My Depression (The Up and Down and Up of It) is a new animated musical HBO documentary co-directed by famed Broadway writer, director and composer, Elizabeth Swados. It tells the true life tale of the struggles and triumphs of living with and managing depression. That is right you heard correctly, an animated musical documentary… on depression! It gets better. Swados employed the voiceover powers of film, comedy and music industry legends Sigourney Weaver (as Elizabeth Swados), Steve Bucemi, Fred Armisen and Dan Fogler!

Having such infamous and gargantuan talents coming together, with beautiful Roald Dahl-esque colorful and metaphorically powerful animations led by award winning animators and co-directors, David Wachtenheim and Robert Marianetti, and captivatingly catchy musical interludes like the macabre “Suicide Mobile” sung by Steve Bucemi, the creation has the power to truly transform viewers’ perspective of depression. But is the documentary’s message in line with the scientific consensus? Is the message it spreads for the greater good?

In true Brain Blogger fashion we have put the colorful collaboration under the science-o-scope. The results of the analysis are in: There is some great news, some good news, some bad news and some ugly news.

The Great – Stigmatizing Depression

My Depression is truly in keeping with science research on mental health stigma. The telling of Swados’ story is living proof that you can be wildly successful and have a myriad of wonderful things in life yet still suffer from depression.

Importantly, it depicts floating discriminating heads of the general populace spouting all-too-common , ill-conceived and cliché judgments:

…stop being so self-indulgent…you need a hobby…what about people who are really sick, snap out of it!

Misunderstanding depression leads to unjust discrimination and negative judgments, which can be damaging. What is worse is how these negative views become internalized in the sufferer, leading to the development of self-stigma, shame and hate.

We then witness self-stigma in action where Swados conveys she is unable to recover, undeserving of care and responsible for her illness. This leads to the well-known “why try” effect where she believes she is deserved of a doomed life of depression, confines herself to her bed and seems to give up on her goals, ambitions, passions and life altogether. As the documentary shows, and in line with research, this spiral can take you on a rollercoaster ride of ups and downs to the “suicide bus”.

The Good — Individualizing Mental Health Problems

My Depression sends out another excellent message:

Depression can come in different forms for different people…

It’s even in the title itself. Swados’ depression is her depression, its personal, and can even be different for the same person at separate times in their lives. This is painted perfectly in the animation, where Swados drags her heels through the aisles of the world’s gloomiest supermarket filled with depression ingredients, with popular products like “Anxiety”, “Misery” and why not a dash of “Shame”?

The fields of psychology and psychiatry have been moving in this direction, where instead of being quick to jump in and label someone with a generalized depression diagnosis and continue on with treating depression, research is showing the importance of individualizing treatment to suit that particular individual’s representation of depression in helping them back to wellness—faster, easier and with less chance of relapse. Therapists treat real people with individual problems, not a depression clone cut straight out of the DSM.

The Bad — Personifies Depression

Swados’ depression is personified as a rather annoying and intrusive little black storm cloud. Being followed by dark clouds is often used to describe what depression feels like, and likely truly represents what depression felt like for her.

Yet there are potentially negative implications of representing depression as a separate living being. There is the danger that viewers, particularly sufferers, may take the concept that depression is an uncontrollable creature with a life of its own and that you can’t control to heart.

This metacognitive belief that you don’t own your depression and can’t control it, and that your depression owns you, makes healing from depression a darn sight harder. And if you don’t shake the belief that you have no control over depression, research shows that there is a high risk of depression relapse, and it puts you at risk of other mental health problems like hallucinations and delusions.

Towards the end there is a focus on how depression is treatable, however Swados’ characterful cloud of depression is perhaps the most powerful and memorable visual metaphor and has the potential to do both harm and good.

The Ugly —Effective Therapy Misrepresented

Finally the story ends on a positive note. Swados seeks out professional help. One of the most powerful messages in the documentary for those with depression to take home is that part of her turning point in recovering from depression is seeking therapy:

“That’s why it is also important to find a good therapist who can teach you how to cope and work through life’s surprises”

However, for psychologists and psychiatrists that stay true to evidence-based therapy they may not be particularly pleased with how the process of diagnosis and treatment was represented. The moment she sits in the chair she immediately gets given a very resolute sounding “factoid”:

I don’t know if you are aware of this but severe depression is often hereditary Liz, it’s a well-known fact that mood disorders are often passed from parents to children and on and on and on…part of your problem is the result of chemical imbalances in your brain, it’s actually not unusual, and if you are willing, of course, we can try and correct that with some of the newest medications available.

This is a grossly over-generalized and relatively old-fashioned, one-sided psychiatric view of depression and how best to treat it. What is the first thing the therapist suggests, in the form of a catchy song, drugs.

Although this may be completely normal for her particular case (who knows?) viewers should not presume this is the standard or most generally effective route to long-term mental health and wellbeing. Being immersed in psychology, psychiatry and neuroscience developments on a day to day basis, this is unlikely to be the general view based on current research.

Whether her psychiatrist used far more effective tools of change than medication and talk-therapy alone, such as including the most effective belief, thought and behavior molding interventions tailored to that persons specific problems, that alter how your brain functions at a neurological level for long-term change, and can sometimes work well with medications that create a window for improved efficacy of said interventions by temporarily reducing symptoms, eventually working on removing the potential dependence on medication that often results… is anyone’s guess.

The general impression is left that while therapy (whatever kind of therapy that was) is important she found more value in beginning:

…a series of medications and more medications and even more medications and trying to find the right ones that would work for me…it took around 3-years of trying this and that until my doctor and I eventually found something that really worked.

Thankfully, the documentary does touch on medication side-effects and briefly mentions that:

…the drugs help but not all of us and not all of the time.

Swados also mentions that before she met her therapist she also tried a number of things from healthy eating to exercising and meditating. An integrative and more holistic psychologist or psychiatrist would gradually incorporate establishing these habits. Many of these habits don’t stick and often people don’t experience the full benefits obtained from the therapeutic opportunities they present (like with drugs)… unless of course they are guided through the process by an expert using interventions proven to enhance the benefits.

In Sum

While there are a few more messages in disagreement with current scientific opinion that we haven’t mentioned, the number of near impeccable and insightful scientifically backed messages that we also didn’t touch upon in this article far outweigh the bad.

With the title echoing through the entire documentary, we cannot place blame on the scientifically incongruent parts to her story, Swados is not a scientist. It was called “My Depression”, not sciences, not her therapists, or any therapists for that matter, but hers. It’s humorous, it’s serious, it’s powerful, it’s moving, it’s clever, it’s entertaining and it mostly agrees with predominant scientific theories… totally worth the watch!

References

Lucksted A, & Drapalski AL (2015). Self-stigma regarding mental illness: Definition, impact, and relationship to societal stigma. Psychiatric rehabilitation journal, 38 (2), 99-102 PMID: 26075527

Sarris, J., Glick, R., Hoenders, R., Duffy, J., & Lake, J. (2014). Integrative mental healthcare White Paper: Establishing a new paradigm through research, education, and clinical guidelines Advances in Integrative Medicine, 1 (1), 9-16 DOI: 10.1016/j.aimed.2012.12.002

Valiente C, Prados JM, Gómez D, & Fuentenebro F (2012). Metacognitive beliefs and psychological well-being in paranoia and depression. Cognitive neuropsychiatry, 17 (6), 527-43 PMID: 22530974

Goldstone E, Farhall J, Thomas N, & Ong B (2013). The role of metacognitive beliefs in the proneness to hallucinations and delusions: an analysis across clinical and non-clinical populations. The British journal of clinical psychology / the British Psychological Society, 52 (3), 330-46 PMID: 23865408

Teasdale JD, Moore RG, Hayhurst H, Pope M, Williams S, & Segal ZV (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of consulting and clinical psychology, 70 (2), 275-87 PMID: 11952186

Richardson, C., Faulkner, G., McDevitt, J., Skrinar, G., Hutchinson, D., & Piette, J. (2005). Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness Psychiatric Services, 56 (3), 324-331 DOI: 10.1176/appi.ps.56.3.324

Image Copyright Home Box Office, Inc.