Many there will have paid little attention to the confirmation last week of a new leader of the Senedd. Vaughan Gething has often pinned his allegiances to the trade union movement. But will his attention, like so many before him, shift away from these industrial regions? On a joint visit to North Wales yesterday, Gething and Keir Starmer vowed to “turbocharge jobs and growth”, but how many in Port Talbot were listening? The steelworks’ fate represents more than just the closure of another foreign-owned company, the latest in a long line to vacate these towns. It signifies the final nail in the coffin of South Wales Industry.

This story reads all too familiar to people from this part of the Isles. Since the birth of industrialisation, the Valleys have been continuously weathered by a collective system of manufactured depression, which has shaped and damaged the psychological condition of the Nation. Indeed, the very first signs of what is now commonly referred to as the Great Depression can be traced back to the economic collapse witnessed in the Valleys of South Wales in the spring-to-summer period of 1924. While only 2% of the population was unemployed at the start of that year, the impact was so profound that, by August 1925, it had risen to a staggering 28.5%. While numerous factors contributed to this, two stood out, both products of the raw realities of global economic and political conflict.

The first was the Treaty of Versailles, whose terms required a defeated Germany to supply cheap coal to Europe as part of its reparations. As the British representative on the Council of Four, the Welshman David Lloyd George was thus a signatory to a settlement that effectively pulled the rug of profitability from under the South Wales coalfields: the price of Welsh coal fell by nearly 50%. The second was a turn in the United States to more exploitable markets for energy in the Southern Hemisphere. By the time the Wall Street Crash had bankers and investors jumping from buildings in 1929, the Valleys of South Wales already had 45% of its workforce conscripted into the army of the unemployed.

The use of the military metaphor is not unintentional. As some 241 pits closed by 1936, resulting in the now familiar pattern of outward migration form the region of the fit and able, the only moment of reprieve would be the outbreak of the Second World War, resulting in the need once again for the region’s coal to help motor to machineries of warfare. What must it do to the psychology of a people knowing the survival of their own communities was tied to the continuation of a war as local boys and men continued to fight and dig for yards back home?

If the Valleys were subject to abandonment and social neglect in the decades that followed, by the end of the Eighties and the defeat of the miners, it was clear the industrious way of life which once sustained these communities had been largely destroyed. Port Talbot was in many ways an exception to this, though it should be added that many of its workers were descendants of miners from nearby collieries and still tried to carry the socialist spirit of defiance, which was somewhat captured in Michael Sheen’s The Way.

Abjection would soon become a defining term, which could be routinely applied across the entire coal-face region. The figure of the hardened miner was replaced by the steroid-using gym worker, a grim contrast to the emaciated bodies seeking quiet refuge as they administered heroin into their dejected veins. Stories started to become more commonplace about adults and even teenagers taking their own lives. Soon we all knew of somebody who could no longer face the reality of an abandoned world. Like most things in the Valleys, the more time passes, the greater the problem becomes. And the realisation these towns were facing a suicide epidemic captured international media attention in 2008, as the tragic loss of so many young teens in quick succession within a 10-mile radius of Bridgend led many to question the causes and possible solutions.

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Government statistics continue to document rising numbers of suicide, with Wales home to the highest percentage of any region in the United Kingdom. While the most convenient explanation for this often focuses upon the mental health of the afflicted, and invariably advocates more therapy and intervention at an individual level, less attention has been given to the idea that depression should first and foremost be seen as a social phenomenon — that is also inseparable from the lived conditions, the ecologies and atmospheres, into which a community is thrown.

Having said this, what is also peculiar about the Valleys is how the exponential rise in suicide corresponds to the regreening of the landscape, posing a direct challenge to those who primarily correlate wellbeing with environmental recovery. Recovery means nothing if people feel like they have no value or purpose to their existence, regardless of how many daffodils are growing.

While suicides among young girls (as in Bridgend) have become a growing problem — indeed I have lost two cousins this way — it is the vast rise in young male suicides that registers as the most pressing of concerns. Again, while there are many explanations offered for this, given how the figures compare to other social groups (notably black and Asian), surely such a phenomenon can only be properly explained by attending to the crisis of white male subjectivity.

Today, what we look upon are social systems in which young white men are struggling to find any meaning let alone political agency. As other groups are being encouraged to find a sense of purpose and belonging through a shared sense of historical outrage, such an identity has been denied them. The same men have also been thrown into a cultural milieu in which they are being asked to embrace their vulnerabilities, while stripping them of the very qualities of passion and fight that might allow them to deal with difficult times. Should they have the gall to question the status quo, often they are accused of exhibiting white male fragility, which is a rather peculiar way of defaulting back to a desired framing of brokenness.

Because people are not born vulnerable. Systems produce them that way. And if there is a violence to speak of today in places like the Valleys, it’s not one of masculine hardness — it’s a violence of the vulnerable.

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Young white men are continually being told they should aspire to whatever the new digital world has to offer, knowing full well to be born in the Valleys means the chances of escape are less with each rotation of the clock. This reminds of how static the empty time of social depression can truly be. Yet still some have the temerity to call them privileged. If such a word has any meaning, it should be linked to the luxury of time — or to properly separate those who inhabit a dead time that has no prospect versus those with the luxury of time to fire off social-media missives, day after day, without it having any impact on their material welfare.

Back in Port Talbot, meanwhile, as the spring rains fall and the furnaces that give life to the town are slowly doused, it’s hard not to be pessimistic. If a century of mass industrial closure has seen very little to replace it, the speeding up of automation and artificial intelligence promises to leave farther behind those who weren’t even at the starting line to begin with. Faced with these conditions of social depression, should we be surprised when desperate young men try to find a lasting way out? I know personally what it’s like to live through seasons marked by the weight of absence. It’s suffocating. It’s debilitating. And it’s soul-destroying.

***

As the writer Philip Pullman puts it in his 2005 introduction to The Anatomy of Melancholy, Robert Burton’s sonorous and digressive 17th century masterwork, “those readers who have some experience of the disorder of the mind we now call depression will know that the opposite of that dire state is not happiness but energy”.

By this definition, we could say the British state is, if not depressed, consumed by melancholy. Doom is sensed lying on the horizon but the exertion of will necessary to avert it is no longer seen as possible, or even desirable. The British state lies in bed staring at the ceiling, waiting for death. It cannot build houses, it cannot build railways; it cannot dig a hole in the ground and fill it with water; it cannot fix schools that are falling down. The simplest task is too difficult, and anyway, why even bother? There are always reasons to be found for why any exertion is pointless, why helplessness is sensible policy. No wonder, like children of a depressed parent, young Britons now yearn to flee the oppressive atmosphere of home. Yet Burton’s text, reissued for its 400th anniversary, reminds us that we have been here before.

Anatomy is most often read today as a pre-modern self-help book. Yet it contains within it, rarely-discussed, an astute reading of the nation’s political dysfunction that uncannily echoes the present. “Kingdoms, provinces and Politickal Bodies are subject in like manner to this disease,” says Burton, with the body politic exhibiting the same symptoms of what later writers would term “the English malady”. For where “you shall see many discontents, common grievances, complaints, poverty… cities decayed, base and poor towns… the people squalid, ugly, uncivil; that kingdom, that country, must needs be discontent, melancholy, hath a sick body, and had need to be reformed.”

Burton’s diagnosis is distressingly apt for modern Britain. According to ONS statistics, around one in six British adults suffered moderate to severe symptoms of depression last autumn, while 17% of British adults are taking antidepressants; but among those aged between 16 and 29, depression rates reach 28%, and for those under 24, up to 46%. Depression and anxiety are now the greatest drivers of long-term unemployment, and suicide is the single most common cause of death in young British men. Whatever the psychic wounds of postmodernity or social media, the most obvious cause is material: the insecurity built into Britain’s faltering economic model. Renters suffer depression at twice the rate of homeowners, while dwindling savings and growing debt strongly correspond with increased rates of mental distress, and homelessness is on the rise. The body politic and personal health are intertwined: Britain’s economic dysfunction is making people depressed, and deteriorating mental health is weighing down productivity. But how to reform such an unhappy polity?

As the historian William Mueller noted in his forgotten 1952 book on Burton as a political theorist, “A distressed state and a diseased individual, macrocosm and microcosm, can look to similar cures.” Burton regarded the economic instability of England as one of the principal causes of the melancholy of his day, so “the emphasis on economic reform runs throughout Burton’s Utopia, underlining his contention that one effective antidote to England’s melancholy lay in economic advance”.

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Mueller situates Burton in a social context not so different from ours, where, as he puts it, the replacement of the stable economic regime of the agricultural order by the birth of modern capitalism led to unstable employment in industrial and commercial labor markets which fluctuated with world conditions: international squabbles would deprive English industry of its foreign markets, while an influx of foreign capital, with wildly uneven domestic distribution, “caused an inflation of land values, rents, and commodities, which affected not only the unemployed but also the employed, whose wages did not rise commensurately with prices”.

Like a 17th-century Yimby, comparing the prosperous and orderly cities of the near continent with our own urban wastelands, Burton contrasted “those rich, united Provinces of Holland, Zeeland, &c., over against us; those neat cities and populous towns” with “our cities thin, and those vile, poor, and ugly to behold in respect of theirs, our trades decayed”, our “beneficial use of transportation, wholly neglected”. A levelling-up advocate of his day, Burton deplored that “amongst our Towns, there is only London that bears the face of a City… and yet in my slender judgement, defective in many things. The rest (some few excepted) are in mean estate, ruinous most part, poor and full of beggars, by reason of their decayed trades, neglected or bad policy, idleness of their Inhabitants.” As in any provincial town today, or even London’s depressing main shopping thoroughfare, the nation’s melancholy was written in the dismal vista of its streets.

Why did England suffer this sad torpor? Fundamentally, the question was one of “ill government, which proceeds from unskilful, slothful, griping, covetous, unjust, rash, or tyrannizing magistrates… not able or unfit to manage such offices” — an immediately recognisable modern sentiment in rolling 17th-century prose. Like modern-day attempts at reform, from Thatcher to Truss, their flailing attempts to cure the malady had only worsened it, so that “the State was like a sick body which had lately taken physick…and weakened so much by purging, that nothing was left but melancholy.”

But England’s sad state derived from more than just inept politicians. A melancholic himself, who wrote to both cure and wallow in his own unhappiness, Burton was wearied of what we would today call “the discourse,” the “vast confusion of… new paradoxes, opinions, schisms, heresies, controversies in philosophy, religion” which distracted from good governance. As historians of melancholia note, the Calvinist milieu in which Burton wrote was a “suspicious and inquisitorial society, constantly on the watch to spy out the sins of others and to suppress all deviations from the true way” — no doubt the modern reader will empathise.

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An advocate of “few laws, but those severely kept”, Burton condemned the accretion of legalistic intrigue and self-promoting lawyers which, then as now, hampered strong executive government: “they will make more work for themselves, and that body politic diseased, which was otherwise sound”. Instead, as Mueller observes, “politically, he would have a highly centralized state ruled by a wise and kindly monarch, a sort of philosopher-king.” Socially, Burton proposed a proto-welfare state for the deserving poor, and enforced labour for the wilfully idle. Burton proposed to ban costly offensive wars, while maintaining a strong navy and army for national defence.

Economically, Burton was a mercantilist, who believed that the route to English prosperity, and thus happiness, was in a favourable balance of trade with a strong export economy and secure and well-paid employment for English workers. “Industry is a Loadstone to draw all good things; that alone makes countries flourish, cities populous, and will enforce by reason of much manure, which necessarily follows, a barren soil to be fertile and good, as Sheep… mend a bad pasture.” China’s rise, and the panicked reactive counter-tendency towards industrial policy almost everywhere in the West but listless Britain, makes this position, until recently considered quaintly archaic, seem strikingly relevant.

Torn between affection for the lost and stable social order of feudalism and a desire for economic growth and prosperity derived from well-planned industry and rapidly expanding cities, it is possible to read Burton as the antecedent of modern political tendencies, a sort of postliberal before liberalism had been invented. This interpretation of Burton, as a dissident political and economic theorist with lessons for today, is not as quixotic as it may at first appear. Modern historians of both melancholy and depression have long placed both unhappy conditions in political and economic context, notably the German sociologist Wolf Lepenies, who, as the philosopher Jennifer Radden observes, argues that “melancholy, or at least an enervating nostalgia and ennui, has been the fate of whole classes of people made idle by social, political, and economic arrangements”.

For the historian Matthew Bell, melancholia — “ the spectral absence of meaningful politics”— finds expression in the phenomenon of “retreatism” whose adherents “are not rebels; they do not attempt to disrupt or undo society. Nor are they outsiders who set themselves beyond social norms. Retreatists withdraw from society while remaining within it. They form a silent and disengaged opposition.” Such a position surely describes the viewpoint of British voters, hostile to the dysfunctions of the Westminster system, while increasingly certain it is so resistant to reform there is no point in voting. Why, says melancholy’s seductive inner voice, even bother? Freud credited the depressive with “a keener eye for the truth,” and which British voter today, surveying the options permitted him by Westminster, would not feel melancholic?

Yet it need not be this way. “Our land is fertile we may not deny, full of all good things, and why doth it not then abound with cities, as well as Italy, France, Germany, the Low countries?” asks Burton. “Because their policy hath been otherwise, and we are not so thrifty, circumspect, industrious; idleness is the malus Genius [evil genius] of our nation.” His closing advice to shake off the enervating grip of melancholy, to “be not idle” has become famous as a self-help axiom, yet it is also a political doctrine. It was no good for Burton himself, or for the England of his day– he died, perhaps by his own hand, in 1640, two years before the nation plunged itself into civil war — but perhaps it is not yet too late for Britain.  Doom may yet be averted, the torpor defeated, if only the effort is finally made. The bonds of dysfunction can still, perhaps, be shaken off through vigorous, reformist exertion.

It is difficult, perhaps, viewing the revolving carousel of nonentities returning to parliament this week, to believe that the cloud will ever lift, but it is not yet too late, Burton reminds us: for “Hope refresheth, as much as misery depresseth; hard beginnings have many times prosperous events, and that may happen at last which never was yet.”

Originally entitled Les Particules Élementaires, the book’s first appearance sent the French literary scene into a frenzy; selling thousands of copies, sparking many an op-ed, and causing the owner of a literary prize awarded to the book to withdraw his patronage. International publishers scented a transferable succès de scandale. The designer of the UK translation put a skeletal nymphet on the cover, insolently facing the camera dressed only in her knickers.

The implication to the reader was that he was purchasing a combination of hot sex and cool Gallic hipsterism in literary form. No greater joke has ever been played on the British novel-buying male. In fact, Atomised presents a sexual wasteland full of neurotics, narcissists, and malformed losers. And, much like its anorak-wearing author, no character in the book possesses any cool whatsoever.

Atomised is the story of two half-brothers, Michel and Bruno. Michel is a robotic rationalist, constitutionally unable to form meaningful human relationships. In his professional life as a biologist, he searches for a way to eliminate the mess of concupiscence from the human condition. Bruno, on the other hand, is a monomaniacal sexual obsessive, restlessly questing through brothels, orgies and naturist colonies for a degree of satiation he never finds.

For Bruno, there are only two kinds of women: the enticing unavailable ones that make him feel inadequate and tormented; or the ones he can have, that make him feel bored and detached. For both brothers, moments of tender love and compassion from women are fleeting, and each is psychologically unfit to receive them. The immediate cause of all this is their monstrous hippy mother who — “believing that maternity was something every woman should experience” — decides to keep the accidental human by-products of her trysts, but leaves the nurture of them to inadequate others. The distal cause, meanwhile, is the fall of Western civilisation.

The book is replete with failed parenting relationships, failed marriages and failed erections. Humans are animals upon whom nature has played a cruel trick, bestowing them with socially malleable cravings that endlessly distress them and which capitalism exploits. Suffering is everywhere and, in the absence of the Judeo-Christian framework, has no meaning. Death is feared pathologically. Sexual promiscuity is the only permissible way left for males to engage in competition with peers, but the prizes are ultimately terrible. Pneumatic young women gain tenuous social capital from acting like sex objects. Ageing female bodies literally have no point anymore, and their owners know it.

Since the book’s publication in 1998, patterns of critical evaluation have had plenty of time to settle. And many of these have tended to treat it, along with the wider oeuvre within which it sits, as containing a serious political message, or as otherwise having something to teach readers.

Understandably, conservative and “post-liberal” thinkers often relate enthusiastically to the Houellebecquian universe as one that tests post-1968 liberal values to complete destruction. In this reading, Houellebecq is primarily demonstrating the awful downsides of the intrusion of the capitalist market into the realm of sexual reproduction. It’s certainly true that some passages — describing the advent of abortion and the pill, the rise of individualism, and the collapse of the family against the predations of the market — might have come straight from the pen of a post-liberal polemicist (at least, if he was a bit drunk).

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But still, Houellebecq is not proselytising for a return to the values of the past. He doesn’t want us to go back to some prelapsarian age — partly because he thinks it is too late anyway, but also because it all sounds absolutely terrible. In Atomised, he lampoons the alternative:

“You are at one with nature, have plenty of fresh air and a couple of fields to plough (the number and size of which are strictly fixed by hereditary principle). Now and then you kill a boar; you fuck occasionally, mostly with your wife, whose role is to give birth to children; said children grow up to take their place in the same ecosystem. Eventually, you catch something serious and you’re history.”

The extent to which Houellebecq is personally invested in the hyper-liberalised society he describes in his novels was illustrated recently by the revelation that he inadvertently participated in a Dutch porn film (his stated excuse being that he was “depressed at the time of signing the agreement and had drunk several glasses of wine”). This version of Houellebecq is no austere conservative reactionary, but rather a sad-eyed, impulse-driven Mr Bean figure — drunkenly importuning female interviewers, making extravagant public shrines to his dead corgi, and starring as himself in a comic film about his own fictional kidnap. Liberalism, like love, makes fools of us all eventually.

Even so, there is clearly something right about the conservative critical approach. Progressive responses to Houellebecq are much less convincing. The most predictable of these would diminish the work simply on the grounds that it doesn’t sufficiently distance itself from the misogyny, homophobia, and Islamophobia it often represents. On this view, the reader can still perhaps learn something from Atomised, but only as a cautionary tale — showing us the origins and outlook of the much-reviled incel mindset, for instance. In the same vein we are told that Houellebecq’s subsequent works act as prophylactics against Right-populism and Islamophobia, since they understand these things from the inside, and are thus useful to the Left-liberal who wishes to know how his enemy thinks.

Atomised is indeed often misogynistic, though much of the time it seems to stem from a more general misanthropy than from any specially targeted animus against women. In any case, with a mother as poisonous as Houellebecq’s — on whom the character in Atomised is loosely based — surely the man should be let off the hook a bit. In 2008, aged 83, she gave a gloriously disinhibited interview describing her son as an “evil, stupid little bastard”, “a liar, an imposter, a parasite” and “a petit arriviste ready to do absolutely anything for money and fame”. (She also offered future biographers an epigraph laconically summing up Houellebecq’s output as a whole: “What’s all this stuff about an old chemist who wonders if his secretary is having a wank?”)

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A more charitable — in fact, quite hilariously optimistic — approach, also coming from progressive critics has been to try and recuperate Houellebecq as a previously unrecognised ally to Left-liberal causes. For instance, it has been speculated that he is actually offering a useful critique of hegemonic masculinity or even “queering” heterosexuality outright. Touching as it is to see the keenness of the academic to reconcile the demands of his two perennial masters — a love of edgy transgression, and the desire to write only what a Guardian reader might approve of — this strategy is doomed. The same writer who describes a commune dedicated to personal development as full of “deranged old lefties who were probably all HIV positive” is no secret friend of Judith Butler.

There are always things to learn from as multifaceted a novelist as this, whether or not he intends to teach you anything. Still, I prefer to treat a book like Atomised, not (only) as a rich seam of information to be mined about the zeitgeist, but more as an enveloping mood. And Christ, that mood is bleak.

Houellebecq invites you to wallow in despair at the state of society; to sink to the depths with no hope of air. He is in the tradition of great pessimistic writers: Beckett, Baudelaire, Sartre. He may have a diagnosis for social malaise but there is no hint of a cure here. All you can do is face the darkness, laugh occasionally at the absurdity of it all, and distract yourself by having appalling sex with people who vaguely revolt you.

Some censorious types worry that incels might be reading Houellebecq, but I tend to think he is exactly who incels should be reading. For when you suspect that your life is sapped of all prospects of success, sexual or otherwise, it can be reassuring to read a book that confirms your experience. As Schopenhauer — another pessimist with a terrible relationship with his mother, and a stated inspiration for Houellebecq — once wrote: “Life is a business which does not cover the costs.” For those men who have found that the sexual revolution did not cover their costs, reading Atomised must come as a relatively harmless salve to the anguished mind.

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The term “hopeless” covers two possible emotional states: one where specific hopes suddenly die, to your great disappointment, or one where you haven’t experienced anything as proactive as hope for a long time. The first involves mental turmoil; the second can feel grimly peaceful and reassuring. As another great philosopher, Michael Frayn, makes his headmaster character say in the film Clockwise: “It’s not the despair, Laura. I can take the despair. It’s the hope I can’t stand.” Pessimist writers such as Houellebecq can take us to this second place. Depending on how churned up you originally felt, the trip can sometimes feel like a holiday.

But there’s another more positive function that pessimistic writing also serves. In ordinary life, it’s easy to confuse a temporary mood with a fact about the world, and vice versa. Feelings of hopelessness tend to settle like dust on social landscapes, seeming as if they have always lived there, and infusing present and future with heaviness and gloom. Trying to avoid this impression by denying it or distracting oneself doesn’t necessarily make it go away.

There’s a lot of doomsaying in the air at the moment, and it seems to be catching. But sometimes, with despair, you have to go down to come up. Sometimes, as if in a Buddhist death meditation, you have to imaginatively inhabit your miserable vision to its utmost, without deviation. For me, this is primarily what Atomised does. It confronts you with the purest synthesis of a despairing take on liberal society, and make you live there for a while, drinking it in. And after a while, the feelings of despair start to lose their power, and you start to realise that hopelessness is only a mood after all. It’s not the world — it’s you.

Barrett is the main case study of the “acid casualty”: the archetypal subject who, after a few too many trips, is said to endure a mental collapse from which they may never return. His story is frequently shared as a parable in online forums such as Reddit, which is a recruitment pool for psychedelic studies. And while attitudes around psychedelics have softened in recent years, this meme still lurks subtly within the public consciousness. One doesn’t have to ask too many baby boomers before someone shares a story, perhaps of a friend from school or university, who got lost ashore on the other side.

The first recorded reference I could find was in 1974, from Changes magazine. A passage spurns the “unique contemporary type: that kind of burnt-out acid casualty who ends every sentence with ‘Man’”. Amid the Nixonian disappointments of the Seventies, the acid casualty was a way to culturally dismiss the psychedelic ruptures of the Sixties. No longer an agent for spiritual awakening or a wonder treatment, LSD was cast as a trigger for madness and a tool for mind control. Many casualties were reported in the press: Peter Green of Fleetwood Mac, Roky Erickson of the 13th Floor Elevators, Arthur Lee of Love, and Brian Wilson of The Beach Boys, who suggests his LSD experiments “fucked with his brain”.

What really caused these cases of psychosis is not known for certain, but the explanation usually focuses on their internal worlds. In a new film about his life, Have You Got It Yet?, some of Barrett’s contemporaries cast him as an Icarus figure — one who communed with the Gods prematurely and “reached for the secret too soon”. Other narratives are less grand: perhaps he “boiled his brains with acid”, sustaining real organic damage to his nervous system through excessive chemical stimulation. Or perhaps the breakdown was inevitable. His former bandmate David Gilmour suggests that Barrett had in him a “switch waiting to be turned”, a “weakness of some sort”, maybe a vulnerability embedded in his genes. Such determinism echoes the public understanding of severe mental illnesses, such as schizophrenia.

However useful such layers of analysis can be, they risk downplaying the external factors that might have engendered the distress. If an individual takes a drug to cope with experiences they find hard to bear, it is not necessarily wise to blame the drug for any subsequent mental break. Touring several nights a week for months straight, Barrett’s deranged behaviours could be partly triggered by the exploitative atmosphere of the music industry.

“He feels that the application of commercial considerations is harmful to the music,” a report in Melody Maker stated in December 1967 — after the chart failure of “Apples and Oranges”, a by-the-numbers psych-pop single that Barrett had written amid intense managerial and label pressure to produce another hit. “He’d like to cut out the record company, wholesalers and retailers.” The same year, Pink Floyd performed on Top of the Pops for the first time, and Barrett expressed some reluctance to go on stage. It was then that Pink Floyd’s bassist Roger Waters first noticed that something might be wrong.

Barrett deteriorated rapidly. Before another scheduled performance on Top of the Pops, he turned up at a friend’s door barefoot and in a panic. In 1971, Barrett — now three years out of Pink Floyd — refused to leave his home for a photoshoot; he was afraid of “aliens”. What appears to be deranged at first makes a kind of sense when one considers that the aliens he feared were in fact his managers and hangers-on.

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Robert Chapman’s biography describes how, even after Barrett had achieved some semblance of later-life balance in his hometown of Cambridge, obsessive fans would regularly knock on his door, film him with camcorders, steal his paintbrushes, climb over his fence, pose as couriers to secure autographs, and scan the neighbourhood trying to catch a glimpse. And something strangely under-discussed in the documentary and Barrett’s biographies is how the massive success of his former band — which had ejected him without warning in 1968 — might have made him feel. It can’t be a coincidence that Barrett retreated into isolation at the Chelsea Cloisters Hotel just as Pink Floyd hit the big time in 1973 with Dark Side of the Moon, which is partly about him and his madness.

Many acid casualties were as much victims of a music business that eviscerates its workers as of overwhelming psychedelic trips. Peter Green of Fleetwood Mac rejected the music industry in even more radical terms than Barrett, pledging to give away his earnings to charity, to reflect his new Christian beliefs; a move viewed by his contemporaries as the initial spark of his madness. The 13th Floor Elevators took LSD daily for long stretches of the Sixties; but their breakdowns were surely influenced by the predation of the local Texan police force, which sought to destroy the band’s acid evangelism through arrests and threats of violence.

Someone else deemed an acid casualty is Brian Jones of the Rolling Stones, the subject of a recent BBC documentary. On top of the relentless psychoactive effects of fame and public pressure, Jones’s paranoia can be seen a response to prohibitionist drug policies: after a humiliating court appearance for drug possession Jones, as Nick Kent writes, “was too scared to go into a shop to buy cigarettes even, because he thought anyone behind the counter had to be a plain-clothes cop”. Jerry Berkers, bassist of the Krautrock band Wallenstein, may have collapsed under the weight of his LSD visions, but it’s thought his trips reacquainted him with the trauma of time spent serving in Vietnam.

And yet, our interpretation of mental breaks often place little emphasis on the worlds in which they’re situated. In his classic text, The Triumph of the Therapeutic, Philip Rieff describes the ascendancy of the “Psychological Man” — the embodiment of late modernity — who understands himself in internal terms. We are our thoughts; our self stands behind the glass of our eyes, variously disappointed and enchanted with the stream of our inner lives flowing out into the world we perceive. And yet in studying history’s casualties, it seems that what was happening on the outside was flowing into, and warping, their internal worlds.

Even among those who reject the simplistic diagnosis of acid casualty, a more subtle form of othering can occur. “There can be no doubt that Syd was a schizophrenic,” Waters said — despite the fact that Syd was never diagnosed with anything other than an undisclosed personality disorder. Indeed, the schizophrenia diagnosis, applied to many of history’s casualties by both psychiatrists and onlookers, may seem like an objective description. But the reality is far more complex.

Schizophrenia is popularly understood as a biological phenomenon: an organic madness, in which its primary explanation lies within the individual. But poor outcomes for schizophrenia are independently shaped and predicted by parental socioeconomic status, poverty, class, immigration status, living in urban environments, and membership of a racial minority. Evidence tentatively suggests that those labelled schizophrenic in countries such as India and Ghana fare better than those in the United States, since they are less likely to be medicalised or face the stresses of developed modern life. This supports the idea that the music industry’s pressures may have been far more harmful to the acid casualties than either their original or psychedelically altered brain chemistry.

It’s easy to apply the labels of “acid casualty” and “schizophrenia” — and it sounds authoritative — but, in truth, the latter diagnosis is broad, vague, and variably administered. Dr Robin Murray, one of the UK’s most senior psychiatrists, suggested in 2017 that “the term schizophrenia will be confined to history, like ‘dropsy’”. As early as 1973, when many casualties were being diagnosed, the World Health Organization suggested that, for all its faults, the term should be preserved partly “for the benefit of non-professional contemporaries who enjoy talking about schizophrenia without knowing what it is”.

Commentators are therefore right to remark on the hypocrisies of “mental health awareness”: depression and anxiety are being unduly neutralised in the language of medicine, while “serious conditions like psychosis and schizophrenia are being overlooked”. The general public was understandably struck by the news last year that depression is not, as they’d been told, a mere “chemical imbalance”. The Moncrieff paper fast became one of the most accessed in modern history. But the popular reckoning with the parameters of schizophrenia is nowhere to be seen.

It is acknowledged even in the DSM-5, psychiatry’s “Bible”, that the majority of those who develop psychotic disorders have no family history of the disease — weakening the idea that genetic predisposition can fully explain mental breaks. The medical establishment has found hundreds of biomarkers “associated” with schizophrenia, but many of them overlap with other conditions, and may point to a broad “sensitivity” — which may make mental collapse more likely, but not inevitable.

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But since the Sixties, the biogenetic model of schizophrenia has been in ascendance; and the basis of diagnosis always influences the rationale of treatment. Just as the understanding of depression as unsettled brain chemistry allowed some irresponsible medical practitioners to sell antidepressants as a silver bullet, our understanding of mental breaks as caused entirely by internal factors can be harmful. Many acid casualties faced great failures from the psychiatric sector following their diagnoses: involuntary electroshock, premature discharges, and shocking over-prescription.

None of this is to say that our treatment of those experiencing mental breaks has become worse since the Sixties. The antipsychotics on offer now seem to be more tolerable than those of their forebears. But stigmas towards psychosis and schizophrenia have, by some measures, deteriorated — possibly because of the othering that associates the stereotyped schizophrenic with some alien influence in their nervous system. Though we might not label anyone an acid casualty these days, our readiness to see mental distress as solely internal may prevent us from reckoning with the unhealthy pressures our society places on individuals. Psychiatry always attempts to remain apolitical. But it might do well to accept that mental breaks can, at least in part, be blamed on a troubled world in which, to quote psychiatric researcher John Read, “bad things happen and can drive you crazy”.

Often, such grim descriptions are paired with an upbeat solution: better access to mental health care, including psychiatric drugs. Given the understanding of mental health that has been promoted to the public for the past 40 years, this advice makes sense. We have come to understand that depression and other mental problems are disorders of the brain. Psychiatric treatments fix this brain disorder, or at least induce changes in the brain that are helpful to the suffering person.

However, if the past is prologue to the future, this understanding will continue to make the problem worse. For the past 35 years, we have sought to spread “awareness” of depression and other mental health issues. This has led to a dramatic increase in the prescribing of antidepressants: in 1990, the CDC reported that fewer than 3% of adults had taken an antidepressant during the previous month — a number that rose to 13.2% in 2018 and 23.1% earlier this year. Yet the burden of depression in the United States and other Western countries has only risen during this time.

There is a fundamental reason why. We have organised our thinking, and care, around a narrative of medical progress — of effective drugs that fix chemical imbalances in the brain — that isn’t to be found in the scientific literature. And the chasm between what is told to the public and what is found in the scientific literature has led our societies astray.

Writers, philosophers, and doctors have long observed that melancholy — a time of sadness or grief — visits nearly everyone now and then. As the 17th-century physician Robert Burton advised in The Anatomy of Melancholy, “it is most absurd and ridiculous for any mortal man to look for a perpetual tenure of happiness in this life”. It was only when melancholy became a “habit” that it could be considered a “disease”.

This was the understanding that prevailed until the Eighties. People often suffered bouts of depression, particularly in response to setbacks in life, but such feelings were seen as normal. Depression was only a “disease” in cases where people stayed depressed for no apparent reason, and these were rare. Community surveys conducted in the Thirties and Forties in the United States found that fewer than one in a thousand adults suffered an episode of “clinical depression” each year. Among this group, most did not need to be hospitalised, and only a small minority became chronically ill.

These findings led experts at the National Institute of Mental Health (NIMH) in the Seventies to advise the public that depression was an episodic disorder, which would generally clear up on its own. Most depressive episodes, wrote Dean Schuyler, head of the depression section at the NIMH, “will run their course and terminate with virtually complete recovery without specific intervention”.

However, this understanding of depression was soon to disappear.

During the Seventies, leaders of the American Psychiatric Association (APA) worried that their field was in crisis. Critics argued that psychiatry functioned more as an agency of social control than as a medical discipline, that its diagnoses lacked validity, and that its brand of talk therapy, psychoanalysis, was no more effective than other therapies offered by psychologists and counsellors.

In response, American psychiatry decided to rebrand itself. The public needed to understand that psychiatrists were medical doctors who cared for patients with real diseases. Not only would this rebranding improve psychiatry’s public image, but it would also give psychiatrists a privileged place in the therapeutic marketplace. They had the power to prescribe drugs, while psychologists and counsellors did not.

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The APA, when it published the third edition of its Diagnostic and Statistical Manual in 1980, reconceptualised psychiatric disorders as diseases of the brain. The age-old distinction between ordinary depressive episodes and “clinical depression” was dropped, and both were lumped together as a single “disease”. Nancy Andreasen, future editor of the American Journal of Psychiatry, set forth tenets of this new psychiatry in her 1984 book, The Broken Brain. “The major psychiatric illnesses are diseases,” she wrote. “They should be considered medical illnesses just as diabetes, heart disease and cancer are.” With this understanding in mind, the APA quickly set out to market its new model of depression to the public.

It found an ally in pharmaceutical companies, who were also eager to change the narrative. Erasing the distinction between ordinary depression and clinical depression promised to create a huge market for antidepressants. Pharmaceutical companies gave money to the APA to develop its PR machinery in the early Eighties, and then, in 1988, they provided funds to support a NIMH campaign, called the Depression Awareness, Recognition and Treatment (DART) program, that was designed to sell the disease model to the public.

In anticipation of this campaign, the NIMH had conducted a survey of public attitudes about depression. Only 12% of Americans said they would take a pill — an antidepressant — to treat a depressive episode. And 78% said they “would live with it until it passed, confident that they could handle it with their own”. The purpose of DART was to relieve the public of this “misconception”. According to the NIMH, Americans needed to understand that depression was a “disorder” that regularly went “underdiagnosed and undertreated”. Absent treatment, it could become a “fatal disease”.

The public was also presented with a new — apparently scientific — theory of depression: that it was caused by a lack of serotonin in the brain. Thankfully, scientists had discovered a medicine, selective-serotonin reuptake inhibitors (SSRIs), that fixed this chemical imbalance. Prozac and other SSRIs were heralded in the media as “breakthrough medications” that could not only fix depressed patients but make them feel “better than well”.

Untreated depression was now presented as a pressing public health concern. Most important, people were being trained to monitor their own emotions, and to treat sadness or emotional discomfort as symptoms of a disease requiring medical intervention.

The PR blitz worked. In a 2005 press release, the APA shared the “good news”: 75% of consumers now understood that “mental illnesses are usually caused by a chemical imbalance in the brain”.

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The low-serotonin theory of depression arose in the Sixties from the discovery of how the first generation of antidepressants, tricyclics and monoamine oxidase inhibitors, altered normal brain function. Both hindered the normal removal of serotonin (a monoamine) from the synaptic cleft between neurons.

Once this “mechanism of action” was discovered, researchers hypothesised that perhaps depression was due to too little serotonin. However, when researchers ran experiments to test whether people diagnosed with depression, prior to being medicated, suffered from low serotonin, the results were disappointing. As early as 1984, NIMH investigators concluded that “elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression”.

Investigations into the low-serotonin theory continued, but none provided convincing evidence to support it, and in 1999, the APA, in the third edition of its Textbook of Psychiatry, declared the theory dead, writing that decades of research “has not confirmed the monoamine depletion hypothesis”.

These conclusions were never promoted to the public, and so, this past June, when British investigators published a review of the history of this research and found there was no evidence to support the low-serotonin theory of depression, their conclusions were reported as shocking. In fact, we have known as much for two decades.

The real story, however, is even worse. Antidepressants block the normal reuptake of serotonin from the synaptic cleft. In response, the brain adapts to try to maintain its normal functioning. Since antidepressants raise serotonin, the brain responds by dialing down its own serotonergic machinery. In other words, antidepressants induce the very abnormality — a deficit in serotonergic function — hypothesised to cause depression in the first place.

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Antidepressants, then, do not fix any known disorder. But, their defenders might counter, could they nonetheless help depressed people?

Here, too, the evidence is thin. In the world of “evidence-based” medicine, placebo-controlled, double-blind randomised trials (RCTs) are the gold standard for assessing a drug’s effectiveness. A recent meta-analysis of such studies determined that 15% of depressed patients treated with an antidepressant experience a short-term benefit; the remaining 85% are exposed to the adverse effects of the drugs without any benefit beyond placebo.

Even those short-term results suggest a major problem with widespread use of antidepressants: six of seven patients experience the drugs’ side-effects without any corresponding benefit. The most common side-effect may be sexual dysfunction, which in some cases can last long after patients stop taking the drugs. But some patients can also suffer from a drug-induced worsening of their original symptoms.

There are two notable elements of this drug-induced worsening. First, antidepressants triple the risk that a depressed patient, within 10 months of initial treatment, will turn manic and be diagnosed as bipolar, which is a much more severe disorder than depression. Second, over the long-term, antidepressants increase the risk that a person will remain symptomatic and functionally impaired.

The latter worry showed up in the Seventies, not long after antidepressants were introduced. At that time, clinicians still had a memory of depressive episodes that regularly cleared up without the use of drugs, and several reported that patients treated with antidepressants were now relapsing more frequently than before. Epidemiological studies agreed. The third edition of the APA’s Textbook of Psychiatry, published in 1999, summed up the disappointing findings: Only about 15% of patients treated with antidepressants recover and are still well at the end of one year.

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Studies conducted since then suggest that even that 15% recovery rate may be too high. In the largest antidepressant trial ever conducted, the STAR*D study, only 108 of the 4041 patients who entered the trial remitted and remained well at the end of one year, a stay-well rate of 3%. The vast majority never remitted, remitted and then relapsed, or dropped out of the study. Meanwhile, a 2006 NIMH study of depressed patients who didn’t take antidepressants found that 85% recovered after one year, just like in the pre-antidepressant era.

Naturalistic studies in depressed patients regularly find that, over the long term, medicated patients are more likely to remain symptomatic and to become functionally impaired. These findings led Italian psychiatrist Giovanni Fava to propose, in a series of papers dating back to the Nineties, that antidepressants induce a biological change in the brain that makes patients more vulnerable to depression. As Rif El-Mallakh, an expert in mood disorders at the University of Louisville School of Medicine, put it in a 2011 paper: “A chronic and treatment-resistant depressive state is proposed to occur in individuals who are exposed to potent antagonist of serotonin reuptake pumps (i.e., SSRIs) for prolonged time periods.”

In other words, there is reason to believe that the mass prescription of antidepressants is making us, on the whole, more depressed. Indeed, the “economic burden” of depression — composed of workplace-related costs (absence from work), suicide-related costs, and direct-care costs — has steadily risen since the SSRIs came on the market. In 1990, it was calculated at $116 billion in inflation-adjusted terms. By 2020, it had nearly tripled to $326 billion.

Disability due to mood disorders has also risen. In community surveys conducted in 1991 and again in 2002, 30% of the adult population was found to suffer from an anxiety, mood, or substance disorder, based on DSM diagnostic criteria. However, while the prevalence of these disorders didn’t change, the percentage of people who got treated did, rising from 20% in 1991 to 33% in 2002. Over the same period, the number of American adults receiving a government disability payment due to a mood disorder rose from 292,000 to 940,000.

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Following the publication of DSM III in 1980, the public was told a story of a great advance in medicine. Research had found that depression was due to a chemical imbalance, which antidepressants fixed. We organised our thinking around that narrative: depression was a biological “disease” that required medical treatment. This false narrative is the root cause of our mental health crisis today.

The tragedy is that there is another, more optimistic narrative about depression that exists in the scientific literature. This narrative informs us that human beings are responsive to their environments, and that depressive episodes often arise in response to setbacks in life. Time, and finding ways to change one’s environment, regularly lead to a spontaneous remission of depressive feelings.

A society that wants to promote good “mental health” should strive first to create more nurturing environments — improving access to housing and childcare, and working toward a more equal distribution of financial resources. It should also favour, as a first response, holistic treatments for depression — diet, exercise, walks in nature, social engagements, and so forth — as these complement our natural capacity to recover.

Antidepressants could still serve as a useful tool. Their use would simply need to be informed by research that tells of their limited short-term efficacy and of their potential negative long-term effects. Doctors would also need to inform patients that these drugs do not fix a “chemical imbalance”. True informed consent would dramatically reduce the use of these drugs, and surely diminish prescribing habits that treat them as a go-to response.

Paradigm shifts do happen, and today’s mental health crisis is telling us that one is desperately needed. Forty years of the disease model of depression has left us sicker and unhappier than ever before. There is little reason to believe that more of the same will fix our problems, and plenty of reason to think it will continue to make them worse.

And yet I worry, too. I worry because selling a book, especially for any kind of decent advance, is a tricky business, and the temptation to be prurient and sensationalist must be considerable. I am a committed enemy of romanticising mental illness, which contributes to the impression that the mentally ill are somehow living deeper, more “intense” lives, rather than more painful ones. I want mental health memoirists to understand their profound responsibility to tell the grubby, sad truth about this life.

But mostly, I envy people who write mental illness memoirs. I envy their memories. They can recall the details of their psychiatric histories; I often can’t. Years have passed, faster and faster, since the major incidents in the history of my condition. For important portions of that history, I was brutally depressed, or grindingly manic, or actively psychotic, conditions not conducive to the formation of lasting memories. I have spent 15 years on and off (though mostly off) memory-destroying medications, and have now been on them for five years straight. And for most of that time I was actively in denial, about all of it, to the point of believing at points that it wasn’t real. I did not tell my siblings, those I was always closest to, for more than a decade after my first diagnosis. Sometimes I’d assert that I was finally on the straight and narrow, finally cured — an assertion that always, always preceded the next ruinous crash.

Some things I remember like they were yesterday. Some I don’t remember at all. When I write about my own mental health history, I write in ellipses and at a Dutch angle — for aesthetics, yes, to satisfy my own standards as a writer, but also because to tell it otherwise would make me feel like a liar. I just don’t trust my memory of some details.

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I have spotted a similar instinct in other mental health memoirs. Girl, Interrupted is imagistic and ruminative, much less a recounting of the day-by-day events of Susanna Kaysen’s commitment to McLean Hospital, and much more a series of pleasantly meandering meditations on the concept of sanity and the self. Kaysen also includes original forms and files from her hospital stay; George Scialabba’s brilliant and haunting How to be Depressed consists of little else.

And then there’s Strangers to Ourselves. It’s not a straightforward memoir but rather a collection of brief vignettes, or case studies, about mental illness, written by Rachel Aviv. Her own story opens the volume. She became anorexic as a six-year-old, barely literate, and mostly unable to define what was happening to her. Aviv leaves unsettled the question of whether she was “really” anorexic — her age and stated motives for not eating complicate the question — and instead contrasts her own condition with those of the older patients around her. By reproducing her own experience of mental illness, Aviv brings a little skin to the game in a text that’s mostly about telling other people’s stories for them.

More important, her personal history segues into Aviv setting the boundaries of her project. The book is about people whose “lives unfold in different eras and cultures, but they also share a setting: the psychic hinterlands, the outer edges of human experience, where language tends to fail”. She explains her holistic approach:

“the book draws not only from conversations with them but from their diaries, letters, unpublished memoirs, poems, and prayers… It’s impossible to go back in time and uncover what baseline feelings existed before a story was told — when a person’s angst and loneliness and disorientation had yet to be given a name and a vessel — but I find myself searching for the gap between people’s experiences and the stories that organise their suffering, sometimes defining the course of their lives.”

This is what I needed, from this book, up front: both information about how these individual stories were compiled and an acknowledgment that we all, as patients, construct truths with the raw material of memories that so often refuse to cohere, and therefore use the textual record to confirm and supplement our stories. In the opening section, she quotes her younger self as writing: “I had some thing that was a siknis its cald anexorea.” I was initially sceptical: it sounds like an adult writing the way they think a child would write. But Aviv later explains that she had dug out her childhood diary. I didn’t need her to do so to make her recollection of her illness more real; it just helps to know that the exact wording came from the page and not her memory.

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Sometimes, texts are all there is to go on. Aviv can’t speak to some of her subjects, such as Ray, a depressive who has been dead for years. Instead, she pulls significantly from his unpublished memoir, which follows his decision to sue a psychiatric facility where he was committed. Ray struggled through psychoanalysis at Chestnut Lodge, where he lived in for long months, only to come later to feel that he had been fooled by a broken paradigm that forbade the use of antidepressants. As Aviv tells it, Ray’s psychiatrist seemed to think of such drugs as a shortcut rather than a cure, and therefore avoided their use.

Aviv tells Ray’s story both for its own sake and to consider the fundamental conflict in late 20th-century psychiatry. The Freudian assumption that all psychiatric conditions could be traced to discrete events in childhood, and cured through excavating these memories in psychoanalysis, dominated American psychiatry for decades. It led a lot of patients to endlessly recite early traumas, without much therapeutic gain. That approach was overtaken by an ascendant hope that new drugs could fix chemical imbalances in the brain and turn psychiatry into a medical field like any other. Now, we appear to have swung back the other way: decades of disappointments in psychopharmacology have inspired many to declare that “there’s no such thing as a chemical imbalance”, which has become an inescapable social media bromide.

What frustrates me is that people seem unable to accept that the interaction between the brain and the mind is extremely complex. That the simplistic not-enough-serotonin theory of depression appears to be wrong does not imply that all neurological explanations are off-limits. We don’t have to yaw constantly between “all brain” and “all mind” explanations. Aviv, thankfully, settles on no pat answers to these questions, instead, simply meditating on them via Ray’s strange story.

Likewise, she uses every case study to examine the nuances of some broader social or economic or political issue. There’s Bapu, a Brahmin-class Indian woman whose religious adherence straddles the line between faith and madness; her story considers the conflict between Western medicine and spiritualism. There’s Naomi, a young black mother whose deepening paranoia compels her to attempt to drown herself and her two young children; her story illustrates how entrenched racism complicates psychiatric care for people of colour. There’s Laura, an affluent young woman who starts taking a cocktail of medications at a young age and finds it very hard to stop; her narrative helps explore the thorny questions of how long patients should stay on drugs. It’s never advisable to draw too deeply from individual stories in analysing societal trends, but the connections Aviv draws to such trends give the book teeth, making it more than merely poignant.

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The final section enables us to consider Aviv’s responsibility to her subjects and the difficulties of telling their stories. It focuses on Hava, an anorexic who Aviv encountered at a young age and whose life she sees as something of a road untraveled, given her own early struggles. Hava appeared to be making clear progress in her life, finding a steady boyfriend and planning for her future; sadly, years of making herself sick had damaged her body’s ability to regulate the reflex, and one night she choked on her own vomit in her sleep. She is one the three people profiled who were dead prior to the completion of the book, but Aviv’s deference to their own words makes their stories seem like memoirs all the same.

Perhaps it’s a sign of solipsism that this book often provoked me to wonder what Aviv would make of my story. I crave the simplicity of having my life printed out in black and white text; I also dread the inevitably reductive nature of such an exercise, and I’m scared of what someone else’s eyes might see in my narrative. For me personally, mysteries abound. I couldn’t possibly tell you the name of the doctor who diagnosed me as bipolar. At the time, I was not conscious in a conventional sense and everything that happened seemed to happen somewhere outside of me, people puttering around and talking in strange language I didn’t understand. There was an ER, there was a shot of haloperidol, and there was a stretch in a grey and muted psychiatric facility. Someone must have written my diagnosis down on a chart. Who that was is known only to God and, I imagine, to some mouldering file somewhere that I have absolutely no interest in digging up.

There are a lot of things I don’t understand about my own history. Worse, I can’t remember if the weight of years, mental illness and medication has simply obscured that knowledge, or if I never knew. In general, my time in the mental health system has been marked by constant confusion; I would feel like a liar if I said, “and then this month, in 2011, this happened”.

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Do the subjects in Strangers to Ourselves struggle the same way? What must it feel like, for those who are still living, to read this book? Aviv tends to avoid the overly literal, rescuing the book from questions of simple authenticity and making it, usefully, a record of how foggy our recollections can be. But I can also imagine readers who might be frustrated by the lack of clear lines between certain truth and imperfect memory. All of us long for order in the stories we read. I think that’s why people gravitate towards mental illness narratives, to clarify something that has been obscured by instability. But how do you faithfully translate what is by its nature not translatable?

I honestly don’t think writers tell lies in mental illness memoirs. I wouldn’t even say they bend the truth. I would suggest, perhaps, that they take the fragments of what they know happened, and through them assert a kind of truth, as part of a therapeutic process. That asserted truth might not look exactly like that of a dispassionate observer — say, one of the many doctors who wander into our lives, speak to us condescendingly, make marks on a chart, and shuffle out of our story. But I can’t see much harm done, when patients tell it themselves. The conceit of a memoir is that other people will be entertained by our misfortune; so long as we tell our stories with integrity, those who suffer through the instability and boredom and deprivation of dignity common to serious mental illness are entitled to our own frames. I only hope that both writers and readers know that the attempt to organise the experience is quixotic and we are narrativising the un-narrativisable. I understand the feeling that we must try anyway.

Aviv, like me, is wary of the way that definition can trap and limit us. In our online culture of mental illness, diagnoses are celebrated: young people wield them like talismans for a sense of validation. And I am not entirely a stranger to the seductive power of becoming one’s diagnosis, letting it become the load-bearing element of your personality. But I am also no stranger to the way that, further down the road, that self-definition becomes cramped and uncomfortable, even horrifying, as you start to want to be something else. (To the newly-diagnosed, I urge you, do not become your illness.) For years I resisted writing anything about my mental illness; now I worry constantly that when I do so, I pigeonhole and limit myself.

“People can feel freed by these stories,” Aviv writes, “but they can also get stuck in them… a role that at first seemed freeing, but it began to destroy them.” This is the most recurrent theme in Strangers to Ourselves: the double-edged sword of the stories we tell to make our disorders comprehensible. Aviv’s is the kind of mental illness narrative I trust and value the most: suspicious of narrative itself. It’s perhaps a kind I could even write myself. The bigger kind, the longer kind, the “and then this happened on this date” kind, is both beyond my abilities and against my best interest. As Aviv writes, “there are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which”.

Of the primates, humans spend the most time dreaming: 20-25% of sleep. Sigmund Freud’s probably erroneous theory that dreams are unconscious, censored, unfulfilled wishes, to be analysed and interpreted for their true meaning, has dominated culture for more than a century. But since the Sixties, many other dream purposes have been theorised, tested, and confirmed.

In newborns, dreams stimulate neurons to form networks. In children and adults, dreams rehearse coping behaviours; convert new learning and experiences into long-term memory; assist in problem-solving and creativity; maintain and update our unique identities; and allow for emotional acuity, so that we don’t slip into fear bias, viewing neutral facial expressions as menacing.

My favourite dream purpose is that dreams improve mood. Called the “mood regulatory function of dreams theory”, this covert, complex, antidepressant effect was most researched and elucidated by Rosalind Cartwright (1922-2021), a psychologist and neuroscientist known as the Queen of Dreams.

Over a period of 40 years, beginning in the Sixties, Cartwright did a series of studies on depressed people. “I wanted to study whether there is a natural healing process that could be detected in dreams,” she wrote in The Twenty-Four Hour Mind (2011). She had people sleep overnight in her lab, where she repeatedly woke and interviewed them about their dreams. She found that dreams were filled with negative, troubling material, but that they became increasingly positive throughout the night, “drawing together more and more remote associations”. By morning people felt happier, calmer, and better prepared to live.

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I hadn’t heard of this auspicious purpose, which doesn’t seem to have ever been theorised before the 20th century, until I read Cartwright’s book. When we get a full night’s sleep, our minds tell us around two hours of interconnected stories over three to five dreams, cycling between NREM — non-rapid-eye-movement — and REM sleep. The process “works well only if sleep is intact, regular, and long enough to complete its nightly tasks”, wrote Cartwright. If we interrupt our mind’s storytelling, each night is like one to three disturbing, depressing, nihilistic short stories, instead of one weird, fantastical, autobiographical, ultimately uplifting novel.

Dreams also work on problems over weeks and months. Studying divorcees with untreated depression, Cartwright compared those who recovered after five months with those who did not. The dreams of the people who didn’t recover were simple and brief, with few characters and little to no emotions. The dreams of those who did recover were long and dramatic, with numerous characters and complex plots, involving many emotions, scene changes, and references to past events.

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Dreams are just one benefit of sleep. In Why We Sleep (2017), self-described “sleep diplomat” Matthew Walker shared sleep’s many other benefits. Sleep maintains a healthy microbiome, balances the body’s insulin and blood sugar levels, cleans the brain, maintains healthy testosterone levels (helping us focus), protects our DNA, enhances the function of every major organ, and strengthens our immune systems.

A 2015 study, in which the cold virus was squirted up the noses of 164 people, found that 45.2% of those who’d slept an average of less than five hours the previous week became infected, as opposed to only 17.2% of those who’d slept seven or more hours. Walker wrote: “Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer.”

People who chronically under-sleep experience microsleeps, in which conscious perception — in all channels, from visual to audio — shuts down for a few seconds, often without the person knowing it. “A two-second microsleep at 30mph with a modest angle of drift can result in your vehicle transitioning entirely from one lane to the next,” wrote Walker. More car accidents are caused by “drowsy driving” like this than by alcohol and drugs combined.

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Unfortunately, the sleep-deprived do not know they are operating at suboptimal levels. Studies have found that people consistently underestimate their “performance disability”, wrote Walker. The underslept do not know that if they slept a fraction more they’d be physically healthier; less depressed, anxious, irrational, and moody; less dangerous to themselves and others.

Our ancestors slept seven to eight hours a night, beginning at around 9pm, and, except in the cooler winter months, 30 to 60 minutes each afternoon, according to studies on the Gabra in Kenya, the Hadza in Tanzania, and other aboriginal groups. Some modern cultures retain this schedule, with siestas. A Harvard study done in Greece found that individuals who did not have daily naps suffered a 37% increased risk of death from heart disease.

Arguably much worse than death, lack of sleep and dreams can lead to unconscious murder of loved ones, committed while sleepwalking. A 2012 study in Neurology found that 3.6% of US adults sleepwalk, while a survey of around 5,000 people in the UK found that 2.1% had violent behaviours while asleep. Cartwright served as a sleep expert in two sleep-murder cases. In 1987, a 6’5”, insomnia-ridden man named Kenneth Parks drove 14 miles to his in-laws’ house, where he choked his father-in-law unconscious and fatally stabbed his mother-in-law. In 1997, a chronically sleep-deprived, caffeine-tablet-using man named Scott Falater stabbed his wife 44 times, rolling her body into a swimming pool.

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In court, Cartwright argued that Parks and Falater were innocent. Both men were “bewilderingly motiveless”, both displayed “profound remorse”, and both were unconscious of their actions. Falater is now serving a life-sentence in Arizona, while Parks was acquitted by a Canadian court, which called his behaviour “non-insane automatism”.

We are always partly dreaming according to Cartwright. Our 24-hour minds, like our bodies, are self-healing systems, which modern society disrupts. Cartwright wrote that “most of the medications that are prescribed to relieve depression also suppress REM sleep”. Sleeping pills, Walker explained, do not provide natural sleep. Ambien produces a destructive kind of sleep, causing a 50% weakening of the synaptic connections formed during learning. Artificial lights, especially LEDs and electronic screens, disrupt the circadian rhythm.

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By Will Storr

A hundred years ago, less than 2% of Americans slept six hours or less a night; now, almost 30% do. Children are sleeping two hours fewer per night than kids 100 years ago. The problem seems worst in the US and the UK. This is good news. It means that life, for many people, can easily be improved. Mental illness and physical health problems can be alleviated night-by-night, at home, in bed.

Walker wrote that Freud made a “remarkable scientific contribution” to dream research by situating them in the mind, but that his theory of “wish fulfilment” had been rejected by modern science. Dreams are not just an epiphenomenon, nor simply a place where we try to fulfil our unconscious wishes. Dreams are “an internal psychotherapist”, wrote Cartwright.

Cartwright was “as much a pioneer in dream research” as Freud, according to Walker. Her research shows that our minds, evolved over hundreds of millions of years, are smarter, more complicated, and more caring of us than anyone ever thought.

The Miserable Older White Woman emerges from the same blend of old-school misogyny and ageist ugh-mom-ism that brought us first the Wine Mom and then the Karen, in the summer of 2020. In theory, a Karen was a white woman who called the police on black people who were simply minding their own business. In practice, the term started getting used (and is indeed still used) in reference to any woman over the age of 25 who has spoken up, in any context. In the early pandemic days, I was once called “Karen” after asking some teenagers on public transit to put on masks. But anti-maskers also got labelled Karens too, so we can’t win (unless we stay silent).

Who has it in for these women? A significant number of the Twitter accounts piling hate on middle-aged women seem to be controlled by young men who give off incel vibes. They are also angry at young women for rejecting them, and their mothers for not sending their favourite meal down to them that evening in their proverbial basement. What is clear is that these women are an avatar for complaints that span, or defy, the ideological spectrum. The Miserable Older White Woman inspires an intense, if difficult to pin down, political fury. Both progressives and the Right seem to agree that “Liberal white women on antidepressants will be the end of our civilisation”, but the stereotype allows a range of people to channel a variety of frustrations. She’s the 53% of white women who supposedly (but not actually) voted for Donald Trump in 2016, but also the tear-strewn pussy-hat wearer at the Women’s March protesting that election’s outcome.

For the Left, the privileged lady wrangling a prescription for her non-problems can be blamed for all of society’s woes: racism, imperialism, the housing shortage, the cost of living, climate change, perhaps even monkeypox. Her antidepressant usage can be categorised as yet another indulgence she engages in while other people suffer, akin to a day at the spa: “White women live off of Starbucks and antidepressants.” The Left-produced caricature lives in a large suburban house with a rich husband and resents her perfect life: “Excess red wine, antidepressants, free time and money has truly done wonders to boomer white women.” This is a women whose problem is that she has it too good. If she had to deal with the same adversity as everyone else, this would build character, and she’d stop the whinging.

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For the Right, the Miserable Older White Woman is the opposition: “Democratic party supporters are self-hating college-educated white women. Basically if you live in an apartment in LA and own four cats, a massive ‘sex toy’ and consume a lot of antidepressants you are a Democratic party voter.” And she is getting her comeuppance for her decades of liberalism. She foolishly bought into the feminist myth that women have brains and should have high-powered careers and look at her now, all alone with her cats, pining for the life she could have had if she’d settled down when still turning heads. If she’d stayed a virgin until marrying Ward Cleaver at 22, she wouldn’t be popping pills of any kind. She’s sad because she’s alone, but don’t feel sorry for her, it’s a misery of her own making. A lesson for young women: get married before you’re middle-aged — and why not to one of the charming young men who spend their days online mocking older women?

And yet critics from the Right also have it in for the Miserable Older White Women who have settled down, but who fail to have either aged into traditionalist matrons or remained chipper 20-somethings. Pratt, of “Welcome to Hell”, more recently made the rounds for introducing Twitter’s cynical masses to the Peach Mom, a comic about the angst of an apparently well-off stay-at-home mom (albeit with side hustles) who despises her husband for doing less of the housework and childcare. The woman behind these evidently autobiographical comics then got widely ridiculed, in part because it is objectively ridiculous to post comics to the internet that bash your spouse, but also because she was a Miserable Older White Woman, unhappy with her lot, but for no good reason. Why wasn’t she grateful that she had a provider husband who also did some housework? (Much was made of the fact that he apparently does childcare when she goes out in the evening to teach yoga, as though the teaching of yoga is an indulgence and not a part-time job.) She should be grateful, was the gist.

But the common ground of why she’s demonised is that she represents liberal modernity, to people across the political spectrum who object to it. The Miserable Older White Woman is a normie, a Hillary not Bernie supporter. An AWFL (“affluent white female liberal”); a Twitter search for that very-online acronym paints a similar picture. Her reaction to Kamala is an enthusiastic yaaas. She posts milquetoast liberal messaging to her Instagram, about Black Lives Mattering and trans rights and abortion rights, but in a cringe way.

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There’s a perception, among her detractors, that liberal modernity has given women of this demographic too much ground, which has made them (as well as everyone else) worse off: “Affirmative action, war on poverty, and the modern feminist movement empowered white women. This newly empowered group remade society in a way that harmed men that couldn’t adapt. This new society is not so great and white women begin taking massive amounts of antidepressants.” Men’s rights activists agree with far-Left advocates for the true marginalised: white women are spoiled pseudo-victims. They are society’s actual most powerful, but imagine themselves oppressed.

Does it all come back to Hillary Clinton? Hillary — per her haters — the privileged complainer. Hillary, the embodiment of the dorky, stodgy mom who does not know how to relax. Unlike other ways of medicating away bad moods, antidepressants have exactly zero reputation for being edgy or fun. Much like you know who. Even Hillary’s supporters faulted her, during the 2016 US presidential campaign, for not appearing to have a good time. (Too young, too attractive, and too fun-loving is also a problem, as a certain Finnish prime minister could attest.) The people who wanted to vote Democrat in 2016 but just couldn’t stomach Hillary are, in their rhetoric, very like those who see a stat on older white women’s antidepressant usage and go: “makes sense.”

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Middle-aged women don't want sex

By Mary Harrington

There’s also cross-ideological consensus that older women have committed the crime of having aged out of hotness. A Reddit theorist suggests older white women are upset because “they’re the most protected and coddled class when they’re young. When their looks fade they stop getting preferential treatment which is hard for most to adjust to.” The thing where “when you’re accustomed to privilege, equality feels like oppression”, in other words. So, according to their critics, these women used to have too much and are now bitter over a normal existence.

To appear old is, in a sense, to look miserable. Society values women for youth, a fleeting quality, which is enough to make anyone miserable. But there’s also the specific fact that the changes to facial features that happen naturally with age read, on women, as anger. Women sick of being told they seem angry seek Botox — an anti-aging treatment — to remedy the situation. One wonders whether Miserable Older White Women are as miserable as all that, or just look that way, and are disproportionately prescribed antidepressants because their doctors — fallible humans like the rest of us — interpret their ordinary facial expressions as ones of distress. The medical establishment has made stupider mistakes.

Women, particularly housewives, have long been prescribed drugs at a much higher rate than men. One can look at this as society throwing drugs at women to distract them from their situational misery so that they don’t question the situation itself. But one might just as easily see this as a case of men not having access to proper mental health care, or indeed to the drugs that can be used relatively safely to make them less miserable. Are the men who sneer at antidepressant-using women just repulsed, or are they also, perhaps, envious? Do they wish they could be like the women who face somewhat less stigma for going ahead and making an appointment with their GP? Is the Miserable Older White Woman’s crime being miserable, or is it valuing herself enough to do something sensible about it?

When the first antidepressants were developed in the Fifties, the condition was considered so rare that the drug research seemed like a waste of money. But in a 2017 survey, 12.7% of Americans had taken antidepressants in the past month (and nearly twice as many women as men). It is not to deny the existence of catatonic states of despair to suggest that there may have been a definitional leak.

One might retort that “depression” was simply “under-diagnosed”, but equally present in every earlier stage of human history. Consider, though, the discovery of SSRIs, a class of drugs that combined lifetime use with a better safety profile than earlier antidepressants (just weight gain, sexual dysfunction, and the occasional suicide upon withdrawal). And consider the context of that discovery: a world where pharmaceutical companies fund much of the research used in their own regulation, and that research is easy to skew. In short, it is a truth universally acknowledged that a pharmaceutical company in possession of a new drug shall be in want of an endemic illness. As the GlaxoSmithKline slogan bluntly went: “Does your soul have a cold?”

Still, it would be sophomoric to think that depression was wholly and solely constructed by Big Pharma. Until recently, it was understood that “no man living is free, no stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself; so well composed, but more or less, some time or other he feels the smart of” melancholy. So wrote Robert Burton, a reclusive life-long fellow of Oxford, four centuries ago, in his freewheeling account of sadness, The Anatomy of Melancholy.

Burton was writing in one of the last periods where the role of the writer wasn’t to express an individual thesis, but instead to summarise everything. As such, his Anatomy has little in the way of synthetic thought. As Burton says, “I have read many Bookes, but to little purpose, for want of good method, I have confusedly tumbled over divers Authors in our Libraries, with small profit, for want of Art, Order, Memory, Judgment.” He can’t even settle on a definition of melancholy — “whether it be a cause or an effect, a disease or symptom … I will not contend about it” — but he does examine some potential causes. Black bread, melons, hot air, cold air, excessive exercise, defective exercise, the stars, God, hot baths, a hot brain, Calvinism, Catholicism, excessive studying, excessive merrymaking, excessive “chamber-making”.

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The West needs to grow up

By Paul Kingsnorth

As for melancholy’s symptoms, “the tower of Babel never yielded such confusion of tongues, as the chaos of melancholy doth variety of symptoms”. Indeed, it’s sometimes difficult to separate cause from symptom, as in the glorious description “lascivious by reason of much wind”. Burton’s aim is to “adventure yet in such vast confusion and generality to bring them into some order; and so descend into particulars”. Many of these loopy excursions come to a familiar enough conclusion: melancholy’s cause is sin, and its cure is God: “We ought to fear our own fickle estates, remember our miseries and vanities, examine and humiliate ourselves, seek to God, and call to Him for mercy.”

But Burton does not deny the importance of strategies to combat melancholia. These include behavioural changes — drink a glass of water upon waking; seek hills or mountains; “be not solitary, be not idle” — and mental ones — avoid prolonging passionate thoughts; avoid believing in predestination; “be meek, merciful, and patient”. There is comfort here, for the post-modern reader. Thanks to the rapid rise of neuroscience and the branding of depression as a “brain disease”, many third-party carriers reimburse doctors for medication management only, and many depressed people are simply handed a prescription by a general practitioner and told to check in in six weeks. In Burton’s day, the old Galenic system of humours did emphasise the physical. But these days depression is treated like heartburn; in more exploring reaches, it’s treated by impersonal, one-size-fits-all cognitive behavioural therapy, now the province of therapy apps advertised by Instagram scroll.

At the extremes, the “chemical imbalance” theory raises troubling questions about human character; and its Brave New World-style treatment can make the human being feel like an unruly dog. No matter how many analogies one can make to infectious disease or broken legs, depression is experienced at a complicated level inextricable from one’s most virtuous traits — sensitivity, self-criticism, ambition — and to think of oneself as merely a malfunctioning machine or a bundle of “trauma reactions” can impoverish the self.

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Pleasure: a disappointing debut

By Ann Manov

The experience of The Anatomy is one of overload, and perhaps it is best to read it with the desperation and joy of Samuel Johnson, who “frequently resorted to [The Anatomy] for the purpose of exhilaration” while running his tiny, failing school at Edial Hall. Its very eclecticism and capaciousness is its virtue. Perhaps reading anecdotes about ancient kings won’t cure you: but given that depression rarely is “curable” at all, there’s something beautiful about feeling this continuity of human experience, across time and space, to feel one’s sadness as part of a world history full of delight and variety. Compare the experience of the sad person today, asking their doctor for Prozac or maybe playing with an adult colouring book, to the experience of a Samuel Johnson. The first is made to feel small and simple; the second is made to feel himself more intelligent, more dignified, more ambitious. Moreover, as any reader of Shakespeare’s tragedies will know, the early Moderns had a way of laughing about despair, solitude, even suicide — a kind of manic sad clowning found absent from the way most people talk about mental health now, both infantilising and deadly serious. Burton, after all, wrote The Anatomy under the name Democritus Junior: the laughing philosopher.

I read The Anatomy the winter after my first law school exams, ambivalent about a course of study that was beginning, nonetheless, to gel into inevitability. I was staying on the couch of a family member in Florida, in a condo surrounded by red and orange tropical plants and buzzing constantly with the exertions of a leaking air conditioner. Through the screen door, at any hour of the day or night, I could see the recently discharged woman next door swaying silently in front of a blue-fuzz TV. Against her state, obviously, The Anatomy is of little use. But for the sort of low-grade malaise I found myself in — the sense that my fears would never disappear but my possibilities, one by one, would — The Anatomy made me feel a little bit better. I read it on the beach, I read it over diner milkshakes, I read it on hot and sleepless nights, on that orange leather sofa that congealed to my skin.

The Anatomy clocks in at 1,392 pages — my paperback quickly broke in half — and any paragraph swims through a dizzying array of references, Homeric through Renaissance; medical, theological, and philosophical. On the one hand, its difficulty made me feel accomplished; and on the other hand, it made me feel, basically, that it was fine to be scared, to still be doubting. I could try cabbage one day, clear water another, oranges, opening windows, perfume, walking in fields, sweet-scented baths, confessing to a friend, faith in God, eating earlier, fasting, seeing sunlight upon waking, reading Herodotus, reading Elizabethans. And above all, as Burton’s last section of course requires, truly and steadfastly resisting despair.

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Mental illness doesn't make you special

By Freddie DeBoer

Small consolations, it’s true, but ones that fit into a life well lived — unlike antidepressants, with their dubious efficacy and their near-certain, unpleasant side effects; and unlike so much of self-help, with its individualism, and its transactional focus on convenience and utility. Burton’s salves are enriching, not subtracting. They make the reader feel, in some small way, in control of their condition, an active agent. As the habit makes the monk, the medicine makes the patient, and against the pop psychology and medical cocktails more commonly on offer, there’s something to be said for the demanding and delightful sublimations of The Anatomy. That the book is often baffling only further recommends it. It feels good to do something difficult; and it feels good to get out of one’s own time, to defamiliarise one’s own condition: though people may have always felt sad, they felt differently about feeling sad.

The Anatomy of Melancholy won’t cure depression. But there’s something comforting about this futility: if sadness has always existed and always will, even for those, like Burton, of exemplary learning and unparalleled discipline, even in the most foreign reaches of time and place, even after 13,000 pieces of advice and 400 years, then we might try to make something generative of some of the pain, to “write of melancholy, by being busy to avoid melancholy”.

Rob Barrow is the CEO of MindMed: a leader in a new species of pharmaceutical firm. These companies, described as “corporadelic”, are aiming to change mental health — and maybe the world — through psychedelic drugs. 

Barrow was the opening speaker at the PSYCH Symposium, held recently in the National Gallery. The agenda: “to connect and collaborate”, and to “expedite access” to “psychedelic healthcare” across Europe. The wider mission is an old Sixties dream — brotherhood, connection to nature — repackaged for a new age of all-powerful corporations and philanthropists.

These are boom times for psychedelics. Celebrity endorsements, Netflix documentaries, and all-star conferences abound. In recent weeks we’ve seen The New York Times and the BBC broadcast stories of veterans dissolving PTSD in MDMA, and psilocybin’s apparent (and, it seems, swiftly-discredited) capacity to “free up the depressed brain”. 

Maybe the most extraordinary moment, though, was the Psychedelics House of Davos, featuring a World Economic Forum-sponsored panel: “shamanic investing” expert Silvia Benito, Deepak Chopra, and the Countess Amanda Feilding. Feilding’s Beckley Foundation has fronted her quest since the Sixties to rehabilitate psychedelics — LSD is her favourite — and, curiously, the ancient art of trepanning.

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Harm reduction has captured the US

By Jacob Siegel

It’s been a strange turnaround. Criminalised and forced underground since 1970, psychedelics and related drugs have been found, by a a growing number of clinical trials, useful in treating mainly psychic ills, including depression, PTSD, anxiety, and addiction. The “peak states” furnished by LSD, psilocybin (the active ingredient in magic mushrooms), MDMA, ketamine, and others — combined with pre- and post-session therapies — can help ease chronic distress. Johns Hopkins studies of psilocybin for end-of-life anxiety, depression, and smoking cessation, for instance, indicate rough efficacy rates of 85%, 75% and 80%, respectively — although their sample sizes were not large or diverse, and their results have not yet been replicated.

Establishing efficacy in trials according to a gold standard of evidence is difficult. Long-term follow-ups are scant and a host of concerning side-effects — re-traumatisation, debilitating changes in visual processing, strokes — are under-explored. COMPASS Pathways’ Phase 2b trial of psilocybin for depression prompted concern among commentators and retail investors, who noted that suicidal thinking and behaviour were higher among those administered psilocybin than the control: a serious adverse event (SAE) rate of 5%, with a resulting crash in the share values of psychedelic firms. Whether down to chance, a small sample sensitive to noise, or, as COMPASS argues, the inherent risks of dealing with highly depressed patients, one broad conclusion should remain the same: psychedelics are powerful, and we ought to tread lightly. 

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How science has been corrupted

By Matthew Crawford

Joining these difficulties are a host of barriers faced by those who want to conduct research on psychedelics. “The Science” is always political, as Covid-19 showed in spades. Psychedelics are researched in an uphill, pragmatic battle against anti-drug prejudice. Britain remains sclerotic and authoritarian on drug policy, as revealed by our new culture war-driven push to persecute “middle class cocaine users” and black-mark their passports. These rules are reified in institutional obstacles to further research (some of them bizarre), which a UK campaign led by Crispin Blunt MP is attempting to reform. Similarly Byzantine practices afflict researchers in the United States. Research must therefore be conducted alongside a push to change attitudes, convince committees, and win a PR war. 

The response of psychedelics firms, backers, and some scientists has been to hype their products. Story-hungry media and a searching mental health sector have been willing enablers. We see studies from top institutions suggesting psychedelics can “decrease political authoritarianism”, help combat climate change, or “navigate a path to peace” in Palestine. A recent “population study” suggested psychedelics “lower the odds of crime”, with an “association” observed between peyote use and decreased “motor vehicle theft”. In particular, a famous (and flawed) chart by ex-Drug Tsar Professor David Nutt showed harms from LSD and magic mushrooms as near-zero, with the results replicated in downstream “drug information” and “harm reduction” resources. 

The corporadelic movement is playing “the establishment game from inside the establishment”, Countess Feilding said at the Symposium. “Use the light of science to destigmatise and rehabilitate psychedelics.” This rhetorical approach has been dubbed the “Trojan Horse”, with medico-scientific corroboration a vessel for the larger mission.

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The missionaries dwell in a broad church. Consider the Multidisciplinary Association for Psychedelic Studies, or MAPS, and its founder Rick Doblin. Funded by and collaborating with corporadelic firms, MAPS is in Phase-3 studies into MDMA for PTSD, in particular for veterans: a group bound to elicit sympathy from the conservatively-minded. “We don’t actually do science,” Doblin said. “We do political science.”

He foresees that psychedelic therapy, and an envisioned network of “thousands of clinics” by 2035, will democratise “the sense of connection, not just the idea of it, but the felt experience of it”. 

“It is inevitable that in hyping things up too much, risks can arise”, Countess Feilding clarified via email. “On the other hand, it seems vitally important to establish if psychedelics have a major part to play in the survival of Homo sapiens and in improving our health, happiness, and outlook.”

But today’s psych-elites don’t seem particularly interested in democracy: they are drawn from Silicon Valley, Burning Man bros, billionaires, and California narcissists. A “market opportunity of £1.8 billion by 2026” remains for the taking, Symposium attendees were told. Billionaires like Peter Thiel, venture capital, hedge funds, Google, and the owner of GoDaddy have piled into psychedelic medicine; dozens of new firms with names like Eleusis, Awakn, Field Trip and MindCure have appeared, all decked with white-sheen websites and evangelical web copy. And the safer psychedelic retreats currently cost thousands of dollars, and may well stay that way.

“I believe loving money is one of the greatest gifts you can give humanity at this time,” said Azrya Bequer, one half of a husband-and-wife duo behind BEQOMING, an outfit earmarked “to serve the 0.1% of the wealthiest people in the world to start making better decisions for our planet and our future generations” — through facilitated ayahuasca ceremonies. 

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Why now? Psychiatry is in crisis, commentators observe: in total contrast to the advances of physical medicine, and despite tens of billions of dollars invested in treatments and research, outcomes remain broadly stagnant. It is a field in search of a silver bullet. 

But squaring the circle of the world “out there” has been psychedelia’s perennial problem. “It’s all in the mind, ya know,” George Harrison’s acid cartoon blurbed in 1968’s Yellow Submarine, to the trumpets of All You Need Is Love. The cost-of-living crisis, inequality, institutional decay — the more material drivers of our distress — received little mention at the Symposium. There was talk of trauma, the inner healer, the true self. Or, for pharma firms profiting from a brain-centric, diagnostic view of misery, there is “chemical imbalance” and “brain disorders”, leveraged by overstretched references to “neuroplasticity” and pretty pictures of brain scans. Even the Department of Defence is directing $26.9 million towards novel psychedelics for veteran PTSD, whose battle scars they reduce to a “neurophysiological dysfunction”. 

MindMed’s former CEO, JR Rahn — now CEO of a “People-Powered Pharma” outfit called LOVE Inc. — put it this way: “Forty percent of the country is suffering — that’s a big, big market.” 

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That market is greedy. Reportedly in keeping with the FDA’s regulatory requirements, plans are in place, in time, for MAPS to administer MDMA to children as young as seven. “The sooner you treat people for their trauma, the more benefits when you come to talk about insurance coverage and all,” Doblin said. “The more lifetime benefits there are, the more suffering you avoid.”

It’s tricky territory. A psychoactive as powerful as MDMA would seem precisely contraindicated for children, whose developing brains may render them susceptible to long-term changes and dysregulations. Doblin is firm and provocative. “The prohibitionist argument leaps from problems that can be caused by daily or frequent use of marijuana, or other drugs, to arguments for abstinence”, he said over email. “Daily use of marijuana in high school can be problematic but that doesn’t mean the message to adolescents should be to never use marijuana.

“For adolescent patients with PTSD, their brains are already warped by their PTSD, so not using MDMA to protect their brains doesn’t make sense”, he said.

The mission is not without its own traumas, however. Strikingly, at least four participants in MAPS’ MDMA trials experienced significant deteriorations in their wellbeing that were neither chased up nor reported in their much-vaunted paper, published to mass media attention in Nature. Across psychedelic culture, victims of sexual assault and rape claim they have been told to keep silent to avoid drawing stigma to the Mission.

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No psychedelic drug is yet approved by regulators, though MDMA stands at the penultimate Phase 3 stage. More banal realities can be stubborn. Despite complacent claims, including from Professor Nutt last month, that psilocybin is “the most effective antidepressant” — and “we don’t need [controlled trials]” — an Imperial College head-to-head of psilocybin versus an SSRI indicated no significant difference, even after a six month follow up. Press teams and media downstream — even The Daily Mail — spun these results in a more sympathetic tone: that “psilocybin performs as well as antidepressant”. Brought to trials desperate for help — and inflated by PR pumped by research departments about “brain resets” — the patient may experience striking collapses in mood as mushroom euphoria dissipates and depression returns, or if the promised mystical experience fails to manifest. 

These are just some of the under-explored problems with “therapy on acid”. Patients are also vulnerable to hyper-suggestibility, sexual abuse, exploitation, and risks of guru complexes among therapists, who can programme their clients with their own worldviews. These issues were rarely mentioned at the Symposium. Reportedly contacted by representatives in Rwanda, Doblin has elsewhere spoken of seeking to dissolve the animosities of Hutus and Tutsis with MDMA. An outfit known as Unlimited Sciences, a “psychedelic research nonprofit” launched to “inform public perception, education, policy and practices”, is raising funds for a study on the outcomes of mainly-female Saudi refugees at an ayahuasca ceremony: a population for whom such bioethical issues are likely aggravated.

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In the “Great Psychedelic Craze” of the Sixties, it was believed that LSD and cannabis could create a revolution. Draped in white robes and beads, Dr Timothy Leary told reporters that “the kids who take LSD aren’t going to fight your wars” or “join your corporations”. Looking around the Symposium was to see the death of a dream. Far from overturning power structures, psychedelic utopianism has been captured by the elite. 

We listened to Christian Angermayer, the billionaire “Prince of Psychedelia”, who says he “finally understood Bitcoin” after his first psilocybin trip, and has since tattooed the molecule on his arm. He compared his therapists to shamans, drawing a straight line between the apocryphal drug cults of early Christianity and “ancient Egypt”. Angermayer reassured investors of market deteriorations in guru-like tones: “The market is a cycle like life is a cycle … as a company, if you are fully-financed, you almost have to say: okay, ignore the stock market, it does not contribute to your mental health.”

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Just as mindfulness became McMindfulness, psychedelics has become McPsychedelics. The transition has not been universally applauded: two senior psychedelic figures described crying at the Symposium. “We thought we were getting Woodstock, but we’re getting Prozac Nation 2.0,” said Jamie Wheal, who was prophetic commentator on the psychedelic scene in 2019.

“How can we compete with this?”, asked Lauren Katalinich of the UK Psychedelics Society, gesturing woefully towards a Symposium room of grey fabric and black suits. Capital does as capital will. In its quest for new and fruitful markets to carve, it has gone from without to deeper within, and plumbed the fathoms of inner mind. Corporadelic firms post marketing photos of misattributed “shamans” on Twitter; “mystical experience”, a predictor for depression, sells. There is perhaps no psychedelic feature that couldn’t be captured and marketed: nominally-radical notions, like encountering hyper-realistic entities and God Himself on DMT, become news copy and advertisements to entice clients. 

At its height in the Sixties, the Great Psychedelic Craze believed it could levitate the Pentagon through sheer “vibration”. For the Second Great Craze, the world of “net zero trauma” is its infinity point — where the trip is heading is anybody’s guess. Utopia translates as “no place”.

An earlier draft of this article described COMPASS Pathways’ Phase 2b trial as exhibiting a ‘red flag of suicidal thinking’ among patients administered psilocybin. This has been contextualised. An earlier draft also suggested that Unlimited Sciences were raising funds for a study to administer ayahuasca to Saudi refugees. This is not the case. Funds are instead being raised to study the population outcomes, with no input on administration. 

Eloise is a champion of neurodivergence, an omnibus term that’s recently ballooned in popularity, which can include autism, anxiety, borderline personality disorder, or indeed any other psychiatric condition that’s hot right now. The term is designed for making sweeping pronouncements. Forget the fact that, say, autism and schizophrenia are so different that they have at times been described as opposite conditions. Forget the fact that saying you’re neurodivergent has as much medical meaning as saying you have a disorder of the body. The idea is that there’s a group of people whose brain chemistry differs, in some beautiful way, from some Platonic norm. And it’s an idea that’s taken on great symbolic power in contemporary liberal culture.

There is, for example, a thriving ADHD community on TikTok and Tumblr: people who view their attentional difficulties not as an annoyance to be managed with medical treatment but as an adorable character trait that makes them sharper and more interesting than others around them. (They still demand extra time to take tests, naturally.) It’s also easy to come across social media users who declare how proud they are to be autistic; I’m glad they’re proud, but their repetitive insistence makes me wonder who exactly they’re trying to convince, us or them.

Darker, there’s the world of “DID TikTok”. DID, dissociative identity disorder, is a profoundly controversial condition, once known as multiple personality disorder. Many serious experts question whether it exists at all; at the very least it’s incredibly rare. And yet thousands of adolescents have diagnosed themselves with the condition, and happily perform their various personalities for their social media followers, typically in ways that defy all established psychological understandings of the disorder.

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By Stuart Ritchie

Against this backdrop, Eloise is a marketing department’s dream come true: hers is a story of the young, beautiful, dysfunctional — and successful. Eloise is the perfect 21st-century woman, from a certain internet-enabled philosophy of human affairs. She is an admirer of witchcraft and believes that women have a mythical connection to water. She does a lot of drugs and becomes bisexual. She uses Tumblr and travels the world, vacationing in Lisbon and the south of France, and moves to Los Angeles to be an actor, taking care to embed that period of her life in a self-defensive patina of irony. She lives an enviable life of obvious socioeconomic privilege, which she does not have time to recognise, as she’s too busy cataloging her psychiatric maladies.

She crams them into every last anecdote: apparently nothing happens to her that she does not ultimately attribute to those maladies. Eloise’s love of swimming as a child is, for instance, laboriously explained in terms of her neurodivergence. I’m talking thousands of words. It seems never to have occurred to her that a love of swimming is not exactly rare among children, or that she doesn’t have to justify her joy at being in the ocean by making it “deeper”. Again and again, she holds perfectly mundane attitudes and behaviours up to the reader and says “Isn’t this special?”

The label of neurodivergence is so vague and capacious, pretty much anything can be pulled into its orbit and made “diverse”. There’s a meme that crops upon Tumblr, TikTok and Twitter that starts with “the neurodivergent urge to…” and is immediately followed by, well, just about anything a person does. Common examples include the neurodivergent urge not to reply to an email or to order food in rather than cooking what’s in the fridge.

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Take Eloise’s nightmares. She has, at times in her life, suffered from debilitatingly bad dreams that made sleep a constant source of fear and pain. This sounds like an awful condition, and she deserves sympathy. But she gives the game away when she writes: “Maybe my relationship with dreaming wasn’t like everyone else’s.” Not like everyone else’s, no. But certainly like that of many people who suffer from recurring and terrifying nightmares. Eloise writes that, according to the Mayo Clinic, nightmare disorder “only affects around 4-5% of adults, which shocked me: did adults really not have nightmares?” It’s as if she genuinely does not know the difference between 4% and zero.

It is perhaps comforting to see every last detail of one’s life as the product of some uncontrollable force. “I am this way because I was born this way,” Eloise writes, in a remarkably bald denial of personal responsibility. As a pawn of the various interior forces that do combat in her brain, she is adamant that there is nothing wrong with her, that her suffering is all in service to some deeper way to live, and that she is proud of the very conditions she asks us to treat as a perpetual get-out-of-jail-free card for her behaviour.

The implication is that the neurodivergent might just be better than other people. As with introverts, social media users have developed a discourse around neurodivergence that is nakedly self-celebratory, a bragger’s genre. Eloise has clearly endured a great deal of hardship, but like her culture she seems to feel that this hardship can only be given meaning by being woven into a journey of self-actualisation. Eloise writes that her life is “underpinned and ultimately made whole by obsession”. Can you imagine a sadder statement: an adult telling you that there is nothing to distinguish her or give her value but her psychiatric conditions, conditions she shares with millions of others?

Diagnosis is the Holy Grail of the neurodivergence narrative. Eloise fixates on hers and its quasi-mystical powers. No reader could doubt that her problems are real, but she seems to have treated getting diagnoses like a consumer on Amazon. She states flat out, on several occasions, that she went shopping for an autism diagnosis, went to doctors with the express intent of wringing one out of them. There was a time when self-diagnosis was understood to be unhealthy, and perhaps embarrassing, but this is a brave new world we’re living in now.

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Once enough people insist on mental illnesses as upbeat and fashionable lifestyle brands, then any of us who oppose it are guilty of the most grave sin of all, the sin of perpetuating stigma. It’s stigma to call autism a disorder, despite the fact that it renders some completely nonverbal and unable to care for themselves; it’s stigma to suggest that someone with ADHD bears any responsibility at all for problems at school or work; it’s stigma to speak the plain fact that people with psychotic disorders sometimes commit acts of violence under the influence of their conditions. It’s stigma, in other words, to treat those of us with mental illnesses as anything else than wayward children.

Stigma, that cartoon monster, has never been in the top 100 of my problems in 20 years of managing a psychotic disorder, but never mind; stigma is the ox to be gored in contemporary pop culture, and so we must fixate on it to the point that we sideline the health, safety and treatment of those with mental disorders.

What I find tragic about those who buy into the neurodivergence narrative is that they become their illnesses. And yes, there are alternatives. Eloise and people like her seem never to consider one of the possible ways that they could have dealt with their myriad disorders: to suffer. Only to suffer. To suffer, and to feel no pressure to make suffering an identity, to not feel compelled to wrap suffering up in an Instagram-friendly manner. To accept that there is no sense in which her pain makes her deeper or more real or more beautiful than others, that in fact the pain of mental illness reliably makes us more selfish, more self-pitying, more destructive, and more pathetic. To understand that and to accept it and to quietly go about life trying to maintain peace and dignity is, I think, the best possible path for those with mental illness to walk.

But in this culture, all must be monetised, all must be aspirational, anything can be marketed. Eloise lacks the self-awareness to ask whether there’s something exploitative and ugly about turning psychological illness into fodder for soap opera and motivational posters. Again and again in this book, Eloise gins up the kind of statement on mental health that you might find in an Instagram meme, wedges it awkwardly into some prosaic story about her youth, and then skips away. At one point she mocks “Airbnb-style Live Laugh Love signage”, and I could only think, you’re writing a book filled with it.

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The most real, most human, most honest, and most humane part of Eloise’s book is something she wrote in a journal in 2009, when she was a teenager:

I fear my mind, as one single assembly by one fireman on fire safety in primary school caused this deep-seated fear. That shows the true extent of my mind’s power over me. Although these things are unlikely to happen, just yet, I fear every one of them one day. I don’t need a doctor to tell me that is a problem. But I want, so badly, to get better.

This is what it’s actually like to have a mental illness: no desire to justify or celebrate or honor the disease, only the desire to be rid of it. But the modern conception of neurodivergence (and disability activism generally) wants to have it both ways. Sometimes, people would prefer for you to think of their conditions as debilitating hindrances for which they may demand special dispensation. And sometimes they would like them to be seen as positive personality quirks that make them unique.

It is hard to witness the damage that has been done to this young woman, by a culture that insists she views her suffering as part of a beautiful journey. Today’s activists never seem to consider that there is something between terrible stigma and witless celebration, that we are not in fact bound to either ignore mental illness or treat it as an identity.

Were we wiser and more serious, we might be able to see psychiatric disorders as both natural and lamentable, as beyond the control of the individual but still within their responsibility. We would have sympathy for those who suffer from them, but recognise that sympathy only accrues to those whose conditions are unfortunate, unhealthy. We might be honest and say that, yes, it’s bad to be afflicted with psychiatric disorders.

We might, then, have the courage to say that mental illness sucks, that there’s nothing good about it, that the efforts to bend it into some superpower of greater creativity or deeper living is sour grapes from those who can’t escape. We might help people like Eloise, rather than celebrating them as self-actualised girlbosses. We might have the wisdom to ease her suffering, while we patiently tell her that there’s nothing beautiful about it.

Johann Hari used to be a star columnist at The Independent, and popped up in numerous other publications. After his various misdeeds came to light in 2011, he briefly disappeared, then reinvented himself as a non-fiction author and highly successful TED Talk speaker.

Maybe there’s nothing wrong with this transformation. He did, after all, apologise — after a fashion — for the plagiarism and the malicious editing. Perhaps he’s now a reformed character, worthy of rehabilitation. But as Jeremy Duns has pointed out, Hari has never provided a full account of everything he did wrong. His articles are still online without any flags from the newspapers that published them — and some of them make quite, well, surprising assertions.

But what if his books really are that good? They must have done something to earn such laudatory quotations and blurbs from varied luminaries including Hillary Clinton, Elton John, Russell Brand, George Monbiot, Glenn Greenwald and Tucker Carlson. On the back of all this support, and some heavy marketing, his books have been best-sellers.

Unfortunately, the books are not, in fact, that good. In his first, Chasing the Scream — in which he announced that “everything you know about addiction is wrong” — Hari hadn’t quite changed his ways. Even though he posted audio clips of his interviews online (a concession born of the ethical lapses he’d previously committed), actually listening to the clips revealed that, in very many cases, he seemed to be misconstruing what his interviewees said.

The neuroscientist Dean Burnett wrote an exasperated critique of an extract from Hari’s second book, Lost Connections, which asked “is everything you know about depression wrong?” Hari’s condemnatory attitude to anti-depressant drugs, for example, wasn’t exactly nuanced, and he made some truly bizarre (and bizarrely untrue) points — for example that, “if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away”.

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Hari’s third book, Stolen Focus: Why You Can’t Pay Attention, published yesterday, is not much better. Which is frustrating, because the phenomenon Hari addresses — the feeling that, with so many distractions around in the modern, online-centric world, it’s harder than ever to focus — is one many of us experience. Hari says that he and almost everyone around him feels this way, and describes a several-months-long “digital detox”, where he went to live in a small town on Cape Cod with no smartphone and no internet.

But that’s all anecdotal: does Hari actually present any evidence that shortening attention spans is a society-wide problem? There’s a study on how topics appear and disappear on Twitter more quickly now than a few years ago; some research on how many distractions office workers experience; and a dodgy-sounding but headline-ready statistic about how often we “touch our smartphones” each day (2,617 times, apparently).

It’s not until more than halfway through the book, page 176, that Hari drops what should be a bombshell: “We don’t have any long-term studies tracking changes in people’s ability to focus over time.” In other words, he quietly admits that there isn’t really any strong scientific evidence for the main thesis of the book. That’s despite how true the attention problem seems to many of us. It must be said that, on closer inspection, the people I know who complain the loudest about not being able to focus are people who have still managed to write tons of columns, scientific papers, or even books in the past years: even Hari mentions in passing that he wrote a 92,000-word novel while on his Cape Cod getaway, turning the story from an interesting self-help tale into a grotesque humblebrag.

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Clearly, we need some better data to understand how deep and widespread an issue this actually is. But let’s give Hari the benefit of the doubt, and consider how he tries to explain the phenomenon.

Most of the book is dedicated to the causes of our collective attentional problems. The first is, unoriginally, social media. Isn’t it very revealing, Hari writes, that there’s no button on Facebook that you can press to help you meet up with your friends in person? Facebook won’t, he says, “alert you to the physical proximity of somebody you might want to see in the real world”. Hari explains that the whole business model of social media precludes the encouragement of joys like looking your friends in the eye or giving them a hug, and instead is based on keeping you fixated on your screen, scrolling endlessly, never leaving the house.

Except Facebook does have exactly the feature that Hari claims doesn’t (and couldn’t) exist. It’s called “Nearby Friends”. It gives you a little map of where your friends are physically at that moment (if they have opted in). It’s been available since 2014. A two-second Google search would have enlightened Hari. Maybe he wrote that part of the book while he was in internet-free isolation.

The more you think about Hari’s objections to social media, the sillier they become: for years Facebook has been one of the main tools people use to arrange meet-ups and in-person events. It can and does introduce us to people who become our friends in real life. People don’t just use social media because we’re mindless drones, hoodwinked by Big Tech. But Hari barely mentions its benefits, and instead regurgitates (though thankfully, with citation) the catastrophic view put forward by many before him, including Tristan Harris and Jaron Lanier.

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Indeed, many of the other causes Hari identifies are rehashings of previous pop-science and pop-psychology books: we aren’t sleeping enough (Why We Sleep); kids don’t play outdoors any more (Free Range Kids and The Coddling of the American Mind); we don’t eat the right foods (a million diet books). Of course, it’s not a crime to write a book that doesn’t provide any new information. But Hari’s irritating, breathless style turns every single fact he “discovers” into a startling revelation, every single expert he speaks to into the absolute best in the world. Hari’s research — a series of interviews for a pop-psychology book — becomes an intense, globetrotting journey of personal discovery. His mind is so often blown that it’s little wonder it has such difficulty in paying attention.

It’s not just that Hari thinks he’s discovered earth-shaking new information. (As Dean Burnett wrote of Lost Connections, Hari “repeatedly presents well-known concepts and ideas … as fringe concepts that he’s discovered through his own efforts”.) He also thinks he’s a hard-nosed scientific truth-seeker. At the start of the book, he solemnly assures us that: “I studied social and political sciences at Cambridge University, where I got a rigorous training in how to read the studies these scientists publish [and] how to assess the evidence they put forward”.

What makes this risible isn’t just that he’s touting his undergraduate degree as if it makes him an expert (a fairly substantial proportion of the population also have one). It’s that Stolen Focus exhibits no talent for assessing evidence. A few times there’s a small concession to a flaw in a study, or to the fact that scientists disagree on a point — but Hari fails to add any of the necessary uncertainty to his argument. After a cursory mention of the “other side,” he usually just blunders on regardless, assuming his argument is right.

The book builds up to Hari’s ultimate theory for why we have all these attentional problems: it’s capitalism itself! Our blinkered focus on economic growth, Hari writes, puts us in a rat-race that ruins the workings of our brains. We should abandon the idea of growth, he argues, and aim for what the economic anthropologist Jason Hickel calls a “steady-state economy”.

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Never mind all the evidence for the benefits of economic growth in alleviating grinding poverty and hellish disease, particularly in the Global South. Never mind Hari’s own assertion that poverty can be another cause of attentional problems. What’s more important than the world making progress is that he, Johann, sometimes has a bit of trouble focussing on his next book.

Hari’s call to kill capitalism is not the only embarrassing, student-level politics in Stolen Focus. He thinks we should have an activist movement called “Attention Rebellion” to do, well, he never actually says what. He thinks we should nationalise Facebook — which would, to be fair, probably solve the problem of how distracting it is, by making it unusably slow and terrible.

When focused on the individual who is easily distracted, he does provide some realistic advice. But that includes things like: pre-commit to getting tasks done; use special software to restrict access to social media; get some decent sleep. It’s all pretty obvious (if, in many cases, easier said than done). With Hari, as was once said about Freud, “what is new in his theories is not true, and what is true in his theories is not new”.

And yet, despite all this, it seems that the media establishment — especially outside the UK, where his unethical past is less known — just can’t get enough of him. His first book is apparently being made into a documentary series presented by Samuel L. Jackson. And from what he’s said in interviews, more non-fiction is forthcoming — not to mention the Cape Cod novel. But this is a writer who’s shown himself again and again to be either untrustworthy, unoriginal, or uninformed. If he’s right to say that our moments of focus are becoming ever-more precious, isn’t it time we started paying attention to someone — anyone — else?

Katy Perry’s Firework was perhaps the ultimate chin-up-tits-out song for the first generation to be fully net-native from childhood onwards. And not just because in the official video Perry shot sparklers from her boobs.

Her song struck a chord with many: Firework peaked at number three in the UK charts, and number one in the US. Her prescription for feeling bad is simple: don’t feel bad. Instead, all you have to do is “own the night like the 4th of July”.

But how, in practice, is one meant to “own the night”?

A new book offers some suggestions — aimed, it seems, at the adults who were once teenage Katy Perry fans. Why Has Nobody Told Me This Before? invites us to see becoming less paper-thin as an important form of self-improvement. “To me,” opines author Dr Julie Smith, “working on maximising our mental health is no different to working on our physical health.”

Looking through the problems Smith describes, one can infer a few things about the implied reader and their struggles. This person is anxious, perfectionist, keen to be liked, prone to minutely dissecting social interactions, spends a lot of time scrolling through social media and worrying about others’ perceptions.

This suffers “low mood” and “anxiety”, struggles with “stress” (there’s a whole chapter on it) and thinks a great deal about couple relationships (another chapter). Typical self-limiting beliefs include imagining that failing at one thing makes them a ‘loser’, or that because someone hasn’t called in a while it’s “because she hates me”.

Dr Julie never explicitly addresses her book to one sex or the other. But I’m willing to bet you know more women than men who fit the description above, an egregious bit of stereotyping that is supported by studies which show women consistently score more highly for anxiety, perfectionism and neuroticism than men.

It’s tempting to suggest that the kind of neuroticism addressed in Dr Julie’s book is new: a product of the navel-gazing social media age, perhaps. And considerable evidence has been amassed now to suggest that social media is making young people more neurotic — especially young women.

A few months before Firework reached number one, in October 2010, Instagram was launched. In the four years that followed, as girls sang along to Katy Perry’s song about transcending your insecurity to wow the crowd, the rate of hospitalisation for self-harm among American girls aged 10 to 14 doubled.

Similar trends are visible in the UK: the Guardian reported in 2017 that over the decade 2007-2017 the rate of hospitalisation for self-harm among girls under 17 had risen by 68%. And Instagram is heavily implicated: summarising its effect on self-perception, a 2019 internal presentation by Facebook, Instagram’s parent company, reported: “We make body image issues worse for one in three teen girls”.

But delving into historic medical literature on women’s mental health suggests that while Instagram may not be helping, it’s possible that the platform is exacerbating something that already existed. Feminists have long written critically about sexist portrayals of women’s emotionality in medical literature. Over three centuries ago, in 1681, the physician Thomas Sydenham offered a description of what he calls the “hysteric diseases”, which sounds strikingly like the emotional world experienced by Dr Julie’s implied reader:

“They indulge terror, anger, jealousy, distrust, and other hateful passions; and abhor joy, and hope, and cheerfulness… They love the same persons extravagantly at one time, and soon after hate them without cause… So unsettled is their mind, that they are never at rest.”

Unlike Dr Julie, Sydenham wastes no time in attributing this form of mental distress more to women than men. Few women, he asserts, “are quite free from every species of this disorder”. But unlike the ancients who thought neurosis was a function of female physiology, Sydenham thought it was mostly an effect of material ease.

In his observation, women who do hard physical work don’t suffer from “hysteria”, while men “who lead a sedentary life, and study hard” do. Sydenham called this male version “hypochondria” rather than hysteria, but describes both ailments as characterised by similar symptoms: “lowness”, “disordered mind” and “incurable despair”. For Sydenham, this ailment of ease inevitably includes more women than men, for men “cultivate the earth, hunt and kill wild beasts for food, and the like”, while the wealthier a woman gets the more likely she’ll be to be exempt from such gruelling work.

But perhaps material comfort is a double-edged sword. We might infer from Sydenham’s comments that without a healthy channel for aggression, and a sense of being able to act on the world around us, both sexes grow restive — and a historically sexed division of labour has made this especially the case for women. The accompanying sex role stereotypes, meanwhile, have long since taught women to bury all such dark and dangerous emotions.

Far from pursuing agency and a full range of emotional expression for its implicitly female readership, Has Nobody Told Me This Before? continues the time-honoured tradition of teaching women to internalise. Sigmund Freud based his theories of the human psyche on the twin pre-rational drives of sexuality and aggression; but these, considered fundamental human drives by psychoanalytic psychotherapy, barely feature in Dr Julie’s manual for self-optimisation: two mentions each. In contrast, “anxiety” appears 77 times. And while there’s a brief discussion of anger, this is only in the context of grief. Implicitly, anger is never about aggression — it’s always a cover for something cuter and more deserving of sympathy, such as fear or loss.

At the micro-scale, the book offers uncontroversial and often practical advice on how to be slightly less neurotic. Our minds can play tricks on us, Dr Julie advises, so troubleshoot practical reasons for feeling low, such as tiredness or thirst, before you catastrophise. Try not to obsess about things that go wrong: go for a short walk and think about something else. Write down three things a day you feel grateful for. Get enough exercise, sleep regularly and for long enough, eat real food and not too much of it, stick to a regular routine.

But its overarching message is unnerving. In Dr Julie’s world, there’s no question of using kinetic emotions such as anger or aggression to change anything around us. Rather, when experiencing strong emotion, she encourages the reader to use “physical movement” to “use that physiological arousal in the way it was designed to be used”.

I doubt Dr Julie has in mind the physical movement of her reader’s fist toward someone else’s face, which is arguably how the “physiological arousal” of anger is “designed to be used”. But this bait-and-switch exemplifies the pervasive message of this book: that somehow, we’re all alone in a world of shadows, where authentic encounters with other people are not possible. Nothing we feel can ever be expected to change anything, so it’s best we learn to manage it.

When experiencing strong feelings of any kind, she advises, the solution is never to act on them but rather “build your awareness of how you respond to various emotions” so you can “practise stepping back from them and responding to them with compassion”. In other words, “managing our mental health” means not becoming more immediately present in your social world. It means learning to detach from the kind of strong, kinetic, engaged and embodied feelings you’d need if there were real people out there, and instead detonating excess emotional force in a carefully controlled vacuum.

And this should be enough, the book implies, for each individual contains the solutions within them. As Katy Perry puts it:

It’s always been inside of you, you, you
And now it’s time to let it through

The chapter on “values” makes this clearest of all — for it invites the reader to compile her own ex nihilo. “Getting clarity on our personal values can guide us on setting goals that will bring meaning and purpose,” she declares, a statement that a cynic might observe is on the circular side: deciding what you understand the meaning of life to be will help you to determine the meaning of life.

One might also wonder if it’s a little cruel to ask an anxious, neurotic, socially uncertain and emotionally labile perfectionist to conjure a viable personal philosophy into existence without help from external referents. But leaving that aside, Dr Julie doesn’t acknowledge how the demand that each reader determines her moral system in a vacuum can backfire. For while it holds out a promise of self-containment, it also explains why anger is so curiously absent from this book.

For there are forms of righteous anger that aren’t covers for fear, loss or past trauma. This kind of anger is a fundamentally social emotion that expresses outrage at some other or others violating a set of shared principles. But in Dr Julie’s world, there are no shared values. And this means anger can never be righteous – and thus can only be detonated safely, in isolation, and never employed constructively in social encounters.

This presents further difficulties, too. For losing the shared terrain on which legitimate anger might be expressed doesn’t eliminate the underlying human tendency to aggression — even if Dr Julie doesn’t acknowledge that such a tendency exists. And if Sydenham catalogued the psychic distress more than three centuries ago of people who lacked healthy means of expressing agency and aggression, those means have shrunk still further today.

This is especially the case for girls, 84% of whom were shown in a recent study to be too sedentary — a higher figure than for boys, just as in Sydenham’s day. At the same time, studies show girls are more likely than boys to be both the victims and also the perpetrators of online bullying.

No wonder, then, that girls and young women are miserable. We raised a generation with few direct outlets for healthy aggression, and the most sedentary lifestyles in history, and told them not to assume any shared values with those around them — which meant they could never be legitimately angry. Then we handed them a set of social media tools for covert interpersonal aggression and watched their mental health implode.

Fittingly, Dr Julie first attained the fame that landed her this publishing deal on Instagram. She has thanked her audience by writing a book which denies the existence of any basic human drives and disavows the social importance of any shared values, while reinforcing every young woman’s essential isolation and concurrent duty to self-improve.

I’ll say this for Dr Julie’s book: it offers some useful tips to the Instagram generation, in coping with the main modern delivery mechanism for covert female aggression: Instagram. But it offers nothing to broaden the Instagram view of life: a competitive, value-neutral performance, where self-optimisation is everything and other people aren’t entirely real.

Every young woman is a firework; every young woman owns her own night. And no one is coming to help her with it.

In their understandable desire to get on with trials that might help people who are suffering, many researchers have sidestepped the question of what depression actually is. Instead, they’ve simply agreed on a definition and stuck to it. The Beck Depression Inventory is a questionnaire routinely used to diagnose and define depression: if you’ve ever spoken to your GP about feeling low, you might have come across it. It’s named after Aaron Beck, one of the most important figures in the history of psychiatry (who died aged 100 on November 1st this year). He came up with 21 questions that cover guilt, feelings of failure, weight loss, insomnia, and suicidal thoughts, among other common depressive complaints.

The problem is that the medical profession, and psychiatry researchers, might be relying a little too much on that list of symptoms. Indeed, in an odd, unintentional, circular move, they might have actually turned lists of symptoms into the very definition of depression. An essay by the eminent psychiatrist Kenneth Kendler argues that this is a fundamental mistake: the number of boxes a patient ticks on the list of symptoms that get you a diagnosis isn’t the same as “depression” (nor is their Beck Depression Inventory score) — even if psychiatrists and researchers often act like it is. The Inventory is very often used as the criterion for improvement in studies of treatment: if you achieve a 50% drop in symptoms as measured on his questionnaire, you count as having been positively affected by the treatment. But these criteria are a decent index of many of the common symptoms — not all of them. We know anxiety commonly comes alongside depression, Kendler notes, but it’s not on the standard diagnostic list. If we confuse the disease itself with a useful-but-limited list of its manifestations, we’ll find it harder to truly understand patients’ experiences.

Some researchers have gone a step further: should we stop using the concept of “depression” entirely? One study of thousands of depression patients found over 1,000 unique combinations of symptoms that all still count as “depression”. Maybe it’s time, argue some, to focus on understanding subtypes, or even just specific symptoms, rather than the monolithic entity of “depression” itself.

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In some senses — and perhaps ironically — this accords with Beck’s philosophy: he was known for being sceptical of focusing on the ultimate, root causes of mental illness. Which brings us to the other major contribution for which he is remembered: Cognitive Behavioural Therapy. Beginning in the 1960s, Beck reacted against the most popular form of therapy at the time, which was based on Freud’s psychoanalytic theories of the mind. Beck — who himself was originally trained to administer psychoanalytic therapy — began to doubt that depression symptoms were always caused by childhood traumas and unconscious repression. Some of the Freudian theories were rather far-fetched — as Tony Soprano says to his psychoanalytic therapist, after she suggests for the umpteenth time that he might be harbouring some Oedipal desires: “I don’t wanna fuck my mother! I don’t give a shit what you say — you’re never gonna convince me!”

Instead, Beck suggested a much more proximal reason for the disorder: depression patients (and those with other disorders) are suffering from “thought distortions”. For example, they might catastrophise, blowing minor unfortunate occurrences in life out of all proportion. They might overgeneralise, thinking that a fallout with one friend means that they’re hated by everyone they know. As well as focusing his Depression Inventory on these kinds of thought patterns, Beck argued that therapy should target them and train patients out of them, rather than looking for some underlying explanation for all their symptoms.

Beck won the argument: although psychodynamic therapy still exists, CBT has now become the most popular — and by far the most studied — type of psychotherapy. New guidelines, announced this week, give patients the option of group CBT as the first line of treatment for mild depression; but even before then, it was extremely widely used. Its application goes well beyond depression: the language of CBT, with all its ideas about catastrophising and perfectionism and self-blame, is now, as Scott Alexander has memorably argued, “in the water supply”. But “popular” and “culturally influential” doesn’t necessarily mean “good”. What do the studies say about whether it works?

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Despite the sheer volume of research, the evidence is actually quite poor. The meta-analyses (reviews of all the studies that have looked at a particular question) do conclude that CBT works compared to doing nothing (a common control group, to which the therapy is compared, is made up of people who are on a waiting list for treatment). But it’s worth remembering that positive studies are more likely to be published than ones concluding that the experiment in question doesn’t work. And the overall literature on psychotherapy does show signs of this kind of bias.

So, even if the studies are right that CBT is beneficial (and in my view they most likely are), the extent of the benefit might be somewhat exaggerated. Those meta-analyses compare CBT to other common forms of psychotherapy, including the psychoanalytic kind (these days usually called “psychodynamic” therapy). The general picture is this: the effects of CBT are essentially the same as any other kind of psychotherapy. They all reduce depression symptoms, and they all still seem to work up to a year later (this particular kind of meta-analysis has to assume all the trials are comparable, though — and that’s often quite a big assumption).

It’s a very similar story for drugs: the meta-analyses show that essentially all forms of antidepressant work better than placebo. But these effects are likely a bit overblown by all the dodgy practices in the scientific literature. And the evidence for one antidepressant being substantially better than another is, to use the kind of language one often sees in the review studies, “limited” (which means researchers only have the vaguest clue).

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By Stuart Ritchie

Although this is good news in one sense, it’s worrying (even depressing) in another. There is evidently a gaping hole in our evidence base on treating depression. If essentially all the major therapy types work to the same degree, despite being based on entirely different — often opposing — principles, it’s pretty difficult to pin down exactly why they work. What exactly are the therapists doing in their sessions that makes the treatment effective? Can we really say that Beck was correct about CBT being the best treatment if other forms of therapy, which take an entirely different approach, can do the same job?

Maybe it doesn’t matter whether therapists stick to Beck’s plausible cognitive theories or Freud’s absurd psychosexual ones. Maybe just having a regular interaction with a smart, sympathetic, well-organised person who focuses on your problems is what helps. That wouldn’t explain, though, why the analyses showed that some forms of self-directed therapy can also make a difference. Either way, all this raises the question: how can we make our therapies better if we don’t know the active ingredients? But then, how can we establish the active ingredients if we don’t even know what we’re treating?

You can call Samaritans for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.

You can even be treated for it. You can get specialist treatment at a dedicated NHS clinic. South Korea has gaming “rehab centres”. Gaming addicts have “lost interest in their own lives” and “​​do not feel the passing of time in the real world”, according to a doctor who treats the condition there.

But it is far from clear that “gaming disorder” or gaming addiction exists, at least as a well-defined condition separate from any other compulsive behaviour; and there is a hint that the WHO has made the decision under political pressure from China and other countries. 

The WHO says that its decision was based on “reviews of available evidence and reflects a consensus of experts from different disciplines”. But when you look at WHO-commissioned evidence, the studies are completely wild. This review of the literature carried out on behalf of the WHO found that “the prevalence of IGD ranged from 0.21-57.5% in general populations”. This one was rather less crazy, but the studies it was aggregating found that between 0.16% and 14% of people had the disease. Another found 0.7% to 25%.

For comparison, about 8% of people who take opioids in the US end up addicted. So video games might, if we take those numbers at face value, be several times as addictive as opioid painkillers, which seems… unexpected. Or, equally, it could barely exist at all.

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“The problem,” says Dr Pete Etchells, a psychologist at Bath Spa University and author of Lost in a Good Game, “is that depending on your definition, your understanding of who has or doesn’t have this disease varies wildly in the literature”. That is because, he says, “we don’t know what it looks like, we don’t know what it is, and we don’t know what its unique features are that separate it from other behavioural or impulse disorders”.

Obviously, some people have problems with playing video games too much. You will have read stories about South Korean teenagers wetting themselves rather than getting up from their gaming chair, or people developing blood clots. But rare anecdotes don’t tell us much about the wider problem, and people can develop problematic relationships with almost every form of enjoyable human activity — with exercise, with sex, with tanning.

The question is whether there is something unique to gaming which causes these problems. Dr Andy Przybylski, a psychologist at the Oxford Internet Institute, has worked on gaming addiction in the past, and argues that — as far as we know — there isn’t. He carried out a study in 2017, which looked at people who were classified as “addicted” to gaming at one time, and checked whether they still were six months later. If gaming “addiction” was comparable to, say, tobacco, gambling, or alcohol addiction, then you’d expect that most people would be. 

But as it turned out, of the 6,000 people recruited, none of them met the diagnostic criteria for gaming disorder at both the beginning and the end of the study. That is, no one stayed “addicted” for six months. Dr Netta Weinstein, another author of the study, told me at the time that it’s “a question of whether a diagnosis is stable”, and it suggests that internet gaming probably isn’t an addiction like smoking or alcohol.

Przybylski, then, was surprised to see that the WHO decided to classify IGD as a separate illness, and has been asking the WHO whether or not they have any more evidence. Recently he received an email which said: “It is challenging, if not impossible, to document and communicate through WHO channels the rationale and justification for each decision.” 

But obviously you can prove, or at least provide strong and convincing evidence for, the existence of most illnesses, and the WHO could very straightforwardly point to that evidence. There’s a reason why Covid denialists are considered crackpots and cranks: because it’s pretty straightforward to develop diagnostic tests which show you the presence of a virus, and you can tell that the presence of that virus correlates strongly with a particular set of negative health outcomes.

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With psychiatric conditions, of course, the picture is often messier. You can’t swab someone and see if they have depression; you can only ask them a series of questions, or observe their behaviour. But there are established criteria by which to do so, and when you test someone with one twice, a week apart, they usually give the same answer.

But with gaming disorder, as we’ve seen, that doesn’t seem to be the case. So the WHO creating a new diagnostic category is a big deal. It gives clinicians licence to treat the disorder, and — perhaps more importantly — it tells people, and parents, that gaming disorder is a real thing. “It’s a very emotive topic,” says Etchells. “If you say suddenly that games can be addictive, so many people play them that that can be a really scary thing. We already know that parents are scared and concerned. Throwing it out there without any explanation or caveating, I feel it’s quite irresponsible.” He worries that the WHO decision will pathologise normal, healthy behaviour, like playing video games after work to destress.

The question, then, is why has the WHO done it? They didn’t need to; the American Psychiatric Association hasn’t yet added it to the Diagnostic and Statistical Manual of Mental Disorders, and the Royal College of Psychiatrists hasn’t formally recognised it. 

One possible answer is that the WHO has been pressured into doing it. Professor Geoffrey Reed, a medical psychologist at Columbia University and senior project officer for the WHO’s ICD-11, told another psychologist by email in 2016 that the WHO was “under enormous pressure, especially from Asian countries” to include IGD.

(I’ve asked both Professor Reed and the WHO about this; the WHO has declined to comment at short notice, and if Prof Reed gets back to me, I’ll include any response here.)

There has been huge concern about video gaming in several east Asian countries. In Japan and South Korea, there have been years of worries about the “hikikomori”, young adults who shut themselves off from society, living in their parents’ homes, never leaving, eating delivery food, watching Netflix, browsing the internet and playing games. The phenomenon has also been widely reported in China, Hong Kong and Singapore. These countries are huge consumers and producers of video games, and notably of spectator e-sports, and people have been quick to blame video games for the condition.

And this has led to a widespread reaction which looks suspiciously like a moral panic. South Korea banned under-16s from playing internet games between the hours of midnight and 6am in 2011 to improve children’s sleep, a decision that was only overturned in August. Etchells says that research showed the ban was counterproductive — it increased children’s time on the internet and “had no meaningful effect on increasing sleep”. China recently enacted an even more stringent law, banning under-18s from using internet games between 10pm and 8am. 

Societies are entitled to ban anything they want, of course. But the concern is that they’re hiding behind science to do it. “It’s an extreme example of people pathologising things they find distasteful,” says Dr Stuart Ritchie, a psychologist at King’s College London. “Some people find video games distasteful — they don’t like the idea of kids shooting at each other. But you have to ask what the quality of the evidence is.” Przybylski agrees: “If people want to create rules, they should create rules. But if you’re saying it’s based on evidence or science, you should show your notes.”

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“We’re talking about very complex generational issues, and trying to explain them by looking at one simple factor, and that’s never the case,” says Etchells. If there was a simple causal link, he points out, given the billions of users, you’d expect to see enormous effects, not weird ambiguous trends in messy data.

The trouble is, as Przybylski says, that mental health provision is poorly resourced and expensive. If a teenager is diagnosed with a mental health condition in the UK, he says, “they can age out of being a teenager before you’re seen by a psychiatrist”. Video game addiction, on the other hand, is shiny and exciting, and it sounds cheap, because it seems like there’s an off switch — just turn off the console!

But it comes at a cost. For one thing, even if hikikomori is a real problem in China and other countries, and even if a causal link can be shown to video games, it makes no sense to create a global diagnosis for a highly region-specific problem. For another, it frightens gamers and their parents, perhaps unnecessarily, and gives cover to any old quack or charlatan who wants to promise to treat “gaming addiction” at their expensive clinic, despite there being no clear diagnostic criteria and no agreed treatment.

Most of all, though, there’s a reputational risk for the WHO. “It’s putting its credibility on the line,” says Przybylski. It’s supposed to be a neutral scientific body: it cannot be seen to be making scientific decisions for political reasons. For the last two years, it’s faced criticism of cosying up to China over Covid – praising the Chinese government for transparency and for “setting a new standard for outbreak response” even as it censured doctors for trying to spread the word about the disease. If it transpires that the WHO has put gaming disorder into the ICD-11 as a result of political pressure, whether from China or elsewhere, its credibility will be even more undermined.

The academic community and the WHO have “really dropped the ball” on gaming disorder, says Etchells, rather than being brave enough to stop, take stock, and work out whether it really exists at all as a coherent concept. “I can see how it’s difficult for the WHO to go against these strong opinions, but they need to,” he says. “They can’t come up with disease classifications built on politics.”

But this year’s winners would do well to consider what happened to many Nobellists after they accepted their prize. Take Kary Mullis, who won his Nobel as the inventor of the Polymerase Chain Reaction, or PCR (a fundamental technique that’s now used not just in Covid tests but in essentially all laboratory genetics research): he spent the last part of his life strenuously denying that the HIV virus causes AIDS. Or Luc Montagnier, who won his Nobel for discovering that very HIV virus — and went on to publish research on what amounts to homeopathy.

More recently, Michael Levitt won the Nobel in 2013 for important computer-modelling work relating to protein structure (his Twitter name “@MLevitt_NP2013”, NP for “Nobel Prize”, helps you see just what a big part of his identity the award is). Throughout the Covid pandemic, he has been drastically wrong in his rosy predictions — and sometimes conspiratorial-sounding theories — about the spread of the disease. In July 2020, for instance, he stated that Covid in the US will be “done in 4 weeks”.

All these brilliant scientists lost their grip on reality after they won their Nobel (and there are many other examples; there’s even a name for the phenomenon: Nobel Disease). But at least, in all those cases, the Nobel itself was awarded for a genuine scientific breakthrough. There’s one case where the prize was given, and has never been rescinded, for a disastrously misconceived “discovery” — one that went on to blight thousands of lives.

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In 1949 the Nobel Prize in Physiology or Medicine was awarded to the inventor of a disturbing procedure — an attempt to treat mental illness — where a surgeon either injected pure ethanol directly into the brain to kill a clump of neurons, or used a special instrument with a sharp wire to slice away the connections between parts of the brain’s frontal lobe. Oh, and before they did so, they had to first punch or drill a hole through the skull — usually somewhere near the eye.

The frontal lobotomy (or sometimes “leucotomy”) wasn’t the first ever attempt at “psychosurgery” — the treatment of mental disorders by operating on the brain. But its invention is most strongly associated with the Portuguese doctor, politician and general polymath Egas Moniz. Inspired at least in part by previous research on chimpanzees, who became notably less aggressive and more docile after their frontal lobes were chopped out, in 1937 Moniz reported a case series of 20 patients suffering from conditions like anxiety, depression and schizophrenia whom he’d had lobotomised.

According to Moniz, his “very audacious” and “always safe” procedure — which he couldn’t perform personally due to crippling gout in his hands — worked wonders: the patients were more placid, more rational — and easier to control. He declared some of them “cured”.

But was this evidence any good? As the psychologist Ann Jane Tierney put it on the 50th Anniversary of Moniz’s Nobel Prize:

“A contemporary scientist can find considerable fault in Moniz’s work, including the inadequate follow-up times, absence of control groups, and the superficial and subjective evaluations of patients performed by individuals least likely to be objective.”

That is, even setting aside the upsetting nature of the procedure — and we should set aside our “yuck” reactions, since there are many horrific-sounding medical procedures that are genuinely helpful — the evidence that Moniz put together to support the use of lobotomies was hopelessly unscientific and biased in favour of his desired conclusion that the technique was useful.

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And yet the Nobel committee, some years later, decided to give him the award. By this time, the lobotomy had skyrocketed in popularity and was being used across the world. The best-known proponent was the US neurologist Walter Freeman, an almost unreal character who seems straight from a medical-themed horror movie. Across several decades he performed thousands of lobotomies for an ever-widening list of complaints — not just psychiatric conditions, but also things like “being a badly-behaved child” — and did so theatrically, in front of an audience, often making the initial hole in the skull using an ice pick.

But, also by the time the Nobel was awarded, the horrific downsides of lobotomy were well-known: the fact that there was no evidence of any long-term benefits in the majority of patients was a quibble in comparison to the most obvious problem: the lobotomised were often changed entirely. Many emerged from the operation with altered personalities or slower-running brains; others lost physical abilities. Still others died immediately due to bleeds on the brain (Freeman claimed a 3.6% fatality rate but other sources suggest it was far higher). Most infamously, John F. Kennedy’s sister Rosemary, who had a learning disability, was lobotomised by Freeman and a colleague in 1941. The procedure, aimed at alleviating her seizures and aggression, was a disaster; it left her, permanently, with the mental capacity, independence, and continence of a small child. The story was hushed up, and Rosemary was kept in a psychiatric hospital and then a special school, far from prying eyes, until she died in 2005.

Even if he never intended for lobotomy to be used so terribly haphazardly, it does seem unlikely that Moniz deserved the world’s most prestigious scientific prize for inventing the technique. But there he is, on the official Nobel website among the other winners. We’re left with questions reminiscent of the ones being asked about statues of less-than-ideal historical figures: should we keep this reminder of a past that had very different values from our own? Should we somehow contextualise it? Or should we get rid of it altogether? Should we — more than 70 years after it was awarded — remove Moniz’s Nobel Prize?

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It has been suggested before. There are still people alive today who were lobotomised early in life, often with tragic consequences, and it might be seen as a measure of justice for them and their families to remove the Nobel committee’s endorsement. It’s not unheard of in science: some journals have begun to remove or flag research papers, even very old ones, from scientists who are under serious suspicion of misconduct.

But Moniz’s research — while slapdash, especially by today’s standards — wasn’t deliberately fraudulent, at least as far as we know. If we were to go back and wipe out the historical science that now seems poor-quality to us, we’d have to disown huge swathes of the literature, and rescind any number of prizes awarded over the years. On top of that, context reveals that Moniz might technically have won the prize for lobotomies, but it’s at least plausible that the committee actually wanted to give it to him some years previously, for his work on cerebral angiography (a pre-computer technique, still used to this day, that allows doctors to X-ray the blood vessels in the brain).

Besides, it’s worth asking: what’s the point of rescinding a prize given to a long-dead scientist for a treatment that’s almost extinct? Everyone now knows how terrible a mistake the craze for lobotomies was; psychosurgery in general — almost entirely replaced by drug treatments during the latter half of the 20th Century — is nowadays vanishingly rare. Formally condemning it isn’t going to practically help any of its victims.

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Perhaps the least the Nobel organisation could do is provide better context about Moniz’s award. At the moment, his page on their site notes, with some understatement, that the operation “could lead to serious personality changes”. The only other discussion I could find about him on their website is a bizarre essay from a psychiatrist in 1998 who defended Moniz in no uncertain terms:

“I see no reason for indignation at what was done in the 1940s as at that time there were no other alternatives!”

His phrasing isn’t exactly sensitive (the exclamation mark is in the original), but does he have a point? Lobotomy came before reliable psychiatric drugs or other treatments were developed; not all doctors who used it were as flamboyant or clumsy as Freeman. It’s among the worst dead ends in medical history, but shouldn’t we expect missteps and mistakes in our march towards scientific progress?

Maybe the real moral of the story — as well as those of all the Nobellists, who went off the rails — about the pitfalls of honouring scientists. The Nobel Prizes have been criticised as “absurd” in a world of collaborative, cumulative science that relies less and less on individuals. And maybe we shouldn’t expect there to be enough Earth-shattering discoveries for major awards to be given every single year.

That’s not to say we shouldn’t honour our best and most creative researchers; we just shouldn’t turn them into heroes with opinions that are somehow above criticism (a bit more criticism of our top scientists would’ve helped in the early stages of the pandemic, to give one obvious example). Perhaps having Moniz listed among the Nobellists is the greatest reminder possible that even the best scientists don’t comprise a pantheon of divine beings: they’re just humans, and some humans make terrible mistakes. Winning a Nobel doesn’t make someone infallible. It doesn’t even make their prize-winning discovery particularly “true”. The only thing that can do that — the only thing a scientist should really care about — is the evidence.

W-3: A Memoir is the result of Bellow’s advice. At first Howland “did not have the energy for such reflections”, but as she recovered she digested, leashed and channelled her misery, observing, like a panopticon, every detail of the ward and its inhabitants: the gangs of student doctors “marching in with their stethoscopes jutting from their pockets”, the “dusty, disabled equipment propped up in corners”, the overflowing ashtrays, the basket weaving, the thin-legged black cleaning staff “thrusting their mops with a strange listlessness”.

Following the book’s publication in 1972, Bette Howland was launched in the literary firmament. Over the next decade she produced two books of short stories and was lauded with prizes, including a MacArthur Genius Award, after which everything went silent. No more publications, no more praise. By the nineties, Howland (who died in 2017) had disappeared altogether and her masterpiece was cast into the oubliette of forgotten books. Then, in 2015, W-3 was found by a literary editor in a dollar box in a second-hand book shop, and a new edition was published this Spring, which is when I discovered it myself.

The timing could not have been better: the world of Covid-19, with its regulations and mayhem and the way in which it has turned us all into inmates is just like W-3. Howland’s memoir is a metaphor for the pandemic. “Let me explain right away,” she says of W-3, “that I didn’t belong here. But that goes without saying, no one belonged here.” This alone might serve as the epigraph to the last 18 months, during which none of us has belonged in the place in which we found ourselves, which for many has been in front of a screen, staring all day at our own distorted visages.

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The patients in W-3 belonged to a tight “community” in a large teaching hospital, itself a unit of a sprawling gothic university, which also happened to be where Howland, before her suicide attempt, had worked as a part-time librarian. Now a full-time member of the institution, Howland found herself, like a Russian doll, occupying less and less space in her own life. Sound familiar?

The first thing she noticed about W-3 was that despite being told there were “no rules”, the “air was thick with them”. There were rules everywhere, attached to everything. The rules came mostly from above, but the patients ruled themselves in after-dinner meetings where they requested various freedoms, such as permission to take a bus journey or to meet up with a friend.

In Howland’s first meeting in W-3, Sydney is chairman and Fran is secretary. “Fran read the minutes very loud and fast, holding the notebook up so I could see her black eyes moving. She wore a shower cap over her curlers; coarsely graying hair.

‘Any additions or corrections?’ she asked in a challenging voice.

‘Actually, I think I’m supposed to say that,’ Sydney said, glancing at the notes of parliamentary procedure he was crushing in his fist’.”

No one has anywhere else to go or anything else to do, and meanwhile Trudy keeps interrupting:

“‘Hey! I’ve got another question! When do I get to talk?’

‘So far,’ Sydney observed, ‘you’ve been doing more talking than anybody else’.

‘Oh fuck. Fuck you. I know all about these meetings. Don’t worry, I’ve been to plenty of meetings. I bet I’ve been in more nuthouses that you have. So you don’t have to go getting stuck up with me about your dumb meeting!’“

These community meetings are not unlike what I imagine the Cabinet meetings to have been like during the recent crisis: Boris Johnson, with his “go to work, don’t go to work” directive, might have been schooled in W-3.

But they are even more reminiscent of the Extraordinary Meeting of Handforth Parish Council, called by two councillors “following the refusal of the council chairman to call such a meeting,” which went viral in February. Remember Jackie Weaver being told ‘to “read the standing orders! Read them and understand them”?  All zoom meetings are like nuthouses. You have no authority here, Sydney.

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Howland also noticed that in W-3, despite the amount of time spent grooming themselves, “everyone looked essentially the same — peculiar”. The inmates kept up appearances while looking dreadful. The women, like “birds in a barnyard,” wore clownish quantities of make-up: black eyebrows, red cheeks, “eyelids like wilted butterfly lids”. Hair, which always looked “wrong”, was controlled by tongs, towels and wigs. The kitchen smelt of burning hair; even the cleaning staff wore wigs. One wig, crooked and silky black, rested on a patient’s head “like a roosting wing.”

“Clothes”, however, were the focal point of the female patients. “On W-3, all inmates were expected to wear ‘clothes'”, and “clothes” meant anything that was not hospital garb. One woman swished down the corridors in a sleeveless evening gown and a single opera glove, because self-care proves you are still sane.

I read W-3 while lying in my pyjamas. Like many people, I wore pyjamas all day throughout the pandemic because lockdown meant “no rules” as well as nothing but rules. I would have worn a wig if I had one. Like other women in my neighbourhood community, I accessorised my bedclothes when I exercised the dog. Feathers in our greying hair, bangles on our wrists and slippers on our feet, the dog-walking sorority circled the local park, shouting through our masks while waiting for our animals to bend their legs and shit.

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When I met my Creative Writing classes on Zoom, I put on a jumper in order to look sane. My students, on the other hand, kept their cameras off so that no one could see what they were wearing or where they were living or who they had reverted to being. They too were occupying less and less space in their own lives, most of them now spending 24 hours a day in their childhood bedrooms, beneath faded Snoopy duvet covers and the florescent stars their mum put on the ceiling 15 years ago to help them sleep at night. In emails to me they described despair, depression, deepening levels of panic as their debts accumulated and their worlds closed in. For four solid terms I talked to row upon row of black squares, an oubliette of forgotten people.

The only student to put on her camera was a girl who sat up in bed in a negligee as though caught unawares on camera. Ready for her close-up, she wore full make-up: orange foundation, false eyelashes, big pink lips, her hair coiffured to within an inch of its life. There was a connection, I thought, between the excessive performance of presence in W-3 and in this student’s bedroom, and the otherwise excessive performance of absence in the seminars. When the whole community is sick, on-stage and off-stage become versions of the same thing.

“Cook and eat your misery,” I counselled my seminar groups, just as Bellow counselled Bette; harness your ward and its inhabitants. One or two of them did, but for the most part they lacked the energy for such reflections. The bulbs had all blown leaving nothing but darkness. Except, as Bette Howland said of her own state, “it wasn’t dark — it wasn’t anything”.

Psychedelics, like psilocybin (the active ingredient in magic mushrooms) and lysergic acid diethylamide (LSD), are strange drugs. They don’t automatically make you happier, like MDMA, or more confident, like alcohol. Instead they do … something. They make the world seem unfamiliar. You can see this in any depiction of them in popular media: the spaced-out teenager staring at her hand for hours. “Have you ever really, like, looked at your hand, man?” It’s like an artificial dose of deep-and-meaningfulness.

A few days ago, there was some excitement over a study that found that psilocybin was as effective as escitalopram — the joint-best-performing antidepressant — in the treatment of depression. What’s interesting about the way it is theorised to work is, in fact, in the exact way that it makes the spaced-out teenager look at her hand: it removes the familiarity from our surroundings. And that mechanism can tell us something profound about how our brains interact with the world.

First, though, the study. It took 59 patients diagnosed with moderate-to-severe depression, and gave 30 of them two quite large doses of psilocybin three weeks apart, as well as a course of placebo capsules every day for six weeks; it gave the other 29 a normal daily dose of escitalopram, and a tiny dose – so small as to be ineffective – of psilocybin at the same three-week interval as the others. Then they measured the subjects’ mood, using four standard scales of measuring depression; two questionnaires filled out by the patients, and two by their doctors.

The results were intriguing. The researchers preregistered one of the scales as the “primary outcome” of the study, and the other three (among other things, including measures of well-being, suicidality, work and social functioning, and anxiety) as “secondaries”. That’s to avoid “p-hacking” or “hypothesising after results are known” – getting your data and chopping it up until you can make it say whatever you like.

On the primary outcome, psilocybin did not outperform escitalopram. Or, rather, it did, but not by enough to reach “statistical significance”, so, by convention, scientists say that the result could have been a fluke. Still, though: magic mushrooms did at least as well as the best antidepressant in treating depression, which is quite exciting.

And it did reach statistical significance on several of the secondary measures, and it also had a faster onset and fewer and less troubling side-effects. Preregistration is there for a reason, and we should pay more attention to the primary outcome than the secondary, but it’s all interesting and suggests more research is worthwhile.

Some caveats: First, it’s a small study, and study leader Dr Robin Carhart-Harris of Imperial College London pointed out to me, correctly, that by the standards of exploratory Phase II trials it’s a pretty fair size (and we’ve all been spoiled by these N=30,000 Covid vaccine trials). But still, it’s small and should be treated with caution. 

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Second, RCTs like this are supposed to be “double-blind” – that is, neither the subject nor the doctor know who’s had the real drug and who’s had the control. Obviously it’s hard to properly hide from people whether they’ve had a psychedelic trip or not, but they hoped the way it was administered would put some doubt in people’s minds. Dr Carhart-Harris said that even in clinical trials into “normal” SSRI antidepressants, about 80% of subjects can correctly guess whether they’re in the treatment group or the placebo one, so this isn’t completely unusual.

And third, the people on the trial were not randomly selected from the population but were self-referred, and were probably all people who wanted to try psychedelics. Dr Carhart-Harris agreed that those who didn’t get the “big, mystical experience you get with psilocybin” would likely have been disappointed.

These are good reasons to be a bit cautious. Certainly the study hasn’t “proved” anything. But I think it’s one more decent data point in a growing body of evidence that psychedelics can have a positive effect on depression, and as long as everyone is upfront about the fact that it’s exploratory and should simply point us towards the value of doing more research, then it’s fine. Other scientists broadly seem to say that it’s definitely good new evidence, if not some huge breakthrough.

But the reason I find it really interesting is the theory behind it. The idea is that depression is caused by our mental models of the world going wrong, and that psilocybin relaxes the hold those models have on our sense of reality.

Here’s what I mean by that. We feel like we’re looking out through a clear, unvarnished window onto the world, but (obviously) that’s not how it is. We only see colour and sharpness in a tiny area in the centre of our field of vision; the image on your retina is distorted by the curve of the eyeball and half-hidden by blood vessels; there’s a big missing bit where the nerve cables to the brain leave the eye. It blurs and moves constantly as our eyes, head and body move around. But our brain is constantly using that information to create what feels like a pin-sharp, three-dimensional image of our surroundings, in real time.

It does that by combining the information from your senses with an existing model. If new information doesn’t meet expectations, it is either ignored or used to update the model. So, to use an example from an earlier paper of Carhart-Harris’s, I have a strong prior belief that walls don’t move rhythmically as though they’re breathing. The unfiltered sense data coming in from my senses is noisy and weird and sometimes it might contain information that could be interpreted as “the walls are breathing”. But my top-down model of the world has that strong prior belief – walls don’t breathe! – so the information is ignored as an anomaly.

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Of course, if I had some weaker belief, such as “I used the yellow cup when I made coffee,” and then I looked down at my cup and it seemed blue, then the sense data would override my prior belief, updating it (and it would register as a surprise: my attention would be called to it). 

You can see your priors at work when you interpret ambiguous illusions, such as the McGurk Effect or this video of a mask. You don’t tend to see inside-out faces, so your brain really struggles to see one: your strong prior belief is that faces come out, not in.

What psychedelics seem to do is reduce the strength of your top-down models, your prior beliefs, about the world. That means that the sense data coming in can update them more easily. Your rock-solid assumption that walls don’t breathe is rendered much weaker, so random noisy fluctuations in the data coming from your eyes override it, and (as often happens with psychedelic experiences) still objects seem to move: walls seem to breathe, patterns on wallpaper seem to crawl. Things that are utterly familiar which your attention would normally ignore altogether – things like your hand – become strange and alien. I assume you’d be much more capable of seeing that the mask was inside-out if you were on mushrooms.

(People may recognise that this is just Bayes’ theorem: you have a prior belief, of some given level of confidence; new information comes in, and you update that level of confidence appropriately. If your prior belief is strong enough, then it will take a lot of new information to shift it.)

I’ve been talking about visual “beliefs” here – walls don’t move, my coffee cup is yellow, my hand is a pretty normal thing which I don’t need to pay too much attention to. But this system of prior beliefs updated with new information applies to much higher-level concepts as well. Imagine I have a prior belief that I am a productive and decent member of society, and then some new information comes in that I am in fact a chiselling little crook: say, I get convicted of fraud. Depending on the confidence of my prior belief and the strength of the new information, I will reduce my confidence in my belief or even change it altogether.

What Carhart-Harris and Karl Friston suggested in their previous paper (see here for a good writeup) was that in depression, our prior beliefs get stuck in a sort of “hole” that is too deep for new information to shift it out of. We form pathological, incorrect beliefs about how terrible everything is or how worthless we are, and the belief is so confident that new information coming in – good news or positive feedback or whatever – is unable to shift it.

They have a metaphor of a sort of belief “landscape”, with hills and valleys. You are a little car or something on the landscape; you naturally roll downhill, but you can go a little way uphill, with work. The further down you are, the “truer” your beliefs are, or – more precisely – the more accurately they match your experiences. So your goal is to get as low as possible. Strong beliefs like “walls don’t breathe” are very deep valleys, and it takes huge amounts of new information to “drive” up the sides of them to get out; weaker beliefs such as “my coffee cup is yellow” are shallower, and just a little bit of information lets you get out and roll down into the deeper, more accurate valley, marked “my coffee cup is blue”.

The trouble is, you might end up getting stuck in a local dip, unable to climb out into the deeper, better valley next door. That’s a delusional state: you have some belief, “the US government is run by paedophiles out of a pizza restaurant”, say. The world would make more sense if you didn’t hold that belief, but the sides of the valley are too steep to get out into the next one, in which the US government isn’t run by paedophiles out of a pizza restaurant. So even though new information comes in, it’s never enough to shift you out, and you keep rolling back down.

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This is what is apparently going on with depression, according to Carhart-Harris. Your prior beliefs have formed a “landscape” in which you are stuck in a delusional belief about your own worthlessness or the terribleness of the world. If you could get enough information to get you out of it, you’d roll down into the deeper, more accurate valley next door in which you’re not depressed. But you can’t.

Now, psychedelics. Remember how they weaken your Bayesian priors? In this metaphor, that means they reduce the height of the hills and the depths of the valleys: they flatten the landscape. Suddenly, while on psychedelics, pessimistic or negative beliefs are weakened (along with beliefs in non-breathing walls). So your little car can drive out of the valley and by the time the psychedelics wear off, and the hills and valleys become steep again, you have successfully moved into the non-delusional bit and stay there.

This Bayesian model seems to be the closest thing there is to a working theory of how the brain works; it seems to explain decision-making and willpower quite effectively, among many other things. We have prior beliefs and update them all the time with new information. Our brains are constantly generating a model of the world, and hallucinations happen when our confidence in that model is reduced so we pay more attention to anomalous sensory fluctuations.

Of course, the fact that there’s a convincing-sounding theory behind psychedelic therapy for depression doesn’t mean it’s true; one scientist friend says that “When people repurpose a drug/activity that they enjoy taking/doing, and say it cures depression, I’m highly sceptical. You might even call it my … prior.” So let’s remain cautious.

And, of course, even if it does work, psychedelics relax your priors on true beliefs as well as false ones – so it is possible that you would climb your way out of some real belief and then settle into a delusional one. Carhart-Harris agrees this is a risk, albeit a rare one, and that’s why it’s important to use psychedelic therapy only in carefully controlled situations.

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And there’s a further problem that even if it is shown to work, there’s a strong societal and regulatory resistance to the use of recreational drugs as medicines. Professor David Nutt, a professor of neuropsychopharmacology, also at Imperial and who also worked on the study, agreed that that is a difficulty, but he felt that the growing evidence of their effectiveness and the overwhelming evidence of their comparative safety should overcome it. (“I wouldn’t care if they ended up in the same category as morphine,” he said, “as long as they can be used in medicine. But they shouldn’t have been illegal in the first place.”) Other psychoactives, such as ketamine and MDMA, are also being studied for use on depression and PTSD.

I hope psychedelics turn out to be effective against depression, if only because almost nothing else is – antidepressants do “work”, as in have more effect than placebo, but it’s extremely hit-and-miss and any given SSRI will probably have no therapeutic effect in any given patient: doctors will probably have to try several before finding an effective one. But I also hope they’re effective because I think the theory is lovely and elegant, making good clinical use of this theory that our brains are Bayesian reasoning machines, and that sometimes our priors can get too strong and need a bit of massaging to relax them.

And I also hope they start selling them in Camden Market again. I’m too old for that stuff these days, but I don’t get why the young people shouldn’t be allowed to have fun.

The phrase ‘mental health’ appears in almost every news story about the new restrictions placed on students, and recurs in statements made by officials. Larissa Kennedy, President of the National Union of Students, said on BBC Radio 4’s PM that “we need to think carefully about the implications for mental health for students”, while the Scottish Liberal Democrat leader, Willie Rennie, insisted on BBC Radio Scotland that “mental health support” should be made available by universities. The students themselves echo this vocabulary, with freshers telling journalists of their “history of anxiety”, or using oddly clinical language to describe this unpleasant introduction to university life. One young woman, for instance, described how isolation had “unfortunately” led to her “experiencing mental health issues”.

We might expect an 18-year-old to use more prosaic words when she is far from home, living with strangers, banned from leaving her accommodation, and now facing the prospect of Christmas without her family. Words like ‘sad’, ‘angry’, ‘upset’, and ‘lonely’ spring to mind. But over the past several decades, these ordinary words have been crowded out by medicalised words that seem to give an aura of authority. This new discourse speaks not of ‘sadness’ but of ‘depression’, not of ‘worry’ but of ’anxiety’, and not of ‘happiness’ but of ‘mental health’.

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There are several factors at play here. One is the steady expansion across the globe of American psychiatry — well documented in the book Crazy Like Us by Ethan Watters — which has led to both the medicalisation and the Americanisation of forms of emotional distress that in other times and places have been considered an expected part of the human condition.

The American Psychiatric Association publishes a diagnostic manual, the DSM (now in its fifth edition), that is used the world over as the bible of psychiatric diagnosis. The DSM sets out in cool, logical bulletpoints the steps by which a person’s dysfunction or distress becomes pathological. A diagnosis of depression, for instance, requires either a “depressed mood” or a “loss of interest or pleasure”, accompanied by three of the following: weight loss or gain, physical slowness, fatigue, feelings of guilt, poor concentration, or recurrent thoughts of death. Tick, tick, tick, tick: congratulations, you’re mad.

Tellingly, the so-called “bereavement exclusion” — which excluded a patient from a diagnosis of depression if he or she had been recently bereaved — was removed from the fifth edition of the DSM, meaning that ordinary grief is now technically considered a disease. Some forms of mental illness are easily distinguished from everyday experience, but others are not, meaning that ‘pathological’ can be distinguished from ‘normal’ only by drawing a line on the spectrum of severity, and that line can easily slip. Meaning that, as the outspoken critic of over-medicalisation Allen Frances puts it, “normality is an endangered species”.

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There is a slightly conspiratorial, anti-capitalist way of framing this psychiatric concept creep, a framing that leans heavily on the role of Big Pharma. I won’t dismiss this theory, but nor do I believe that it tells the whole story. Yes, in a privatised healthcare system, doctors have an incentive to prescribe medication that patients don’t really need, but we also have to acknowledge that medication, effective or not, is often what patients desperately and loudly want. An old friend of mine who works in mental health services once told me that although she and most of her colleagues were signed up to the so-called social model of madness and distress — which understands mental illness as not just biomedical, but also as a product of the social environment — most of their patients didn’t want to hear it. They wanted to take a pill and feel better. They didn’t want to be told that they were suffering from what some medics darkly refer to as ‘Shit Life Syndrome’.

The huge rise in the diagnosis of depression, anxiety, and other slippery conditions among young people is often attributed on the Right to over-sensitivity. The ‘snowflake’ narrative suggests that these youngsters are either exaggerating their distress, or that it has been induced in them by a political ideology that discourages resilience. There is some truth to the idea of mental illness as status symbol, as we can see from the fashion for including one’s psychiatric diagnoses in one’s Twitter bio, frequently found alongside pronouns, an anime avatar, and rainbow and rose emojis. In a social hierarchy constructed around marginalised identities, identifying as mentally ill can certainly boost one’s victim status.

But for the many young people who really are sad, vocalising that sadness by ‘identifying as’ mentally ill also offers another advantage, and one that the critics of the ‘snowflake generation’ often miss. The clinical social worker and psychoanalyst Lisa Marchiano describes the appeal:

A  diagnosis carries with it a sense of absolution. It isn’t our fault that we have anxiety or depression. Forces beyond our control have conspired against us… when our diagnosis becomes an important part of who we are, we are encouraged to abdicate responsibility for our plight. We are adrift on life’s turbulent currents, without blame, but also without agency.

The psychiatrist Lewis Kirshner argues that while madness was once considered “an existential possibility present at the margins for every person”, in contemporary society we understand it as a sort of biological taint, present from birth, that will sooner or later announce itself in the form of symptoms. Thus the presence of this ‘identity’ is outside the individual’s control, they are (as Marchiano puts it) “adrift on life’s turbulent currents”, and temporary remission is available only through drugs or talking: publicly, in an effort towards destigmatisation, or privately, to a therapist. The trouble with this understanding of mental illness is that there now seems to be an awful lot of ‘biological taint’ present in the population since, according to Kirshner, approximately half of Americans meet the criteria for a major psychiatric disorder at some point in their lives. If fully half of us are irredeemably mad, maybe there’s something else going on?

A new book, The Lonely Century by Noreena Hertz, poses an interesting challenge to the ‘biological taint’ theory by suggesting that loneliness is both responsible for a huge amount of the emotional suffering that attracts psychiatric diagnoses, and that its prevalence is a consequence of recent historical trends: family breakdown, the rise in both domestic and international migration, the disintegration of civil society, and our increasing dependence on the internet, particularly social media. We are social animals, and loneliness makes us very, very sick. While the elderly are particularly vulnerable to it, the young are also suffering terribly. Those ‘snowflake’ young people on Twitter are telling the truth when they write about their profound unhappiness. It’s just that they’re using these feelings as evidence of their special, oppressed status, rather than seeing themselves as part of a lonely generation in need of better company.

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Perhaps the reluctance to face up to this peculiar sadness induced by 21^st-century living is because the most reliable remedies to loneliness are disturbingly traditionalist: get married, have kids, live near your extended family, go to a weekly religious service. Hertz points, for instance, to the surprising longevity of the Haredim, an ultra-orthodox Israeli community who, despite being disproportionately poor, overweight, and sedentary, live significantly longer than their peers. “Community,” Hertz writes, “the value of which was so repudiated by neoliberal capitalism’s focus on individualism and self-interest, seems to have a health benefit of its very own. And for the Haredim, community is everything.”

If we accept Hertz’s diagnosis of what really ails us, then we should look differently at the unfortunate students locked away in their halls of residence, and indeed the many other people locked away from the world as a result of Covid-19. First, we should do away with the clinical language of ‘mental health’ and its false sense of legitimacy, and return to words with more emotional resonance, particularly the word ‘lonely’. Second, we should think of isolation, not as something that might aggravate the psychiatric symptoms only of those with a ‘biological taint’, but rather as an unbearable imposition on any person, given our deeply social natures.

So, instead of using phrases like “experiencing mental health issues”, we could instead be more straightforward: “I want to see my friends and family, and I can’t, and that makes me sad because I’m a person who needs affection and companionship, just like anyone else.” You don’t need to tick off a checklist in the DSM to know that people need company — it’s a need as fundamental as sunshine.

One would think a worldwide lockdown — which has cancelled all our plans for the foreseeable future — would be exactly what these young people longed for. But when the concept was first introduced, I was a bit amused by the panic it was met with. Why were millennials posting about the trauma of cancelled 30th birthday parties they didn’t want to go to anyway? Why weren’t Zoomers delighted at the opportunity to retreat further into the digital world of Houseparty hangouts, Zoom parties and FaceTime dates?

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It was strange, pre-lockdown, to observe the young being so very un-vibrant. Fine, be a tired mum. Go to bed at 8pm when you’re 80. A farmer would understandably be exhausted at the end of the day. But a single 30-year-old with a desk job, one would presume, might still have a little zest for life — a desire for adventure, or, at the very least, experience.

I saw it in my friends as well — not Zoomers, but near or post 40. Asking about New Year’s Eve plans was met with a sour “nothing” or “watching a movie”; even an attempt to make drinks plans for a Friday night was like pulling teeth. A 2018 think piece in Vogue  discussed the “staying at home movement” as “the ultimate indulgence”. A 2017 article in The Cut acknowledged that the familiar game of “cancel-reschedule ping-pong” usually ends in abandoning attempts to meet up entirely, but concluded: “doesn’t it also feel at least a little good to bail?”

I couldn’t relate. Cancelling plans constantly is rude and that “ping pong” game usually ends in someone giving up on more than just plans — no one likes to chase others around, so the end result is that we just forget those relationships entirely. This has always depressed me: I value friends and socialising. I like to meet up, in real life, with those I care for. Why would I want to waste my time lying around on the couch feeling sorry for myself?

I know the excuses people employ: I have social anxiety, I’m exhausted, I’m stressed, I’m broke, I’m an introvert, I’m an Aquarius, what is there even to do? But I don’t accept them. People have been broke, tired, stressed or shy for all of history, yet we remain social creatures. Why the desperation to avoid human connection?

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One of the problems is social media. In the internet age, people believe that technology not only can, but should, replace face-to-face, shoulder-to-shoulder interactions. We attempt to do everything online — politics, dating, debating, socialising, learning, loving. The younger generations have never known anything else. Millennials and generation Z are more heavily reliant on smartphones and social media than older generations — so much so that their use is often reasonably viewed as an “addiction.”  And they have been conditioned to conflate online interactions with actual communication, and to equate social media connections with real-life ones. In some ways, their lives have been made more convenient; in other ways, young people have suffered.

Take Tinder, for instance. This dating app, while claiming to connect people, actually does the opposite. Nancy Jo Sales, who wrote the infamous (if you ask dating app fanatics) article “Tinder and the Dawn of the Dating Apocalypse”,  for Vanity Fair told me:

“I don’t actually think the point of dating apps is to connect us with anything but the app. The whole point of it is to get you to keep using it.”

Indeed, dating apps have been designed like slot machines — they aim to get the player addicted, to keep swiping — offering the same dopamine hit you get when you hit the jackpot. Yet, ask a single person, and they will probably repeat the narrative offered by dating app companies: this is the best way to meet as many people as possible — why not expand your horizons? In fact, finding love is even less likely within the context of being offered seemingly endless choices, and we are less likely to commit. Overuse of social media or dating apps — the new normal in terms of meeting sexual partners — are shown to increase anxiety and depression, as well as to decrease self-esteem. Similarly, social media — which sells us the idea that we are connecting with thousands of people around the world, makes us feel lonelier and more disconnected.

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Don’t get me wrong, I am no Luddite. The internet is an incredible resource, and I am grateful that I can do many aspects of my job comfortably, from my sofa. But I know I need more than that. I know my health and wellbeing depend on my connections to others — as does my work.

But the cancel-everything-to-wallow-at-home-in-the-dark movement is often framed as “self-care”. In truth, it is the opposite. “Self-care” — ensuring that we are mentally and physically healthy — requires personal relationships and physical contact with others. Both millennials and zoomers revel in anti-social behaviour compared to older generations. For millennials, even the thought of interacting with others can be repulsive. A 2018 survey of 1,200 UK employees found that they “look to avoid human interaction” in the workplace.

Rather than recognising the value of human connection, the younger generations have isolated themselves — and then justified this behaviour online by insisting it is a version of ‘self-care’. Research shows they are deluded: the happiest people are the ones who are sociable — or force themselves to be, even if they don’t feel like it. Laurie Santos, Associate Professor at the Department of Psychology at Yale University and host of the podcast, The Happiness Lab, found that “happy people prioritise social relationships”. Referencing a paper by Marin Seligman and Ed Diener, Santos said:

“Strong social relationships are necessary for happiness — they’re not sufficient for happiness, but you can’t find happy people that don’t have them… And that means taking a hard look at your priorities to figure out if those social relationships are falling by the wayside.”

Not only that, but the dreaded “interactions with strangers” has been shown to improve our wellbeing, which means that talking to a barista or your Uber driver “can really bump up your mood”. It is not only a great way to build compassion for others and learn about those who share the world with you, but it makes you feel good.

Millennials and their Zoomer successors, for all their talk of self-care, are lonelier and more anxious than other age groups — and face rising rates of depression diagnoses. It’s the worst of both worlds: they neither make time to reflect by themselves — as this “alone time” is actually spent on phones or computers — nor are they out in the world, interacting with others and building intimacy. They become simultaneously incapable of being alone, yet refuse to connect with others in healthy and beneficial ways. And so they are lonelier than ever.

In other words, these anti-social generations are doing it exactly wrong.

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Those who used to whine about having to leave the house — and post memes about how great it is to go to bed at 9pm alone — have got what they wished for: legally enforced isolation. There is no option even to make plans! The pressure is lifted — we are free to be alone, at home, all the time. And yet, only a few days into the lockdowns, social media was full of desperate posts, complaining of mental health crises. The stay-at-homers have been spooked.

And good thing too. Perhaps, when we come out of this, they’ll stop taking the world for granted. They’ll remember that it’s important to hug our friends, to reach out, to get up off the sofa, to talk to the person sitting next to you at the bar. They’ll realise that holing up at home — typing away angrily at whomever our latest target is; swiping through faces, hoping for a momentary jackpot; or posting selfie number 24 of 30, filtered just so, captioned to sell our audience on a life, mood, and nose we don’t have — doesn’t make you happy.

When they’re able to make plans, perhaps they won’t cancel. Maybe they’ll just turn up.

Depression is a problem. The World Health Organisation calls it one of the “leading causes of disability” worldwide, and says there are 260 million sufferers — about one in every 30 people globally. The number of sufferers has gone up by about 50% since 1990, according to the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, although since the global population has also increased by about the same percentage in that time, the prevalence hasn’t really changed. If we look at all mental health issues together, almost a billion people — more than one person in eight — are affected.

This is a serious burden, whether or not it is getting worse. But it goes largely untreated. The same WHO article says that between 76% and 85% of people with depression in developing countries receive no help (although they base this claim on data from 2007 so it may be outdated). In the developed West, of course, the figures are less — but still, here in Britain we are facing an NHS funding shortfall, and not everything that we would like to fund can be funded. It’s against that background that we see the proliferation of depression-treatment apps.

In theory, at least, an app doesn’t need a doctor, or an appointment; it’s fast and scalable and cheap. So if you can farm out a decent fraction of treatment to them, then you’ll provide a huge amount of benefit to a large swath of society, and save the NHS millions as you do so. 

The trouble is that there doesn’t seem to be a great deal of evidence that they actually work.

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A study from November last year looked at 293 mental health apps and found that only 3.41% — that is, ten of them (!) — even claimed (!) to have evidence showing their effectiveness. Of those 10, only three were backed by independent research, i.e. research not carried out by the people who made it.

The apps — things like Destressify, “a complete program for developing the practices that permanently rewire the brain” and give you “20% less stress in four weeks” in “as little as 10 minutes per day”, or MoodMission, an app which gives you short “missions” to improve your mood, such as running on the spot — take ideas from therapy, such as CBT or mindfulness, and offer it to you in app form. Those are in fact two of the 10 which have some research evidence, but even they are small, un-preregistered studies which (knowing what I know about the state of psychological research) I would be cautious to trust.

That doesn’t mean that the apps are worthless. You could argue that you don’t need to test your app if it’s just offering well-evidenced CBT therapy, although of course getting CBT therapy from an actual human may be very different from getting it from a screen, in the same way that French lessons from an actual French teacher are probably more effective than Duolingo. But only 30% of the apps tested even claimed to have experts helping with the design, meaning that “over two-thirds of apps for treating depression and/or anxiety were developed without any professional input”. Other studies have found similar shortages of expert input and evidence; this one found that 89% of apps have exactly no research evidence.

A more recent study, covered in this excellent post on the mental-health blog Mental Elf, found that even the evidence that exists is somewhat problematic. The study, a meta-analysis, looked at 18 earlier papers studying mental health apps, to see what percentage of users dropped out – they thought that would be a good proxy for how well-engaged the users were. The study found that more than a quarter of participants dropped out before the study was completed; and once they accounted for publication bias, that figure went up to almost half. Disturbingly, real apps fared no better than “placebo” ones. For comparison, only about 14% of people using “non-app controls”, e.g. face-to-face therapy or some other more traditional method, drop out.

It also found that the rate of drop-out wasn’t affected by what particular kind of therapy the app offered, but by whether or not there was an actual human involved. If some real therapist is looking at your app inputs and responding to them, you are less likely to give up on the whole process, which probably isn’t surprising. A psychologist I asked about this said “I would predict that these apps are only useful insofar as they connect people to actual services or actual people, or destigmatise seeking help.”

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Yet there is a keenness to use them, and partly that’s for the cost-based reasons mentioned earlier: you can send out an awful lot of apps for the cost of one clinical appointment. But also, I think, it’s to do with our fascination for all things tech. A lot of the time this manifests as negative scaremongering — the obsession with “video game addiction” and “internet addiction”, for instance, neither of which really stand up to scrutiny, but which are already the subject of “boot camps” for sufferers in China, which may have actually killed users.

On the other side, though, there’s an eagerness to use Technology to cure all ills. I am sincerely hopeful that it will, some day: the use of big data to improve medical research, for instance, is a fascinating thing, leading to profound changes in how science is carried out. AI in radiology can augment human decision-making; in many arenas it is about as good or slightly better than human experts at spotting problems, but marvellously, it makes different mistakes, so when you use both human and AI, each one spots the things the other missed.

That’s all brilliant and I hope it carries on. But it can lead to overenthusiasm, such as the health secretary trying to get the NHS running on AI when large parts of the NHS is still running on Windows XP. 

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The possibly premature introduction of mental health apps into healthcare seems like another example of overenthusiasm. For instance, the NHS lists 20 “trusted” mental health apps, ranging from free to £30. Some offer guides to mindfulness meditation, such as Be Mindful, the £30 option. Others provide a “toolbox” of stress-reducing techniques, or CBT-like methods of managing negative thoughts.

Unlike many of the apps discussed above, most of these have some sort of evidence base: Be Mindful, for instance, proudly lists studies finding “63% depression reduction”, “40% reduction in stress”, and “58% anxiety reduction”. But digging into it a little, those studies are either uncontrolled, meaning it’s impossible to know whether the effect was caused by the app or just by people getting better, or small, and when the effects are as implausibly large as that, it sounds like something’s not right. It’s definitely better than no evidence, and £30 is a lot cheaper than a course of mindfulness therapy, but there is plenty of room for scepticism.

I don’t want to put anyone off using an app if they find it helps them with their mental health. But if you’re scrolling through an endless list on the App Store, trying to work out which one to use: be wary. It’s far from clear that they’ll do any good.

My father is a psychoanalytic psychotherapist, so I grew up with the opposite world view: that we’re all a bit damaged, dysfunctional and deluded. On more than one occasion, when I expressed some teenage angst, he chuckled and — with great affection in his voice — said I was a fascinating bundle of psychopathology. When I accidentally stabbed myself in the hand with a pencil while revising for my A Levels, he described this as a “particularly primitive piece of acting out.” He was probably right.

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Slowly, the world has come round to my father’s point of view. We have new shibboleths proclaimed by mental health advocates: mental health exists on a spectrum, just like physical health, they say. Sometimes we’re up, and sometimes we’re down. One in four of us is experiencing a diagnosable mental health problem at any one time: two thirds of us will experience mental illness in our lifetimes.

All this is technically true. But as a public narrative it’s creating its own disasters. If everyone is a little bit crazy, and everyone should ask for help, it creates a wall of demand that medicalised mental health services will never be able to meet, and that is compromising our ability to help those most in need. We are not in the middle of a mental illness epidemic. We are in the middle of a treatment crisis, where there is not enough help to go around.

Yes: about ‘one in four’ of us has a diagnosable mental health problem. But it was about one in four back in 1993 when we first asked this question in a survey of what’s called “Adult Psychiatric Morbidity”. It was one in four in 2000, in 2007 and in 2014. Of course, it’s absurd that this survey is only done once every seven years: we won’t have the next survey results until 2023 at the earliest, so maybe things have changed. But long term, the pattern is clear. Numbers of people with poor mental health are pretty stable.

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So what’s changed? Why all the noise about a crisis? We’ve done something wonderful by stripping the stigma from mental health problems. We’ve empowered people to come forward and ask for help, instead of suffering in silence. Between 2007 and 2014 the number of people in treatment rose from 25% of those with symptoms of a common mental disorder to 40%. That’s an extra 1.5 million UK adults who felt able to ask for help, and got some.

So why am I not celebrating? Because providing treatment for those “common mental disorders” too often comes at the expense of help for those with less common, but more serious, conditions.

It’s vital to understand that there isn’t one single thing called “mental health problem” just as there was never a single thing called “lunatic”. Depression is not the same as bipolar disorder, which is not the same as anorexia, which is not the same as schizophrenia, which is not the same as post-traumatic stress disorder, which is not the same as post-natal depression, which is not even the same as post-natal psychosis.

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Diagnosis itself is, of course, controversial in mental health circles, and among people with these conditions or symptoms. We are largely swimming in the dark when it comes to understanding what is happening in the brain, or in what you might call the “mind”, if you believe such a thing exists separately from the squishy mass of neurons inside your skull. What we do know is that all of these conditions come with pain: pain so profound that it sucks the purpose from life and can lead people to isolation, rage, self-harm, and suicide.

The first job of our health services has to be to help those at most risk. The NHS often talks about people in crisis: that includes people considering ending their life, hurting themselves or someone else, and people experiencing psychosis — a break in their ability to comprehend reality that may include hallucinations or delusions. People going through a crisis of this sort need expensive care — either in-patient care in a psychiatric hospital, or intensive support in the community.

And you don’t need to be in crisis to need hospital care. People with eating disorders, post-traumatic stress disorder, post-natal depression and a range of other conditions can also need intensive support for weeks or months at a time, to help them eat enough, care for their baby, or process their trauma. Doing that at home often just isn’t possible, and certainly not possible when you remember how little support is available. But we’ve all read stories of people denied help, or shipped to a hospital the other side of the country, because there just aren’t enough places to go around. We have fewer beds for this kind of treatment than we did in 1998.

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That should be the story that dominates our headlines, not yet more celebrity interviews about challenging stigma that encourage everyone to put their hands up for help. I know celebrity depression is a lot more beautiful than a homeless man with schizophrenia who hasn’t washed since he lost his home because he thought the rent collector was a demon. But we mustn’t let the easy story crowd out the difficult one.

We have thrown extraordinary levels of political capital at stripping away stigma, and telling people it’s good to talk. There’s been an upsurge in the number of people getting treatment but no corresponding dip in the number of people with problems. This deluge of demand isn’t curing anyone, it’s overcrowding our stretched mental health services, and it acts as an epic distraction from providing intensive care for the 5% or so who are quite literally struggling to stay alive.

“What were we to think?” wrote the archaeologist Leonard Woolley in his record of the excavation. “Here were half a dozen diverse objects found lying on an unbroken brick pavement of the sixth century BC, yet the newest of them was seven hundred years older than the pavement and the earliest perhaps two thousand: the evidence was altogether against their having got there by accident…”

What was behind this mysterious collection? Among these objects lay what Woolley eventually came to call “the key”, a clay cylinder inscribed in the contemporary Babylonian dialect that described another object — a brick — and gave a record of its discovery by the city’s governor. It was, by all accounts, a museum label. This was a museum, itself older than most of the exhibits in the British Museum.

Iraq is a culture so old that even before Classical Greece had reached its zenith, Babylonia’s civilisation was ancient enough to have had its own museum reaching into the already distant past.

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Few parts of the world have yielded as impressive an array of artefacts and as prolific a written record of its history as this region, home to a number of cultures collectively referred to as “Ancient Mesopotamia”. Hundreds of thousands of cuneiform tablets and fragments have been unearthed since antiquity, bringing to life civilisations that rose and fell millennia ago. But while the people who impressed those wedges are long gone, their stories are very much alive in the clay they left behind, and in lives recognisable to those we lead today.

I recently met my two-month-old nephew for the first time. He cried his way through every night that I stayed with my brother and sister-in-law, both of whom sported matching bags under their eyes and a shared look of merry shellshock. The baby’s cries roused the dead — of that I have no doubt — and no amount of cooing, changing, feeding or pleading could quiet him. Deprived of sleep and desperate, my sister-in-law opened Spotify one morning and within seconds of hearing the opening chords of Lewis Capaldi’s “Lost on You” the new-born closed his mouth, opened his eyes, and burped.

Her strategy sounds familiar to many and, indeed, has a very long history. A 4,000-year-old cuneiform tablet preserves a poem whose syntax, style and simplicity suggest that it was a lullaby, probably sung by many a parent or wet nurse desperate to quiet a crying baby in the still of night. Although less lyrical in translation, it reads:

“Little one, who dwelt in the house of darkness —
well, you are outside now, you have seen the light of the sun.
Why are you crying, why are you yelling?
Why didn’t you cry in there?
You have roused the god of the house, the kusarikkum [A protective spirit in the shape of a bull with a human head] has woken up:
‘Who roused me? Who startled me?’
The little one has roused you, the little one has startled you!
‘As onto drinkers of wine, as onto tipplers,
may sleep fall on him!’”
(Translation by W. Farber, “Magic at the Cradle: Babylonian and Assyrian Lullabies”, Anthropos 85, 140.)

The lullaby begins with a reference to the silent darkness of the womb and ends with an invocation by the house god that the crying baby, like a drunkard, might finally fall sleep. And who sleeps more soundly than one who has had too much to drink?

Just as the sleepless nights of parenthood can be understood across different cultures thousands of years apart, so too can the spinning vortex after one too many pints — not to mention the merciless morning after, the onslaught of light and noise, the pulsating of one’s skull to the steady rhythm of a sledgehammer. Beer was common in ancient Mesopotamia, the first culture to record its use; so common that the hangover cure from ancient Ashur (capital of the Assyrian Empire and close to modern-day Mosul) called for medicinal ingredients to be mixed with none other than… beer.

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Back then, beer would have had a thick consistency, like runny porridge. A layer of detritus left behind by the brewing process would collect at its surface, and imbibers could only drink the liquid below through a straw. This everyday beverage features in countless medical therapies as the liquid of choice to dilute herbs, plants and minerals.

“If a person drinks beer and as a result his head continually afflicts him, he continually forgets his words (and) slurs them when speaking,” the Assyrian guide advises. This treatment for intoxication and its aftermath lists 11 plants to be soaked in beer and oil overnight under the star of Gula, a goddess of healing. The patient is to drink it before sunrise and “before anyone kisses him” in order to recover.

A hangover is only one of thousands of conditions addressed in medical texts from ancient Assyria and Babylonia, which describe symptoms of and treatments for ailments as diverse as fevers, seizures, headaches, heavy periods, STDs and depression.

A tablet from the library of the Neo-Assyrian king Ashurbanipal at Nineveh prescribes a treatment for a condition known as “Heartbreak” that calls for various plants and herbs to be mixed with beer, wine, water and oil. Another text from the Library of Ashurbanipal describes symptoms that may sound familiar to anyone who has experienced depression; the tablet describes a patient whose face “grows darker and darker”, who “becomes gloomy, is depressed”, who feels sad and refuses to speak, and who walks with hunched shoulders and struggles to sleep.

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The Royal Library of Ashurbanipal contained countless texts on scholarly subjects such as medicine and astronomy, a repository of learning intended to help scholars do their jobs and help the king run his empire. King Ashurbanipal liked to boast, in the same proverbial breath, about his military might and intellectual prowess – the original very stable genius. Visually, he represented himself in palace reliefs as riding into battle or wrestling a lion with a stylus tucked into his belt.

Alongside the highly curated works of scholarship that lined the shelves of royal libraries like that of the learned Ashurbanipal are the more mundane texts that record the everyday lives of people. A receipt for “the finest beer” from a brewer named Alulu, a marriage contract with an added adultery clause, a court deposition over unpaid silver in a remote trade outpost of the Old Assyrian empire, letters from an Egyptian pharaoh who demands gifts and from a slave woman who laments a stillbirth, and more.

Roughly once a year, someone on Twitter discovers a charmingly relatable customer complaint from 1750 BCE found in Ur.

“You said to me as follows, ‘I will give Gimil-Sin fine quality copper ingots’ …but you did not do what you promised me. You put ingots that were not good before my messenger.”

Thus begins a letter from a Babylonian named Nanni to another named Ea-Nasir. He goes on to accuse Ea-Nasir of mistreating him and his messenger, and of accepting payment but sending nothing in exchange — all because of one measly mina that Nanni still owed the copper merchant. The letter ends with Nanni’s demand for a refund and his promise never to accept copper from Ea-Nasir again, Ancient Babylonian for “Only giving this one star because zero stars was not an option” (Nanni and Ea-Nasir have even achieved the status of becoming a meme.)

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Etched into clay tablets from Mesopotamia are experiences so familiar they often read as if written by our family, our friends, and perhaps even our enemies. Lullabies and beer, heartbreak and depression, very stable geniuses and sub-par customer service. Tablets unearthed from Iraq’s shifting landscape bring to light life in cuneiform; they revive a past long dead but very much alive in the things we do every day.

Iraq’s ancient past continues to form part of its modern story. Few will forget the images of smoke billowing up over the city of Nimrud, reduced to scarred reliefs and irregular rubble when Isis swept through Iraq in 2015. They deliberately targeted the country’s heritage so that when the dust of their destruction settled, they could fill the resulting empty space with their own narrative. “When I heard about Nimrud,” Mosul’s archaeology professor Hiba Hazim Hamad, said at the time, “my heart wept before my eyes did.” Cultural heritage matters to the people who rely on it, who connect to it, and who live and die alongside it.

Thankfully, objects are not the only relics of Iraq’s past, the stories of which connect people as disparate in time and space as a wet nurse in ancient Ur singing a lullaby to quiet a crying baby and my New Jersian sister-in-law playing Spotify in Switzerland. Cuneiform tablets remind us that we have more that unites than separates us, and that we are our stories.

Like Ennigaldi-Nanna did 2,500 years ago, we still look to the past to understand our place in this mad world. We are human beings who have babies and hangovers, who buy stuff and get sad, who lie and cheat and love and fear and live and die. We are the stories that came before us and the stories that we leave behind, and when the rubbish of this epoch buries the eroded brickwork of all that we have done, I wonder what museum labels will say about us.

Mental health is having a moment. The mythical British stiff upper lip is long gone, and we are all encouraged, from even as lofty a place as Kensington Palace, to let our vulnerabilities show. And, uncomfortable as it is, this can only be a good thing.

The label ‘mental health’, however, is clinical and abstract. It can feel deserving of an employment policy or hashtag campaign. But it is also offputtingly worthy. Like most, I wouldn’t normally choose to immerse myself in anything with ‘mental health’ as a theme during my holidays.

Two books out this summer have helped change my mind. Far from being misery memoirs or po-faced, finger-pointing tomes about injustice, they are powerful and unexpectedly enjoyable adventures into the lives of others.

I Never Said I Loved You, by Rhik Samadder, is the memoir of a failed actor, born in Lewisham to Indian parents. It traces his journey from skinny, self-harming brown boy in the age of the National Front, to landing a job writing for the Guardian via a comedic round robin email from his temp account, which ended up in Private Eye.

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Already receiving plaudits for the beauty of the prose, Rhik’s memoir deals with childhood sexual abuse with a deceptively, and sometimes breathtakingly, light touch (Rhik is best known for his tongue-in-cheek kitchen gadget reviews). He speaks of the way abuse seems to make you susceptible to further abuse, somehow more visible to those who would harm you: “For the rest of my youth I bore violation like a beacon, like a broken window… like a crap Spider-Man whose secret power was being repeatedly molested.”

The section on the long-lasting effects of childhood racism was painful to read – Rhik attempted to sandpaper his skin, searching for “Just a scrap of Cauc beneath the Asian”. I have trouble with the phrase ‘check your privilege’, but Rhik’s straightforward, un-self-pitying narrative did more for my understanding of how being white has shaped my life and outlook than any angry demands that I do so.

Disconcertingly, woven among the traumatic events are some of the funniest passages I have ever read in non-fiction. The description of the Drama Centre acting school (“Drama Centre had earned the nickname Trauma Centre, the first casualty of trauma being rhyme”), which turned out Russell Brand and Gemma Chan, makes it sound like a sadistic madrassa for broken weirdos. His decision to give up acting came after an audition for an unpaid touring show in the Highlands involving a singing vagina puppet. His depression sometimes reads like a supporting character in a farce.

Jailbirds is seemingly a very different book. It brings us the voices of women in prison, via their chaplaincy assistant and art teacher Mim Skinner. Like anything to do with criminal justice, the themes are myriad – housing, welfare, education, gender – but underpinning all of them is mental health. We learn that 46% of women in prison have attempted suicide over their lifetimes (it’s 21% for men in prison); 53% report having experienced sexual, physical or emotional abuse in childhood, and that’s just those willing to talk about it.

Skinner’s book offers insight into the lives behind these statistics. I won’t forget the story of Paige. Plagued by serious mental health problems and addiction, her pregnancy is the longest she gets to spend with her baby. After he is taken by social services for “involuntary adoption” Mim encounters a “death in custody” notice on her way to work. Paige has killed herself.

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As with I Never Said I Loved You, these heavy, sometimes heartbreaking stories are interspersed with humour and absurdity. A running theme is the plethora of  obscure rules and regulations, which present challenges for the ingenuity of both inmates and staff. In one memorable section Mim, aghast at food waste, smuggles contraband vegetables from the prison garden in a leek-scented backpack, terrified of causing a lock-down. She veers from desperately trying to secure accommodation for offenders on release (38% do not have accommodation arranged, ending up inevitably back with abusive partners, pimps or on the streets) to vetting young offenders’ self-penned raps: “Does ‘tits’ and ‘fine ass’ count as inappropriate attitudes”?

Both writers wrestle with their own privilege, their ‘right’ to experience depression and anxiety. After witnessing inmates’ own mental health crises for too long, Mim herself ends up in counselling, despite thinking: “Mim, stop being a drama queen, you’ve got a lovely fucking life, and should be grateful so stop whining.” Rhik admits: “For decades, I didn’t feel worthy of saying I had depression. The grandiosity of depression struck me as showing off… I had confused suffering with a packet of Rolos, worried that I might take the last one.”

The two books both offer lessons in the way trauma works, helping explain the common passivity of those who’ve suffered, especially in childhood. Rhik writes:

“After trauma, our brains change, interacting with our nervous system in new patterns. Depressive responses are all but inevitable… Following a situation of extreme helplessness, we can lose our fight or flight instinct: adjusting to the reality that episodes of violation are inevitable, we give up trying to avoid them. Often, we seek them out instead. Repeating dangerous experiences of the past, in an unconscious attempt to fix them.”

For the repeat female prisoners (48% of women in prison committed an offence in order to support the drug use of someone else), that pattern looks familiar. If you’ve ever been slightly frustrated by people who seem, at least from the outside, to be stuck in the victim mentality, it’s humbling to read how difficult it is to escape from.

For those of us who have enjoyed broadly robust mental health, it’s not always clear what we are to do in this moment when the reality of mental health struggles are increasingly visible. I have sometimes felt overwhelmed by the pain presented, and in my worst moments ungraciously repelled by uncontrolled outpourings published elsewhere. What these two self-aware, wry and beautiful pieces of writing do is take the data and discomfort and make the reader connect – actually empathise – while also occasionally snorting with laughter.

One of the truths that the sometimes messy ‘mental health moment’ teaches is that we are all more tender, more fragile than we appear – than, often, we care to admit. Whether an unlikely member of the “metropolitan intelligentsia” with a column in a broadsheet, or a ‘criminal’ going back to prison because you sold yourself to buy drugs for your abuser, every person has more to them than what first meets the eye. And their stories, honestly and skilfully told, have power.