Depression has a long history dating back to ancient times. It has been treated with everything from exorcism to modern drugs and therapy. Depression is considered to be a serious health disorder, demanding comprehensive treatment and often stigmatizing the person suffering from it. Adopting another stance towards disease and its treatment – trying to find the ways improve the quality of living of the patients with depression, help them to accept the disorder and, subsequently, find a personal way to cope with it (also with the help of technology) – opens up for the other ways of understanding and treating the disorder.
Understanding of depression through the history
Affective disorders and specifically depression is slowly but steadily becoming one of the highest-ranking cause of disease in the western world. Nowadays, depression is recognized as a real illness, but it was not always this way. Depression was not even called “depression”, but “melancholia.” The earliest accounts of melancholia can be traced to Mesopotamian texts. Back at the time, it was understood as demon possession and required spiritual healers rather than ‘common physicians’. The early Babylonian, Chinese, and Egyptian civilizations also shared the same explanation of the condition and suggested beatings and starvation in order to exile demon from the patient’s body. Ancient Roman and Greeks, had a drastically different opinion, more progressive one, considering depression a biological and psychological disease. In opposition to the radical treatments mentioned above, they believed that music, massage, baths and gymnastics are beneficial for those suffering from melancholia. Shortly before the fall of Roman Empire and during the Middle ages, mental illnesses including depression were again considered as devil possessions. Treatment included exorcism (as well as burning and drowning in the most severe cases). Only in 1621, Roberto Burton discussed psychological and social causes of depression (poverty, fear, loneliness) and recommended his patients to use diet, exercises, herbal medicine, travelling and music therapy as a remedy. The industrial age, brought the heavy machinery into manufacture and corresponding philosophy into the healthcare: doctors saw melancholia as a malfunction of a human machine: faulty hydraulics (blood flow) or insufficient elasticity of human fibers. Thus, such methods as drowning, vomiting, electroshocking were considered beneficial. The early 20th century introduced Freud’s psychoanalytical approach: melancholia was seen as a response to a loss, real or symbolic. Freud believed that psychoanalysis may help the patients to resolve the unconscious conflicts, while the other doctors of his time used more “conservative” methods, such as electroconvulsive therapy and lobotomy, still seeing depression as a brain disorder.
Depression in modern society
In present, depression is considered to arise from a combination of biological, psychological and social factors, with physio therapy and neurotransmitter medication being a preferred form of medical treatment. Depression is widely recognized as a common and serious medical illness. Besides obvious advantages of this acknowledgement, such as the opportunity for the patients to receive proper medical treatment, sick leaves and simple compassion from the others, such a paradigm has certain drawbacks. Effective drug treatment of depression started in 1957 and remains the most popular approach to date. Despite the fact that 30 to 50 percent of the patients do not show a response when given a particular antidepressant, and the therapeutic effect ends with the end of the drug prescription and 65 to 80 percent of people taking antidepressants still suffer from depression within one year. In several cultures, depression still remains a stigma. Even to date, in several languages – Thai, Nigerian or Indian – there exist no word for depression. Depression can be seen as burden by the patients themselves, forcing them to conceal the symptoms from family and friends. It is not infrequent that depression is being confused with other health disorders. According to the Diagnostic and Statistical Manual developed for American psychiatrists in 1970s, depression and grief had identical symptoms and could only be distinguished from one another based on the duration of the disorder and presence/lack of physical loss. But what about losing a job and mourning for a loved one longer then than it was suggested? The manual didn’t have an answer…
Development of psychotherapy, brought the world a wide array of intervention practices, with cognitive behavioural therapy (CBT) being the most popular and effective one. Roughly speaking, CBT helps patients to restructure negative and irrational beliefs into positive and rational ones. Despite the seeming simplicity, the method is not free from some serious shortcomings. The approach is being criticized for being too mechanistic, for a lack of a strong link to cognitive psychology and neuroscience, as well as for relatively high dropout rate. Even more, according to the recent studies, CBT became half as effective in treating depression as it used to be in 1977. Among the possible reasons is wearing of the placebo effect – patients’ belief in the method as a novel “miracle cure.”
But is there really a solution to the depression? Facing the truth, with all the advancements in pharmacology, physio therapy and psychotherapy, we are still not that far in our methods and general understanding of depression from medieval quacks with their exorcism methods.
Technology has the answer…. or it thinks it does?
Technology has a long history of assisting healthcare and helped to find solutions for a broad range of health problems. One would assume that the same applies to depression. Well, this assumption is debatable.
Researchers started to use technology to assist in depression treatment long before the computerization of the society. In 1930s electroconvulsive therapy (ECT) found its way into psychiatry. The method implies inducing seizures in the patients by applying certain amount of electric current to the brain. The method can be potentially dangerous and is generally used in the most severe cases of depression. Currently, ECT is being replaced with more sophisticated and less invasive methods for example transcranial magnetic stimulation (TMS), vagus nerve simulation (VNS) and cranial electrotherapy stimulation (CES). The methods are still considered experimental and their effectiveness is yet to be tested.
Information technology has a strong record of providing healthcare with diagnostic applications for various illnesses, and depression is not an exception. There exist a wide array of solutions capable of recognizing, predicting, analysing depression. What is missing now are the application more focused on actuation rather than sensing. Simply put, we are already very efficient in detecting depressive states in patients, but not so good in helping them out. Besides that, the field of modern information technology is dominated by the vision, which can be characterized by the term “solutionism” meaning that with a proper algorithm, a proper code a technological solution can be found to any world problem. Such vision eliminates other possibilities for improving life, considering them inefficient. Such an approach can hardly be applied when designing for people suffering from depression due to the complexity and variability of this health disorder and all the above mentioned issues of currently acknowledged ways of medical treatment. Nevertheless, there exist a number of projects trying, for example, to digitize CBT techniques and confine them into the mobile device.
It can be challenging and time-consuming to understand the true causes of depression in a particular case and find the therapy suitable for a particular patient, but what can rather be done is helping the people to accept the fact that something is wrong with their mind and body, develop empathy for themselves and help them to improve the quality of life. There are projects that view depression in a broader scope, providing every-day aid without a fixed end result, in opposition to the orthodox treatment. Such projects as Soma Mat and Breathing Light strive to re-activate the bodies of the patients via playfully engaging with the movements using such modalities as light and heat, not demanding physical activity or regular, but not promising any “miraculous recovery” in return. People who tried these prototypes reported a feeling of relaxation and relief, which is a good start.
Taking the best practices and insights from the similar projects may set a nice trend in contemporary depression treatment, bring new knowledge and, hopefully, more efficient methods for curing. All in all, the first step can be treating those depressed and anxious, not as machines with broken and malfunctioning parts, but just as normal human beings with unmet needs.
About the author
Pavel Karpashevich is an Early Stage Researcher of AffecTech project. Pavel’s focus is developing interactive systems for users suffering from affective disorders with a focus on family interaction, allowing them to physically, bodily create digital expressions together.
AffecTech is established with support from the Marie Skłodowska-Curie Innovative Training Network funded by European Commission H2020. The AffecTech network brings together institutions from across Europe including Lancaster University in the UK, and the Royal Institute of Technology (KTH), Sweden.
1. David Boles. 2008. No Word for Depression. David Boles, Blogs. Retrieved January 11, 2018 from https://bolesblogs.com/2008/10/14/no-word-for-depression/
2. Brett and Kate McKay. 2015. The History of Depression. The Art of Manliness. Retrieved January 11, 2018 from https://www.artofmanliness.com/2015/03/16/the-history-of-depression/
3. Oliver Burkeman. 2015. Why CBT is falling out of favour. the Guardian. Retrieved January 15, 2018 from http://www.theguardian.com/lifeandstyle/2015/jul/03/why-cbt-is-falling-out-of-favour-oliver-burkeman
4. Oliver Burkeman. 2016. Therapy wars: the revenge of Freud | Oliver Burkeman. the Guardian. Retrieved January 15, 2018 from http://www.theguardian.com/science/2016/jan/07/therapy-wars-revenge-of-freud-cognitive-behavioural-therapy
5. Hanshu Cai, Ziyang Wang, Yanhao Zhang, Yunfei Chen, and Bin Hu. 2017. A Virtual-Reality Based Neurofeedback Game Framework for Depression Rehabilitation Using Pervasive Three-Electrode EEG Collector. In Proceedings of the 12th Chinese Conference on Computer Supported Cooperative Work and Social Computing (ChineseCSCW ’17), 173–176. https://doi.org/10.1145/3127404.3127433
6. Filipe Fernandes, Luís Duarte, and Luís Carriço. 2013. DETACH: Authoring Digital Therapeutic Artefacts. In Proceedings of the 7th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth ’13), 268–269. https://doi.org/10.4108/icst.pervasivehealth.2013.252062
7. Gabriele Ferri, Wouter Sluis-Thiescheffer, Dries Booten, and Ben Schouten. 2016. Playful Cognitive Behavioral Therapy Apps: Design Concepts and Tactics for Engaging Young Patients. In Proceedings of the The 15th International Conference on Interaction Design and Children (IDC ’16), 486–498. https://doi.org/10.1145/2930674.2930698
8. Brandon A. Gaudiano. 2008. Cognitive-Behavioral Therapies: Achievements and Challenges. Evidence-based mental health 11, 1: 5–7. https://doi.org/10.1136/ebmh.11.1.5
9. Johann Hari. 2018. Is everything you think you know about depression wrong? The Observer. Retrieved January 11, 2018 from http://www.theguardian.com/society/2018/jan/07/is-everything-you-think-you-know-about-depression-wrong-johann-hari-lost-connections
10. Asim Jan, Hongying Meng, Yona Falinie A. Gaus, Fan Zhang, and Saeed Turabzadeh. 2014. Automatic Depression Scale Prediction Using Facial Expression Dynamics and Regression. In Proceedings of the 4th International Workshop on Audio/Visual Emotion Challenge (AVEC ’14), 73–80. https://doi.org/10.1145/2661806.2661812
11. Martin Livingston. 2008. Treatment options in depression: past, present and future. Prescriber 19, 5: 9–10. https://doi.org/10.1002/psb.200
12. Evgeny Morozov. 2013. To Save Everything, Click Here: The Folly of Technological Solutionism. PublicAffairs.
13. National Institute of Mental Health. 2015. Depression: What You Need to Know. Retrieved January 10, 2018 from /nimh/nimh/product/Depression-What-You-Need-to-Know/NIH 15-3561
14. Rashmi Nemade and Kathryn Patricelli. 2016. Historical Understandings of Depression – Depression: Depression & Related Conditions. Menthal Health Care dba Gracepoint. Retrieved January 10, 2018 from https://www.gracepointwellness.org/5-depression-depression-related-conditions/article/12995-historical-understandings-of-depression
15. Rashmi Nemade, Natalie Staats Reis, and Mark Dombeck. Historical Understandings of Depression. Retrieved January 10, 2018 from https://www.mentalhelp.net/articles/historical-understandings-of-depression/
16. Ranna Parekh. 2017. What Is Depression? American Psychiatric Association. Retrieved January 10, 2018 from https://www.psychiatry.org/patients-families/depression/what-is-depression
17. Humberto Pérez Espinosa, Hugo Jair Escalante, Luis Villaseñor-Pineda, Manuel Montes-y-Gómez, David Pinto-Avedaño, and Veronica Reyez-Meza. 2014. Fusing Affective Dimensions and Audio-Visual Features from Segmented Video for Depression Recognition: INAOE-BUAP’s Participation at AVEC’14 Challenge. In Proceedings of the 4th International Workshop on Audio/Visual Emotion Challenge (AVEC ’14), 49–55. https://doi.org/10.1145/2661806.2661815
18. Nancy Schimelpfening and Steven Gans. 2017. The History of Depression. Accounts, treatments, and beliefs through the ages. Verywell. Retrieved January 10, 2018 from https://www.verywell.com/who-discovered-depression-1066770
19. Anna Ståhl, Martin Jonsson, Johanna Mercurio, Anna Karlsson, Kristina Höök, and Eva-Carin Banka Johnson. 2016. The Soma Mat and Breathing Light. In Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA ’16), 305–308. https://doi.org/10.1145/2851581.2889464
20. Nikhita Vedula and Srinivasan Parthasarathy. 2017. Emotional and Linguistic Cues of Depression from Social Media. In Proceedings of the 2017 International Conference on Digital Health (DH ’17), 127–136. https://doi.org/10.1145/3079452.3079465
21. 2016. Brain Stimulation Therapies. National Institute of Mental Health. Retrieved January 15, 2018 from https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml
22. Four Drawbacks of Cognitive Therapy. Psychology Today. Retrieved January 15, 2018 from http://www.psychologytoday.com/blog/the-justice-and-responsibility-league/200903/four-drawbacks-cognitive-therapy
23. Using Technology for Alternative Treatments. Depression and Bipolar Support Alliance. Retrieved January 12, 2018 from http://www.dbsalliance.org/site/PageServer?pagename=wellness_depression_emerging_technologies