David Servan-Schreiber:
Can this man cure your depression?
Pills and therapy can't heal the blues,
but the leading French psychiatrist thinks he knows what can.
17 May 2004
Where do you get the blues? Most people would say in the head. That's
where we look for mental problems. Depression, anxiety, distress are all
the result of brain chemistry going wrong - not enough serotonin, for
example. And that's why we treat them with talking therapies and "serotonin
reuptake inhibitors" such as Prozac.
But according to a fascinating and controversial book by the psychiatrist
DR David Servan-Schreiber - French-born but working in America - this
is the dreadful mistake that has crippled psychiatry for the last 100
years. Instead of focusing on the mind with talk and pills, the most effective
way to heal the mind is through the body. And there is plenty of evidence
to show that it is effective.
Over the past 10 years, our consumption of antidepressants in the UK
has more than doubled, along with a huge increase in our rates of anxiety
and depression. Fifty to 70 per cent of visits to GPs are related to stress,
and eight out of 10 of the top-selling medications are used to treat related
problems. Something doesn't seem to be working. And it has recently
become clear that drug companies have been concealing evidence that these
drugs are often little better than placebos.
Servan-Schreiber believes that his approach, which has been dubbed "postmodern
psychiatry", can do an awful lot better. In his book, entitled Healing
without Freud or Prozac, he pulls no punches. "When I say heal,"
he writes, "I mean the patients are no longer suffering from the
symptoms they complained of, and those symptoms do not come back."
The book was first published in France in March 2003, where it proved
hugely successful. "I took a year off to write a book and then I
was going to go back to my practice in America," he says in his charming
Charles Aznavour accent. "But now, my time is taken up with lecturing
and teaching this new approach, to psychiatrists and at medical schools."
The book details seven approaches to healing mental illness, all of
which use the body as the doorway to transforming mental pain rather than
attempting to tinker with brain chemistry or better understand the problem
by talking about it. "They all capitalize on the mind and brain's
own healing mechanism for recovering from depression, anxiety and stress,"
he says.
Some will be familiar as treatments in other fields, such as acupuncture,
physical exercise and omega-3 essential fatty acids, while others are
more research - one involves circadian rhythms; another developing "heart
rhythm coherence" with biofeedback; a third, a technique known as
EMDR, makes use of eye movements. But they are all backed up by research
evidence for their effectiveness.
EMDR (Eye Movement Desensitization and Reprocessing), for instance,
has at least a dozen studies showing that it can treat trauma better than
anything else. Servan-Schreiber describes what happened with Lillian,
who had spent years in psychotherapy discussing the effect of being raped
by her father, before EMDR. "In little more than an hour," he
writes, "Lillian's terror as a tiny rape victim had changed to
acceptance and even compassion for her aggressor - the most adult perspective
conceivable."
EMDR appears ridiculously simple. While recalling a traumatic event,
the patient follows the therapist's finger with their eyes as he moves
it rhythmically from side to side. Some kind of, as yet little understood,
reprocessing of the emotion takes place so that the memory loses its toxic
charge and the patient can move on.
Many of the techniques don't just suppress symptoms as drugs do;
they seem to give people the opportunity to handle their emotional lives
more effectively, to gain wisdom, to use an old-fashioned word. It's
what psychotherapy at its best can do, but too often doesn't. No wonder
DR Servan-Schreiber has made such a splash across the Channel. His personal
charisma, as well as his theories, gave rise to very positive press and
media coverage, and his book is a bestseller.
But although he aligns his whole-body approach with such movements as
ecology and natural foods, Servan-Schreiber is no flaky maverick with
an obsession with natural healing. "I have a PhD in cognitive neuroscience
from Carnegie Mellon University, and I was director of the psychiatric
services at a hospital in Pittsburgh, treating the psychological problems
of seriously ill people with the likes of heart disease or cancer,"
he asserts. For 20 years, he was mainstream.
But in 1997, a number of things happened that forced him to rethink
the value and effectiveness of what he was doing. First, as one of the
directors of Médecins Sans Frontières, he went with a relief
group to help Tibetan refugees in northern India. "It was a shock,"
he says. "There was a medical system, complete with medical schools,
laboratories, pharmacies and clinics, that was just as successful with
many conditions as we were in the West. Yet the methods they were using
- mainly herbs, meditation and diet - were ones that I had been taught
were valueless, mere placebos."
Then, what he describes as his "medical arrogance" took another
blow as he observed how a close friend handled serious depression with
a technique that involved deep relaxation and re-experiencing of old buried
emotions. "Afterwards, she was free of the weight of 30 years of
unexpressed grief and she had a sense of renewal and completeness that
I knew I could never have achieved with the pills and talking therapy
that I had to offer."
The final straw was when he was asked to write a "field guide"
to depression for Médecins Sans Frontières. "I realized
that if I did it from a Western perspective, it would be all about antidepressants.
It seemed to me pathetic that this was aimed at people who had had enormous
life dramas, and the answer to their misery was Prozac. It suggested to
me that psychiatry had given birth to a monster, especially when local
practices were effective and often more appropriate."
As a result, he began to look into these other, often older methods
to see what the evidence was for their effectiveness. "To my surprise,
there was a lot once you started looking." The explanation as to
why they work, however, is based on findings from the state-of-the-art
neuroscience laboratories at the University of Pittsburgh and other centers.
The key lies with the nature of the emotional brain.
Physically, it lies in the center of the brain, beneath the newer - in
evolutionary terms - overarching structure of the cortex. The cortex is
the "intellectual" part of the brain that controls such functions
as problem-solving, planning, speaking. It is the cortex that is at work
during psychotherapy. But it is the emotional brain, or limbic system,
that produces the fear and rage that trouble those who are psychologically
distressed, and where memories of trauma and neglect are stored. "Neuroscience
research has shown clearly that the basic disorders involving depression,
stress and anxiety are all related to the functioning of our emotional
brain," says Servan-Schreiber, "which we mostly do not understand
and look after badly."
The same research explains why concentrating on the body can be so effective.
Besides producing emotions, the limbic system is also intimately linked
with our major metabolic systems - the heart, the guts, the hormones and
the immune system. There is constant two-way traffic, with messages coming
up about what is going on in the body, and messages going out to ensure
a smooth working of the whole.
"Just as the emotional brain has an innate ability to keep the
body's systems in harmony," said Servan-Schreiber, "so there
is a natural mechanism to balance the emotional responses. It is this
system that we can tap into by working with the body. This new picture
explains why working with the body can be more effective than psychotherapeutic
talking cures - the links between the emotional brain and the body are
denser and faster than those between the emotional brain and the cortex."
Servan-Schreiber set up a hospital in Pittsburgh devoted to researching
and practicing this more integrated form of psychiatry. "My aim was
to cure without harming, and at low cost." But it's an approach
that proved hard to maintain within the US system because it is far less
profitable.
Regardless of these and other practical problems of implementing his
system, postmodern psychiatry is perfectly in sync with the latest ideas
about depression. Only last week, New Scientist ran an article
on the new view of depression that suggests a key factor is damage to
the neurons in a part of the emotional brain known as the hippocampus,
involved with memory and learning. This damage seems to be linked with
excess amounts of the stress hormone cortisol.
This new view means that the one theory about depression that everyone
is familiar with - that it is linked with low serotonin levels - is almost
certainly wrong. Instead, the spotlight is on another brain chemical called
BDNF (brain-derived neurotrophic factor) that helps brain cells in the
hippocampus regrow. The article enthused about a new generation of antidepressants
that this could lead to. What it didn't emphasize was that drugs aren't
the only way to raise BDNF levels. Exercise, omega-3 oils and acupuncture
can do it as well.
"These methods empower patients," says Servan Schreiber. "I
hope a new generation of psychiatrists will be trained to use them."
The Instinct to Heal: Curing Depression, Anxiety and Stress Without Drugs
and Without Talk Therapy
by Dr David Servan-Schreiber, is published in paperback on 4 June 2004
(Rodale, 12.99)
|
Friendly
