about 110 electroshocks. Really. In the beginning I was so exceptionally depressive and suicidal that maybe, I’m not sure but maybe, the first few shocks actually helped saving my life. I don’t know. In my case, the problem was that therapists went on shocking me with regular intervals, for about three years, even when probably it wasn’t necessary anymore. A treatment-on-autopilot. That’s plainly dangerous and wrong.
In general, electroshock treatments are so radical that they should be given only as the very last resort option, and only with the patient’s express content, after giving ample information and discussing it with him in an open, honest way. If there still are places where people get shocked against their will, that practice should be stopped. Right now.
…we are not happy with your progress
you’re not yet considered sane
if these pills are not effective
we’ll electroshock your brain
don’t even think of spitting out
we know your tricks, we’re on to you
we will check underneath your tongue
comment: In principle, forced medication is just as bad as forced electroshocks. In practice, maybe we can imagine a few cases where psychiatrists might find arguments to defend such a practice, saying that it’s no big deal and – as a kind of short-term safety measure –in the patient’s own interest.
But I still would find it very dubious, something that ought not to happen. Personally: as far as I can remember, I myself was never forced to take pills. Lucky me?
…we know exactly what you’ll do
your accusations are a joke
your credibility is shot
just keep your eyes down and your mouth shut
that’s the only choice you’ve got
so you’re a doctor and i am just a crazy little girl
who would you believe?
comment: Yes, some psychiatrists, especially in institutions, tend to assume a paternalistic we-know-best attitude, not taking the patient seriously. That’s not just wrong: it also is counterproductive. It will make the patient only suspicious, and sometimes with good reason. It will get in the way of a positive therapy, hampering instead of helping. All therapies should be based in the first place on open and informative communication between therapist and patient: the latter should be listened to (and answered to) seriously.
I suspect in this respect I may have been a little lucky because of my background: even when I was totally immobilized and almost incommunicable by my depression, psychiatrists possibly recognized I was a PhD with a university research job: in other words, to some extent one of their own kind. I’ve often had the nagging feeling that just because of that, they took me a little more seriously than many other patients, even when I tried to interfere on behalf of some fellow patient. But everyone deserves to be taken equally seriously!
…well he’s a doctor and you are just a crazy f*cking bitch
who would you believe?
we’ve filled your prescription, you’ll never run out again
we’ve filled your prescription, the drugs are your only friend
comment: Hmm… I don’t know. When suicidal I sometimes had the feeling that death was my only friend, but I’ve never had the feeling that pills were my only friend. Nor do I remember therapists actually suggesting something like that to me.
But don’t worry Emily, I do get your meaning, just like everyone else will. Psychiatrists sometimes like to suggest too easily that pills will solve everything. They won’t.
…we’ve filled your prescription, you’ll never run out again
we’ve filled your prescription, the drugs are your only friend
now, take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take it, take it, take it, take it
take it, take it, take it, take it
swallow, swallow, swallow, swallow
swallow, swallow, swallow, swallow
Emily Autumn is an artist, and artists exaggerate. They have to. Without exaggeration and sometimes even a little distortion, there would be no art. It’s exactly this that makes art stand out from plain, dull reality. It’s exactly this that makes art effective, impressing, and beautiful.
Art does not always have a message, but Emily’s art does have one. Apart from the necessary exaggeration, basically she has a true and important message. Your own interpretation may be different from mine, but I feel it boils down to this:
Psychiatry should respect people’s individuality and human dignity. Not, as still happens too often, ignore, overrule, or even destroy it.
• note to blog followers: Sorry for the double (automatic) post notification. By mistake I posted an unfinished draft here first, so I had to trash that and then post the right version. That’s why you got it mailed twice.
Last week there’s been a lot of hubbub about the background and contents of the upcoming DSM-V, the successor to the DSM-IV, the formal American Diagnostic and Statistical Manual of Mental Disorders that will be published by APA (the American Psychiatric Association) next year. I already commented about this here.
The new DSM is being prepared by several topical Work Groups, each of about 10 to 15 experts in the field. These groups are already at work since 2008, but for some reason the background of these experts is beginning to get a lot of attention now. I saw several critical news items about it; four days ago it even made a headline in the Dutch Volkskrant newspaper (one of my daily reads).
What is the reason for all this attention? The already known fact (it never was really a secret) that most of the experts who compile the new DSM are, in one way or another, on the payroll of the pharmaceutic industry.
Now first let me make clear I’m not one of those rigorous pharmaceutic-industry-bashers who think that all antidepressants, and the companies that make them, are Just Plain Evil. I think that some of us, sometimes, can really be helped by pills and by the commercial development of new medication. At some points in my life, antidepressants may have helped me too. I just think that too many people are taking those pills for no good reason, and without being aware enough of possible side effects. OK, now you know where I stand.
Today I found that blogger ALT on her ALT-MENTALITIES blog has done some fascinating research on the actual background of the experts in those DSM Work Groups. How many of these people do have direct financial ties to the pharmaceutical industry, in other words, are getting paid directly by that industries for various of their services? Like writing or just co-signing articles for them, etcetera?
Some examples: for the Psychotic Disorders Work Group this is 80% (8 out of 10); for the Mood Disorders Work Group and the Anxiety Disorders Work Group this is 56% (for both, 5 out of 9). All major pharmaceutical companies, such as Abbot Laboratories, Astra-Zeneca, Avera, Bristol-Myers Squibb, Forest, GlaxoSmithKline, GSK, Janssen-Cilag, JDS Pharmaceuticals, Johnson & Johnson, Lilly, Novartis, Pfizer, Wyeth, are paying several of these people.
ALT gives much more detailed info in her post, with striking examples of DSM Work Group experts who collect grants and payments from pharmaceuticals like so many leaves on a tree: it turns out one member of the DSM Mood Disorders Work Group has no less than 46 reported ties to pharmaceutical companies! For all this information by ALT, please read her full post: “For the DSM-V Task Force, being greasy never been so easy!”
My own comment? Look at it like this.
Suppose your city has installed an Urban Transportation Work Group of experts tasked with writing new guidelines and directives for the city’s traffic and transportation policy for the next ten years. Now suppose that most members of this Urban Transportation Work Group have direct financial ties with Ford, GM, Chrysler, BMW, Mercedes, Audi, VW, Toyota, Nissan, Honda and also with major road building companies. Would you be surprised if your city will adopt a policy of planning just more new highways and parking lots, instead of giving public transport alternatives a fair consideration too?
The amazing thing here is not the role of the pharmaceutical industry, but the role of the APA. That the industry is trying to use every possible way to influence policies and push its products, is a natural aspect of our free market society. What is amazing, is that the APA apparently does nothing to safeguard its own objectivity by keeping such influences out of the door. How can a diagnostic handbook be taken seriously if so many of its contributors have direct financial ties with commercial parties? Don’t they see that these blatant conflicts of interest completely undermine its own authority and credibility?
I am convinced that if the APA keeps allowing people who get payments from the pharmaceutical industry to contribute to their DSM, eventually the DSM will lose most of its present status and validity. And rightly so.
A background problem here is of course that it’s not just the DSM that gets ever more tainted. The same goes for psychiatry as an academic, scientific research discipline. At today’s universities, this academic work gets ever more tainted as well. When ever more researchers sacrifice their scientific objectivity and independence by accepting direct (personal) grants from industrial and other involved commercial parties, psychiatry as a serious discipline will in the end lose much of its credibility, too.
My view is that governments and universities themselves should enforce a much more strict legal line here. Either you work as researcher for a company (nothing wrong with that, in itself) or you work as an independent academic researcher for a university. In the latter case, you simply should not be allowed to accept direct commercial grants. The two positions ought to be kept strictly separated. Not combined and mixed up in the shady, non-transparent way that is contaminating much of today’s psychiatric research.
Yes, I never thought I would take the position of an idealist here… To return to the topic of the DSM, I’m not even sure if we really do need one unified authoritative diagnostic handbook. But if we do, then evidently it should by compiled by independent academic psychiatric experts. Not by people who are in any way on the payroll of Lilly or Pfizer.
If the APA remains blind to this obvious requirement, then the only solution would be for a group of truly independent academic researchers in psychiatry to get together and take the initiative themselves: to develop (in a more responsible way) an alternative diagnostic handbook, based on insights and research that can be trusted to be objective. Without any reason for bias. A handbook that deserves the respect and authority that the DSM has thrown overboard. Maybe we could get a philanthropically inclined, not directly involved company such as Google to subsidize such an effort? In the interest of us all?
I know. I already said I never thought I would take the position of an idealist here. But maybe we should not give up all hope.
Yesterday the Shorpy historical photo blog had a very interesting picture of a 1924 “Mental Hygiene” exhibition. Below is a small copy. To view it in huge format (so you can read everything on the wall) see the original photo at Shorpy.
The fascinating thing about this photo is it shows an early stage of what I like to call “illnification”: the gradual process of how, over the last 150 years, everyday mental problems became more and more formally classified and treated as illness. This includes depression.
Of course depression has always interested doctors – in fact, since the earliest times. In the 1st century AD, the prominent Greek physician Rufus of Ephesus already studied depression; he thought it was caused by “black bile”. Do you want to know what in his view was the best remedy? Sex! He said that having sexual intercourse settles and calms the passions, and thus would counteract depression. Apparently, he did not yet recognize that severe depression can make it difficult to have satisfying sex.
Interestingly, Rufus also thought that depression had something to do with intellectual genius (a notion that was later revived by 18th-century Romanticists). Now maybe that’s a comfort to some of us! A commented edition of Rufus’ 2000-years-old treatise can still be ordered from Google Books, Amazon, or directly from the publisher here.
But I digress. The real process of “illnifying” depression began much later, in the second half of the 19th century. It has accelerated significantly since about 1900. Gradually, pharmacists, psychiatrists and hospitals discovered that there was big business in treating common mental health problems – including depression.
The 1924 Shorpy photo illustrates this in a striking way. It shows advertisements of four psychiatric clinics offering a first examination for free (or 50 cents). Sheets inform the public how to recognize the symptoms of mental problems: “Nervous Mannerisms are Mental Danger Signals – SEE THE DOCTOR”. They list danger signals in children: “Inactivity, Morbidness, Unsociability, Fits of ‘Blues’, Excitability, Extreme Timidity ARE UNCHILDLIKE BEHAVIOR – Should Be Attended To”.
Prominently on the 1924 exhibition wall is this quote:
“We see a time – When the strange child, the worried mother, the confused and depressed workman will appeal to the hospitals for relief – as they now run to them for diabetes, appendicitis, or typhoid fever”.
Here you have it: illnification, 1924-style. Largely, the time they saw coming, has indeed come.
Partly thanks to the commercial motives behind this illnification process, today we have professional attention, medication, therapies and insights that didn’t exist 100 years ago. When something is seriously wrong psychically, today we are indeed more inclined to “appeal to the hospitals for relief”. By itself, surely this is not a bad thing.
But often it looks like this process is still going on, continuously pushing further the boundaries between what are fairly common mood or behavior problems at one side, and what is labeled “illness” or “disorder” on the other side. A prime example is of course ADHD in children: diagnosed with “Attention Deficit Hyperactivity Disorder” today, forty years ago most of the same children would have been simply called “unruly”. Instead of giving them pills, parents would just have waited for them to grow up a little.
The same kind of border-shifting illnification is still going on with mild forms of depression, too. People who forty years ago might have labeled themselves simply as “sad” or “somber”, may today tend more to seek professional help or medication because they now view themselves as suffering from Depression Disorder.
The question that arises here is, haven’t we pushed the borders far enough by now? Aren’t we beginning to overdo it?
Basically, the problem here seems to be that we’ve gotten used to setting our goals a little too high. We all want (hope, maybe even expect) to be perfect. From that perspective, there must be something wrong with everyone who’s not perfect – they ought to be helped and cured. But consequently, because no one is really perfect, because no one of us is happy all the time, we might end up classifying nearly everyone as suffering from some kind of illness or disorder.
This would be pointless and in a few cases (where this classification might have the effect of a self-fulfilling prophecy) it might even be counterproductive. So the question remains: where and how do we draw the border line between common mood problems and depression?
The approach of those 1924 mental health people may have been better than ours. They did not yet strive for perfection. The message on their exhibition was focused on recognizing indications of something abnormal in mood or behavior. Back then, the boundary between just being distressed or suffering from depression still was defined by a simple common-sense notion of what was fairly normal on the one hand, and what was definitely not normal on the other hand.
Maybe that’s where we should draw the border line between illness and non-illness again. And, resisting commercial impulses, stop further illnification.
There may be a personal lesson in this: nobody can be all right all the time. Many of us can hardly expect to go through life without incidental episodes of depression. In many cases, this is not abnormal. It’s just a fact of life. If we won’t run immediately to the doctor for every slight bout of headache, then why should we run immediately to the psychiatrist for every slight bout of depression?
• tip: If you wonder if something is really wrong with you, first ask yourself: isn’t it fairly normal what I am going through?
If what happens to you will also happen frequently to other people around you, then maybe the answer is: yes. Maybe in that case you’re not seriously ill, but just reacting in a natural way.
Of course I do not mean to suggest here that you shouldn’t look for professional help when you really need it.
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?
Author: Henk van Setten
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Today In History:
May 25, 1965 –
Ethel du Pont (49, former wife of President Roosevelt's son Franklin Delano Roosevelt Jr.) hangs herself in her bathroom with the belt of her dressing gown. She had mentioned suicide several times before and was “under psychiatric care” for her depressions.
In the 1930s, as a wealthy heiress from the Du Pont family, she had been a well-known socialite. In 1937 her marriage with the President's son had been a major event, with the couple being featured on the cover of Time Magazine. After their divorce in 1949 she had married lawyer Benjamin Warren.
Following Ethel's suicide, the rich Du Pont family established the Harvard Medical School Ethel du Pont-Warren Fellowship Award to specifically support psychiatric research.