Multimedia: Down and loud
Authors: Raj Persaud
Journal: BMJ (1999)

A Living Hell, BBC2, a 3 part series Wednesdays 11 15 pm, starting 3 March

  L ewis Wolpert—professor of biology as applied to medicine at University College London—became clinically depressed a few years ago after a mild heart problem and required admission to the psychiatric wing of the Royal Free Hospital. A Living Hell follows his journey into uncovering what medical science reveals about depression. Given the media’s preference for personal anecdote rather than impersonal fact, a series like this had to wait until a doctor presenter was suffering from depression himself and agreed to be explicit about his illness on television. However, Wolpert has cleverly used the media interest in his illness to instruct the public on the essential issues.

It is perhaps because there is so much current popular fascination with depression that Wolpert has been indulged by the BBC in focusing on this one illness for three 40 minute programmes. Exactly why this should happen now is something of a mystery to those of us who have been trying unsuccessfully for years to divert media attention away from the much less common (but violent) schizophrenia. One factor may be the rising prevalence of depression among journalists, judging from the current plethora of first person accounts. The recent, widely disseminated estimate from the WHO that depression will be the world’s second most debilitating disease by the year 2020 has clearly been a catalyst.

Unlike the rest of current media coverage, the first programme in Wolpert’s series is never in danger of confusing clinical depression with the everyday emotion we all experience. There are some poignant moments, however, when Wolpert returns to the ward at the Royal Free Hospital and, while relating his suicidal feelings to his psychiatrist, when he chokes for a moment, close to tears, as he recalls how his late wife reacted to his depression. Another sufferer from the illness pauses in emotional turmoil at the realisation of just how she has been affected when she says she now has to develop strategies in order to just get out of bed.

Wolpert presents this series brilliantly, but are there dangers in the media’s need for personal experience as the only credential to declaim on psychiatry? On ITV’s Thursday Night Live (25 February) two psychiatrists in the studio were losing their argument against a baying crowd that antidepressants are safe—until one of the doctors announced he had taken the drug himself. The emotion of the moment temporarily silenced the stunned opponents, but did this confession bolster the negative public impression that psychiatrists are in greater need of help than their patients?

On 21 February the Observer ran a special series of articles on depression over 14 pages in its “Life” supplement. The anecdotal personal experience of middle class journalists got a good airing, but, in the process, the science was drowned out. Yet what newspapers and broadcasters are often aiming to do, and what professors of medicine often neglect, is to satisfy the public’s real interest in these subjects, which is rather self centred—how to prevent themselves getting whatever illness is under the spotlight. To this end, a “nutritionist” in the Observer series penned an ill informed article on how diet might prevent depression, neglecting entirely the research on the subject, particularly recent evidence of a direct correlation across societies worldwide between higher fish consumption and lower rates of depression.

Deborah Orr wrote at length in the Independent (24 February) about her own decision on whether to take the antidepressant paroxetine on the advice of her general practitioner. Her search for the reasons behind her depression led her to conclude this lay in the stress of being married to a husband who has two families to care for. The problem with all these personal accounts is that the many diverse reasons they each generate are too varied to be illuminating. Professor Wolpert believes an antiarrhythmic drug caused his depression, while his wife thought it was his having to return to South Africa, where his father had been murdered.

The crucial issue, however, is not what made you depressed, but how to get better. This is particularly true as recovery strategies involve a narrow range of effective options, the effectiveness of which is largely unaffected by whatever precisely caused a particular depression. Yet the process of recovery and definitive treatment are hardly ever discussed sensibly in the media. This is probably because the public and journalists react vigorously against the idea that a small number of treatments can be applied to a wide variety of different people—they see this as the dehumanising aspect of medicine. This is what doctors do whenever they diagnose: they try to fit a variety of symptoms into a syndrome that then helps them to choose a management plan. But when it comes to the mind, no one wants to feel that their depression is anything other than their own; to do otherwise seems to threaten their sense of identity.