Helen is a freelance writer with a PhD in History of Medicine. She tweets at @helenblackman and blogs at Helen Blackman. In this post she responds to Louise Mensch’s comments about exercise being ‘the best anti-depressant’.
[Content note: Contains discussion of the symptoms of depression, including suicidal ideation.]
On Tuesday night, 21st May 2013, Louise Mensch, never really known for the depth of her analysis, tweeted ‘Self-esteem: exercise is the best anti-depressant and ANYONE can do it. Try this – 3 minute desk-side mini walk.’
Various people then tweeted her to point out that actually it is not true that anyone can exercise, the term ‘anti-depressant’ has a more exact meaning than that, and that the evidence concerning links between depression and exercise is quite mixed. Mensch then loudly repeated her point that exercise is great and argued that the naysayers were all wrong in assuming that exercise couldn’t help depression.
Arguing with Mensch is about as productive as nailing jelly to a wall. She doesn’t actually respond to your criticism but to an imagined criticism that she finds easier to deal with. Thus the conversation could be summed up as:
Mensch: exercise is good for depression and anyone can do it
Tweeters: well actually not everyone who has depression can exercise
Mensch: no you’re wrong to say exercise doesn’t help depression, it does, look, here’s a link to the NHS website proving I’m right
Given the Twitter storm that resulted, Mensch decided to blog about depression, presumably going by the theory that no situation is so bad that it cannot be turned into an opportunity for self promotion.
She has, since writing her blog, tweeted ‘It was very gratifying, upon doing the research, to find out the tsunami of evidence and studies disproving the keyboard warriors yesterday’. Keyboard warriors is a charmingly dismissive term for a group of concerned people trying to engage with her on a serious issue but here is one warrior’s take on depression and Mensch’s views on it.
I was diagnosed with depression about three years ago, although I had probably had it for a quarter of a century before that. Through therapy, and with a lot of help, I came to recognise that the worst symptoms of my depression were an utter lack of self esteem, and catastrophising; that is, in any given situation I could only see the worst. I thought everything was a catastrophe waiting to happen, in part because by that point in my life so much bad stuff had happened.
Depression has a crushing, bone-wearying power. It shatters you.
Depression explodes your sense of who you are into a million tiny pieces. You’re left to examine the fragments of your soul, dizzy with working out which bits are you and which bits are illness. It is exhausting.
My out of body experiences were terrifying. My mind and body disconnected as I found myself surrounded by those fragments of self. Those shattered pieces of who you might be, drift away and you fear to catch them lest you cut yourself. And then there’s the crying. In the supermarket. Watching TV. In the Job Centre. Randomly. Yes I know the little dog in the rubble is sad, but really, a box of tissues later, is it that sad?
So what is Mensch’s take on depression, destroyer of souls? She was tweeting whilst getting her roots done, something which she hates, apparently. I’ll leave out the question of whether exercise is an ‘anti-depressant’ as such. Twitter’s character limit doesn’t allow for nuances such as ‘mood alleviator’ but pushes people towards simplifying issues. According to Mensch’s blog ‘Depression is an incredibly dehabilitating illness, often recurring, and afflicting vast swathes of the population’.
Dehabilitate isn’t actually a word. Otherwise, so far, so good.
‘Depression is characterised as mild, moderate and severe.’ Well yes. What Mensch omitted is the fact that depression does not actually present with a handy label attached. One of the immensely difficult things about it is its amorphous nature.
According to Mensch ‘It is not sadness; it is a disease’. I got the distinct feeling in this point of my reading that Mensch was flicking through The Big Book of Platitudes: Depression Edition. Mental health problems are not, usually, caused by readily identifiable pathogens. Thus anyone with a mental health problem usually has to jump through several hoops to get a diagnosis, generally right at the point in their lives when hoop-jumping seems like Mission Impossible. No acknowledgement of that from Mensch.
But wait. I’d glazed over and missed something key. According to Mensch there is a gender divide. Depression can affect anyone but ‘women more than men (less testosterone)’. Marvellous. Sex difference, sex differentiation, genetics, endocrinology, the construction of sex difference, culture and gender all boiled down to ‘less testosterone’. So is the best anti-depressant really just a big injection of said hormone? Heck, I’d take that. Shaving twice a day would be preferable to wandering round the house looking for something to overdose on only to realise that all I have are ginseng pills.
What Mensch fails to realise with her glib ‘less testosterone’ is the linkage between loss of self esteem, depression and gender. Women are – and this is a generalisation – more prone to low self esteem. I’m certainly not claiming (or denying) that there are biological reasons for it. Many men suffer from low self esteem, lots of women don’t. Nonetheless, women are more likely to put aside their own needs for those of others. Society expects it of women. We don’t talk about ‘career men’ because we do not expect them to put aside their expectations of a career for family and children. We don’t ask men how they juggle conflicting commitments because we don’t expect them to juggle. We expect men to follow their own path whereas we expect women to change to suit others.
It is this changing, this denying of self, that becomes problematic in depression. It is more difficult to value yourself when you are valued for your selflessness. And if you are starting stop valuing yourself, you are heading towards depression. There are a myriad of cultural reasons for the greater prevalence of depression in women that deserve rather more careful consideration than comments about testosterone. (And that’s before we start on considering any gendered differences in diagnosis).
After that veritable smorgasbord of platitudes, Mensch quotes NHS information about depression. Now this information is good, and I have used it. It does not however present the whole picture. She cites various other studies which show good outcomes for those who are depressed who exercise. And yes, that information is out there. However, there is other information out there which Mensch probably didn’t find because, I suspect, she was looking for confirmation of her views, not contradiction. If you look at the British Medical Journal for 6 June 2012, an article on ‘Exercise to treat depression’ records that ‘most trials included in systematic reviews recruited small numbers of patients, had a short follow-up, and did not adequately conceal randomisation or recruited non-clinical community volunteers (or both). Volunteers are more likely to be motivated to exercise and may be less severely depressed than people identified in clinical settings.’ In other words, the tests on which most of our evidence is based is not without flaws.
Incomplete evidence aside, what Mensch has failed to realise is that most people on Twitter had little issue with the idea that depression can be alleviated by exercise. What she has completely failed to respond to are those people with experience of the illness pointing out to her that sometimes when you are depressed you cannot exercise. It is a symptom of depression.
There are days when trying to get out of bed prompts my body to curl tighter into a foetal ball. Sometimes I can manage to tell it to STFU and get on with life. Sometimes this is completely counterproductive and I’m better off in bed.
And I can physically exercise, I do it a lot and I find it helps, most of the time. However for many, those people Mensch either ignored or belittled as ‘keyboard warriors’, exercise is physically impossible. For others, as was pointed out to her, exercise can trigger relapses into eating disorders or mania.
But no, as far as Mensch is concerned, she is right; because she is backed by science and google scholar. PubMed is actually a better bet when you want something peer-reviewed and accurate; science is not a monolith that is always correct. In fact one of the great things about science is the way that it changes in response to evidence. Buoyed up by something, jogging presumably, Mensch declares that exercise is the best anti-depressant because we really can all do it. Well not all, obviously. She doesn’t include those who cannot exercise because of the nature of their disabilities within her ‘all’. Nice. Lovely to know that Mensch routinely excludes people with certain physical disabilities when she refers to ‘everyone’.
So Mensch’s blog does not, for me, read any better than the original, glib tweet.
People pulled her up on that tweet because for those who have been up close and personal with an illness that kills millions each year, to be told that 3 minutes’ walk around their desk is the best way to alleviate it is insulting. Exercise helps many people but the best anti-depressants are those that help a person to piece themselves together again. The best anti-depressant by its very nature must be tailored for you because it must give you a sense of self worth. Sometimes the only option is medication. For me the best anti-depressant is my horse’s soft whuffling neigh when he greets me. That and his unshakeable, absolute honesty since he doesn’t know how to be anything other than just himself, he has helped lead me back to myself.