DEPRESSION

It seems to me that psychology has long overlooked the "Gorilla in the Living Room," the fundamental mental disorder on which so many other disorders rest.

Haw! That's (above) a caricature Mike did of me, showing me in one of my cheery moods, oblivious to anything depressing. Haw! Maybe he's right. For all I know, I might have a mountain of psychological disorders, but I don't think Depression is one of them. Even so I can't help but feel sorry for the people who do have it, a sympathy made deeper by a reading of William Styron's book on the subject, "Darkness Visible."

I think the image most people have of a depressive is that of a lethargic person (above) who spends hours looking wistfully out the window at grey, overcast skies. I don't think that's always correct. My own belief is that depressives are sometimes the most active people you know, the people who are least likely to waste time staring out of windows.

It's true that they're all vulnerable to funks of frightening intensity, but it's also true that lots of them have developed strategies to deflect those funks....I mean, apart from the medication they take. Those strategies frequently include alcohol or drugs...

...but they also might include hypochondria, hoarding, workaholism, over-achievement or sex obsession.

Even crime, even philanthropy!  What all these strategies have in common is that they allow the sufferer to get out of his own problems and focus on something outside of himself.

I find this fascinating, especially the workaholic part (above). I used to regard workaholics as possible candidates for what's called "Obsessive-Compulsive Behavior Disorder, but now I'm not so sure. If a person deliberately cultivates compulsion just to deflect depression, is he really clinically compulsive? Wouldn't it be more accurate to say that he simply has a compulsive "problem?" Surely the stronger term "disorder" should be reserved for the the depression he's trying to avoid.

Okay, I've probably bored everybody to death with all this fuss about naming things. I'll end with this thought: if lesser disorders are dropped from the official list...if vulnerability to depression is recognized as being far and away the central problem...

...the "Gorilla in the Living Room"...

....then psychiatry and treatment is simplified. Whatever drug lessens the frequency of depression will lessen lots of other problems too. In fact, in a general way, I think that's already known to be the case.

My own guess is that if depression were easier to recognize, we'd discover that 1/2  or more of all people have it. Something that widespread might have come about because it's benign or useful in some way. Maybe the deflection strategies it engenders are an essential part of creative thinking or getting things done. Who knows?

A TERRIFIC FILM OPENING

I've a huge interest in film gambits, "gambits" being a chess term for the opening moves of a game. The term can apply to storytelling as well. "It was the best of times, it was the worst of times" was a gambit, as was "Call me Ishmael." Here's the the gambit for the terrific TV miniseries, "Olive Kitteridge."

The story is about a woman suffering from chronic depression in a small New England town.

It opens with silhouettes of buildings set against unsettling dawn skies. You get the feeling that something's wrong in this town, and has been for a long time.

The pounding surf intensifies the mood.

Now here's (above) where the really original part begins. A fishing boat is seen in an ominously tempestuous sea. One still frame can't do this image justice. A ship in a daytime shot usually symbolizes hope and escape. Not so here.

Far from being a symbol for escape, the boat may be seen as a sentry preventing escape and confining the townspeople to their prison.

The film trucks out of a porcelain image of the ship. The painted image is a happy one but the audience knows better. Seeing the creepy ship in this nice old-fashioned context firms up our conviction that whatever's wrong in this town has deep roots, and that the towns people might even have had a hand in covering it up. 

  

Smash cut to a street in the town where a woman is discovered lying dead on the ground. The music and art direction lead us to believe that she was somehow killed by a supernatural thing. It capriciously felled an innocent woman and left her limp as a rag doll on the ice.

This isn't a horror film, so the supernatural element I'm talking about isn't part of the plot. Even so, it's important. Sherlock Holmes stories are like that.  There always a supernatural subtext in them, and it makes the stories more interesting.

Fascinating, eh?

CHRONIC DEPRESSION

Recently I watched a couple of Youtube videos on the subject of Depression. Holy Mackerel! I realised that I know next to nothing about the subject. How many of us do?

Apparently the sexy subject these days is Manic Depression. Plain old run-of-the-mill Depression now appears so...yesterday. Maybe that's because the treatment for Depression is so standard now: anti-depressant pills plus maybe two years of therapy. The therapy is just to make sure you get in the habit of taking the pills. If you have Manic Depression add lithium to the list.

Anyway, through the videos I discovered that I'm in danger of getting some sort of depressive disorder.

 I'm moving to a part of the country where I'll likely have no cartoonist friends and where I'll probably have drastically reduced face-to-face contact. Recent studies show that this will put me in a high risk category for Depression.

Geez, I better enjoy Los Angeles while I still can.

People say that Skype is the remedy for isolation, but is it?  It's a futuristic technology and I love the idea, but it hasn't worked well for me in the past. I always run out of things to say, something that seldom happens when I'm face to face.

You could argue that the kind of depression you get from isolation is really just plain old everyday sadness. If my sad-inducing circumstances improved then my illness would vanish and with it my claim to a serious problem. That's a comforting thought if true, but the behaviorist in me can't help but wonder if the negative habits acquired in isolation can be shed so easily. I don't think they can.

Manic depression certainly is a lot more fun to think about. At least the manic people have times when they think they can do anything and are positively euphoric. The problem is that, according to one video, for some people it doesn't lead to anything positive at all. The ideas they get look silly the next day. They're just spinning their wheels. And besides, the depressive episodes of the disease last longer, and are more severe, than the manic ones.

That's all I have to say about this subject. I really don't know much about it. If I made a mistake I hope someone who knows better will correct it.

BTW: I noticed something called Borderline Personality Disorder on the sidebars of depression sites. BPDs are said to be impulsive, prone to mood swings, and lack empathy and a clear identity. Yikes! I've read that there's 140 kinds of personality disorder. That means an awful lot of us probably have a screw loose somewhere. It's scary!

HOW GERMANY GOT OUT OF THE DEPRESSION

How about a serious post for a change?

If I were an economist the area I'd focus on would be the quest for a market driven method of providing full employment, which I define as voluntary employment at a living wage for everybody who is willing and able to work. That doesn't sound like it would be too difficult to achieve but, believe it or not, no modern economic system, including our own, has ever pulled it off. Even communist countries which call themselves "workers' states" haven't been able to do it. There's plenty of unemployment in those countries, they just don't report it.

Oddly enough, the only country which is widely believed to have achieved it was Germany in the 1930s. But is that true? And if it is true, how did they manage to do it? How did they get out of the Depression so quickly and then create full employment besides? I know nothing about economics, but I just read a book on the subject, and I'll pass along the opinions of the author.

The book is "The Nazi Economic Recovery 1932-1938" by R. J. Overy (1982). Overy believes the recovery was a fake. Unemployed people were simply drafted into The Labor Service, where they were forced to work for an extremely low wage, usually on farms. Once they were in the service they weren't classified as unemployed anymore. According to Overy the real German economic miracle occurred in the 50s, and had nothing to do with Nazi policy.

The Nazis were said by some to be Keynesians because they also believed in big government spending to handle unemployment. The author, who's a Keynesian himself, was revolted by the idea. He says Keynes strongly believed that big government spending had to be accompanied by low taxes. The Nazis believed in high taxes. They didn't want consumers to spend money on things, they wanted them to save their money in banks where the Nazi's could make use of it.

Apparently the Nazis inherited what today we might call a "progressive" agenda from the Wiemar Republic. In Wiemar the government owned or controlled some big industries and when the Nazis took over they simply amplified that policy, gradually expanding it til even small business came under their control.

Add that to fact that Germany didn't try to export or import much during this period and was concerned mainly with self sufficiency wherever possible. Overy says this was disastrous for the country because it cut them off from foreign competition which, if they had engaged in it, would have forced the country to increase efficiency and to modernize. No wonder wartime Germany used slave labor. They were too inefficient to produce enough goods by normal methods.

Overy's book left me feeling sad for the Germans. They had a cruel leadership to be sure, but they were also an energetic, educated people handicapped by a system that just didn't work.

"ANONYMOUS" WRITES ABOUT ELECTRO-SHOCK THERAPY

I recently wrote a post about electro-shock therapy (ECT) where I also touched on the treatment of people who hear voices. I know nothing about these subjects and I was hoping that someone who did would correct me if needed. Well, someone did! Many thanks to two anonymous commenters for the replies which are re-printed below.  

No one is getting forced ECT anymore. It has been a long long time since that sort of thig happened.

ECT is used for severe refractory depression where either drugs and therapy has not worked and the patient agrees, or where the patient is so depressed they have shut down and would need a feeding tube to be placed!



I taught the psychiatry class at our Med College and have since specialized in Anesthesiology and see maybe 10 ECTs a week. They are pretty benign now. The current is much lower, the patient is paralyzed so they can't hurt themselves, and the main side effect is a few hours of confusion and occasionally some "word salad", which is where the patient tries to say something but random words come out. They realize what is going on and you have to tell them that it will only last a little while. Most laugh about it later (A good sign compared to lying in bed starving to death) and one guy actually asked my nurse to record him if he had it again. He did, and she did, and he played it for his family.

The goal of ECT isn't to cure depression, although in the minority of cases it can do that. The goal is to break the untreatable deep depression so that the meds and therapy can work before the person shuts down again.



As for the lady in the video (Liz Spikol, above). Its pretty clear she is having some thought content and process issues. Makes for an interesting show though.

And psychiatrists are not telling people to talk to their voices or that they are "real" in the sense people are making here. They do know that there are neural connections misfiring and the person is actually hearing the voices, so it is "real" in that sense, but they are not having people reason and engage the voices. That does no good. They are having people realize what they are and try to work around them, but not to encourage them to talk to them.



And Jung (above) was crazy. Read his actual writings and it is clear he was as crazy as many of his patients. I wonder if he was doing the Coke like Freud did... may explain it.

And the guy with the Egyptian delusion/myth/whatever you want to call it. How is it unreasonable that the person would be exposed to that? Starting in the 40s and 50s we started seeing tons of alien abductions and alien obsessed delusions, and many were consistent with each other. In Jung's time Egyptology was VERY popular both to the upper classes and the common man. Even if not, the idea that the big visable thing in the sky blows the air around isn't that special.

Here's the second comment, also anonymous:

Hey Uncle Eddie - long time follower, first time commenter... er. I was thinking about your blog on the train today, especially about the entry Mad Pride and the comments by Anonymous. I guess, as with many things, everyone is a little bit right and a little bit wrong about most things. Like Spikol, I have experienced long term major depression which resulted in numerous hospitalisations and on three of those occasions I underwent varying numbers of ECT episodes (the most intensive being 18 treatments over a 6 week period). Unlike Spikol, I was not issued with any incontinence products and fortunately all the staff I ever encountered were most empathetic. However, I did experience headaches, tension in my jaw, disorientation and significant short term (and ultimately long term) memory loss. A number of years later there are still large pockets of memory that I never regained, I believe it has probably been exacerbated by the ECT but I think such a long and entrenched depression has wreaked havoc on my comprehension skills and memory – which provides great opportunities for my siblings to invent histories for me! My protests of “I would never get drunk and fall asleep in the shower recess, missing Christmas dinner and forever disgracing the family” are only half hearted, because I can’t really be sure... but then I am also painfully aware of what my sibling’s idea of fun is too. It can be disconcerting to look at photos of your adult self and not remember the occasion when it was taken. I am aware of a number of people who have benefited from ECT, even though I don’t believe I was one of them. Ah, but there is a happy end note... I am now the most ‘well’ I have been in years thanks to a combination of a therapy program that worked for me and greater access to mental health services and probably good luck: I still find myself weeping sometimes during the news (but that’s probably healthy) and I sometimes become overwhelmed with anxiety (but that’s probably because I’m doing things I haven’t done in years). When I think of my years in ‘the wilderness’ I do feel a sort of pride: In the same way those that have survived a terrifying holiday-from-hell might – so you planned on sun, sea and sand but you got a cyclone, a military-cop, a missing captain and a drunk navigator! You can only wear the scabs and scars of the Bed Bug bites with pride... what else is there do? A note from the Outpost...