Pills and therapy can't heal the blues, but the leading French psychiatrist thinks he knows what can.
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 re-uptake 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 Mdecins Sans Frontires, 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 Mdecins Sans Frontires. "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)