An Introduction to the Strong Programme in the Sociology of Scientific Knowledge

I mentioned in a recent blog post that the work I do takes place in the theoretical framework of the Strong Programme in the Sociology of Scientific Knowledge, also known as the Edinburgh School.

“Great,” you might have been left thinking, “but what the shit does that mean?”

Excellent question. Like 99.99% of the planet, I had little to no idea about the Strong Programme before I came to Edinburgh this year. My sum total knowledge of it came from one 4-lecture series about the Sociology of Scientific Knowledge, delivered by Simon Schaffer (who is by all accounts a fantastic lecturer), who told us that many people in the department (History and Philosophy of Science, at Cambridge) didn’t think he should be teaching us this. It was an excellent series, but the material was so new and so different to any of the core material we’d studied in Philosophy of Science that taking it on as an object of serious study at a time when exams were looming would have been grade suicide. I think the sole reference to it after that came in a supervision I had about expertise, where my supervisor told me about Martin Kusch’s Knowledge by Agreement, which promotes ‘communitarian epistemology’, the idea that knowledge exists only in groups. At the time I thought it sounded like nonsense. It’s certainly a deeply unintuitive concept for anyone to accept, let alone someone who’d spent the last two years immersed in the standard philosophical literature on knowledge – ‘justified true belief’, ‘the Gettier paper’, etc.

But since coming to Edinburgh and throwing myself at some of the literature (not to mention being taught by people who’ve studied and like this stuff), I’ve fallen in love. It’s a rare thing to plough through highly conceptual literature and not end up feeling mystified. It’s rarer still to have it make total sense in your mind, to have it change the way you view the world, the people in it, and relations between us. For me, the Strong Programme has done that. It’s pretty uncommon to find people working within this framework: it’s often dismissed because it’s a relativist theory, or because it’s social constructivism. What’s strange, though, is that there’s rarely any actual weight behind these criticisms. They’re used as heuristics to dismiss it out of hand without ever engaging with the actual substance of what the theory claims. Alternatively, people overlook the SP in favour of Actor-Network Theory, either because ANT seems more readily applicable to other fields, because it already has more work already done using it, or because Bruno Latour is a fabulous self-publicist (he thinks he’s Foucault. He’s not Foucault.).

I want more people to love the Strong Programme as much as I love it. I think it’s an absolute travesty that more people aren’t aware of its existence. Not only could people working in STS benefit from it, but I think it has much broader applicability in other disciplines. The social theory which underpins SP, the Performative Theory of Social Institutions, is extremely flexible and makes a great deal of sense. The underlying ontology, finitism, is not just a useful tool for understanding how knowledge is created in disseminated – it is also, to my mind, correct. I recognise that saying so may undermine my credibility not only with people who despise relativism but also with those who support it wholeheartedly, but frankly it’s a hit I’m prepared to take. I really like the Strong Programme.

So let’s get stuck in.

The Strong Programme grew through the ’80s and ’90s as a reaction to ‘weak’ sociologies of knowledge. Previous attempts at understanding knowledge through a social lens restricted themselves to understanding failed knowledge claims: they were a sociology of error, rather than of knowledge. This meant that phrenology, homeopathy and spontaneous generation theory would all be suitable candidates for sociological analysis; but relativity, evolution by natural selection and the Big Bang theory would not be. Belief in the latter could only be understood as a ‘rational’ response to the evidence of our senses.

There are a number of reasons this claim is total bullshit. Here are two. First, there’s no reason to believe that our current theories are correct. Every single theory we’ve subscribed to, ever, has over time been shown to be incomplete or flawed in some way, and there is precisely no reason to believe that our current theories are going to be the ones to buck this trend. As such, current successful theories are just failed theories waiting to happen, and should be susceptible to sociological analysis on these grounds. Second, it’s just untrue that we believe in, say, evolution because it’s the rational thing to do. I believe in evolution because a large number of people more intelligent than I have spent their entire lives studying evolutionary biology (so that I don’t have to), and have managed to entrench this belief in all of the institutions of our society, so that I was just taught that evolution is the best theory we have to understand how life came to exist in the form we see it today. It would be preposterously arrogant of me to say that the only reason I believe in evolution is because of the evidence of my own senses: I have literally never witnessed evolution take place, and if I had witnessed something which seems to validate the theory of evolution by natural selection, there are a thousand and one other theories which could explain that phenomenon equally well. There is nothing rational which makes me, or you, or anyone, believe in a particular way of understanding the world.

What’s really bizarre is that the same people who are rabidly pro-science (or at least, pro the idea of science as a transhistorical arbiter of objective truth) are also really, really bad at understanding epistemology. Faced with claims from the Bible or another holy text that god exists, they will posit the existence of a Flying Spaghetti Monster, and say that there is just as much evidence for its existence, and so it is just as rational to believe in it. I don’t care to weigh in on that particular shitshow of a debate. What I do want to say is that if you formualte that kind of argument, you should also naturally be a big fan of the Strong Programme, and epistemic relativism more generally. Why? Because you recognise that any set of evidence can be used to push you towards a potentially limitless number of conclusions. If you look at the world around us and decide that there is a god, the form that god will take is underdetermined by the evidence at hand. There could be any number of potential gods or deity-like entities which could explain the way the world is, and belief in any particular one is likely to be best explained by social factors – where you were born, what religion your parents were, what kind of school you went to – rather than by reference to the natural world itself.

You should probably admit that you believe in most scientific theories because someone told you to, rather than because you observed the evidence for them first-hand. That means that there’s a place for sociological analysis in understanding how we, as people, come to believe in some theories and not others based on the say-so of particular individuals.

But it goes deeper than that. Your response to all the above might be, “so what? I know that the scientists who work in gravitational wave physics have good reasons to believe in gravitational waves, based on the evidence before them, and that’s why I believe them over some over schmuck”. Fair enough. But there are a couple of things you might want to consider. First, how do you know they have good reasons to believe in gravitational waves? Sure, you’ve read a really interesting Guardian article about them which explains them super well, but people get tricked into believing convincing-sounding explanations all the time, like when I was 7 and Daniel from down the street told me that he would look after my Pokémon cards for me and then he never gave them back and told me that I’d never given them to him. Fucking Daniel. He can get in the sea.

The gravitational wave scientists tell us they observed the same phenomenon which is supposed to suggest the existence of the waves at two different stations, though. Surely that’s enough for them to believe in the waves based on pure rationality, right? Well, not really. First, we have to explain why each team would believe the other team. Then we have to explain why particular runs of an experiment get to count as ‘good’ runs – what about all the times when they didn’t detect gravitational waves? Then we need to account for why this time is the big one, when various members of the gravitational wave community have been claiming to have detected the waves for the last forty years. What made all the scientists in the community agree with each other that they had, indeed, detected a gravitational wave?

The point I’m making is that it’s not as simple as ‘scientists observe material world, get evidence, evidence leads rationally to theory’, and then ‘scientists tell us correct theory, we believe them’. It’s far, far more complicated than that, and we do ourselves a disservice by refusing to acknowledge that.

There’s an awful lot more to say about the Strong Programme, but this post has just edged past the point where people are likely to stop paying attention, so I’ll leave it here for now and resume in another screed.

Freakonomics and Expertise: What’s Missing?

This week’s episode of Freakonomics Radio is about the topic of expertise.1 As someone working towards a PhD studying expertise, I listened with interest: it’s reasonably rare to hear an in-depth discussion about this field, and trying to comprehend other people’s takes upon the subject and reconcile them with the work I’ve been doing. The academic niche that I work in (Science and Technology Studies, specifically the Strong Programme in the Sociology of Scientific Knowledge, which is heavily social constructivist in its approach) draws on a slightly different set of approaches to the topic of expertise to those cited in Freakonomics, which come more from the Psychology side of the spectrum of social sciences. As a result, I have a few thoughts about the framework of expertise articulated in the programme. Hopefully some of them might be considered constructive.

The academics consulted in this episode, chief amongst them Anders Ericsson, Professor of Psychology at Florida State University, advocate for the idea that expertise can be achieved through ‘deliberate practice’.2 This effectively cashes out as activity which constantly pushes its practitioner out of their comfort zone, often focussing upon ameliorating specific problems or stumbling blocks which they may currently be facing. They note that peak human performance in many areas has improved dramatically over recent centuries: the record time for the fastest marathon has decreased by nearly an hour since the first modern Olympics in 1896;3 Mozart’s ability to perform music at various stages of childhood would likely be considered ‘average’ amongst children at a musical academy today; and so on. The idea is that we stand on the pedagogic shoulders of giants: over time, we have learned the ability to learn better.

The ‘10,000 hour rule’ popularised by Malcolm Gladwell in his book Outliers also makes an appearance,4 with some discussion over whether this amount of practice is indeed the ‘magic number’ for becoming an expert in something, whether it is how one spends those hours that matters more than the sheer volume, and if the proper formulation might in fact be ‘10,000 hours + basic talent’.

I think the formulation of expertise in this programme might benefit from a couple of interlinked observations.

First, I would posit that what they are describing is not the process of acquisition of expertise; rather, they are describing what it means to become adept at a skill. Much of the discussion is focussed around musical or sporting ability, with a cursory mention of writing at one point during the episode.

It is unclear to me that these are forms of expertise. When we talk of experts in society, we tend to talk about them as people who are unusually knowledgeable or skilled in something, but that isn’t a sufficient condition: there’s something extra. Usually that extra thing is the way we relate to them as experts. We ask them, as representatives of their field (whatever the nature of that field), to solve particular problems for us.5 We ask physicists to tell us about gravitational waves. We ask psychologists to help us understand how we learn. We ask cardiologists to tell us how we can minimise our chances of suffering a heart attack in the future. The crucial aspect of expertise which is missing is its sociality: without it, there is no expertise, there is only skill.

You might ask, so what? This is just linguistic nit-picking. It doesn’t matter if we call it skill or expertise, we just want to know how people get really good at things. I should just get back in my ivory tower and complain to the approximately half a dozen people in the world who care. Fair enough. But I think there’s a deeper insight to be gained from the distinction here. A skill can often be learned in some kind of isolation: I can get really good at playing scales on my piano just sitting in my bedroom with some sheet music.

But there’s something missing. We know that people tend to learn much better when they are taught by others. The best tennis players have other extremely skilled players coach them; the same goes for pianists or even academics. This isn’t just because those people know more stuff. It’s because they know how to apply that stuff. What’s missing from the deliberate practice model is the recognition of the power of tacit knowledge: the things we can’t articulate, but which can only be learned from being immersed in the community which surrounds our interest.6 You can practice your scales as long as you like, but you’re never going to understand what it means to give an emotional performance which makes a crowd love you if you don’t mix with (and learn from) people who know how to do just that.

In fact, it’s impossible to even know what constitutes an emotional or moving performance without socialisation. Why? Because our standards for what is good or bad, overdramatic or underplayed, technically accomplished or pretentious nonsense, all vary between times and communities. The extent of this variation is different in different fields, but it always exists. There was a time when Isaac Newton would have been recruited as a virtuoso physicist; if his reanimated corpse were to be dug up today, he would no longer be considered an expert, because he has spent the last three hundred years not immersed within the culture of physics and mathematics. Zombie Isaac Newton could probably, with time and adequate socialisation, be a great contributor to modern physics. But critically, he would be totally incapable of doing so without becoming part of the physics community: he would not only need to read modern textbooks and academic papers to know what physics consists in nowadays, he would also need to know which journals and authors to take seriously and which to ignore, as well as how to converse in the language of modern day physics. He wouldn’t have a snowball’s chance in hell of becoming a virtuoso without extensive social contact with other physicists.

The missing ingredient in this otherwise highly interesting treatment of the problem of expertise acquisition is the social. Malcolm Gladwell recognises in the podcast that ‘you can’t do [10,000 hours] by yourself’, but what he means is that 10,000 hours is a hell of a long time and you’re likely to need people to help you with perform your basic needs whilst you’re playing fifty games of chess every day. Even if that weren’t true, it would still be the case that nobody can become an expert, or adept, or a virtuoso, on their own. Social immersion and tacit knowledge is at the very core of what it means to be truly great at something, and to be recognised as such.

If you’re interested in STS or the Strong Programme and its approaches to expertise and knowledge, there are a few books and papers I’d highly recommend:

Barnes, Barry, The Nature of Power (Urbana: University of Illinois Press, 1988)
Barnes, Barry, David Bloor, and John Henry, Scientific Knowledge: A Sociological Analysis (The Athlone Press, 1996)
Bloor, David, ‘Idealism and the Sociology of Knowledge’, Social Studies of Science, 26 (1996), 839–56
Collins, H. M., and Robert Evans, Rethinking Expertise (University of Chicago Press, 2007)

1Greg Rosalsky, ‘How to Become Great at Just About Anything’, Freakonomics, 2016 <; [accessed 28 April 2016].

2K. Anders Ericsson, Ralf T. Krampe and Clemens Tesch-Römer, ‘The Role of Deliberate Practice in the Acquisition of Expert Performance.’, Psychological Review, 100.3 (1993), 363.

3Wikipedia, ‘Marathon World Record Progression’, Wikipedia, the Free Encyclopedia, 2016 <; [accessed 28 April 2016].

4Malcolm Gladwell, Outliers: The Story of Success (London; New York: Penguin, 2009).

5Zoltan P. Majdik and William M. Keith, ‘Expertise as Argument: Authority, Democracy, and Problem-Solving’, Argumentation, 25.3 (2011), 371–84 <;.

6H. M. Collins and Robert Evans, Rethinking Expertise (University of Chicago Press, 2007).


What I wish they’d told me about postgrad

Postgraduate degrees can be lonely. Like, really fucking lonely.

It sounds trite, but I wish someone had warned me before I decided to do a PhD just how isolating it could be. In my final year of undergrad, I knew that I wanted to stay in academia, and so I spent my Christmas hols writing up research proposal after research proposal. I was lucky enough to receive four years of funding from the ESRC to study at Edinburgh, reading about expertise and authority and the internet, in the Department of Science, Technology and Innovation Studies.

The city itself is excellent and my experiences of the department have been broadly positive. It’s just hard. Hard to drop all of the friends and relationships you’ve built up over the last four years and move somewhere completely new, many hours by train away from everyone you know and love. Hard to make new friends when most people around you are younger, or older, or busy with work, or has their own friends already, or has a long-term partner they live with.

Much of the isolation of a PhD is an extension of the kind of isolation undergraduate humanities students can already experience. Most of my work consists of sitting in an office, library, cafe or park, reading and annotating and trying to think of a vaguely original argument about something which people much more intelligent and harder working than I have dedicated their entire careers to. As someone who doesn’t deal well with being on my own much of the time, there’s an internal tension between wanting to surround myself with people and knowing that if I do so I’m unlikely to get much done. I end up sitting in the ‘collaborative working’ area of our little postgrad office, hoping to absorb some camaraderie and sociality by osmosis, not caring that people’s conversations prevent me from concentrating on my reading because at least this way I can pretend that reading paper after paper isn’t such a lonely fucking chore.

The isolated nature of the work brings with it the additional problem of making it harder to motivate myself to work in the first place. I used to be a science student with constant lectures and labs, and it was difficult not to see people. Getting out of bed was rarely a struggle because there was always somewhere I had to be at 9, or 10, or 11. Now the lack of deadlines or immediate pressure is just one more reason to stay in bed for another three hours and stare at the space on the wall. On a good day I’m in the office before midday. On a bad day I never make it in.

But it’s not just the work itself that’s lonely. It’s all of the baggage that comes with being a postgraduate student at a new university. Even as the youngest person in my cohort (I’ve just turned 23, the average age is probably around 26), most of my friends are undergraduates who are significantly younger than me. There’s nothing intrinsically wrong with that – I’m not so silly as to think that there’s something weird about hanging out with 18 year olds – but it does make some things difficult. It might be fine to be friends with undergrads because your hobbies coincide, but getting invited to parties gets a bit harder, and when you are invited you’re the guy who’s a bit out of place because he’s older and he’s been through this and there’s this disconnect of experience which makes you feel as though people are looking at each other as if to say ‘why is he here?’.

Worse, your schedules just don’t match up with most of your friends’. When you’ve just handed in a solid 15,000 words of work and you’re ready to unwind, they’re just getting into the meat of exam season. Then, just when it’s getting to the point where you’re starting to stress over your dissertation and could do with some company, everyone fucks off for the summer and you’re left in a half-empty city full of people you’ve never really had the chance to get to know.

As a postgrad, it’s just much harder to form lasting bonds with the people in your cohort. A lot of people are only there for a year, which means that no matter how fast you make friends, you’re going to find it hard to really get to know them, particularly when the workload of a Masters or PhD can be pretty intense. It’s exacerbated by the fact that a lot of people are holding down jobs or long-term relationships, so they’re not around much of the time. Add to that the fact that lectures and seminars can be somewhat scarce at this level, and the result is that you’re unlikely to even know everyone in your cohort. More likely is that you get to know a few people reasonably well, but you don’t necessarily hang out with them all that much because they’ve got other commitments and so have you and your schedules just might not collide.

When you’re an undergrad you’re thrown in together with whole hordes of others in your subject groups and your halls of residence. It’s (usually) pretty easy to have two or three quite large groups of friends from where you live, and nights out, and myriad societies and sports teams. That makes it easier to find people to hang out with at random times of the day when you’re feeling isolated, or to have an impromptu dinner or even to find people to live with the next year. I’ve been looking for one or more people to live with since around November, and I still can’t find anyone. It’s not for want of trying: most of my postgrad friends don’t know if they’re here next year, or if they are then they have partners they live with; and all of my undergrad friends have groups they’re flat-hunting with, and I get the feeling nobody particularly wants someone four years their senior barging into their pre-existing friendship groups. That’s totally fair, on all fronts. It’s just sad.

I guess what I’m trying to say is that if you’re considering a postgraduate degree, think really hard about whether this is something you can handle. If you’re really worried about moving somewhere new, maybe consider staying at your current university, or just go to bloody London because everyone seems to move there anyway. I don’t think I regret it (yet), I just wish someone had told me this before I started on a four year degree in a new city.

Antidepressants aren’t Happy Pills: on SSRIs and authenticity

A friend recently told me that they weren’t comfortable with the idea of going on SSRIs to deal with their depression because they didn’t want to have to constantly worry about whether the happiness they were feeling was ‘authentic’. They (and a lot of people) might not get much happiness naturally, but they’d rather that than have to concern themselves with whether their feelings are truly theirs.

This seems a pretty common concern for people considering medicating depression. I have a few thoughts on it. Fundamentally, I’m uncertain that ‘authenticity’ is a productive or positive way of framing our discussion about antidepressants, but saying that straight off the bat isn’t super helpful, so let’s reach that conclusion organically.

A lot of what antidepressants make you feel is a complex product of expectations and chemicals. We’re really not sure exactly how they work, and for people with mild or moderate depression the evidence for their efficacy is pretty mixed. For a lot of people taking SSRIs can mean they’re effectively taking a placebo, so what they think we’re going to feel is a crucial factor in what they actually feel.

As such, the authenticity question is a much greater problem for people who are concerned about it. If you’re scared to go on antidepressants because you think that the happiness they’ll make you feel isn’t real (whatever we mean by real), then, in the immortal words of South Park, you’re gonna have a bad time. This is particularly bad for the kinds of people who tend to be candidates for antidepressants (i.e. depressed people), because we have a tendency to overthink things in creatively shitty ways. This includes emotions: happiness is rarely the child of introspection, and if it is introspection’s offspring then it’s the kind that’s kept in a cupboard under the stairs and is only let out for family gatherings and birthday parties. Whilst depression obviously isn’t something which can be cured just through the power of positive thinking (thanks, mainstream media!), it’s also not totally impermeable to changes in our thought processes. If you’re not constantly worrying about the authenticity of your feelings, then those feelings are considerably less likely to be the kind that perpetuates the cycle of bullshit that characterises depression. People who come on to antidepressants not caring about the aetiology of their emotions – people who just want portable dark cloud of acid rain and existentialist angst perpetually hanging over their head to fuck off – are less likely to have these issues. That means they’re much more likely to draw greater benefit from the drugs.

But the problem with this whole line of reasoning is that it presumes that antidepressants make you happy. That’s not my experience, and from talking to various other members of the Depression Mafia (or Melancholiati, if you prefer) I know it’s not their experience either. SSRIs, rather than making me happy, usually help to blunt the worst of the lows that I would normally feel. If my thoughts are a train, and they normally speed down the tracks towards the broken bridge over Nihilism Valley, antidepressants can act to conveniently shove the train of thought into a disaster-averting siding (though the siding may well lead straight over a cliff into the Sea of Shit and Sorrow and Staying In Bed Until 1).

That is to say, quite a lot of the work done by SSRIs is in maintaining neutrality, rather than promoting happiness. That isn’t necessarily a bad thing: neutrality makes it a lot easier to take advantage of opportunities to feel happiness in a way that you wouldn’t be able to normally, because you’re stuck in bed staring at the space on the wall the entire morning because you can’t bring yourself to muster even enough energy to flop onto the floor like a fish with a deathwish.

Framing SSRIs as ‘happy pills’ is counterproductive: if people with depression go on them hoping to feel happy, then not only are they going to be let down when they learn that the pills don’t work that way (which in itself can make depression worse, as you begin to feel like nothing can make you better), but they’re also susceptible to all the concomitant concerns about the authenticity of their happiness. Because so much of the effect of antidepressants is contingent on expectations, it might help quite a lot of depressed people (and those who love them) to change the way we talk about SSRIs and similar drugs. They’re not happy pills. They’re normal functioning human being pills.

What’s it like being on antidepressants?

Note: This post contains discussion of depression, self-harm and suicide.

I went back on antidepressants just under a month ago. This is the third time I’ve been on them. When I was first diagnosed in 2012 I was put straight on venlafaxine, which is a heavy duty SNRI*. I never found it hugely helpful. It blunted my mood, making me unable to feel the kinds of highs I’m used to, and made my self-harming behaviour worse. I can’t quite remember what it did to the kinds of suicidal ideations I used to have, but I’m fairly certain it didn’t make them go away. I ended up taking myself off them. Then, in the first half of 2013, I went on citalopram, which is an SSRI and is usually more of a first-line antidepressant**. Again, it wasn’t a panacea, and I ended up taking myself off them in the summer.

Now, a solid three and a half years later, I’m back on. Why? I can’t sleep for shit. I wake up about five times a night because my brain, like some kind of bizarro headmaster tasked with planning the school day, doesn’t seem to understand that time exists in increments other than ninety minute blocks. Then, when I do wake up in the morning, I can’t get out of bed. Unless there’s something that I need to do, somewhere I need to be, I just stay there. It doesn’t matter how motivated I was the previous evening, how determined I was to launch myself into the next day screaming the lyrics to Eye of the Tiger. When I wake up, it’s genuinely like a different person has taken control of my body and won’t let me out of bed. Morning Tim doesn’t think that life is worth living. As the sort of wanker who likes to go to far-flung places and argue with strangers at the weekend, I often find myself saying ‘non-existence is utility neutral’. We usually take for granted that getting out of bed and doing the things we do is a net positive. Morning Tim doesn’t believe that’s true. He’d rather sleep forever, because unconsciousness is a blissful reprieve from having to get up and fucking live.

I thought it might just be the winter. I’ve recently moved up to Edinburgh and, whilst we’re on the same latitude as a lot of Scandinavia, we don’t seem to have nearly the same level of cultural understanding of seasonal depression and similar conditions. I thought the lack of light (and the cold and the rain and the wind and the difficulty making new friends) could be the issue, and that it would all get better when spring came.

No such luck. When I started self-harming again I knew it was probably time to go back to the doctor. He was very nice (and quite concerned when he saw the marks on my torso, because it looks a little bit like I’ve been using my stomach as a makeshift tally chart, as though I’m doing a zero-budget remake of Memento). He put me on 50mg of sertraline per day and prescribed me some zopiclone, a sleeping pill. I went back a week later and he gave me temazepam, a stronger sleeping pill, because I was still waking up in the middle of the night like a rooster with performance anxiety.

I thought that, in an attempt to navigate the thin line between useful stigma-reducing writing that helps to normalise the use of antidepressants, and cringe-inducing oversharing, I would post something about my experiences with SSRIs over the past few weeks. ‘Eight Things you Won’t BELIEVE Antidepressants do to your Mind and Body’, if you will. (‘Number seven will SHOCK you!’).

Obviously these experiences are deeply personal, and they certainly won’t reflect the myriad lived experiences of other people living with depression and other forms of mental illness. But it’s a start. If this is helpful for people who might not understand what antidepressants do or why people take them, or for people who’ve been on/are currently on them themselves, then I’ll chalk it up as a success.

1. The first weeks are difficult (who knew?)

When you first go on antidepressants, you’re often told that they may take a little time to have an effect. For some people, this two to three week wait is agonising: you’ve taken all the action you can take, and now all you can do is sit back and hope that it works – that the fog in your mind clears and that you’ll be able to function like a normal human being again.

One of the deepest frustrations of depression is the disconnect between your desires and your ability to act on them. At a really deep level, you wish you could be happy (or at least feel something other than gnawing emptiness), and you sometimes even know the kinds of action you should take if you want to be happy. But the bridge between those desires and the ability to make your mind in-the-moment act upon them is gone. It’s been burned. The hope of SSRIs is that you can start to rebuild that bridge, and that even if it’s never going to support a six-lane motorway (, either cut this comma or put another one or put another one between ‘that’ and ‘even’ to make it a subordinate clause) you might at least be able to get some foot traffic passing over it. But that rebuilding takes time, and in the meantime you’re left wondering: is what I’m experiencing right now just what I would be experiencing without the drugs? Have the drugs started working already? Am I only experiencing this because I expect to feel something?

2. Expectations are a bastard

The struggle with the placebo effect is compounded by mental illness. If you expect to feel better, and then you do feel better, it’s entirely possible to then roll back all or some of those effects if you start to think that the reason that you’re feeling better is because you expect to. It’s a circular clusterfuck of meta-expectations and reflexivity, like an entirely mental Human Centipede.

This means that it’s incredibly difficult to separate out the provenance of your feelings and any side effects you might have. This gets particularly tricky when it comes to alcohol and sex, two areas where expectations and anxieties already temper our experiences in a variety of fun and deeply frustrating ways. We’ll get on to that.

3. Bouncing back is easier

I had a bit of a setback the other day. A thing happened that would normally probably lay me low for a few days, and I possibly would have ended up hurting myself because when I’m in a state of complete melancholy, that just seems like the thing to do. As it was, I felt pretty awful, but today I’m sat in the office writing this rather than wallowing in a marinade of my own self-loathing, and I avoided treating my body like a prehistoric cave wall entirely.

One of the things I’ve noticed about antidepressants is that they put a floor under how low your feelings can go, or at the very least they elasticate those feelings: even if you go low, you end up bouncing back up far more easily than you would under ‘normal’ circumstances.

4. I’ve stopped self-harming

This is probably a big one. Of all the stigmatised aspects of depression – not seeing people, not keeping appointments, not being able to work or articulate yourself properly, being overly despondent, staying indoors or in bed all the time – there’s little on the same level as self-harm. I have vivid memories of being immediately shut off from an interview I was giving on BBC London because I wasn’t unequivocally negative about self-harm (it’s obviously not great, but it’s one of a constellation of symptoms of a deeper pain rather than being something which ought to be condemned in and of itself, and it can be a coping mechanism for people who have nothing else).

Most of my scars aren’t too bad, but there are a few situations in which people have noticed them and it’s been a bit awkward (usually for them rather than me – I’m always completely open about how they got there). Even if I’m not getting odd looks in the gym changing room, I still feel somewhat self-conscious about the marks on my abdomen which look like a small child’s attempt at Roman numerals. So the fact that I’ve managed to avoid any further encounters with razor blades is a huge plus. Here’s hoping it continues.

5. It’s totally screwed my alcohol tolerance

Now I’m not saying I’m a heavyweight, but I used to be able to, as it were, bosh a large quantity of pints and be pretty much fine. Two bottles of wine would get me pretty wankered, but I probably wouldn’t have a hangover the next day.

No longer. The week after I restarted SSRIs I went out and had a couple of pints. Lying in bed later on the room was spinning a little bit. A week later I had my first hangover in a long time.

It seems to work both ways: I get drunk more quickly, but sobering up also takes less time. Weirdly though, alcohol also just affects me differently. I’ve only got a sample size of a few occasions but on one night after consuming what wasn’t really a large amount, I just felt weird. I can’t quite place the feeling, but it just felt wrong in a way that I’m not used to.

I’ve noticed previously that alcohol is a bit of an emotional Russian Roulette when I’m on antidepressants. I’m glad that I’m now a really cheap date, but the randomness of the effects is pretty infuriating.

6. My sleep problems haven’t gone away

Sleeping pills, it turns out, might be able to knock you out for a decent period, but they can’t stop me from waking up several times a night. They also only give you a week’s supply at a time, because apparently they’re super addictive, which means that I’m now back to attempting to put my head down and snooze like a normal person. I still wake up constantly, and bizarrely my jaw seems to be clenched the whole time I’m sleeping, and it makes getting up in the morning a (H?)herculean task, because if there’s one thing Morning Tim loves, it’s an excuse to be able to make me sleep longer. “Oh what a shame you woke up and couldn’t get back to sleep last night – guess it’s time for another three hours now 🙂 🙂 :)”.

7. Sex is different

The most common side effect of antidepressants is change in sexual function, so it would probably be remiss of me not to talk about sex at least a little bit (in a further ill-advised exercise in navigating the usefulness/oversharing line).

Once again, it’s really hard to separate out the aetiology of any changes: do they come from the drugs, or my expectations of what the drugs will do? A lot of people have changes in their libido from SSRIs, but then a lot of people’s libido fluctuates naturally over time anyway. It’s not that I don’t want to have sex now, because I still do. It’s just that the desire is kind of tempered a bit, again in a way that I can’t quite articulate yet. SSRIs also make it a bit more difficult to, well, do it – in a variety of ways, but mostly they just desensitise you somewhat. This seems to be a continuation of a general theme: a lot of what antidepressants do for me is stopping me from feeling some of the worst of what I would normally feel. This sits uncomfortably with the fact that a lot of depression stems from feeling nothing at all – but that nothingness isn’t neutral. It’s an aggressive emptiness, a melancholy which yawns and threatens to swallow you whole. The drugs help negate that. If the trade-off is that they make sex different – not worse, per se, just different – then I think I’ll take it, at least for now.

8. It’s not a panacea

Whilst I certainly feel a lot better than I have been – I have relatively normal amounts of energy, my thoughts don’t drift to death and existential emptiness too much more than is natural for a philosophy student, etc – SSRIs certainly aren’t a cure-all. The techniques I learned through counselling a few years back, combined with my own ‘on-the-job’ experience of treating my own depression, have helped me a lot this time around, and without them I doubt that the drugs alone would have done a huge amount. If you’re considering going on antidepressants, probably also think about counselling if that’s an option open to you. I went through four counsellors, and none of them were exceptional, but that doesn’t mean that they aren’t incredibly helpful for other people.

What’s particularly interesting is that the physical side effects of antidepressants serve to reify the mental effects. It’s often really hard to know that they’re doing anything – you just put them in your body once a day and hope, like a multivitamin or a fish oil tablet (except without the aftertaste of Satan’s belly-button lint). When you get side effects, in spite of the fact you know they might only be happening because you expect them to happen, they help you to know that the drugs are doing something. That in turn makes it easier to see the positive effects they’re having upon your mental health. And that, I hope, is mostly a good thing.

*Seratonin Noradrenaline Reuptake Inhibitor – less common than SSRIs, which are Selective Serotonin Reuptake Inhibitors. They do essentially the same thing, but they also hit noradrenaline. We’re not sure exactly why SSRIs work, but their mechanism of action is essentially keeping the levels of serotonin (a neurotransmitter) artificially high by stopping it from being degraded in the junctions between neurones. This means that they keep stimulating electrical impulses in neurones for longer.

**I’m uncertain exactly why I was given the more heavy-duty treatment first. I think it might be in part due to the fact that I presented with reasonably serious symptoms (they balk a little bit when you start chatting suicide, who knew?), and also because I first went to the doctor in Cyprus, where I lived before I started university, and where medical practices aren’t always exactly the same as they are in the UK.