Lighting up the Abyss

20 November 2016

It’s in your home, it’s in your family, it’s in your city, it’s everywhere. It afflicts and it compromises. It’s discussed in many places, a lot of the time. It is said that it’s reached epidemic proportions. It’s confidently called depression, yet no one knows what it is.

It is said that it manifests in many guises. From unhappiness to obesity, from doom and gloom to insomnia, from exhaustion to undefined need and insatiable hunger. It pervades the home the office and beyond. Yet it defies definition. It is the ‘dark cloud’ that smothers all light. It is confidently described as an emotional affliction and yet much of its manifestations are physical. It is said to be caused by genetic anomalies, by a troubled childhood, by ‘chemical imbalances’ by aberrant flashes seen in the functional MRI, diet and even by the bugs that live in your bowel. And still it remains obscure.

And behold the great men and women of the psychiatry persuasion created a bible which they termed the DSM – the book which lists all mental and emotional maladies. And in the great book they inscribed ‘depression’ in all its possible manifestations and then gave it a code. And in this way it became real. It was a legitimate malady. And when they allegedly identified low levels of the neurotransmitter serotonin as being the cause of this affliction, the flood gates opened. Great pharma research into a legitimized illness which had a code gave rise to the medication for which the funders were forced to pay. From this space the afflicted inherited medical legitimacy for their illness. And their employers, family and friends supported them and complied with the needs of their affliction. And the psychiatrists and big pharma prospered as never before.

And yet ... what is depression? The research around serotonin is tenuous at best. The serotonin boosting anti-depressant medications (SSRI’s) in many cases are not that much better than the placebo effect as regards ‘happiness’. On the anxiolytic side however, they appear to have some benefit.

And so for twenty four years I read, observed and researched this melancholia which has accompanied mankind since the beginning of recorded time. And since I was not a psychiatrist but still trained in the neurosciences, and since I was not bound by any institutional tenure and yet had access to all the technology that I needed, I had delicious freedom to say, write and do whatever I pleased. And when I arrived at a place of medical respectability, a consultant neurosurgeon, it was too late for the medical Establishment to excommunicate me – for behold the enemy was within!

My great inspiration, my inspirator, was Viktor Frankl. He nailed it from the outset. Frankl recognized that the symptoms of melancholia reflected a meaninglessness at a specific point along the life path. And if you believed that there was nothing that you could do to improve the situation, to make it more meaningful and gratifying, then you moved into a space which I subsequently defined as hopeless-helpless. And in the study of many life narratives I noted that those with more disadvantaged nurture histories in the form of deprivation, were more prone to hopeless-helplessness. They had less resilience to withstand the drift into the black abyss of extreme hopeless-helplessness. And so I concluded that we all have an existential imperative – we need to maintain purposeful business. Otherwise we slip into the existential crisis of hopeless-helplessness.

The hopeless-helpless mind state is associated with raised levels of inflammatory mediators. These mediators result in inflammatory conditions which underpin neuro-degenerative conditions (Altzheimers disease, Motor Neuron Disease, Parkinson’s), cardiovascular disease, immune suppression and cancer. And yes, they also diminish serotonin but more specifically, dopamine while raising levels of adrenaline which collectively is associated with an increase in the inflammatory indices, thereby perpetuating the vicious circle that will spiral you down the plug hole into hopeless-helplessness.

The final clincher is in the research. When hopeless-helplessness was identified as a single variable apart from the obscure entity of depression, the correlation of cardiovascular illness and outcomes as well as those of cancer, correlated directly with degrees of hopeless-helplessness rather than with that amorphous entity called depression.

And so I conclude that I have no idea what depression is. It is an obscure entity from which many have derived a lucrative profit while others have gained a legitimate malady. It should be emphasized however that I am in no way minimizing the nature or the consequences of the affliction. Rather, in the place of this undefined amorphous entity I would propose that there are degrees of hopeless-helplessness. These are existential crises which may reflect a low deprivation-induced resilience to loss or alternatively, loss of a significant life entity and/or loss of meaning and purpose. The remedy I believe is not mega-doses of serotonin promoting drugs, or changing the diet or having colonic purges!! Rather, I would suggest that we seek meaning and purpose when it wanes (with professional help if necessary). Engage with the world and each other and seek to contribute value to ourselves and to our environments. And finally let us secrete much oxytocin (Nature’s own antidote for inflammation and associated hopeless-helplessness) by striving to be sensitive, non-judgmental and caring. Thence shall we inherit clarity, calmness and trust and an end to hopeless-helplessness. Amen.

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