This is an old (1997) NOVA documentary from PBS on one of the classic cases of a feral child. "Genie" was isolated and neglected in every possible way (other than barely enough food and water to keep her alive), and when discovered she was unable to speak and presented more as a wild animal than a 13-year-old girl.

Her case, and a handful of others, revealed that there is an age "cap" of socialization and language, after which it is nearly impossible to alter the brain and behavior. It also demonstrates how important the attachment system is in allowing infants to become human beings - in many ways, Genie was never fully human. 

Her case highlights the degree to which extreme neglect can destroy a human being. I have seen this film several times over the years, and it tears my heart each time I see it.

Genie: Secret of the Wild Child

NOVA Documentary | 1997 | Transcript



This is an Emmy Award-winning documentary about a girl who spent her early life chained in a bedroom. Brought up in confinement, "Genie" was primitive, brutish, and hardly capable of walking or talking. NOVA follows the contentious attempts to unbolt the secret of the wild child who has reached near maturity in an agonizing seclusion with almost no human contact.

The story begins in Los Angeles on November 4, 1970, when authorities have taken under protection a thirteen-year-old girl that was kept in such solitude imposed by her parents that she never even learned to talk. The parents have been accused of child abuse.

Genie was imprisoned in a bedroom and bound to a potty chair for the most of her early life. Fully kept under control, she was made to sit alone every day and night. She had almost nothing to look at and no one to talk to for more than a decade. The girl allegedly was emitting immature noises and was still in diapers when social workers found out about the case, but the officials were anticipating she may still possess a normal ability to learn.

The girl who gave an impression of an infant would be well known as "Genie." She was transported to Children's Hospital in Los Angeles where she instantly gained the affection of doctors and scientists. She was delicate, lovely and poignant... and Genie was about to put on trial an idea paramount to science and society: that caring, encouraging and affectionate environment could make up for even the most brutal past.

Genie had an awkward walk and other almost non-human features. She continuously spat, sniffed, and clawed. She hardly articulated anything or produced any noises. Investigation showed that she was abused for making noise and as a consequence, had learned, basically, not to vocalize. And she really didn't speak at all. She was mute most of the time.

Watch the full documentary now

This is wonderful to see, finally - even if it is less than honest about the existing evidence for lifestyle interventions to affect depression levels. Drugs for depression are not treating the depression, they are creating an effect of feeling better through making people, for lack of a better word, stoned.

I have seen, firsthand, a client start walking 3-5 days a week (exercise and nature/environment), begin practicing contemplative prayer (meditation), spend more time with her dog (animal therapy - goes on the walk, then fetch in the park), and start spending less time at home by joining church activities and spending time with her kids and granddaughter (socializing). These synergy of these simple changes have been more effective than years of medications and various attempts at therapy.

Lifestyle medicine for depression

Jerome Sarris, Adrienne O'Neil, Carolyn E Coulson, Isaac Schweitzer, and Michael Berk
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Published: 10 April 2014

Abstract (provisional)

The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Full Citation:
Sarris, J, O'Neil, A, Coulson, CE, Schweitzer, I, and Berk, M. (2014, Apr 10). Lifestyle medicine for depression. BMC Psychiatry, 14:107 doi:10.1186/1471-244X-14-107

Introduction

While modernity has provided multiple technological and medical advances including increased life-expectancy, it has come at a cost, in that a range of lifestyle issues are now negatively affecting our mental health [1]. As Hidaka [1] and Walsh [2] comment, in Western society people are increasingly becoming more sedentary and eating a poorer diet than previous generations. This, in combination with sleep/wake cycle pressures, substance misuse, and psychosocial factors such as more competition and time pressure, social isolation and less intimate engagement with the family unit, may exert a cost on mental health. Further, the combination of stress, fatigue, inactivity, and sleep deficiency in people who are “timepoor”, may advance obesity, and this in turn may promote a sedentary life with potential for resultant depression.

Due to the afore-mentioned challenges of modern urbanity, there is now the need to consider a “Lifestyle Medicine” approach for the potential prevention, promotion and management of depression. While medication and psychological interventions are first-line treatments for depression, Lifestyle Medicine offers a potentially safe and low-cost option for augmenting the management of the condition. While the evidence base remains patchy, many lifestyle or environmental factors are mutable and can provide the basis of practical interventions for the management of depression (summarised in Table 1). Lifestyle Medicine involves the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing, adding a therapeutic and potentially preventative approach to illness [3]. This may involve modification of: diet; physical activity and exercise; relaxation and sleep-wake cycles; recreation and work-rest balance; and minimisation/avoidance of smoking, alcohol or illicit substances, in addition to the use of mindfulness-based meditation techniques [2]. Although the evidence base remains in its infancy, environmental issues are also considerations, such as reducing exposure to pollution (air, water, noise, and chemicals) and increasing time spent in nature, and are areas of current investigation. Activity scheduling such as encouraging engagement in meaningful activities and adequate social contact [1] is additionally of value. Further, Lifestyle Medicine may involve the application of clinical psychological techniques, insofar as motivational and behavioural factors are intrinsic to people trying to embrace lifestyle changes [3].

Table 1 Lifestyle Medicine for Depression

Lifestyle element................Evidence level....................Cost
Diet............................................CS, LO.................Moderate expense 
PA/Exercise..........................CS*, LO*, CTs ...............Inexpensive 
Recreation.................................OB, CTs..................Variable expense 
Relaxation/Meditation.................CTs..........................Inexpensive
Sleep......................................CS, LO, CTs...................No expense 
Environment..........................CS, LO, CTs...........Potentially not adjustable 
Socialization..............................CS, LO.........................No expense 
Animal/Pet therapy....................CS, CTs.....................Moderate expense 
Vices (smoking/alcohol)............CS, LO.................Potential to save money

CS = Cross-sectional, OB = Observational Study, LO = Longitudinal, CTs - Clinical Trials, NAT = Nature-Assisted Therapy, PA = Physical Activity. 
*Data assessing the relationship between exercise and depression has revealed mixed outcomes.

Comments on each Lifestyle Element:

Diet - Relationship found between dietary quality and depression; RCTs now required to validate
PA/Exercise - Strong evidence of efficacy for improving mood
Recreation - No studies exploring recreational activities for depression (aside from music therapy)
Relaxation & Meditation - Evidence supports relaxation techniques (especially with a mindfulness component) in improving mood
Sleep - Strong causal link between sleep amount and quality, and depression risk
Environment - Association between reduction of pollution and mood; CTs showing NAT improves mood
Socialization - Strong association between social support/networks and mental health
Animal/Pet therapy - Studies support the psychological benefits of animals and pets
Vices (smoking, alcohol) - Association between smoking and alcohol, and depressed mood

While lifestyle modification has been recognised by practitioners for centuries as a means by which to improve health outcomes, the field of “Lifestyle Medicine,” particularly in the context of mental health, is a relatively new field. While papers have discussed its broader application on health and in particular prevention of chronic disease and cardiovascular/metabolic conditions, little attention has been given to its application for mental health, and in particular depression, which is predicted to be the predominant cause of disability in the developed world [4], and is being argued as one of the prevalent noncommunicable disorders [5]. Some studies show that patients with sub-threshold depression rate lifestyle or psychosocial approaches as strategies that are most helpful in improving their mood [6], while patients with clinical depression have rated exercise as the most effective intervention [7].

There is a heuristic theoretical framework explaining why the modern lifestyle may be impacting mental health. Obesity [8], poor diet [9], poor/decreased sleep [10], exposure to chemicals and pollutants [11], and high stress levels [12], may potentially disrupt the hypothalamic pituitary adrenal axis, increase cortisol and increase low-grade systemic inflammation and oxidative stress. Both neuroendocrine disruption and inflammation have been linked to the aetiology of depression [13,14]. Specifically, increased levels of proinflammatory cytokines, interferon gamma and neopterin, reactive oxygen and nitrogen species and damage by oxidative and nitrosative stress, in combination with lowered levels of antioxidants, may potentially damage mitochondria and mitochondrial DNA; this may result in neurodegeneration and reduced neurogenesis [14].

This opinion paper aims to provide a context for Lifestyle Medicine by providing an overview of the lifestyle factors that are linked with depression risk before exploring the evidence and clinical application of modifying these elements. The paper firstly explores data for which there is sound evidentiary support (diet, physical activity and exercise, mindfulness meditation, management of recreational substance misuse, sleep, and social interaction), and then touches on lifestyle and environmental elements that have nascent data and are subject to confirmatory investigation (greenspace and pollutant exposure, hobbies and relaxation, and animal/pet therapy).

Read the whole article.