Depression: Kindling

“Kindling” is a concept brought over from the treatment of seizure disorders. Once you have had seizures, your threshold is lowered, and you are more likely to have them later. This has been found to apply to depression as well. In extreme cases, this is of course your basic “Well, duh.” People who had been in concentration camps when young were more likely to be depressed when they were elderly, even if they had had no intervening episodes of depression. Well I’m shocked. In the 80’s and even 90’s in the psych biz, we thought that helping people “deal with these issues” beforehand would provide some protection. Great theory. It seems to make things worse, though. The idea that you have these issues lolling around in your unconscious, waiting to explode upon you, while you walk around untroubled and unaware, a walking time-bomb of psychic misery, is one of those half-truths that make psychology dangerous.

Putting off psychic misery isn’t necessarily dangerous. If you can put it off until you’re 90, you likely won’t have to deal with it at all.

But there is at least a half-truth in it, and it’s worth mentioning. You can have a highly stressful event send you into an episode of depression. A second highly stressful event can send you into a second episode. But the third and subsequent episodes may not require so much push. Once depression has been kindled, the path to it becomes easier. This is part of why doctors are often so big on trying to treat normal grief. They’ve been burned before, and wish they’d treated some of their previous clients more aggressively.

Sadness is not depression, but continued sadness can lead to depression. There is a current line of thought that says any chronic illness should prompt consideration of treatment with anti-depressants as a prophylactic. I’m not sure that’s going to hold up under investigation. It’s a theory. But I do know that one of the arguments against the practice is bogus. As I mentioned in my previous Kubler-Ross posting, there is this idea of grieving, or accepting, or dealing with any bad thing as a process. That immediately suggests that it is something you have to go through, and interfering with that is bad. “Don’t give her medication. She has to go through the normal grieving process,” they say. Well, there isn’t one. People grieve. They have many different emotions. As time goes on, they think about the terrible event less often. It still hurts when they do. There’s no process.

The body, including most of the brain, does not have much emotional vocabulary. The body does not perceive a difference between sad, unhappy, not happy, displeased, not pleased. It feels bad. That’s it. The higher parts of our brain create the subtle differences between those concepts. This is why parents are teaching culture when they teach emotional vocabulary. A four-year-old knows little difference between “sad” (inner directed) and “displeased” (other-directed). Parents teach that, and while teaching it, also give cues as to what is an appropriate response. “Are you sad because your friend is gone?” “You’re unhappy that the dog knocked over your tower, aren’t you?”

Depression is moving into different territory, where the lack of energy, changed sleep and appetite, or waves of sadness start to develop a life of their own. This can happen easily if you’re “just sad” about a death or a loss. The sadness, which is directed toward an event, can become the place the emotions go to live. Telling people who are already hurting that there is some “process” they’re supposed to be going through just adds to their burden.