Thank moo: Depression and why a cow is the best gift you'll ever give
While early November might seem premature to talk festivities, the week's arrival of toffee-nut latte and candy cane cups at Starbucks can mean only one thing: Christmas has landed. But before you get cracking with your wish list, here's a case for a different kind of gift.
I was 25 when I took my first antidepressant. For months, I'd been crippled with pain and fighting to suppress a sick voice in my head. Like a weed, it'd spread through my body until every moment felt like slow suffocation.
One morning I drove myself to the medical center, terrified I was possessed. After describing my symptoms to a doctor, they said it wasn't possession I was battling; it was depression. The situation was simple. I had a chemical imbalance in my brain, and serotonin-boosting drugs would fix it. And for a while, they did. But my body adjusted to the drugs and we upped the medication, a pattern that continued until I was on the highest possible dose and in therapy. My experience isn't unique. Over 65 percent of people who first feel better on antidepressants are depressed again within a year. And although standard treatments have a real and valuable place in treating depression, they can't always address the underlying issues that cause it.
In 2001, South African psychiatrist Derek Summerfield was in Cambodia researching chemical antidepressants. The drugs were new to the area, but when Summerfield explained what they were, local doctors said they'd prescribed antidepressants before. Confused, Summerfield asked for more information and was told about a farmer who'd had his leg blown off by a land mine. The farmer was given an artificial limb and returned to work in the fields. But he quickly became depressed, crying all day with physical and psychological pain. Doctors went back to see their patient and better understand his trauma. In the end, they bought the man a cow so he could become a dairy farmer. And within a couple of months, his depression had gone.
The cow, doctors explained to Summerfield, was an antidepressant.
To the Cambodian doctors, finding an antidepressant wasn't about changing brain chemistry. It was about finding a solution to the problem that caused depression. Acknowledging the pain their farmer felt echoed what the World Health Organization (WHO) has long said. If you have depression, you're not weak or broken. You're a person with unmet needs.
While the chemical imbalance narrative is widely accepted by society, it's not the full story. The WHO also reports that depression results from a complex interaction of social, psychological and biological factors. In the same way, we have physical needs – water, food, air – and we have psychological needs too. When these needs aren't met, we suffer.
Depression and expatriates
In his 2018 book, "Lost Connections," international best-selling author Johann Hari talks about Summerfield and the holistic approach taken by Cambodian doctors. Hari identifies nine causes for depression, and only two are biological. The other seven relate to how we live – namely, disconnect. Globally loneliness is on the rise; it's also a leading factor in depression.
Living away from our native homes and culture is an enriching experience. But can it add to feelings of isolation? Shanghai-based clinical psychologist Laura Ruesjas-Lukasik specializes in depression and cultural adjustment.
"Loneliness and isolation are significant factors impacting the mental health of expatriates," she says. "Depression is without doubt one of the most significant effects, along with anxiety, marital discord and alcohol abuse."
Research linking depression and expatriates emphasizes the impact on one group in particular: the trailing spouse.
"It's important to note that depression doesn't equally affect the working and non-working partner," Laura highlights. "Working partners have adjustment issues alongside having to support their family. But for the trailing spouse, there's a sense of losing control and a questioning of self-worth."
Adding: "They undergo a great deal of emotional stress, having to recreate their identity in each new place. It's not only a process of adjustment but one of internal questioning. It's not unusual to experience loneliness, anger, low self-esteem and a lack of belonging."
To be happy, we need a sense of belonging. We need to feel seen and valued. We need a sense of purpose and a future we understand.
A new approach
Yes, biological imbalances are factors in depression, and chemical antidepressants give considerable relief to many. But when the cause of depression goes deeper than chemistry, so too must the cure. Pain isn't a personal malfunction; it's a signal to society. And instead of making depression the job of individuals to overcome, we must work together to fix something bigger than ourselves.
And what better time?
In one way or another, everyone has been affected by COVID-19. Be it anxiety around virus transmission, the psychological impact of lockdowns and self-isolation, or stresses linked to financial difficulties, unemployment and alienation. Simply put, we've suffered. And as the WHO put it, "the mental health impacts of the pandemic will be long term and far-reaching." Something the international community, most of whom are desperate to see loved ones but still can't travel, know too well.
So with the festive season fast approaching, keep in mind the meaning of any national holiday – from Thanksgiving to Chinese New Year – and what's commonly referred to as the true meaning of Christmas: togetherness, compassion and understanding.
Worldwide, more than 300 million of us have depression. This year, give the person in your life a cow.