Storied Mind» medication

Depression Is a Creative Force in Human Evolution?

john — Fri, 05 Mar 2010 22:05:17 +0000

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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.

But quite possibly, it’s not true at all – at least when you untangle the confused use of the word depression. Lehrer has taken a lot of heat for failing to do that. The psychiatrist Ronald Pies, for example, writes in his Psych Central post, The Myth of Depression’s Upside that Lehrer ignores many studies that reach the opposite conclusions about the effects of depression on thinking, relating both to mental function and the level of activity in the brain. He offers this anecdote:

The notion that severe depression may bring forth good things reminds me of a lecture I once attended on “fire safety” in the hospital setting. We were shown a movie of a house that had burned down in such ferocious heat that a package of frozen muffin dough had been completely baked. “So, the house wasn’t a total loss!” quipped one of the world-weary attendees. Yes, of course—people can learn from their severe depressive episodes, but often at the cost of emotional and spiritual conflagration.

Edward Champion at Reluctant Habits attacks Lehrer’s interpretations of the experiences of Charles Darwin, Kay Redfield Jamison and David Foster Wallace.
Peter Kramer also has little patience for the idea. That’s not surprising since Kramer produced a very convincing study, Against Depression, that attacked a long-standing tendency in our culture to glorify depression.

Prior to Lehrer’s article, Jerry A. Coyne, a Professor in the Department of Ecology and Evolution at the University of Chicago wrote a devastating two-part critique of the Thomson-Andrews paper itself. He’s an expert on evolution and author of the highly praised Why Evolution Is True. He methodically takes apart the speculative reasoning and “paper-thin evidence” supporting the conclusions of Thomson and Andrews about the evolutionary benefits of depression. He looks at the original research papers cited by them and brings out the way in which their interpretations distort the actual findings of the studies.

So what’s going on? Why have there been so many claims about depression as a boon to human life, and why has there been a strong positive response from the public (excluding, of course, the hundreds of thousands of us who’ve lost so many years to the effects of this illness)?

I think part of it has to do with the confusion about what “depression” means. The same word is used to refer both to feelings of sadness or dejection in everyday life and to a set of clinically defined illnesses. Unfortunately, the psychiatric profession, however much it hopes to dispel this confusion with the Diagnostic and Statistical Manual (DSM), only reinforces it.

By setting the bar so low for a diagnosis of a major depressive episode (experiencing five out of nine listed symptoms for at least two weeks), the DSM invites psychiatrists and physicians to prescribe treatment for even isolated occurrences. To add to the prevalence of a depression diagnosis is the startling fact, reported in a recent study, that a quarter of psychiatrists and two-thirds of non-psychiatric physicians do not bother to use the loose DSM criteria when making a diagnosis.

Even when studies or popular books and articles do make the distinction between severe and mild depression, they tend to drop the qualifiers after that caveat, rely on the single word and make much more sweeping claims about depression’s beneficial impacts on life. The influence of drug industry advertising also encourages the idea that people shouldn’t put up with sadness but rather take the latest medication to restore a happy outlook on life. (But that’s a long story for another day.)

Many people do value depression as a factor that gives them a distinctive outlook on life, and they don’t want to sacrifice this dimension of mental experience to a drug-induced “cure.” I have no quarrel with that and respect whatever adaptation to depression people need to make. But individual experience and choices are one thing. Speculative theories about the brighter side of depression from psychiatric researchers are another. They have real-world consequences and need a lot of rigorous testing before put into practice. Unfortunately, that usually happens, if at all, long after the idea has gotten wide publicity and influenced attitudes of public and providers alike.

Trying to Explain Recovery from Depression

john — Fri, 04 Dec 2009 21:48:42 +0000

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A friend recently asked me if I could help him understand the change for the better I’ve experienced in the last couple of years. At the same time, a reader here asked if I could elaborate on what I mean by taking charge or putting myself at the center of my own recovery – an idea I first discussed soon after starting this blog. Both are closely tied together, and I thought I’d summarize a few thoughts I’ve had so far on how to account for what I’ve been through.

As I’ve written earlier, I don’t really know what turned me around. I doubt that the experience can ever be explained in the sense of cause and effect. It’s something that comes from the wholeness of a person, not the cut-away sections that are analyzed in isolation from all the others.

Here are some of the actions I’ve taken in the recent past that have helped get rid of depression – not the more conventional treatments. I’ve taken medication for most of the past 18 years, but it has never had a lasting effect or come close to ending the problem. I’ve also had many types of therapy over several decades. While many of those experiences have been powerful in terms of personal growth, they’ve never changed the overall dominance of depression. The reason for bringing them up in this list is to discuss the mindset that these treatments tend to encourage.

Writing. First, I started writing Storied Mind. I’d written journals off and on for years, and these were full of ideas and descriptions of depression. Mostly they recorded the raw experience and the frustration I felt at not being able to get better for very long. There were also several periods when I was too depressed and mentally blocked to sustain writing. The blog has been quite different because I’ve written more consistently and looked at many more dimensions of the illness than ever before. Writing is the way I discover things, and it also has an important healing effect. This has helped me stay with the revitalizing energy that creative activity brings with it.
Online Community. The people I’ve gotten to know as a result of getting active online are a treasured resource in healing. Reading about the experiences of so many others, exchanging ideas with them, receiving and offering support – all have had an enduring impact. This community has been a source of insight and encouragement throughout the past two years. What I’ve learned has helped change permanently some of my basic attitudes about depression.
Running out of Medical Options. A couple of years ago, I was quite nervous about running out of medical options since none of them worked for very long. At the time, I was putting my hopes on TMS – transcranial magnetic stimulation – and followed its progress in working toward FDA approval. I’d heard a lot of positive reports since I knew someone who had worked on one of the major studies of its effectiveness. However, the evidence submitted to FDA didn’t show much advantage over placebo. Medical treatment seemed less and less likely to offer any hope.
Challenging the Mindset of Treatment. So I stopped waiting for something to cure me and relied more on internal work of my own, bolstered by the help of the online community. I was starting to question the whole concept of the medical model of treatment that focused narrowly on a few key neurobiological processes. The medications based on that model didn’t work in my case. Health providers tended to blame me, in effect, by attaching the label of treatment resistant. That was no help at all.

I realized I had to stop expecting cures within the limitations of that model. Before then, I had understood – based on my experience with cancer – that I had to become an active partner with the medical providers. My energetic determination to get better had made a big difference in the speed of recovery at that time. Now I had to push farther in that direction. Taking charge of my recovery from depression meant changing the basic expectation that someone or something outside myself was going to cure me. That approach didn’t work, so I had to come up with a different strategy – and there was no one to do that but me.
Rethinking Depression. I found inspiration in reading Reynolds Price’s memoir (A Whole New Life) of his experience in stopping the extreme pain of spinal cancer that permanently severed nerve connections to his legs. Nothing helped him until he did hypnosis. That started his ability to rethink the pain so as to end its debilitating effect. One of the interesting things about this was that the pain itself was pure phantom – it came from his legs where he had no nerve sensation at all. That got me thinking that such concepts as pain or depression are powerful mental constructs that respond to sense perceptions and chemical changes in the body. They assume a life of their own and influence the expectations and assumptions we have about their permanence. If Price could disempower “pain” in his experience, could I do the same with “depression?”
New Assumptions. Somehow, I internalized this idea and felt new hope. Combined with the healing effect of writing the blog and all the support I had from the online community, this new idea helped me to change long-held assumptions. I stopped assuming, for example, that depression was a permanent condition that would always reassert itself. I stopped assuming that it was a single overwhelming force and broke it down into the separate symptoms that were more manageable. I challenged more effectively the inner voice that was always telling me I had no hope, had no self-worth, had never done anything right. Most important, I assumed that depression had no more power over me than I gave it – however unconsciously. I didn’t have to be its victim. That was a hard one since it contradicted all my earlier ideas.
All that was exciting and hopeful, but there was still something missing. I’d often had breakthroughs and new awareness of possible recovery in the past, but those never resulted in real change because they never touched my basic beliefs about myself. Those beliefs had been completely negative, and depression had been their perfect mate. The eroding emotional and mental effects of the illness seemed the natural outcome of my lack of self-worth. The belief that I deserved only a life of depression had to change, and somehow it did. That was a great gift, a sudden realization that I was fine, that depression was a nuisance rather than my fate, that I could live a full life again.

All these factors, and others, must have had a cumulative effect in helping me get to that shift in belief. I can list, narrate and speculate about all this, but that’s about as close as I can get to explaining the outcome. Of course, changing for the better is a process, not a one-time achievement, and it takes a lot of attention and quick response each day to make sure I’m staying on the right track.

I’ll keep on writing about it and always seek insight from the online community. So I hope you’ll share some of your experience in making progress, however halting or incomplete it may seem. Every step counts, even the backward ones.

Changing the Mind’s Experience of Pain: The Witness of Reynolds Price

john — Thu, 17 Sep 2009 22:00:27 +0000

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When I think of recovery from a terrible illness, I think of Reynolds Price. His beautiful memoir, A Whole New Life, records the powerful experience of his mental and spiritual healing from the excruciating pain of a crippling illness. However, there could never be recovery from the physical impact of mostly inoperable spinal cancer. It left him a paraplegic for life.

Most of the memoir records his painful struggles of the disease’s crippling progress. After surgery to relieve the tumor’s pressure on the major nerves emanating from the spine, he gradually lapsed into paralysis. He also endured a brutal course of intense radiation treatment that burned and scarred a great deal of tissue. Eventually, he lost all use of his lower body and became dependent on full-time attendants. His muscles began the unpredictable spastic leaps that have continued from that time on.

But the worst and most unrelenting problem was a scalding pain that became his constant companion.

There were … hours in which I dwelt on the steep and constant rise in a pain that had many times seemed as high as I could bear. Whatever the cause … the searing burn down the length of my spine and across my shoulders and the jolting static in both my legs only soared in intensity. Like most real agony, the pain afflicted more senses than one; it often shined and roared as it burned. More than once I panicked in the glare and noise.

The initial treatment for his pain consisted entirely of drugs, from morphine through a series of antidepressants, steroids and the often addictive methadone, regularly used at that time as an alternate to heroin in treating drug addicts. Not one of these helped his pain, but as often happens, he continued taking many of them anyway. He also tried the visualization techniques originated by Carl Simonton, a pioneer in the mind-body connection approach to the treatment of cancer. His Getting Well Again is a classic description of self-help techniques based on this method. Isolating visualization from the other dimensions of that approach, however, didn’t work for Price.

It was only after three years of constant pain that Price began working with the Duke research program on pain prevention and management. He started with biofeedback training that helped him develop abilities to concentrate his thought on specific parts of his body to eliminate tension and pain. After mastering those skills, he worked with a psychiatrist who was an expert in the use of deep hypnosis. That was the answer. As someone susceptible to hypnotic trances, Price found these experiences completely successful in relieving all his pain. He mastered the techniques well enough to be able to counter recurrences – largely because he had a completely different mental and emotional response to what he felt as pain.

He is quick to point out that these treatments would not necessarily work for everyone as well as they did for him. That is partly due to his own receptivity to biofeedback and hypnosis, which is not the same for everyone, but also partly to the particular nature of his pain. And that factor gives me a sense of the possible relevance of Price’s experience to the treatment of long-depression.

His pain did not have any immediate physical cause.

The ultimate cause, of course, was the cancer that broke the connection between his brain and his lower body. The now useless nerve endings then died and with them went any possibility of transmitting those signals that the mind interprets as pain. The agony that he experienced resulted entirely from the mind’s attempt to compensate for the loss of information from the lower body. It produced the same phantom pain that amputees often experience as coming from a missing limb.

What enabled him to make this breakthrough? Here is a brief excerpt from his interpretation.

With all its powers, my mind can make no significant physical amends to me for the permanent wreckage done to my spine … . The causes [of pain] are past yet the panicked alarm continues to blare. The mind’s only hope for sanity then is to shut down the useless but frantic circuits and look elsewhere for ease and continuance. In the summer of ‘87, my mind was finally ready for that action. … It had desperately needed to hear and believe that the unending stream of neural alarm meant nothing now. The need had been filled. Now my mind understood that The harm is done. It cannot be repaired; pain signifies nothing. Begin to ignore it.

Few of us who’ve lived with chronic and severe depression can imagine achieving a degree of mental control that would lead to the end of that dark dominance over both thinking and feeling. And with the current emphasis on the neurobiological causes of depression, the possibility seems remote. Yet deep meditation and many non-western traditions are based on the mind’s power to effect just such healing.

I think of it this way. Depression, similar to pain, is not a physical phenomenon in itself but a psychological response that corresponds somehow to changes in the brain’s neurobiology and circuitry. Let’s set aside all the controversy over the physical dimension and what causes what. Whatever might be going on in the brain is shaped by the mind into experiences of despair, worthlessness, fear, obsessiveness and the rest. It seems reasonable to me that the mind could train itself to come up with different experiences, to distance itself from the overwhelming nature of this psychic pain and find a degree of peace in that way.

These thoughts occur to me as I read Price’s account of his healing partly because I’m trying to figure out my own experience of recovery – which has gone far beyond the effects of any medication I’ve ever taken. Even though I never found a single method to follow in an intensive way, my mind has, in fact, come up with a completely different approach to the experience of depression. The question I ask myself is the same one Price asked. Why now? – especially since I’ve been doing more or less the same things for years. I’ll keep you posted as I try to work out that puzzle.

In the meantime, read this beautiful book. If you’re like many of my friends, Reynolds Price may be – unfortunately – the finest and most prolific writer you’re never heard of.

What do you think about changing the mind’s orientation toward depression, as Price changed his toward pain?