Twenty years ago, a psychiatrist named Derek Summerfield found himself in Cambodia. For the first time, chemical antidepressants were being introduced to local doctors.
Depression existed in Cambodia as much as anywhere else. Patients were presenting with all the same symptoms – hopelessness, guilt, loss of interest or pleasure in activities once enjoyed, change in weight, change in appetite, issues around sleep – the list goes on.
But when Summerfield explained what this new drug, antidepressants, could actually do, the doctors were confused.
They didn’t need new chemicals, they explained. They already had antidepressants.
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Summerfield assumed these doctors were referring to some kind of herbal remedy that didn’t necessarily do any harm, but certainly wasn’t peer-reviewed.
He asked what they meant, and their explanation wasn’t at all what Summerfield was expecting.
It was the Rule of the Cow.
A local doctor used the example of a man he treated who was living with crippling depression.
He was a farmer who one day had been working in his water-logged rice fields, when he stepped on a land mine, instantly losing his left leg.
Rushed to hospital, the farmer made a physical recovery and was eventually fitted with an artificial leg.
And then he went back to work.
But work wasn’t the same anymore. Working with an artificial limb submerged in water was exceptionally painful. Returning to the rice fields themselves was traumatic and anxiety-inducing.