Foes of Flow: The King's Speech & The Fighter

King George VI in search of flow

Monarchies put a lot of stock in continuity, so stammering interrupts royal speech in a particularly discomforting way.  I’m sure, though, that a disabling stutter is just as agonizing for a working-class bloke or a trauma-torn vet.  You’ll know what I mean if you’ve seen The King’s Speech. If you haven’t, go see it soon; Colin Firth and Geoffrey Rush definitely deserve the year’s Oscar for Best Friendship.

We all want continuity--what Mihaly Csikszentmihalyi calls “flow”--in whatever realms we care about most: our speech, writing, economy, relationships, sport, music, dance…the morning commute. It goes by many names (swing, pace, groove, the zone, grace)  but it is singularly recognizable, beautiful, and satisfying. 

All kinds of things keep us from achieving flow, but some of the most painful, and a theme of both The King’s Speech and this year’s other great holiday film, The Fighter, are the psychological impediments that inhibit continuity, even when, physically, it should be achievable. The protagonists in both movies are hobbled by psychological forces that have physical consequences. And both required radical treatments that addressed the psychological roots of their problems: in one case, a boxer’s inability to  flow to victory, the key was detachment from his dysfunctional family; in the other, a king’s inability to deliver a pivotal speech, the key was the therapeutic honesty of a challenging but compassionate friend.

Also mortal foes of flow are physical problems (like epilepsy and stuttering) that interrupt the continuity of consciousness in ways that have disabling psychological and psychiatric consequences. A seizure is the ultimate interruption of flow; and the constant threat of one is enough to make a confident person’s experience sputter and jerk. Half of those who suffer from uncontrolled epilepsy also are depressed.

The mysterious relationship between the brain and the mind--between the physical and the psychological--may be the key scientific and medical question of the century. And it is nowhere more intriguingly and painfully played out than in psychogenic illness, such as many non-epileptic seizure disorders and much stammering. These disorders are as important to study as they are difficult to get a handle on.  

Placebo: Buy Shares Now!

Please don’t ever say “just the placebo effect.” Placebos are potent treatments that kick the butts of many billion-dollar drugs. And their price can’t be beat.

In his wide-ranging New Yorker piece, “Head Case,” about the state of psychopharmacology (is it evil or merely useless?), Louis Menand reviews Irving Kirsch’s book The Emperor’s New Drugs (Basic; $23.95). Kirsch, a psychologist in the UK, argues that antidepressants are just (I hate that!) expensive placebos. While they usually do a little better than placebos in drug trials, Kirsh argues that there is no good way to protect the double-blind nature of such trials; most antidepressants have side effects such as nausea, restlessness, and dry mouth. Once a patient detects those, he knows he’s on the drug side of the trial. A patient feeling no side effects may assume he’s taking sugar pills and may get more depressed than he was to begin with, amplifying the minimal statistical gap. Great point, but...

Well, read the whole piece. It’s fascinating. I certainly don’t want to minimize the importance of hucksterism and venality in the psychopharmacology business, and I want to write more about it soon,  but I just want to say here what I always do when I hear about billion-dollar drugs that don’t beat placebos in trials: Let’s invest in the placebo effect! It helps at least a third of severely depressed patients. And it also helps patients with Parkinson’s, and chronic pain, some kinds of epilepsy, and many, many other serious conditions. When we figure out what’s going on with placebos, doctors--or clerks for that matter-- may be able to prescribe them honestly, inexpensively, and in good conscience and make millions of people better. And a little side benefit: we’ll begin to map the current no-man’s land extending the broad distance between neurology (the science of the brain) and psychology (the science of the mind). That should bring with it some other exciting (anti-depressing!) philosophical benefits, too.

Depression's Adaptive Value

Johah Lehrer’s interesting piece, The Upside of Depression, in the Feb 28 NYT Magazine argues for the adaptive value of depression. The basic idea, taken from evolutionary psychology, is that depression must have an important survival value or it would have been selected out long, long ago. Certainly, Lehrer’s sources argue, it wouldn't as prevalent as it is today. Depression, they say, is like an emergency brake, forcing patients to halt, disregard distractions, and focus on a central problem. Like any emergency system, it can malfunction and cause big problems of its own. Suicide, for example, certainly isn't adaptive.

But the point of Lehrer's article is that patients who are simply given anti-depressants may not address the root cause of their depression. Andy Thomson, a psychiatrist at the University of Virginia, tells the story of a patient “who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget," Thomson says. “‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’ ”

Lehrer doesn’t talk about it in his piece, but there must be profound society-wide ramifications of broadly quelling individual discomfort with anti-depressants. There are global-scale versions of that “alcoholic son of a bitch” and we live with and tolerate them at our peril. Are widespread war and famine depressing enough to stop us in our tracks and move us to re-consider the compulsively consumptive behaviors that make them possible? How about threats from environmental collapse, nuclear annihilation, or terrorism? If we disable the idiot lights of our personal depressions with drugs, then we may also disable the collective ones too, allowing ourselves to march cheerfully along toward a very depressing future. That would be maladaptive in the extreme.