On the way to the sleep lab one night.
On the way to the sleep lab one night.
I recently read a book by Jonathan Rottenberg, who describes depression as part of the mammalian mood system. The human mood system is designed to drive and shape behaviour – it pushes us in positive directions and away from bad ones. For example, if a bear is fishing for salmon in a spot that is usually really good and no fish appear, that bear will experience frustration and unhappiness. This mood state will cause him to stop trying to fish in that spot and look for anther one. If he finds fish elsewhere, his mood system will reward him with positive emotions.
With humans, if you set yourself difficult-to-achieve goals, or undergo extreme stress, your mood system will shift downward. It’s trying to tell you something, but you may not be as in-tune with your moods as the bear is, and you may not listen. If not, the mood system will downshift your mood again and again, until eventually you either adjust your goals, or become totally incapacitated by your mood. If you don’t pay attention to low moods and learn from them, they will stop you in your tracks.
The mood system knows much more than we do. It has inside information on the health of our bodies, information that we don’t have access to. If, for example, we are deficient in an essential nutrient, or we are severely sleep-deprived, or we are being bombarded by too many demands, our mood system will take all of these elements into account. If we set crazy, unrealistic goals, our mood system will do everything it can to stop us, and turn us onto a better path.
We are sometimes like a frog in a pot of water that has been set to boil – the water starts out cool, but over time, it gradually heats up until we are boiling. Our mood system knows that pot of water is going to boil eventually and, if necessary, it will scoop you out and toss you to safety, where you might lie for months, wondering why you feel so bad. But at least you’re alive! The mood system gives you signals meant to influence your choices so that you survive and even thrive.
While our mood system sees clearly, and sends us clear signals, our society often places greater value on other signals that override these vitally important ones. Many of these other signals come in the form of prescriptions – you should be successful; you should be happy; you should be rich; you should be thin; and so on.
To go back to the bear analogy – what if the bear could be convinced that if he just kept on fishing in the unproductive spot on the river, he would one day catch the biggest salmon ever? What if the bear believed that if he didn’t catch that salmon it is really his fault – that he wasn’t a good enough fisher? What if he thought he was weird for feeling depressed about his situation and then started worrying about not being happy?
If the bear listened to that kind of talk, he would probably persist in fishing at that unproductive bend in the river until eventually he became so depressed he had a nervous breakdown and crawled into a hole for a long time. When he came out later, he would hopefully find a better place to fish.
But here is the hard part: we don’t always know we are doing things that are dangerous to our well-being. As Rottenberg points out, we live in a time and place that is a perfect storm for low mood.
We hardly get any sunlight and spend all our time indoors. We get far too little sleep, on average. Our diet and exercise patterns are poor. And I would add that modern living forces us to synchronize our biological rhythms to a very fast-paced work world – we have to show up on time, every day, week after week, year after year. All of these factors, and many others, affect our mood.
For these reasons, Rottenberg says that we are now experiencing a depression epidemic. Depression may protect us from futile, often dangerous behaviours, but it is a very costly adaptation. Depression can be even more difficult to deal with than the situation that triggered it. To recover you need help from doctors, therapists, friends, family and often medications.
It is a very difficult, but productive process, where you learn about yourself and grow as a human being. By listening to depression, you discover yourself and the world anew. Ultimately, Rottenberg’s understanding of depression is a very optimistic one, because although he makes clear that there are many ways to become depressed, there are also a great many ways to recover from it, and all of them offer the potential for growth and renewal.
I would like to challenge the notion that there are “mental” illnesses and “physical” illnesses – that certain illnesses are biological and others are psychological.
For example, what are the causes of high blood pressure? Well, according to WedMD, it is caused by the following factors, most of which are no less “psychological” than the causes of depression or anxiety disorders:
And if you look at the list, you will see that many of these “causes” of high blood pressure are the same as the causes of depression. The following all contribute to depression’s onset or its return after remission: stress, alcohol abuse, family history of depression, genetics, older age and lack of physical activity.
There are other known (and probably unknown) causes for depression, anxiety and high blood pressure, no doubt, but isn’t it interesting that people with high blood pressure are almost never sent to a psychologist for therapy, even though their condition would probably be improved by learning to cope better with stress, reduce alcohol consumption and change and improve lifestyle?
What about type 2 diabetes, many cases of heart disease and chronic pain? These conditions could also be improved through specific types of psychotherapy and counselling, often in conjunction with medication.
I have grown tired of the argument that people who suffer from certain “mental” illnesses like depression and anxiety should not take medications, but should instead see a therapist to get to the root of their problems.
These illnesses are not curable, as far as we know. They are conditions, just as high blood pressure and diabetes are conditions. Those who suffer from them have to manage them, usually with some combination of medication, exercise, stress reduction, nutrition and, often, psychotherapy. Why is it that people with conditions that can be measured with a blood pressure cuff or a blood sample are not so often told to get to the root of their problems?
And then we have scientists like Dr. Irving Kirsch, whose research into anti-depressant medications resulted in him confirming his own bias that the medications don’t work and are nothing but placebos. Imagine if you were a diabetic and had been taking a medication that helps you keep your blood sugar in check and a scientist publishes a study telling you that it’s all in your head? “Guess what? Your medications don’t work! You just think they do!” That’s what Kirsch has done, and many media outlets trumpeted his message uncritically.
Scientists are in the midst of developing an antidepressant medication that works in hours instead of weeks. Perhaps if we start having medications that have rapid effects, the notion that antidepressants are nothing but placebos will come to an end.
We have learned that even our genes are influenced by our environment, with certain genes being turned on or off depending on the conditions in which we live. There is no absolute division between environmental and genetic causes of illness, just as there is no real dividing line between the psychological and the biological. It is all on a continuum. To believe otherwise is to create obstacles to wellness for people suffering from a great number of conditions. Why close the door on psychotherapy for high blood pressure problems? Why discourage sufferers from using medications for their anxiety?
I realize there is a problem with medications being overprescribed in many cases, but there is an even bigger problem with under-treatment of diabetes, depression, high blood pressure, chronic pain and anxiety disorders.
Just as there are biological and psychological dimensions to all diseases, there is a moral aspect as well. We can call on sufferers to improve their diets, manage their stress, get to the root of their problems. We can deny health coverage to smokers who develop lung cancer. We can discourage medication because we are so sure that sufferers can pull themselves up by their bootstraps.
But moral judgements won’t reduce suffering or lower the great burden of disease that society continues to bear. The costs to us are enormous in terms of lost productivity, social breakdown, medical expenses and quality of life.