A Different Kind of Antidepression

In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didn’t need these new antidepressants, because they already had antidepressants that work. He assumed they were talking about some kind of herbal remedy.

He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job—working in the rice paddies—was leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away. “You see, doctor,” they told him, the cow was an “antidepressant”.

To them, finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.

This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that “the dominant biomedical narrative of depression” is based on “biased and selective use of research outcomes” that “must be abandoned”. We need to move from “focusing on ‘chemical imbalances”, they said, to focusing more on “power imbalances”.

— Johann Hari, in an edited extract from his book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, courtesy of the Guardian.

(Please note that this is not intended to disparage or cast doubt on other treatments such as therapies or medications; rather it is meant to present an alternative, if not complementary, approach to helping those who struggle with depression in all its forms and degrees. Given that this malady affects diverse people for diverse reasons, it is sensible to consider every possible approach or treatment paradigm to address it.)

How Mindfulness Can Help Depression

Mindfulness meditation is one of the biggest trends in both medical and New Age circles. It broadly describes a form of mental training in which one deliberately focuses on emotions, thoughts, and sensory experiences of the present moment. Though it has roots in various religious traditions both Western and Eastern (especially Buddhism), it has long been observed to have secular applications as well, and the practice itself does not require any particular religious ritual or component.

There has been a lot of research showing that mindfulness, like meditation as a whole, has tangible mental and physical health benefits. The most recent study to confirm the benefits of “mindfulness-based cognitive therapy (MBCT)”, as it is known in medical parlance, was published in The Lancet, a leading medical journal. As Al Jazeera reported:

In this study, 424 adults in England with recurrent major depression, who were on maintenance antidepressant drugs, were randomly assigned to go off their antidepressants slowly and receive MBCT or to stay on their medication.

Study results published showed that after two years, relapse rates were similar in both groups — 44 percent in the therapy group versus 47 percent in the antidepressant drug group.

“Mindfulness gives me a set of skills which I use to keep well in the long term”, Nigel Reed, a participant in the study, said in a statement. “Rather than relying on the continuing use of antidepressants, mindfulness puts me in charge, allowing me to take control of my own future, to spot when I am at risk and to make the changes I need to stay well”.

The researchers said that while they found no evidence that [mindfulness] was superior to the use of antidepressants in preventing relapse, they said “both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms and quality of life”.

“We believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions”, Kuyken said.

I can personally vouch for the effectiveness of this approach, although it is worth reiterating that this is just one of several ways to combat depression, and by no means is it a wholesale replacement of other therapies (indeed, it is usually complementary).

Solutions will always vary from individual to individual, but with the rate of depression growing across the world, any new options on the table will certainly help; moreover, mindfulness techniques are beneficial to overall wellness, not just as a therapy for depression.

On Depression, Suicide, and Being a Good Person

The psychologist Rollo May once noted that “depression is the inability to construct a future”. Whatever the scientific merits of that observation, I believe it offers a reasonable explanation for how someone could do something that most of us would find impossible: consciously ending their own lives, often regardless of their seemingly positive circumstances. If one is unable to see any point to their lives, or to conceive of any future beyond the painful past and present that is all they know, then what other choice to they have, as far as they can see?

Obviously, depression and suicidal ideation are fundamentally personal matters that affect each individual differently, so I am reluctant to generalize about how it feels, where it stems from, and so on. Please take this as the uneducated stream of consciousness of one person and nothing more.

All I can say is that as a sufferer of depression and anxiety (both thankfully far milder than most), as well as someone familiar with the subject through loved ones and personal research, I have learned one valuable thing: no expression of love or validation is too small. Every little bit counts. No matter how futile it may seem, at the very least we must try.

I have heard too many stories of people being brought back from the brink of suicide and despair by the spontaneous phone call of a loved one, or the random act of kindness from a stranger. Humans inherently seek out validation and meaning in their lives; as a social and sentient species, we require both love and a sense of purpose. Simply being acknowledged by another human being, or being given something to work towards — a charitable cause, the making of art, the caring of others — is enough to enrich our lives and keep us going.

There is little I can say that is not already known: that suicide is irreversible, that depression and mental illness are nothing to be ashamed of and suffer alone with, that the people around you care and want you to stay. The unfortunate reality is that no matter how much we remind ourselves of these things, or how much we try to be there for others, the tragedy of the human condition continues. Many of us will be or feel powerless to help ourselves or others. In response to tragedy, we will reflect, act accordingly in the short term, but then move on until the next grim reminder.

Of course, this is not to discourage people from seeking help or offering it — doing good is still valuable and necessary regardless of whether bad things continue to happen. Over the years, I have learned from both personal experience and the accounts of others, that no matter what your mental status — depressed, suicidal, satisfied, etc — doing good for others feels deeply uplifting and self-actualizing. After all, we need to start somewhere, and in such a cruel world, no act of goodness is too small. It will always matter to someone, perhaps enough to save their lives. What have we got to lose in the process?

Ultimately, my point is that we must remain vigilant in our goodness and conscientiousness, to be kind and loving to as many of our fellow humans as possible. As the Scottish author Ian Maclaren rightly advised, “Be kind, for everyone you meet is fighting a hard battle”. In doing so, we can better our chances at enriching, if not saving, both others’ lives and our own. Even if it does not work out — if people continue to suffer, act self-destructively, or remain unmoved to act morally — at the very least we can say that we did very sincere best, and will continue to do so as long as human suffering on both an individual and societal level remains.

If you have read up to this point, thank you, and remember that I am always here for you, whether you’re an acquaintance or my very closest loved one. Your value as a person is all the same. Try me, you’ve got nothing to lose and no judgement to contend with. I know I can seem distant and unavailable, but believe me, I can and will make the time. It is hardly an inconvenience. On the contrary, it would be my honor. Be well my readers.

Robin Williams and the Tragedy of the Comedian

The recent death of  iconic actor and comedian Robin Williams has understandably lead to much shock and sadness, especially in light of the fact that he had committed suicide. Needless to say, there are no shortage of eulogies and reflections related to his legacy, accomplishments, and characters — what one would expect when such a titanic and beloved personality departs so suddenly — as well as discussions centered on his lifetime struggle with addiction and depression (which was nonetheless masked or mitigated in the public eye by his consistent lightheartedness and energy).

While I can go at length about this matter myself, or share a trove of excellent pieces covering everything there is to know and appreciate about Williams, I will stick to one that I found especially informative and relevant.

Over at Cracked, David Wong wrote an engaging piece that explored why it is that so many energetic, humorous, and seemingly well-adjusted people — celebrity or otherwise — end up as unlikely victims of suicide. I recommend you read the whole article, as it does a good job of mixing in thoughtful musings with the magazine’s characteristic wit and humor (which in this instance I found appropriately more tactful than usual). The crux of it is this:

Every time [a funny person makes] a joke around you, they’re doing it because they instinctively and reflexively think that’s what they need to do to make you like them. They’re afraid that the moment the laughter stops, all that’s left is that gross, awkward kid everyone hated on the playground.

I can attest to these both by observation and experience. I am very insecure about my personality and personal merits, which is one reason I indulge in sharing knowledge or being a clown, both online and off — it makes me feel valuable and desired, even though I also subsequently feel terrified of the “real” me being discovered and subsequently disliked.

Thankfully, my own struggles with self-loathing and the subsequent depression have never been bad enough to lead to addiction or self-destructive behavior. In fact, as I have gotten older, I have graciously been made to feel very accepted by many people despite my flaws, which has helped me passed my personal hangups, slowly but surely.

Speaking more broadly, one big point to glean from the article — and from the many similar observations of suicide victims appearing well on the surface — is that most people suffer in silence. Even those of us without depression or a serious mental illness feel the need to mask our hardships, internalize our negative feelings, and opt not to be a “burden” to those around us.

For many people, the alternative coping mechanism is to act out, to find worth and validation as someone entertaining and fun. One finds a purpose in brightening others’ days so that they do not suffer the same way you do. Imparting laughter and happiness is a way to gain social acceptance while also feeling like you’re doing some good in the world, which is always a nice feeling no matter what your mental state.

It is thus little wonder that so many troubled people gravitate to behaving or embracing seemingly contradictory behavior. It gives meaning and uplights their moods and others’. It is also a way to lighten the pain and burden of depression by making it more bearable, or even funny. What else is there to do with so much intractable sadness and hopelessness — aside from escaping into mind-altering substances, or ending your mind altogether.

Obviously, not all happy and humorous people harbor deep-seated and often fatal pain. Rather, it is that not all sad and pained people seem to clearly be that way. Symptoms of depression manifest in many different ways, as do the ways that people deal with them, so generalizations should be made with caution. But clearly, there is a pattern of suicides being unexpected and unlikely.

The observation that sufferers of depression are often those who we least expect is somewhat of a cliche, but clearly it is something that needs reminding. Too often we remain shocked and surprised when someone like Williams commits suicide, but maybe that reflects the strong sociocultural pressure to keep one’s sadness buried as much as possible. Maybe it testifies to how strong the stigma of depression, suicide, and addiction are, such that people would rather put on a mask and trudge through it at their own risk, rather than let it become exposed or admitting to a problem.

Of course, these are all just visceral musings and generalizations, not any sort of sociocultural prescription. Tragedies like this naturally elicit a lot of self-reflection and soul-searching, perhaps because there is something fundamentally relatable with how people choose to cope with their struggles, whether through humor, lashing out, or addiction.

My thoughts on all this are incomplete. Expect more later my friends. Until then, feel free to share your own ideas as usual.

 

 

 

Link

The following excerpt is from a post on Brute Reason discussing the problems with using psychiatric terms in a colloquial and metaphorical sense.

These words are used so casually that our conception of their meaning gradually shifts without our even noticing it. It’s like a boy-who-cried-wolf type of situation in that regard. If nine different friends joke to you about how they’re ‘sooooo OCD’ because they like all their books organized just so on their shelf (a situation familiar to just about every bibliophile, honestly), then the tenth friend who comes to you and tells you that they have OCD is probably going to evoke that mental image, rather than one of someone who actually can’t stop obsessing over particular little things and carrying out rituals that interfere with that person’s normal functioning, perhaps to the point of triggering comorbid disorders like depression. This may be a person who washes their hands until they are raw and hurting, someone who has to flick the light switch on and off seven times every time they leave a room, or someone who has recurring, uncontrollable thoughts about hurting someone they love even though they have no actual desire to do that.Well, that sounds a little different than insisting that your books be categorized by subject and then alphabetized by author, no?Likewise, if your friends are constantly telling you they’re ‘depressed’ because their team lost or because they got a bad grade, only to return to their normal, cheerful selves within a few hours, the next person who tells you that they are “depressed” might elicit a reaction of, ‘Come on, get over it! You’ll feel better if you go out with us.’

And so the meanings of words change.

We must either change the way these words are used, or at the very least recognize the nuance in their meaning — not everyone who says they have anxiety or depression actually does, in the clinical sense; moreover, those who do make a serious claim to such conditions should be given the benefit of the doubt, and not assumed to be displaying mere personality quirks or the like.
Thoughts?

The Perks of Shyness: Sensory Processing Sensitivity (SPS)

Never heard of it? Well if you’re the shy, introverted type, you have most likely experienced it.

It’s a personality trait characterized by sensitivity to any kind of stimuli. Basically, people with SPS have an above-average ability to notice subtleties in their environment: they’re better at reading people, or noticing minute details in their surrounds. Studies have found that SPS and other closely related personality traits – such as behavioral inhibition and introversion – are correlated with greater awareness of subtle stimuli (including social and emotional cues that most people otherwise don’t notice), giving more attention to things, and greater sensory reaction times. Indeed, MRI tests have revealed that the brains belonging to people with SPS showed far greater than normal activity in high-order visual processing.

And while you may feel glum about being so shy, individuals with SPS have typically reported having richer, more complex inner lives than others – which makes sense, given that shy people, by definition, spend much of their time looking inward and reflecting. In essence, the shy person is substituting their social life with their own rich inner life: philosophizing, reading, exploring, and enriching themselves in their own way (which isn’t to say that being extroverted is bad, as it’s merely another approach to enriching one’s life).

So take this into consideration the next time you’re lamenting your shyness, as I often have (although I have my extroverted moments as well). Obviously, this information may be little consolation to those of you are particularly tormented by the social ramification of shyness, but it doesn’t hurt to keep it in mind. You may not realize it, but you’re social inhibitions are something to be proud of, especially if you make the most of them. 

Can you relate?

Don Ritchie, the Savior of the Suicidal, Died in May

“A conversation can change a life.” – Donald Ritchie

I know it’s odd to publish a post about someone’s death this belatedly, but I had no idea that this wonderful man had passed on, and I think he deserves a posthumous mention. Also known as the “Angel of the Gap,” this brave and compassionate Australian devoted more than half his life to saving people from attempting to end their lives by jumping off a cliff  near his home. News.com reports:

Mr Ritchie spent 50 years coaxing desperate people back from The Gap, the notorious cliff at Watsons Bay where hundreds have died or thought about taking their lives.

He helped save 500 despairing souls – usually with little more than compassion, a warm smile and a hot cuppa.

“Those who knew him knew he was a very strong person and a very capable person,” Mr Ritchie’s daughter Sue said today.

Federal MP Malcolm Turnbull, whose electorate includes The Gap, added: “A true hero, one of our greatest Australians. RIP.”

Born in Vaucluse in 1926, Mr Ritchie died peacefully at home on Old South Head Road, Watsons Bay yesterday.

The former navy seaman turned life insurance salesman was never one to shout about his exploits.

He helped because he could.

Ms Ritchie said: “It was just something that he saw and that he had to do something about.”

New South Wales Mental Health Minister Kevin Humphries recalled when Mr Ritchie was named a Local Hero in the 2011 Australian of the Year Awards.

“Upon accepting the award Mr Ritchie urged people to never be afraid to speak to those most in need,” he said.

“Always remember the power of the simple smile, a helping hand, a listening ear and a kind word.”

A funeral will be held in Sydney on Friday.

Mr Ritchie’s family asked for donations to be made to the Black Dog Institute or to Lifeline.

As humble and simple as he was altruistic. The Global Post offered a more detailed account of his exploits, though it’s unfortunate that so few major media outlets mentioned him much before or after he died.

In his earlier years, Ritchie would physically restrain people from jumping off the cliff while his wife called the police, UPI reported. However, as he got older, he would simply offer distraught people at the edge of the Gap a cup of tea and someone to talk to.

Father Tony Doherty from Rose Bay Parish and a good friend of Ritchie’s told ABC News about the first time he saw Don literally talk someone off the ledge.

“I watched this figure gradually encourage [a man] to come back to the safety of the cliff,” said Father Doherty. “He has this wonderful soft, appealing voice that encouraged this little fellow not to jump.”

Ritchie won numerous community awards and a Medal of the Order of Australia for his efforts, and was named an Australian local hero of the year in 2011, according to the Telegraph. He also received gifts, Christmas cards, and letters from those he saved, sometimes a decade or two later, the Telegraph reported.

“Those who knew him knew he was a very strong person and a very capable person,” Ritchie’s daughter Sue told AAP News on Monday. “It was just something that he saw and that he had to do something about.”

However, Ritchie was not always successful in his attempts to stop suicides, according to the Telegraph. He saw several people jump, including one instance where he spoke to a quiet young man who “just kept looking straight ahead,”  Ritchie told The Sydney Morning Herald in 2009.

“I was talking to him for about half an hour thinking I was making headway,” said Ritchie. “I said ‘why don’t you come over for a cup of tea, or a beer, if you’d like one?’ He said ‘no’ and stepped straight off the side his hat blew up and I caught it in my hand.”

Whether he saved 160 people or 500 doesn’t matter – even saving a single human life is incalculably valuable. Mr. Ritchie has left behind quite a legacy: imagine having over a hundred people go on with their lives because you did nothing more than offer them an ear.

Not only is a wonderful example of the best aspects of humanity, but he offers an important lesson about what it takes to help another human being. All any of us want as humans, whether we’re suicidal or not, is someone to talk to and care. A small show of kindness or a simple offer to hear someone out could literally be all it takes. As Mr. Ritchie was found of saying, “a conversation could change a life.”

Indeed, he changed far more than many of course ever hope to. I hope more people take his lesson to heart. Think of all the lives we could improve or even save.

(To be clear, I’m not making light of suicidal and other morbid mental illnesses; obviously, certain individuals may require far more than human empathy to get better, as even Ritchie learned to his dismay. But the point is to at least make the effort. Taking a few minutes to check up on someone, be they friend or stranger, costs nothing but potentially save the most precious thing at all).

Finally, the Sydney Morning Herald also published an article that includes an interview with the charismatic but down-to-Earth Ritchie, whose sincerity and approachability makes it no mystery that he could coax people from the brink. As much as I’m tempted to mourn his death, I can’t help but feel happy that he lived such a full and accomplished life. I’m further consoled by the fact that there are many other low-key heroes just like him (including a very similar case in Japan).

 

World Mental Health Day

I had almost forgotten that today was devoted to raising attention to mental health issues, although it didn’t help that, sadly, the observance is still new and obscure. Luckily, CNN managed to get a word out about it:

Clinical depression affects about 5% of the world’s population. You probably interact with sufferers each day without realizing it. On this World Mental Health Day, dedicated this year to depression, here’s what they want you to know. Some last names have been omitted to protect individual privacy.

You can read more about these stories here. It’s not easy going public with depression: like most mental disorders, it’s heavily stigmatized, and it either isn’t taken seriously or is regarded as a sign of personal weakness on the part of the sufferer (“why don’t you just get over it?”).

While it’s certainly true that there are misdiagnoses and a lot more we need to learn, the fact is that mental illness is real. The brain can get sick and damaged just like any other organ, yet it is usually only with diseases or disorders of the brain that people become skeptical or even hostile.

That needs to change. It’s hard enough struggling with mental health problems without feeling alienated, put down, or weak. I say this not only as a sufferer of (albeit mild) mental issues, but as a humanist concerned about the well-being of others, whatever the nature of their problems.

Suicidal Ideation and Attention Seeking

Whenever I’m helping out someone who is suicidal or struggling with mental illness, I’m often advised not to bother, because such individuals are most likely trying to draw attention to themselves, and I’ll only be wasting my time.

First of all, I’d rather make the mistake of assuming an attention seeker is serious about their problem, rather than the other way around – a lot of people have lost their lives that way.

Second, and perhaps most importantly, the fact that someone is so desperate for attention is itself a problem worth addressing. Anyone who threatens drastic actions such as suicide in order to get others to care about them clearly needs love and help. Obviously, their tactics will need to be confronted and addressed eventually, but ignoring them isn’t going to help.

I’m not a psychiatrist. I don’t always have good advice, or any real solution for that matter. Sometimes I don’t even know what to say. But more often than not, all anyone wants – and I say this as a sufferer of depression – is just someone else to talk to, someone who cares. That much I can certainly offer. It may not be enough, but it may also be everything. It never hurts to try.

This is just what I’ve learned from experience. People are welcomed to share their own views and perspectives on the matter.

Suffering From Depression?

Well you’re in good company: many of the world’s most talented and accomplished figures, past and present, have struggled with depression. They include Abraham Lincoln, Tchaikovsky, Mark Twain, Thom Yorke, Isaac Newton, Winston Churchill, Charles Dickens, Jim Carrey, Buzz Aldrin, and Princess Diana – among many, many others.

I’d like to believe that depression is the price we pay for brilliance. Almost every depressed person I’ve ever known as been exceptionally skilled or intelligent in one way or another. Ernest Hemingway, another sufferer, once called it the “artist’s reward.”

Would we rather embrace our uniqueness, at the cost of this mental burden, or lose what makes us extraordinary so as to be mentally “normal”? I know it’s not always one or the other – I’m sure you could be unique and still be happy – but it’s just something I’ve been thinking about.