Spilling out over the side to anyone who will listen


  Friday, December 27, 2002

By divers Meanes men come unto a like End

from Essays After Montaigne

The most usuall way to appease those minds we have offended (when revenge lies in their hands, and that we stand at their mercy) is, by submission to move them to commiseration and pitty: Neverthelesse, courage, constancie, and resolution (meanes altogether opposite) have sometimes wrought the same effect.

And just as there's more than one way to forestall revenge, there's more than one way to seek relief from depression and related emotional illnesses (and there's more than one way that those illnesses can be caused). People are generally most comfortable with a clear distinction between the physical and psychical, and thus between pharmaceutical and therapeutic treatments for emotional disorders, but careful examination of emotional processes renders any such distinction hopeless.

According to our best understanding (which is by no means complete), everything psychical ultimately emerges in the purely physical realm of neuro-chemistry. Thoughts and emotions seem to be the result of complex chemical reactions in our brains. Exactly what contributes to those reactions (stimulus, memory, our soul, diet, blood flow, etc.) is unclear, but it's more clear that the locus of those reactions is our brain, as a gunshot wound, lobotomy, or similar trauma to the brain will clearly demonstrate. It seems therefore that to become manifest, the psychical must become physical, so that there is an equivalency between mental activity and chemical reactions. And furthermore, the accumulated effects of those reactions shape the structure of the brain. The brain of a person who suffers from depression looks different than the brain of a person who doesn't. And that's true regardless of the causes of that depression.

Depression seems to be the result of interactions between experiences and the mental activities that integrate and react to those experiences. A person may have a predisposition to rumination or moodiness (which would probably be seen as genetic and neuro-chemical in origin) that makes social interactions more difficult, leading to isolation, alienation, and ultimately, depression. Perhaps the initial predisposition is best addressed by medication, allowing the person to then learn positive social interaction in a therapeutic context. Or perhaps the initial predisposition can be best addressed in a therapeutic context after the social difficulty has been addressed with medication. Another person may have suffered an emotional trauma (which would probably be seen as experiential in origin) as a result of which the person is unable to function emotionally. Perhaps medication will prove most effective, or perhaps therapy will prove most effective. Given the current state of the art, there's no way to know what will be more effective in either case but by trial and error. What we do know, according to Andrew Solomon in The Noonday Demon, is that, regardless of the cause of the depression, medication or therapy alone will prove effective about half the time, while the two together will prove effective about eighty percent of the time.

My own case seems to support this theory. Though intellectually gifted as a child (something that seems to have worn off a bit as I've grown up), I had difficulty relating to others emotionally (which has also worn off a bit). This seems to have been genetic (many members of my family enjoy the same gifts and suffer the same difficulties) and neuro-chemical (I can't locate any emotional trauma that could have caused this). My brain chased itself in circles, particularly when presented with thoughts that could be fed with any sort of emotional energy--thoughts that sought order from unmanageable chaos--leaving me self-absorbed and confused. Retrospectively, it appears that I have something like Asperger's Disorder. This predisposition was exacerbated by the chaotic and emotionally distant household in which I grew up. Where I needed more than most children to learn how to live with myself and others emotionally, I was taught far less than most children. I didn't have access to emotionally healthy or mature adults or models of healthy emotional relationships. Where I needed a sense of safety and order, I had only chaos and confusion.

I eventually learned to function quite well, mostly by avoiding all things emotional. To render the model in terms of geological formations, I syphoned all of my diffcult emotions (fear, sadness, anger, etc.) into a pool deep in my psyche, which I then covered with a slab of anxiety that I learned to avoid. (Anxiety can be seen in kinetic terms as an emotional excitation that can serve to counter or prevent the emotional slump of depression.) That worked for me as a child, a teenager, and even a young adult. I seemed easygoing and carefree, willing to try anything. When I drank too much, this tended to fail (drunkeness poked a hole through the slab, allowing all sorts of unpleasant emotions to leak out), so I didn't do that very often, and I never tried other drugs, fearing the potential loss of control.

As an adult, this became much less tenable, and when I got married, it became impossible. I couldn't choose just those emotions necessary for a healthy relationship. Regular trafficking in emotions opened a spring from that pool in my psyche--I often found myself angry for no good reason, far angrier than circumstances could even begin to warrant. Still, after a few years of marriage I managed to find another emotional equilibrium, in part by sharing the more difficult emotional work with my wife. But everything fell apart on a two-week European bike trip that I took without her. Far from home, struggling through jet lag, physical exertion, sleep deprivation, and foreignness without her support, I didn't do well. I finally collapsed completely in Arlon, Belgium, and struggled the rest of the way through the trip. When I got home I started therapy.

Therapy for me began as a guided attempt to more fully experience my emotions. It began slowly at first, but after about a year, I found myself overwhelmed by anxiety. I tried a variety of meditation and other yogic techniques, but there was an energy behind the anxiety that I just couldn't get a hold on, that was stronger than anything that I could muster against it. I went a week without sleeping (which was very disconcerting for a person who generally needs nearly nine hours of sleep a night). At that point, I could have tried to back out of the therapy (which may or may not have worked) or moved forward with some sort of pharmaceutical assistance. I chose the latter, which meant clonazepam. It worked beautifully--there were no side effects, I slept well, I experienced a full range of emotions, and I fell into the pool of depression hidden under the suddenly dissolved slab of anxiety. Because that depression was accompanied by occasional thoughts of escape and images of suicide, my therapist and psycho-pharmacologist worked themselves into a tizzy and decided to move me from clonazepam to an anti-depressant, Celexa. This has worked even better, also with no apparent side effects.

Now, having rendered my anxiety and depression manageable and having stopped my brain from chasing itself, I've found therapy to be far more effective in locating and addressing the experiences that have contributed to my unhappiness; I've been able to work toward a richer and more rewarding relationship with my family; I've been able to feel the full solace from contemplation of the ideas of Plato, Lucretius, Augustine, Dante, Kierkegaard, Proust, and others; and I've been able to write things like this. It is by these means (medication, therapy, spiritual contemplation, communication, etc.) that I'm reaching the same end of emotional health that others have reached by very different means (and that still others have failed to reach by these same means).

6:09:13 PM     What do you think? ()

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