International research studies on anxiety and depression symptoms during the Covid-19 pandemic generally report large increases in the rate of clinically significant symptoms among the general population. A recent UK study, for example, suggested that 64 and 57 per cent of the 3,000 adults sampled reported significant symptom-levels of depression and anxiety, respectively. These are similar to the figures our own research team found in the UAE, with the results published in Psychiatry Research last month.
How quickly we bounce back from this situation is still an open question. Will the elevated symptoms lead to an increase in actual mental illness prevalence across our societies? And if so, what should we do about it?
The real trouble with mental health problems is that they tend to be episodic. For example, after recovering from an initial episode of depression, many of us will go on to have a second episode and then a third and then a fourth, fifth and sixth. In an article for JAMA Psychiatry, Lewis Judd, of the Department of Psychiatry at the University of California, suggests that people living with depression, on average, experience four major episodes across their lifetimes, with each lasting around 20 weeks.
We bounce back, but some of us only bounce back for a bit. It is almost as if, once we discover "dark places", it becomes easier to find our way back there again and again. Psychologists have termed this observation the "kindling hypothesis" – the proposition that each episode of mental illness makes another one more likely.
Mental health professionals used to debate: which works better, pills (antidepressants and anxiolytics) or talk therapy? We now know, however, that was totally the wrong question. For depression at least, both treatments are roughly equal over the short term. The critical question, however, is which treatment leads to a longer-lasting recovery, and which one is associated with lower relapse rates?
Even compared to maintenance treatment with pills (long-term antidepressant use), talk-based psychological therapies are associated with lower rates of relapse. In therapy, we learn new ways to cope with and relate to the bumps in life's road. We might also develop better defences against the slings and arrows of outrageous misfortune (the bad stuff that just happens).
It is hard to see what learning, if any, takes place by consuming antidepressants. However, this pharmacological approach can help many people weather the storm until it passes.
This longer-term benefit of talk therapies – treatments such as cognitive behaviour therapy – has led to an increased investment aimed at improving access to such evidence-based psychological approaches. The UK government, for example, under the banner "no health without mental health", invested £400 million from 2010-15. The aim of this investment was to ensure that "every adult that requires it should have access to psychological therapies to treat anxiety disorders or depression".
The Abu Dhabi government recently set up a hotline to help safeguard mental health during the pandemic. The programme, one of many, involves trained responders offering essential information, and, crucially, lending a compassionate ear to people struggling to cope with the outbreak.
These are good initiatives. But even the best talk-therapies still have troubling relapse rates. In some studies of depression and anxiety, the relapse rate at six months can be as high as 50 per cent.
This has led psychologists to develop programmes that are specifically aimed at relapse prevention and, better still, primary prevention – preventing illness before it ever occurs. Mindfulness-based stress reduction and mindfulness-based cognitive therapy are two leading examples of this prevention-orientated approach. Their popularity is rooted in their success.
Individuals who make lasting recoveries from mental health problems, those who learn to live amicably with their demons, and make peace with despair, what do they gain from their experience?
Carl Jung, Sigmund Freud's one-time protege, certainly thought they gained a lot. In his autobiography titled Memories, Dreams, Reflections, he wrote: "Only the wounded physician heals... and then only to the extent he has healed himself." Jung was referring to the idea that the most successful healers or therapists draw on the knowledge of their own hurt to help others. Those who have recovered from psychological wounds are well placed to help others.
This brings to mind the novelist Matt Haig, who after experiencing a suicidal episode of depression in his twenties, went on to write the No 1 bestseller, Reasons to Stay Alive. Haig describes books as being like antidepressants. His own works of fiction have provided solace and healing for millions.
Similarly, the experience of being overwhelmed by emotions can be associated with great works of visual art. The poet Charlotte Smith once wrote: "Those paint sorrow best who feel it most." Echoing this sentiment, on his 2018 album Ye, the billionaire rapper Kanye West refers to his experience of bipolar disorder as a superpower rather than a disability. This is an idea that echoes across continents and down through the ages. For example, the 12th-century Benedictine abbess, Hildegard Von Bingen, today celebrated as Europe's first-known female composer and one of the greatest European poets of the medieval period, experienced bouts of deep melancholia, a condition roughly equivalent to contemporary mood disorders.
We often talk about mental health problems as enemies to be overcome and vanquished. However, perhaps we could also look at them as teachers to be heeded, or gifts we have yet figured out how to use. Once we learn the lessons and harness these gifts, our recoveries will be longer-lasting, and we will have been refined by our journey.
Justin Thomas is a professor of psychology at Zayed University