In the Mood

It occurred to me the other day, in a slow-witted way, that one’s mood is rather like the weather.  Some days are dreich, some cloudless, but mostly round these parts, it’s showers and sunny periods.  There’s not much point in complaining about it; just wrap up and get on with whatever you are supposed to be about.  You could imagine the late Duke of Edinburgh saying as much.  I don’t suppose he would have had much time for his grandson’s book, whose German translation is entitled „Reserve“.  But nowadays the quality of reticence, of being reserved, the stiff upper lip if you will, has rather fallen out of fashion.  It’s okay not to be okay.  So we say, let’s talk about the weather.

I haven’t read Prince Harry’s book.  I said in my German class last week that I was waiting for it to be remaindered.  Then I would pop into Waterstones and say, “Have you got a spare spare spare?”  It was a cheap gag.  I’m not proud of it.

When I was a medical student the psychiatrists were keen on making a distinction between “reactive” or “exogenous” depression on the one hand, and “endogenous” depression on the other.  You might be low, on the one hand, because outrageous fortune had just hurled too many slings and arrows at you, or, on the other because of some chemical imbalance in the brain which depressed your “affect” no matter what your external circumstances were.  The distinction was not clear-cut; there could be a progression from reactive to endogenous depression because sooner or later life’s endless vicissitudes would alter the brain’s hard wiring.  You might say, “Life eventually got to me.”  In this sense, endogenous depression was seen as a more serious illness than reactive depression, more likely to culminate in an altered mental state, a psychosis.  The voices might tell you to kill yourself.  This was the end of the spectrum psychiatrists were interested in.  Talking therapies were not so much in vogue.    

I remember the lecture when these theories were being propounded.  My neighbour leant over, shook his head, and whispered to me, “It’s all reactive.”  I don’t know why he thought that.  Maybe he looked at the patients, and at how miserable their lives were, and concluded than in their shoes he would be just as wretched.  But if he was right, then you might argue that depression was hardly a medical condition at all, rather a social one, and that its treatment would involve an attempt to improve a patient’s living conditions.  Yet at the time, major depression was seen as an organic disease, to be treated by interfering with neurotransmission, using potent drugs such as the tricyclic antidepressants.  The trouble with the tricyclics was that they were very dangerous in overdose, and after all, depressed patients were liable to overdose.  The selective serotonin reuptake inhibitors, SSRIs, were yet to come on the market.

Electroconvulsive therapy, ECT, was still in vogue.  Here, the idea was that if depression really was a disease of neurotransmission, then somehow you could “wipe the slate clean” by passing an electric current across the brain.  I suppose it was analogous to treating ventricular fibrillation by passing a current across the heart, thereby “defibrillating” the rogue arrhythmia and bringing the heart muscle to a standstill in the hope that it would recommence in normal sinus rhythm.  ECT’s immediate effect was to cause an epileptiform convulsion.  Thereafter, it was hoped, the brain in quietude would revert to something more like its normal self.  The first locum I ever undertook as a medical student was in a psychiatric hospital and I assisted at a weekly ECT session.  The therapy was performed, mercifully, under general anaesthetic.  The anaesthetist was a cheerful young woman with a very sunny personality and the clinic was always a happy one.  I often wondered whether it was actually the weekly contact with her that improved the patient’s mood.  Or could it have been the general anaesthetic itself, rather than the ECT? 

ECT still fulfils a role, albeit more limited, but this sense of “wiping the slate clean” still persists in state-of-the-art therapies, for example, involving the use of hallucinogenic drugs to reset the brain’s myriad connections.  Professor David Nutt, head of Imperial College London’s Centre for Psychedelic Research researches this field, using Psilocybin, a component of magic mushrooms, under strict monitoring conditions.  (Don’t try this at home.)  You may imagine the use of such drugs to be controversial, and indeed Prof Nutt is no stranger to controversy.  He used to be chairman of the Advisory Council on the Misuse of Drugs (ACMD).  He told the government that horse-riding was more dangerous than ecstasy, so they sacked him.   

Nowadays, the distinction between reactive and endogenous depression has rather fallen out of favour, and psychiatrists are more inclined simply to note the severity of the condition in terms of its impact on the patient’s life.  (To return to the weather analogy, is this a short-lived squall, or is it what the inhabitants of Auckland have just experienced, the worst weather event in 200 years?  I look at the pictures of the Auckland streets, so familiar to me, turned into rivers.  Fortunately, New Zealanders are extremely resilient.)

The mood-weather analogy is not purely theoretical.  Seasonal Affective Disorder is a real entity. The climate continues to change, there is war in Europe, earthquakes abroad, rampant inflation at home, strikes and rumours of strikes, bile on social media, violence in the classroom…                                                       

Yet whose mood is not now beginning to lift, despite this winter of discontent, at the sight of banks of snowdrops, and the prospect of longer days?  I await, with buoyancy and hope, the crocuses. And then the daffodils.    

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