Wired: Anxiety Strikes at Harvard Law School

Freud was of the opinion that in fear a person is responding to a specific and immediate threat to physical safety while in anxiety a person is responding to a threat that is objectless, directionless, and located somewhere far off in the future—ruination, for example, or humiliation, or decay. Daniel Smith, Monkey Mind: A Memoir of Anxiety

I spoke at Harvard Law about the challenges of living with depression and the epidemic of poor mental health in the legal profession. It was a memorable event.

Days before I am scheduled to talk, my sleep goes cuckoo. I become incredibly anxious about my speech. What if I fall flat on my face? I graduated from some third-tier law school, after all. I don’t belong lecturing at Harvard.  My churning nighttime ruminations now seep into my days as the event gets closer.

Up, Up and Away: Lifting Depression By Tweaking Your Antidepressants

In my last post, I wrote about a recent downward turn in my mood. While not severe, it still sucked: low energy and motivation,  sadder more often than I’d like, and lack of joy in things that formerly made me happy.

If felt like I had one foot in gooey, hot asphalt. I keep trying to yank it out to no avail. Finally, I called my trusty psychiatrist. His name’s Chris.

We hadn’t seen each other for six months. Over the past ten years or so since he’s been my shrink, that was about normal because not much had changed in the past decade: we’d found a combination of two pills seven years ago that was effective in managing my depression.  Sure, there had been some ups and downs over that period of time. But nothing like the psychic hurricane that blew through my brain when I first experienced major depression years ago.

He suggested I stay with my two old friends: Cymbalta and Lamictal. But, he said that we could “tweak” my treatment by adding

The Neuroscience of Depression: An Interview with Dr. Alex Korb

new-korb

The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb.  Dr. Korb is a neuroscientist, writer, and coach.  He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year.  His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

On Depression, Hope, Hopelessness, and Freedom

Hope is a desire for something combined with an anticipation of it happening, it is the anticipation of something desired. To hope for something is to make a claim about something’s significance to us, and so to make a claim about ourselves.

One opposite of hope is fear, which is the desire for something not to happen combined with an anticipation of it happening. Inherent in every hope is a fear, and in every fear a hope. Other opposites of hope are hopelessness and despair, which is an agitated form of hopelessness.

Hope is often symbolized by harbingers of spring such as the swallow, and there is a saying that ‘there is no life without hope’. Hope is an expression of confidence in life, and the basis for more practical dispositions such as patience, determination, and courage. It provides us not only with aims but also with the motivation to attain those aims. As the theologian, Martin Luther said, ‘Everything that is done in the world is done by hope.’ Hope not only looks to the future but also makes present hardship easier to bear, sustaining us through our winters.

At a deeper level, hope links our present to our past and future, providing us with an overarching narrative that lends shape and meaning to our life. Our hopes are the strands that run through our life, defining our struggles, our successes and setbacks, our strengths and shortcomings, and in some sense ennobling them. Running with this idea, our hopes, though profoundly human—because only humans can project themselves into the distant future—also connect us with something much greater than ourselves, a cosmic life force that moves in us as it does in all of nature. Conversely, hopelessness is both a cause and a symptom of depression, and, in the context of depression, a strong predictor of suicide. “What do you hope for out of life?” is one of my most important questions as a psychiatrist, and if my patient replies “nothing” I have to take that very seriously.

Hope is pleasant in so far as the anticipation of a desire is pleasant. But hope is also painful, because the desired circumstance is not yet at hand, and, moreover, may never be at hand. Whereas realistic or reasonable hopes are more likely to lift us up and move us on, false hopes are more likely to prolong our torment, leading to inevitable frustration, disappointment, and resentment. The pain of harboring hopes, and the greater pain of having them dashed explains why most people tend to be modest in their hoping.

In his essay of 1942, The Myth of Sisyphus, the philosopher Albert Camus compares the human condition to the plight of Sisyphus, a mythological king of Ephyra who was punished for his chronic deceitfulness by being made to repeat forever the same meaningless task of pushing a boulder up a mountain, only to see it roll back down again. Camus concludes, ‘The struggle to the top is itself enough to fill a man’s heart. One must imagine Sisyphus happy.’

Even in a state of utter hopelessness, Sisyphus can still be happy. Indeed, he is happy precisely because he is in a state of utter hopelessness, because in recognizing and accepting the hopelessness of his condition, he at the same time transcends it.

Neel Burton, M.D., is a psychiatrist, philosopher, writer, and wine lover who lives and teaches in Oxford, England. He is a Fellow of Green-Templeton College, Oxford, and the recipient of the Society of Authors’ Richard Asher Prize, the British Medical Association’s Young Authors’ Award, the Medical Journalists’ Association Open Book Award, and a Best in the World Gourmand Award.He is author of Heaven and Hell: The Psychology of the EmotionsHide and Seek: The Psychology of Self-Deception, and other books.

 

 

 

The Bald-Faced Lies Depression Tells Us: Part 1

Whatever the cause, clinical depression sufferers are often shackled to a prison of ruminative, negative thoughts about the world and themselves.

They are full of self-loathing, feelings of worthlessness, and a sense of failure.  Confidence in their ability to build and maintain successful relationships is eroded.  Their sense of competency about their work can plummet as they struggle to get things done, be productive and earn a living. Some may even hate themselves when lost in this destructive process.

If that weren’t tough enough, are brains actually work against in this negative spiral. Psychologist Margaret Wehrenberg writes:

“Brain function plays a role in rumination in several ways, but one significant aspect

13 Ways of Defining Depression

From the Storied Mind website, blogger John Folk-Williams writes, “With all the conflict about defining depression, it’s not surprising if you’re confused about what it is, where it comes from and how best to treat it. There may not be much disagreement or confusion about what it does to you. But there is a difference of opinion about whether those impacts are a good or bad influence in your life.” Read the Blog

How Faith Helps Depression

Blogger Therese Borchard writes, “A substantial amount of research points to the benefits of faith to mitigate symptoms of depression. In one study, for example, researchers at McLean Hospital in Belmont, Massachusetts, found that belief in God was associated with better treatment outcomes. Of all my sanity tools, my faith is what has kept me alive during severe depressive episodes. When I’m convinced that no one else could comprehend the intense suffering I’m experiencing, I cling to my belief in a God who created me for a reason, who knows my pain more intimately than any other human being, and who will see me through to the other side.” Read the Blog

North of 50 – Depression at Midlife

IMG_6849When first diagnosed with depression fifteen years ago at the age of 40, I thought I would recuperate and, more or less, go back to my busy life as a lawyer and husband with a young family. It didn’t work out that way. I soon found out it was going to be a long haul. And I’m still truckin’.

What’s changed in my experience of depression over the past decade and a half? A lot.

I know much, much more about the illness; it’s contours, triggers, and wily ways. I know what will help when I’m in the thick of it, more often than not. I also accept there will be times when there’s little I can do to make a dent in depression’s cold armor.

My depression doesn’t last as long as it used to. Nor is it typically as deep. In the early days, it seemed like it went on forever. I couldn’t remember a time before it when I’d been happy. And couldn’t envision a future of being anything other than depressed. I felt I was barely living. Nothing gave me pleasure. Even eating good food, one of my favorite things. Everything tasted like ashes in my mouth. Death felt preferable, at times.

I didn’t feel much compassion for my depressed, younger self. I’d slap myself in the head and say, “What the hell’s wrong with you?” I had my own inner medieval-like inquisitor ready to burn my soul at the stake for some unknown sins depression’s twisted thinking had convinced me I’d committed.

The verdict: my depression was my fault.

I don’t believe that anymore. I now understand it’s a bunch of hooey cooked up by my depressed head. After all, depression’s a terrible liar. There’s a cruel irony to all of this. We need our minds to recover – but sometimes it’s this very organ that’s turned against us. Depression isn’t who we really are, but we can feel that way. As Parker Palmer once wrote about his experiences with this affliction, “I wasn’t walking in the darkness, I had become darkness.”

I have the upper hand on depression now. It isn’t the giant that once pummeled me. It isn’t as scary. Because I know know that depression will, yes, always be a part of my life, but it isn’t my life.

I am more than that.

And I have a good and full life that I’m determined to live.

 

The Connection between Depression and Trauma and Neglect

Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.

Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”

A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.

Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.

We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.

 Responding to Trauma by Losing Ourselves:

When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.

Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.

How Sexual Abuse Can Lead to Depression:

If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.

The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.

This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.

If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.

Trauma Comes in Many Forms:

Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.

gifted

One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.

A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.

These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.

Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.

Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.

What Does Depression Have to Do with It?

When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.

If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.

If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.

If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.

In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.

Depression is often simply telling us that we are not really living our lives as ourselves.

To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.

Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.

 

 

Chronic or Recurrent Depression: Why Does Depression Go Away and Then Return?

Some people who experience a single depressive episode will fully recover, never to experience another. (Sign us up for that, right?)

For about 40-60% of us, however, depression is a chronic illness that will come back. By the time most people get treatment, they have experienced multiple depressive episodes already.

Good news: with treatment, recurrences can be less severe, occur less frequently and not last as long.

So why does depression seem to rear its ugly head over and over again for most of us?

Saying you have depression is like saying you have a terrible headache, in that you have disabling symptoms, but it says nothing about the cause of those symptoms.

For instance, in the case of a headache, you may have a migraine, a tension headache, a stroke, a brain tumor, a concussion, or something else. The underlying cause informs the prognosis and treatment of your headache, whether it will come back and the best course of treatment.

With depression, we are just beginning to understand the underlying causes and contributors – which could be medical, neurological, psychological or social – many of which are ongoing and lead to a propensity for depressive episodes.

Depression has a genetic basis, but whether that’s because of biological differences in brain chemistry or temperament or something else, we don’t know yet.

We do know that people in stressful situations or lifestyles have more depressive episodes. This could be stress brought on by work, it could be relationship-related, a traumatic or neglectful childhood, or an unsafe living or work environment.

Recurrence can be caused by psychological makeup – much of which can be based in how we view ourselves, others and everyone’s place in the world. Studies have shown that psychotherapy can change this brain makeup to positively influence our outlook.

There’s still so much to learn about the disease. We need to recognize that for many, it’s a biopsychosocialspiritual illness with multiple contributing components that must all be addressed to create the highest likelihood for treatment to work.

Psychotherapy remains the most effective treatment for depression, and should be part of every patient’s plan for recovery.

Someone with chronic, disabling depression may also benefit from a comprehensive evaluation at a center that respects all contributors to the illness to treat the whole person in an individualized, comprehensive way. One place to do this is at The Retreat at Sheppard Pratt, which also specializes in treatment-resistant depression.

Depression is an intensely personal experience. When pursuing treatment, be sure that you are being understood, and obtaining the level of support you need. For some, particularly those working in a highly stressful environment, that could mean getting away for a short time to focus on recovery, even though it can be a tough decision to make. Be open to all levels of care.

It can be disheartening to realize that your depression will likely come back. Know that you’re not alone, as about 6.7% of the U.S. population have had at least one depressive episode in the past year.

Keep working on your recovery, talking about it to reduce stigma, and supporting those who are studying mental illness. One day, we will know more.

By Thomas Franklin, M.D., Medical Director, The Retreat at Sheppard Pratt

Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.

 

 

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