The most severe restrictions on personal liberty since the Second World War are bound to have an effect on mental health. Writing for the World Economic Forum (WEF) in the early stages of the pandemic, Elke Van Hoof, a Belgian clinical psychologist, noted that around 2.6bn people worldwide were then under some form of lockdown, which she termed “arguably the largest psychological experiment ever.”
The WEF features in the weird conspiracy theory of Covid denialists that the pandemic is all a ruse to implement a global tyranny, so it’s worth stressing that the costs of lockdown are well known to policymakers and scientists. And just as the economic damage of allowing Covid-19 to spread would be far greater even than the disastrous experience of 2020, so would the impact on mental health.
The lockdown “sceptics” (not a term I like in this context, as it implies a willingness to consider evidence) are not wrong to point to the psychological dangers of isolation amid crisis. But they overlook the evidence, known to medical professionals, that Covid-19 is a multi-system illness, with neurological impacts. There have been reports of seizures, confusion and cognitive impairment among survivors, and there is clinical evidence from a study by Oxford University researchers that those with "long covid" are at greater risk of developing mental disorders.
After the influenza pandemic of 1918-20, which killed an estimated 50m people worldwide, there was a sharp increase in the incidence of psychiatric disorders. It is likely that the coronavirus crisis of 2020-21 will have a similar effect and it’s vital that policymakers be prepared for it, and especially for a rise in what are collectively known as mood disorders—above all, clinical depression.
Depression is far worse than the sadnesses we all experience from time to time, and which are a natural sentiment in a crisis that is destroying lives and livelihoods. Depression is, rather, an abnormal emotional reaction to adversity (and sometimes has no apparent external trigger at all). It’s known by its symptoms: a persistent low mood, and a marked loss of interest in normal activities. It may also be apparent in lassitude or alternatively agitation, dramatic weight loss, disturbed (or excessive) sleep, feelings of worthlessness or guilt, and constant thoughts of death, especially by suicide.
It’s an extensive phenomenon. The World Health Organisation estimated in pre-pandemic times that more than 250m people worldwide were living with depression. It is the principal cause of suicide. It’s a condition that I suffered from in a severe form for a year, in 2013-14, and from which I made a full recovery. Having had this utterly confounding experience, which I’d never had before, I sought to find out all I could about the science of the mind and its disorders. I’ve written a book setting out what I learnt about the condition, and the state of scientific knowledge concerning it.
My conclusion is twofold: depression really exists, and there are sound, evidence-based treatments for it. That may not sound a dramatic thesis, but both parts of it are insufficiently appreciated in public discourse. To this day, the notion that depression is a voguish medicalisation of the stuff of life is widespread, along with the allied notion that the proper response to low moods is to show a bit of initiative, resilience and gumption. Such advice is a modern version of the stiff-upper-lip approach to life, and it’s tragically misguided.
Depression and other mood disorders (such as generalised anxiety disorder) are real illnesses, like any other, and they have a complex mix of causes. There’s no point in urging someone suffering from depression to try and get well through an effort of willpower. It won’t work and that failure will thereby merely intensify their sense of guilt and shame. The persistence of depression has huge costs in human welfare: it breaks personalities and families, and causes misery, unemployment and self-harm.
My experience of depression taught me that, while the condition is in many respects mysterious, there are effective treatments that can help. The reason our knowledge of mental disorder is limited is that it’s the product of a physical organ of immense complexity: the brain, comprising around 100bn neurons and many trillions of connections between them. Scientists know that the activity of these nerve cells is the basis of our cognitions, thoughts, emotions and memories. But our knowledge of how the mind can break down and malfunction is still rudimentary.
Fortunately, we do not need to solve the mystery of consciousness in order to alight on effective treatments for mental disorder. I was immensely lucky in my experience of depression to have support from my employers and the care of friends and family. Many who suffer from depression do it alone. But for all in this condition, the availability of neuropharmacological and psychological treatments can shift the burden of negative thinking and heal the mind of its maladies.
The benefits of fresh air and exercise are often lauded as a cure for depression, and they are valuable in themselves for physical and mental health. Yet it’s important that those who resort to scientific treatments feel no shame or stigma about doing so. Antidepressant medication has the clinical trials behind it: the evidence is that it works better for most people, most of the time, than do placebos. Antidepressants aren’t a cure, but they enable the mind to escape wild swings of emotion and thereby help the sufferer to get better.
Still more important, and which changed my habits of thinking for good (in both senses), are psychological therapies with good science and evidence behind them. These are not the much-parodied psychoanalytic techniques of Freud and his followers, but time-limited remedies—notably Cognitive Behavioural Therapy—that focus on the cognitive distortions that cause depressive and catastrophising ways of thinking.
They work. They’re cost-effective healthcare treatments. They improve and save lives. They will be greatly needed as we emerge slowly from a historic public-health crisis.
