12
CONQUERING OUR SHADOWS
SOME DAYS WE would just as soon stay in bed. We drag ourselves into the morning, and even simple things seem to take a huge amount of effort. Trivialities bring us to the edge of tears, and affronts seem to lurk around every corner. If we could, we’d walk away from everyone and everything. But being alone is also unbearable. Our thoughts flow more slowly than normal. We berate ourselves, feel empty and worthless, and see our misery as well-deserved punishment for . . . whatever. “I don’t deserve any better.”
We all know such dark moods of self-doubt and despair. As unpleasant as they might be, they’re programmed into the brain and can actually be very useful. When we have lost something, when a relationship ends, or when we have failed to reach a goal, the organism responds with sadness—a signal that we should relinquish a possibly senseless goal. Depression is a natural energy-saving program. When we feel drained of energy, we pull back and reflect, and in the end we often attain a new strength and clarity.
A DANGEROUS ENERGY-SAVING PROGRAM
But too much sadness can also do damage. When it digs in, it develops a life of its own that has little to do with what caused it. Then we are no longer sad because a disappointed brain briefly needs reorientation—but because we’re sad. The emotions that are supposed to serve the organism turn against it and the downward spiral of depression sets in—negative feelings breeding negative thoughts that get us truly depressed. Soon there’s no telling hen from egg: since the situation seems hopeless, we feel we’re powerless and become passive. And because we don’t take our fate into our own hands, nothing improves. Depression creates a situation in which discouragement really does seem warranted. We become trapped in a vicious cycle that precludes the possibility of happiness.
Severe depression is an illness that requires treatment. As with a toothache, it’s best to act quickly. The longer despair rages unchecked, the longer it takes to get rid of it, the more damage it can cause, and the greater the likelihood of sliding into another depressive phase. Someone who feels worthless for much of a two-week period, suffers from constant listlessness, tiredness, or sleeplessness and even dwells on thoughts of his own death should get the help of a physician.1
This is reason for neither shame nor despair. Every eighth person has had this experience or will have it at some time in his life—more than 40 million people in the United States alone. Depression is a common illness, hardly less widespread than high blood pressure and arthritis. But unlike these other illnesses, depression is eminently curable. The chance that a depressed person will laugh again is extremely high. Almost everyone improves after being treated, with more than 80 percent experiencing a complete remission.
The tips in this chapter address a less serious form of mood disorder, everyday sadness—something that is not merely a nuisance, but one of happiness’s great spoilers. Psychologists and brain scientists have long puzzled over whether the kind of melancholy that we’re all familiar with is related to serious depression. In the light of new research it seems very likely. Both result from the human brain’s adaptability: we can learn to be happy, but we can also learn to be unhappy. Sadness is for the most part nothing more than learned unhappiness. And this gives us the ability to overcome it.
LEARNED HELPLESSNESS
In order to get a better handle on our negative feelings, we have to understand where they come from. The explanations given for depression are an encouraging example of how science can actually become simpler in the course of time. The second-century Greek anatomist Galen ascribed melancholy to an excess of bile, while for Freud the suspect was the unconscious raging of unresolved childhood conflicts. Today we assume that an enduring sadness simply stems from the experience of not being able to improve an unpleasant situation. “Learned helplessness” is the term given to the modern theory of depression: despondency is a product of resignation. When this kind of “down” coincides with an inherited tendency to sadness, the result can be depression.
The first person to make these connections was the University of Pennsylvania psychologist Martin Seligman. In 1965, he conducted a simple experiment in which he divided dogs into two cages whose floors were wired to give off harmless but unpleasant electric shocks. In the one cage the dogs could turn off the electricity by pushing their noses against a plate. The dogs in the other cage could do nothing to switch off the charge and had no choice but to suffer the shocks.
Once the dogs had gotten used to their environment, Seligman brought them all into a new cage with a low wall. To escape the unpleasant electric charge, they had only to jump over the wall. The dogs from the one cage, who had learned that they could do something against the shocks, left quickly. Those in the second group, on the other hand, were resigned to their fate, although escaping would have been so easy. They lay on the ground, whimpered, and bore one shock after the next. Their helplessness in the old cage had apparently been so deeply internalized that they carried the feeling into the new situation, where it made no sense. Losing interest in playing with one another, in food, and in sex, they showed all the symptoms of depressive listlessness.2
Our resolve in facing life head-on depends much more on the way in which we assess a situation than on reality, something that was shown in experiments with people who have been exposed to intolerable levels of noise. By pressing a button, one group could turn it off, while the other could do nothing. Afterward, all the participants were brought together in the same room, where they could turn the noise off with a lever.3 Those who’d been in the room with the off button quickly discovered the lever, while the others wouldn’t even try to operate it. Later, they sat quietly in a corner, and when they were asked to participate in a game, they made no attempts to win. They were also less able to solve simple word puzzles, even in the absence of any time pressure. In every way, they felt and behaved as if they were helpless.
THE ANATOMY OF UNHAPPINESS
“You can’t do anything about it anyway.” This is a depressed person’s affirmation. Her despondency is confirmed by her appearance: she drags her feet, her eyes are lifeless, her shoulders droop—as if not only her spirits but her muscles have lost their strength, as if her entire being is fueled only by a pilot light.
The waning of vitality is also evident in her brain. Letting us see right into the skull, tomography shows us with particular vividness how activity diminishes in the left prefrontal cortex.4 Because this area is responsible not only for motivation and desire but also for the control of negative emotions, the effect of melancholy is pervasive, and for two reasons: not only do we lack drive, but we also find it harder to get a grip on our sadness, shame, and anxiety. Depression is a consequence not only of the dark feelings that cast their shadow over everything we experience, but also of the absence of desire.5
This kind of depressed condition can also arise with frightening ease in healthy people. When the London brain researchers Chris Frith and Raymond Dolan asked their experimental subjects to read sentences such as “Life is not worth living” while playing Prokofiev’s “Russia under the Mongol Yoke” at half speed, the volunteers soon complained of dampened spirits, listlessness, and a feeling of worthlessness. The activity in their brains resembled that of people who are treated for clinical depression.6 Those who suffer from depression see their misery as tunnels without end, whereas the volunteers quickly found their equilibrium again once the experiment was over: the everyday sense of being “down” differs from pathological depression less in quality than in its duration.
HOW MISERY TAKES ON A LIFE OF ITS OWN
A few sentences can change our mood, but the reverse is also true: our mood can determine what we perceive. The border between perception and emotion is porous in both directions. In one experiment, depressed and healthy people were asked to identify optimistic and pessimistic prophesies in a potpourri of sentences. The depressed participants were better at interpreting statements such as “The future looks very black” than upbeat statements such as “The future looks very favorable.” And they were also better able to remember the negative sentences.7
This, too, is connected with the structure of the prefrontal cortex—a part of the brain that has a large influence on our moods and serves as working memory, temporarily storing information that we need to have at hand. This is why our emotional state has such an impact on our response to what we’ve just seen, read, or heard. The prefrontal cortex is also linked via various nerve paths to our long-term memory. It may be because of these connections that we tend to recall sad memories when we’re down—something that has also been demonstrated in psychological experiments.8
Once we’ve begun to see the world through dark lenses, the brain is tempted to keep the negative mood going. It seeks out stimuli that match our emotional state, giving dark thoughts, negative experiences, and bitter memories preferential access to consciousness. We see misery everywhere, and the whole organism reacts correspondingly. “. . . [Y]ou can think of depression as occurring when your cortex thinks an abstract negative thought and manages to convince the rest of the brain that this is as real as a physical stressor,” writes Robert Sapolsky, a Stanford University biologist and neuroscientist who specializes in stress.9
We react to news of danger, whether it’s real or imagined, much more strongly than to good news. Forgetting our pleasures and hopes until we’re safe helps us respond appropriately to the slightest warning. But when we’re depressed, we direct what is otherwise a survival mechanism against ourselves. Chronic melancholy is widespread because this program is so easily misled: our brain has a talent not only for recognizing threats but for imagining them. We worry about things that will probably never happen and color them in vivid detail, but just thinking of them is enough to pull us down. Depression is the price that we pay for our imagination and intelligence.
One rather radical remedy against depression is to surgically sever some of the connections between the region that conjures the dark thoughts of the future—the cerebral cortex—and the rest of the brain, resulting in an immediate improvement. Electroconvulsive therapy (ECT) works similarly. It’s usually administered under brief sedation and involves harmless electrical currents that work similarly to the reset button on a computer. These impulses extinguish the storage in the short-term memory of the prefrontal cortex and break the endless cycle of brooding thoughts. Through strategic interventions like ECT even the most stubborn depressions disappear.
Fortunately, doctors rarely have to resort to such drastic measures. But the fact that they can help people out of the misery of even the most serious depressions is instructive for living with our daily troubles. It shows to what degree our thoughts and imagination can influence our mood. Very often it’s our capacity for imagining misfortune that renders us unhappy.
Discontent is something for which our minds bear the full responsibility. To what absurd lengths we sometimes go to keep a bad mood going is nicely illustrated by this joke: What does a Jewish telegram say? “Start worrying! Letter to follow.”
BAD MOODS KILL GRAY MATTER
When we feel threatened, we’re more alert than we are otherwise. Nature has arranged it this way so that, in critical situations, we respond to the slightest sign of danger. This special sensitivity is further enhanced by stress hormones such as cortisol, that are released into the blood and then usually disappear as soon as there’s no longer any reason to be afraid.
When someone suffers from depression, however, the stress hormones don’t disappear. Depression is a state of permanent stress: we perceive any careless remark as a slight, every triviality as a small catastrophe—and as further proof of the world’s evil. As a result, more stress hormones are released, which makes us still more sensitive. Thus the vicious cycle continues endlessly, until, sometimes, it gets so bad that the depressed person retreats into a darkened room and doesn’t leave.10
Even worse: when the depression lasts too long, the brain itself comes under attack. Of all the discoveries that recent research into depression has brought to light, this may be the most disturbing. Depression not only involves an imbalance in the neurotransmitters, but also affects the hard-wiring of the neurons. To what extent the damage can be undone is still unknown.
In the process, the brain loses its adaptability—melancholy is a state of rigidity that paralyzes all initiative and ossifies the depressive condition. Our ability to feel fades, and our judgment and concentration diminish. Tests have shown that depressed people are less able to solve even simple tasks, such as the sorting of playing cards.11 At the beginning of a depressive phase, the working memory is affected, and the stress hormones impede the brain’s ability to think.
Abilities that aren’t exercised deteriorate. The circuits in the brain begin to shrink as soon as we use them less. And this is what happens in a depression. As the feeling of hopelessness increases, the brain sends stress hormones, which can harm the neurons and do lasting damage to the brain.12 If this condition is prolonged, the consequences can be devastating: gray cells shrink. Then the brain works less and less well, and the spiral continues downward.
In people who have suffered repeatedly from serious depressions, the space in the prefrontal cortex occupied by certain kinds of neurons is diminished by a third, as the psychiatrist Grazyna Raykowska of the University of Mississippi Medical Center discovered.13 Other parts of the brain lose so much matter that they just shrivel up. This has been observed, for example, in the hippocampus, on which memory depends.14
Normally, the brain learns and forms memories when the neurons, like climbing plants, constantly grow new fibers, which then link them to other neurons. In depressed people, however, the brain seems to freeze, like vegetation in winter.
PILLS AGAINST UNHAPPINESS
The discovery that depression could be a result of too little neuron growth has radically changed the direction of research into unhappiness.15 Until now, scientists have assumed that periods of sadness were simply the cause of a chemical mixup in the brain due to a low level of certain transmitters, for which the success of pharmaceutical treatment was cited as evidence. For almost five decades doctors have been prescribing medications for depressed patients that elevate the levels of the transmitters serotonin and noradrenaline, which are chemically related to dopamine. More than 60 percent of patients diagnosed with serious depression have been helped by these drugs, and an even greater number when the pills were combined with appropriate psychotherapy. Prozac, probably the most famous medication of this kind, has in the meantime been superseded by medications from the class of the so-called serotonin reuptake inhibitors that are still more successful. The conclusion seemed obvious: depression could be explained by a deficiency of serotonin and noradrenaline.
However, it was soon determined that reality was more complicated. If the amount of serotonin is lowered in the brains of healthy people, their mood remains stable. So, whatever the claims, depression can’t be explained only as a serotonin deficiency. A medication like Prozac, sometimes lauded in the media as a happiness pill and described as rose lenses for the mind, has almost no effect on well-balanced people. It raises the mood only of those who are truly depressed. Prozac and similar medications are pills against unhappiness, not for happiness. They can remove the bad feelings, but they don’t create positive ones.
This may be explained partly by the fact that the level of serotonin seems to be linked to the stress system. When a large amount of serotonin is circulating in the brain, fewer stress hormones are released. By making more serotonin available, antidepressants diminish susceptibility to chronic stress and the negative feelings that accompany it, as was shown by Juan Lopez and Elizabeth Young at the University of Michigan.16 But when people are free of stress, the medications have no effect—as little effect as aspirin has on the well-being of people who have neither pain nor fever.
Why does it take so long for antidepressants to take effect in depressed patients? The quantities of transmitters in the brain change as soon as the medication gets into the blood, that is, after just a few hours. Nonetheless, it almost always takes about four weeks until patients report improved spirits. Apparently, for Prozac and similar drugs to become effective, they have to take a detour, and that takes time.
It’s possible that the medications awaken the brain from something like a hibernation.17 When they release more serotonin and noradrenalin, the gray cells begin to grow again. This has two possible explanations. For one, the presence of fewer stress hormones reactivates the growth of the gray cells. Secondly, serotonin and noradrenaline work directly on the neurons, indirectly activating certain genes in the nucleus. These genes, in turn, stimulate the growth of nerve growth factors, the brain’s natural fertilizer.18 And as soon as the gray cells sprout again, the symptoms of depression disappear. The frozen brain is brought back to life.
SHOWING MELANCHOLY THE DOOR
When the brain is inactive, we feel depressed. This is why the standard reaction to unhappiness—withdrawal—only makes things worse, for then the brain really begins to lose any incentive to become active again. Listlessness and paralysis, both emotional and intellectual, spread and take hold. Doing nothing is no cure for a bad mood.
In serious depressions, medication is often the only means to prod the brain out of its immobility. But the much more frequent common sadness of everyday life is best overcome with a double strategy that involves gently stimulating your brain on the one hand and, on the other, guiding your thoughts and feelings to deprive the depression of a foothold.
Sadness can be the consequence of an acute emotional strain. The loss of a close person, a bit of bad luck, stress in work or family, or even a sudden change of location like at the beginning of a vacation can result in so much stress that the organism demands a retreat. This need is expressed by a feeling of listlessness, sadness, and tiredness. It may be wise to give in to its demands for a while. For how long depends on the cause. A recovery that last weeks is hardly appropriate after the strain of a long journey, but the death of a family member is another matter entirely. As the French say: “Reculer pour mieux sauter,” step back in order to jump better.
But the feeling of being “down” often takes on a life of its own. If there once was a cause, it happened a long time ago, and now the melancholy feeds on itself. Nothing seems appealing. To further fuel the vicious cycle of listlessness and inactivity by being passive makes no sense whatsoever. Whoever has had a leg that was in a cast for a long time knows how dramatically muscles can weaken in the course of an enforced rest, and how feeble the desire is to take those wobbly and difficult first steps. But there’s no getting around it if one wants to walk again. Similarly, we have to reaccustom the brain to activity after an extended period of depression.
RELAUNCHING THE BRAIN
Activity—any activity—helps against sadness. You take up life’s reins again. When you do something, you engage your brain and deprive it of the opportunity to go down thought’s darker paths.
How much our emotions and our ability to reason influence one another has been shown by PET scans tracking people through different moods as they work through problems. Since feelings and problem solving are processed in areas of the cerebrum that overlap considerably,19 there’s apparently less space for pessimistic emotions when we direct our attention elsewhere.
Even better for our spirits are activities that bring a sense of success. It’s important that we set goals when we’re going through periods of sadness, though we shouldn’t overdo it, since the brain isn’t up to its normal level of activity.
For this reason, it’s best in such times to engage in simpler tasks. Housekeeping, cleaning up, shopping and taking care of correspondence and e-mail serve as a gentle warm up. They require relatively little effort, are stress free, and give a sense of accomplishment. Because the little jobs of daily life are often neglected, a “down” phase is well spent taking care of them. And when you see the result, you make the pleasant discovery that the melancholy even yielded some good outcomes.
That the experience of success becomes especially important when people are having a hard time can be explained by the functioning of the two halves of the prefrontal cortex, according to the neuropsychologist Richard Davidson.20 When we’re sad, its left half, which both directs us towards goals and controls negative emotions, is insufficiently active. But if we decide to strive for even a small goal, we reactivate this part of the brain that is so important for our well-being. And when our plan is transformed into reality, these neurons in the prefrontal cortex give a signal and release a feeling of success that we have every reason to enjoy.
RUNNING AWAY FROM MELANCHOLY
We’ve already seen that physical activity and sports result in positive feelings, which makes them an ideal tool for driving away depression. Physical movement has a two-fold effect on our feelings.
First, when it’s done right, it always gives a feeling of success. We can all set goals for ourselves that correspond to our abilities. People who aren’t used to regular physical activity can have the same sense of triumph after jogging a mile as an athlete who has run a marathon. More important than absolute achievement is that you gauge the level appropriately, so that you don’t give up. People who don’t like physical activity balk at the effort, the sweat, the ordeal of it all—but therein lies its power. There is a guaranteed reward for beating your inner couch potato: just knowing that you’ve done something for yourself by facing down your sense of lazy comfort can chase away a good deal of sadness.
Second, physical activity has a direct effect on the brain. Movement encourages the growth and even the new formation of neurons, as the California neuroscientist Fred Gage has shown. He put rats on a simple treadmill in a cage and observed greatly improved scores in subsequent memory tests. Even mice that had not learned well were better able to do so after running. Gage found one solution to the riddle in parts of the brain that are critical for memory. The rodents that ran had more nerve growth factors and twice as many newly formed neurons as those that had just hung around.21
But activity doesn’t only make us smarter. By stimulating neuron growth, movement works against depression’s most dangerous symptom: the disappearance of gray cells. Exercise is a kind of natural Prozac. This analogy works also in that physical movement releases serotonin—the same transmitter whose levels are increased by pharmaceutical antidepressants.22 In contrast to medication, which only diminishes sadness, movement also yields positive feelings, because physical effort releases the euphoria-inducing endorphins. This might explain why regular exercise for half an hour three times a week is as effective against melancholy with some people as the best medications currently available.23
THE ROBINSON CRUSOE THERAPY
To recharge the brain is one measure against melancholy; arming ourselves against negative thoughts and feelings is the other.
The English literary hero Robinson Crusoe put this second principle into operation. He, too, was plagued by depression after he was washed onto his island, helpless, without companionship, with no hope of being saved. But, Crusoe said to himself, no situation is so hopeless that one should give up. So he took a pencil that he’d saved from the stranded ship and made a list of plusses and minuses. Some examples:
Then he drew his conclusions: “Upon the whole, here was an undoubted testimony that there was scarce any condition in the world so miserable but there was something negative or something positive to be thankful for in it; and let this stand as a direction from the experience of the most miserable of all conditions in this world: that we may always find in it something to comfort ourselves from, and to set, in the description of good and evil, on the credit side of the account.” This happiness saved his life. Had he given into his all too understandable despondency, he soon would have died in his isolation. He wouldn’t have had the opportunity to meet his companion Friday, and he wouldn’t have been saved by an English ship.
Did he talk himself into a fool’s paradise? No, for both sides of his ledger are true. The question is only on which side you stand, and it’s usually more useful to see things optimistically. Deciding for the glass that is half full instead of the one that is half empty is one of the most effective of all antidotes for depression.
All this sounds so hopelessly simple—almost too good to be true. The National Institutes of Health spent ten million dollars to test Crusoe’s method in one of the great therapy experiments of all time. The psychologists proudly called it cognitive behavior therapy, though a better name might have been The Crusoe Therapy. The study lasted six years and involved hundreds of participants suffering from moderately severe to severe depression. Sixty percent of them were cured by the cognitive behavior therapy—the same success ratio as with patients treated pharmaceutically.24 If medications and cognitive therapy are combined, the percentage is somewhat higher still, and the danger of relapse is reduced.25
Psychoanalysis, on the other hand, is not only much more expensive but also less effective. After the lengthy and expensive treatment on the couch, hardly a third of the patients improve.26 One might as well swallow sugar pills. Indeed, numerous studies have shown that about a third of people with depression are cured by taking placebos—pills with no active ingredients at all. Sometimes good common sense is better than the most complicated intellectual constructs.
In cognitive behavior therapy, the psychologist supports patients as they change their ways of thinking. This can be very useful when negative thought patterns have been deeply engrained during a prolonged depression. For everyday purposes, it’s not really necessary. The Crusoe Method is so simple and yet so effective that it can be used by anyone.
OPENING OUR OWN EYES
How do we attain this change in perspective? When we suffer from depression, entire streams of negative thoughts pass before us. We see all our intentions failing and are convinced that they had to fail, because in the end we’re losers. Everything that happens confirms our worst fears.
We spin inner monologues. A colleague passes without looking up. She doesn’t even say hi. You think: She probably wants to get back at me. But she has no reason to. She can’t stand me, and her behavior proves it. And isn’t she justified in her dislike? I am hard to take. Even my voice is hoarse. Wouldn’t it be better to steer clear of the cafeteria today and not bother everybody?
Many of us are so accustomed to this kind of silent script that it goes by us very quickly and as if by reflex. Our first job, then, is to notice it. There are numerous strategies for doing this. Crusoe’s tactic is especially effective: if you write down your fears, self-accusations, and struggles, you may be shocked at first at how numerous they are. But merely writing down the ways in which we torment ourselves helps us to overcome them.
Putting our fears and feelings of worthlessness down on paper also makes them tangible—and thus easier to test than ideas that just swim around in our head. The trick from then on lies in dropping the dark thoughts at the moment we notice them. There are two ways of doing this. The better of the two is to turn your attention immediately to something else and to walk away from the negativity. This isn’t always possible, however, because some fears force themselves into consciousness no matter how hard we try to keep them out. In this case it helps to imitate Robinson Crusoe and write down arguments against thoughts that are tormenting us. When we think someone is snubbing us, for example, it’s likely that she’s just thinking of something else.
If you’re wondering whether you’ll have to stand vigilant with pencil and paper until the end of your days—you won’t. Writing things down is only a way to get started, like training wheels on a bike. The mastery over our dark thoughts and feelings quickly becomes a habit. As the gray cells are reprogrammed, the left front lobe is trained to master negative emotions a tenth of a second after they first appear. As this ability grows, the bitter feelings vanish.27