Depression is good for you?

A new study by Doctor Paul Keedwell of the Institute of Psychiatry suggests that depression might not be as much of a bummer as we think.

Keedwell points out that the depressive gene must have some evolutionary benefits to have survived this long.

"I have received e-mails from ex-sufferers saying in retrospect it probably did help them because they changed direction, a new career for example, and as a result they're more content day-to-day than before the depression."

One woman left an abusive relationship and moved on, he says, and might not have done if depression had not provided the necessary introspection.

Similarly, unrealistic expectations are revised when depression sparks a more humble reassessment of strengths and weaknesses.

The idea, once popular in CBT and positive psychology, that depression is just 'bad', and that we should all try to be as happy bunnies as possible, has become somewhat dated.

Even Martin Seligman, the founder of Positive Psychology and once the global cheerleader for happiness and positive emotion, told me in an interview earlier this year that he now recognizes that people with depressive personalities might nonetheless lead far more meaningful lives - in terms of the effect of their lives on the lives of other people - than happier people.

He gave the example of Winston Churchill and Abraham Lincoln, both of whom suffered from bouts of depression.

It's difficult to generalize about why some people who have bouts of depression go on to achieve great things. Sometimes, their depression arises because they have great expectations and ambitions, which are then thwarted. They don't then necessarily change or lessen their ambitions - sometimes the world just catches up with them, and they fulfil their ambitions, so feel happier.

That was, arguably, the case with Churchill. He wasn't necessarily made more sympathetic or more self-analytical by his depression. Quite the opposite. His doctor, Lord Moran (my great-grandad, I'm proud to say), says he was distinguished by an amazing ability NOT to question his decisions or brood over them, at least during the hecticness of war.

I wonder, however, if the experience of battling depression helped him in the black days of 1941, when Britain stood alone against Nazi Germany and it looked like we were going to be conquered. Churchill was mentally prepared for that situation, used to pressing on even when the situation seemed immensely bleak.

In other cases, I think depression can help people achieve great things, simply because they never feel they have done well enough. The voice in their head never tells them 'congratulations, you've got somewhere, you've made it', so they are restlessly driven onwards , onwards, to try and validate their existence in production.

I'm not sure that's what Keedwell is talking about - he's implying that a bout of depression can be a growing experience that helps us become a more whole and realized person.

Maybe. But the depressive fear of failure and nothingness can also be a tremendous spur to action. The depressive keeps achieving, like a shark that keeps swimming because if it stopped for a moment, it would sink.

There's a wider point here, which is that success is not the same as happiness. Our civilization and our economy depends on restlessness, unhappiness, emptiness, the desperate search for approval and acceptance.

It is these negative feelings that drive civilization forward, that keep the scientist in their laboratory, or the lawyer in their office, or the banker at their trading desk, or the shopper in the mall.

If we all accepted ourselves just as we were, GDP would plummet. So in that sense, depression is certainly 'good' for the survival and expansion of our society.

The Courage to Take Mental Health Seriously

I like this Guardian article by Jonathan Naess, who founded the mental health charity Stand to Reason:

Our deepest fear: taking mental health seriously?

Mental health patients should have more opportunity to make informed decisions about their treatment, says Jonathan Naess

February 27, 2008 11:32 AM

Dr Paul Keedwell is clearly a remarkable psychiatrist, writes Jonathan Naess; not least because, like the proverbial turkey voting for Christmas, he is an advocate of less not more medication from psychiatrists of mild to moderate symptoms of depression.

Keedwell's book is remarkable too for its profound respect for the subtlety of our experience of depression. Until recently stigma and discrimination has made it difficult to talk frankly about what it feels like to be depressed, and to look with clarity at what insights and benefits we may gain from it.

He argues convincingly from the new science Evolutionary Psychology that there must be some significant evolutionary advantage to depression (as well as the obvious costs) otherwise it would simply have been bred out of us by now. It should surely make us pause for thought before using powerful psycho-tropic drugs to blast away mild depression, if this experience has served our ancestors well for millennia.

His recommendation happens to be in line with current National Institute for Health and Clinical Excellence guidelines, albeit broadly ignored by many GPs and psychiatrists throughout the UK, not least because for years we have had scandalous under-investment in talking therapy with the result that there is often an eight-month wait to access cognitive behavioural therapy.

More worryingly, the announcement yesterday of the large study of published and the unpublished data from big pharma under their Freedom of Information Act, accessed from the United States regulatory body the FDA, revealed that service users may have been misled in placing too much confidence in SSRIs unless being treated for most severe forms of depression.

As psychiatrists like Keedwell leave behind the medical model, it opens up the possibility for us to make informed choices about a range of services. Stand to Reason has members with a wide spectrum of experience of mental distress including depression and of taking medication: some are passionately for whereas other are against. Similarly, Keedwell's view of the "importance of resolving intrapsychic conflicts arising from childhood and infancy" is a bit too Freudian for my taste. Having tried both, CBT has been a far more effective tool for managing my mental health. For all the evidence, nobody has more information about our mental health than ourselves. Because one size does not fit all, we need to be passionate advocates for our right to choose.

Keedwell writes in today's Guardian, "the British public seems to feel threatened" when discussing the positive aspects of mental illness.

When Nelson Mandela made his inaugural address to South Africans as their first black president in 1994, he said:

Our deepest fear is not that we are inadequate
Our deepest fear is that we are powerful beyond measure...
And as we let our own light shine, we unconsciously give other people
Permission to do the same.
As we are liberated from our own fears, our presence automatically liberates others.

High flown rhetoric, or a beautiful dream to think that this could ever apply to mental health? Stand to Reason is encountering the truth of Mandela's words when engaging with companies in attempting to change workplace cultures. A senior HR professional from a big four accountancy firm last week explained to me the sorts of difficulties that teams can face, and the emotional intelligence needed to debrief effectively after an audit goes wrong. He then turned round and said, "You know, if we can get mental well-being at work right, it will make the rest seems like a piece of cake."

Click those blues away

Internet support sites can help you overcome depression, says a new study. But only if you've been through therapy already.

My personal experience of the support site, www.social-anxiety.org.uk, is that alot of people go there for a serious moan, and to agree with each other's moans about how unfair and harsh the world is, rather than to try and help each other to change.

But such sites are definitely useful. They put people in touch with support groups, with CBT groups, with information about their condition. It is giving the power to the individual, to the sufferer, empowering them to find out about their condition and learn how to overcome it, rather than the Freudian model of therapy, where it all depends on the mysterious intermediary power and Gnostic wisdom of the analyst.

Positive psychology in state schools

Here is an article I wrote for the Times last week, looking at a new scheme to introduce Martin Seligman's positive psychology into UK secondary education. It has interviews with a few other leading lights of the 'politics of wellbeing', such as Lord Layard, Geoff Mulgan, and Anthony Seldon of Wellington College.

Psychoanalysis: great art, bad science

Darian Leader, Last of the Psychoanalysts, is back banging his drum for the ideas of Sigmund Freud and against CBT, with his new book about melancholy, which is reviewed by Hanif Kureshi here.

Leader is a rabid critic of CBT, which he has compared to the brain-washing techniques of the Cultural Revolution. If only we all had access to psychoanalysts like him, he mourns, then we could accept that the roots of our mental illnesses are the sex and violence in our unconcious, and return to whatever Freudians call health.

Kureshi loves psychoanalysis, apparently. So do loads of other artists - like David Crane, creator of the Sopranos, who made a psychoanalyst one of the heroes of his TV series.

Artists like psychoanalysis because its method is very like their method - it relies on flashes of insights into the deep darkness of our motivation. But, like art, it refuses to test its findings. They must be self-evidently true about the human condition, like a novel or a film.

CBT, by contrast, has the guts to test its findings in clinical trials, something psychoanalysis has never done. Instead, psychoanalysis, like the novel, relies on anecdotal evidence and the haphazard observation of the author / analyst.

This is a great way to write a book, but a catastrophic way to formulate a medical theory.

And psychoanalysts are, in fact, often great writers - Freud is a far better writer than just about everyone working in CBT. But that doesn't mean his wild claims are right, anymore than the equally wild and untested claims of, say, DH Lawrence or Norman Mailer are right.

You have to test your findings, otherwise your insights are 'just' art, and not science.

The Drugs Don't Work...

Lots of UK papers are leading today with a new report from the Psychology department at the University of Hull, which reviews around 50 studies carried out by pharmaceutical companies, both the studies they published, AND the ones they for some reason chose not to do.

The results are startling. Says The Times:

Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence.

The new generation of antidepressant drugs work no better than a placebo for the majority of patients with mild or even severe depression, comprehensive research of clinical trials has found.

The researchers said that the drug was more effective than a placebo in severely depressed patients but that this was because of a decreased placebo effect.

The study, described as “fantastically important” by British experts, comes as the Government publishes plans to help people to manage depression without popping pills.

The really shocking thing is that the pharmaceutical companies should have done these reports and not published them. Some politicians and experts are now saying drug companies should be legally obliged to publish the results of all research studies, not just the ones that support their case...it reminds one of investment banks only publishing research that supports the deals they sell...

The report comes as GP prescriptions for anti-depressants like Prozac are hitting record levels.
This may be because GPs are not trained in emotional analysis, and do not always understand the alternatives to anti-depressants, such as CBT.