Archives for : depression

We know what good depression treatment looks like. You probably won’t get it.

We know what good depression treatment looks like.  You probably won’t get it.

Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD) (Flory). That is my justification for treating depression in a blog primarily devoted to PTSD.  Depression usually follows some of the earliest symptoms, such as anxiety and flashback but there are no fixed rules (https://www.ptsd.va.gov/understand/related/depression_trauma.asp).

As I’ve posted recently, it has become almost commonplace today, at least among those impressed by the latest results of neuroscience, to say that Descartes got it backward.  Not “I think therefore I am,” but “I am therefore I think.” The mind is composed of body.  Brain makes mind possible.

Yet, this is not how we experience ourselves.  “I feel therefore I am” is probably the first and fundamental experience of self, or at least the experience that makes life worth living.  It is the feeling of being alive. Depression is the opposite.  It robs existence of vitality and pleasure.  That’s the cardinal symptom of major depression; it can make life not worth living. Depressed people are about twenty times more likely to commit suicide (Gotlib and Hammen).   

“Depression is the flaw in love”

A couple of recent books that take the neurological basis of depression seriously, also see love and its loss as central to the experience of depression.  Because the mechanism of depression takes place in the brain, and because medication and other treatments that work on the brain help, doesn’t mean that our experience of the world is unimportant.  Most important is loss, above all the loss of love: of being loved, of a loved one, as well as the loss of values crucial to one’s identity, such as the loss of religious belief.*

Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest.

Love, though it is no prophylactic against depression, is what cushions the mind and protects it from itself. Medications and psychotherapy can renew that protection, making it easier to love and be loved, and that is why they work. (Solomon, p 15)

Medication and therapy make love possible.  For what is the good of a more balanced mind if one has nothing of value to do with it?  Generally, this love is of another person, but it can be love of one’s work, or faith. 

Stress causes depression among the vulnerable.  Surprisingly, humiliation is the greatest stressor, loss is the second. (Solomon, p 61).  But perhaps they are not so different.  Though we seldom think about it this way, loss is shaming.  After loss we are exposed to the world, naked and alone.  Once you experience a shaming loss, you will never be the same, for you will have learned something about your vulnerability that you may have sensed but never known.

Continue Reading >>

Share

Kandel, The disordered mind. Or was Descartes wrong?

Kandel, The disordered mind.  Or was Descartes wrong? 

It’s become almost commonplace today, at least among those impressed by the latest results of neuroscience, to say that Descartes got it backward.  Not “I think therefore I am,” but “I am therefore I think.” The mind is composed of body.  The brain makes mind possible.

This is the argument of Eric R. Kandel, author of The Disordered Mind and Nobel Prize winner for his research on memory storage in neurons.  The reader need not be intimidated.  Kandel clearly explains recent developments in neuroscience for the non-specialist.  He tries, but fails, to put together the neuroscience of the injured brain with the experience of emotional distress.  He knows one is incomplete without the other, he calls for a “new scientific humanism,” but all he ever says is that both brain and experience need to be taken into account.  Sometimes that’s enough, but about some experiences, such as PTSD, he cannot get out of the brain.    

I feel therefore I am

It’s absolutely true that brain makes mind, and yet this is not how we experience ourselves.  “I feel therefore I am” is probably the first and fundamental experience of self, and it would not be wrong to say that feeling is at least as body-based as it is mind-based.  The fundamental experience, or at least the experience that makes life worth living, is the feeling of being alive, filled with the vitality of existence.* 

Neuroscience doesn’t capture the feeling of being human.  It’s about neurochemical events responsible for this feeling, but it doesn’t capture the experience of being alive, sad, happy, depressed, in love, etc.  The question is how much this matters, and how the neurological explanation can be made useful without diminishing the experience of life.

Thus, we now know that psychiatric illnesses, like neurological disorders, arise from abnormalities in the brain. (p 41)

It’s not true, at least not when stated like this.  These “abnormalities,” which exist, may be the brain’s normal reaction to an abnormal environment. What goes on in the brain is caused by the environment we live in, not just autonomous neurochemical events in the brain itself.  Everything I experience changes my brain.  But that doesn’t mean that all, or even most, psychiatric diseases arise from abnormalities in the brain.  Some do, some don’t, and many are a mix.  Besides, the term “arise” is too vague. 

Kandel talks about PTSD at some length, and I’ll get to that shortly.  His treatment of the topic is disturbing, but the scope of the book is broader and worth considering. 

A “new scientific humanism”?

As research into the brain and mind advances, it appears increasingly likely that there are actually no profound differences between neurological and psychiatric illnesses and that as we understand them better more and more similarities will emerge. (p 43)

This convergence will contribute to the new, scientific humanism. (p 43)

I have only a scant idea of what Kandel means by “the new scientific humanism.”  It would have helped had he defined “humanism” to begin with.  I think he means that experience still matters, particularly one’s own experience of events such as depression.

Continue Reading >>

Share