Examining Depression

Canterbury Bells - Antique - emerged after decades under leaves-to alter-illusion

Some people think of depression as one condition or disease, easily defined and characterized. I believe that is untrue. First of all, there are many people who have depression and are not aware of it. They cover it up, cope with its symptoms and achieve customary and even great things (look at Van Gogh). However, this does not mean that the syndrome will not catch up with them eventually and cause breakdowns or even suicide. Of course, this was far more common in the day before the discovery of psychoanalysis and psychotherapy.

The other thing that many therapists have realised (even if they overuse it) is that anxiety can be a mask for depression. Yes, anxiety is often simply anxiety, or even panic disorder, but pretending that one is not depressed can be exhausting and frightening. The effort creates anxiety and this stresses the body until one breaks down, or resorts to drug and alcohol use. Not surprisingly, the use of alcohol–a depressant–in particular merely exacerbates the depression. It creates a spiral of increasing feelings of low self-esteem, a sense of despair and lack of motivation and energy, “treated” with a drug that only makes these feelings worse.

Another attempt at self-treatment is the use of stimulants, such as cocaine or methamphetamine. For some people, the feeling of depression is so disturbing that they seek to reach a state of hyper-awareness and a constant state of agitation and excitement. Just as the alcohol user seeks more of it as the effect wears off, the user of stimulants dislikes it when their effect winds down and even a state of calm takes over. They fear that the next step is depression, so they need more coke, more meth or more of whatever stimulant they choose.

I remember a brilliant, young man from Georgia who was in graduate school for physics at the University of Massachusetts. He had two difficult areas of study and yet was very “non-nerdy”. His persona was open and relaxed, so much so that his presence in a room had an almost mesmerizing, calming effect on everyone.

Sadly, he became caught up in using cocaine and eventually dealing it. He became hyper, paranoid and lost his calming, laid-back personality. One morning, he burst into my bedroom at 8 A.M. on a frigid, winter day. He was raving about having been attacked by a giant karate expert and fleeing to his car, barefoot across the ice. His feet were cut up and bloody. I gave him some peroxide and bandages, then plied him with a 1 mg of Valium and a glass of wine. This seemed like a reasonable amount and a simple way to stop his raving. He calmed down but soon became annoyed at his relaxed state! Sure enough, he pulled out some coke and did a line, while I protested.

He said that the wine and Valium had “brought him down too much”! After a couple of lines, he returned to his hyper state. I asked him if he had more cocaine out in his car and he said “Yes”, as if it was totally normal. I grew angry (angrier!) and told him I didn’t want to be part of some drug war, nor become an accessory if he got arrested. Sadly, I made him leave, heading out to parts unknown. Months later, I heard that he was back in Georgia, “hanging out with the good ol’ boys and drinking bourbon”. This was all he could take, he said; the atmosphere of academia and the cocaine culture was too much of a lure to him.

Though it seemed that he saved himself to a degree, it saddened me that he had given up so much in terms of his studies. Was he depressed? Did his calmness and laid-back attitude mask depression? Did he seek out cocaine because the depression was so unbearable, he needed an escape? I would never find out but it seems plausible.

What is depression, according to the psychological and medical community? The National Institute of Mental Health characterizes depression as a persistent feeling of sadness, lack of interest and a feeling of hopelessness (among other symptoms) that lasts for two weeks or more. This is a bit arbitrary, since people often experience what is called “reactive depression” after major traumas such as the loss of a loved one, a job or diagnosis with a serious illness such as cancer. This sort of depression can last longer than two years and then resolve. This is not seen as the same as what is called “clinical depression”, which, unlike the reactive kind, will not resolve with time, but persists for at least two years and should be treated.

Often known as “dysthymia”[1], clinical depression or “Major depressive disorder”, can increase and decrease in intensity, but never goes away. Common signs are difficulty with sleeping (either too much or too little), eating, trouble with everyday activities such as work, housekeeping, school work or when older, raising children. Having a child can exacerbate depression or even create a temporary form usually called “Postpartum depression”, which can even turn into psychosis.

There are other forms that you can read about at the source below, but I would like to focus on dysthymia, the most common form of depression. Stories of various people’s depression often remind me of a well-known fantasy novel, The Wizard of Earthsea,  by Ursula K. LeGuin. The hero, Ged, is on a journey of self-discovery and begins to notice a dark shadow in the distance and becomes convinced that it is after him. He knows that it was created by one of his spells that went wrong. It is supposedly an ancient creature that wishes to possess him, according to his teacher, an archmage. He increases his flight from it, hoping to outrun it in his ship, but it just gets closer each day. The hero’s journey continues but he becomes more frightened and possessed with a sense of doom, as the shadow draws closer. Finally, it attacks him, scratching his face and destroying his wizard’s staff.

Finally, in desperation, and with advice from a wise man, he turns and faces the shadow, chasing it from place to place, determined to fight it. When he does, he realizes that the threat is actually his own fear, embodied. The darkness shrinks, he accepts the shadow as part of himself, gives it his own name and is finally at peace. By acknowledging the shadow/fear, he takes away most of its power.

The analogy here is that so often, with depression (and anxiety), we try to run from it or subdue it with drugs, alcohol or even frantic activity such as work or causes. These go against LeGuin’s Buddhist philosophy with which she infuses the Earthsea trilogy. Things in the novel’s world need to be in balance, she has the inhabitants say.

Ironically…and happily, the practice of Buddhism has led modern practitioners of psychology to come up with a technique to address emotional problems such as depression and anxiety. It even works well for panic disorder, which has had few effective treatments until recently.

The therapeutic version of Buddhist “mindfulness” is called “ACT” or Acceptance-Commitment Therapy. The idea is that, rather than trying to deny things like depression or anxiety, one accepts that it is there, then uses imagery and mindfulness to put the negative thoughts on “hold” so that one can take care of the necessities of life.[2]

One reason for its effectiveness is that it leaves behind the traditional use of talk therapy, to a great degree, and utilizes the awareness of how one thinks about things like depression or anxiety. In our culture, so many people are conditioned to believe that if they have one of these psychological problems, then they are somehow “less” or “broken”. However, when one uses ACT, there is a new and encouraging sense of personal power, an ability to direct one’s approach to problems. That is accompanied by the sense of balance and awareness.

I do not claim to be any kind of expert on depression and I should add that there are certainly people who do need more than therapy (medication), not just for depression but anxiety and panic disorder. But it is freeing to have a technique that allows the individual much more control and hopefully, an alternative to alcohol or illegal drugs to quell the pain.

Another approach to depression is the one our son thought up. He says that he “embraces” his depression as a part of himself, much like the wizard Ged, of Earthsea. While it’s tempting for a parent to object, wanting one’s child to be happy and never depressed or anxious, it is best to realize that your offspring should do the same thing as any other healthy, young adult does: forge his or her own lifestyle and philosophy according to their personality and preferences. Just because you don’t usually get depressed does not mean that your son can expect the same thing.

One can be grateful that new methods for treating depression via therapy and self-exploration are now commonplace and easy to learn, usually with no cost.

[1] https://www.nimh.nih.gov/health/topics/depression/index.shtml

[2] https://contextualscience.org/list_of_resources_for_learning_act

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The Kids R Not “A.I.-lright”!

I was reading a post about an online therapy site called “Koko”, which offers “alternative ways of thinking” to troubled people. Apparently, it is now either partially or wholly taken over by an A.I. Really? I mean…REALLY?! It’s bad enough that people actually talk to Alexa but this is, as a Far Side cartoon once wrote “Just Plain Nuts”. In a scene from the breakthrough show, “Mr. Robot”, a lonely F.B.I agent asks Alexa if she loves her. The perfect answer, to which everyone should pay close attention, is: “I am not capable of that kind of thing.” It does not take a genius to figure out that Alexa, though programmed to say that “I feel good when I help you” and that she likes the color ultraviolet, is not capable of any human emotion or thought process, let alone love. This includes, concern, compassion, curiosity, reasoning, responsibility and any other type of thought that is involved in real therapy. One things at which Alexa DOES excel is admitting that she does not know something. More humans could use this trait but having it does not make a therapist.

I have often thought of an online therapy site as being potentially helpful for those who think that going to a therapist means that one is crazy, or those who don’t believe in it or those who are just not ready to spill their deepest thoughts and feelings to a real person. After all, not everyone is cut out for the therapeutic modality. And in fairness to the online shrinks and even to an A.I., not all therapists are great. Some should never be allowed to dispense advice about life to anyone. I have known some of these people. But there are far more good, live, trained therapists out there who can and do help those in emotional pain. They see them regularly and remember their names. They take notes and remember what both of you said in a session. Still, it is probably better for some people to seek online help than go to a live shrink and get nothing out of it for whatever reason. That lonely F.B.I. agent comes to mind, pathetically.

But I draw the line at promoting the idea of entrusting one’s mental well-being, including the decision about whether or not to end one’s life, to a software program. Where in blazes did humans get the idea that talking to an A.I. was remotely helpful, at least in the long run? If said descendant of Hal tells you that you should ignore the thugs who bully you every day, or that getting a hobby can ease depression, or that thinking about PTSD differently will cure it, and these “solutions” do not work (a good bet), then who is held accountable? A shrink can be reviewed, disciplined and even sued or sent to jail for screwing up someone’s life even more than it already is. How do you punish an A.I. for doing the same thing?

When I first read that this online shrink was named Koko, I immediately thought of the talking gorilla. It is not out of the realm of possibility that one might be better off having a hug-fest with a gorilla, or even the family dog, than listen to programmed “solutions” parroted by a brainless, soulless machine who, let’s face it, does not even know you are there, much less give a damn what happens to you.

For more well-deserved paranoia:

http://www.vox.com/conversations/2017/3/8/14712286/artificial-intelligence-science-technology-robots-singularity-automation