How Everyone Became Depressed

The rise and fall of the nervous breakdown

What Did Simon Winchester Really Have?

Winchester makes ECT into a miracle treatment.

When Simon Winchester, later a distinguished journalist and author, was a student at Oxford in the mid-1960s, awoke one morning, “the whole world seemed to have changed, had suddenly gone entirely and utterly mad.”

How so?

All the objects in his room he could see quite clearly, “yet all of them now looked in some strange and menacing way, entirely unfamiliar.” The pictures “made no sense.” He couldn’t figure out what was going on in them. A Van Gogh portrait, The Bridge at Arles, that previously had seemed “a congenial and comforting confection of color, now had a horror to it. Somehow the bridge itself now looked broken, impossibly built.” The pile of dirty plates (he was an undergraduate!) seemed precariously on the point of toppling over.

Winchester felt “frightened and alone, trapped against my will in some weird new continuum far beyond my understanding.” He pulled the covers over his head but half an hour later things were just as bad. He slept another eight hours, woke up in the early evening horrified at the time, needed the car to run an errand, crashed it, and walked away from the damage in a daze.

This state of bewildered puzzlement and confusion persisted for three days, then he awoke again and all was normal.

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These confusional episodes --let’s call them by their proper name, psychotic – continued for weeks, as an expedition to Greenland loomed (he was a geology student and he and his pals were going to search for rocks). Greenland was a series of these mini-episodes of distortion and the terrifying belief “that I was losing my marbles, and had no-one to run to, no place to hide.”

But in-between, he was fine, and romped with his pals, enjoying the Greenland sunshine.

The episodes continued. He graduated from Oxford, married, and got a job. Two years passed. The episodes became ghastlier. “The first few seconds of each and every day were limned with fright, and with near-manic relief when I knew the day ahead would be good, untroubled.”

The came the denouement: Visiting an aunt in a northern English town, now four years after the initial onset, he sat despondently at breakfast when the doorbell rang: It was the local family doc, paying a house call on the aunt. The doc glanced at him, muttered a few questions to Winchester’s aunt and wife, then came over to him, put a hand on his shoulder, and said, I know what’s wrong with you; and I know how we can fix it. Don’t worry any more. You’ll soon be fine.”

The doc ordered an ambulance that transported Winchester to the local mental hospital, where immediately upon arrival he began a course of electroconvulsive therapy (ECT). There were some ups and downs, but bottom line: After a series of ECT stimuli, Winchester was well again! And stayed well for the rest of his life. A miracle cure.

So, the question is, what did Winchester really have?

His own analysis (concluded after reading through a copy of the American Psychiatric Association’s Diagnostic and Statistical Manual -- DSM) was that he had a “dissociative disorder,” a fugue. But this is nonsense. At no point did he think another personality was competing in his brain with the real Simon; nor did he have significant black-outs in which he might, say, rob a bank (male criminals today often cop to “dissociative disorder”).

Did he have melancholic depression? Several very acute clinical observers today opt for this choice because (a) the family doc made a spot diagnosis on the basis of Winchester’s slumping posture at his aunt’s, morosity written upon his face; and (b) because Winchester responded beautifully to ECT.

Yet there are problems with the melancholic depression diagnosis. For one thing, Winchester did not have any mood complaints. He wasn’t deeply sad, nor did he have “psychomotor changes,” meaning either agitated pacing, muttering “It’s all my fault,” nor stuporous withdrawal. Nor was he anhedonic: incapable of pleasure. He had a normal life between these brief psychotic episodes, and indeed horsed around with his pals on the glaciers of Greenland before briefly contemplating suicide. Also, a single course of ECT cured him and he never again relapsed. Melancholia is a chronic relapsing illness.

Interesting, eh? Common things are common. I think he had a subthreshold psychotic disorder, with episodes of delusional thinking and perception (German psychiatrist and philosopher Karl Jaspers called this a “primary delusional experience,” the delusive thinking and perceptions not yet organized into a fixed system.). These are quite common, though are not included in DSM. But you wouldn’t expect such a condition to respond to readily to ECT; and then there’s the question of the family doc’s flash diagnosis: the light often leaves the eyes of melancholic patients; their sadness is palpable. It’s difficult to miss.

Winchester’s illness has now become famous since Barton Swaim reviewed his book in the Wall Street Journal.

Swaim is dubious about the whole electricity business: He calls ECT a “barbaric” treatment and believes that Winchester is kidding himself about its effectiveness: “He is convinced that it worked.” Obviously, such a brutal treatment should by rights fail! The editors compound the calumny with an ECT photo showing a defenseless young man, his head covered with sinister wires, as a (black) hand seems to clutch at his throat.

This badmouthing of ECT is a public health disaster. We have these ill-informed journalists, with access to major media, repeating the prejudices they have harboured ever since they saw “One Flew Over the Cuckoo’s Nest” in 1975. But the success of ECT is the most interesting aspect of Winchester’s book: he was made whole again by convulsive therapy, and stayed well thereafter.

Indeed, Winchester makes ECT into a miracle treatment. To be sure, ECT is highly effective and quite safe. But it’s usually not so effective, at least in some conditions, that you never again need any maintenance treatment. This raises false expectations.

The ink-stained wretch who wrote the book summary for the website Byliner, where the book may be downloaded, didn’t believe the ECT part either. 

But because Winchester himself makes such a big deal of ECT’s obvious success – it is, literally, the point of the book – the reviewer didn’t think he could slide over it entirely in silence. Yet he shows us his critical acumen in assessing the events “that led to the controversial treatment of electroconvulsive therapy, which may or may not have cured him once and for all.” It’s as though we were discussing high colonics! Only in the media is ECT still “controversial.” Psychiatry now embraces it. This stuff is read by lots of people. The next time Dad gets sick, the psychiatrist may recommend ECT. Lots is riding on whether the family accepts the recommendation.

Edward Shorter, Ph.D., is the Jason A. Hannah Professor in the History of Medicine at the University of Toronto.

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