Authors: Dean Burnett
All of these theories may contribute to, or may be consequences rather than causes of, depression. Research is ongoing. What is clear is that it's a very real, often extremely debilitating condition. Aside from cripplingly awful moods, depression also impairs cognitive ability. Many medical practitioners are taught how to differentiate between depression and dementia, as on cognitive tests serious memory problems and being genuinely unable to muster up any motivation to complete a test look the same, as far as the results are concerned. It's important to differentiate; the treatment for depression and dementia vary considerably, although often a diagnosis of dementia
leads to
depression,
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which just complicates matters further.
Other tests show that people with depression pay more attention to negative stimuli.
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If shown a list of words, they'll focus far more on those with unpleasant meanings (“murder,” for example) than neutral ones (“grass”). We've discussed the brain's egocentric bias, meaning we focus on things that make us feel good about ourselves and ignore things that don't. Depression flips this: anything positive is ignored or downplayed; anything negative is perceived as 100 percent accurate. As a result, once depression occurs, it can be extremely hard to get rid of.
While some people do seem to develop depression “out of the blue,” for many it's a consequence of too much time being hammered by life. Depression often occurs in conjunction with other serious conditions, including cancer, dementia and paralysis. There's also the famous “downward spiral,” where people's
problems mount up over time. Losing your job is unpleasant, but if then your partner leaves you soon after, then a relative dies and you get mugged while heading home from the funeral, this can be just too much to deal with. The comfortable biases and assumptions our brains maintain to keep us motivated (that the world is fair, that nothing bad will happen to us) are shattered. We've no control over events, which makes matters worse. We stop seeing friends and pursuing interests, maybe turn to alcohol and drugs. All this, despite providing fleeting relief, taxes the brain further. The spiral continues.
These are risk factors for depression, which increase the likelihood of it occurring. Having a successful and public lifestyle, where money is no object and millions admire you, will have fewer risk factors than living in a deprived high-crime area, earning barely enough to survive and with no family support. If depression were like lightning, some people are indoors while others are stuck outside near trees and flagpoles; the latter are more likely to get struck.
A successful lifestyle doesn't provide immunity. If someone rich and famous admits they suffer from depression, saying, “How can they be depressed? They've got everything going for them,” makes no sense. Being a smoker means you're more
likely
to develop lung cancer, but it doesn't affect
only
smokers. The brain's complexity means many risk factors for depression aren't linked to your situation. Some have personality traits (such as a tendency to be self-critical) or even genes (depression is known to have a heritable component
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) that make depression more likely.
What if the constant struggle against depression is what spurred someone to be successful? Staving off and/or
overcoming depression often requires considerable willpower and effort, which can be channeled in interesting directions. The “tears of a clown” cliché about successful comics whose skills stem from fighting internal torment is a perfect example, as are many famous creatives who endured the condition (Van Gogh, for instance). Far from a preventative, success may
result
from depression.
Also, unless you're born to it, achieving wealth and fame is hard work. Who knows what sacrifices a person made to obtain their success? And what if they eventually realize it wasn't worth it? Achieving something you've worked for for years can rip the purpose and drive from your life, leaving you adrift. Or, if you've lost the people you value on your determined upward career path, this can eventually be seen as too high a price. Being successful in other people's eyes is no defence. A healthy bank balance does not overrule the processes underlying depression. Even if it did, where's the cut-off point? Who would be “too successful” to be ill? If you can't be depressed because you're better off than others, logically only the most unfortunate person on earth should be depressed.
This isn't to say many rich and successful people aren't very happy; it's just not a guarantee. The workings of your brain don't drastically change because you have a film career.
Depression is
not
logical. Those describing suicide and depression as selfish apparently struggle with this concept, as if those with depression make a table or chart with the pros and cons of suicide and, despite there being more cons, selfishly opt for suicide anyway.
This is nonsensical. A big problem with depression, perhaps
the
problem, is that it prevents you from behaving or thinking “normally.” A
person with depression is not thinking like a non-sufferer, in the same way that someone who's drowning is not “breathing air” like someone on land. Everything we perceive and experience is processed and filtered through our brain, and if our brain has determined that everything is absolutely awful, that'll impact on everything else in our lives. From a depressed person's perspective, their self-worth may be so low, their outlook so bleak, that they genuinely believe their families/friends/fans would be better off without them in the world, that their suicide is actually an act of generosity. It's a very upsetting conclusion, but not one arrived at by a mind that's thinking “straight.”
Accusations of selfishness also often imply people with depression are somehow choosing their situation, that they could enjoy life and be happy but consider it more convenient not to. Exactly how or why they'd do this is rarely explained. In instances of suicide, you get people saying it's the “easy way out.” There are many ways to describe the sort of suffering that overrides millions-of-years-old survival instincts, but “easy” isn't an obvious one. Perhaps none of it makes sense from a logical perspective, but insisting on logical thinking from someone in the grip of mental illness is like insisting that someone with a broken leg walks normally.
Depression isn't visible or communicable like a typical illness, so it's easier to deny that it's a problem rather than to accept the harsh unpredictable reality. Denial reassures the observer that “it will never happen to me,” but depression is still affects millions of people regardless, and throwing accusations of selfishness or laziness at them purely to make yourself feel better can't help. As a behavior, that's a much better example of selfishness.
Sadly, the truth is that many persist in thinking it's easy to ignore or override a powerful debilitating mood disorder that regularly affects sufferers to the very core of their being. It's an excellent demonstration of how the brain values consistency, that once a person has decided on a certain viewpoint, it's hard to alter it. The people demanding that those with depression alter their thinking while refusing to do the same in the face of the evidence are showing just how hard it is. It's a terrible shame that those who are suffering the most get made to feel worse because of it.
It's bad enough when you have your own brain conspiring against you so severely. To have other people's doing it too, that's just obscene.
Emergency shutdown
(Nervous breakdowns, and how they come about)
If you go out in the cold weather without a coat, you'll catch a cold. Junk food will mess up your heart. Smoking ruins your lungs. A poorly set-up workstation causes carpal tunnel and backache. Always lift with your knees. Don't crack your knuckles or you'll get arthritis. And so on.
You've probably heard these things before, and countless similar nuggets of wisdom about how to stay healthy. While the accuracy of these claims varies considerably, the notion that our actions affect our health is valid. Our bodies, marvel-ous as they are, have physical and biological limitations, and pushing these limits has consequences. So we watch what we eat, where we go, how we behave. If our bodies can be badly
affected by what we do, what's preventing the same from happening to our complex, delicate brains? The answer is, of course, nothing.
In the modern world, the biggest threat to the well-being of our brains is good old stress.
Everyone experiences stress on a regular basis, but if it's too intense or too frequent, then we get problems.
Chapter 1
explained how stress has very real and tangible effects on our health. Stress activates the hypothalamicâpituitaryâadrenal (HPA) axis in the brain which activates fight-or-flight responses, which release adrenalin and cortisol, the “stress” hormone. These have numerous effects on brain and body, so the effects of constant stress become very apparent in people. They're tense, not thinking straight, volatile, physically wasted or exhausted, and more. Such people are often said to be “heading for a nervous breakdown.”
“Nervous breakdown” isn't an official medical or psychiatric term. It doesn't involve the literal breakdown of nerves. Some use “mental breakdown,” which is technically more accurate, but still a colloquialism. Regardless, most people will understand what it is. A nervous breakdown is what happens when someone can no longer cope with a high-stress situation, and just . . . “snaps.” They “shut down,” “withdraw,” “fall apart,” “can't cope.” It means a person is mentally no longer able to function as normal.
The experience of a nervous breakdown varies considerably between individuals. Some experience bleak depression, others crippling anxiety and panic attacks, some even hallucinations and psychosis. So it might be surprising that some see nervous breakdowns as a defence mechanism of the brain. As unpleasant as they are, they're potentially helpful.
Physiotherapy can be exhausting, hard and unpleasant, but it's certainly much better than not doing it. Nervous breakdowns may be the same, and this makes more sense when you consider that nervous breakdowns are invariably caused by stress.
We know how the brain experiences stress, but how does something cause stress in the first place? In psychology, things that cause stress are known (logically) as stressors. A stressor reduces personal control. Feeling in control makes most people feel secure and safe. It doesn't matter how much
actual
control we have. Every human is technically a meaningless sack of carbon clinging to a rock hurtling through the uncaring void around trillions of tons of nuclear fire, but that's too big for a single human to be aware of. But if we can demand and get soy milk in our latte, that's tangible control.
Stressors reduce options for action; something is more stressful if there's nothing you can do about it. Getting rained on is irksome if you have an umbrella. Getting caught in the rain without an umbrella while locked out of your house? That's stressful. With a headache or a cold there are medications available to minimize the symptoms, but chronic illnesses cause a lot of stress because there's often nothing to be done about them. They're a constant source of unavoidable unpleasantness, providing a very stressful situation.
A stressor also causes fatigue. Whether frantically running to catch a train after oversleeping or working on an important last-minute assignment, dealing with a stressor (and its physical consequences) requires energy and effort, depleting your reserves, causing further stress.
Unpredictability is also stressful. For example, epilepsy can cause incapacitating seizures at any moment, so they're
impossible to plan for effectively, which is a stressful situation. It doesn't have to be a medical condition; living with a partner prone to mood swings or irrational behavior, meaning you risk a rage-induced fight with someone you love if you accidentally put the coffee jar in the wrong cupboard, can be incredibly stressful. These situations provide unpredictability and uncertainty, so we end up constantly on edge, expecting the worst at any moment. Result: stress.
Not all stress is debilitating. Most stress is manageable as we have compensatory mechanisms to balance the stress reactions. Cortisol stops being released; the parasympathetic nervous system activates to relax us again; we replenish our energy reserves; then carry on with our lives. However, in our complicated, interconnected modern world, there are many ways in which stress can quickly become overwhelming.
In 1967, Thomas Holmes and Richard Rahe assessed thousands of medical patients and asked them about their life experiences, attempting to establish a link between stress and illness.
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They succeeded. This data led to the formation of the Holmes and Rahe Stress Scale, where certain events are assigned a certain number of “life change units” (LCU). The more LCU an event has, the more stressful it is. A person then says how many of the events on the scale happened to them in the previous year, and an overall score is assigned. The higher the score, the more likely someone is to become ill from stress. Top of the list is “death of a spouse” with 100 LCU. Personal injury scores 53, getting fired 47, trouble with in-laws 29, and so on. Surprisingly, divorce scores 73, whereas imprisonment scores 63. Oddly romantic, in a way.
Things not on the list can be worse again. A car crash, involvement in a violent crime, experiencing a major tragedyâthese can cause “acute” stress,
where a single incident causes intolerable levels of stress. The events are so unexpected and traumatizing that the usual stress response is, to quote
Spinal Tap
, “turned up to 11.” The physical consequences of the fight-or-flight response are maximized (you often see someone shaking uncontrollably after serious trauma), but it's the effect on the brain that makes such extreme stress hard to get over. The flood of cortisol and adrenalin in the brain briefly enhances the memory system, producing “flashbulb” memories. It's actually a useful evolved mechanism; when something severely stress-inducing happens, we definitely don't want to experience it again, so the highly stressed brain encodes as vivid and detailed a memory of it as possible, so we won't forget and blunder into it again. Makes sense, but in extremely stressful experiences it backfires; the memory's so vivid, and
remains
so vivid, that the individual keeps re-experiencing it, as if it were constantly reoccurring.