Psychosocial interventions?BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39360.457743.BE (Published 11 October 2007) Cite this as: BMJ 2007;335:736
- Dave W H Baillie, specialist registrar in adult psychiatry
Given that the serotonin theory of depression has been dismissed as a myth propagated by the drug industry,1 and given the efficacy of psychosocial interventions, I was surprised that Pop considered only a pharmacological approach when treating a depressed gorilla.2
While even the most enthusiastic evangelists of cognitive behaviour therapy might acknowledge the limitations of cognitive restructuring in a gorilla, more pragmatic activity scheduling and behavioural activation both have a good evidence base as stand alone treatments for depression.
Damasio conceptualised emotional experience as being embedded within visceral and musculoskeletal states.3 In depression, reduced efferent activity from the peripheral nervous system can be stimulated by dance movement therapy, another proved treatment for depression.4
Ayurvedic philosophy, and more recently Harrison et al,5 have shown an association between low mood and overcrowding. This could be the case at the zoo, and a letter in support of rehousing, the ubiquitous default intervention of the helpless psychiatrist, might have been useful.
Dian Fossey observed the importance of social hierarchy in gorilla groups, and Pop's patient's withdrawal from the role of alpha male may have precipitated an existential crisis characterised by a failure to negotiate Erikson's final task of development—integrity versus despair. Or in the words of The Jungle Book's King Louie, “I'm (was) the king of the swingers, the jungle VIP I've got to the top and then had to stop and that's what's bothering me.”
Competing interests: None declared.