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Biology 202, Spring 2005
Third Web Papers
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A Failure of Will—A new way of thinking about Depression


Elizabeth Diamond

A Failure of Will—A new way of thinking about Depression

Depression, at least from personal experience, is not so much a perpetual state of sadness but more of helplessness; a feeling of descending into a situation into which you have little or no control whatsoever. Looking back at my experience, I remember feeling as though there was something that I should have been doing in order to alleviate the unexplained sadness and general anxiety, yet at the moment it felt as though there was nothing I could do; nothing could have helped me. Leo Tolstoy probably described these emotions best when he wrote in his story "A Confession" after a year of depression: "Why should I live, why wish for anything, or do anything... is there any meaning in my life that the inevitable death awaiting me does not destroy? ... The spring of life dried up within me, and I despaired and felt that I had nothing to do but to kill myself. And the worst of all was, that I felt I could not do it" (5). These are not unique feelings, for they are a common experience shared by many sufferers of depression. But if the symptoms and the disorder in general are not rare, why are so many sufferers of depression reluctant to seek help right away?

The answer is related to the question of "normality" that we discussed in class: there cannot be any one definition of what is normal because of inherent differences in any individual's brain. These differences in brain structure result in subtle changes between individuals Despite the fact that depression is regarded by the medical and scientific world as an illness like any other physical ailment, there remains a troubling question of "normality" for the sufferer, and a feeling of doubt as to "what is wrong with me?" and even a rejection of any other external causes that may be the main problem and root cause of the sadness. For a patient with severe depression, "this sadness may be denied at first. Many complain of bodily aches and pains, rather than admitting to their true feelings of sadness" (1). In the DSM IV's definition, one of the main criteria for depression was an "abnormal depressed mood." Can we always look at depression and other psychological diseases as abnormal? We can never really know if someone isn't normal or not simply based on what we can observe, for reality can be slightly different for different people; it is all based on how each individual perceives the world. It is perhaps this classification into categories of "normal" and "abnormal" that creates the patient's reluctance to come forward for treatment. Depression is commonly seen as not a physiological problem of the brain, but a personal problem; one that must be caused by some sort of personal failure or shortcoming. Even many sufferers of depression commonly see themselves as failures for not being able to realize the root cause of their sadness, and coupled with the helplessness that stems from these self-defeating thoughts, results in a self-perception of being "abnormal" and therefore inferior or worthless.

In fact, this is not the case at all, and we can examine certain biological factors that contribute to clinical depression, including chemical imbalances or a lack of serotonin neurotransmitter receptors on the dendrites. Situations in a person's environment can also contribute to a general emotion of "feeling depressed," but there is a difference between a normal level of sadness and deep depression—the DSM IV defines major depressive disorder as a state of "abnormal depressed mood most of the day, nearly every day, for at least two weeks" (1). The state or mood cannot be related to any environmental factors or situations, such as physical illness, alcohol, medications, or the loss of a loved one. Thoughts of death or suicide, feelings of inadequacy or helplessness, and loss of interest in once-pleasurable activities are all familiar symptoms of this disorder. Depression is often characterized by a marked decrease in neocortex activity, and perhaps even more interestingly, signs of atrophy in the hippocampus. Dr. Yvette Sheline of Washington University conducted MRI research on depressed women and discovered that overall volume of their hippocami was smaller than those of the control group. The decrease in volume was also proportional to the number of days depressed (2), and showed a strong correlation with memory problems in these patients, indicating depression's cumulative effects. This is of great significance in because the study offers more evidence to why certain physiological changes within the brain may result in depressed symptoms: Dr. Ronald Duman of Yale also performed these studies on a cellular level, and found that even in adults, new neurons are created in the brain, more specifically within the hippocampus. Stress caused by the depressed state prevents new neurons from being formed, resulting in the observed atrophy. For whatever reason, treatment with antidepressants increases the rate of neurogenesis in depressed patients, most likely because the cells that are being produced in the hippocampus are the same ones related to neurotransmitter transmission and release (4).

This brings us to the concept of "will" in the depressed person. Obviously, the patient wants to be "normal" in the sense of being emotionally content and not at constant odds with the world or with themselves. But however much they try, it is very difficult for the patient to break out of the negative mindset and feel better; that is, the I-function cannot act upon the other processes that must be causing the depressed state. This "failure of will" does not imply any personal weakness on the part of the patient, but rather simply biological limitations of the brain; the I-function cannot change a chemical imbalance, for example, any more than it can deliberately focus the lenses in the eyes. Speaking in class of depression as a "failure of will" was for me an interesting way of looking at depression after the explanation of the biological effects; I had never thought of the condition in terms of "will" before. I had, in fact, always regarded my depression as a failure of my will in the sense that I was not doing something right, that it was my own personal shortcomings that were contributing to the feeling of helplessness and inability to escape the sadness. If we are to define "will" as the I-function acting upon various internal factors in order to solve a problem within our control, then our will does not apply to depression. Looking at the biological factors that contribute to depression, it is safe to say that such things as hormone imbalances and receptor/dendrite growth are things beyond which the I-function is capable of influencing.

Once we conclude that our "will" does little to mitigate major depression, this puts the responsibility upon the parts of our nervous system over which we have no control. Since sufferers cannot will ourselves to "snap out of" the sadness and apathy, it is clear that the I-function is not connected to, or does not have any influence over, the areas of the brain that influence the depressive state, such as the hippocampus involved in neurogenesis. Once again, depression falls under the growing list of nervous system functions that are beyond voluntary control of the I-function. Therefore, there still remains a question as to choosing correct methods of treatment that would affect the neurobiological factors. Yet even though studies by Drs. Sheline and Duman have shown that antidepressant medication does help to prevent the characteristic atrophy of the hippocampus, medication alone in practice does little without some form of therapy or contact with another person who can offer support The most common treatment for depression is to administer serotonin reuptake inhibitors, or SSRIs, to keep the important neurotransmitter in the synapse longer and prevent its degradation, keeping a more stable level of the chemical within the brain. However, any effect of the drug may take several weeks to manifest because of a lack of the serotonin receptors on the dendrites in the first place. In this lag time between administering the medicine and perceiving an actual effect, the patient will most likely continue to express the symptoms, which may even be exacerbated because the supposed treatment is not producing the desired effect, leading to an even deeper cycle of depression and self-doubt. It has even been shown that such drugs often have less effect than the placebo in test groups (3), strong evidence that medication alone is not the recommended or safest method of treatment.

With more and more doctors simply prescribing medication at the first signs of depression (3), has society simply become "pill-happy" with an emphasis on being glad all the time (again, a pervasive false conception of what is "normal" or equating constant happiness with well-being), with medication as the only recourse? Perhaps a better way to speed treatment and recovery for depression sufferers would be to show a more accepting and tolerant attitude towards their condition as we would show to a patient of any other ailment, offering support and a positive outlook rather than scorn caused by any misconceptions about the patient's will. Yes, depression is a failure of will in the sense that we cannot control genetics or brain/chemical makeup, but depression is most certainly not the failure of the patient's desire to be a productive person. Helping the depressed person through a difficult episode by simply offering support allows the person to better understand their condition, and perhaps at the end of the episode, foster a sense of creativity in which to express the depths of suffering and finally experience relief after living so long in the dark.

References

1)Mental Health: Major Depressive disorder: , A comprehensive definition of major depressive disorder, its symptoms, and related conditions and treatment.

2)Decreased Hippocampal 5-HT2A Receptor Binding in Major Depressive Disorder:, Dr. Yvette Sheline's paper on her findings of atrophied hippocampi in depressed patients.

3)Against Depression, a Sugar Pill is hard to Beat, The text of a Washington Post article about the effectiveness of the placebo effect in depression studies.

4)The Infinite Mind: Depression in the Brain, A very good general source describing the work done on a cellular level on the brain structures in depressed patients.

5)A Confession, Translated text of Leo Tolstoy's "A Confession"


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