When I’m talking about the importance of metaphor, I often use the following example. What do you reckon?
Do you know anyone who has a stomach ulcer? 30-odd years ago,everyone knew somebody, or several people, who did. It was assumed to be a “lifestyle disease” caused by eating rich food and drinking alcohol. One would constantly meet middle-aged men drinking milk in pubs, because that was what their doctor said to do. Then in 1982, it was discovered that the actual cause of stomach ulcers was, fundamentally, a bacterium called Helicobacter pylori. Most cases of stomach ulcer were then immediately cured with a short course of antibiotics.
The illness known as “depression” is following a different – and yet somehow similar – course. The metaphors medics use to think and talk about it are changing dramatically, alongside a change in treatment.
The condition has been recorded since classical times, known by various terms such as “melancholia”. But a new language around “depression” became popular in the 60s, when the drug companies believed they had found a pill that would cure it: the equivalent of an antibiotic. However, they were mistaken: in all but a few cases, the pills had very little effect above placebo. Placebo, though, turned out to be very effective against this “disease”.
Since the 1980s, the researchers have been trying to understand what this condition really “is” – hindered by the drug companies who want to sell tablets. But nowadays the value-for-money authorities won’t allow doctors to prescribe tablets alone, and for good reason: “depression” is not an “illness” caused by a bacterium, but a very natural and evolutionarily-sound adaptation of the healthy human body.
The “illness” metaphor is useful insofar as it removes any suggestion that depression is caused by a moral failing. But beyond that, I think it’s mostly unhelpful.
What do you think human beings used to do during the winter? The records suggest that even as recently as the 1700s in rural France, for example, peasants pretty much went into hibernation: they would stay indoors, not talking, not thinking, not reading. Just sitting or lying down, huddled together in one room, using as little energy as possible and eating and drinking only a little. Probably they had very little to eat or drink, but seeking food or water involved getting cold and using up energy – and they just didn’t feel like it.
Thus, it’s likely that humans are adapted to adopting semi-hibernation when the environment demands it. This state has physical and “emotional” components: the person is disinclined to get out and do stuff, their metabolism is reduced etc.
With this awareness, the appropriate treatment for “depression”, rather than a pill, is changing the person’s environment so that their system doesn’t feel that it’s endless winter, and hibernation is no longer an appropriate response.
The key elements are:
- daylight, particularly early-morning daylight
- movement/exercise, ideally in the daylight
- a healthful diet low in carbs (which trigger hibernation), high in other nutrients
- purposeful activity.
This, as I understand it, is the basis of most modern treatments. Doctors in the UK prescribe exercise in preference to, or alongside, drugs, for example.
- Does the “hibernation pattern” metaphor fit your experience of “depression”? Or is there a more useful metaphor out there? Please comment below.