DEPRESSION. It’s what’s Inside Your Head? – Johann Hari.

“Ask not what’s inside your head, ask what your head’s inside of” W. M. Mace.

“It is no measure of health to be well-adjusted to a sick society.” Jiddu Krishnamurti.

How does your brain change when you are deeply distressed? Do those changes make it harder to recover? The real role of genes and brain changes.

The distress caused by the outside world, and the changes inside your brain come together. If the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing, your genes are activated by the environment. They can be switched on, or off, by what happens to you.

Genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression. Your genes can certainly make you more vulnerable, but they don’t write your destiny.

Marc Lewis’s friends thought he was dead.

It was the summer of 1969, and this young student in California was desperate to block out his despair any way he could. He had swallowed, snorted, or injected any stimulant he could find for a week now.

After he had been awake for thirty-six hours straight, he got a friend to inject him with heroin, so he could finally crash.

When Marc regained consciousness, he realized his friends were trying to figure out where they could find a bag big enough to dump his body in.

When Marc suddenly began to talk, they were freaked out. His heart, they explained to him, had stopped beating for several minutes.

About ten years after that night, Marc left drugs behind, and started to study neuroscience. He became a leading figure in the field, and a professor in the Netherlands.

He wanted to know: How does your brain change when you are deeply distressed? Do those changes make it harder to recover?

If you look at a brain scan of a depressed or highly anxious person it will look different from the brain scan of somebody without these problems. The areas that relate to feeling unhappy, or to being aware of risk, will be lit up like Christmas tree lights. They will be bigger, and more active.

Fifteen years ago, if you had shown me a diagram of my brain and described what it was like, I and most people, would have thought: that’s me, then. If the parts of the brain that relate to being unhappy, or being frightened, are more active, then I’m fixed as a person who is always going to be more unhappy, or more frightened. You might have short legs, or long arms; I have a brain with more active parts related to fear and anxiety; that’s how it is.

Wrong. To understand why we have to grasp a crucial concept called neuroplasticity.

Your brain changes according to how you use it. Neuroplasticity is the tendency for the brain to continue to restructure itself based on experience. Your brain is constantly changing to meet your needs. It does this mainly in two ways: by pruning the synapses you don’t use, and by growing the synapses you do use.

For as long as you live, this neuroplasticity never stops, and the brain is always changing.

A brain scan is a snapshot of a moving picture. You can take a snapshot of any moment in a football game, it doesn’t tell you what’s going to happen next, or where the brain is going. The brain changes as you become depressed and anxious, and it changes again when you stop being depressed and anxious. It’s always changing in response to signals from the world.

Social and psychological factors have the capacity to physically change your brain. Being lonely, or isolated, or grossly materialistic, these things change your brain, and, crucially, reconnection can change it back.

We have been thinking too simplistically. You couldn’t figure out the plot of Breaking Bad by dismantling your TV set. In the same way, you can’t figure out the root of your pain by dismantling your brain. You have to look at the signals the TV, or your brain, is receiving to do that.

They, the distress caused by the outside world, and the changes inside the brain come together.

Once this process begins, it, like everything else that happens to us, causes real changes in the brain, and they can then acquire a momentum of their own that deepens the effects from the outside world.

Imagine that your marriage just broke up, and you lost your job, and you know what? Your mother just had a stroke. It’s pretty overwhelming. Because you are feeling intense pain for a long period, your brain will assume this is the state in which you are going to have to survive from now on, so it might start to shed the synapses that relate to the things that give you joy and pleasure, and strengthen the synapses that relate to fear and despair. That’s one reason why you can often start to feel you have become somehow fixed in a state of depression or anxiety even if the original causes of the pain seems to have passed.

While it’s wrong to say the origin of these problems is solely within the brain, it would be equally wrong to say that the responses within the brain can’t make it worse. They can. The pain caused by life going wrong can trigger a response that is so powerful that the brain tends to stay there, in a pained response, for a while, until something pushes it out of that corner, into a more flexible place.

And if the world keeps causing you deep pain, of course you’ll stay trapped there for a long time, with the snowball growing.

How much of depression is carried in your genes?

I had assumed I inherited it in my genes. I sometimes thought of depression as a lost twin, born in the womb alongside me.

Scientists haven’t identified a specific gene or set of genes that can, on their own, cause depression and anxiety, but we do know there is a big genetic factor.

Scientists studying the genetic basis for depression and anxiety have concluded that it’s real, but it doesn’t account for most of what is going on. There is, however, a twist here.

A group of scientists led by a geneticist named Avshalom Caspi did one of the most detailed studies of the genetics of depression ever conducted. For twenty-five years, his team followed a thousand kids in New Zealand from being babies to adulthood. One of the things they were trying to figure out was which genes make you more vulnerable to depression.

Years into their work, they found something striking. They discovered that having a variant of a gene called 5-HTT does relate to becoming depressed.

Yet there was a catch. We are all born with a genetic inheritance, but your genes are activated by the environment. They can be switched on, or off, by what happens to you.

If you have a particular flavor of 5-HTT, you have a greatly increased risk of depression, but only in a certain environment. If you carried this gene, the study showed, you were more likely to become depressed, but only if you had experienced a terribly stressful event, or a great deal of childhood trauma.

If those bad things hadn’t happened to you, even if you had the gene that related to depression, you were no more likely to become depressed than anyone else.

So genes increase your sensitivity, sometimes significantly. But they aren’t, in themselves, the cause of depression.

This means that if other genes work like 5-HTT, and it looks as if they do, then nobody is condemned to be depressed or anxious by their genes.

Your genes can certainly make you more vulnerable, but they don’t write your destiny.

For example, we know that even if you are genetically more prone to put on weight, you still have to have lots of food in your environment for your genetic propensity to put on weight to kick in. Stranded in the rain forest or the desert with nothing to eat, you’ll lose weight whatever your genetic inheritance is.

Depression and anxiety, the current evidence suggests, are a little like that. The genetic factors that contribute to depression and anxiety are very real, but they also need a trigger in your environment or your psychology. Your genes can then supercharge those factors, but they can’t create them alone.

Endogenous Depression?

Is there some group of depressed people whose pain really is caused in just the way my doctor explained to me, by their brain wiring going wrong, or some other innate flaw? If it exists, how common is it?

It used to be thought that some depressions are caused by what happened to us in our lives, and then there is another, purer kind of depression that is caused by something going badly wrong in your brain. The first kind of depression was called “reactive,” and the second, purely internal kind was called “endogenous.”

Scientists have studied people who had been hospitalized for reactive depressions and compared them to people who had been classed as having endogenous depressions. It turned out that their circumstances were exactly the same: they had had an equal amount of things happen to them to trigger their despair. The distinction seemed, to them at that time, based on their evidence, to be meaningless.

There’s no agreement and scant evidence that endogenous depression actually exists, but researchers generally agree that if it exists at all, it’s a tiny minority of depressed people. This means that telling all depressed people a story that focuses only on these physical causes is a bad idea.

There are however situations, in addition to manic depression and bipolar disorder where we know that a biological change can make you more vulnerable. People with glandular fever, or underactive thyroids, are significantly more likely to become depressed.

It is foolish to deny there is a real biological component to depression and anxiety, and there may be other biological contributions we haven’t identified yet, but it is equally foolish to say they are the only causes.

Why then do we cling to the idea these problems are caused only by our brains.

Junk Values. You can have everything a person could possibly need by the standards of our culture, but those standards can badly misjudge what a human actually needs in order to have a good or even a tolerable life. Our culture creates a picture of what you “need” to be happy, through all the junk values we have been taught, that doesn’t fit with what we actually need.

Get a Grip. For a long time, depressed and anxious people have been told their distress is not real, that it is just laziness, or weakness, or self-indulgence.

The right-wing British pundit Katie Hopkins said depression is “the ultimate passport to self-obsession. Get a grip, people,” and added that they should just go out for a run and get over their moaning.

The way we have resisted this form of nastiness is to say that depression is a disease. You wouldn’t hector a person with cancer to pull themselves together, so it’s equally cruel to do it to somebody with the disease of depression or severe anxiety. The path away from stigma has been to explain patiently that this is a physical illness like diabetes or cancer.

We have come to believe that the only route out of stigma is to explain to people that this is a biological disease with purely biological causes. So, based on this positive motive, we have scrambled to find the biological effects, and held them up as evidence to rebut the sneerers.
“See! Even you admit it’s not a disease like cancer. So pull yourself together!”

But does saying something is a disease really reduce stigma?
Everybody knew, right from the start, that AIDS was a disease. It didn’t stop people with AIDS from being horribly stigmatized. People with AIDS are still stigmatized, greatly stigmatized. Nobody ever doubted leprosy was a disease, and lepers were persecuted for millennia.

Professor Sheila Mehta set up an experiment to figure out whether saying that something is a disease makes people kinder to the sufferer, or crueller.

Believing depression was a disease didn’t reduce hostility. In fact, it increased it.

“This way is better”, Marc said, “because if it’s an innate biological disease, the most you can hope for from other people is sympathy, a sense that you, with your difference, deserve their big-hearted kindness.
But if it’s a response to how we live, you can get something richer: empathy, because it could happen to any of us. It’s not some alien thing. It’s a universal human source of vulnerability.

The evidence suggests Marc is right, looking at it this way makes people less cruel, to themselves and to other people.

Pills Pay Big

For decades, psychiatrists have, in their training, been taught something called the bio-psycho-social model. They are shown that depression and anxiety have three kinds of causes: biological, psychological, and social. And yet almost nobody I know who has become depressed or severely anxious was told this story by their doctor, and most were not offered help for anything except their brain chemistry.

Why? CASH!

It is much more politically challenging to say that so many people are feeling terrible because of how our societies now work. It fits much more with our system of neoliberal capitalism to say, “Okay, we’ll get you functioning more efficiently, but please don’t start questioning … because that’s going to destabilize all sorts of things.”

The pharmaceutical companies are major forces shaping a lot of psychiatry, because it’s this big, big business, billions of dollars.

They pay the bills, so they largely set the agenda, and they obviously want our pain to be seen as a chemical problem with a chemical solution. The result is that we have ended up, as a culture, with a distorted sense of our own distress.

Just defective tissue!?

Telling people their distress is due mostly or entirely to a biological malfunction has several dangerous effects on them.

You leave the person disempowered, feeling they’re not good enough, because their brain’s not good enough.

Secondly: it pitches us against parts of ourselves. It says there is a war taking place in your head. On one side there are your feelings of distress, caused by the malfunctions in your brain or genes. On the other side there’s the sane part of you. You can only hope to drug the enemy within into submission, forever.

But it does something even more profound than that. It tells you that your distress has no meaning, it’s just defective tissue.

This is the biggest division between the old story about depression and anxiety and the new story. The old story says our distress is fundamentally irrational, caused by faulty apparatus in our head. The new story says our distress is, however painful, in fact rational, and Sane.

You’re not crazy to feel so distressed. You’re not broken.

“It is no measure of health to be well-adjusted to a sick society.” Jiddu Krishnamurti.

from

Lost Connections. Uncovering the Real Causes of Depression and the Unexpected Solutions

by Johann Hari

get it at Amazon.com

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