Therapy before pills is great, but why wait till people are depressed to teach them how to self-heal?
I was asked by a journalist in Scotland about this: Millions of people with mild depression in England will be offered therapy, exercise, mindfulness or meditation before antidepressants, according to new NICE (National Institute for Health and Care Excellence) guidelines. What do I think and should Scotland introduce a similar approach?
I think it’s great news. Therapy, exercise, mindfulness or meditation, and even social prescribing by GPs of activities like community gardening, men’s groups and sea swimming, have all been shown to provide better long term outcomes than medication for mild depression. They are more cost effective too. And just more human. That people with mild depression were offered antidepressants in the first place amounts to public health negligence on an industrial scale in my view.
Mild depression, like sadness, grief and physical illness is an essential, inevitable and healthy part of being a ‘whole’ person. As is death. We may or may not be willing to come to terms with what it means to be alive and human, but to the extent that we do, we heal and become whole. Integrated and adjusted. Less fragmented.
To treat the “symptoms” of being human may alleviate emotional and psychological distress in the short term but ultimately it undermines the whole point of that discomfort: the body telling us that something is wrong. If we ignore the message, the body may shout even louder, perhaps hitting us with anxiety attacks, more severe depression, or migraines, back pain and other physical symptoms.
The conscious ego (who we think we are in day to day waking life) of a typical person living in Western culture in 2021 is adept at coming up with reasons not to heed these warnings. So they keep going for months and years in a job or relationship that isn’t working. They feel overwhelmed and don’t know how to change. It’s “too big to deal with” — getting through another working week is hard enough — so they put their head down and keep pressing on. The question they must eventually ask themselves, though, is unavoidable: is this really how I want to live? If it is then anti-depressants work very well.
Another way to see depression is as a message from a deeper knowing within us. Far from being broken, the depressed version of us is fundamentally OK, feeling what are supposed to be feeling, and furthermore we already have all the resources we need to feel better. Sure, we can’t access them right now because the way we are living is mis-calibrated, but we can re-calibrate by developing curiosity about our inner signals, getting to know ourselves, and learning to trust our instincts. Too often this inner trusting is drilled out of us in childhood. Ancient Greeks would see a man’s aversion to his own inner truth as a disability, rather like we see other phobias today as irrational and counterproductive.
Given that we are not brought up to trust our instincts, the temptation is to medicalise melancholia as something to do with brain chemistry and just take the pills. This misses the thing that make us human: the ability to feel deeply. The vagus nerve is the most evolved part of our autonomic nervous system and it enables us to experience awe, joy, creativity and loving connection with ourselves, other humans and the universe. Some regard it as the most advanced technology on Earth because it holds the key to our highest potential.
For someone who has been feeling depressed and isolated, their ventral vagal social engagement system can be brought online through the support of a therapist initially, until they learn to give themselves the safety cues their vagus nerve needs to be activated. This might be through activities that connect them with the wonder of being alive such as painting, dancing, walking or simply regular social connection.
In many cases taking pills to numb out robs people of the opportunity to develop self mastery and heal through this expansive process. Life gives us certain moments — which register in our guts (connected to the vagus nerve) — to break through and grow. Or we can turn away. Red pill or blue pill. As Alan Watts said, all life moves from lower order to higher order. You never know what the higher order will look like and as soon as you do it means it’s not in the future but in the past. You are looking at life through the rear view mirror. The transition from lower to higher orders can seem scary and even impossible. That’s the point.
This is the moment that you, as an infinitely intelligent organism, are being called into initiation. It’s an invitation to step into a purification process. A bit like finally deciding to find and delete all those hidden data folders on your computer that were clogging up the hard drive. We all have a backlog of unprocessed data that we are carrying in our bodies. It takes up bandwidth and reduces our ability to feel present and alive. Confronting the backlog can be scary. Like any initiation, it is uncomfortable, even painful. It involves introspection and shedding layers of identity and old stories about ourselves. Probably, too, coming to terms with grief around losses that we haven’t let ourselves feel yet.
This work is, in my view, why we are here. To feel alive and experience joy, awe and meaning, and the possibility of grief, because everything we love we will lose. So I welcome the news that NHS England will offer therapy, exercise, mindfulness or meditation before antidepressants to millions of people with mild depression. If this actually happens it means people will be supported to take responsibility for their own self healing. It will encourage them to cultivate resilience by leaning into the discomforts of life and develop curiosity about their inner journey.
I hope Scotland follows suit. It would be good timing given that self-reported depression in Scotland has risen by 50% in a decade, with self-reported anxiety, attempted suicide and self-harm also at their highest levels in ten years, according to the latest Scottish Health Survey. My only question is, why are we waiting until people are depressed to teach them this stuff? It’s so obviously needed in schools.
