Sunday, December 18, 2011

Bad Feelings Come From Your Brain, Not Your Life

Well, it's been a while since I've last posted--three months, to be exact.  But today I have something to talk about.

Recently I read an article that was published in the December 1975 Saturday Evening Post that addressed depression and brain chemistry.  Scientists were still learning things about brain chemistry back then (as they are today) and had not yet developed the drug Prozac, but what the author says is interesting, in that she says that severe depression can be relieved quickly with the use of drugs. She also says that long term therapy might need to include psychotherapy.  The central point she makes is that depression is a common malady and has been for centuries, and that we should think of it as a medical condition rather than a shameful mental illness.

I would concur with everything Marion L. Steinman says with respect to depression; all of it is still true today, as well.  But I would also say that with the advent of all these popular drug therapies it's become almost trendy (among a certain set) to be taking anti-depressants.  In fact, many non-psychiatric physicians have taken to prescribing psychotropic drugs as if depression were strictly a medical condition that is effectively cured with medication.

Many people believe that to be the case, including those who suffer from depression or anxiety.  But I've always believed that there's more to it than that.  The drugs don't work for everybody, and they don't work perfectly either, even for those who've taken them for years.  Plus, there are still the residual effects of the condition that cause emotional and behavioral problems not fixed with drugs.

Recently, drug marketers have been trying to get people who already take an anti-depressant to take an additional drug to deal with the depression that is not completely cured by the first medicine.  This additional drug is more powerful and is actually a different kind of drug--an anti-psychotic rather than an anti-depressant--with many more serious side effects. 

I feel this strategy is at best misguided; people might be better helped (with less risk) by learning to do other things to mitigate the ill effects of their brain chemistry instead of immediately medicating it.  At worst, the pharmaceutical companies' strategy is purely financial: drug companies are trying to find more people to buy the drugs they manufacture--drugs that are currently being prescribed to only a small group of people--whether they really need them or not.

Implicit in the ads is the message that only perfect relief from depression is acceptable.  Unless you're happy all the time, your current drug is not doing its job.  This message is not helpful.  Depression and other brain-chemistry caused psychological maladies are not the same as pneumonia or some other disease that can be cured with medication.  Even if a person's antidepressant is effective, the condition is chronic and must always be accounted for and monitored in his or her daily life.

One of the comparisons Marion makes in her article is that depression is like the common cold.  While that's a comforting analogy for people who tend to think of mental illness as wierd, it's not quite accurate since the common cold comes from an outside source, while depression comes from within. A better analogy would be one that compares depression to a chronic genetic disease like Parkinson's or muscular dystrophy.  Medication can alleviate symptoms but does not make the condition disappear.  (For a while doctors thought Prozac could change one's brain chemistry permanently.  I think they have probably since found that they were wrong.)

If a person has a debilitating chronic condition, he or she must work around it as much as possible. Medications can only do so much.  The person who lives with the condition must find ways to accomodate its presence in his or her life.  Depression is like that; medications can help, but people must still do things to deal with it as best they can.  I've come up with ways to deal with mine without medication, but even people taking medication need to find ways to cope.

My method is simple: awareness and pre-emptive strategies.  If those don't work, then strategies to cut the duration of the attack are the next option.  Being aware involves 1) acknowledging that the feelings are generated by the brain and not by the outside world; and 2) realizing I can do something to make them go away or at least diminish them.

What I do depends on where I am and what I'm doing at the time I feel the onset of brain chemistry imbalance.  If I'm at work, there are certain things I can't do that I can do at home, and vice versa.  Most of my coping strategies involve some form of scanning--either visual or auditory or even olfactory or tactile--that focuses the mind on paying close attention, noticing details.  But exercise, reading and writing also help because they involve focusing the mind on a particular goal.  It's important to remember that the action doesn't have to have anything to do with what is happening at the time the brain chemisty takes a turn.  That's because it's usually true that the brain chemistry's fluctuations themselves don't have anything to do with what's going on at the time.  They may be random or on a cycle, but the changes occur because of something in the brain, not something in the world around us. 

It is vital to remember this one point because it makes the bad feelings into a physical problem, not a mental or emotional or relationship problem.  And so when you feel the bad feelings coming on, you don't have to fight with your spouse or quit your job or make a drastic change in your life.  And you don't necessarily need to hide in your house or disrupt your daily life either.  You can even do the exercises in your head while going about your normal routine--driving to work, sitting on the toilet, taking a lunch break, cooking dinner--by making that activity part of your therapeutic strategy.

For instance, while cooking dinner you can pay close attention to the smells or the colors or the textures of the food you are preparing.  While driving to work, instead of talking on the phone, you can pay attention to the cars around you, to the sounds of the smells or sights within your view.  You'll probably be safer that way, too, as well as less stressed out.  Often people who are depressed or angry think about what has gone wrong or will go wrong in their lives.  If you pay close attention to something neutral, it stops you from those thoughts. But the act of noticing (scanning/focusing) itself works to alleviate the symptoms.  I have my theories about why that's true, but the fact is it works!

I guess that's enough for now.  More next time.  See you then.

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