Storied Mind

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What is it about depression that draws people to search for the benefits it brings to its lucky victims? Since I’ve been writing this blog, many writers have had great success with books and articles describing its positive role in life – giving people a creative edge, helping them figure out their lives or simply serving as a healthy and normal response to misfortune. The problem with each of these essays is that they invite confusion between mild depression, or limited periods of deeper mood changes caused by life events, and the much more severe depressive disorders.

The latest contribution in this vein is Jonah Lehrer’s New York Times article, Depression’s Upside. It’s about a theory that takes depression’s virtues to a much higher plane than that of individual insight. Depression, it turns out, evolved as part of our genetic makeup because it enhanced the human capability for analytical thinking and problem-solving. In short, depression has helped the human race survive.

This isn’t his idea. He’s summarizing the conclusions of a scientific paper by J. Anderson Thomson, a psychiatrist, and Paul Andrews, an evolutionary psychologist, but he adds a lot of additional material to support the notion that depression has its brighter side.

The concept is that depression improves the mind’s ability to focus attention on “complex social problems” (failing marriage, loss of job) through the process of rumination – the repetitive analyzing of a single problem. (Hence, the theory is called the analytic-rumination hypothesis or ARH.) Rumination fires up the area of the brain that specializes in analytical thinking, making it easier to break apart the elements of a problem that might otherwise seem overwhelming and so make it easier to find a solution.

Isolation from the rest of the world supports this tight mental focus and keeps the mind from being distracted, as does – I presume – loss of interest in sex, food, human relationships and fresh air. Since all these symptoms are coordinated so nicely to help with problem-solving, the authors contend that they must represent an evolutionary adaptation rather than a malfunction.

If this is true, I’ve really bungled the gift of my genetic inheritance. In all the decades of dealing with severe depression I never solved a single complex social problem. Amazingly enough, my mind was infinitely distractible, incapable of clear decisions and subject to aimless drift into a cloud of nothingness. At other times, I obsessed about my failings and worthlessness in prolonged self-torture and often thought of suicide. Perhaps, though unaware of it, I did sharpen my analytical abilities while sleeping all the time. However, my isolation from my family, if you can believe it, seemed to create problems rather than solve them. Clearly, I’ve given evolution a setback, especially since I’ve likely passed on this my distorted version of this gift to our three sons. Read the rest of this entry »

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Like many, I’ve been worried that the revision of Diagnostic and Statistical Manual of Mental Disorders, the source for all our diagnoses, could lead to what’s been called the medicalization of normality. But there are even more fundamental problems inherent in the classification system itself. It slots you into a fixed category based on a checklist that ignores many symptoms, and the categories lack any means for measuring the progress of treatment over time.

In my own case, I’ve always had a depression diagnosis (under the DSM-4 system, that’s major depression – recurrent – non-psychotic). I’ve had various symptoms that don’t show up in the official criteria for this category. I’ve discussed some of them – especially anxiety (though it took me many years to think of mentioning it) – with psychiatrists and therapists, and they’ve been quite responsive. The problem is that there were many I never brought up, especially relating to the upside of the cycles that included the recurrent major depressive downside. Those high energy phases didn’t strike me as manic, as I understood the word (no climbing tall buildings or emptying bank accounts), so why talk about feeling incredibly good, or the less friendly but high-intensity fits of rage. What did they have to do with depression?

As John McManamy points out, there’s significant overlap between unipolar recurrent depression with bipolar depression, yet the classification system shuts them into different categories. I don’t know if I’ve been incompletely diagnosed all these years, but I do know that antidepressants have never worked very well for me and that I’ve done much better since I started taking lamictal.

Before the draft came out a couple of weeks ago, I was encouraged by a statement of guiding principles relating to dimensional assessments. The leadership seemed open to changing some of the basic problems of the classification system. You can read their ideas in the FAQ section of the DSM-5 website, especially the description of dimensional assessments. It’s worth quoting:

… In the earlier versions of DSM, as with the current DSM-IV, disorders were described and arranged by category, with a specific list of symptoms for each mental illness. In this categorical system, a person either had a symptom or they didn’t, and having a certain number of symptoms was required to receive a diagnosis. …

… The categorical syndromes do not always fit with the reality of the range of symptoms that individuals experience. … Also, because the criteria for diagnosis are “yes/no” (i.e., does the individual have this disorder or not?), in most cases there is no method in DSM-IV to account for the severity of the disorder, and thus no specified way to determine if the patient is improving with treatment.

… [D]imensional assessments … would allow clinicians to systematically evaluate patients on the full range of symptoms they may be experiencing. For instance, information about depressed mood, anxiety level, sleep quality and substance use would be important for clinicians to know regardless of the client’s diagnosis … [and] would allow clinicians to rate both the presence and the severity of the symptoms … . This rating could also be done to track a patient’s progress on treatment, allowing a way to note improvements even if the symptoms don’t disappear entirely.

Read the rest of this entry »

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I’ve heard of a number of off-label uses for antidepressants, but turning them into non-lethal weapons for crowd control is a new one for me. The Soft-Kill Solution in the March Harper’s describes research on the use of “calmatives” or central nervous system depressants for just this purpose.

The article describes the history of the use of non-lethal methods by both the military and civilian law enforcement. The following quote refers to a research report that was published online in 2002 by the Sunshine Project.

As [the Pentagon's Joint Non-Lethal Weapons Directorate] research director Susan Levine told a reporter in 1999, “We need something besides tear gas, like calmatives, anesthetic agents, that would put people to sleep or in a good mood.”

[Academic researchers reported in 2000] that “the development and use of non-lethal calmative techniques is both achievable and desirable,” and identified a large number of promising drug candidates, including benzodiazepines like Valium, serotonin-reuptake inhibitors like Prozac, and opiate derivatives like morphine, fentanyl, and carfentanyl …

The report cited in the article is The Advantages and Limitations of Calmatives for Use as a Non-Lethal Technique, prepared by the Applied Research Laboratory at Pennsylvania State University. Here’s one of its key conclusions. Read the rest of this entry »

Just a note to point you to this new post at Health Central.

I hope you’ll drop by and leave a comment.

Recovery from depression meant a lot of change in the way I lived, and cutting out the stress of a tension-filled job was at the top of the list. Once I had ended that life of constant pressure, I could feel the relief at the start of each day.

A freedom and energy filled me, and I could step at once into the work of writing that I had long wanted to do. That sounds like a happy ending, but things are not so simple.

Depression was not overwhelming me anymore, but the illness is generous with the legacies it leaves behind. Over the last year, I’ve had to deal with many of those. As I’ve often written here, there was no getting away from depression by going to a new place, finding a new job or trying different relationships. The same proved true of trying to leave stress behind by changing the kind of work I did.

I’ve kept stress with me almost every hour of every day. Instead of chasing the unattainable goals of someone else’s rules, I’ve set up plenty of my own. And not just rules about work. I’m too inventive to stop there. I have rules to follow about almost everything. At any moment, I should be following a rule or condemning myself for breaking one. Nothing is too trivial to merit its guidelines for measurement.

The rules are remnants of battered self-esteem – or rather the weapons of choice to do the battering. I would never have been able to push depression aside if I had not changed my belief about myself. Out went the assumption that I was worthless, bad, inadequate, doomed to fail (and on and on), but it’s taken awhile to dismantle the structure of rules that I had created to bind up that bad person. Read the rest of this entry »

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An important part of my recovery has been exploring emotional memory when I respond so deeply to a story or song or even just a moment in a film that somehow reaches right inside. A feeling long held back flows out freely, even though broken away from the memory that stirred it. So I have to stop and ask – what is this, where is it coming from? The emotion is often grief over loss – and there have been plenty of those through decades of depression – but it can also be a happier surge of recognition, powerful reminder of a breakthrough in recovery.

Sherwin Nuland’s 2001 Ted Talk video about his recovery from depression provoked just such a response. It affected me so deeply that I started looking for a written version. I found it in the opening pages of his memoir about his father, Lost in America: A Journey with My Father.

Nuland grew up in the South Bronx in the 1930s and 40s, one of two sons of Russian Jewish immigrant parents. Quite apart from the personal meaning I found in that opening chapter, the memoir is a moving, beautifully written story of life in a close-knit family dominated by an overbearing father – who also played a part in his depression.

Nuland’s recovery story parallels the experience of many who’ve been through this nightmare. He captures so well those powerful moments – the terrible ones that led him into a mental hospital and the thrilling, even funny ones that brought him back. There are several that resonate for me. Read the rest of this entry »