Many roads out of an emotional valley

Since its publication several weeks ago, Depression: The Common Sense Approach, by Dr Tony Bates, has been reprinted and continues, according to publishers Gill and Macmillan, "to walk out of the shops". All of which says something about the obvious and crying need for a book like this. An average of 5.2 per cent of the population is said to be depressed at any given time and, though the majority affected are adults, reports indicate that children and young adults are increasingly affected.

One study of 3,000 schoolchildren found 5 per cent with mild to moderate depression, the problem often reflected in poor school work and aggressive behaviour. Emerging into adulthood is the other, and more obviously problematic, time for young people with reports of depression and suicide among adolescent males in particular on the increase.

The irony behind Tony Bates's wise and timely book is that he had to be persuaded by the publishers to write it. A clinical psychologist, Bates admits that, initially, his "stomach turned at the thought of adding another book to those already out there on depression. "I'd problems with two kinds of books - the biological view, which sees medication as the exclusive answer; and the kind which promises a new life, free of unhappinness, and demoralises people who cannot achieve this. I came to feel that a book which related to the internal experience of the depressed person, to the horrible confusion and distress experienced, and which acknowledged that there are different ways out, a different set of strategies for each individual, would be helpful."

Helpful his slim volume certainly is. It is also practical, informative, sympathetic and clearly written. From the opening chapter, which looks at recognising depression, through others on causes, recovery plans, self-image and staying well, Tony Bates deals in sympathetic no-nonsense.

Gently exuberant and tirelessly committed to his work as a psychologist, and to cognitive psychotherapy in particular, Bates says the book is a "collaboration between myself and a depressed patient. Her voice parallels what I'm telling. Sarah, the patient, took care of the tone of the book. I wanted to present researched, effective treatments."

He adds with a grin: "I didn't have time to write the great book on depression, so I let go of a certain grandiosity in order to be practical. I wanted to give suggestions but not to be dogmatically prescriptive."

Sarah's voice, in excerpts from her recovery journal, runs through the book. "Depression is like an assignment in life that nobody ever sets for you to do," she writes. By the end she says she has "come a long way from some very dark moments and from painful days of despair", that she now has precious moments "when I feel happy, relaxed and content as I realise just how precious life can be".

Chapter nine, "Living With a Depressed Person", is proving very popular - hardly surprising given the meagre help available to those trying to cope. `I've had great, really huge, feedback to that particular section," Bates says. He comforts relatives and friends with the information that "there is only so much you can do" and talks about the conflict for parents of giving space to the young depressed person - though not so much that he or she will feel isolated.

"It doesn't take a whole lot of work to pull someone back from the brink of despair. There's a life instinct in all of us which believes life can be better and that we should give it a chance. Given the bloody painful reality of the lives we're living, it's amazing more people don't kill themselves. It's a tribute to the spirit in people that there's resilience to deal with suffering and adapt and go on."

He is adamant about the need in this country for therapeutic centres for young adults." A minority are getting lost, not getting aboard the development train. When the gap opens up it is very painful for those not doing so well. Their needs are not being met by the psychiatric hospitals. They need a place where they can get personal and group therapy and are encouraged to find a creative outlet, develop self-esteem and make decisions. Those who get lost or stuck at that age can go on getting worse for 20 or 30 years. Maybe some of the proceeds of our very, very successful economy could be ploughed back into help for the increasing numbers of young people who can't keep up and can't tolerate the pain of being left behind.

"I was dogged with depression and had to fight it a lot in my 20s," he says. "I had to work a way out through therapy and feel I know what depression is like inside."

Francis, another voice in the Bates book, is inspirational. "I would like to say to anybody that feels like I felt, that there is hope. You are as good as anybody else and the only one you have to prove that to is yourself. So get whatever help you need now. Don't wait until you're 43 years old like I did."