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domenica 20 novembre 2011

Managing Depression With Weightlifting? Or, How You Feel Is A Lie

home_for_the_holidays_robert_downey_holly_hunter_

“She feels her feelings when she feels them.” – Robert Downey Jr. in Home for the Holidays.

Those who know me will be shocked to hear that I’ve struggled with depression all of my life. Those who really know me won’t be shocked at all.  I’ve always had a tendency to laugh at everything, make a joke of life, and be the life of the party.  This can trick people around me into believing that I’m a “care-free” guy.  I’ve never been that.  I never will be.  But, I DO have a happy life.  And now, because of the ways I’ve learned to manage my depression, my smile and my laughter represent me far greater than they used to.

A decade ago, I had few coping skills and was a rabid Nihilist.  I believed there was no point to anything and I lived my life that way. I couldn’t hold down a job, I couldn’t finish college, and deep down I was always deeply sad and lonely.  Today, I’ve learned to manage a disease that can be horribly debilitating.  I have my degrees, my business, I’m getting married in a week, and I can honestly say that I love my life.  I’d like to tell you HOW I changed so dramatically in the hopes that my methods will help you like they did me.

NOTE:  I’m writing this essay to you as though you are like me.  It is a personal account of how I have dealt with (and continue to deal with) my own depression.  If you suffer from depression, it could be that yours manifests itself differently than mine, and has causes different than mine.  However, I suspect that the underlying reasons for why my own methods have worked for me have a universal quality to them that should apply to most people.  Also, my methods are good for you regardless of your mental state:  exercise, meditation, a rationalistic view of emotion.  These things, I believe, will help anyone, depressed or not.  The point: this is personal.  Take it as such.

van_Gogh_Wheat_Field_with_Crows

Most people have no conception of what day-to-day life is like for a person with depression.  You can think of a persons life as a painting.  The average persons canvas is covered in paint of many colors.  Each small part of that canvas is a moment in their life.  Sometimes the colors represent sadness, sometimes happiness, sometimes boredom.  But, the colors always blend together, and at no point is there a space where the blank white canvas shows through.

For a depressed person, their life is a stippling painting.  It is made up of many (a great many) dots, all of different colors.  When seen from afar, it looks just like the normal persons painting.  It appears to be that the colors are blended together.  They have colors representing all the same emotions.  They are genuinely happy in some moments.  Sometimes exuberant.  But, if you zoom in really close, every moment is surrounded by the blank emptiness of the white canvas.  The colors do not blend together. Each moment of color is an isolated event punctuating an undercurrent of emptiness.

Normal people have an undercurrent of contentment.  That is the natural state for them.  They have acute moments of real depression and sadness usually brought on by a particular event (justified).  They strive for things, they long for things, they have ups and downs in their emotional life.  However, deep down they feel content.  This is why most people can feel “bored”.  A depressed person can’t feel bored.  They feel empty. There is a difference.  Only a fundamentally content person can feel boredom.

What makes a person a depressive isn’t that they are sad all the time.  Most of us aren’t.  It is the emptiness.  There is a giant hole in the middle of yourself that you can’t fill.  No matter how hard you work, no matter how many times you “change things up”, you cannot possibly fill that hole. Trying to fill it can bring its own sense of fulfillment.  But, the instant you stop trying, you go right back to where you started – empty.

Depressed_Brain

The trouble we have here is that a Depressed person is not worrying about something or sad about something.  They are just sad and empty.  Period.  No reason.  No justification. We haven’t the ability to make that feeling go away by rationalizing to ourselves that the reason we are sad isn’t a good enough reason.  There is no reason!  At least in the sense that the sadness wasn’t caused by an acute event.

The only real reason is that our brains are broke!

People with true depression have a different brain anatomy than the rest of the folks out there.  This physiological difference is at the root of our trouble.  I come from a family of depressed people (my Mom’s side).  So, for me, I know there is some genetic component at play.  While no one is completely sure which comes first (brain difference that causes depression, or depression that causes brain difference), the fact is that we aren’t like other people.

In a study that appeared in The Proceedings of the National Academy of Sciences, they found “a 28-percent thinning in the right cortex — the outer layer of the brain — in people who had a family history of depression compared with people who did not,”  and that this was associated with problems with memory and attention.

“If you have thinning in this portion of the brain, it interferes with the processing of emotional stimuli,” Dr. Peterson said. “We think that’s what makes them vulnerable to developing anxiety and depression — it essentially isolates them in an emotional world.”

The Prefrontal cortex is the part of your brain that deals with (among other things) the regulation of mood states.  If it is atrophied, then your ability to deal with these tasks gets downgraded.  This becomes particularly problematic given that without the prefrontal cortex running at full speed, you can’t dampen the negative emotions generated by the Amygdala.  The amygdala is that part of your brain that deals with Fight or Flight responses.  It is your brains Fear Factory.  To add fuel to the fire, in depressed people the amygdala tends to be overactive.

Think of the Amygdala and the prefrontal cortex as the brains Yin and Yang. You need both to be strong and healthy to have a strong healthy brain that is in balance.  Depressed folk ain’t in balance.  Generally, the prefrontal cortex is responsible for saying, “Hey, Amygdala, I got your message.  We’re cool here.  No need to freak out, dude!”  But, when your brain is broke (like mine), you can be flooded with negative emotional responses that can result in despair and overwhelming helplessness.

The above was a gross oversimplification.  There is a lot more going on here physiologically, including a reduction in hippocampus volume, an increase in amygdala metabolism, an altered blood flow and metabolism in the limbic system generally, and much more.  (For instance, the contribution of Glucocorticoids (cortisol, the main stress hormone for humans) on neural death in the hippocampus implies a snowballing situation where negative moods beget a brain more prone to negative moods!)  Also, it is unclear whether these changes are CAUSED by depression or if depression is CAUSED by them – Correlation NOT Causation! 

AND, not every depressed person has all of these symptoms.  It is a highly complicated disease.  My advice is to not get too hung up on the physiology.  Instead, focus on the practical solutions people have used to combated it.

NOTE to the Overachiever: Much of the justification for a behaviorist approach to handling depression – over pharmacology (for people like me) – can be found in the article I cite below by Dimidjian, S., et al. (2006)

EDIT :  I want to make it VERY clear that I am NOT against medication for the treatment of depression.  There are a great many people (some of whom are close friends of mine) who need it.  This is a brain problem.  Medication can, in some cases, be the most direct way to deal with the issue.  And the more severe your case is, the more important the medication might be.  What I’m offering are some other ways to deal with our depression – that can be used in conjunction with medication if that is what works best for you.

black-hole

There is a line that gets bantered around in Olympic weightlifting circles (often attributed to Glenn Pendlay or John Broz):  How you feel is a lie.  In weightlifting, what we mean is that some days you’ll walk into the gym feeling totally dead tired and yet you will hit a Personal Record (PR).  Other days you will feel amazing but have a horrid workout.  You just don’t know till you go for it.

This maxim applies equally well to how a depressed person should think about their own emotions.  How you feel is a lie.  Your brain is messed up. It will thrust upon you emotions like sadness and loneliness that have nothing to do with reality.  And if you entertain them, you will make things worse.

I ended up having an interesting “Facebook Discussion” with some friends of mine on this very topic, and I wrote something there that bears repeating here:

Most of the time, sadness, loneliness, etc. are totally irrational feelings when you are a depressed person. Finding ways to “fake it till you make it” goes a long long way. It’s how I can be so disciplined about exercise and meditation. I don’t wait for it to be a good time. I do it no matter what I want.

I’m afraid that the vast majority of depressives never learn this. They honestly believe (in the moment) that the way they feel is – at least to some small degree – justified. But, it almost never is. That sadness, sense of helplessness, aloneness … all bullshit (most of the time!). Your brain is lying to you. Mine certainly does. Nothing has made a bigger difference to me than a full and total acceptance of this fact.

How I feel is a lie.

In the gym, if you let yourself stay home because you didn’t “feel up to it”, you wouldn’t have had that chance at a PR.  With depression, if you let your emptiness and sadness control what you do, you will only become more sad, and you won’t have the opportunity to feel happy.   

Until you totally accept that your emotions are NOT rational, and that you need to do those things that are good for you regardless of what you think you want in the moment, you will NEVER get better. 

Depression is so debilitating precisely because of the trick your mind plays on you.  It tricks you into believing that how you feel is valid.  This sparks a downward spiral of sadness that makes life impossible.  The more you play into its tricks, the harder it gets to drag yourself out of it.

You’ll notice that I was presuming something about the Objective nature of the outside world in relation to my own emotions and perceptions about that world.  Keep in mind that to say that my feelings are “irrational” is NOT to imply that there are “rational” emotions that I SHOULD be having.  All emotions are irrational if we accept that we are totally subjective creatures – which I DO believe epistemically.  But, some of those emotions are also HARMFUL to you and to those around you. Love is irrational but great!  Debilitating sadness is irrational and not so great.

meditation

I got into Olympic Weightlifting for a reason.  I got into Mathematics for a reason.  I got into Meditation for a reason.  Those reasons are all the same:  They are hard.  Their being hard meant that they took my mind off of the undercurrent of sadness and emptiness that pervades the mind of a person like me.  But, there is more to it.

These are also things you have to practice regularly to be any good at.  Remember what I said about the empty hole inside of a depressed person like me.  It is not something that will ever be filled.  Other people have little holes with bottoms to them – like a well.  They fill up the hole, they are satisfied by a job well done, and they move onto the next hole to fill.  We don’t get to have that.  We get one giant unfillable hole.  Our only option is to find solace in the act of shoveling dirt into it.

That means Practice.

Ritual and routine are your friends.  I’m not telling you to live a regimented life devoid of variation!  Far from it.  You need new stimuli.  I’m saying that you need to have some anchors.

The most important is an exercise routine.  A DAILY exercise routine (see my friend Bret Contreras’s article on the subject here).  Other people can get away with doing 3 day/week routines in the gym and be fine.  You can’t if you are like me.  You MUST do something physical every single day.  It may only be for 15 minutes.   But you gotta do it!

Olympic weightlifting was what I found worked best for me.  It is something that can be (and is best when done) daily.  It is remarkably complicated to get good at which plays into my need for constant hole-filling!  And, it has the added benefit of being (paradoxically, given my last sentence) simple and basic.  It is simple in the sense that you only work on a few exercises everyday, always the same basic workouts, always done in the same way – that is ideal.

I gravitated to a “Bulgarian-influenced” style of training because of the Zen-like simplicity and its daily practice aspect.  Because it actually produced remarkable results with my athletes is the reason I stayed with it as a basis for my coaching.  I fully admit to some post-hoc justifying here.  That doesn’t mean I don’t believe in the methods on their own, I do.  But, my move toward using them started from an emotion and personal place.

Meditation should also be performed daily. There is no excuse not to do it.  5 minutes a day is plenty to start.  Just sit, shut up, and try to think about your breathing.  I have a proscription in my post on Happiness as a Skill.  (You’ll notice that in that article I make the point that negative emotions should be controlled.  Now you know the deeper reasons why I came to this belief!)

To quote myself:

Another way to get control of yourself is to meditate regularly.  I don’t mean in some froo froo hippy way, I mean just sit there, shut your eyes, and start counting your breath.  In and out, that’s one rep.  Don’t think about anything else at all.  Just counting.  If you start thinking of something else, that’s OK.  Adjust, and go back to where you left off.  Start out by counting up to 10 every day.  Once that is easy, add 10 more.  Keep going till you can go all the way to 100.  At this point, you can stop counting all together and just focus on the breath itself.

Doing this, at least a few times a week has a remarkable effect on how able you are to control your mental states.  It is exactly like exercise.  At first, you suck.  Eventually, through practice, you get better.  And one day, you find it just isn’t that hard anymore.

“Practice” should become the word of your life.

Plutarch

“You must learn the principles in such a constant way that whenever your desires, appetites, and fears awake like barking dogs, the logos will speak like the voice of the master who silences his dogs with a single cry.” — Plutarch

The Greeks believed that if you didn’t take care of yourself, first, then you would never be able to take care of others.  They believed in Ethics as Ethos, a practice.  That is, one takes practical steps to improve who they are as a person so that they can better take care of others.  It becomes a part of your character.  A basic Zen philosophy isn’t far off from this.  I subscribe to it myself.  In fact, it is the driving force behind everything that ends up on this blog and behind my coaching in the gym.  I’ve found ways to help myself. And I want to help you to help yourself.

There is a sense in which you must learn to use your reason to your advantage.  But, this is made doubly hard by the fact that in the worst moments of depression your reason is suspect.  The goal then is to slowly develop the skills to distance yourself from your own emotions.  Recognize the Loki-like mischievousness of them.  And, be able to override your own mind.

That might sound silly, or unusually “meta”.  You want to have a Meta-Mind that has veto power over your Mind?  Come on …

I’m serious.

But, like everything in life that is worth a damn, it will take a lot of hard practice!  Meditation and a regimented exercise routine act as character builders on one end, and as teachers of your “Meta-Mind” (forgive me the strangeness of such a term!) on the other.  Each time you choose to engage in one of those activities when you really don’t want to, you’ve just practiced that act of overriding the negative parts of your mind.  Sometimes it will be easy to do, sometimes it will be brutally hard, and still at other times you will fail.

Pushing forward is the goal.  You will get better.  Your mind will be stronger.  And you will, without realizing it, be a better person more capable of helping others.

nietzsche

I’m still a Nihilist philosophically, but my application of that philosophy to my life has taken a 180 degree turn.  I used to believe that if life had no inherent meaning, then there was no point to anything.  I know believe the opposite.  Life has no inherent meaning, so it is incumbent upon us to create that meaning.  We do this via loving each other, putting work into those things we are passionate about, and increasing the number of moments where we can feel some semblance of happiness and fulfillment.

I’ll never be a content person.  I will always struggle with irrational moments of sadness, loneliness, and even despair.  But I’m not the man I was a decade ago.  Who I am today is a generally happy guy who laughs a lot, smiles a lot, and knows how to (most of the time) control the darker sides of his nature.  That didn’t happen by magic!  I built this person that I am now.  It took years of hard work and I will never be done with this project.  I accepted that to be the man I wanted to be it was going to take a life of constant toil.  No pill, no moment of epiphany, no perfect experience was going to “cure” me.

I am who I strive to be.  I want no less for you.

Austen, James H. 1999. Zen and the Brain.  The MIT Press. Cambridge, Massachusetts.Davidson, R., et al. 2003. Alterations in Brain and Immune Function Produced by Mindfulness Meditation.  Psychosomatic Medicine.  65:564 –570Dimidjian, S., et al. 2006. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.  Journal of Consulting and Clinical Psychology.  74(4), 658–70Gillani N, Smith J. 2001. Zen meditation and ABC relaxation theory: An exploration of relaxation states, beliefs, dispositions, and motivations. Journal of Clinical Psychology. 57: 839–46.Hastings RS, et al. 2004. Volumetric analysis of the prefrontal cortex, amygdala, and hippocampus in major depression.  Neuropsychopharmocology.  May 29(5):952-9Herrington, John., et al. 2010.  Localization of Asymmetric Brain Function in Emotion and Depression.  Psychophysiology.  1-13.Kabat-Zinn J. 1982. An out-patient program in Behavioral Medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry  4: 33–47Sapolski, Robert M.. 2001. Depression, antidepressants, and the shrinking hippocampus.  Proceedings of the National Academy of Sciences.  October 23; 98(22): 12320–12322Sheline, et al. 1993. Hippocampal atrophy in recurrent major depression.  Proceedings of the National Academy of Sciences.  Apr 30;93(9):3908-13.

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