This journey started when I was a little boy, seeing my mother’s pain, and led unexpectedly to using botulinum toxin to treat depression. Sounds pretty far –fetched, but then many scientific discoveries are only logical in hindsight. I will never forget the etched and furrowed brow of my depressed mother – her suffering became a memory that inspired me to try and figure out what role our facial expressions play in our mental health.
Serendipity drew me into the facial expression field- I am an artist and was intrigued by a riveting series of photographs of hysteric and depressed patients from the 19th century in the Parisenne hospital Salpetriere. I began working on paintings based on these women. To try and understand their world better I read authors from their time.
Freud led to Darwin’s gem of a book, The Expression of Emotions in Man and Animals from 1872. Wow! Reading this wonderful but relatively unknown work of Darwin’s opened my eyes to a new way of viewing emotion. Darwin and William James, the American psychologist, both recognized that the bodily expression of our emotions really is the emotion, and that our facial expressions are a central driving force of our emotions.
I found 40 years of research demonstrating that facial feedback to our brains really occurs. The more I read, the more I was convinced of the importance of facial expressions for our emotions and our mental health. Our emotions are embodied by our faces, embodied by the muscles that help move our lips, our eyes, our eyebrows. You need your smile to help you “feel” the emotion. Conversely, frowning will negatively affect your thinking, coloring your view of the world around you. But I realized that very few people were aware of this line of reasoning, or of why Botox could possibly help ones mood.
More than ten years ago I hypothesized that Botox could help control the flow of negative emotions by quieting the facial muscles that really express negativity, the muscles between the eyebrows that help create the frown. In 2003, I began a clinical trial to test my hypothesis that Botox inhibition of the frown muscle could help depressed patients. My 2006 study, Treatment of Depression with Botulinum Toxin A: A Case Study showed that nine of the ten patients were no longer clinically depressed after Botox injections into their frowns. Exciting but just the beginning! Although the press covered the study around the world few seemed to understand the science behind the experiment. Botox was an emotional molecule for many, which distracted attention from the real science behind the study. I realized that the message would need to be much clearer – so I began to write a book about the science behind my study and what led to my hypothesis– explaining why facial expressions could be used to treat depression, why frowning might send signals to the brain making one more depressed . Last year I published “The Face of Emotion: How Botox Affects Moods and Relationships” (Palgrave Macmillan), providing a framework for understanding the therapeutic power of our facial expressions. In it I wrote:
The brain is measuring the strength of the frown muscle contraction, weighing it against the strength of the smile, which can been seen as the pulse of the positive feelings of happiness – and then producing an emotion. I call this emotional proprioception- just as your mind tracks the smallest movements of your hands or feet, it is tracking those little muscles that control your face.
The next step was to repeat my clinical trial, but this time with more patients and in a trial that was blinded and controlled. I had the good fortune to be introduced to a really open-minded and astute psychiatrist, Norman Rosenthal, a kindred spirit who had worked for many years at the National Institutes of Mental Health before heading up a clinical trial center. So Rosenthal and I began our fruitful collaboration and embarked on a controlled study of Botox depression with his fine team of psychiatrists. We entered 74 depressed people into a double blind, placebo controlled study and when we finally analyzed the data, the results were clear and strong. Botox beat placebo, significantly reducing depression levels, regardless of whether patients were already on antidepressants (to which they had not responded) or were untreated.
As a son who watched helplessly as his mother suffered so miserably from depression, I am heartened at a potential new treatment option for this debilitating disease. And I am encouraged by discussion of our new study by Dr. Richard Friedman, in an Op Ed piece in the The New York Times Sunday Review section on March 23, 2014. Only by much dialogue that generates interest among mainstream physicians will the research be propelled along. Although there are many available treatments for this very painful affliction, none were successful for my mother. I hope that, with replication of our findings, FDA approval will eventually follow, and someone else’s mother will be able to live a normal life.