Tuesday, February 15, 2005

Does bullshit cause depression?

I'm sure that bullshit is not the cause of all depression (and by "depression" I mean some version of "clinical depression"). But what I find fascinating about depression is its intersection--or not--with events in people's lives. That is, depression is profoundly "internal," and it is only sometimes (apparently) precipitated by events "outside" one's mindbody. It also seems to me that, at least in some people, even if the original precipitating cause is external and/or obvious, the (understandable, predictable, but in many people transient) depression rewires the brain.

Physical pain seems to provide useful analogies here. One type of pain is the relatively transient pain that we experience when we cut or bruise ourselves, for example. It may bother us for awhile, we may even need stitches or something, but time and the body's own mechanisms eventually heal the pain associated with the injury.

Another type is chronic physical pain: some pain disorders arise because the pain is constant, persistent, untreated. Even when the original cause is treated and, presumably, healed, the pain persists. (This article notes
But in some cases this nerve hypersensitivity continues well after the stimulus is gone, like an alarm frozen in the "on" position. The pain takes on a life of its own.

"Persistent pain is not just long-term acute pain," said Dr. Allan I. Basbaum, a professor of anatomy at the University of California, San Francisco and editor of the journal Pain. "The nervous system has changed."

Doctors classify pain into various categories, but there are two main types of persistent pain. One, sometimes called nociceptive pain, results from damage to tissues, as from arthritis or a burn. The other, called neuropathic pain, results from damage to the nerves themselves and is often set off by diseases like diabetes or shingles.

The third type of pain seems similar to an injury I had about eight years ago, to a shoulder. A combination of a handball injury and mousing made it such that even raising my arm to put on my coat caused excruciating pain. I took nsaids, but only sporadically, and it just wouldn't heal. After a few months (I know) I finally went to the doctor, who (a) sent me to physical therapy and (b) gave me some kind of napricin. I took the latter for four days, as directed (i.e., every 12 hours, rather than every 6-7 hours as other nsaids required), and it made me nauseous--but it also took down the inflammation enough such that my shoulder could begin to really heal. I realized that the pain and inflammation were sufficiently intense and severe such that it kept my body from healing itself. Once I took away a little of the inflammation, my body could get to work and get rid of the rest.

It seems--from my armchair-observer status--that depression responds similarly, i.e., in one of three ways. It goes away by itself, aided by time and perhaps some minor (but not chemical) intervention. It rewires the brain such that antidepressants become something the person is likely to need for the forseeable future. Or it doesn't respond to time, but it does respond to antidepressants, and the person can eventually stop taking them. (It's not clear to me how many people actually stop taking them, though.)

At two points in my life I probably qualified as clinically depressed, and, in at least one of those circumstances, I still couldn't tell you what "caused" it. I eventually just snapped out of it--mostly, I got tired of it. At at least one, possibly two, other times in my life, I went through horrific experiences that, on some level, should have caused depression, but didn't. In the first instance, I went through serious turmoil, but it was entirely appropriate to the horrific situation I was experiencing. In the second instance, I was terribly depressed when pretty much everything in my life was going wrong (people dying, massive debt, being forced to think up a new career, being unemployed, having an unsatisfactory love life, and pretty much all at once), and it continued until I eventually found a job--but it went on for about four years. Still, when friends suggested that I was depressed and that I should "see someone," I pointed out that (a) I couldn't afford to do that, and (b) given my circumstances, anyone who wasn't depressed in those circumstances wasn't paying attention. That is, it seemed to me that my mood was an appropriate response to my situation and would only be a cause for concern if the situation changed I didn't. I didn't think of myself as depressed, on some level, even though on some other level I suppose I was. In any case, when the situation changed--mainly, I got a job--I was able to change the rest of it, too.

Where, then, does bullshit fit into this schema?

I'm unwilling to pose a direct causal connection. But I continue to think about my second experience. That is, as noted, depressed mood was a completely appropriate response to what was happening in my life. Someone who was broke, unemployed, in debt, being forced to change careers, and, for at least part of the time, mourning somone, but who wasn't exhibiting signs of depression, well, that sounds peculiar to me. I know that I really wasn't much fun to be around during a lot of that time--hell, I didn't like being around me all that much. And I wonder sometimes whether my refusal to pretty up my circumstances when people asked about them is related to my eventual ability to heal the wounds.

I actually think we're given wildly conflicting messages. We're not supposed to burden the people around us with the ugly facts of our lives, but we're also a culture of whiners sometimes. We're supposed to tough it out, but the pharmaceutical industry promises a cure for all kinds of ailments and why should we suffer? How can we sort out which ailments need what kind of intervention? We're constantly beset by diet fads, even as we refuse to adopt the Simple Two-Step Diet Plan (eat less; exercise more) and even as we look for more ways to process food-like substances before we ingest them. We worship at the temple of stick figures, even as obesity plagues the land. Where is reality in all of this?


Blogger kStyle said...

Very interesting post. I'm going to reflect on this a bit.

You might be interested to hear that in Chinese medicine, "depression" can be one of several patterns. Here are a few different, and interesting, links on the topic.

I haven't read this one yet:

Or this one:

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Blogger Emma Goldman said...

Those really were interesting--not least because I didn't recognize myself in any of the descriptions (which fits in with my thought that my responses were appropriate in important ways, relative to my situation). I do wish I could hook you up with a friend of mine in Boston who's been taking antidepressants for years (and cannot function without them).

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