Placebo: What Your Brain Can Do for You

The placebo effect is the measurable, observable, or felt improvement in health not attributable to treatment. This effect is believed by many people to be due to the placebo itself in some mysterious way.

So states this article on placebos and depression from the Skeptic's Dictionary, and appropriate resource. Like this UCLA article about placebo usage, it discusses how, when a patient is told they are receiving a placebo, the effectiveness often goes away. Is this because the treatment was all in their heads? Or that the depression was?

Many studies try to compensate for the "placebo effect." Others, more recently, have specifically studied this factor as a healing process. A study by Dr. Arif Khan showed, according to the New York Times, that:

It turns out that the more severely depressed people are, the less likely they are to respond to a placebo. And people with more mild depressions get better with just about all treatments, including placebos. Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

Other studies, including one by Dr. Irving Kirsch, suggest that medications are nearly useless because the placebo effect is so high in depression treatment. Meanwhile, doctors wrestle with the ethics of "tricking" patients with placebos.

I think the point is not quite being realized by the scientific community. Depression is a disease that is has an effect upon the body as well, because the brain controls all things. Placebo is the brain's natural ability to repair damage to all the human systems. This process is easily interrupted by doubts and limiting beliefs. At this point in our development we have identified the process, and we recognize that it can be encouraged by presenting patients with a physical talisman, if you will, of healing; the pill. More severely depressed people need more than a sugar pill because they are so very sick their limiting beliefs extend deep into the unconscious, metastasizing like cancer. They need medications to bring them to the point where the placebo process can recover enough to even try to work.

I foresee a time when the scientific community will focus serious research on placebos, not to remove them as a variable or identify what is "in a patient's mind," but to determine how to harness our own healing ability and hone it. This research will not be conducted by drug companies, because it would not be advantageous to cure such a lucrative market for maintenance medications. It will be research into areas currently sidelined as psychology or superstition, and will tap into the true potential of the human brain.

The lucky depression patients have found other avenues to unlock these secrets, either through sugar pills or prayer or exercise or therapy, and they have been given a chance at true healing, y allowing their brains to overcome depression naturally. It's time the scientific community figures out a way to give the rest of the victims that opportunity.

Self-Care Options

This article reinforces my position on the paradox of depression: you aren't going to get better if you can't learn to do it yourself, but depression keeps you from believing that this is possible. Drugs and therapy can be important tools for recovery, but neither of them will succeed without your help, and neither of them should be considered for a lifetime. If you plan for a day when you won't need them you're much more likely to reach that day.

Either of those treatment options may give you the needed push to get to a point where you can do something for yourself, crawl just far enough out of your own personal pit that you can take at least a small amount of responsibility for your own recovery. If they can't get you to that level, and you aren't functional enough to make it there without further help, you should find that help. Never forget that the worst symptom you have is the belief that you are going to stay this way, that nothing you do can change it, that it's pointless to even try. Don't give in to that crap, because if you expect the worst you're rarely disappointed. Do you have anything to lose by trying for more? Can it really get worse than it is? Really?

Some thoughts on the five suggestions given:

• Keep Active: yep, I've mentioned how important even a little bit of exercise can be. Don't want to get out of bed? Consider having a friend drag you out if necessary.
• Eat well. A well-balanced eating strategy will help you feel better now and later. Good thought. I've had comments here from depression victims that eat like crap, and it shows in the writing that they're just making things worse. Your body needs good fuel to do a good job.
• Get adequate sleep. I would modify this to say, "Get appropriate sleep." Insomnia is a symptom of depression, but I was more prone to the fourteen-to-sixteen-hour power nap. I psychiatrist I knew said that the best way to regulate sleep is to get up at the same time, every day, without fail. Your body will take care of the rest.
• Control stress. Coping with depression is stressful enough, so try to limit other sources of stress. And depression does a marvelous job of amplifying the other stress, doesn't it?
• Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life. I can't emphasize this more. You need to be around people, even if you don't feel like it, because even if you believe you're alone in a crowd it is better than being alone alone. Do it even if you don't want to.
  

Cleaning House

Is a messy home a caused by depression, or is depression caused by a messy home? I've heard passing references to a link between disorganization on the outside and fogginess on the inside, but I wasn't able to find any research on the subject. I know that I'm no stranger to having a bit of untidiness in my life, and there are plenty of other people I know who fall into both the categories of "depression victim" and "house cleaning challenged."

However, as my mother would say, "Dull women have immaculate homes."

There might be some wisdom to the axiom linking an orderly environment with an orderly mind, but until someone does a study I'm not making any pronouncements. However, I think it's fair to say that a messy home feeds really well into the cycle of I'm-not-good-enough that depression creates and builds upon. If you don't have the energy or focus to clean, it's pretty certain you'll put it off. As the mess builds, so does the guilt. The problem gets bigger as the guilt feeds the depression, which diminishes the energy levels and reinforces how impossible the task is. You know the drill, you've probably done it to yourself. Charming little cycle of self-recrimination and self-fulfilling prophecies. You expect that you can't clean the place up, and your mind works overtime to make sure that it doesn't make a liar of you. Didn't think you had that much mental energy, did you?

As with everything depression-related, small victories add up. Commit to not adding to the mess today. You will not create another dirty dish without washing it. One dish isn't so tough. And those socks? Just force yourself to put them in the hamper; you'll be glad you did. Keep up on not adding to the mess, and you'll see you can control your world after all. Then you'll be ready to take a step or two towards the bigger mess.

I would keep making small victories. Don't try to clean every dish in the kitchen, but do try to wash all the ones in the sink. Maybe picking up all the dirty laundry is a bit much right now, but how about just the stuff that you piled on your bed? Each time you succeed you're teaching yourself that you are capable and you are in charge.

Use Holidays Properly

Why are there so many holidays in December and January? We have Hanukkah, Christmas, Yule, Kwanzaa, New Year's Eve, St. Lucia's Day, and all manner of variations on those, as will as ancillary celebrations (such as Advent). In one form or another, these celebrations focus on happiness or light. Celebrations of light, all clustered around the longest night of the year? Surely this is not a random occurrence. Obviously the human spirit craves light and the life it brings, and the dark times of less activity and more eating are being offset by singing, candles, parties (okay, that's also a handy excuse for eating), and opportunities to spend time with other people: cultural and religious offsets to the physiological reactions to winter. We understand that times of cold and darkness can wear away at our resolve, and we fight back by creating a flurry of activities aimed, purportedly, at joyfulness at this darkest time. Hopefully it's enough to carry us through the remaining ice and snow as the days grow longer.

Enter depression, subtle twister of goodness.

Looking at the world through the unwholesome filter of depression can make a good thing into a painful experience. Holidays are designed to bring people together; you just want to be left alone. They encourage you to give; you're overwhelmed by the idea of shopping, or terrified that you'll choose the wrong item. Indoor creative crafts flourish; your mind is a pile of mush and you're sure you can create or decorate anything.

If you've read this blog for any amount of time you know that it's my firm belief that depression has physiological, psychological, and spiritual components, and gleefully will attack you on all those fronts. This is a time of year when it can use the forces of nature (less sunlight and warmth) as its strength, overwhelming the forces of culture (social activities, giving and happiness). Well if it will use the momentum of the year, you can too.

Go to the parties, even if you sit by yourself. Joy is also an infectious disease, and if you expose yourself to it you may find that you catch it. Surround yourself with people that won't judge you for your failings - there is no better time of year to find the goodness in your fellow man than right now. Sing and don't care how you sound. If buying gifts is too expensive or you hate the crowds, try making your own and (here's the trick) stop caring if they're perfect. Spend some time volunteering as a Santa or Salvation Army bell-ringer. Force yourself to be in situations where you will be exposed to the goodness of humanity.

All the drugs in the world will not get you out of bed. Your therapist and your gods cannot do this for you either. Depression is working very, very hard to convince you that you have no power, no worth, no purpose. Set yourself a schedule of things to do, things that intellectually you know are good at this time of year, and stick to it no matter what. You will find many, many excuses to avoid positive, social activities, because the more of them you engage in the more the depression will fight back and try to suck you back in. That's why I suggest literally writing down (or getting a friend to, if you must) your holiday activities and going through the motions. Sooner or later the habit will find its way in deeper, helping out whatever treatments you might have going for you.

And then you'll discover the most amazing gift of all - that you can.

You Deserve Better Than Hope

Hope implies that we have a chance, even a small one, of getting what we hope for.

Hope is a funny construct - it can pull people out of the pits of despair, giving them the power to survive and succeed, but when dashed it can shatter a soul.

Hope is a passive, yet passionate, state.

Hope does not lead to action. In many cases it is a substitute for action.

Hope is somewhat optimistic, and largely dangerous.

If you're emotionally vulnerable and have a desire for a better turn of events, I don't think hope is the best way to go. Yes, there is a chance that things will turn out as you hope they will. But only a chance.

Because hope doesn't do the work, and for a depressed person it just becomes an excuse.

"Nothing ever goes right for me. I should just give up."

If I hope to win the lottery and don't buy a ticket, whose fault is that? That one might be too obvious. If I apply for a job, and hope I get it, but I never call to follow up on the application, whose fault is that? The hiring manager's? Mine, maybe?

It's really easy to be passive about life when you've got the thousand-pound weight of depression on your soul. You hope for good things to happen, but you expect those hopes to be dashed. When they are, you can easily confirm your suspicion that your life sucks, your luck is terrible, the Universe is against you, and you smell funny.

Okay, that last one is just your imagination, unless you have another issue.

But actually that last one is just like the rest of them - they're all things that you can change, but only when you stop being passive about them!

Hope is a dream killer. Sure, sometimes things work out as we hoped they would. But then we are robbed of the satisfaction of accomplishing them, because they just . . . happened. And if those good things didn't happen through our actions, then we have not learned how to make them happen again. Dreams that come true through the random action of the Universe don't turn into phenomenal stories of personal transformation any more often than single-celled organisms evolve into sentient primates with language and culture.

I'll let you look up the odds on that for yourself.

If you feel the need to hope for an outcome, do yourself a favor and find out what it would take to get yourself there. Does it seem too big a goal? No worries. Find a smaller goal, one that you can achieve, that will move you closer. Is your goal to be free of depression? Maybe the best goal you can achieve for yourself is calling a counseling center. Doesn't seem like much, but if you make that call, you have taken action. You are teaching yourself that you refuse to allow yourself to drift aimlessly through life. You are empowered to make decisions that will affect your fate.

Personal responsibility is washed away by hope; hoping absolves us the obligation for our own lives.

Don't let depression suck you down into that hole where you believe all that claptrap about not having power. You do. And you can start using it as soon as you realize that there are much better tools out there than hope.