The Mystery Known as Depression, Part 8/12

8. THE PHYSIOLOGY OF HOPELESSNESS


There is an understanding within the psychological profession that pain killers help suppress depression. This means that somewhere there is the recognition that pain may be a factor in causing the disorder. And there is also ample research that points to the fact that some depressions are activated states; stress hormone levels are high, often just as high in anxiety states.

Early alterations in hormones and neurotransmitters are part of the way memory is inscribed. There is a danger: lack of fulfillment. And that danger – of needs not being met – is accompanied by an inordinate secretion of stress hormones. Trauma to the fetus and infant causes the sympathetic system to gear up, producing more adrenaline, dopamine, cortisol, noradrenaline. Once need remains unfulfilled, we are activated...toward fulfillment. When the critical period for fulfillment has passed then these attempts at fulfillment are always symbolic. Needing applause, for example, or constant approval. Or, on the flip side, avoiding criticism (“Say I am good. Please. Don’t criticize me. I can’t take any more.”) Once the imprint is embedded by methylation, there is very little that can change it. A person’s personality is fixed very early on, and future experience no longer makes a great and radical difference. (It is a study of methylation that we plan for the fall).
Being vigilant is a matter of survival. The whole system is on alert, and stays alert as long as needs are not met and the imprint remains is fixed in the system. It is not that we have a memory and then there are hormone changes; those changes are part of the experience, entwined with the memory. And in turn, it is the changes in biochemistry that influence our ideas and attitudes and behavior.

For instance, feelings affect the hypothalamus, which governs the output of oxytocin and vasopressin, the “love hormones.” These hormones help us establish loving relationships, and they also function as partial painkillers. Love can do that. Love is the major painkiller for a young child, so it is not an accident that with early love our "love hormones" are more in abundance. But if no one came to love us early in life when we were lonely or felt neglected, chances are we will suffer from chronically low output of these hormones. The underlying feeling will be “No one wants me,” or “No one loves me.” It was, and is, hopeless. “No one wants me” governs our life. It is engraved not as an idea but as an ineffable feeling. It makes us shy in social situations, gives us a hangdog look, and compels a defeated posture. All ingredients of depression. In short, depression exists everywhere within us, not just in the brain. It constitutes the subtext we respond to in a therapy. Eventually we will need tranquilizers to hold down the feelings that are pushing from below.

Deficiencies in hormones or neurotransmitters can establish systemic vulnerabilities so that later trauma creates full-blown afflictions. We do not see any apparent disease when the child is five, but the seeds have already been sown. We may say later on, "Anorexia is caused by too much noradrenaline," too little of this or that. However, these are not causes, they are accompaniments to the original trauma, one which we can no longer see and cannot imagine in a person who is 40 years old. The imprint produces deviations in personality and physiology, which ultimately ends in specific symptoms. Thus, the aggressive sympath may have an excess of noradrenaline. It doesn’t cause anorexia; it is part of the ensemble of reactions to the original event. Interestingly, Canadian researchers recently reported success in combatting chronic, severe anorexia by using the same deep brain stimulation technique in the same area of the brain that worked to treat depression. (Involved in both cases was Dr. Andres Lozano, a neurosurgeon at the Krembil Neuroscience Centre of Toronto Western Hospital and professor of neurosurgery at the University of Toronto.) The results, originally reported in the medical journal The Lancet, showed that the patients not only gained weight but also saw changes in their mood and their ability to control emotional responses. (Lipsman et al., 2013) "By pinpointing and correcting the precise circuits in the brain associated with the symptoms of some of these conditions, we are finding additional options to treat these illnesses," stated Dr. Lozano. (ScienceDaily 2013)

I do not share the enthusiasm. Indeed, I find this both dangerous – it is experimental brain surgery, after all – and unnecessary. What the researchers claim is that they moderate the activity of dysfunctional brain circuits. So why are those circuits dysfunctional? I submit that it is due to imprints that distort them. In reality, they are not dysfunctional, that have been deviated as a defense against traumatic input. And instead of correcting the deviation of circuits, one must attack the origins of those dysfunctions. Otherwise the vicious cycle in all of psychology and psychiatry continues to repeat; something goes wrong and exudes symptoms, but instead of seeking generating sources one is constantly beating back the symptoms. The surgeons claim they are heralding a new way to treat these illnesses. They claim that they are correcting the precise brain circuits associated with the symptoms. And they are: correcting symptoms and their neural circuits but I submit those circuits are secondary to the imprint. They want to help those who suffer, as we all do, but in attacking the suffering we sometimes forget why that suffering occurs.

If we don't get to the primal imprint we are left with radical therapies such as brain surgery, which is finding a recrudescence in the field. This approach to anorexia is becoming popular and joining brain surgery for deep depression. These brain surgeons are stimulating the area just below the corpus callosum around the cingulate, which has a lot to do with feelings, whereas we do the same without surgery. Not exactly the same; we connect the imprint so that there is no longer brain activation where it should not be. When patients relive early traumas there is cascade of changes back to normal. It shows us unmistakably how early traumas spread their tentacles throughout the system. If we don’t get to the primal trauma, then we have to treat each symptom de novo, and each separately with a different drug or a different psychotherapeutic mode.

We may think of the imprint as a conductor of an orchestra. Since experience affects almost every one of our systems, from the muscles to blood to brain cells, the imprint is bound to cause effects everywhere. The same imprint can, and does, affect the central nervous system, heart, and blood sugar levels. It can alter all of the survival functions because survival was at stake. That means effects on the deep brainstem level where so many survival ploys are organized. Compounding our early pain with later experience makes symptoms manifest, giving rise to high blood pressure, diabetes, migraine headaches, hypothyroidism. The simple fact of chronically high cortisol set up by the imprint can impact memory later in life, not to mention making us more vulnerable to cardiovascular disease.

Let’s take a look at some of the physio-chemical effects of an imprint. Suppose there was diminished oxygen at birth and during gestation, which may be caused by a carrying mother who smoked cigarettes during her pregnancy or had anesthesia to kill her pain during labor. These two factors establish a physiologic record in her baby’s system. This record orchestrates a large variety of reactions in the baby; each reaction is an adaptation to the original threat against survival. Thus, there is lowered oxygen demands brought about by alterations in breathing, such as shallow and short breaths, then there is lowered thyroid output, lowered blood pressure and body temperature, exhaustion, such as chronic fatigue syndrome; and many phenomena governed by brainstem functions, such as butterflies in the stomach, dizziness, spaciness, and a vague terror. When terror is set down early, the fetus or newborn has no cortical capacity to dilute its impact. The nature of deep terror is so profound that in the reliving decades later it is only possible to feel for moments at a time. And it is dangerous to push a patient deeper into the feeling.

Hopelessness, helplessness, despair, and resignation can be imprinted through this diminished oxygen; all of the true sensations which accompany the memory. These pains elicit its equal and opposite reaction—repression. The pain is “suffocated” in its tracks and the result can be depression, a state that could be compounded by an unfeeling, dictatorial home environment where the child had nowhere to go with her feelings. It is not that parents necessarily suppressed the child’s feelings but that they may not have been present emotionally. The result is the same: no one to tell one’s feelings to. We are again helpless and hopeless. What is worse, the parasympathetic child makes no effort toward the parent to get love; she gives up and doesn’t try.

Research by A. R. Hollenbeck, another specialist in fetal life, documents how any drug given to a carrying mother will alter the neurotransmitter systems of the offspring, especially during the critical period when these neurotransmitter systems are forming in the womb. (Hollenbeck, Grout, Smith, & Scanlon, 1986) He states that administration of local anesthetics, such as lidocaine (to aid the birth process), during sensitive (critical) periods in gestation is capable of producing enduring changes in the offspring's behavior. Brain chemicals such as serotonin and dopamine can be changed permanently when an animal undergoes birth even with a local anesthetic. This again affects the gating system.
The more painkillers a woman takes during labor the more likely her child will be to abuse drugs or alcohol later on. Karin Nyberg of the University of Gothenburg, Sweden, looked at medication given to the mothers of 69 adult drug users and 33 of their siblings who did not take drugs. Twenty-three percent of the drug abusers were exposed to multiple doses of barbiturates or opiates in the hours just before birth. Only three percent of their siblings were exposed to the same levels of drugs in-utero. If the mothers received three or more doses of drugs, their child was five times more likely to abuse drugs later on. (Nyberg, Buka, & Lipsitt, 2000) Enough animal studies have been done to confirm this finding—that exposure to drugs in the womb changes the individual's propensity for drugs later on.

There is some evidence that a mother taking downers during pregnancy will have an offspring who later will be addicted to amphetamines, known as “uppers” (speed), while a mother taking uppers during pregnancy – coffee, cocaine, caffeinated colas, will produce an offspring later addicted to downers—Quaaludes, for example. And the reason that the person can take inordinate doses, such as drinking two cups of coffee before bedtime and still be able to sleep easily and well, is that there exists a major deficiency of stimulating hormones—the catecholamines. In short, the original set-points for activation or repression have been altered during womb-life and persist for a lifetime.

I have treated patients who have taken enormous doses of speed and have shown very little mania as a result. While other of my patients have taken lethal doses of painkillers in previous suicide attempts, enough to kill anyone else, and still lie awake hours later, only feeling slightly drugged. The severe brain activation by imprinted pain resists any attempts to quell the system.

Psychotherapists must ask the question, “Why does a tranquilizer or painkiller that works on lower centers of the brain calm the patient and change his or her ideas?” We know that it often does. We know that someone suffering an acute heart attack can feel terrible, yet when given a shot of a painkiller, it changes his ideas and attitudes about the experience. This alone should inform us that feelings drive ideas and not vice versa.