Depressed? Go and clean the kitchen

Anne Garvey on a radical self-help approach
Anne Garvey
Tue 4 May 2004 17.25 CEST

    Five years ago, Dr Clive Sherlock came face to face with a runaway patient. She had escaped from a psychiatric hospital minutes before she was about to be sectioned under the Mental Health Act. “She was in a sad state,” he explains. “Her husband and son had died within a year and she had a history of depression and anxiety. No one was doing anything for her.” Under his care, she recovered enough to live a normal life. He is quite sure that, had she been sectioned that day, she would still be a mental health invalid.

    As a psychiatrist in the NHS and through research at Oxford and Cambridge, Sherlock has confronted the triad of mental health problems: anxiety, depression and stress. It’s hard to overstate the damage that this threesome do. The bill in lost working days was reckoned at £4bn last year. Add that to an eerily similar figure paid out by the NHS for prescription drugs and you have a crisis.

    So how are we dealing with this pandemic? “Poorly,” says Sherlock. “The problem is spreading and the only line of defence – drugs – is failing. As psychiatrists we have only the haziest idea of how they work. For 20 years I watched, and used myself of course, the hit and miss ‘Try that, then try something else’, which is the profession’s stock in trade.”

    His proposed solution is something he calls the Adaptation Practice, and it’s a deceptively simple approach. At the heart of the practice is the need to keep to a routine (of the patient’s own making); they are urged to put as much effort as possible into whatever they are doing. The aim is to get the patient so absorbed in what they are doing that they are not so caught up in worrying thoughts. Only then, says Sherlock, can someone start to pay attention to the emotions within them. Familiarity with those emotions removes our fear of them and so they no longer have such a strong hold on us.

    “Feelings control what we think, say and do. I always ask my patients if there is something they would like me to know about their past, but my emphasis is on the present. The practice promotes doing, not thinking.

    “Patients agree with me a programme for themselves. They empty their bins. They choose a time to get up, regular mealtimes – anyone with eating disorders agrees to sit at a table for a quarter of an hour and to keep to that timetable.

    “If someone says they’ll get up at 10, but don’t make it until 10.20, that’s all right. What isn’t OK is to give up on the programme. One woman told me she was fed up with the practice. ‘I don’t want to do all this,’ she announced. ‘Can’t I just talk to you about myself?’ I explained that any number of psychiatrists would be happy to hear her talk about herself, but Adaptation Practice meant that she did something. It is sometimes a shock when people realise that it is only they who can do something.”

    Emily, a 23-year-old Cambridge graduate, is one of those whose lives have been turned around by Sherlock. After starting at university, her GP put her on antidepressants, including Seroxat, culminating in a three-week stay in a psychiatric hospital. “When I went home I just wandered about, taking Valium and falling asleep in parks. The defining weekend came when I went to see Clive. I had said to myself, ‘If this doesn’t work, I shall kill myself.’ He was sympathetic but not indulgent. He convinced me that I did have a choice and that the solution lay with me and no one else.

    “I came home and started cleaning the kitchen until I was exhausted. I noticed that I felt a tiny bit better. The amazing thought occurred to me: ‘Maybe I can deal with it on my own and I don’t need antidepressants.’ I stopped thinking about things. That was incredibly hard. Every other counsellor and psychiatrist I have known has wanted to wrap me in a duvet of protection. Even the mental hospital, the asylum, is a place away from your problems. Clive’s idea is the opposite. But he lets you know that you have the power to make it different. I found that very hard. Here was I, someone who was ill, and he was saying that getting better was my responsibility.”

    Emma, in her early 30s, was working in the City when she was prescribed antidepressants for the first time. She took them for years before attending one of Sherlock’s residential weekends. Thanks to Sherlock’s practice, she has trained herself to stay in the moment and not let critical thoughts take over. “Most of us are convinced that there is something to be gained by constantly churning things around in our heads. The practice shows you how to let go of this barrage of what Clive calls ‘persistent, worrying thoughts’. It’s not that you don’t think. But you also live, and be and do what you are doing. You do not allow this constant critical evaluation to run its insistent tape in your head all the time.

    “I now live independently without benefits, without drugs. I don’t feel that life should be always wonderful. It is often a great struggle. But I have got a framework, some pattern to work to and I am succeeding.”