Better Living Through Chemistry? Love, Depression and Pharmacology

Last night I went to see The Effect at the National Theatre, a new play by Lucy Prebble, who made waves with her previous piece ENRON. (It ‘stars’ Billie Piper, who I’d not seen on stage before but – just as an aside – her performance confirmed so much that I’d heard: she’s a very fine actress indeed.)

The play is set within a drug testing programme. Two subjects are beginning a 4 week residential clinical trial of a new anti-depressant. Neither of them know if they are on the drug, or on a placebo and thus, when they begin to ‘fall in love’ are unsure whether these are ‘real’ feelings, or ones brought on by the medication…. and, if it is just the chemicals, does that even matter – because isn’t that how love happens anyway?

The tensions between the doctors who are monitoring give the script an opportunity to raise the medical, ethical and philosophical questions about the relationship between brain physiology, mood, identity and its inter-relation with the world.

In a central scene, the two doctors discuss what causes depression – and the argument twists between ‘chemical imbalance’ – depression as an illness with a pharmacological cure – and external events, such as unemployment or relational breakdown.

The pharmacology industry have a vested interest in promoting depression as an illness –  it is the brain ‘gone wrong’ – and their anti-depressants as a way of curing it. The data on this – as the play explains – is at best inconclusive. Drugs can work well in the short-term, but their long-term efficacy is highly questionable, especially given the high levels of dependency and chemical/psychological addition.

This is on the ‘down’ side. But what the play does well is contrast this with the ‘up’ – what if there were a drug that could help people fall in love, or, when long-term relationships are struggling, help them to stay in love? Because don’t we already talk about finding ‘chemistry’ with someone? Don’t we understand that somehow love is a violent chemical reaction?

The key question that the play interrogates is thus the nature of reality and experience: is there something beyond the biochemical processes that medical research is now understanding better. In other words, are love and depression, up and down, to be best understood in psychiatric or pharmacological terms?

The play has some flaws. Set in a clinical environment, it can be a little too clinical, and some of the relationships didn’t feel true. But it precipitated a lot of interesting questions, particularly as I’d just finished reading Stuart, A Life Backwards. (spoiler alert if you’ve not read it)

In this fascinating biography of Stuart Shorter, a ‘chaotic homeless’, violent man from Cambridge, Alexander Masters works back through his life to the events that may have set him off on a path of glue-sniffing, extreme violence and anger and, tragically, an early death.

Stuart himself is perhaps the most lucid witness in all of this: he suffered severe trauma as an abused child but, he sees clearly, not everyone who suffered similar things to him ended up as suffering violent paranoid episodes and with multiple addictions. In other words, his identity is an amalgam of events and physiology, which are so intertwined that it is near on impossible to work out cause or effect.

Cause…effect…and thus responsibility. The Effect ends with questions of where responsibilities lie, and it is this area of brain function that is perhaps more pertinent for, as neuroscientist David Eagleman has written in Atlantic, changes in the state of our brains can radically affect our behaviour and our drives, turning, in some cases, ‘normal’ people into violent killers.

These questions are connected. If we think we should rush to chemical ‘cures’ when we feel sad, we need to think why we might not want pills to feel love, or why criminals shouldn’t have a pharmacological defence.

As someone who has ‘suffered’ depression these questions are all too real. I’ve very much resisted any chemical cures (apart from the socially ‘normed’ ones of alcohol, caffeine etc.). Instead, I’ve tried to be phlegmatic about circumstances, and also careful about seeing the via negativa, the viewpoint of life that resists the always-up happy hedonia that society and media present as something to aspire to.

Chronic depression is utterly shit, no doubt about it – and thankfully I’ve not had experience of it first hand. But more mild forms perhaps need to be reconsidered as simply part of who some people are – an identity which goes against the grain of pop-culture. I know very few writers and artists – always flies in the ointment of pop anyway – who don’t have some creative connection with their black dog, as long as he remains under control.

No answers really – plays and books should resist handing them on plates, and I think both The Effect and Stuart, A Life Backwards do well in this regard. I’d recommend them both.