During the Eighties, a young GP called Sam Everington was working in a deprived part of East London.
Many of his patients suffered from depression, so he applied the knowledge he’d acquired at medical school — that depression was the result of a chemical imbalance in the brain that could be alleviated by medication.
However, Dr Everington soon realised that the drugs weren’t working: few of his patients showed much improvement.
He thought long and hard about this, and came to the conclusion that depression is far more complex than the medical model allows for. It’s not just a biological phenomenon, it’s social, too. It’s no good dishing out tablets if patients are disconnected from the world and feel unsupported. We are, after all, social animals.
It’s true that there are patients who, despite everything going fantastically well in their lives, can suddenly be struck down with depression for absolutely no discernible reason (stock image)
Depression, Dr Everington decided, was just as much a societal problem as it was a blip in someone’s brain chemistry.
So he embarked on a fascinating experiment. He took over a piece of scrubland near his surgery and started ‘prescribing’ gardening to depressed patients.
Over several months, patients worked on the land, preparing it for planting, watering and weeding it, spending hours outdoors engaged in physical activity.
Then, as the flowers came into bloom, they saw all their efforts had paid off. Passers-by commented on the garden’s beauty and charm.
What perhaps was even more beautiful is what the garden had done for the patients.
As they tended the plot, they talked — initially about the garden and what they were doing, but later about themselves, sharing details of their lives, their problems and challenges.
Over time they became friends, finding common interests and providing the support, understanding and care for one another that, for a variety of reasons, they had previously lacked.
This week, I read how a GP surgery in Dursley, Gloucester, has started something similar, ‘prescribing’ allotments to depressed, stressed and lonely patients, and to those with joint and mobility issues.
It made me think of Dr Everington’s experiment all those years ago, and I wondered why it has taken so long for the benefits of such ventures to filter down.
Today, Sam Everington — or Sir Sam, as he is now — is a highly regarded GP in East London. He continues to be one of the main proponents of ‘social prescribing’ — of which, thankfully, the health service is increasingly in favour.
Sir Sam’s experiment has long struck a chord with me because I’ve always regarded the biological explanation for depression as rather simplistic. It doesn’t fit with what I observe in my clinic.
It’s true that there are patients who, despite everything going fantastically well in their lives, can suddenly be struck down with depression for absolutely no discernible reason. Some sort of chemical imbalance seems to be the problem in this group.
But for many, many others, their depression is clearly rooted in social factors. They may, for one reason or another, be disconnected from family members and friends, live in poverty, or have had a troublesome upbringing which impacted on their ability to form relationships.
They are also often in profound emotional pain — and the only real salve for all this is support from another individual.
Social prescribing should inform how we tackle all mental health problems — an acknowledgment of the complex interaction between biological, social and psychological factors.
But the real lesson from Sir Sam’s experiment is that it’s no good just sending people out with a trowel and a packet of seeds. Such initiatives need to be carefully managed, especially in the early days when the dark cloud of depression still hangs over patients and everything they do.
Social prescribing is about ensuring there’s a system in place to support patients as they get better.
