A Cure For Darkness (book review)

Hosted by the Mental Health Foundation, the Mental Health Awareness Week is taking place from 10 to 16 May 2021. As a Psychiatrist, I simply had to share a post about mental health (rather than travelling) today. Being an avid reader, I’m sharing my thoughts on the recently-published book ‘A Cure for Darkness: The Story of Depression and How We Treat It’, by Alex Riley. I’m also discussing about bibliotherapy and the beneficial effects that reading has on the mind and the brain.

A Cure For Darkness

‘A Cure For Darkness’ is a blend of scientific theory and personal memoir. Written by Alex Riley, a science writer who’s struggled with depression himself, it is by no means a self-help guide, but an informative book that does exactly what it says on the tin: it tells the story of how our understanding of the causes and our approach to the treatment of depression (and mental illness in general) has changed over the millennia. Throughout the book, Riley highlights the complexity of this common, but still misunderstood condition, and discusses the various treatments that have been used since antiquity, treatments diverse, and sometimes dangerous, quite like depression itself. The book is divided into four parts, which are further divided into a total of 27 chapters.

The first part, ‘Cutting Steps Into The Mountain’ is primarily focused on the work of Sigmund Freud and Emil Kraepelin, two leading figures of modern-day Psychiatry, two pioneers whose clinical and academic work contributed to our current understanding of mental (or psychiatric) disorders. Once we’re introduced to Freud and Kraepelin, Riley takes us back to antiquity and then to the Middle Ages before returning to the twentieth century. He shows how our approach to the understanding and treatment of depression throughout the centuries has followed a non-linear course; ancient wisdom and compassion gave way to a misunderstanding that led to the inhumane conditions of mental asylums, where patients were chained and bled.

In the two middle parts of the book, the author discusses the development of the so-called biological treatments for depression (brain surgery, electro-convulsive therapy (ECT), antidepressant medication) during the twentieth century. He then talks about the psychological treatments (talking therapies), as well as the challenges of talking about, let alone treating, depression in the third world. The final part, ‘The Universe Within’, is about current practice, as well as cutting-edge research into the causes and treatment of depression. For example, here, Riley talks about the insights from recent neuroimaging studies and the little-understood links between depression, inflammation and diet, as well as the use of deep brain stimulation (DBS) and psychedelic drugs in the treatment of the condition.

What Riley successfully demonstrates throughout this book is that depression is an incredibly complex and diverse clinical condition. He shows how our understanding of the biological, psychological and sociocultural mechanisms underpinning depression has improved, alongside the sometimes empirical, sometimes scientific treatments. By doing so, he sheds light on the reasons why successful treatment of depression can be such a huge challenge for clinicians and patients alike.

As a Consultant Psychiatrist myself, I think that Riley does absolute justice to such a complex, diverse and ultimately misunderstood condition. His approach follows the holistic bio-psycho-social model (that Psychiatrists currently use) with regards to both causation and treatment of depression (and mental illness in general). Talking about the past, present and future treatments of depression, he offers a comprehensive overview of those, and overall he follows a well-balanced and rounded approach. As a reader, I found Riley’s writing engaging and I certainly enjoyed reading this book. I would definitely recommend it to trainee psychiatrists, as well as to anyone who wants to better understand the complex causes of depression and gain an insight into the challenges that clinicians face when it comes to its treatment.

‘A Cure for Darkness’ was first published on 13th April 2021.

Bibliotherapy, and mental health and wellbeing

A combination of the Greek words biblio and therapy, bibliotherapy refers to the therapeutic use of reading and storytelling.

I’ve previously written about reading as a way to improve one’s mental health and wellbeing. I specifically wrote that self-help books can help with psychological or emotional difficulties. Often using therapeutic techniques used in therapy, self-help books can be very useful as a first step, whilst waiting for therapy, or as an adjunct to therapy. Although they’re lacking the therapeutic relationship with the therapist, they are excellent in that they provide psycho-education and support for self-care. Like psychotherapy, they encourage us to pay close attention to our internal world; they can also empower us to take steps to improve our mental health and wellbeing. In fact, there is a huge evidence base around the value of reading to support health and wellbeing.

In the UK, there is a scheme endorsed by health professionals and supported by public libraries that allows people to visit their local library and take a book out for free. ‘Reading Well’ has two strands: ‘Books on Prescription’ and ‘Mood-boosting Books’.

Another excellent resource is the Overcoming website. It features a large number of resources, such as a list of self-help books (many of which are available on the Reading Well scheme) and free downloadable materials.

Further reading

If you’re interested in science and the brain, and want to read more about how books and reading can affect the human brain, check out the following articles:

Short- and Long-Term Effects of a Novel on Connectivity in the Brain

In this article, published in the Brain Connectivity journal, the authors (Berns et al.) describe an experimental study to find out whether reading novels can cause changes in brain function and structure. To determine that, they used functional magnetic resonance imaging (fMRI) to track changes in the participants’ brain activity. Their findings support their hypothesis that reading novels can cause longer-term changes in the connectivity of the brain. Further research studies are nonetheless required in order to inform on the generalizability and the clinical implications of their findings.

Reading Literary Fiction Improves Theory of Mind

In this article, published in the Science journal, also in 2013, the authors (Kidd and Castano) provide experimental evidence that reading novels enhances the reader’s performance on theory of mind tasks (theory of mind is defined as the human capacity to comprehend that other people hold beliefs and desires and that these may differ from one’s own beliefs and desires). I suppose that their findings come hardly as a surprise to most bookworms; yet, it is important that scientific research confirms what’s instinctively known to most bibliophiles. Bearing in mind that the theory of mind is impaired in some mental disorders, such as autistic spectrum disorders, I wonder whether reading literary fiction could have a specific therapeutic use in those populations.

Alex

(the Traveling Psychiatrist)