Mind & Life XIII--Day 2/Session 3: How to Get Undepressed

This day went more smoothly: the sound system had been fixed, His Holiness’ health had improved, and the panelists had a certain rapport with one another.

Zindel Segal reported that people who have been depressed before are very likely to become depressed again. Individuals who have experienced depression seem to take “normal” sadness as a cue to engage in depressive thinking, and the more readily they have these thought this predicts how readily they will have a relapse.

“Depressive thinking” arises automatically, without consideration, and has an avoidant aspect: you’re trying to suppress things or keep them at a distance. It’s very self-centered and repetitive; it doesn’t solve any problems, and it traces the same thoughts over and over. Classic ruminations of this sort would be along the lines of “happiness=success and wealth”; “making (or admitting to) a mistake is a sign of weakness”; or my favorite, “If others respected me I’d feel fulfilled.” What’s more, you’re sure you’re a terrible person for feeling depressed.

People who have been depressed before are likely to perceive these thoughts as containing some emotional wisdom, and ruminating on them to be a problem-solving activity. Not surprisingly, when you’re thinking this way, your problem-solving skills are actually quite diminished!

Mindfulness-Based Cognitive Therapy (MBCT) is designed to prevent a relapse in people who have been depressed, by retraining some of these habits of mind. Instruction effectively counteracts the tendencies of depressive thinking. What if you didn’t see your thoughts as anything but passing weather? Could moods be curious mental events that will pass, that don’t necessarily reflect the truth, and are amenable to modification?

This is essentially the skill set that I’ve learned from residential Zen practice. I wouldn’t trade the experience for anything: I deeply appreciate the emptiness of my thoughts, opinions, and moods. But I’m also really happy that a stripped-down cognitive system is available to folks who aren’t able (or foolish enough) to sign up for the monastic treatment.

It’s also reassuring to me to see that MBCT training involves looking at elements of ones’ life, and encouraging habits that counteract depression. The little gems of mental hygiene I’ve discovered as a result of looking minutely at my thoughts and feelings are all incorporated in MBCT! Just grounding the awareness in the body has saved me from many a precipice. Giving internal voices a chance to weigh in and be heard is a key part of good mental hygiene, in my view. At some point I found that engaging in creative activity--doing something pleasant that I’m good at--greatly reduced the incidence of (apparently) spontaneous angry thoughts.

These all pay off tremendously and should be a part of everyone’s life—and they all turn up in MBCT because they work for people in general, not just me. Actually, studies show that this therapy works best for people who have had recurrent depression. That would be me! I’m so happy that this is available to people. The hardest thing about depression is that complete lack of hope. You really think you’re the most miserable piece or crap, totally alone in the world. Ironically, depression is so devastating because the depressed person is actually far from alone--they’re part of an epidemic. Turns out, depression is projected by the WHO to rank second (behind heart disease) as the health issue that is most costly.

Helen Mayberg, a colleague and collaborator of Dr. Segal's next presented some really breathtaking research. Using PET scans, researchers have been able to identify regions of the brain that experience either increased or decreased activity during depression. One sort of depression mimics “normal” sadness: the prefrontal cortex shuts down, and the hypothalamus, insula and cingulate all light up. In very rough terms, this translates as: you become mentally numb, and emotional centers deep in the brain light up.

This is a neurological correlate of the behavioral observation that depressive types tend to linger over and concretize their sadness, setting the stage for relapse. Dr. Mayberg noted that illness can be conceived of as the inability of a system to rebalance or right itself following a disruption. In depression, a normal disruption of feeling sad (rejected, lost, grief-stricken, disappointed) persists—because of choices we make--, and the system falls more solidly out of balance, until you have a persistent biological reality that you can’t shake.

For those individuals whose depression is so debilitating and persistent that it can’t be cured by therapy, medication, or even shock therapy, Dr Mayberg and colleagues have found a cure. It’s striking in its audacity as well as the often instantaneous relief it affords from what is often years of torment.

While the patient is awake, an electrode is inserted into the cingulate 25 nucleus, and when it reaches its target, the results are astounding. It’s as if the veil is lifted. In a sudden reversal of some of the most dogging symptoms of depression, patients will suddenly become talkative and inquisitive about the operating room, or spontaneously begin expressing fondness and gratitude for the medical staff gathered around them. Afterwards, with the stimulator permanently implanted, patients’ problems aren’t’ magically solved, but they report feeling like themselves again, and have a sense that they can finally begin to work on their life issues.

(Interesting that you can have a sense of “this is how I really am”, in spite of being enshrouded in a deluded mental state for years or lifetimes beforehand. How we know when something true came up later.)

At this point, some discussion ensued about whether it might be possible to tailor mindfulness-based treatment for depression to a patient’s particular type of depression, and whether the treatment would adopt a mechanical, skill-centered approach, or instead address really modifying how people conceive of the self and the unpleasantries it encounters as an inevitable part of life.

Chozen Bays noted that hell is equivalent to hopelessness, and that meditation (or cingulate stimulation) can provide some relief from depression so that people can truly practice. We all want a magic pill, but treatment of any sort is only a prelude to the work one must do for oneself. She opined that we nourish the brain with what we take in, and that a diet of violence is not appropriate. We simply aren’t wired to live with a world’s worth of suffering bombarding us through the news media. In light of the challenges of this age, she said, “we need the extraordinary help the dharma provides.” How true.

And with that, Chozen was on her way to becoming one of the very popular people of this conference. Fortunately I got a chance to visit with her and say hi before other people discovered what I am privileged to know-- namely, what a lucid and heartfelt person she is.

There’s more to say, but I’ll leave it there for now.