How Not To Cheer Up a Depressed Person 4

Lessons From My Living Gloom

How Can Anyone Measure Depression?

Modern neuropharmacology is mind-blowingly sophisticated. Yet the critical metric needed to deploy it couldn't be cruder. 

If you’re depressed, your healers’ key diagnostic tool is some form of this simple query: 

Are you feeling the same, better, or worse?

Your answer determines your treatment. Exactly how, depends on the treatment.

Sometimes a certain answer might mean adjusting a dosage. Or it might prompt trying another pill. For one therapist, a particular answer might lead them to pursue a particular childhood memory. For another, a tweak to your CBT regime. Focusing on a different acupuncture meridian. A switch of homeopathic remedy. Applying a different crystal to your forehead.

I didn’t try all these cures, but whatever their training, experience and qualifications, my would-be healers faced the same insurmountable challenge. 

They can't possibly know how I'm feeling. 

Sure, they've seen many more people presenting similar symptoms than you or me. As a species, our behaviour is far more predictable than we like to think, and they’ve seen it all before. 

But how can they possibly know what's going on in my head, if I don't even know what's going on in my head?

I won't get into all that new fMRI research revealing that much of what we think is voluntary, is in fact involuntary. This brings into question our whole perception of free will, and I’m trying to keep this tight. 

Suppose I am the master of my fate - what do I know about how I’m feeling? Or to be precise, what do I now remember that I thought I knew when I was depressed? 

Well, I remember feeling sorry for my would-be healers. I’d feel guilty at not feeling better. I'd often answer their 'how are you feeling?' queries by casting around for something positive to say. For someone as conciliatory as me, it felt rude not to. 

But even if my doctors and therapists suspected me of answer-doping, how can they calibrate for that with any confidence?  

The next patient through their door might, for their own conscious or unconscious reasons, go the other way. They may choose to exaggerate their pain, rather than play it down. There’s no red cell count for depression, no bodily fluid to deliver a precise metric. 

How then, can anyone know whether I dial my reported suffering up or down. And up or down from what, exactly?

Welcome to the tangled mess of variables that confronts every doctor. Their cursor hovers over which box to tick for the patient assessment, anticipating my Same/Better/Worse verdict.

Filling in that 'how the patient is feeling today' box is critical to my treatment, but there’s so much packed into Same, Better or Worse.  My one-word answer conceals so many layers, levels, filters, moving parts, and overlapping Venn diagram arcs, it makes the challenge of treating depression seem impossible. 

That’s before you even consider our poor understanding of the way the various families of antidepressant work. Their tongue-twisting names and polysyllabic active ingredients are intimidating enough. A glance at the long list of possible side-effects makes your heart sink further.  But it also reveals that these pills to be very crude tools indeed. 

Included in every box of antidepressants is the manufacturers’ small print. This usually covers several pages, all in tiny font. It’s printed on paper so creased from being folded tight to fit in the box, you have to smooth it out to make it legible. 

The information contained in this list is as hard to read metaphorically, as it is literally.  I suspect most people don’t bother, certainly not every time you start a new box. 

We leave that stuff to the experts in white coats. When I was depressed, I lacked the energy, motivation and focus to pay close attention to those closely-printed columns of boilerplate yada-yada.

But now I do, they make even less sense. Antidepressants are big big business these days, with billions prescribed and popped around the world every day. 

The neuroscience behind these pills represents the state of the art, delayed only by official approval procedures. They are the sharpest tools of the depression trade.

But scanning the list of side-effects is a surreal experience. Many are self-contradictory, and others could make you worse. 

My current pills include warnings of these possible side effects:

• depression

• suicidal thoughts

• weight loss 

• weight gain

• sleep loss 

• excessive sleep 

Big Pharma employs top marketing professionals, and lawyers. They wouldn’t include these on the list unless they absolutely had to. There’s something deeply weird going on here.

Why should I take a pill prescribed to ease depression, that may cause it?  What confidence should I have in a pill that might both make me gain or lose weight? Are these Schrodinger’s Pills, or Snake Oil?

Ask these kinds of questions, and you feel like the kid hooting at his stark-naked monarch in The Emperor’s New Clothes.

One of the better-thumbed books in my Depression Library is Robert Whitaker’s Anatomy of An Epidemic. The author was Director of Publications at Harvard Medical School before becoming a Pulitzer Prize-winning author.  

Anatomy of An Epidemic was first published in 2010, and is about America, but the Emperor’s New Clothes question it asks is no less pertinent now:

Why are so many Americans today, while they may not be disabled by mental illness, nevertheless plagued by chronic mental problems - by recurrent depression, by bipolar symptoms, and by crippling anxiety? If we have treatments that effectively address these disorders, why has mental illness become an ever-greater health problem in the United States?

These are deeply inconvenient questions. 

I was surprised at my own instinctive answers, which involved speculating about the increase in diagnosis, and social trends. Making excuses, basically.  

Mental illness seems to get a free pass, or occupy a blind spot in our critical analysis. If in any other context you were to show me two graphs with identical hockey-stick upturns over the same period, my first guess would be to assume causation. 

More smokers: More lung cancer

More thalidomide: more deformed babies

The more inconvenient the logical conclusion, the more prone we are to avoiding it. This is the human condition - we’ll look for any reason not to change when we don’t want to.

More atmospheric carbon: More global heating 

is a particularly depressing example. 

But at least there are significant numbers of people pointing out this Inconvenient Truth.  

Why, as a society, are we so much more resistant to assuming causation between:

More antidepressants: More depression? 

Since I recovered my capacity for critical thinking, and energy to research, I’ve discovered this is a very active debate. Among a small group of mental health policy professionals. 

These critics tend not to be funded by the obvious beneficiaries of this doublethink, Big Pharma. This may explain why the debate is limited to a small group of mental health policy professionals.

But what of all the front-line staff, dealing with our tsunami of mental health problems every day in consulting rooms, GP surgeries, and therapy suites?

Considering the epidemic confronting them, I’m amazed at the persistence shown by the various mental health professionals who’ve treated me over the past few years.  Somehow, in the face of this relentless, elusive Black Dog, they remain undaunted, trying to make me better despite its lugubrious omnipresence, and foul stench. 

Depression, in many ways, can be defined as excessive self-absorption.  So it’s unsurprising that when I was depressed, I thought the problem was me. 

Now I’m able to step back and see my experience in a broader context, I’m starting to wonder if it wasn’t all about me. The issues seem so complex, and entangled, as to be insuperable, and unlikely to boil down to any single factor.  

Big Pharma isn’t the only healer with shaky evidential grounds for claiming to make you better. Even friends for whom talking therapy has been a huge help, say finding the 'right' therapist is hit-and-miss. And once you’ve found the 'right' one, talking is expensive, slow, with no clear end point. 

And you'll never know what would have happened if you hadn't done it. Finding the right therapist, the money to pay them,  getting to appointments on time every week, all take their toll in stress and anxiety. Might you have recovered quicker without all the stress involved in talking therapy? 

Who knows? I certainly don’t. But then how can you?

This personal reflection isn’t the right place to debate such big picture issues, however disturbing. 

If you’re depressed and in a black hole, it’s natural for you, or those close to you, to seek help. 

Big Pharma and the counselling profession aren’t the only two doors out of the cellar, but even in my deepest gloom, my respect for science deterred me from trying ‘alternative’ therapies. 

So Pills and Talking are the ones I tried. It’s reasonable to ask, how well do these ‘scientific’ therapies stand up to scientific scrutiny?

Control Experiments

My second-favourite saying of Dad's, and another one I find myself using more as I get older, is: 

'There are no Control Experiments in Life'.

It's not strictly true. 'Life', broadly speaking, includes double-blind clinical trials. 

These are the foundation of medical research, our best way of ‘proving’ efficacy.  Gather a pool of patients with identical health conditions, randomly inject half of them with a single variable (e.g. a Covid vaccine) and squirt an inert placebo into the other 'control' half.  

Neither jabber or jabee, at either end of the syringe, knows which is which. Hence, 'double-blind'.  The difference in outcomes between the two cohorts defines the treatment’s efficacy.

But even here Dad may have had a point. The whole purpose of the double-blind rigmarole is to prevent the results being biased by either the doctor or the patient knowing whether their particular syringe contains salt water or vaccine. 

That's because if the jabber and/or the jabbee think they know they've got the Good Stuff, the subtle alterations in their body language and other non-verbal communication often mean the control group reports feeling around 30% better, even though all they had was salt water or a sugar pill. 

30% is an average from thousands of trials, by the way. In individual trials, the placebo effect can be anything from 15% to 72%. 

Some trials have found control group subjects continuing to report feeling better even after they were told they'd had the dummy dose. Control group patients have been known to request a supply of sugar pills or salt water to keep them feeling better.  

I won't even start on the implications of the 'nocebo' effect.

Man The Storyteller

By all means write a book about your own escape route from the Black Dog. Go ahead and give someone else’s account of their recovery to a suffering friend or relative. 

I respect your altruistic desire to help others, to spare anyone a moment of avoidable pain. Why, after all, am I writing this? To deliver my Big Takeaway from my experience of my own, and others' depression. 

But beware of Man the Storyteller, because that's you too.

We excel at storytelling. It comes so naturally we don't realize it. Human culture and civilization spring from our ability to imagine patterns in chaos. We attribute intention to instinct, see coincidence as destiny, and impute purpose to inanimate objects. 

Storytelling has given us the glory and gore of the great religions. It has gifted us the imagination both to decode the mysteries of the double helix, and the capacity to delude ourselves that a virus 'cares' that we're 'battling' it.

It's incredible that dung beetles can navigate by the stars, but do they see Dung Beetle Twins, like we pick out the constellation of Gemini? Pavlov trained his drooling dogs to associate food with sound, but his experiments reveal nothing about whether dogs think they know why other dogs fall in love. 

Storytelling is a wonderful power. So far as we can tell, it’s unique to homo sapiens. 

So let's be 'wise humans'. Don't let your enthusiasm for your own miracle cure, your admirable intention to buy that Matt Haig book for everyone you know, or your sincere faith in your God, overwhelm a vulnerable, depressed friend.

How Not To Cheer Up A Depressed Person

Why am I telling you all this, when all those multitudes of others, including Matt Haig, have written so movingly and insightfully about depression? 

For me, all those attempts to help me, by my wife, my family, my friends, my doctors and my therapists, made me feel worse. 

Does that make me sound monstrously selfish and ungrateful? If so, maybe I was right for these past six years, and I really am a monstrously selfish ingrate. 

Or maybe ‘We’re all wired up differently’ is Dad’s most precious legacy. 

Ignoring our teenage mockery, he kept showing his children the key, so we’d know where to find it when we needed it. 

When depressed, any attempt to help me was doomed to fail. Here’s how my infallible lose-lose defence system worked.

• If you didn't offer to help me, that proved I was worthless, and I'd feel worse. 

• If you suggested I read this book, or that article, and I didn't, I'd have let you down, and would feel worse. 

• If I did read it, and still felt bad, I'd have failed, and would feel worse. 

• If you told me that opening up about my emotions would help, and I tried, but still felt bad, I'd feel worse. 

See? Not a single scenario in which any intervention could help. You, and I, literally couldn't win. 

Looking at it now, it was quite brilliant in its way. Is it my own invention, or so common there's a standard psychological phrase for it? Either way, if you’d told me, I would have found a way to make it make me feel worse.

So I'm not going to presume that any of what I've written here will be of any use to anyone who's depressed. Might do, might not. 

This advice, for what it's worth, is directed to those friends and family who want to help. 

All I'm saying is tread gently. By all means offer that book or article, but in a quiet, offhand, casual way. No pressure. Take it or leave it. 

Instead of 'You've got to read this', try 'I found this kind of helpful'.

Replace 'What you need is mindfulness' with 'Do you know anything about mindfulness?’.

I'm absolutely not saying don't write a book about your own experience, or reach out to a friend, or even a stranger, with depression. That's all really important. 

Just don't assume that what worked for you, or an account you found moving or compelling, will have the same effect on others. Offer your experience tentatively, with humility rather than assertiveness. 

You see, we're all wired up differently.

**

SternWriter (Robert Stern) worked for international broadcasters in Tokyo, Hong Kong and Beijing for a decade before spending twenty years as a documentary filmmaker, broadcast consultant, and journalist trainer with his independent production company Litmus Films. 

He has broadcast live in Japanese on public broadcaster NHK, and co-presented a game show in Chinese seen by an audience of 100M in China. At one point he’d made 2 of the UK’s top 10 crowdfunded documentaries. When depressed, none of this prevented him from feeling like a worthless fuckup.

Following his recovery from depression, he’s stopped scraping a living from filmmaking to set up non-profit social media network See Through News, with the modest goal of Speeding Up Carbon Drawdown by Helping the Inactive Become Active, and started taking growing vegetables more seriously. 

During lockdown he wrote The Quiet Revolutionary, an interactive Zoom play celebrating the life and work of his father, Dr. Gerald Stern (1930-2018), and his father’s hero, James Parkinson (1755-1824). The World Premiere was performed by the author and members of local Parkinson’s UK groups in May 2021. Robert welcomes invitations from any other Parkinson support groups for encore performances. Depression is a common symptom of Parkinson’s disease.