TOL Interview: Writer/Director Larkin McPhee
> 5/22/2008 3:10:30 PM



On Wednesday May 21st, PBS aired a new documentary titled Depression: Out of the Shadows. This new film tells the story of a dozen diverse people who have struggled with depression and managed to achieve some degree of recovery. While many of their lives contain years of tragedy, they also carry reasons to hope. We got the chance to speak with the film’s director, Larkin McPhee, about her work and the messages she wanted to convey. Watch Depression: Out of the Shadows online here, or find out about when it will be airing in your area.


TreatmentOnline: In what ways is this documentary different from other works about depression? And in what ways is it connected?

Larkin McPhee: Well, honestly I haven’t seen much on depression. I think that’s been a problem. I was stunned by how little is out there, and what is there is usually short and doesn’t go into depth or explain much about the illness. Jane Pauley had done a special on Bipolar Disorder years ago. I heard of one documentary called Drop Dead from HBO, but I couldn’t get ahold of it. There is very little out there. 

TOL: It is very surprising how little in-depth coverage exists. Perhaps people dismiss depression as a simple phenomenon, just like normal sadness but worse.

LM: Yes, I don’t think that people understand it that well. The word depression is used too liberally. As Andrew Solomon points out in the beginning of the film, that word describes both a kid disappointed about losing a baseball game and the reason a person ends up in a mental institution for the rest of their life. It is used too frequently and it is confusing. It is much more of a medical disease that people are unable to snap out of. 

TOL: You just stressed the classification of depression as a medical disease, as did many of the subjects in your film. Was that one of the major points that you wanted to convey? 

LM: I think that the goal of the documentary was to reduce stigma, and to show that this is an illness that manifests itself in many different ways. Stress is an enormous trigger, but that biology plays a major role. And it varies from person to person. A child that gets depressed in elementary school, in my mind, probably has a more biological risk factor than someone who doesn’t encounter this illness until their 60s. There is a very complicated mix of environment and biology, and the purpose of this film is to show that it can happen to anybody, no matter your age or your race or social status. There are no boundaries.  

TOL: I did notice that you interviewed a wide variety of people, from every demographic. Businessmen, gang members, senior citizens, teenagers, and more. Was that variety something that you constructed deliberately? 

LM: Yes absolutely. You want to show people how complex it is. Its an equal opportunity illness. 

TOL: How did you go about finding subjects?

LM: A great variety of ways. Through doctors, through friends who might tell me a story about a kid. A lot through colleagues. You hear stories of great doctors here in town like Helen Kim, so I called her up and she connected me to Elli, the post-partum mother. There is a lot of chance involved. I was doing work for my college and calling people up for a reunion and one of these people was Josh Lipton, who said you might want to talk to my son who has bipolar disorder. 

Andrew Solomon was the reason I pursued the film in the first place. He wrote the book, “The Noonday Demon” and I was so deeply moved that I wanted to include his story, and include him as both a patient and an expert.

TOL: The way that this film came together is symbolic of the power of sharing stories, of the chain that can be created. Andrew Solomon inspired you to seek out others to share more stories and this will hopefully inspire others.

LM: The more people talk about it, the more people open up. 

TOL: Did you have any problems with people volunteering, but then not fully opening up. 

LM: Thats a great question. In the end I was able to get everyone to fully share, but it took time to get some people on board, such as Josh Lipton my great friend, because they are concerned that the whole story won’t be told. And the beauty of PBS is that we can take the time to tell the story and not give you some sound-byte that doesn’t complete the story. Hart is a young kid with his whole life ahead of him. He wanted to participate in the film, but was that a good idea? Did he understand what the consequences could be? But ultimately, they trusted me to deal with his story in a sensitive way, and I was very careful to be right about the facts. I mean, I’ve always cared about facts no matter what the film is. But in this instance, you want to double, triple check to make sure that you are not misrepresenting a person’s story. 

TOL: Did any of them want to scrutinize the footage before it airs?

LM: I think that they all would have wanted to see it, but we can’t show them stuff. And thats the deal, thats the rule with television no matter what the subject.

TOL: How did you arrive at the right balance between the science, the facts, and personal anecdotes?

LM: Every story that I picked, you know, when you choose stories, you really want them to have helpful information for your viewers, but you don’t want them to all be the same, to all be taking medication and therapy. Because you want to show that the film isn’t about just that, even though that is the most effective treatment. For many people that isn’t the whole story. I found other stories that reflected different ways to get well. For example, the CEO couldn’t take any medicine, it made his symptoms worse. I thought it was fascinating that he attributed his recovery to the support of his best friend. But there were so many other things about his story that I was drawn to. The fact that he insisted on mental health parity for the football team that he managed. Or the fact that one way he stays healthy today is giving one-third of his working hours to helping others.

TOL: He is certainly a powerful role-model for the business community.

LM: And for everyone, I hope. He is remarkable because he has done some things that are less science-y, things that have been reported about like the therapeutic benefit of helping others.

TOL: I noticed that you included many treatments outside of the mainstream, such as electroshock, ketamine, and deep brain stimulation. Do you think that the public and the scientific community are close to accepting them? 

LM: Ketamine and deep brain stimulation are highly experimental, and very few people have been exposed to them. So that is confined to a very small, small, group of the most depressed. However, electroshock therapy saves lives. My hope is that people who have not responded to other treatments might consider it because it has really changed lives, saved lives. Cuckoo’s Nest has really stigmatized that treatment, and the really interesting fact is that ECT might be the most effective treatment out there. But it is much more involved, you have to go into the hospital. It is one more thing to consider in the tool-kit and they shouldn’t rule it out because they think it is going to hurt them, that they are going to lose their memory.

TOL: One Flew Over the Cuckoo’s Nest had powerful, dramatically disturbing footage of ECT. Your documentary is powerful in a more subtle way, because you show how mundane the treatment can be. You can sort of just talk to your husband while going through a regular procedure, like any other medical procedure. 

LM: I’m very glad that that is what you take away from it. Because that is the point: it is sort of an underwhelming experience. There is no violent shaking on the table. The administration of ECT has improved with anesthesia, and drugs that control it. Short term memory loss is still an issue, but when you look at the ravages of depression, you are going to want to be treated rather than worry about minor memory loss. 

TOL: As your film pointed out, depression does cause real damage to the brain, so that can balance out the short term memory damage. 

You mentioned that some people are unresponsive to the traditional treatments. I was wondering if you encountered people who would have been suitable for the documentary, but that you decided to exclude because you wanted to present a uniformly hopeful image. 

LM: You know, I actually did not come across a story where a person was not doing better in some way. And I think that that is true for most people. You are going to get better to some degree, though that doesn’t mean that you are going to be well. I wanted to offer hope in all these stories. My feeling is that a lot of bad things happen to people in this world, and depression is one of them, but the good news about depression is that it is highly treatable, so I wanted to focus on that hope because there are other illnesses that we cannot conquer. I thought that Dr. Shep Newland’s story was extraordinary. That was a man that they were ready to give a frontal lobotomy to, that just stuns me. This was a brilliant man. The fact that his doctors, within a week of his admission, were looking at that option. And this man was probably deemed crazy when in fact he was just very badly depressed. I think that is a miraculous story, because he could have been written off, he could have had that lobotomy, and he would have never been the same. But instead that young resident intervened and said let’s give ECT a try first. Thats the real message of hope. Even when you think the person is gone and you are ready to take extreme measures. I mean, we aren’t doing frontal lobotomies any more but...

TOL: The parallel to lobotomies could be that people are giving up by committing suicide.

LM: Actually, that is what I was going to say to you. Those were the stories that I did hear about, and thats why I felt it was very important to have a story about suicide in the film. Because you know, sadly, it is a very high risk, especially for those with bipolar disorder. 

TOL: We have to send the message to those thinking of giving up: Hold on. Things will better. 

What was the most interesting thing you learned from creating this film?

LM: One of the things that I came away with was a newfound respect for our brains. You know, the brain really does respond to everything in the environment. The people we interact with, the food we eat, the exercise we get or we don’t get. The support of loved ones. The amount of stress. All of those things dramatically impact our brains, and if you are prone to depression this group of factors is something you really need to pay attention to. We can’t do anything about our DNA, but we can do an awful lot about our environment. Having purpose in life is one key to staying well. Especially for the CEO, having that sense of giving back to others was so helpful. 

TOL: Yes, a lot of the people in the documentary had others helping them, and were in turn helped by helping others. Shep had a picture of his children that got him through the darkest times, some of them wrote about their experiences to help others, and some of them mentored younger generations. 

My last question is, how close do you think depression is to being out of the shadows?

LM: I think everything is getting a lot better. People like Philip the CEO, just by insisting on mental health parity, I think we all are realizing that these are big issues. And we are trying to get the word out. There are articles in Newsweek. It is more in the public eye. My hope is that this film opens up the discussion and makes a good case for treating the illness and makes a good case for, as Philip said, treating the whole person. 

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