My George W Bush Depression

As part of my mcmanweb overhaul, I am in the process of writing new articles on depression to replace the old ones on the site. Following is an extract from an article-in-progress:

The old DSM-II of 1968 distinguished between “endogenous” and “exogenous” depression, namely between what it saw as depression occurring as a result of the mysterious biological processes of the brain and depression as a result of how one reacts to one’s environment. In one sense, the DSM-II was making a naive “mind-brain” distinction.

Yes, it is useful to think in terms of the mind. But every decision we make, every thought process, every emotional reaction, is mediated through the meat housed inside our skulls. And some meat is not as well-equipped as others to handle the load our environments dump on us.

But the endogenous-exogenous distinction does encourage us to examine where our depression might be coming from. If your marriage is falling apart, for instance, or your situation at work is going badly, it is obviously worth exploring this association. Sort of like investigating whether a person with a pulmonary disorder is working in an asbestos mine. For some crazy reason, the “modern” DSM-III of 1980 and its successors didn’t think this was important.

A personal example:

In November, 2004, I went out for the evening happily thinking I had fired the President, only to have Dan Rather inform me a few hours later that my optimism had been unfounded. Immediately, I felt like Augustine of Hippo after Alaric the Visigoth sacked Rome in 410 AD. (See My Augustine Depression.)

Was I “depressed”? Sure. But was it clinical depression? No. We all have our bad hair days. The DSM mandates at least two weeks for a depressive episode. But suppose my bad hair day had triggered something far more pernicious, a depressed state that persisted for weeks and months? Clearly, I would be in a state of clinical depression.

I knew I could ill-afford to assume that I would rebound from my bad hair day. The situation was not going to go away. There would be post-election follow-up. Days on end of mindless blah-blah-blah. Days on end of exposure to that same stupid grin. For me and my biologically vulnerable brain, this was the equivalent of sending me back down into an asbestos mine. My obvious solution was to immediately change my environment: A total news black-out. No discussing politics.

Also, as a result of my depressive funk, I found myself unable to concentrate on my usual work. So I turned to a different project. This turned out to be my neglected draft to a book I had in mind. The change in routine reanimated me and booted me out of my depression. I completed the manuscript a couple of months later, then found a publisher.

Maybe I should have dedicated “Living Well with Depression and Bipolar Disorder” to George W Bush.  

Supplements for Mental Health - The Evidence

As you may know, I very recently updated the content on mcmanweb, including my articles on supplements. My position is generally sympathetic, but I also urge skepticism. This extract from a longer article explains why ...

Before we examine the brain, let's look at an adjacent organ - the eye. There are convincing studies, published in reputable journals such as JAMA, showing that various nutrients - in particular lutein (found in dark green leafy vegetables) significantly reduce the risk, or slow the progress, of age-related macular degeneration (AMD).

These studies are not necessarily conclusive, but why they are so convincing is that:

1. They address a condition that everyone clearly understands (loss of vision in the center field).
2. We know this condition's causes and effects (build-up of blood vessels supplying the retina in one form of the illness).
3. We can identify a specific region of the anatomy (the macula in the retina).
4. We know this region's function (high resolution vision).
5. We can identify specific biochemical processes (such as cone cells processing light).
6. We have linked a specific agent (lutein) to the macula.
7. We see a clear link all the way down the chain from treatment (lutein) to structure (intact macula) to function (operating macula) to outcome (good vision, lower risk of AMD). 

Now, let's switch from the eye to the brain, from AMD to depression. Yes, we have studies, but here's what we're up against:

1. They attempt to address a condition that no one understands (feeling sad? loss of energy? irrational thinking?).
2. We don't know this condition's causes and effects (environment? biology?).
3. We can't identify a specific region of the anatomy (hippocampus? amygdala? anterior cingulate? cortices?).
4. Even if we could identify a specific region (in all likelihood we are talking many regions), we are a long way from connecting function to the condition we are trying to fix).
5. Our understanding of the specific biochemical processes is primitive (such as "chemical imbalance" involving serotonin or dopamine).
6. We have not linked any specific agent to any region or any process.
7. We cannot show any clear link all the way down the chain from treatment (with any agent) to structure (such as changes to specific brain regions) to function (such as an optimum anterior cingulate) to outcome (feeling good? more energy? rational thinking?).

Just to be clear, I have used these same arguments elsewhere to demonstrate that we have clear lack of evidence for using antidepressants to treat depression.

Here's where I'm going with this: Pharma has invested billions in clinical trials that have been rigged in every conceivable way to make antidepressants look good, and they have failed miserably. In hindsight, it's easy to see why:

They were testing for the wrong condition ("depression," as opposed to something more specific such as loss of energy or lack of motivation) on a wide population (anyone who was "depressed") with no understanding of the underlying biology or the environmental conditions that bring on "depression".

Thus, if you are skeptical of meds for psychiatric conditions, be equally skeptical of supplements for psychiatric conditions. No matter what you may hear - from any source - we have no credible evidence remotely approaching what lutein does for macular degeneration, nor are we likely to for decades to come.

Iris Chang, An Appreciation

A brief note in appreciation of Iris Chang, who was born yesterday in 1968. Ms Chang is the author of The Rape of Nanking (1997), which documented the atrocities visited on the Chinese by the invading and occupying Japanese Imperial Army beginning in 1937.

In a very short space of time, in one locale, hundreds of thousands of civilians were rounded up and killed in indescribably horrific ways, and up to 80,000 women raped.

Ms Chang was motivated to investigate after hearing personal stories from her grandparents and after attending a seminar in 1994. Unbelievably, no one had bothered to write a book in English on what had happened. Two years of total immersion in the project followed. According to Ms Chang, she was ...

... in a panic that this terrifying disrespect for death and dying… would be reduced to a footnote of history, treated like a harmless glitch in a computer program that might or might not again cause a problem, unless someone forced the world to remember it.

The book was hailed as a journalistic and scholarly tour de force, with many honors accruing to its author, including National Woman of the Year from the Organization of Chinese Americans. Predictably, she was bitterly attacked by ultranationalist Japanese groups in denial, and by attention-seeking nitpicking scholars too lazy to research and write their own account.

To date, Japan has refused to apologize for the holocaust.

I confess to never reading the book, nor, with my tendency to spin into runaway depression, am I likely to. Last year, however, I did view a documentary based on her account. It’s a story that needs to be told and retold, that we need to hear and re-hear.

Ms Chang followed up with 2003 book on The Chinese in America. In Aug 2004, while on the road promoting her book and working on her next book about the Bataan Death March, she suffered a nervous breakdown and was hospitalized for three days with “reactive psychosis.” Over the months, she was beset by depression and was taking mood stabilizers.

In November, by the side of a road in rural California, Ms Chang aimed a revolver at her head and pulled the trigger. She left three suicide notes. She was 36.


Thanks to my friend David Kincheloe for the heads-up. You can read the post on his blog here.