Castles in the air - they are so easy to take refuge in. And so easy to build, too.

आम्हां घरी धन शब्दांचीच रत्नें | शब्दांचीच शस्त्रें यत्न करुं ||
शब्द चि आमुच्या जीवांचे जीवन | शब्दें वांटूं धन जनलोकां ||
तुका म्हणे पाहा शब्द चि हा देव | शब्द चि गौरव पूजा करुं ||
- abhang of Tukaram Wolhoba Ambile of Dehu

There's No Freedom Like That of a Child's Imagination

கடலுக்கு உண்டு கற்பனைக்கு இல்லை கட்டுப்பாடு

Wednesday, August 13, 2014

Depression and the brain

Far too much of how we see our bodies had been influenced by religion and spiritualism. While we may slowly come to accept that there is nothing such as a soul, we still think that there is something such as the mind, somewhat detached from the corporeal self. Too many otherwise rational people think so too; it is hardwired into our languages.

There is no such thing. There is only a brain, an organic thing, made up of hundreds of thousands of interconnected neurons. A very material thing, flesh-and-blood, as fragile as the rest of the body. Just like the liver (the other very complex organ), the brain can suffer disease and disorders. Some, we're willing to understand, like infectious diseases or cancerous growths or developmental disorders brought on by genetic defects or childhood accidents. Some others, that manifest as behavioural problems, we resolutely refuse to acknowledge.

But behaviour is only the symptom, the real disorder is the imbalance of nutrients, neurotransmitters, hormones in the neurons or the matrix surrounding them. These require treatment with medicines to alleviate the root cause (though we sadly cannot eliminate them completely in many cases) along with counseling and monitoring to alleviate the symptoms. At no point can we separate the two.

Insensitivity only damages the patients further. They are suffering from anxiety or low self-esteem or obsessive or paranoid behaviour not because they are acting consciously, but because their brain (and not the non-existent mind) is ill. It is just the way one avoids certain foods or behaves in a certain way when the liver or stomach or lung is ill.

We understand that a pregnant woman's craving for sour things is a consequences of the physiological changes affecting her entire body including her brain. We are able to distinguish this as an involuntary craving, not as conscious desire. Agency is not imputed to such behaviour. Depression, anxiety disorders, SPD, etc are also because of such physiological changes.

If you see someone behaving oddly, and for a sustained period of time, you have good reason to believe that they are ill and need psychiatric medical attention. What they don't need is your empathy, which though well-intentioned and sincere is not useful. Do you empathise with a jaundice patient or do you give them liver medicines?

And they certainly don't need your sympathy, or advice for positive thinking. That it's mostly fake and only serves to alienate them further. The brain though ill, is not entirely dysfunctional. It can still sift your words and behaviour, and catch whether you're being an insensitive idiot or not.

Believe me, I have been to the brink and back. Positive thinking did 1% towards bringing me back, counselling and physical de-stressing perhaps another 20%. The rest of the job was done by paroxetine, in gradually increasing doses.

Have you heard of anyone battle cancer or hepatitis or a common cold through 'will-power' alone? Without chemotherapy or surgery or other medical intervention? You may wait out a common cold till it goes away, but had anyone ever willed it away? If anyone says so, I'm willing to give them a chance to prove it publicly, by letting them have the disease again.

In the same way, you can't 'battle' depression or anxiety disorders by 'steeling your mind' or 'thinking positive' or whatever other phrase that's fashionable. You need to get the patient to hospital. Positivity helps, but treatment and professional counseling help even more. And keeping a sensible silence for the duration of the treatment helps best.

So next time you see someone with depression and want to help, do me a favour. Make a bonfire of all the will power and positive thinking books to keep the patient warm, burn all your fake sympathy and useless vocabulary in it and call an ambulance.

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4 Comments:

Anonymous Anonymous said...

Superb article. And telling it like it is.

Most people have a condescending view about a patient, and tell them, 'Don't be weak, be strong.' 'Think positively. Don't fill your mind with negative thoughts.' 'How can you be depressed when everything is going so great in your life?' 'Be grateful for what you have and be happy. See, that person is so much more unfortunate than you, and still smiling.'

They fail to understand that depressed patients don't WANT to feel depressed. They don't want to think negatively. They can't become happy, or positive, even if they long to, on their own.

It's like being at the bottom of a dark pit, lonely and hopeless. And one can even see his friends and relatives standing up there, on the edge of that pit, exhorting him to climb up and come out. But he doesn't have the strength, and is sometimes, so overwhelmed by hopelessness, that he doesn't even want to.

As you pointed out, in a state of depression, positive thoughts, motivational talk is all good advice. But of no use to the depressed patient.

I, too hope that one day, the world will learn to see from the depressed person's point of view.

10:22 AM, August 13, 2014  
Anonymous Anonymous said...

Well written! I have some questions. How do you diagnose these problems? How do you decide what behaviour is normal? Is it impossible for a person to imagine some of these conditions? Are there techniques to detect chemical imbalances in the brain to decide one way or the other?

7:18 PM, August 14, 2014  
Blogger Max Babi said...

I would like to disagree with you Raamesh, as my depression started from school and lasted 46 years without treatment. Only in 2010, I decided to do something about it and detoxified my body. The melancholy that was the power source, left me. I am glad I didn't go to doctors nor shout out for an ambulance. What docs do is create the right ambience so your body cures itself, which affects the mind positively. Keep sane !

11:53 PM, August 14, 2014  
Blogger Raamesh Gowri Raghavan said...

The Diagnostic and Statistical Manual fourth edition (DSM-IV) lays down the definitions of pyschiatric diseases and the criteria used to diagnose them.

To be diagnosed as clinically depressed, often the following criteria are used: low-self esteem, anhedonia (loss of pleasure), unsocial behaviour, loss of energy, loss of appetite persisting over two weeks or more. Further tests may be done using fMRI to detect changes in the brain.

Usually, your GP is trained enough to suspect that a patient may have depression, and therefore recommend a psychiatrist.

But please do not confuse the clinical condition (which can attack anyone), with emotional situations which may be temporary.

12:44 PM, August 15, 2014  

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