The Myth Of (Chemical Imbalance) Depression: The Case For A Holistic Approach

Depression is a real disorder. So let’s get that out of the way, should the provocative title make you want to storm the castle with pitchforks and torches; please know that I am not negating anyone’s experience, suffering or diagnosis. What I am challenging is the simple pathologizing of depression as the sum of symptoms or based solely on neurobiology.

Our mind, brain and bodies are a complex interactive system. While it is the job of family physicians, psychologists and frontline responders in mental health to try and stabilize people with mood disorders (i.e. through drugs), it doesn’t really get to the full picture. In fact, in a recent blog, I pointed out that emerging independent meta-analyses of pharmaceutical (anti-depressant, psychotropic) drugs show placebo is in effect upwards of 70 per cent. Think about that for a second.What that means is that of those patients taking SSRIs for example (anti-depressants), up to 70% or more might be responding to treatment without any actual outside chemical involvement! McGill professor Amir Raz recently conducted a survey where 65% of psychiatrists reported under-dosing their patients. In other words, patients were responding to treatment as if they were getting a prescribed dose of a drug, whereas instead of, say 20mg dosage of Prozac, the psychiatrist was only actually giving them 10mg pills. This points to what is called ‘top-down’ regulation of our system (as opposed to ‘bottom up,’ which implies that if you treat the body with chemicals, the mind will respond with a correlating psychological improvement.

More recently, investigative research is further revealing that anti-depressants such as SSRIs can actually inhibit serotonin production in the body, that they don't work on any definitive 'mechanism of action,' and that the prevalent idea that depression is caused (or even diagnosed) by low seratonin levels is not fuller supported by conclusive research evidence. In simpler terms, apart from organic pathology (physical defects, masses, etc), the field of psychiatry does not base any mental disorder on etiology (origin of disease), let alone depression; correlation is not causation.

So what does this mean? Am I suggesting that one can ‘think’ their way into/out of depression? Actually, to some extent, yes. But that’s for another article. What I am addressing is that the psyche and the body are an interdependent system. Emotional awareness (and the experience of ‘mood’) are a function of how the oldest and most basic regulators of our brain respond to what is going on in the system as a whole. We have inherited a 30,000 year old brain that is skewed for negativity. In other words, we have evolved and adapted by automatically scanning our world for danger–mostly through our five peripheral senses. However, feelings are derived from raw information fed to the brain/limbic system from a small area called the periaquaductal grey–which sits atop the brain stem (lizard brain). Neuroscientists have established that this primary organ defines consciousness in all organisms. What sets humans apart say, from chimpanzees (with whom we share 97% of the same DNA), is our pronounced frontal cortex, which regulates rational/executive function. But that tiny matchstick like organ atop our lizard brain is what signifies whether we are ‘ok’ or not.

So here’s how it works: the brain takes in information from two essential pathways: the five senses; and the autonomic nervous system. It then interprets that information through conscious awareness (sight, sound, etc & feelings). If it perceives that input to represent a threat, then it will signal the mid-brain, the Limbic system, to override and make fight/flight/flee signals flood our system. The same goes if basic regulatory functions (hormones, blood sugar, etc) signal that little duct atop the brain stem that things are not copacetic (cool, ok, normal). So, in either case, our ‘higher’ brain never gets to interpret the information–it goes straight into red alert (panic, anxiety, aggression…). Bingo! Mood disorders. What does come into our higher consciousness is then often distorted by the limited, trauma response. This can appear as negative beliefs, self-loathing, and in extreme cases, as paranoia and hallucination.

The bigger problem, however, is that the brain, at its sensory input level, doesn’t distinguish between past, present or future, real or perceived threats. This creates havoc with our (lack of) conscious, rational response. So yes, low serotonin levels or high cortisol (stress) levels in our system can signal us to take action (’seeking’ behaviour). But these drives to seeking behaviour may need more rationalconsideration (i.e., do i need serotonin in the form of a cookie? Or maybe a hug, or more importantly, re-assessing a boundary?).

To make matters worse, often these triggers are the old responses based on ’stuck’ patterning from childhood or unresolved events in our past. Our system is triggered into the same neuro-hormonal response, and in the case of chronic disorders like anxiety and depression, this elicits a chronic response: hypoarousal (depression; trying to feel ‘less’) and hyperarousal (feeling too much, anxiety disorders).

Recent research from the prestigious peer-reviewed journal The Lancet, for example, points to how childhood trauma is correlated with the onset and history of bipolar disorder. Meanwhile, ground-breaking research from UBC shows that parental stress can have a genetic effect on children. Of course, all of this still approaches the issue from a psycho-pathological purview. And while the mind/body approach is supported by evidence-based research, there is an even bigger perspective: that which speaks to the tagline of this blog–spiritual psychology.

Our evolutionary design functions to protect us from danger. But there is a cost. Our very highly tuned psyche/nervous system is still dependent on the threat/response dynamic. We seek pleasure and avoid distress. And that has been critical from an evolutionary standpoint. The problem is, and the contemplative tradition of Buddhism and its exquisite science of the mind shows us, is that if our relationship to reality is only based on seeking pleasure and averting pain, it sets us up to swing between those polarities of experience, caught in a constant kind of ‘over-steering’ and correcting of course. This, really, is the basis for our suffering. And Buddhism, so simply and adroitly, suggests that this inherent disorder is directly treatable from within, simply by virtue of what cognitive neuroscience deems ‘meta-awareness’ (or mindfulness). By doing a kind of ‘exposure therapy’ with our own thought/emotional reactions and patterns, via meditation and self-reflection, we can down-regulate the symptoms that swing us out of natural equilibrium (calm presence, openness, alertness). And in turn, brain research is showing us more and more, the activity of this kind of mindful self-regulation strengthens cortical activity and actualmass/density in the pre-frontal regions (associated with more complex, rational, compassionate thought, and impulse control).

So what does this mean for sufferers of depression? Certainly, this aversion/attatchment manifests as established mood and behavioural disorders and warrants appropriate intervention to stabilize the patient. At the same time, it represents a inherent and even commonplace challenge/condition which ties us together in our universal experience. And in a world that values material acquisition, despite the psychic, biological and environmental damage it renders, it would seem quite appropriate that we would be disturbed. And yet, our entire culture–from media to our schooling–normalizes the destruction of the world and our spiritual, individual and collective witness of trauma. For practical reasons, we are forced to some extent to deny this harsh reality to survive, and in its place self-medicate with pleasure through self-gratification. In the end, human compassion cannot, however, be assuaged with toys or fleeting pleasures. We all know this to be true; when we die, all we really account for is the love we shared in our lifetime.

I will be exploring this issue much more in an upcoming book. For now, my friends, suffice to say that while depression and mood disorders are de facto a medical issue, they are a humanistic concern as well. In my practices–Aikido, EMDR psychotherapy–mindfulness and social support facilitate the regaining of self-control, strength of self/spirit. And these, in turn, are cultivated not through compensation (either through ego or material wealth), but conversely by compassion and reconciliation of conflict. On a personal level, this may simply relate to the healing of distortions we internalized about our value in childhood, or the validity of our life’s purpose. And thus, we are moved not only personally–but collectively–to enlightened action.

Courting Chaos: Dating As The Playing Out Of Our Existential Panic (And Biological Design)

The ego gets a really bad rap. Trapping us in straitjacket of projected desires, unfulfilled wishes and an unchecked, self-sustaining petulant sense of self-entitlement, it really does get in the way--a lot.

Yet, we need it to function. The evolution of human consciousness and neuro-psychology thus far must yield some sense of identity, some delineation (if to avoid the delusion of separation) to develop empathy through an awareness of others not being 'us,' and on a neurophysiological level to balance the function of each hemisphere of our brain. The left: analytical, logical, time-sense oriented; the right: spatial, interrelational, globally oriented. One complements the other in synchrony--what is called neural integration. Thus our sense of 'I' is precariously hinged on the delicate balance of interplay between these complex functions of consciousness that form our early, and ongoing, narrative. This is what gives us our internal 'map' of the world, how we navigate perceived danger, are wired for optimism/pessimism, vulnerability, and carry with us our personalized set of principles and preferences to make our way through our world. It is, in essence, what defines our world and gives us our very meaning structure.

So where does it all go wrong? The precipice, the anticipation of intimate relationship is a good place of observation. Here, our otherwise undetected narrative operation (the 'program' of 'me') collides with an onslaught of stimulus and 'meaning splits' or self/other dichotomies: me vs us, safety vs abandon/surrender, desire vs rationality, predictability vs vulnerability, impulse vs self-control--all swelling forth in a tsunami of excitation and pleasure hormones surging through our system, flooding our cortical structures and nervous system. It's a wonder we function at all!

Fortunately, nature has devised clever adaptations to make it a relatively predictable process: excitation and lust, underscored by complex biochemical processes (sorting out pheromone and DNA matches in kissing, smelling, touching our potential mate, for example), give way to bonding and partnership. The downside of this elegant design is that our social-biological drives for partnership (bonding/love, security, survival) have an internal flaw: that which initially compels us to choose our partner is no longer available to us once we give over to monogamy. In other words, we go from the drug of desire to the drug of bonding, the latter process of which doesn't necessarily extinguish the evolutionary impulse to continue the cycle over and over. How to we maintain this intricate balance between lust and love in the long-term? Esther Perel's work is enormously instructive in this area (Mating In Captivity), and I will pursue this question in future installments.

For now, the question remains how do we 'go with the flow' in the pre-commitment phase of dating? How do we 'obey' the signals of desire and compatibility, feel a sense of careening into desire, while checking our own ego-projection (as compared to really seeing the object of our desire as who they are)? The impulse to rush in does not balance well with the caution of going slowly. Here is where our core self-worth, our close friendships and family relationships, and our steadfastness to our own principles are critical.

Going slow is not easy. Depending on our early childhood love attachments, and how we've adapted, it can be disastrous for our sense of well-being (as we equate it with lack of security or even our basic worthiness). However, it's good to experience the rise/fall of our own ego projection and expectations, idealization, fantasies early on in the dating process. It gives a sense of appreciating the person as they are, and what being in a relationship with them would be more realistically like without the haze of infatuation, without the clamouring for security and completion of 'me' through union, without the myopic greed of entitlement. Intimate love is a dance, a rhythm, a negotiation, an unfolding agreement that must continually be granted permission.

Fearlessness, Vulnerability And The Mask Of Everyday Life

I was walking my dog this morning--the usual route through my neighbourhood. It is a crisp and clear day, the sun peeking out sheepishly behind the ersatz celestial bedcovers of clouds.

I have a very large breed dog, one who elicits every reaction from fear/avoidance, to grins and blithe indifference. A woman came down the sidewalk from the approaching direction, seemingly with the latter disposition. I say this because the gigantic sunglasses she was wearing hid any dare of outward mood. Her expression was blank, even slightly dismissive as I offered a "hello" (as I had been, all morning, to all I greeted).

Now, I don't expect everyone I encounter to acknowledge my gestures or presence. I can certainly appreciate a woman perceiving a friendly morning smile and 'hello' as unwanted flirtation, or even just intruding on her insulated experience (she was also wearing earbuds). What did jump out at me, in kind of a ridiculous way, was that she was wearing a very distinctive animal beanie on her head. You know: kitty/doggie/bunny ears perked up high, Nordic chin ties dangling down. Kind of like a five year-old hasidic jew in animal drag. So the slight frown and dismissal of my greeting suddenly made the whole experience profoundly ridiculous. As I walked past her, my gangly, huge young dog trotting down the block, sniffing, peeing, mushing his face in the melting snow, I began to laugh at the encounter.

I'm not singling this woman out here. There are plenty of days where I want to shield myself from the intrusions of the world--especially the rage-provoking imposition of someone else's insistence, through a smiling suggestion that I connect on a human level, to 'lighten up' and be happy. Sometimes we just want to be insulated in our grouchiness. I'm serious. And yet, as I type that sentence, I see the absurdity of the statement. We are walking contradictions. We seek to belong, to feel a 'part of' the world, while simultaneously wanting it to leave us alone. The paradox is akin to the early stage of development of our childhood--'come here...leave me alone.' We want the autonomy and the attention. We are all trying to walk this tightrope of emotional need and stoicism. Somewhere along the way, we learned to try and hide it, to put on the mask that "I'm ok. I don't need anyone." There is a simple and heartbreaking reason for this adaptation: fear and shame.

Social Psychologist Brené Brown talks about this via the conversation about vulnerability. The fear part of the equation is that we are afraid to show our true selves for fear that we will be rejected, for being too weak, too open--not what we think others expect from us. There is a primal, evolutionary driver beneath this: weaker herd members die alone, hungry. The deeper catalyst for shutting down is shame. That is, we feel at our core (and as the result of gaps in our attachments in early life, the lack from feeling insecure, dismissed or not truly seen/heard) that we are not enough. And the fact that we dislike and want to divest ourselves of this feeling is a strong motivator to keep others from seeing this illusory core flaw in ourselves. In truth, the opposite (as Brown's research shows us) is true. When we turn inward/outward stress into social connectedness through vulnerability, openness (what I would call 'being human' with ourselves and others), we allay these self-distortions, and find solace, support and resilience. We no longer hide from ourselves, from life.

In Aikido class last night I was teaching my black belt students how to deal with a knife thrust to the abdomen. The exercise is less about control of the weapon, as it is control of one's own fear. When we offer ourselves to our attacker with openness and fearlessness, a willingness to die in the act of being fully present, and subsequently move in synchronized step with their movement, the 'target' ceases to be there (nor the collision of attacker/defender). The attacker's subconscious mind perceives total vulnerability, and at the moment of anticipated full-power contact, the defender turns to let the weapon glance by, while applying downward energy. The attack is controlled because the attacker's energy has been matched without reaction, and their power absorbed.

'O'Sensei' Morhei Ueshiba, circa 1960s

When we relinquish our sense of having something to defend, we become invincible. We see the preciousness of our own life as vital as that of our so-called opponent. In effect, we are overcoming our own ego-defensiveness. We are taking appropriate, in-the-moment action to reduce the conflict. As I say often in my class: we are not training for the unlikely, though ultimate, challenge of someone challenging our life--that comes as a byproduct of the training. We are training to overcome the aggression and fear towards ourselves, to help us foster self-responsibility and coexistence in daily life.

Addiction As Compulsion (And Why Morality Fails)

Post-mortem: Philip Seymour Hoffman

One of the most brilliant actors of this, or any other time, recently succumbed to a relapse of addiction after 20+ years of sobriety. The internet has been, predictably, awash in speculation, opinion and judgement at the actor's death (which had him leave behind three children and a spouse).

A recent article critically examines the 75 year-old 12-step program model, and why this and other models of recovery are flawed in terms of long-term results and efficacy.

The article assesses the approach of author Dr. Lance Dodes, the former director of Harvard’s substance abuse treatment unit at McLean Hospital, describing his theoretical orientation here:

 "Addiction is a compulsive disorder, an attempt to cope with anguish by engaging in ritualistic behaviour that is soothing and predictable, despite ongoing negative consequences."

The piece mentions that Dodes comes under scrutiny for selectively assigning certain conditions as medically-related (Obsessive Compulsive Disorder), while characterizing addiction/substance abuse as distinctly a psychological disorder (with clear physiological symptoms). Notwithstanding the latter point in parenthesis, I believe Dodes is on the right track. Most of what we now know about pharmacological intervention (drug treatment), for example, when it comes to say, pain management, or depression, is that placebo is statistically very high, upwards of 70-80%. What this points to, as McGill researcher Dr. Amir Roz points out, is that our physiological responses/conditions are to a large extent top-down regulated. In other words, mind controls body.

This is also to say that the socio-psychological benefits of peer support, anonymity, and spiritual connection are not without tremendous benefit as regards the 12-step movement. It's just that the process is underscored by a fundamental moral purview of addiction which, while trying to simultaneously surrender our poor self-control to the universal authority of a 'higher power,' undermines our immediate sense of agency and self-healing. The article makes the case that while a great many people who do engage programs like AA experience change, it doesn't speak to the statistically much higher people whom recover without any organized program.

Where do we go from here??

Join us March 1st in Vancouver for a life-changing workshop, as we get to the heart of addiction with Have A Nervous Break...THROUGH! With Michael A. Gordon, MSc.