Mental Health and the Brain: Working Group, June 15th

See An Expanded Neurobiology of Depression.

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Rich conversation, thanks all.  It further strengthened my feeling that depression is not well understood either as "sadness" or as "chemical imbalance."  And that substantial future progress, both conceptual and therapeutic, depends on taking a broader view of what's going on, one that includes greater attention to internal experiences. 

Perhaps the most striking feature of depression is that it is a mix of several different characteristics, of which sadness may not be even the most typical one.  There are clearly both sensory features (grayness, relative loss of perceptual range in several modalities) and motor ones (slowing and reduction of movement, flatness of tone in speech), as well changes in sleep and eating patterns and cognitive abilities.   There are also several features of self-experience: senses of being trapped, of being located in an inescapable present with no meaningful future or past, of helplessness, of hopelessness, of loss of ability to motivate or control oneself. and of alienation, distance from both others and onself.

Cataloguing the mix is important from several perspectives.  One is that it makes it likely that depression is not a particular single thing but rather the expression of a more or less orderly interaction among a diverse array of things.  A second is that it makes explicit the question of what the causal relationships are among the diverse array of things.  And a third is that the diverse array of things includes what one is consciously experiencing:  "stories" of one's sense of onself and one's relation to one's surroundings.

Could the diverse array of characteristics of depression all be secondary consequences of one of them, or of some other underlying cause?  In principle, yes of course.  But thinking about depression in terms of a number of interacting parts, as an emergent property of a complex system, opens up a whole array of alternate conceptions that may in fact better fit existing observations, and perhaps a set of new productive questions as well.  The death of someone one can trigger depression but so too stressful situations (eg marital or job difficulties) in which sadness is less obviously a significant factor.   And depression can also be triggered by seasonal changes, in the absence of an obvious connection to either sadness or stress.  Moreover, depression often has a certain independent coherence to it, waxing and waning over periods of time relatively independently of external manpulations.  Both the property of their being different ways to get into a particular state and of some independent coherence of that state are perhaps more consistent with the notion of multiple interacting entities, with reciprocal causal relations ("loops") among them, than they are with a single cause/multiple effects notion.        

From this perspective, "chemical imbalance" should perhaps be thought of as being potentially as much an effect as a cause of depression.  And the same holds for "self-experience," the stories one has about one's self and one's relation to the world.  Of course one's stories can be affected by one's neurotransmitters, but conversely one's neurotransmitters can be effected by one's stories.  Depression can be helped, in some cases, by pharmacotherapy.  It can also be helped, in some cases, by talk therapy.  There is no mystery in this, if one adopts an emergent systems perspective of depression, and an associated understanding that internal experiences, stories, are not simply consequences but also have themselves causal efficacy in the web of interacting components. 

The emergent perspective on depression also suggests that internal experience may be as significant an indicator of what is going on in the brain as are measurements of neurotransmitter metabolism.  A feeling of helplessness and hopelessness, of being trapped in an eternal present, of having been abandoned  all seem to me significant in this regard.  External circumstances giving rise to those feelings can trigger depression; perhaps so too can such internal experiences generated by the brain without any associated external experiences?  The internal experiences can perhaps be a cause as well as an effect?  This might also make sense of some of the other non-arbitrary mix of characteristics in depression.  Perhaps diminished activity and a more general inclination to hide is part of what might, in some circumstances, be an adaptive response to being abandoned and unprotected in a world of unknown threats?  

What might lead to an experience of abandonment and helplessness in lieu of some dramatic change in external circumstances?  Here too it may be helpful to think in terms of multiple interacting elements.  One's conscious experience is built on and in turn influences a diverse host of elements of the cognitive unconscious, a continuing dialogue from which a coherent conscious story of oneself and one's place in the world emerges.  Should that dialogue be for some reason interrupted, one might well have a conscious experience of a a dissociation, a split between the self one is aware of and other aspects of oneself.  Such a split could in turn result in a sense of having been abandoned (by another part of oneself), a feeling of loss of control/will, and the other elements of a sometimes adaptive response to abandoment in a hostile unknown world. 

Might a prolonged conflict between conscious and unconscious understandings be at least sometimes a significant element in human depression?  Such a possibility is of course consistent with the presumptions of psychodynamic psychotherapy.  And might make sense in other terms as well.  Depression associated with seasonal affective disorder might well be thought of as the result of a conflict between unconscious expectations of the amount of light that should be present at any given time and one's conscious awareness of the actual amount of light.  And so might perhaps be relieved either by phototherapy or, at least in principle, by something that makes one less conscious of the experience of light.  Virtually all organisms are subjected to changing lighting conditions.  Is it possible that humans are subject to depression because of consciousness, and that organisms lacking consciousness don't experience a conflict under such circumstances and hence don't exhibit depression in the human sense of the word? 

Might something similar be going on in the case depression caused by the death of someone one is close to?  There is perhaps an unconscious expectation of continuing contact coupled with a conflicting conscious awareness of the person's absence.  The mismatch between unconscious expectation and the lack of anticipated contact may be initially disturbing but responded to by unconscious changes.  Could depression result when conscious expectations fail to become adjusted in the way unconscious one's are? 

More to mull, but perhaps a direction for some new thinking about depression in broader conceptual terms, one that might also have useful therapeutic implications as well?  And perhaps one that can both contribute to and draw from discussions of education and other things as well?