Talking it through: Zimbabwean children who have lost their parents to Aids at a trauma counselling course in the school holidays, 2004. (Photo: Getty)
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Talking cure: Vikram Patel on The Life Scientific

Jim Al-Khalili spoke to the leading psychiatrist about treating depression in Zimbabwe, yet had to shoehorn in some clunky biographical details.

The Life Scientific
Radio 4

In The Life Scientific (Tuesdays, 9am), presenter Jim Al-Khalili talked to the pioneering psychiatrist Vikram Patel about the kinds of depression and psychosis suffered in developing countries compared to those in the west. Patel contends that they are the same. He estimates that 10 per cent of the global population – whether they live in a tin hut or a waterfront condo – will suffer from depression at some point and might benefit from the talking cure or medical intervention.

Of the 150,000 psychiatrists potentially needed in India (population 1.2 billion), only 4,000 are currently employed there. When Patel went to Zimbabwe, there were nine psychiatrists for ten million people. He trained local lay counsellors, encouraging them to work alongside traditional faith healers, who recognised depression as a form of distress called “thinking too much”. Was Patel just pushing the medicalisation of an already pragmatically accepted social condition? It didn’t sound like it. He said the same thing in a hundred different ways: “No matter where you are, depression responds to the same treatment.”

Given the potency of the subject, it was perhaps no surprise that each inquiry from Al-Khalili was overstuffed. It’s a Radio 4 idiom – the information-packed phrase posing as a question. Kirsty Young has to do it all the time on Desert Island Discs, sometimes condensing her guest’s crises in not one but several marriages into the few seconds leading up to asking about the fourth choice of song, while trying to sound not remotely engulfed by the biographical maelstrom.

At least she seems to do it when her subject is in the same room. When Al-Khalili abruptly announced, “Then you came over to study in Oxford as a Rhodes scholar, Vikram Patel, after which you spent several years in London training in psychiatry, but in the summer of 1993, you boarded a flight from Heathrow bound for Harare in Zimbabwe; what drew you there?” it sounded like the whole thing had been plopped-in later – by the producer, perhaps even pretending to be Jim in the edit. It was one of a few jagged moments that sent an ex­ceptional conversation into the realms of the abstract.

Antonia Quirke is an author and journalist. She is a presenter on The Film Programme and Pick of the Week (Radio 4) and Film 2015 and The One Show (BBC 1). She writes a column on radio for the New Statesman.

This article first appeared in the 12 March 2014 issue of the New Statesman, 4 years of austerity

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Out like a light: why bad sleep poses a danger to us all

Our species has declared war on the night and sleep has been the victim.

At 4.02am on 2 November 1892, near Thirsk railway station in Yorkshire, an express train crashed into a goods train. Ten people were killed and 39 injured. Nearly a century later, at 1.23am on 26 April 1986, the No 4 reactor at the Chernobyl nuclear power plant exploded, killing two people instantly and causing multiple deaths from radiation. To see how these seemingly unrelated tragedies are connected requires that we understand biological time.

Our lives are ruled by time, but the alarms that drive us out of bed in the morning or tell us that we are late for a meeting are recently adopted chronometers. Life answers to a more ancient beat, which probably started to tick early in the evolutionary process. Embedded in our genes are the instructions for a biological or “circadian” clock that regulates our sleep patterns, alertness, mood, physical strength, blood pressure, and more.

Normally, we experience a 24-hour pattern of light and dark and this aligns our day to the Earth’s rotation. The clock is then used to anticipate this rotation and fine-tune physiology and behaviour before these conditions change. Temperature, blood pressure and cognitive performance all decline as you wind down to sleep. Before dawn, these processes are slowly reversed in anticipation of the new day.

The daily sleep cycle is the most obvious of these rhythms. While asleep, we don’t eat, drink, make money or have sex, so we have relegated the sleep state to a lowly position on our list of priorities. At best, we tolerate it; at worst, we regard it as an illness in need of a cure. Such attitudes are not only wrong, but dangerous.

Though sleep may involve the suspension of most physical activity, the brain is consolidating memories and solving problems; it co-ordinates the removal of toxins; promotes cell division and tissue repair; and rebuilds metabolic pathways. In short, without sleep, our performance and health deteriorate rapidly.

Our species has declared war on the night and sleep has been the victim. The unintended consequences of cheap electric light are twofold. More light at night, together with forms of entertainment including social media, have eroded our sleep time by as much as two hours every night. On top of this, many of us are trying to sleep at the wrong time. Those with night shifts work when they are sleepy and try to sleep when they are not. The body clock fails to adjust and remains synchronised to the natural light/dark cycle.

Shortened sleep and working against biological time have been linked with many health problems. These include lapses in attention and uncontrollable micro-sleeps; impulsiveness and loss of empathy; memory impairment and reduced creativity; immune suppression; higher risks of Type 2 diabetes, infection, cancer and cardiovascular disease; weight gain; and a susceptibility to depression, anxiety and mood instability.

In our quest for instant gratification, it is unlikely that we will stop doing what we like when we like. However, understanding the consequences of bad sleep will help us to reprioritise sleep. Perhaps, one day, the self-inflicted tired will be viewed with the same contempt as that for smokers huddled outside a building. Employers need to recognise that employees with disrupted sleep will be less productive. Why not introduce more health checks and offer advice to those at risk? As night-shift workers are more likely to have heart disease and Type 2 diabetes and to be obese, firms could provide food that reduces these risks. Finally, technology could be used to alert an individual that they are falling asleep both in the workplace and during the drive home.

So, what happened at Thirsk railway station in 1892 and Chernobyl in 1986? These disasters and others like them were linked to excessive tiredness, people working at the wrong biological time and a breakdown in procedure. James Holmes was the signalman at Thirsk. The day before the crash, he had been awake for 36 hours, caring for his daughter, trying to find a doctor and looking after his grief-stricken wife when the baby died. He reported to the stationmaster that he would be unable to work the next night, but no replacement was sent and he was forced to do his shift. He fell asleep, and he had forgotten that the goods train was on the line when he allowed the express through.

After the crash, Holmes was found guilty of manslaughter but given an absolute discharge. The railway company was blamed for ignoring him, and for failing to use procedures which would have detected that he had fallen asleep.

Russell Foster is Professor of Circadian Neuroscience at the University of Oxford

This article first appeared in the 23 March 2017 issue of the New Statesman, Trump's permanent revolution