Brain Chemistry and Addictions

Today I want to explore the connection between bad brain chemistry and addiction.  In the past, I've pointed to various self-destructive behaviors as being the BBC sufferer's attempt to fix the problem caused by his or her bad brain chemistry.  It's a form of self-medicating to binge on alcohol, food, tobacco, drugs, shopping, gambling, sex, video games, channel surfing, texting, hand-washing, hoarding, or even violent behaviors such as beating or killing or destroying someone or something.  (People who kill animals obsessively, for instance, are self-medicating, I believe.)

People use these forms of medication because they work--they make the bad feelings go away.  Unfortunately, even the relatively harmless remedies don't work for very long, and people find they need more and more of the medicine more and more frequently to obtain the same result.  In other words, they develop a tolerance for it, and as their tolerance builds so do the medicine's costs and debilitating side-effects.

There are treatment programs for the more well-known obsessions, and people are becoming aware of how many ways there are to become addicted, thanks to a number of shows currently on TV that depict such maladies.  One of the things all the treatment programs seem to have in common is that the addiction is a medical problem, something that can't be helped.  The two methods used to treat addictions involve either swearing off the behavior completely or gradually decreasing the incidence until it's at a reasonable level.  Both seem very difficult for the addict to accomplish.

The same serotonin uptake inhibitor drugs used to treat depression are often recommended for addictions, with the idea that bad brain chemistry is causing the addictive behavior.  I wonder, though, if there's a way to using cognitive therapy to fix addiction. I'm guessing it would be very difficult, but maybe it would work better than what is being used currently.

Let's think about that for a minute.  The addictive behavior is in response to the feeling state produced by the brain.  The logic goes like this: I feel terrible.  Doing X will make me feel better, so I need to do X so I can feel better.  And I need to do it right away.

The urgency of the need is indicative of its being brain chemistry induced.  It's not simply a desire, but a powerful urge, a craving that is out of the normal realm of desire.  And what kind of need falls into that category?  A life-or-death urgency.  When one is in a fight-or-flight situation, time is of the essence.  If you're confronted by a mountain lion about to pounce, you can't afford to wait until a more convenient time.  You need to respond now!

Does the brain create that need?  I don't think the brain is particular about what the person uses to respond to the apparent emergency.  Whatever works is what the brain will be satisfied with.  The need is for the pain (that comes from the fear) to stop.

I know, I know--it doesn't feel like pain.  For example, I was at a luncheon today and even though I wasn't hungry after the first several bites, I ate everything on my plate in addition to the candy appetizer.  There are a lot of theories about why I did that, but I'm satisfied that it's an addiction.  The clean plate is the signal to stop, not the full stomach.  (Shirley Simon talks about this in her book, Learn to Be Thin.)  But I don't recall any pain associated with my behavior.

But what produces that desire to see the clean plate?  That's the question that most intrigues me.  In order to change my behavior, I would have to know the answer; otherwise, it's just a matter of doing what I'm told--to respond to the full stomach instead of the clean plate--a task that seems like it should be easy.  After all, it's just a matter of doing one thing instead of another.

So, what produces the urgency to eat until the plate is empty?  It must be providing me with the medication that I need to make the bad feeling go away.  But what is the bad feeling?  I don't recognize it when it sweeps over me.  But I do feel anxious when I see that there is food that is not being eaten, on my plate or someone else's.  Where does that feeling come from? 

Let's look at my original premise: the brain produces the bad feeling for no reason other than its own hyperalertness.  I feel hungry and that frightens me, so I try to feel less frightened by eating.  At that point, my mind is keenly focused on food.  I'm not paying attention to other things around me becaused I'm distracted by the desire to eat.

But what happens when I do eat and I'm no longer hungry?  Why do I keep eating?  How is my brain producing this desire?  Clearly it's not related to physical satiety.  What is it related to, then?  Well, maybe it's just what I've learned to do to make the bad feeling go away.

Like right now I feel bad, but the reason (I tell myself) is that my sister is unhappy.  I want my sister to be happy, so I try to do something right away to make my sister feel better so I can feel better.  Did I start out with the bad feeling that then fixes on my sister's problems?  If my sister no longer had problems would I still need something to be worried about?

Perhaps that's an addiction like any other.  I feel bad->I look for a reason to feel bad->Finding a reason creates the need to find a solution->act on that desire by carrying out the solution.

So, if I apply this reasoning to my eating behavior, I have this.  I feel bad (brain chemistry solar flare); one of the ways to make myself feel better is to eat; when I eat, I feel better.  I might even keep eating until I'm sure I won't feel bad again.

But the fact is, any number of actions will fix the brain chemistry.  And by the way, sometimes the brain chemistry produces euphoria instead of dysphoria.  It doesn't matter, really, the response is the same--do something to get my brain back in balance.

Some people would say: oh, come on! Is there no good reason to feel bad in your world?  Yes, there are good reasons to feel bad.  It's reasonable to think that I would feel bad because someone I love feels bad.  But then my desire to do something about it has more to do with me than with my loved one.  I want my sister to stop feeling bad so I can stop feeling bad.  That's about me, not her.  And even if I do solve this problem for her, she'll come up with another one, and another one after that.  And I'm going to keep feeling bad with her until she stops feeling bad (never, apparently).

So, what to do? More on that later.

Worrying

This morning I woke up early, as I often do, and started worrying. No doubt my brain chemistry is to blame, because I felt really terrible.  As usual, there was no reason to feel terrible.  Yes, I have plenty to worry about, as any person does.  But I know that worrying does no good, especially if what I'm worrying about is not under my control.  And certainly worrying in the middle of the night and losing sleep is not good for me at all.

Worrying is a form of caring, or at least that was what I was brought up to believe.  If you're not worried, you don't care.  But worrying is also a way to try to control the person you're worrying about.  Letting her or him know that the worrying you're doing is painful suggests that the person could stop the painful worrying by fixing whatever is causing the worrying: "If you go out in the snow storm tonight, I'll worry about you until you come home.  I'll be up all night and I have to go to work in the morning.  If you really cared about me, you wouldn't go out and make me worry that way."

So the person who worries shows she cares, but the person she worries about should show he cares by not doing whatever it is that makes her worry.  But if her pleas work and she never has to worry again, how will she show she cares?  It's a paradox, but don't worry.  She'll find something else to worry about soon enough.

Worrying happens in anticipation of a threat, because worrying always involves the future.  When we worry, we fear what we imagine could go wrong rather than what is going wrong now.  The worry is based on what has happened in the past and what could logically happen in the future given the present set of circumstances.  It's kind of like betting on what could go wrong; you win if you're right.  But you don't really want to win because that means that whatever could go wrong did go wrong.  (People who believe in Murphy's Law ["whatever can go wrong will go wrong"] are great worriers.)

Unlike a real and present danger, imagined dangers can escalate quickly, especially if the worrier has a good imagination.  What is the end result of a particular decision? No one knows, but worriers can always imagine.  I'm reminded of the series of commercials on TV that shows bizarre sequences of events resulting from using Cable TV instead of Dish.  The Rube-Goldberg-like scenarios are highly improbable but also highly imaginative and entertaining.  In a (mostly) comical way, they show the extent to which a single innocent-seeming decision can lead to disastrous consequences.

We all have the ability to imagine such consequences and to fear them.  We might even try to avoid them by making a different decision (such as not sticking with Cable TV).  Worrying, though, is something we do when we don't have the ability to head off consequences, mostly because the decision is another person's to make.  So we suffer pain from a life-or-death situation that hasn't happened yet.

Is that really different from the scenario we come up with during a brain chemistry attack?  Not really.  Ordinarily, the story we invent to explain the brain-generated bad feeling is one that is happening now.  With worrying, the story takes place in the future.  And then, once the soon-to-be-life-threatening scenario is imagined, it becomes like any other fictional rationale and takes on a life of its own.  The worrier tries to respond to what seems like a flight-or-fight situation.  But how would she respond?  Well, it depends on where and when the worrier is coming up with the dreaded scenarios.  If it's the middle of the night and the worrier's in bed, she's limited in her responses.

For instance, if I wake up and worry about whether or not the door is locked, I will eventually have to get up and find out.  Once I do that I feel better for a few minutes, but now I'm wide awake, and though I go back to bed, I don't go to sleep right away.  Instead, because the bad feeling is back, I find something else to worry about, something I might vow to fix in the morning.  Luckily, once morning comes I have a clearer perspective and find I don't have to do anything.  Or perhaps I find that I can't do anything.  But unless the bad feeling is gone completely, I still anticipate the bad event.  Sometimes I'll tell myself that I can't do anything, or that there's a solution I can apply in the future if it comes to that, and I do feel better.

The important thing is--as with all bad brain chemistry attacks--to get rid of the bad feeling as quickly as possible.  Now, I can hear protests from those people who are heavily invested in the value of worrying.  If I get rid of the feeling, doesn't that make me a bad person, an unfeeling wretch?  Well, that's a question that comes up whenever a person who is miserable because of brain chemistry tries to stop feeling bad.  If a person stops feeling bad, the logic goes, then he stops feeling.  That's utter nonsense, of course, because joy is every bit as legitimate a feeling as sadness or anxiety or anger.  Why is it not as valued, then?  A good question, and one I think needs to be answered.

The Power of Ruby Slippers and Magic Words

So, you're the owner of a hyperalert brain that gets alarmed at the slightest provocation and sends life-or-death signals that must be responded to immediately to avoid psychic pain. Your fight-or-flight response to that alarm causes problems in your life in many ways, not the least of which is the effect is has on the people around you who witness it.

But part of the difficulty of avoiding psychic pain is that the person experiencing the false alarm and responding to it doesn't realize that the bad feeling is coming from his brain.  He thinks himself fully justified in being angry or sad or anxious or lethargic because he has come up with reasons for his feeling state that make perfect sense to him.  That they don't make sense to others doesn't matter to him.  He may tell himself that his friends or family or coworkers just don't understand, or that they are jealous and seek to sabotage him.  It doesn't occur to him that he is getting upset about something minor or easily tolerated or quickly remedied, and if some brave person points it out to him, he indignantly insists his complaint is legitimate and his so-called "friend" should support him in his beliefs.

A friend who wants to support him, though, often doesn't fare any better. She may get trapped into what would seem a rational strategy of offering suggestions for how the person could fix the problem.  These suggestions are usually rejected, one by one, until the helpful friend gives up in exasperation.  The offered solutions are rejected ostensibly because they are bad solutions, but in reality, the problem is not what the hyperalert person has presented it to be; the problem is his brain chemistry.  The friend's suggested remedies will not help the real problem. The sufferer probably realizes the truth on some unconscious level, so he avoids solving the imagined problem to avoid facing the probability that even if he finds a solution, he will still feel bad. 

And that's what usually happens.  A problem solved may be followed by momentary relief, but then the bad feeling returns and another, equally intractable problem is identified that must be solved in order for the hyperalert person to feel good again. And so the cycle continues, sometimes for a whole lifetime.

How can this be avoided? Well, the first step is to acknowledge the brain's role in producing the bad feeling.  That's not easy. People often are heavily invested in their rationale for why they are unhappy. Acknowledging the brain's role means acknowledging that your unhappiness is all in your mind.  When you've spent a lifetime blaming everything and everyone outside yourself for your misery, you're not eager to accept that you can stop being miserable whenever you want.  And perhaps even more difficult to accept is knowing that you had the power to change all along, that all those years of misery could have been avoided.

Once you see your brain chemistry as the culprit, the next step is perhaps harder to take: to make a different decision about what to do when the bad feeling strikes.  The brain's alarm is powerful; the strength of the longstanding stimulus-response chains makes it hard to think and to resist.  The sequence is firmly established, after all, so the organism doesn't have to think, just react, the way she should in a real life-or-death situation. But when it's not life-or-death, changing her response means going against powerful conditioning.  It gets easier with time and practice, but there's always a chance that the automatic response mode will kick in when the hyperalert person least expects it, undoing perhaps months of "normal" behavior.

False Alarms

Making the bad feeling go away--ideally, before the person responds inappropriately--is the ultimate goal of my cognitive therapeutic technique.

Bad feelings come from the brain, but sometimes the brain is making a mistake. It's sending fear chemicals when there's no reason to.  I don't know why this happens (yet), but my guess is that the brain is wired to sound the alarm at the slightest provocation. Like the over-sensitive car alarm that goes off when someone merely brushes up against it, the hyperalert brain may also be too sensitive.

But even though the brain's alarm is false, the mind responds by taking the alarm seriously and trying to figure out where the threat is coming from so it can direct the body to do something about it.  It follows the brain's stimulus with an immediate response, a response that often causes the person problems.

My technique tries to interrupt that stimulus-response chain with a time-out during which the mind determines if the brain has sent a false alarm.  If there is no threat, the mind stands the body down.

Simple, right?  Yes, but despite the mind's accurate assessment that there's no threat, the brain continues to send out an alert.  It's similar to what happens when your smoke alarm goes off from a steamy pot of spaghetti cooking on the stove.  You know there's no fire, but you want the terrible noise to stop, so you frantically run around, moving the source of the "smoke," waving towels at the alarm, and if all else fails, pulling out the battery. 

Getting the erroneously produced bad feeling to go away is like stopping a false smoke alarm: you try everything until something works.  It's so painful, you would never just wait until it went away on its own.

People who are hyperalert suffer from false alarms frequently. Whenever the alarm happens, they do whatever they can to make the pain stop.  Often, because they haven't assessed the degree of threat, they are responding to the alarm as if it were a real life-or-death emergency.  Their actions to stop the threat (whether fight or flight) work; they feel better. But their response leaves everyone around them feeling worse because it was inappropriate, frightening, offensive, or even harmful.

Getting back to my example about the smoke alarm: what if you didn't stop and assess whether or not there was a fire? What if, every time your smoke alarm went off, you assumed there must be a fire, evacuated the building and called the fire department?  The firefighters would come each time because it's their job, but after a few such times they might come more slowly, and they'd probably be angry with you for the time and money you wasted on a non-emergency, especially if a real emergency happened at the same time.  You might even be prosecuted or charged.  And needless to say, when you really did have a fire, the fire department would assume that it was just another false alarm. ("The Boy Who Cried Wolf" story comes to mind here.)

Something similar results each time the hyperalert person "goes off" over some minor event. People who might otherwise be sympathetic to a shower of tears or persuaded by an angry protest become inured to the hyperalert person's irrational outbursts.  Each incident solidifies in their minds that the person is troubled; they end up disliking or fearing her or him and staying away as much as possible to avoid the next unpleasant encounter.

The Third Option

Today I want to talk about what's behind my treatment technique called scanning.

Earlier in this blog I wrote a post called "Fight or Flight? How about neither?" In it I outlined my approach to the fight option, where I get enraged about an event in a way that suggests I'm afraid for my life, yet the circumstances of that event are anything but life threatening. My approach is first to realize I'm not in a life-or-death situation, and second, to do something other than fight in response. That's where the neither of my title comes in.

The third option is the option that arises when the organism determines he or she is not threatened, or at least, not yet.  That option might be called Watchful Waiting.  It involves holding off taking an immediate action to vigilantly look, listen, taste, touch, smell, investigate, explore, check things out, closely scrutinize, experiment, think, surmise, wonder.

I know you've seen animals use this option when confronted with a new creature in their environment.  If the animal doesn't feel particularly threatened, it will check things out--poke or prod, sniff, provoke, closely watching what the other creature does.  Sometimes the animal gets a nasty surprise in response to its investigations: the creature being poked pokes back.  Other times the new creature is deemed harmless and the animal moves on.

Wild animals must often be on the lookout for predators as they go about their business.  Hooved animals, for example, need to go to the watering hole to drink or bathe, so despite the good chance that they'll meet a big carnivore there, they go.  But they stay vigilant, wary of the predator's approach.  That heightened awareness helps them to escape when their lives are in imminent danger. They can quickly switch to fight-or-flight mode if need be.  After all, they have little choice; if they stay away from the watering hole for fear of encountering a predator, they'll eventually die of thirst.  So they go, but stay watchful. 

Some animals have trouble striking the right balance between acting and watching.  The male cardinal that visits our birdfeeder is an example.  He comes to get the seeds my husband and I put out for him, but if other birds (sparrows, for instance) come to feed at the same time as he (though there's plenty of room for all), he spends most of his time fighting to keep them away and barely gets a chance to munch a seed or two in the interim.  I admit that the sparrows might seem a bit intimidating in large numbers, but if the cardinal would stop fighting, he'd see that the sparrows are not going to get all the seeds and he would be able to eat his fill.  He chooses fight instead of watchful waiting, and consequently, he doesn't get to eat. 

The cardinal's mate, on the other hand, has figured out the sparrows are no threat. When they come to eat, she doesn't try to chase them away but instead continues eating, and then all the birds can happily eat their fill.  Obviously, at some time in the past the female cardinal made the choice of watchful waiting when confronted with a possible sparrow threat, and she is the better for it, unlike her mate, who must look for a time when sparrows are nowhere in sight to eat without interruption.

Humans are no different than other animals. When confronted with a potential threat, they too must decide whether to fight, flee, or watch and wait.  Of course, the choice first depends on the degree of threat.  If one's life truly is in imminent danger, then action is the right choice.  The trick is to assess the threat correctly.

But unfortunately, if you're a hyperalert person, bad brain chemistry can make a correct assessment difficult.  For instance, if my brain is suddenly flooded with fight-or-flight chemicals, I'm going to react without thinking, even though there is no real threat to react to.  Making a different decision at that point is hard, but what I should do is to immediately recognize the feeling as coming from inside myself rather than from outside and then choose to ignore it and avoid the erroneous and possibly harmful fight-or-flight response. 

Once that is accomplished, the next step is to make the feeling go away, and here is where the third option, Watchful Waiting, comes into play.  More on this later.

My Theory

I've been thinking lately about hardware and software with respect to the brain and the mind. The hardware (your brain) is what you're stuck with, but the software (your mind, your interpretive apparatus) you can re-program.  People who use drugs and other chemicals are trying to fix the hardware without changing the programming, believing that fixing the hardware is enough.  Whether it really fixes the hardware is still being researched, but I believe that the behavior that has resulted from the faulty hardware also needs to be fixed because it will continue despite the chemical patches applied to the brain.

It's important to re-program the mind, whether or not you try to patch the brain, because it is the programming and your response to the programming that are making your life miserable, not the brain.  The brain is doing its thing, but your response to what your brain is doing is causing the problems.

Here are the main tenets of my theory:

1.  Hyperalert people have a certain inconvenient brain chemistry.

2.  The hyperalert brain delivers a message of danger, evoking fear.

3.  The mind tries to contextualize the fear.

4.  The mind causes the organism to respond with fight or flight.

5.  The action causes the organism to feel better (until the next time).

In order to be more convincing with my argument, though, I need more back up from science. So I'm going to buy a textbook about this subject and read it and then study this topic until I have support for my theory.

Creating Narratives

This morning, I went back and read all my posts for the past year and a half.  I like my ideas about brain chemistry but I wish I could share them with more people.  This is the shoal on which my ship of good intentions founders: the hard reality of the difficulty of getting people to listen and understand and agree that my perspective is valuable. 

It seems that everyone loves to disagree these days.  All our media is filled with conflict, much of it, it seems to me, manufactured for the purpose of selling more goods and services.  Ah yes, commerce.  The bedrock upon which our nation was founded.  Nothing wrong with that, but I wonder if our method of promoting sales is good for us.

We seem to have entered a period in which every communication between people must be a narrative. There's nothing wrong with that on the face of things, but unfortunately, a good narrative, one that succeeds at getting people's attention and entertaining them, must contain conflict, and that conflict must be sufficiently compelling to get the viewer/reader to stay with it to the end.  "Only trouble is interesting," say the fiction-writing teachers.  So in an effort to get people to pay attention to their messages about goods and services that are for sale, advertisers (and the shows they sponsor) copy fiction's structure and try to create narratives with as much "trouble" as possible.

And so we have shows like the long-running Survivor and its many imitators, to the point where every reality show must have some kind of conflict to be seen as viable.  Even shows that are not contest shows (that is, already set up for conflict) must, it seems, contain conflict in order to be thought interesting.  For instance, American Chopper, a reality show centered on what would normally be considered a peaceful activity (crafting a motorcycle), becomes instead a soap opera about the crafters' intra-familial fights.  That soap operas are traditionally fictional is my point: what we call "reality" shows these days are more fictional than the shows they are trying to emulate.  Because of the success of American Chopper and other conflict filled shows, we now have a number of shows that are, like soap operas, based entirely on dysfunctional relationships (Keeping Up With the Kardashians is one of the many).

But what does this have to do with brain chemistry? Well, the process of creating narratives in the media is similar to the process individuals with bad brain chemistry engage in to rationalize why they feel bad.  The bad feeling that comes from the brain is out of context, so the sufferer creates a context that makes sense.  She writes a narrative that contains a conflict to which she must then respond. And owing to the requirement that in order to be sufficiently compelling a narrative must have serious conflict with dire consequences, the person who feels bad must create a conflict that requires an immediate and serious response.  Life or death, fight or flight.

Unfortunately, the drama unfolding is only happening in the sufferer's mind.  It's a private screening.  Like listening to one half of a cell phone conversation, watching a brain chemistry compelled drama makes the viewer feel as if she is missing something.  Why are you so upset? is a question that the unfortunate witness asks herself, and she can only answer that there is no rational reason and therefore the person who is upset is irrational and therefore, at best, is to be avoided and at worst, to be feared.

Hyperalertness Is the Key

Today I read an article in the NY Times that describes the latest research in depression. Scientists now think that the process of treating depression is much more complicated than they first thought when they heralded Prozac and other drugs like it as a miracle cure for depression.  I could've told them that.  In fact, I did try to tell people that the drug, even if a person could safely use it, is not a panacea.  I don't use it because it makes my heart race, but also because it doesn't seem to work too well.

What I've been using--scanning, primarily--has been working for me (most of the time), although I'm not sure why it works.  I have my theories, but they are not backed up by science so they can't be right, right?  Well, reading that article has made me wonder if there is perhaps some science behind my theory.  One of the things the article stated was that the growth of new neurons seems to be related to improvement in mood for depressed people. They're not sure how, though.  And they think that maybe it's not Prozac that's helping but the creation of new cells (that takes a few weeks, perhaps) that does the trick, and that somehow Prozac and serotonin are stimulating the growth of new cells.  An interesting idea, since my theory involves the use of mental focus to alleviate depression, although my technique works right away.

Another thing the writer said was that they're wondering if the way the brain organizes itself has something to do with depression--that if you act depressed, you feel depressed.  That's somewhat like what I surmise--that the brain creates a feeling state that is interpreted by the mind as danger and the mind quickly fills in the causes that then prompts a logical response.  The brain makes you feel something out of context (another point the article makes--that depression is non-context sadness), and so you supply the context and act on that.

Something else in the article: statistics that some large number of people (49%?) are suffering from untreated depression.  That's because they're handling it somehow and don't want the stigma of treatment.  I can understand that.  I want to tell my colleagues that I suffer from brain chemistry problems, but I'm afraid they'll never look at me the same way again, that they'll see me as "sick" somehow, even though intuitively they know I am.

But what the article doesn't address but which I feel is inherent in depression is that it is directly related to other unpleasant mental states: anger, rage, anxiety, panic, hyperactivity, attention deficit disorder, even schizophrenia, paranoia, and mania disorder.  I believe that sufferers are hyper-alert and that the condition of hyper-alertness is causing all these problems, mainly in society, because that is where the problems are most acutely felt.  We live in groups, and so our mental disabilities affect the other people in our groups.

I still maintain that hyper-alertness was once a prized ability; the hyper-alert person was an asset to a group of people who were nomadic or hunter-gatherers or even farmers surrounded by wilderness and predatory animals.  But in a safe society, such people are not an asset--they are a detriment.  Their skills are not put to use, and can be a real disrupter in most circumstances. 

However, in parts of society--even our supposedly safe society--hyper-alertness is still an asset.  In high crime areas, for instance, it pays big dividends to be someone who can scope out the dangers, can interpret the behavior of other humans who may intend harm (though there are fewer non-human predators these days, there are still some).  I was reading a novel in which the main character is the survivor of an abusive father.  He learned to "read" the signs of the father's changing moods and keep out of harm's way when possible.  Such early training made him an excellent detective, of course.  But what wasn't brought out in the novel was that the father's alcoholism and rage was a sign of the same qualities he possessed and passed down to his son, what I call hyper-alertness.

More later.

Chasing the Blues Away

Some days are harder than others to chase the blues away.  It's funny--I've heard that expression all my life but never before this moment really thought about it as being a real struggle. When you think about what people do to chase the blues away, it usually involves having a party, or maybe going for a trip, or watching a comedy show, or even singing the blues.  People do have to work at keeping sadness at bay, and the blues are usually thought of as something that happens without warning or even sometimes without reason. 

In the middle ages and the Renaissance, people thought melancholia was a condition brought on by the wrong combination of bodily fluids--too much black bile, they surmised. (In fact, the word melancholy can be translated as black [melan] bile [chole].)  Hamlet was thought to be suffering from the condition.  If you think about it, they weren't too far off with their theory; they just picked the wrong organ.  The blues always results from an imbalance, but it's of brain chemicals.  Chasing away the blues can only be done by correcting that imbalance, whether through chemicals or diet or exercise or some other activity that triggers the change.

Sometimes I have a hard time finding the right activity to fix my brain chemistry.  Today I tried staying home from work, reading a mystery novel, and now writing.  None of these techniques are working too well.  What to do?  I'm not really sure.  Keep trying, I guess.  Maybe I'll have lunch, see if that works.

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.

Fight or Flight? How About Neither?

I don't write in this blog every day because a daily report of my feelings would, I think, be repetitive and boring.  Every day is pretty much the same: I wake up feeling afraid or depressed and then I have to do something to make that feeling go away.

What I do varies with how bad the feeling is.  Usually, just getting up and moving around, doing my morning routine, helps dispel the gloom.  Exercise, when I have time for it, also helps, sometimes a lot.  If the feeling is really bad, then I know that the reading I do on the bus to work--especially if it's a very interesting book--will probably help. And when I get to work, my job will help even more because it's a job that involves a great deal of scanning (a very useful activity for gloom-dispelling).

But there's more to it than just pushing back the gloom.  Throughout the day, I also have to remain vigilant to its influence on my interactions with other people.  I can make bad brain chemistry go away, but only temporarily.  It's always lurking behind the scenes, waiting to jump in at the most inopportune times.

For example, I can be having a particularly bad morning brain-wise, but if I have time to work on neutralizing the bad feeling, especially when I first get to work, I can succeed in being pleasant.  If I don't have time to do my therapy, then I might not fare as well.  Something a coworker says might trigger the fight-or-flight response and I'll snap at that person, saying something regrettable that hurts her feelings.  That's not very good for coworker relations.

What could be worse, though, is that now I've shown a side of me that I wanted to keep hidden, the side that is irrational and somehow shameful because it's out of my control.  And once that BBC beast is out of the closet, there's no putting it back.  The damage is permanent: no matter how my future actions might modify people's view of me, I will henceforth be seen as someone with a "temper."

Okay, it's true, it's a minor character flaw compared to some. I could be something worse--a chronic liar or a thief or a drug addict.  But the fact that my fits of temper happen suddenly and without my consent bothers me.  I don't like these irrational feelings to take control of my mind.  So I try to stay alert to the pre-cursor feelings and stay away from potential clashes with people during those times.  It doesn't always work, and sometimes it's exhausting, but it's all I've got for the moment.

I'd call it "anger management," a commonly used term these days, but I don't think it describes the actual phenomenon.  What I am managing (and I think many other people are too) could not be anger because most of the time there's no good reason to be angry--at least not as angry as the situation would seem to warrant.

Conflict is inevitable between people who live or work together, and we don't get what we want all the time.  That frustrated desire produces anger, it's true.  But the response to being thwarted should match the type of obstacle, it seems to me.  Being temporarily blocked on a small matter should not produce a full-out rage.  If it does, it's a sign, I believe, that the emotion being expressed is not anger at all, but fear.  And not just ordinary fear, but the kind of fear that evokes a fight-or-flight response--that is, fear for one's life.

Why would someone be in fear for her life just because someone got ahead of her in line at the copy machine?  There's no good reason, obviously. Something else is going on.  I think it's brain chemistry.

Here's how I believe it works: the brain is humming along with its normal balance of chemicals and then suddenly the level of tranquility chemicals takes a nose-dive for reasons known only to DNA. As a consequence, the person with this bad brain chemistry suddenly feels very frightened. Being a rational creature, he looks around for a cause and, coincidentally, at that moment he is told the meeting he scheduled for 1:30 is going to have to be postponed to 4:30 because the big boss went overtime on his meeting and screwed up the schedule. But now because of the boss, the employee's schedule is screwed up; he was going to go home early today to watch his son play soccer. So he "goes off" on the messenger, loudly telling him and anyone within earshot that the boss is an incompetent jerk who can't even control a meeting let alone a department.

Is this fellow inconvenienced by the schedule change? Definitely. Frustrated? Probably. Is his life in danger? Of course not. But he feels like his life is in danger because that is what his brain is telling him. And in that circumstance, his response is completely rational and not disproportionate at all: between fight or flight, he chooses fight. Unfortunately, when he makes that choice, he puts himself in real danger if the inappropriate rage he expresses over this minor incident causes him to lose his job.

Someone might say that such a person has anger management issues, and if he were to go for treatment, he'd be taught techniques for dealing with his anger. That's all well and good, but it seems to me that the treatment is telling him that his anger is not the problem, only the expression of that anger. It's okay to feel anger; it's not okay to express that anger by punching someone in the nose.

But I say that what he is unsuccessfully managing is not anger at all, but bad brain chemistry.  And if he doesn't know that, all the anger managment techniques in the world won't work, because he doesn't realize that the cause of his behavior is not his unruly anger, but brain-chemistry-induced fear.  And not realizing the true cause means that he will continue to feel irrational fear, mistake the cause as outside himself and life-threatening, and respond in what to him is a rational way to meet that threat.

This is not to say that knowing the truth will set you free.  Just because I know the cause of irrational "fight" (as opposed to flight) does not mean that it's easy to manage.  But at least I can look for the warning signs and try to head off an imminent attack before it happens.  I don't always succeed, but I've gotten the number of incidents down to two or three times a year, when it used to be two or three times a month.

It's a work in progress.  I've got "flight" (depression, anxiety) pretty well handled; "fight" is going to take a while longer to contain.

See you next time.

Pollyanna's Secret

There have been many times in my life when someone with bad brain chemistry (BBC) argued that to pretend to feel happy when you're not happy is phoney.  "Don't be a Pollyanna," that person would say, then follow up with a declaration of contempt for those people who are always cheerful or perky.

I must admit that from time to time I was one of those Pollyanna-hating people.  And the only reason I felt that way is because I couldn't believe that anyone could be that happy--even Pollyanna had to be putting it on. And to fake feelings you don't have is contemptible.

But as I eventually learned, there are people who are that happy.  They have good brain chemistry and a happy disposition.  And maybe in addition to being blessed with those good traits, they've learned to look on the bright side of life, so that even when they have an occasional sad moment, they talk themselves out of it.  And what's wrong with that, anyway?  ("Always look on the bright side of life" is, as you may know, a line from a sarcastic song by Monty Python, people with bad brain chemistry, no doubt.)

I think that bad brain chemistry people don't really hate the Pollyannas of the world--they envy them.  They want to be happy too, so they try to figure out how they can get there.  What they come up with, however, is based on false data, the data they invent in their efforts to determine why they are currently unhappy.

For example, a BBC person feels bad, but doesn't realize he's feeling bad because of bad brain chemistry, so he goes off in search of a reason in his environment.  He scrutinizes his life, his work, his family, his friends, his health, the government, the air--you get the picture.  With all that scrutiny, he's bound to find something that bothers him.  Let's say he picks his work.  There he finds a rigid, obnoxious boss with whom he's had numerous clashes.  But there's more to dislike at work.  There are also his coworkers, who are uncreative apple-polishers; and there's the work itself--boring and beneath his talents.  He might go on, finding other faults with his job to add to the already tall stack of grievances.  No wonder he's so unhappy!  Who could be happy in such a place?  So he starts looking for a better job, one where he's appreciated for his intelligence and where he's surrounded by interesting, creative people. And if he's really in the throes of BBC-inspired zeal, he may quit right away, all the better to spend time looking for that perfect job.

But of course there is no perfect job.  Even if he finds a job that is closer to ideal than the one he has now, he'll soon find something wrong with that one too, and the cycle will begin again. And again.  Such is the nature of the quest for happiness that doesn't take into account the main cause of unhappiness: bad brain chemistry.