- 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 capitalise 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 recherchÈ - 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 Desensitisation 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
- 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 MÈdecins Sans FrontiËres, 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 MÈdecins Sans FrontiËres. "I
realised 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 centres.
The key lies with the nature of the emotional brain.
- Physically, it lies in the centre 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 empha- sise
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."
- - 'Healing without Freud or Prozac', by Dr David Servan-Schreiber,
is published in paperback on 4 June (Rodale, 12.99)
- © 2004 Independent Digital (UK) Ltd http://news.independent.co.uk/uk/health_medical/story.jsp?story=522149