Separation distress and the importance of valued people

I stumbled onto two interesting authors, Jaak Panksepp and Douglas Watt…

“‘Big Pharma,’ as big business, seeks antidepressants that may become billion-dollar blockbuster drugs. Accordingly, it may neglect drugs that are off-patent (e.g., buprenorphine) as well as those that only serve a small subset of the population. Many authors (ever since Valenstein, 1998) have argued that the pharmaceutical industry may be exercising an increasingly distorting influence on prescription and treatment landscapes for the whole of medicine in the United States. This may be particularly true in relationship to depression, where many depressed patients are never referred to psychotherapy and instead are only put on first-line antidepressant drug regimens under the simplistic aegis that depression is “just a chemical imbalance.” These trends take place despite evidence that pharmacology is often only partially effective in depression (see recent STAR*D reports: Rush, 2007; Rush, Trivedi, & Fava, 2003) and despite evidence that patients suffering from trauma-related depressions do quite poorly treated alone with psychopharmacology without psychotherapy”

 Far be it from me, an academically untrained but round-eyed acolyte of the big world, to feel at all qualified to take on the authors’ implication that depression may be the result of anything but “a chemical imbalance” though an initial “trauma” may have initiated the process, and the chemical imbalance following the trauma can’t be fixed wholly pharmacologically. But I’ll state modestly that some day soon, almost every state of depression, whatever the cause, will be cured chemically sans psychotherapy…

…psychotherapy definitely has a purpose… probably always will; intelligent people understand that they have subjective limitations regarding self-awareness, and some have an interest in resolving recurring, stunting issues, or simply gaining insight for the sake of growth with the help of trained facilitators. But some day drugs will blow away our depression, regardless, with remaining only a curious interest in why we do the things we do and think what we think, for the sake of treating ourselves and others better.

~But my little declaration is not the reason for this post. Jaak Panksepp and Douglas Watt really have their stuff goin’ on, and are speaking my language. My personal theory of depression (…depression not caused by an innate anomaly) involves three roots: an unsuitable industrial diet, inappropriate exercise (not enough and chronic cardio), and stressors, including modern stressors (pollution, lifestyle etc). In this piece, the authors deal with separation stressors leading to a “protective” state of depression (do I smell the pernicious stench of dynorphin again?).

Whether or not this thesis is correct, the thing that jumps out and reminds me is the importance of keeping one’s self as engaged and socially involved as possible. Clearly (if only for the production and cultivation of calming oxytocin, which is known to sustain opioid reward in the brain), the importance of maintaining and nurturing relationships with people we value and who give us value in return can’t be overstated in a world that increasingly creates and promotes options for insularity and “aloneness”.

Equally, one must have a healthy hierarchy of values…

…if not, being depressed and alone might actually be a better situation than being depressed with people who don’t elevate us… don’t challenge us to go higher, but erode our quality of life, sense of self-esteem and our quest for happiness. In this case, until one has redeveloped a healthy sense of worth through proper diet, appropriate exercise, a low-stress lifestyle, and insight perhaps helped by psychotherapy, I think sometimes we can wait until we are in a better state to nurture rewarding relationships with quality people…

…just relax, and be good to yourself first.

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3 Comments (+add yours?)

  1. Itsthewooo
    Dec 16, 2011 @ 00:21:55

    Such an epic response. I am sorry. I’ve been so rambly lately.

    I am so tired of the BS that psychotherapy is required/effective for depression.

    For example, we have kidneys, hearts, and brains. Any of these organs can be diseased. No one asks you to go to an (unscientific, mumbo-jumbo) talk therapist for “insight” if your kidneys nephrons are destroyed and do not properly filter body wastes or if your heart EF is low post heart attacks. We can see , obviously, that some kind of environmental insult and/or genetic defect damaged the organ pre or postnatally, and the only treatment is medically addressing, circumventing, banaging, curing, or replacing the area of damage and dysfunction.

    Why do we treat the brain differently?

    Even if we suppose that stressors are a trigger for depression (and this certainly stands to reason), what on earth would make us assume that talking about it will make any kind of dent in the problem?

    Thing is, I DO believe that discussing problems in therapy, for SOME people, may be effective. I believe if and when this works, it is so by tricking the brain into thinking they have a close ally/friend they can trust. The therapist is effective by playing the role of a rent-an-ally. I believe this constant, weekly or more feedback of having a supportive trusted ally normalizes endorphin function and also helps normalize brain stress response, both of which are strongly implicated of depressive disorders. Endorphin system helps to regulate the stress response, to suppress it; some research suggest people with melancholic major depression have somehow gotten themselves into a state of insensitivity to endorphin, as evidenced by lack of endocrine response to a challenge of morphine. It appears that in major depression, the endorphin system is broken, cannot regulate the stress response any longer and this may then go on to cause the out of control stress hormone production (surges of CRH, with hallmark early morning awakening and other signs of adrenal hyperactivity). It stands to reason that perhaps for some people, the endorphin/adrenal mayhem can be ameliorated with tricking your brain into thinking you have a supportive group of kin and allies. Enter the therapist and doctor.

    I do not believe in the value of psychological exercises or psychological theories. I believe therapy works, if it works, by the therapist filling a gap of kin/ally in the sick person’s brain, which reduces stress response and bolsters endorphin signalling. Humans need close allies, we are neurologically wired for a tribe… some people with mental disorder may need to use a therapist for this role, depending on the level of isolation and the nature of the trauma.

    Thing is, I don’t know if a therapist is any better than say, a psychic healer, or consulting an astrologer. Both play the role of a hired ally and kin, both are sought out by distressed people for therapeutic purposes. Both lead to the feeling of comradery and support. Both bilk you out of money.
    Main differences I can see is that the psychotherapist has a lot of BS theories to spew out to make his biased subjective ideas appear scientific, whereas the psychic’s ideas are not going to be substantiated by a medical journal and will be called cold reading/schizotypal nonsense. In some ways I think the astrologer and the psychic are a healthier option for a socially marooned isolated wounded person, because they do not have the ability to dominate and bully the patient who is vulnerable the way a “IRL doctor so I am the boss” does.

    Furthermore, I would expect this (a hired faux ally) to only be of relevance in mental dysfunctions stress/endorphin dysregulation which have a root in trauma, e.g. childhood abuse, neglect, abandonment. I would expect such people to respond well to a rent-a-friend as their disability is primarily mediated by a years long lack of nurturing at critical points.

    But for someone with say, bipolar depression, a simple biological fluke in regulating the circadian clock/brain energy utilization which is at best triggered by stressors, but not caused by them? No I don’t think therapy or social relationships figure in that much, other than being another predisposing factor to worsening illness/episode as all stresses are (by disrupting brain energy/sleep, for example, as corticosteroids tend to do).

    Reply

  2. Itsthewooo
    Dec 16, 2011 @ 00:41:37

    More practically, I have spent a great deal of my life struggling with social acceptance, social rejection, aloneness.

    I’ve come to the following insights.

    1) The idea that people will make you happy is false. Malcontent comes from within. So does contentment. It does this via brain functioning: flukes of energy and neurotransmitters and immunological function and wiring and so on.

    The thought that others, having their approval, or some perfect kind of love and support will fill the void, is a childish, infantile delusion. Miserable people think this, and it is a symptom of being miserable.

    From what I can see, based on my years of watching and observing people… constitutionally happy people are so because they are constitutionally happy. The same is true of miserable people. Something, innate (“brain functioning” defined above) makes people happy or miserable.

    2) Relationships, love, social connections and so fourth happen when you are not dealing with a crappy brain. Happy people find themselves around others more often and with more rewarding, longer lasting relationships, because less happy people seek to be around them to distract themselves from their own lacking. Happy people are free of anxieties and obsessive thoughts and compulsions and paranoia and low mood/motivation and other symptoms of brain malfunction which lead to aloneness and isolation. They are self contained and sustained by their own positivity, their healthy optimism for life and grounded balanced perspective.

    Aloneness and isolation is a symptom of a crappy brain, not a cause… although it stands to reason that a person with no cognitive defense against depressive fantasies (that other people will save them from misery) will be made more unhappy in their aloneness. Depressive are given to fantasies, after all. Suicide is a most famous example. Fantasy is the last resort of a person in chronic pain and distress. It is a method of distraction and escape when one lacks the ability to stop the pain and distress. If your brain simply does not work properly, all FUBAR and what not, yea you are going to say “if this was different I would feel better” and you would say “I will jump off of the bridge to make it stop” and all sorts of things which are extreme and/or not true.

    It’s sort of like observing that fat people eat more calories. Is this because calories cause weight gain, or is it because a disorder in the body somewhere in either accessing or utilizing energy, leads to fat storage with symptomatic excessive energy intake and chronic, disproprotionate hunger? My research? It’s definitely the latter. Energy using disorder in the body leads to simultaneous symptoms of excessive fat storage, lethargy, and hunger (thus more calorie intake). But of course, restricting calories can help by tempering the tendency to store food as fat… it isn’t a solution, the real problem is an innate disorder in using and/or accessing energy.

    We know crazy people are isolated, but is it because primarily isolation causes craziness, or does craziness cause isolation? As in the fat-calories example, it really is a two way street… but my opinion is that isolation is the RESULT of craziness, primarily, but I am willing to accept there might be some crazy people who just need hugs and a strong support system and they will be cool.

    It should be noted that isolation and a lack of ability to properly relate to people is a symptom of many mental illness such as depression, psychosis, OCD, many personality disorders and so on.

    I guess… chicken/egg. I am not knocking having healthy relationships and social engagement I just think it’s not as important as we think. There are many mentally healthy people who have few relationships, and they are so because their brains work properly and do not produce distressing feelings/intense anxious thoughts/OCD/blankness of depression or what not.

    There are plenty of people who have strong social relationships and a healthy family who fall into a mental hell of some sort or other.

    Reply

  3. Opie
    Dec 16, 2011 @ 20:18:13

    ~i think that most rational people, depressed or otherwise, understand that one really only ever has one or two real friends.

    …keep in mind though, that i’m not talking about crazy depressed people, just “normal” depressed people. ;D

    …i don’t know enough about crazy people to offer an opinion (i hope)!

    yes, depression causes voluntary isolation. i mean, who wants to be “that” downer, right? and socialising requires energy and motivation, things lacking in an average depressive. but i have friends who are there for me, even when i’m hell to be around. and i force myself to see them and to date women even when i really don’t want to go out. if you’re lucky enough to find those who “get” you and want to lift you, don’t let go; just stay cool and ride it. don’t let go. human relationships may be over-rated for some, but if you crave them (with a healthy insight and no absurd expectations), search for them.

    …but, again, i’m not mixing up “depressed” and “crazy”. that’s out of my experience.

    ‘tell you something, though; going through my worst periods, i did no fantasizing. hell, i didn’t have the energy for that kind of frivolity.

    ~my belief is that psychotherapy is utter bullshit for most depressives. when i was waking up each morning in my usual existential despair (fuck… mornings sucked), and, verging on tears, going to doc after doc looking for some relief that never came, there was no way i would let anyone tell me, with a straight face, that i should mayyybe… with fairy dust sprinkled on top, go into psychotherapy.

    advocates say that therapy can help to rewire and rechannel neurons into a positive emotional state with repetition; but what does that have to do with a low-producing dopamine system or a genetic/family history of depression? tell me that my genetic heritage can be overridden and broken with a therapist…

    …show me the money.

    i maintain that psychotherapy is a mostly fashionable exercise in futility for the organic ailments that you and i are talking about… and how can i stimulate endorphin (i’m not talking about because of acute endorphin repressors) when i simply haven’t adequately produced it from childhood? how can a therapist fix those things in my body that aren’t in my brain, but have everything to do with EDS?

    …having said that, i do think that therapy will help folk who just want to gain insight into how they tick, and to maybe stop hurting those around them.

    nope… the only thing that will work for you and me is some kind of physical/chemical manipulation.

    “Furthermore, I would expect this (a hired faux ally) to only be of relevance in mental dysfunctions stress/endorphin dysregulation which have a root in trauma, e.g. childhood abuse, neglect, abandonment. I would expect such people to respond well to a rent-a-friend as their disability is primarily mediated by a years long lack of nurturing at critical points”…

    …they used to call it “Mother Opium” for a reason. ;)

    ~oh, and your posts don’t really ramble. i’d call them streams of consciousness more than anything. you have a unique, relaxing writing style. it’s like going down a river, effortlessly.

    Reply

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