Something New

We feature each fortnight Nicholas Reid's reviews and comments on new and recent books. 

“OLD BLACK CLOUD” by Jacqueline Leckie (Massey University Press, $NZ 49:99)

 

            Jacqueline Leckie’s Old Black Cloud deals with mental depression, but it is not a manual telling us how to deal with mental depression or what therapies should be consulted by the afflicted . Rather it is what the sub-title says it is: “A cultural history of mental depression in Aotearoa New Zealand”. Old Black Cloud covers attitudes towards mental depression and attempted remedies that were used or tried in New Zealand from the earliest nineteenth century to the present time.

            Her Introduction strikes a personal note. In the 1990s, mental depression was widely believed to be caused by a chemical imbalance in the brain. But  Jacqueline Leckie records pain and depression brought into her family, not by chemical imbalance in the brain but by the death of her mother. She was advised to take Prozac, which she did, but more depression fell on her when she was made redundant from her university position. The clear point is that mental depression can be triggered in many ways, not least by external circumstances. There is now a backlash against the medicalisation of mental depression.  As she works her way through the history of mental depression in New Zealand, Leckie cites many documented cases of severe depression, using the names of real sufferers only from the nineteenth and very early twentieth centuries. Thereafter, for privacy reasons, cases are given pseudonyms with the exception of creative people whose travails are well known.

 

Her first task (Chapter 1) is to define what exactly mental depression is and how it is named. First taking the obvious route of separating mental depression from economic depression, she considers the older term melancholia which, by the mid-19^th century, had come to mean severe mental conditions, such as mania. She quotes Janet Oppenheim’s statement which emphasised the similarities comparing melancholia and depression: “Nervous breakdown, a popular name for incapacitating depression, is not a specific disease that can be traced to a single cause. It is an abstract concept, encompassing many symptoms that vary from one patient to another, with invariably devastating effect. The characteristic sense of overwhelming hopelessness, emptiness, impotence, and uselessness, the incapacity to focus attention or reach decisions, the obsessive thoughts and fears, the diminished self-esteem, the extreme lethargy, and the inability to take interest or pleasure in any aspect of life make existence scarcely tolerable.” (Chap. 1, p.22) The term “manic-depressive insanity” was devised in the 1880s. In New Zealand, a “neuro-pathological” laboratory was set up in Dunedin’s hospital – but it was only in 1953 that a trained psychiatrist was appointed in Dunedin’s hospital. And in Auckland it was only when the Auckland Medical School was set up in 1968 that a psychiatrist was brought into an Auckland hospital. Of course there had been “Mental Hospitals” in New Zealand before that – more concerned with care that cure – and in the late 19^th century there were many discussions about melancholia which was often called “neurasthenia”. Some spoke of “involuntary melancholia” referring to women’s “climacteric” [what we would now call menopause]. Gradually the term “melancholia” was phased out as “depression” took over – although “melancholia” was still used in references to delusions, fantasy etc. sometimes masking what we would now call schizophrenia. In the late 19^th – early 20^th centuries, many doctors understood main causes of depression as alcohol, masturbation and post-natal depression. Since then, of course, there have been many attempts to describe what exactly mental depression is. Jacqueline Leckie quotes one academic description from the 1990s which goes thus: “A major depressive disorder entailed an individual: (1) experiencing at least one or two of the following symptoms during a two-week period – a depressed mood most of the day nearly every day, and a marked loss of interest in all or most usual activities; and (2) having at least four symptoms every day or most days – a change from previous functioning significant weight loss or gain, insomnia or oversleeping, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive/ inappropriate guilt, diminished ability to think or concentrate, or indecisiveness, recurrent thoughts of death or suicidal, recurrent thought of death or suicidal thought/actions.”   (Chap. 1, p.46) While this gives a reasonable description of depression, it is now regarded as inadequate for not considering cultural nuances - the differences between different ethnicities.

Having given descriptions of mental depression, Leckie than turns to specific types of mental depression in New Zealand starting, under the heading “Rawakiwaki” (in Chapter 2), with mental depression among Maori in the 19^th  century. A healer like Waata Pihikete Kukutai understood Pakeha medicine, but tried to persuade Pakeha doctors that not all Pakeha remedies would really help Maori. He was ignored. In his own healing he often used traditional remedies. Leckie notes that while Maori could be broken in spirit by Makutu (a curse), and some chose Whakamomori (suicide) as a remedy, the real depression that plagued Maori was loss of land [confiscated by the government], isolation from others, the death of forebears and alienation from their iwi. The hard fact was that their world had become alien to them. Bringing this issue to the present age, Leckie notes: “International Indigenous literature refers to ‘cultural depression’, which is sometimes described as ‘trying to live in two worlds and fitting into neither.’ ” (Chap. 2, p.64) This was the Maori experience that has persisted. Even now, Maori men are unlikely to ask for help over mental issues.

And what of Pakeha in the 19^th century? (Chapter 3) British immigrants were wrenched from their homeland. “Despondency could set in during the endless weeks at sea, when there was plenty of time for the reality of having severed ties from kin, community and familiar places and activities to hit home. Monotony and the close confines of shipboard life, especially in the dark and stuffy steerage, might alone induce depression.” (Chap. 3, p.81). Often settlers found that New Zealand was a country with comparatively few people and hence many were settled in remote places, leading to a lack of friends and companionship. The result was often deep depression. Furthermore, for most of the 19^th century there was an imbalance of the sexes - three men to two women. It has been determined that single men were more likely than any other adults to be committed to mental asylums. Leckie cites a number of specific cases, but one stands out. The great naturalist Richard Treacy Henry, who was often solitary and alone in the forests in his attempts to protect native birds, was driven to depression by the difficulty of protecting birds (often flightless) from mustelids. He died in a psychiatric hospital. Being stuck in the bush without friends and in primitive quarters could often lead to suicide. As for women, some were terrified into depression my Maori incursions. Others were fighting “puerperal melancholia”, menstruation, miscarriage and menopause.

Leckie calls her 4^th chapter “Enduring darkness” because she is here dealing with particular long-term depression. She notes: “Much has been written about New Zealand soldiers suffering shell shock and neurasthenia during the First World War, but the long-term impact of war on combatants and their families deserves further recognition. Depression was not a common diagnosis for war veterans, but rather was subsumed as a symptom within shell shock, neurasthenia, combat or war neurosis; contemporary terms for this include post-traumatic stress disorder (PTSD) and combat stress reaction.”   (Chap. 4, p.110). After the First World War, New Zealand soldiers who were mentally affected by the war were at first not a major priority. But by the mid-1920s there was a more thoughtful approach and some genuine psychological help was offered. Even so, there were a number of suicides – and these were not all directly caused by the war. Some ex-soldiers were given the opportunity to farm, but a number despaired when hard experience told them they didn’t have the necessary skill to be farmers. Some committed suicide. And naturally unhappy men often killed themselves via booze. By the time of the Second World War, psychiatry was more advanced and more available. – but it is clear that many men still required family as their nearest support and aid. Many men became taciturn, said little about the war and bottled themselves up, conforming to the stereotype of the stoic Kiwi bloke. And some became suicides. There were a number of cases of women committing suicide when they were separated from their husbands who had gone to war.

A chapter called “Living with, and denying, the dark cloud” deals with creative people in New Zealand who have had to endure long spells of depression – the married couple Meg and Alistair Campbell, both of whom were poets and both of whom spent time in psychiatric wards; the stage-person Edith Campion; the novelist “Robin Hyde” (Iris Wilkinson); the painter Rita Angus; and the novelist James Courage, whose depression [in the 1940s and 1950s] was triggered by social disapproval of his homosexuality. An academic Ivan Lorin George Sutherland, was basically so undermined by the pressure of his work that he committed suicide. Jacqueline Leckie carefully notes: “…while some lives, such as Robin Hyde’s, are cut short, many people live long lives through which their depression is either intermittent or persistent. Depression does not necessarily lead to suicide, and nor does it mean unremitting sadness and apathy. People living under the black cloud can be creative, busy and caring, but their lives can also be mundane, or taken up with the daily business and crises of survival. Some come to terms with their depression, perhaps through personal insight, the support of loved ones, or with [various treatments]” (Chap. 5, pp.157-158)

Then, in Chapter 6, “Depression, ethnicity and culture”, we come back to the question of how different ethnicities should be treated when it comes to depression and other mental disorders. Leckie looks back to the Chinese who came to New Zealand in the 19^th century, reminding us that Chinese were not only burdened by being separated from families and often lacking Chinese company but they also had to pay a heavy poll tax which drained their resources. They were shamed when they could not send money back to China. Here was another recipe for depression. Leckie considers the habitual way doctors in the 19^th century reacted to people of different ethnicities thus: “Many colonial doctors under-diagnosed depression in patients who did not come from a similar cultural and linguistic background to themselves. In Aotearoa many doctors looked for identical symptoms to those found in British patients. Doctors could be culture-blind or hold preconceptions about the propensity of other cultures to exhibit specific mental disorders. For example, doctors in African colonies under-diagnosed melancholia and considered depression to be rare among Indigenous patients. This bias carried to the United States, where Black Americans were more likely to be under-diagnosed with depression and over-diagnosed with schizophrenia.”    (Chap. 6, p.164) Leckie also reminds us that in New Zealand now it is erroneous to treat “Pasifika” as one people. The term “Pasifika” covers many and varied Pacific peoples, speaking different languages, having different beliefs, honouring different customs. Therefore, in New Zealand, there should be available in hospitals the languages as spoken by patients, and especially when it comes to psychiatric matters.

However, over the last two centuries, there have inevitably been major road-blocks to the treatment of mental depression. Leckie calls her last chapter “Quacks, shocks and drugs”, examining many treatments and therapies that turned out to be of little or no help to the afflicted, or which turned out to be sheer charlatanism. In the late 19^th and early 20^th centuries, there was an explosion of patent medicines claiming to cure all ailments, including melancholia and depression. They were of no real use. Some drugs that were used turned out to be addictive, worsening the afflicted. It took a long time before such quackery was driven out. As the decades went by, it became more ordinary for the depressed to be out-patients rather than being trapped in a hospital. De-institution-ism became the norm. But “only a minority of psychiatrists and psychologists were drawn to treatment through talking; physical and pharmaceutical treatments for depression remained dominant during the twentieth century.”  (Chap. 7, p.200). Well into the 20^th century there were remedies that are now widely regarded as unnecessary or even barbarous. In the 1940s and 1950s lobotomy (also called leucotomy) was often called for, but gradually it was regarded with scepticism. Then there was convulsive therapy, shock therapy and electric shock therapy. “As late as 1982, Professor Basil James, director general of mental health, was recommending ECT as an effective treatment in severe depressive illness, especially the ‘endogenous type’ (supposedly when depression was genetic, biological or had a physiological basis). In 1985 a former trainee nurse at Sunnyside recalled that it was standard practice for patients to be administered ECT. After ‘several bouts’,  ECT could lead to disorientation and a marked loss of their previous personality; ‘severe loss of affect and appeared to be a zombie… They seemed like shells where people used to live but lived no longer.’  ‘Loss of affect’ is a common phrase in mental health discourse, usually referring to an inability to express emotion or empathy.” (Chap. 7, p.214) There were abusive uses of ECT. Recent research confirms that at Lake Alice Hospital, which is now closed,  ECT was often used as a form of punishment. [NB ECT is still used, but now in a very limited way.] Another dangerous therapy was narcoanalysis, which appears to have been mainly used to keep patients asleep. Only in the 1960s did “anti-depressive” drugs became available, although they too have their shortcomings.

In her Epilogue, Jacqueline Leckie notes that there are now campaigns to make New Zealanders aware of mental heath and to accept that depression is no longer to be seen as a matter of shame. But “Nationwide advocacy and awareness of mental health and depression in Aotearoa emerged during the 1980s, when mental distress among women, Maori, youth and those living in poverty became more evident. As neoliberal economic and social policies and practices were introduced, and the fallout set in, suicide rates increased. According to the historian John Weaver, during the years 1976-1998 suicide rates rose from 10 to 14 within 100,000 and the youth suicide was unprecedented.”  (Epilogue, p.226) There are still some barriers to mental health, especially poverty which deters people from seeking help; the limited use by therapists of non-English languages which would be used for Maori, Asian, Indian, and “Pasifika” people; and consideration of cultural diversity. Mental depression will always be with us, but our awareness of it is now expanded and there are ways of – humanely – combating the plague.

Of course Old Black Cloud is not only a work of history, but it is also a work of advocacy. Jacqueline Leckie writes clearly, explains well and does not alienate us with an overload of recherche words. This is the sort of book that enriches this country.