This week, while thinking about what I might write for my next post, I happened to hear an excellent version of “Get Rhythm” by the rhythm and blues band, NRBQ. The song, written and first performed by Johnny Cash, can set your feet kicking up a storm. The lyrics begin,
Hey, get rhythm when you get the blues Come on, get rhythm when you get the blues Get a rock and roll feeling in your bones Put taps on your toes and get gone Get rhythm when you get the blues
The song goes on from here to tell us that to get rhythm when you have the blues doesn’t cost much and yet “does a million dollars worth of good for you.” This concept particularly caught my attention because just a day before, I had read anarticle titled, “Exercise Leads to Best Outcomes for Depression.” A summary of the study’s findings stated,
A massive new meta-analysis has found that exercise through walking or jogging is better than antidepressants or cognitive behavioral therapy for treating depression. Antidepressants by themselves were the worst treatment for depression, with effectiveness that overlapped with placebo.
And earlier, I read an article on music therapy that indicates,
This comprehensive summary of SRs [systematic reviews] demonstrated that MT [music therapy] treatment improved the following: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson’s disease, depressive symptoms, and sleep quality. MT may have the potential for improving other diseases, but there is not enough evidence at present. Most importantly, no specific adverse effect or harmful phenomenon occurred in any of the studies, and MT was well tolerated by almost all patients.
A more recent study focuses specifically on depression:
Individual music therapy combined with standard care is effective for depression among working-age people with depression. The results of this study along with the previous research indicate that music therapy with its specific qualities is a valuable enhancement to established treatment practices.
In past blog posts, I’ve written about the nature of depression (see HERE) and explained that the way we handle such experiences can enhance the respect we have for ourselves and others have for us. In other posts I questioned the effectiveness of antidepressant treatment while expressing concerns about its well documented negative health consequences (see HERE). In contrast to the drug treatment approach, exercise actually enhances physical health while improving a person’s experience of depression. As a result of these thoughts that flowed from listening to “Get Rhythm”, it occurred to me that I have never discussed the value of dance for helping someone struggling with depression. So, here goes.
How Can Dancing be Helpful?
First, if limited money is an issue for you, note that dancing can be done for free. Just put on some music and dance.
Here’s a simple routine that can be fun and provide enough exercise to enhance your health. Play a rhythmic song and vigorously dance to it. After the song, take a break by doing a relaxing task, like reading part of an article or doing some meal preparation. After five minutes of catching your breath, put on another song and dance again. Do this ten times, and you have an excellent healthy fun workout.
To enhance this workout, if you are experiencing some strong negative feelings on the day of your dance workout, while dancing, allow yourself to deeply feel those feelings. Let your dance movements help you to express and release all of the negative energy.
Now, some people are experiencing depression because they are lonely. They might be stuck on how to go about meeting new people. Taking a dance class might be the perfect solution. Others who enjoy dancing will be there. Sharing this common interest while engaging in the physicality of dancing can be a very healthy way to deal with loneliness.
Finally, finding a music therapist is another option. Dancing is just a part of this treatment, but discussions of the poetry of songs, along with the feelings that music brings to the surface, can be a safe and helpful way to deal with troubling experiences.
Well, those are some of my thoughts for this week. Until next time, if you get the blues, get rhythm,
My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
Welcome to From Insults to Respect. As this post’s title indicates, today I take up the question, “Is depression really so bad?” In doing so, I imagine many will conclude I must be out of my head or a complete numbskull. My challenging task for today is to see if I can convert such insults to at least a modest degree of respect.
As a start, let me be clear that I recognize and empathize with what I imagine the insulters’ position is likely to be:
Depression is every bit as bad as a majority of folks think it is, and even a whole bunch worse. Depression, these people are likely to point out, leads to some folks ending up committing suicide, or attempting it. Other sufferers of depression will end up being hospitalized at great societal cost, including costs to U.S. employers that has been estimated at $187.8 billion a year. This includes $134 billion in health care (health and mental health combined), $20.9 billion in absenteeism, and $32.9 billion in lost productivity. Finally, the anguish that comes from depression is nothing to make light of.
My case about the degree of badness of depression is worth considering is three pronged: 1. Repeatedly, the evidence indicates people who take antidepressants leads to more suicides and hospitalizations. 2. The available evidence indicates the consequences of using the arguments about suicide and hospitalization to convince people to take antidepressants leads to worse long term suffering of those folks experiencing depression. 3. When the nature of depression is clearly understood as a natural, potentially healthy process for dealing with stressful situations, it leads to less harm than believing that it really is so bad.
Evidence that Suicides and Hospitalizations Increase with Antidepressant Treatment
Convincing folks that depression is so serious because some people who experience it end up committing suicide or are hospitalized for suicidal thoughts is counterproductive. People who become convinced by this type of argument are more likely to get treatment with so called antidepressants when they find themselves becoming depressed. Moreover, such people, using the same argument will urge others who are depressed to get such treatment. This would be fine if the treatment sought would be just counseling/psychotherapy, but in modern countries, such as the United States and Great Britain, the first-line treatment is either antidepressant medication or a combination of antidepressant medication plus psychotherapy.
Despite this, according to a November 15, 2023 study appearing in Psychological Medicine by Harvard University researcher Nur Hani Zainal, such approaches can have dire consequences. Treatments that included antidepressant medications, either as a stand alone treatment, or in combination with psychotherapy, had significantly worse outcomes than psychotherapy alone for suicide deaths, suicide attempts, psychiatric emergency department visits, and psychiatric hospitalizations. This is a consistent finding that included 34 random controlled trials.
More specifically, the researcher wrote:
Forty-seven out of 1273 (3.7%) in the combined treatment arm and 24 out of 1240 (1.9%) in the psychotherapy-only arm had suicide attempts and other serious psychiatric adverse events, and this difference was statistically significant (OR 1.96 [1.20–3.20], p = 0.012)…
Thirty-one out of 1030 (3.0%) in the psychotherapy-only arm, and 67 out of 1192 (5.6%) in the ADM [antidepressant medication]-arm had suicide attempts and other serious psychiatric adverse events. This difference was statistically significant.
This analysis, along with others, suggests regardless of the treatment, over 94% of those going for treatment are unlikely to end up having one of the very serious consequences of depression. Framing the need for treatment by raising the prospect that very serious consequences are likely to occur without treatment, rather than being helpful, too often leads to antidepressant treatment, which the best science we have indicates this will increase the risk of such serious consequences.
The Effects of Antidepressants On Suffering
The available research findings indicate so called “antidepressants’ can increase the likelihoodof strokes, heart attacks, falls and even death. Antidepressants can cause side effects, including nausea, agitation, weight gain, lower sex drive and indigestion. Research also suggests that people often experience unpleasant withdrawal symptoms, known as antidepressant discontinuation syndrome, when they stop taking antidepressants, sometimes for weeks or months. Thus, people seeking relief from a challenging emotional experience who turn to the most frequent prescribed treatment–antidepressants–are actually increasing their risks of suffering from these various negative consequences.
A very recent study titled “The impact of antidepressants and human development measures on the prevalence of sadness, worry and unhappiness: cross-national comparison,” the researchers conclude,
“In this study, we examine the relationship among individual symptoms (sadness, worry and unhappiness), human development factors and antidepressant use in 29 OECD [Organisation for Economic Co-operation and Development ] countries. We report that increased antidepressant prescribing is not associated with decreased prevalence of sadness, worry or unhappiness. However, income, education and life expectancy (measured using the Human Development Index) are associated with lower prevalence of all these symptoms. This suggests that increasing spending on depression treatment may not be as effective as general public health interventions at reducing depression in communities.”
An estimated 18 billion dollars a year is being spent on these drugs, (approximately 100 billion dollars spent every six years). This amount does not include the cost of appointment hours of psychiatrists and other prescribing doctors that is part of the required process of people getting access to these drugs. This appears to be a lot of wasted money that can be used more productively in other ways. Given this cost, along with the drugs’ side-effects, and negative health outcomes, framing depression as being so bad so that it ends up encouraging people to take “antidepressants” may be unwise.
So, why do so many who are taking these drugs come to believe they are enormously helpful? There are three major guesses about this.
Many people who become depressed start to feel better after a few months without taking this type of drug. If they do take the drug when they become depressed, and begin to feel better, they attribute it to the drug rather than the natural course of the experience.
If they start to feel better while taking the drug, they may try to stop taking it. Because of the withdrawal effects that feel awful, they are likely to think these awful feelings are due to their depression returning, so they quickly return to taking the drug while now more convinced that the drug is helpful.
Some people are very susceptible to the placebo effect, and therefore any drug that they are prescribed by a doctor leads to the perception that the drug is effective.
Depression as a Natural, Potentially Healthy Process
Conceptualizing depression as a mental disorder tends to fail to motivate active coping beyond taking a pill. Moreover, it fails to honor the labeled person’s perspective. In contrast, framing these concerns as potentially a healthy functional signal can lead to less self-stigma, and greater self-efficacy in making healthy life-style improvements.
One example of this line of thinking is provided in Joshua Wolf Shenk’s (2005) biography of Abraham Lincoln. There the author makes the case that Lincoln’s depression fueled his greatness. Similarly, David Yaffe (2017) has written a biography about the music legend, Joni Mitchell, titled Reckless Daughter. There, he writes of her frequent bouts of depression and quotes her saying,
“Depression can be the sand that makes the pearl. Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in that mire, of an epiphany.”
Schroder, et al. (2023), recently carried out a relevant study. As the authors describe it,
“We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a “signal” that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition) …. The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.”
In a recent blog post, I describe in far more detail this healthy way to understand the nature of depression (see HERE) and a no financial cost process to maximize its benefits. There the reader learns that transforming one’s belief that depression is a “really so bad” experience, to one that develops a friendship with the experience is doable. Once the transformation is complete, I prefer the term “melancholy” for it becomes a distinctly different experience without all the insults directed at oneself and thoughts of being mentally ill.
For many people, it takes more than reading a few paragraphs about this way of thinking. It typically takes some practice over a few months. By beginning with my very first blog post (see HERE) many will find that for free the practice sessions provided are sufficient. Having a counselor/psychotherapist that reacts to such folks’ depression experiences with kindness and empathy, rather than with insults and seeking to convince them that their experience is so terribly bad, can also be enormously helpful. Such counselors/psychotherapists provide a model that leads one to emulate this way of being supportive of themselves throughout their days even when their therapist is no longer present.
Conclusion
Dr. Jeffrey Rubin
There is a subgroup of people who, upon becoming depressed, end up seriously considering, or even attempting, suicide. I am in no way attempting to make light of the experiences of people who reach this level of desperation. Some kind empathetic support can be very helpful to deal with such situations. What I am seeking to convey is that the vast majority of people experiencing depression don’t go to such extremes. For them, the argument that their experience is so bad they need to rush out and get someone to provide “antidepressant” treatment might not be wise.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
In a recent post, I shared some advice the highly respected psychologist and philosopher William James gave to his depressed 13-year-old daughter. It was so well received, I decided to describe another example of James giving advice to another person feeling so very blue.
Unlike my previous example, which occurred when James was a mature professor and father, today’s example occurred in 1866 when James was a mere 24-year-old. But before we get to that example, we shall go back a little further, when James was 19. By doing so, we get to see an intriguing shift in his way of thinking about mental health concerns.
James’s View of the Nature of Mental Health Concerns When He Was Nineteen
James’s cousin, Minnie, two years younger than he, lost both of her parents when she was very young. She somehow appeared to recover from the severe blow, turning herself into the James family’s most enchanting and adored relative. In fact, James’s brother, the famous author, Henry James, drew two of his most appealing heroines from her image,–Minnie Theale in Wings of the Dove, and Isabel Archer in The Portrait of a Lady. Sadly, at the age of seventeen, Minnie began to display emotional patterns that raised serious concerns. James, in a letter to Minnie’s sister, explains his understanding of the cause. “…it is but an organic lesion of the gray cortical substance which forms the piamater [innermost membrane enveloping the brain and spinal chord], which is very consoling to us all.”
On what basis does James have for this explanation of the cause of Minnie’s mental health concern? And why would viewing Minnie as having a brain lesion be consoling? The letter doesn’t answer either of these questions, but blaming the brain for mental health concerns and the belief that such blaming is consoling survives up to the present day.
In recent years, after failing to prove a brain lesion is the cause of mental health concerns, a chemical imbalance in the brain has been promoted and eagerly accepted by many as true.
For example, the most recent relevant survey I could find on the internet suggests that 67% of the general public believe it has been scientifically established that depression is caused by a serotonin chemical imbalance in the brain (see HERE). Despite this belief, a 2022 research article published in Molecular Psychiatry concludes:
…the huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression. This is consistent with research on many other biological markers [21]. We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.
Many believe the reason why this idea has been so promoted is that it legitimizes the lucrative marketing of psychiatric drugs. Although I think there is considerable truth to this, the eager acceptance of this notion by many members of the general public has to do with it being a consoling notion to family members who might otherwise be blamed for their offspring’s concerning behavior. With this way of thinking, it is not anything any family might have done to cause the concerning behavior; it’s some problem in the brain that is the cause.
Now, don’t misunderstand me here. I’m not at all suggesting that family members should be blamed for all such concerns. There are, undoubtedly, many possible reasons why someone begins to act in a way that raises concerns.
When James is called upon to offer some advice to a friend several years after his comment to Minnie’s sister, his notion about the cause of mental health concerns has clearly changed.
James’s Advice to His Friend
In a letter dated, June 8, 1866, James wrote to his friend, Tom W. Ward:
I have just read your letter over again, and am grieved afresh at your melancholy tone about yourself. You ask why I am quiet, while you are so restless. Partly from the original constitution of things, I suppose; partly because I am less quiet than you suppose; only I once heard a proverb about a man consuming his own smoke, and I do so particularly in your presence because you, being so much more turbid, produce a reaction in me; partly because I am a few years older than you, and have not solved, but grown callous (I hear your sneer) to, many of the problems that now torture you. The chief reason is the original constitution of things, which generated me with fewer sympathies and wants than you, and also perhaps with a certain tranquil confidence in the right order of the Whole, which makes me indifferent in some circumstances where you fret. Yours the nobler, mine the happier part! I think, too, that much of your uneasiness comes from that to which you allude in your letter–your oscillatoriness, and your regarding each oscillation as something final as long as it lasts. There is nothing more certain than that every man’s life is a line that continuously oscillates on every side of its direction; and if you would be more confident that any state of tension you may at any time find yourself in will inevitably relieve itself, sooner or later, you would spare yourself much anxiety. I myself have felt in the last six months more certain that each man’s constitution limits him to a certain amount of emotion and action, and that if he insists on going under a higher pressure than normal for three months, for instance, he will pay for it by passing the next three months below par. So the best way is to keep moving steadily and regularly, as your mind becomes thus deliciously appeased (as you imagine mine to be; ah! Tom, what damn fools we are!). If you feel below par now, don’t think your life is deserting you forever. You are just as sure to be up again as you are, when elated, sure to be down again. Six months, or any cycle of time, is sure to see you produce a certain amount, and your fretful anxiety when in a stagnant mood is frivolous. The good time will come again, as it has come; and go too. I think we ought to be independent of our moods, look on them as external, for they come to us unbidden, and feel if possible neither elated nor depressed, but keep our eyes upon our work and, if we have done the best we could in that given condition, be satisfied.
James goes on a bit more in his letter to encourage Tom to seek to harmonize his life to nature’s will and to develop patience, equanimity, humbleness, and kindness. These attributes, he says “would do your heart good.”
As the letter draws to a close, James writes,
I will now, my dear old Tom, stop my crudities. Although these notions and others have of late led me to a pretty practical contentment, I cannot help feeling as if I were insulting Heaven by offering them about as if they had an absolute worth. Still, as I am willing to take them all back whenever it seems right, you will excuse my apparent conceit. Besides, they may suggest some practical point of view to you…..
I am anxiously waiting your arrival on Class Day when we shall, I trust, patch up the Kosmos satisfactorily and rescue it from its present fragmentary condition.
My Take On James’s Letter
Dr. Jeff Rubin
At age 19, James appeared to accept that his cousin Minnie’s troubling emotional behavior pattern is caused by a brain lesion and this notion is somehow consoling. There is no thoughts expressed that perhaps the trauma of losing both of her parents might be playing a part. No wondering if some new disturbing event might have occurred that family members are unaware. A brain lesion theory does provide a simple explanation.
At age 26, when James tries to come up with an explanation for Tom’s emotional concern, the brain lesion notion doesn’t come up at all. Instead, James begins by expressing some empathy for his friend by writing to Tom,”I have just read your letter over again, and am grieved afresh at your melancholy tone about yourself.”I like this. If someone you care about is going through some hard experience, expressing some empathy is a wonderful, humane, and kind thing to do.
Then, James responds to Tom’s question about why he is so “restless” in contrast to James. Perhaps it has to do with a difference in their constitution, James theorizes. But then James suggests that he actually might not really be less restless, he just doesn’t share this with others, preferring to consume his own smoke. In actuality, anyone familiar with James’s biography well knows he suffered greatly from periods of depression. (See HERE for a discussion of James’s bouts with depression and how he came to overcome them).
James goes on in his letter to point to the possibility that Tom might have gone through a period of great pressure and, if so, naturally he would need some time to recover. The recovery process could be experienced as melancholy. He also suggests that certain thought patterns of Tom’s, if changed, might be beneficial.
James concludes by suggesting to Tom that all of what he had written could be wrong, but nevertheless, they may suggest some practical point of view. In providing this post to my readers, I, too, suggest that perhaps James’s advice might be worth considering if either you or someone you care about is struggling with melancholy experiences.
This week, while thinking about what I might write for my next post, I happened to hear an excellent version of “Get Rhythm” by the rhythm and blues band, NRBQ. The song, written and first performed by Johnny Cash, can set your feet kicking up a storm. The lyrics begin,Hey, get rhythm when you get the bluesCome on, get rhythm when you get the bluesGet a rock and roll feeling in your bonesPut taps on your toes and get goneGet rhythm when you get the blues
The song goes on from here to tell us that to get rhythm when you have the blues doesn’t cost much and yet “does a million dollars worth of good for you.” This concept particularly caught my attention because just a day before, I had read an article titled, “Exercise Leads to Best Outcomes for Depression.” A summary of the study’s findings stated,This comprehensive summary of SRs [systematic reviews] demonstrated that MT [music therapy] treatment improved the following: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson’s disease, depressive symptoms, and sleep quality. MT may have the potential for improving other diseases, but there is not enough evidence at present. Most importantly, no specific adverse effect or harmful phenomenon occurred in any of the studies, and MT was well tolerated by almost all patients.
ndividual music therapy combined with standard care is effective for depression among working-age people with depression. The results of this study along with the previous research indicate that music therapy with its specific qualities is a valuable enhancement to established treatment practices.
