Behind Casual: Deep Brain Stimulation and Depression

I got the idea to start writing Casual when I was at WordCamp Europe in the summer of 2018. Just how did WordCamp inspire a science fiction novel? Indirectly. I was taking some time away from the crowds, tweeting about how wonderful it was to be on antidepressants and finally get to enjoy the conference without having a single anxiety attack. That tweet somehow got to chrome, which then brought up an interesting article in my suggested reads.

I wish I had saved the article. But at the time it was just something interesting. Deep Brain Stimulation had cured treatment resistant depression in a woman who had not even left her home in years.

I was shocked. They aren’t really implanting long-term devices in the human brain to provide low-level electrical impulses over an extended period. No. They couldn’t be!

But it turns out they are. This is a known treatment for movement disorders such as Parkinson’s with clear benefits. However, with mood disorders it has had a rocky history.

Research Into DBS and Depression

DBS to treat depression was developed by neurologist Helen Mayberg, and first tested by her in the early 2000s with positive results. She gained FDA approval to start a large-scale clinical trial in 2008. But the trial had some major hiccoughs that you can read about here:

What it boils down to is the trial was halted in 2013 and no one was talking about why. Publicly, the trial was called a failure. Ultimately, the treatment worked for a large number of participants, though, just at a slower rate than what was needed for a successful trial.

From DBS to VR Implant

In Casual, Valya uses a virtual reality implant to treat her depression as opposed to clean DBS. In fact, clean DBS is one of the archaic treatments she turns to later in the book. How did I get from DBS to a VR implant?

Complete creative license.

Although virtual reality is being used to treat depression, it is not quite like the game taking place in Casual. It involves pleasant scenarios combined with cognitive behavioral therapy to teach people to experience joy and satisfaction.

The VR in Casual is based on casual game play. You know those games you download on your phone that don’t take any thought like Candy Crush or Homescapes? When I was in particularly dark postpartum depression, I turned to the game Two Dots.

Whenever I got particularly stressed or depressed, I played a few rounds of Two Dots and the pressure eased. This was a sort of self-developed coping device, and I wondered how it would combine with something like DBS, whether it would work to create positive stimulation and keep depression at bay.

However, I’d like to be clear that ultimately, casual game play was an avoidance tactic for me. It got me through some dark times, but did nothing to actually improve my brain chemistry. In some ways I think I got worse due to not dealing with my actual stress. So I don’t recommend this as a treatment for depression. I just wanted to imagine what would happen if it was actually researched and delivered under medical supervision.

Ethics of the Treatment

Any time we talk science and the development of new treatments, we have to discuss the ethics behind it. I actually think Casual does a fair job of subtly showcasing a lot of the ethics involved in new mental health treatments.

One thing it doesn’t get to, which I hope to explore in a sequel, is the question of changing our personalities to give certain individuals skills or advantages over others.

This article does a good job of addressing those questions:

But I’d like to ask you. How would you feel about an implant that could change your personality? Do you see it as different from the oral medications available today? If you suffer from genetic and hormonal depression, would you get an implant to help treat it? Would you put one in your baby?


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