Me and My Brain

As a longtime sufferer of depression, I've relied on pills designed to treat chemical imbalances in my brain.  These pills are controversial, with conflicting opinions on whether they are really more effective than placebos.  Millions of people swear by them, many claiming that they have clearly been effective in treating their depression.  Of course, such data is anecdotal, as would be any that I could offer.  I can say anyhow, that my depression has been somewhat reasonably managed for years.

When I first began taking the medication, about seven years ago, I did recall a significant feeling that my conscious state had been altered.  Almost impossible to describe, it was as if a kind of numbness came over me, taking "the rough edges" off of things.  My psychological history in the subsequent years was complicated.  In some ways I did seem to feel a certain sense of relief.  Yet a couple of years later, shortly after my first daughter was born, I attempted suicide.  I had certainly entered a deeply depressed state, one in no small part induced by geographic and social isolation, as well as the stress of being the primary caregiver for a colicky infant, all while suffering from devastating chronic neck pain.

So in one sense the medication failed me, or at least was not effective enough to prevent suicidal depression.  But the trouble with measuring the efficacy of antidepressant medications is that the population being treated suffers from an illness that is very difficult to properly diagnose, properly quantify, and much less understand the pathology of.  To what extent was my depression and my behavior driven by brain chemical imbalances, and to what extent was it driven by my habit of mind, or cognitive framing of the world?

Philosophically, the debate over what consciousness is, or to what degree we can understand it, is contentious.  Much of conscious human experience is not well understood, and little data exists to support hypotheses as to either what causes it, or what it even is.  Thomas Metzinger, director of the Theoretical Philosophy Group and current president of the Association for the Scientific Study of Consciousness, defines consciousness as "the appearance of a world".  It is a good start, but doesn't offer much of a clue as to where it comes from or what it in fact is.

There are many phenomena that we can't really explain very well, and yet must start somewhere if we are to hypothesize - especially if there are real-world consequences of our assumptions either way. Critiques of materialism usually see people as assuming too much, relying too readily on a physical framework as a best guess. Critiques of the opposite - immaterialists? - see people as ignoring what seem to be perfectly reasonable logical conclusions drawn from our knowledge of the physical world.

I tend to fall into the latter camp. I'm reminded of the old creationist thought experiment, the clearly "designed" phenomenon in the natural world, such as Mt. Rushmore or a house in a desert, in which physical processes are assumed to be incapable of such complexity. This can be contrasted with a thought experiment designed to illustrate Occam's Razor, where a broken, blackened tree is found in a field - in the absence of clear evidence, one might assume any number of explanations, some more fantastic than others. Yet the most likely, the most reasonable explanation would be that lightening has probably struck it down.

Surely, many biological processes - certainly those involving the brain and/or consciousness - are lacking in a great deal of evidence. But there is also much that we do know, and would be remiss in not taking into full account, if not inferring even further material hypotheses.  For my part, I look forward to advances in this exciting area of science.  Not only for what medical breakthroughs it might provide in the treatment of psychiatric illness, but for what it might tell us about broader, older philosophical assumptions about human behavior and the social structures they inform.

Getting the Light Just Right

 Keith Humphreys presents the following dillema in pain management:

"Every public health official I talk to at the city, county, state and federal levels knows how serious prescription drug misuse and overdose are, yet is also struggling to find ways to limit the damage without causing harm to people in pain. If you can thread that needle perfectly, the world will beat a path to your door."

It's a really sketchy call.  Let me share some of my personal experience.

I've had moderate chronic neck pain since I was in a near-fatal surfboard accident in 1989.  As the onset of the pain was slow - taking maybe 6-8 years to fully present, I watched my quality of life slowly deteriorate.  Depression thus became a growing concern; suicide gradually came into focus as a sort of emergency escape hatch.  The pain was essentially non-stop, worst at night, when sleep was difficult.  Formerly a very athletic skateboarder, my life activities ground to a near halt; more than light/moderate activity risked intense spasms that could last days.

I attempted suicide a couple of months after the birth of my first daughter.  Hard to fathom such a cruel act in retrospect, at the time it seemed perfectly logical.  I was the primary caregiver (my wife taught classes during the day) and the baby was colicky.  I was able to imagine my wife remarrying and finding a better life for her and my daughter with someone who was able to give them what I felt I could not.

I had been taking anti-depressants and over-the-counter tylenol/advil for years.  I had a few sleeping pills I'd stashed from my time spent in a medical environment earlier in my career.  Yet none prescribed.  Anyway, what I took was some combination of those.  I remember regretting it almost instantly.  As the baby cried downstairs, I went to the toilet and tried to induce vomiting.  But it was too late.  I lost consciousness in a matter of minutes.

I found out later that my wife came home from work to find me blue on the couch.  She called the ambulance and had to wait for it to arrive, with me dying by her side.  They pumped my stomach and in two days I regained consciousness.  I spent the next week in the psych ward.  But it was largely unnecessary.  I knew as soon as I woke up what I had done.  It was as if something terrible had rushed out of me, and something beautiful had rushed in.  The pain was still there, it has never left.  But so was my wife, my daughter, my family, my friends, my art, my dreams.  Keeping my mood up is often a daily battle.  But it's never been so hard since.  The suicide, like some taunting devil in the closet, has been banished far, far away.

I now take a doubled dose of anti-depressants and a sleeping pill.  On really bad days I'll take a Xanax.  The doctors I've seen over the years have all been very nervous about treating my pain with opioids.  And for the most part I agree - I try to live without as many "crutches" as possible.  It is partly just a matter of psychology.  The less I worry about my pain, the less I, well, worry about my pain.

But sometimes you can't escape, and it can overwhelm you like a ton of bricks.  A formerly beautiful day full of golden promise can become a wretched bog of shit to slog through.  What a difference a "mood" makes.

I wonder if my pain could have been managed better, I might never have reached the depths of depression that nearly robbed my family of me.  But that's a counter factual too impossible to know.  And yet, there is a correlation between suffering and depression, between pain and suicide.  There is a logic to the thought that the only way to stop the pain is to end your life.  But it is a logic that misses a couple of key things.  One of them is medical treatment.  And the other is the extraordinary power of the mind to transcend physical suffering.

However, that power is not inexhaustible, and all it takes is a few life events to pile up and you have a powder keg of stressors that can break even the most strong-willed patient.  It occurs to me that in this time I was without medical insurance.  Ironically, this was because I had a pre-existing, chronic condition, and could not find coverage.  It may have been no use.  But a better system of pain management, possibly a routine series of visits with a physician every few months, might have helped.  Ultimately, in many ways I got lucky.  These cases can be tricky for the health care system to deal with.  But I find it hard to come to the conclusion that less care would ever be better.  Especially for those who need it most.

Thoughts on Lysergic Acid

Kleiman linked to a Nat Geo special on LSD, which made me ponder...

As a post-hippie child of Santa Cruz, CA I ended up doing LSD at the age of 9. I had scored it from an older brother and shared it with friends. I had a blast. I remember riding in the car with my mother days later and suggesting to her an insight I had developed while “frying”: maybe reality existed only “to the front of us… while what was behind us – what we could not see – was not really there.” I remember her responding to me that she had had the same thought once while on LSD herself. I had not told her about my illicit activities, but worried she was on to me. Had she only known!

A friend at the time saved a hit and later dropped it one morning before school. I heard later they sent him home after he began barking like a dog on the floor of his 5th grade classroom. As a teen he committed suicide.

Recently I reflected that during that period of time in my life my two closest friends were without fathers. One, a native American Indian (yet one more suicide statistic), lived alone with his mother in a small apartment. She was a house cleaner, and one of her ears had been burned off – I fuzzily recall it being a domestic case, but I’m unclear. The other had a father who was either dead or in prison. My father, on the other hand was our family’s sole provider, a high school teacher who cared deeply for us, but often seemed preoccupied – either physically or emotionally.

I dropped a few more times, but never close to the more than 100 my brother did. He ended up having a bad trip that induced in him an anxiety condition that he still medicates for today. Fortunately, it’s now in prescription form, with less side effects than the booze he spent his twenties downing.

I often attribute much of my lifelong battle with depression to a fracturing of my psyche received from LSD and marijuana. Of course, chronic neck pain has always been the primary causal factor. But when the shades of consciousness begin to unravel, and that dark lubrication begins to bubble, one curses anything that might have ever amplified the chaos.

And yet such bittersweet music it is. The human condition is one of fragility, defined by its penchant for wreckage.

The Depression Suggestion

Yesterday I felt somewhat depressed. I had woken up with pretty intense pain - maybe a 5 or 6, which for me is above my normal 3 or 4. My thoughts also had begun to turn towards the impending return to school, the pressures of my boss and the daunting prospects of teaching something almost completely new. And my mood was altered.

I realized a common issue I agonize over when depressed is what might be "causing" it. I inevitably have been dwelling on some element of present dissatisfaction. These generally fall into the categories of neck pain, interpersonal or professional troubles. The neck pain I have generally come to understand as beyond my control - despite the poisonous notion in various circles that the original source of the pain is psycho-dynamic dissonance, its remedy being of course intensive self-reflection and scrutiny. (This is utter nonsense. While psycho-dynamics do exist, they only contribute to overall stress, which in turn exacerbates an underlying physical condition. The idea that they are themselves the root cause of physical pain is a deeply distressing invalidation.) To the extent that the physical pain promotes the depressed mood, I must simply carry on and make my peace with it.

And yet the interpersonal and professional troubles are not - in theory - beyond my control. There are legitimate concerns that, were they to be properly addressed, could cease to be a source of continued stress. The trouble is that in a depressive state, legitimate concerns become obscured by illegitimate ones. Perseveration is a frequent symptom.

Something interesting to note regarding the depressive mood is that it mirrors the mood that accompanies genuine loss. As with other disorders, such as anxiety, it may be true that the mind confuses a physiological reaction with a mental one. For instance, it is said that symptoms of anxiety such as sweating, rapid breathing, quickened pulse can actually trigger the onset of an attack, as if the mind associates these feelings with panic, follows its own fear of panic into real panic. With depression, could it be that the mind interprets the physiological experience of depression, similar as it is to a genuine state of loss, as requiring "justification", and thus inventing mental activities to recreate a similar experience. So while the body feels as if a loved one has just died, in reality there is no real mental anguish. Thus it is invented to create the illusion of unity between body and mind.

Unfortunately there often are reasons to experience some level of mental anguish. And frequently they are in fact the original stressors. Yet the problem is the degree to which they justify reasonable levels of anguish. While one may be justified in worrying about an upcoming job interview as it is important and performance is critical, feelings of depression would not be appropriate. And yet if this normal stress induces a depressive state, the mind is then faced with the cognitive dissonance of events not matching physiology, and introduces a sort of synthetic anguish. In this state, the rectification of causes for worry (Yes, I am qualified; No, they will not think I am too slovenly) will almost certainly not alleviate the depression. And so the mind often becomes even more determined to find some explanation for the mood, and turns up the volume, escalating the conflict.

Mood as the News

On the front lines of emotional illness...

This weekend, reeling from the likely prospect that I will not be being hired back in the fall, I've somehow managed to avoid the lapping tendrils of outright depression. Long a stalwart nemesis of mine, entangled as it is in the existential threat chronic pain poses throughout my days, I'm fortunate to have - at least as of this writing - managed to keep it at bay. God knows why (that saucy bastard!), but I've been able to abide in the belief that my employer's decision wasn't reflective enough of my true capacity as an educator to fully warrant the painful cognitive battlefield of self-deconstruction. Oh, I hear her calling, at least once every few minutes, but like a cheeky damsel I chasten her with a limp wrist and wiggle her elsewhere. So, let's continue to strike while the iron is hot, shall we?


From the positive state, it is difficult to imagine how much could be given over to a negative state of conflict.

The negative mood consumes everything and makes everything relative to its perceived unresolved tension. Every small thing becomes indicative of that same vast, unresolved struggle.

The positive mood is always emphasizing the positive. The negative is there, but more or less resolved. And if not, it is more than buoyed by the comfort in knowing - truly appreciating - the positive. In a positive state, things could happen in one's life that could never happen in a negative state without causing systemic risk. A happy glow surrounds everything.

This is not so much to do with the inherent qualities of that thing (or idea), but its perceived meaning from within each state. The state consumes one and refracts conscious reality through its prism. Things are looked for (or not looked for), but the emphasis is always dependent on the state. The glass is full, or empty; opportunity is there, or not; the self is good, or bad.

The positive state is perfection: it is ebullient, resilient, decisive, generous, and objective.

The negative state is flaw: it is cynical, mordant, sluggish, selfish and biased.

These seem to exist on a spectrum, or at the very least seem to each have spectrums that overlap. The excesses of the positive state - over-generalization and self-delusion - are base characteristics of the negative state. While the positive state exhibits both through a lack of self-reflection, the negative state does so through an excess of it.

The trick is dealing with genuine catastrophe. For at once one is stricken by the emotion pain of having suffered a blow, and the realization that some real flaw exists in one's self and must be corrected. This is never an easy task, however. If it were so easy to sort out what mistakes were made, they likely never would have been. On occasion, this crashing wave seems to wipe the slate clean, receding at once to provide clarity and absolution from past sin.

But to degree that one suffers from melancholic tendencies, the wave never seems to recede. It washes one under, every hour driving the victim deeper and deeper into his watery grave. The choice is never then to simply put things into the past and return to the surface. Shackles are there! Quickly, they must be unfastened! The blindness of the foggy deep all around, the overwhelming sense of doom welling into bright bubbles of burning panic exploding all around.

It is in this desperate, frigid scene that important decisions must be made. What is real must be sorted from fiction. Relative importance must be measured and adjusted, matters then sorted accordingly. The past must be reconstituted and evidence examined. A framework must be erected, refuse removed in rusty, finicky trucks and labels affixed for future reference. Slowly, things must be rebuilt.

And then, just like that, one emerges. All that seems so far away, so long ago. It is as if these really are two places, two very different states of consciousness. Yet for those of us prone to falling, the water is never more than a few unfortunate events away.