Fixing People

In Being Mortal, Atul Gawande tells the story of Bill Thomas, a doctor in a nursing home who comes up with an unusual idea to improve the lifeless atmosphere in the building.  He convinces the nursing home’s director and state authorities to purchase two dogs, four cats, and a hundred birds to keep the residents company.  The animals are at the centre of his plan to help the residents feel more lively and involved in their own lives.  He makes some other changes to the nursing home as well, such as replacing a big lawn on the premises with a vegetable garden that the residents can tend to.  Two years later, these were the results:

[Researchers compared] a variety of measure’s for Chase’s residents with those of residents at another nursing home nearby.  Their study found that the number of prescriptions required per resident fell to half that of the control nursing home.  Psychotropic drugs for agitation, like Haldol, decreased in particular.  The total drug costs fell to just 38 percent of the comparison facility.  Deaths fell 15 percent.

You may be tempted to think that the key takeaways here are the decrease in deaths and the incredible cost savings.  But I think there’s another very important story here.

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I try not to write about myself very much on this site, for a variety of reasons.  In a sense it’s impossible not to write about yourself; after all, I write about what I’m interested in and what I think about topics like what video games are interesting.  I try to keep my personal life more or less out of it, though.  But I can’t write about what I want to write about here without talking about my personal life, so I suppose I will.

I had a lot of problems as a teenager.  I was frequently morose and melancholy.  I had plenty of friends and an active social life, but my friends worried about me.  I was often told, and by a fair number of people, that I should talk to a doctor and get prescribed antidepressants.

I didn’t want to go on antidepressants, though.  I was worried that they would kill my personality.  Whatever problems I had, I was still frequently lively and witty and creative, and I’d heard that antidepressants could suppress those things.

More importantly, I didn’t believe that I was suffering from clinical depression.  I didn’t believe that I had a broken brain that needed doctors to fix it.  I believed that there were specific circumstances in my life causing specific problems, and rectifying those things was what I really needed.  No one would listen to me.

But I was right.

I’m now long-removed from high school.  I’ve never taken antidepressants or any other mood-altering medication.  I’m also an active, fully-functioning, happy adult.  I have a great life that I’m happy to share with the people around me.  And I got there because, very slowly, the things that I was morose and melancholy about got fixed.

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We live in a society where, when things go wrong in someone’s life, we immediately try to figure out how to fix the person.  We believe that’s what’s broken – the person.  We almost never stop to consider an alternate possibility – that people are fine and it’s the environment around them that needs to change.

This should be obvious.  A Gallup poll a few years back found that people living in poverty were twice as likely to suffer from depression as those not living in poverty.  Similarly, being poor is estimated to cause a mental drain equivalent to a 13-point drop in IQ.  We know that poverty – an environmental factor – has enormous impacts on peoples’ brains.  The story of Bill Thomas’s nursing home also helps illustrate how a simple change in environment can have an incredible impact on happiness.  And my own experiences, while hardly scientific, show the same thing.

So often, when things go wrong for people, we tell those people to fix themselves.  To correct whatever they’re doing to cause things to go wrong.  And if they can’t do that, we tell them to go to a doctor and get the doctor to fix them.  Brains are supposed to work in one specific way, we tell people, and if your brain isn’t working that way, you’re broken.  But that’s wrong-headed and cruel.  A lot of these things are social problems.  They require us to stop and examine how things work and why, and to be willing to commit to making the changes that are necessary to help people live happier, more fulfilling lives.

None of this is meant to diminish the problems caused by mental illness or to suggest that all mental illness can be resolved socially.  Some people who escape poverty still suffer from depression.  So did some of the residents of Bill Thomas’s nursing home after it became more lively.  But many of them did not.

We too often act as though our environment is some kind of solid, unchangeable thing that simply exists, whether by fate or the laws of nature.  But it isn’t.  Our social, political, and personal environments are all constructed through our choices, collectively and individually.  The society that exists is the one we make.  We can bring pets into nursing homes.  We can reduce poverty and inequality.  We can listen when our friends tell us that something is wrong and needs to change. We can accept that the brain is not a happiness machine that must be malfunctioning if it’s sad.  We can choose those things, if we care about each other.  And we should.