WHAT I KNOW

The storms come, no stopping them. They also pass.

The wind had been blowing since midnight, and the rain coming hard not down but sideways, off and on. Mostly on. I could see the ocean waves blowing back over themselves and sea and sky are both soft grays with a hint of green in the surf. Two and a half hours till high tide, but all the sand wet from the rain, and we did not get our morning walk. We got out the door for our three miles and had to turn straight back. We don’t mind a light shower, but this was a serious weather front. Storminess predicted to last without a break until Friday, which is not at all unusual for November. I used to count on a solid week of rain in this month—all day and all night without a break. But recently all bets are off. (The days in January of warm east winds and a burst of termites and carpenter ants drowned in the surf has not been predictable for years.) We average about 90” of rain a year—sometimes a mist or drizzle, in a storm sideways like a firehose, not usually coming “down,” and a hundred and fifty inches of rainfall isn’t unheard of. People new to the area are unprepared, friends naively suggest rain gear to walk the sand. Weather reporters in NW cities are alarmed by 45 mph gusts; we are accustomed to 65 mph. There is no rain gear that will keep you dry and safe in a full gale. Stay indoors!

Despite the foam, the ocean looks more tame in this photo compared to earlier in the week. The surf grew and after the rain splattered the glass, an updated photo was impossible.
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WELLNESS

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Early in the first episode of season 14 of Silent Witness, a hospital doctor completely loses it as he observes patients in an outdoor lounge smoking dope and cigarettes and drinking beer and soda. He knocks smokes and cans out of their hands, shrieking: “What is the point?!” They will not regain health if they continue their unhealthy behavior.

There are all sorts of magical diets and pills available for people looking to live healthier lives. In the mean time, they avoid addressing the obvious: sleep, diet, exercise, focus. Someone I know ate a restaurant salad, had an “allergic reaction,” and concluded she was responding to tiny bits of cheese she ate by mistake. Maybe it was the lettuce? About 20% of E.coli infections come from leafy greens. Most of us cannot be troubled to change our behavior unless we are offered that change as a near-magical cure for what ails us.

Sometimes we are depressed because our lives are depressing. We can’t always do anything about that. Sometimes only time will heal us—everyone is depressed when a loved one dies. Taking a pill might not help at all, though we have faith in pills.

Improved health for most of us is simpler than medication. It might come down to getting enough sleep, eating better, avoiding soft drinks and alcohol, taking regular walks, and stilling our minds.

Until there were anti-depressants and an irrational percentage of Americans making Big Pharma billions, nearly everyone with clinical depression recovered with or without treatment within a few months. Medication today has its role, but most anti-depressants need a couple of weeks or months to become effective. While we wait, we might try taking better care of ourselves. This might not be the only answer, but it is a good place to start. And for most of us, it is exactly what we need.

A minimum of eight hours of sleep a night was considered normal for at least a hundred years. That recommendation has dropped to a range of seven to ten hours, and may continue to drop in response to the amount of time we actually sleep. We want to believe our sleep patterns are “normal” and theories seem to evolve in order to support our desires. Is it natural for anyone to “need” only a few hours of sleep? Perhaps not.

A hundred years ago and more, we slept more because it was dark at night. Today we sleep less because we are on our devices with electric lighting. For a long time the belief about sleep was that it kept human beings out of trouble. Except for our intelligence, the reasoning went, we are a harmless and relatively defenseless species. We do not see well in the dark compared to most predators. Curling up someplace safe and sleeping, biologists assumed, kept us out of trouble. They were wrong.

Some medications, advancing age, and brain damage all impact sleep. But sleep does a great deal more than keep us out of trouble. Research into Daylight Savings Time revealed a connection between that one lost hour of sleep and an uptick in heart attacks. We now know that the various stages of sleep allow us to sort and save information (remember), cope with daytime concerns, repair the synapses in the brain, and heal. Lack of deep sleep contributes to dementia. Lack of REM sleep makes us fractious. Lack of sleep can lead to weight gain by making us hungrier, but also has an impact on depression, anxiety, and suicidality. “Add the above physical and mental health consequences up, and a scientifically validated link becomes easier to accept: the shorter your sleep, the shorter your life.” (The Guardian)

Get your sleep. Stop eating a few hours before bed. Turn off devices. Avoid caffeine and other stimulants. Make the room dark and go to sleep at a decent hour.

What we eat makes a difference too. It is amazing to me sometimes how readily people accept that sugar impacts the behavior of small children, but how resistant these same people often are to the impact of what they eat and drink on their own mental state. Sugar, too much meat, refined grains, alcohol and other drugs—all these impact mood.

“Eat food. Not too much. Mostly vegetables.” advised Michael Pollan in The Omnivore’s Dilemma. He’s right about that. Though Pollan does not have the formal training to be considered an expert in nutrition, he has earned his prestige. Because I am largely vegetarian, people like to call themselves “carnivores” when we eat together. No. No, we clearly are not. Look in the mouth of a cat, research the structure of their digestive system. Cats are carnivores. Humans do not have the mouth, teeth, digestive chemistry, or other physiogomy to survive on a meat-based diet. Peoples in the far north such as the Inuit can because 98% of them have a genetic mutation allowing them to exist on fish and mammal flesh. They are genetically adapted to the cold and a meat-centered diet.  For most human beings, nothing about us is adapted to eating that way, though many of us have one of the several genetic mutations allowing us to consume milk after childhood.

Wheat has been part of the human diet for at least ten thousand years. We have been cooking foods for at least hundred thousand years. (There is no physical proof yet, but many anthropologists and evolutionary biologists believe that cooking foods, especially foods that are easier to digest such as legumes, is the reason humans became the smarter, smaller-toothed species we are today.) The wheat found today is somewhat genetically different from what our very distant ancestors consumed. The animals we consume today are also very different genetically, far removed from what our distant ancestors consumed. They are also fed and raised differently. There is nothing remotely Paleolithic about today’s beef, pork, or chicken.

Of more significance is that most of our food (not to mention our water and air) is contaminated. All foods, domesticated plants and animals, are weighted down with chemicals our ancestors could not have known. Pesticides, herbicides, and broad-spectrum poisons that were invented only in the last century. Our drinking water in major cities has trace amount of antibiotics, anti-depressants, and other chemicals as well. You already know about the lead.

Eat better. Save sugar for a rare special occasion. Avoid alcohol and refined foods, packaged foods, “foods” containing chemicals, most meats and conventionally raised food.

There is overwhelming evidence that regular exercise results in improved physical and mental health, less disease and longer life. Fifteen minutes a day could do it.

Meditation or even just sitting quietly for a few minutes each day lowers blood pressure and relieves all sorts of symptoms. The mental rest disconnects us from day-to-day stresses. Turn off social media and stop stewing over things we cannot control. “Relax!” they tell us.  We hear it all the time, and it is excellent advice.

Social interaction is healthy and so is reading a cheerful book. Maybe turn off the news, social media, the gloomy or horrific Netflix movie. Watch something funny. Read a hopeful novel (honest, it’s a proven-effective therapy), and refuse to discuss politics with your raging-reactionary uncle.

Getting enough sleep, eating a healthy diet, moderate exercise, and giving our emotions a clear break from day-to-day stresses and demands absolutely result in improved mental and physical health. Seriously. No doubt about this at all. Trusting that making such healthy changes also triggers hope and hope is another essential. It is likely the primary benefit of most anti-depressants. Taking that little pill each day triggers hope that we might feel better tomorrow. That impact will wear off if the problem is actually untreated mental or physical exhaustion, or if the underlying problem is grief. Everyone feels depression and reveals the symptoms of clinical depression after a beloved family member dies. Such grief mostly needs time for a cure.

SLEEP. DIET. EXERCISE. REST. TIME.

All this is hard if we are depressed. I get that. Depression means it is hard to care much about anything. It’s hard to get out of bed. But if we can care enough to take ourselves to a doctor, perhaps we can care enough to listen to soothing music or take a walk, eat a little better or have a conversation with a friend.

“Dorian Deshauer, a psychiatrist and historian at the University of Toronto, has written that the chemical-imbalance theory, popularized in the eighties and nineties, ‘created the perception that the long term, even life-long use of psychiatric drugs made sense as a logical step.’ But psychiatric drugs are brought to market in clinical trials that typically last less than twelve weeks. Few studies follow patients who take the medications for more than a year. Allen Frances, an emeritus professor of psychiatry at Duke, who chaired the task force for the fourth edition of the DSM, in 1994, told me that the field has neglected questions about how to take patients off drugs—a practice known as ‘de-prescribing.’ He said that ‘de-prescribing requires a great deal more skill, time, commitment, and knowledge of the patient than prescribing does.’ He emphasizes what he called a ‘cruel paradox: there’s a large population on the severe end of the spectrum who really need the medicine’ and either don’t have access to treatment or avoid it because it is stigmatized in their community. At the same time, many others are ‘being overprescribed and then stay on the medications for years.’ There are almost no studies on how or when to go off psychiatric medications, a situation that has created what he calls a ‘national public-health experiment.’ ”—“Bitter Pill” The New Yorker

We have survived as a species for 200,000 years, and we’ve had anti-depressants for only the past few decades. Today, one American in five is taking medication for something no one had access to until recently. Suicide rates have been going up instead of down ever since the introduction of anti-depressants. Let that sink in.

Toward the end of the episode, Nikki is exhibiting symptoms, which a doctor diagnoses as depression: “My soul has the flu.” As it turns out, her brain is not sick nor is her chemistry out of order. Something in her life causes the problem. She experiences anxiety and sadness, and even depression as part of the normal range of emotions every human experiences in life. She does not need medication. Mostly Nikki needs some sleep, a better diet, regular exercise, some mental rest and decompression, and a little time to recover.

We all do.

 

 

BETTER

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We were up on the balcony at the Schnitz in Portland the other evening. A woman sitting behind us dropped her cane and it hit my husband right on the top of his head.

“Oh! I am sorry!”

“It’s okay.”

“No, really, I am so sorry.”

“It’s fine.”

“But are you sure you’re okay? I can’t believe I did that!” She could not stop apologizing.

My husband turned full around. “Hello, I’m Gary.” He grinned.

Soon they knew one another’s history and we all chatted away.

There is some empirical evidence that talking to others, particularly the habit of reaching out to people we meet casually—the person waiting in line in front of us, the man watering his lawn, the woman having coffee at the next table—is a reliable predictor of longevity. It’s certainly no cure for what ails us, but it focuses us away from our pain in the same way the I was taught to focus away from labor pains.

Talking to other people is a challenge during depression, but if we already have the habit and refuse to let go, such casual conversation can be a distraction from our sadness.

Depression IS sadness, but on a level and for a length of time that there is no end in sight. This belief that depression is not often caused by circumstances flies in the face of all evidence. It is not a literal “epidemic” but a failure of our culture to provide meaning and purpose. We fail to eat, sleep, communicate, work, and live meaningful lives and then we wonder . . .

Undoubtedly, suicide is sometimes the result of illness. It is always the result of unbearable circumstances, it is always the result of overwhelming sadness. Like the current “epidemic” of opioid abuse, suicide is about loss.

Sometimes the loss is entirely personal and unknowable. Increasingly, the loss is widespread and a failure of our culture to sustain the human soul.

For most of human history, human interaction was primarily cooperative.

For most of human history, communication was between people, not machines.

For most of human history, people ate what they could find or grow themselves.

For most of human history, we slept more than we do today.

For most of human history, we sat quietly for regularly periods of time. We attended to the seasons, to the darkness and light, to shifts of other living things because this attention was necessary to survival.

Despite growing awareness of the dangers of depression, acknowledgement of suicide, and drug and talk therapy, suicide rates continue to grow.

I have heard depression compared to diabetes, in that we would not expect a person ill with diabetes to thrive only on good intentions. A symptom of diabetes is increased thirst. A glass of water addresses their immediate need but not the problem. The “epidemic” of depression and suicide will not be cured with anti-depressants or even with talk therapy. It will only be repaired by addressing the cause, which is the result of a failed culture, not broken brains.

Wiser people than me have insisted that suicide is not a cry for help. But maybe it is a cry for help in the way we live. Maybe it is a symptom of illness not of the person but of an increasingly unsatisfying, unsustainable, and unbearable way of life.

Maybe I can’t do a thing about any of that. But I can greet others. I can trade stories. As long as I can participate, I will.

Hello! My name is Jan, and you are . . .

 

 

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THE GRIEF EXCEPTION

First, a confession. I am moody. I sometimes suffer from sadness and depression and anxiety. I have, as an example, seriously worried about overpopulation as if it were my personal problem to solve. I can recall lying awake at night, stewing about starvation and disease and the loss of wild places. I can recall standing in the shower arguing aloud with myself about what should be done to save our planet from overpopulation. I might have been ten years old. I was also unpopular at school, had few friends, my mother was seriously ill, and my father smoked too much. I had been molested on the playground. I worried about overpopulation because I was precocious and smart and all around me my favorite places to play were being turned into housing developments. My worry was a response to my environment and real life experiences.

When I was a child, I was terrified about what the world would be like if the growth of world population continued to grow and double. It did more than double, of course, growing from 3.1 billion to an estimated 7.6 billion today. I was not worried for nothing, and all the woodlands and swamps and cow fields I recall in my old neighborhood north of Seattle are long drowned under pavement and 3-bedroom homes. So, sometimes I was worried or anxious. Sad. I dealt with it as best I could, sometimes better than others. As an adult I am generally determined to find that illusive silver lining in any dark cloud.

It might be raining over my head, but focussing on how wet I felt, decades ago, brought me close to death. I looked for brightness then and still do now, not because everything is perfect in my life, but because I am determined to live.

While my mother was dying and I was also working 60-70 hours a week and driving home from work in tears, feeling overwhelmed, useless, and unfocused, I gained pounds. After my mother died, I lost 40 pounds in a few weeks. One day a colleague asked me how I’d managed to lose so much. I looked at her and said, “Grief.” Pills would not have made any of that situation better, would not have helped me cope better, would not have made my mother come back to life. I needed time. I needed to find my own way back. And I did.

Sometimes I read a good book—proven to improve mood—and I avoided the genuine downers (three novels by Cormac McCarthy were enough for me.) I sleep too little and eat too much when I am depressed. Improving both habits helps. Running used to be essential, but even walking now is good. I do things for other people. I commit random acts of kindness. I contact a friend. I listen to music that stirs my heart. It would be easier to take a pill—don’t think I haven’t thought of it—but my reading and research has convinced me that pills are mostly a false promise of an easy fix. For most people, and certainly for long term, drugs profit Big Pharma, not people. My research revealed we have been sold a bill of goods.

I recently read Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions by Johann Hari. Hari reviews the story he was taught about his brain as a teenager, and which remained his truth for more than a decade afterward: depression is caused by a chemical imbalance in your brain and this can be corrected with medication.

The trouble was that while medication provided him with some relief for a while, that relief did not last. It did not make him feel good, only “better” for a short time before he was back in his doctor’s office looking for something better. That might be because no one has proven there is any chemical imbalance in the brains of depressed people, medication fails to “cure” depression in the vast majority of people, and could not cure his own depression. (He was prescribed Paxil, a medication that the company had already proven did not work for teens.) As ineffective as antidepressants are in curing depression they have very real and potentially catastrophic side effects. Big Pharma sold a story that we wanted to hear: The problem is personal, out of the control of the individual, and can only be addressed with pills.

This is mostly a lie.

Instead, most scientists agree, depression and anxiety are related, on a continuum with ordinary sadness—they are actually the same thing—and they are normal, reasonable, and sometimes even healthy emotional responses to our lives. Our emotions slide along a scale that runs from dancing with joy to standing on the edge of a cliff. Fortunately, most of the time, most of us are closer to dancing than jumping off the edge, but there is no medical truth to the story we have been told.

It’s not our brains that are broken, it’s our lives.

When Margaret Thatcher declared: “There’s no such thing as society, only individuals and their families” she denied the truth of our species. We are social animals. We want connections with others, we want our lives to contribute and to have meaning to others. We need this as surely as we need food and water. People are not isolated individuals, we are social beings starved for community.

One “symptom” of clinical depression is isolation. “Have you stopped meeting with family or friends?” Hari documents how isolation is not a symptom of depression. Depression is a symptom of isolation. The entire checklist for depression reads like an indictment of modern life.

When we do meaningless work and feel no connection to others, when we feel powerless over our life choices, when we embrace possessions rather than people, we become sad, anxious, and ultimately “clinically depressed.” Pills will not fix this feeling. We must repair the damage to our communal self-worth. Our depression is not the disease, it is a symptom of a more complex issue that has resulted in millions of people being diagnosed and treated for a disease that interferes with daily function.

The popular definition of depression as a disease over which individuals have no control actually feeds the beast. Taking control and making choices is within our power. While we are not to blame for all our circumstances, it is sometimes within our power to change them. We can choose to be active participants in our mental health instead of powerless victims.

Consider just this one fact: One in six Americans (the French are worse off, and so are the English) is on psychotropic medication, some sort of drug to treat the brain. If we are inherently this sick, how did we ever manage to survive as a species? If it is our brains that need fixing and the drugs fix the problem in our brains, shouldn’t we be healthier now than we were before these drugs existed? Shouldn’t suicide rates gone down instead of up in the last few decades? Look it up.

I was familiar with much of the research Hari cites. I knew that depression was not caused by a chemical imbalance and that pharmaceutical companies had rigged trials in order to pretend drugs could address depression far more effectively than they do, and made $200 billions in profit as a result.

I already knew from the studies he cites and earlier ones, that it is ordinary working people who feel anxiety and stress and depression most profoundly. Those at the top have choices that those in the middle and bottom seldom have. A sense of agency, of the ability to make decisions, and options that make living worthwhile.

I already knew about the “grief exception.” Grieving the death of a loved one causes all the “symptoms” associated with depression—why would this surprise anyone?—but the grieving are not sick and do not require medication. They need time.

The medical community accepted that grieving is natural and human . . . so long as those grieving do not feel “depressed” for too long. If your daughter is abducted and burned alive, how long are you allowed to feel bad? If your baby is stillborn, how long? What about the death of a parent? The medical community allowed a year, but then you are supposed to push that pain out of your life and be . . . fine! Or at least functional. Because if that grief lasts longer than medically necessary, you must be depressed. So you have a year to get on with your life. Except that the medical community shortened that understandable year of grief to a few months, then weeks, and then eliminated it entirely. You are grieving a death? Get over it, and right now!

I have advocated for years that people socialize, sleep and eat better, be creative, and exercise. These DO have a bigger impact on depression than meds for almost everyone. Whenever I suggest this, I have been thoroughly thrashed. If you are too depressed to get out of bed, how can you be expected to take a walk? I am told I am unwittingly and unkindly telling people to “pull themselves up by their own bootstraps.” (I do not dare point out that they managed to get to a doctor, to the pharmacist, and to take their little pills.) The story is that this is not our fault and not within our power to control.

Hari explains how our attachment to this story we have about depression makes it difficult or impossible for us to hear another. It is frightening to challenge the narrative we have taken into our most vulnerable psyche. Yet, we need a more truthful story. While he confirms my faith in healthy habits, he advocates something beyond that.

His new story goes like this: We must collectively and for the good of all reconnect to other people, find work that allows us purpose and potential for growth and meaning, and stop blaming our brains for a society gone awry. We must hold hands and do this together. Yes, we will feel sad from time to time. We may sob and lie awake and cry when something terrible happens to us or the people we do care about. We are allowed. It is normal and a symptom not of brain disfunction but of emotional pain in our lives. Our father died. We did not get the job. Go ahead and feel bad about that. Take a friend out for a healthy meal, go for a walk, read a funny novel. Take all the time you need. We get better.

We must not look always inside, but sometimes do our individual best to look out, and look to others and connect to them to find the way out of our personal pain.

His book has its corny moments—even Hari admits this—and I was familiar with most of the research he cites and his narrative began to fall into a pattern I could predict. I wanted some things that I did not find here. I don’t think the author has written a perfect book or the one I would have written, but I do think he’s right.

We are not broken.

We need to find a better story to explain our distress.

The book includes copious endnotes and online links to additional source material. He’s done his research, and the book itself is well documented. He offers true stories to illustrate his points. There is a great deal of science, but very little that is too complicated for the average reader.

If I had read this book when I was ten (and it is the sort of thing I was reading at that age) I would have felt a lot better about myself and my mental state. I would have recognized the impact events had on my ability to feel good. Instead, I needed most of my life to figure it out.