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Nigel

Nigel

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Tuesday, 21 November 2006
SOME THOUGHTS ON THE SOURCES OF MY DEPRESSION by Nigel H. Sinnott Since I last revised this document, my views have modified somewhat. I incline to the suspicion that my ? and other people's ? unipolar depression may require two elements: a genetic or congenital predisposition to depression (the former being more likely), and (2) a severe adverse event or events, or adverse circumstances, to activate the depression. I would fit such a scenario quite well. My wife has long suspected that my depression is a mixture of inheritance and early circumstances. N.H.S. 12 September 2000. I have suffered from depression since at least 1962, and possibly earlier. I am satisfied that I have unipolar, not bipolar depression. Despite much assertion and dogmatism on the subject, it appears that, at present, the causes of unipolar depression are not known with any certainty. (Some people, as I will mention later, have even suggested that the causes are unknowable.) Nobody has conclusively demonstrated a single and invariable cause of unipolar depression.^{1, 2, 3} Theorists fall into two broad camps: those who claim that depression is the result of neurotransmitter (e.g. serotonin) deficiency, probably of genetic origin, and those who insist depression is a learnt or maladaptive response to extraordinary environmental events (extreme stress, bereavement, childhood rejection and abuse, and others). I suspect that the protagonists in both camps would claim that my background bears out their views. Possible genetic and biochemical causes One of my maternal uncles committed suicide in 1967, and his mother, my maternal grandmother (Mary Leah Morley), committed suicide in 1968, soon after the death of her husband. During the years that I knew her (1944-68), my grandmother appeared to be in a state of prolonged grief for her youngest son (Nigel John Morley) who had died in 1943 in an air-training accident. Her reaction, and her rather withdrawn personality, might plausibly be regarded as signs of chronic depression. There are, however, obstacles to assuming from this that I simply inherit a gene for depression from my grandmother. The first and most obvious objection is that my mother never appeared to suffer from depression (nor, for that matter, did any of my father's family). One could argue that my mother was a carrier of a depressive gene, but was protected from its expression by being female ? having two X chromosomes (one with a depressive and one with a normal gene), whereas I am male, and have an X and a Y chromosome. If so, the depressive gene would have to be sex-linked: I would have an X chromosome with a depressive gene, and a Y chromosome lacking a back-up, non-defective gene. So, however, would all my mother's three brothers, but they did not all suffer from depression! A second objection is that I cannot be sure that my uncle had a history of depression before he committed suicide. A year earlier he had been involved in some financial irregularity at work, and his father had lent him money to resolve this. I lack sufficient information to eliminate the possibility that my uncle committed suicide because of impending financial scandal. To be convinced beyond reasonable doubt that I have inherited genetic depression from my grandmother, I would, among other things, need to be sure that she suffered from depression before 1943, and that she had a secure and stable childhood. (I understand that her parents died when she was very young, and that she was brought up by an older, married sister.) I would probably need evidence that the uncle who committed suicide had a history of depression, despite a reasonable childhood. I have no evidence of depression in his brothers or sister (my mother), but I have heard that my mother was not particularly happy as a child, and I have suspicions ? admittedly tenuous ones ? that the uncle who committed suicide may have felt that his mother cared more about his younger brother (killed in 1943) than about him. (My grandmother did appear to be given to favouritism: I was her favourite grandchild!) It would be rash of me lightly to dismiss a genetic and biochemical origin for my depression, but I feel more evidence is required for it to be really plausible. Possible environmental origins In 1952, at the age of eight, I was sent to boarding school in Oxford (England). This very rapidly created in me an intense and prolonged feeling of loss, panic and emotional pain, which was repeated, in varying degrees, at the beginning of subsequent school terms. I spent ten years at boarding schools, and utterly detested them. I hated communal living and the lack of personal space, and, being a libertarian, I rejected the authoritarian, punitive, right-wing, religious ethos of the two schools concerned. A number of people have testified to their dislike of boarding school life, but by no means everyone who went to boarding school feels the same way. Quite a number of children appeared to adjust fairly speedily to, and then accept, the system. So why was boarding school so traumatic for me? Any environmental explanation of my reaction is likely to make the most sense in terms of events which preceded my being sent to boarding school. Before ? and after ? going to boarding school I was subjected to physical and emotional abuse from my father who, I strongly suspect, resented me from (or soon after) my birth. My mother usually failed to protect me from my father, and often applauded my father's treatment of me. My mother showed no sign of emotional warmth towards me, and occasionally indulged in emotional abuse herself. My main sources of emotional stability were my maternal grandparents, with whom I spent a fair amount of time as a child. They were people I felt safe with, and they offered me something very close to unconditional acceptance.⁴ Childhood abuse as a cause of depression is emphatically denied by Professor Martin Seligman⁵, whereas Dr. Margaret Reinhold, with equal assertiveness, insists that depressive illness is invariably linked with "some form of rejection from parents as a small child".⁶Professor Raymond Cochrane claims that 70 per cent of depressives admitted to hospital have been abused as children, and that victims of child abuse are "at least twice as likely to suffer clinical depression in adulthood as non-victims".⁷ Professor David Karp found that, although some chronic depressives reported child abuse to him, others "insistently made the point" that their depression could not be traced to "an unhappy childhood or poor parenting".⁸ An American authority on suicide, Dr. Edwin Shneidman, suspects ? but does not attempt to demonstrate ? that someone who commits suicide has been "the victim of a vandalized childhood, in which the preadolescent child has been psychologically mugged or sacked, and has had psychological needs, important to that child, trampled on and frustrated by malicious, preoccupied or obtuse adults".⁹ After digesting all this, my opinion, for what it is worth, is that child abuse increases the likelihood of depression, particularly if other factors are involved. In others words, I suspect that many depressives have been abused as children (but not all have); and people who have been abused as children are more likely than the non-abused to suffer from depression (but not all will). This brings me back to my reaction to boarding school. I think it quite possible that paternal rejection and abuse, and at least partial maternal rejection, may not in themselves have been sufficient causes for depression, but they left me peculiarly vulnerable to boarding school life. The coalescence of the two experiences left me with an overwhelming feeling of abandonment. This was by no means delusory, as my parents clearly did not enjoy my company at home, and could afford to pay to have me kept well away from them for most of the year in a manner which was socially acceptable to most of their peers. My emotional pain (sense of abandonment) was therefore repeated and reinforced. It is worth mentioning here that Dr. Reinhold claims that separation from parents sometimes causes "huge and almost unbearable anxiety in very insecure children", especially if "one parent, usually the mother, is hostile to the child".¹⁰ An American authority on suicide, Dr. Edwin Shneidman, suspects ? but does not attempt to demonstrate ? that someone who commits suicide has been "the victim of a vandalized childhood, in which the preadolescent child has been psychologically mugged or sacked, and has had psychological needs, important to that child, trampled on and frustrated by malicious, preoccupied or obtuse adults".⁹ After digesting all this, my opinion, for what it is worth, is that child abuse increases the likelihood of depression, particularly if other factors are involved. In others words, I suspect that many depressives have been abused as children (but not all have); and people who have been abused as children are more likely than the non-abused to suffer from depression (but not all will). This brings me back to my reaction to boarding school. I think it quite possible that paternal rejection and abuse, and at least partial maternal rejection, may not in themselves have been sufficient causes for depression, but they left me peculiarly vulnerable to boarding school life. The coalescence of the two experiences left me with an overwhelming feeling of abandonment. This was by no means delusory, as my parents clearly did not enjoy my company at home, and could afford to pay to have me kept well away from them for most of the year in a manner which was socially acceptable to most of their peers. My emotional pain (sense of abandonment) was therefore repeated and reinforced. It is worth mentioning here that Dr. Reinhold claims that separation from parents sometimes causes "huge and almost unbearable anxiety in very insecure children", especially if "one parent, usually the mother, is hostile to the child".¹⁰ It may also be significant that, soon after starting at boarding school, I developed an eating disorder (resulting in mild obesity) and nail biting. I eventually overcame the nail-biting habit, but a desire to comfort-eat is still and invariably linked with my depression. I clearly do not know if I would be depressed had I not been abused on the one hand, or not sent to boarding school on the other. I can only speculate. I offer the suggestion that, had I been sent to boarding school, but not been rejected and abused beforehand, I would very probably have disliked the school ideology and environment as forcefully as I did (maybe even more so ? I might have rebelled more vociferously and openly), but I would not have found the experience so emotionally exhausting and destructive. Conclusion I cannot eliminate the possibility that my depression may be a biochemical disorder of genetic origin, but I consider the available evidence insufficient for me to hold this view with substantial confidence. My clearly dysfunctional childhood contains a coalescence of factors which would, I think, provide an explanation of my depression sufficient to satisfy protagonists of environmental theories of the origins of depression. Some writers, however, are sceptical of attempts to explain the causes of depression. William Styron claimed: I shall never learn what "caused" my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior and genetics.¹¹ These views were echoed by David Karp, who wrote: "As I see it, efforts to authoritatively uncover the causes of depression are doomed to failure. Depression is simply too complicated for that." ¹² Styron may be right as regards himself, but I venture the impertinent suggestion that in more general terms Styron and Karp may ? at least in part ? be proved wrong, and that, in the fulness of time, some ? maybe not all ? of the critical elements that go into the establishment and maintenance of depression may be teased out and sufficiently understood. Unipolar depression may eventually turn out to be a cluster or complex of mood disorders with superficially similar symptoms but different aetiologies. Keats, ever the romantic poet, begrudgingly conceded that: Philosophy will clip an Angel's wings, Conquer all mysteries by rule and line, Empty the haunted air, and gnomed mine ? Unweave a rainbow . . .¹³ Philosophy in Keats's sense, roughly what we call science today, may not be able to conquer all mysteries, but I see no reason why it should not be brought to bear and into focus on depression. Depression is not some magical curse beyond the powers and ken of mere mortals. It may be complex and tricky to investigate, but this does not mean we should abase ourselves and accept it as unfathomable. Depression is a peculiarly disabling form of hell-on-earth in the mind. And this metaphor reminds me of a remark made by Thomas Paine: "Tyranny, like hell, is not easily conquered. "¹⁴ Tyranny has, time after time, held many in subjection and fear, but those who are not completely helpless in its grasp have a duty to understand it and attempt to overthrow it. Many have succeeded, despite the casualties. I suspect that a similar moral consideration holds for the hell of depression. Notes and references Karp, David A. Speaking of Sadness: depression, disconnection, and the meanings of illness. New York, 1996: pp. 14, 79, 80, 171. (I am impressed with Karp's ideas about "connectedness" and mental health.) Kleinman, A. Rethinking Psychiatry. New York, 1988: p. 73 (quoted by Karp: p. 171). Nuland, S. "The Pill of Pills." New York Review of Books, 9 June 1994: p.6 (quoted by Karp: p208, n2) My maternal grandfather described my father as "the most unnatural father I've ever known". Seligman, Martin E. P. What You Can Change And What You Can't. Sydney, 1994: pp. 230 ? 232. ("If you want to blame your parents for your own adult problems, you are entitled to blame the genes they gave you, but you are not entitled . . . to blame the way they treated you" ? p. 232. This strikes me more as right-wing rhetoric than as serious psychological insight. ? N.S.) Reinhold, Margaret. How To Survive In Spite of Your Parents (2nd edn.). London, 1991: p. 194. Cochrane, Raymond. "Women and Madness." Ethical Record (London), June 1995: pp. 12 ? 17. Karp: p. 35. Shneidman, Edwin S. The Suicidal Mind. New York, 1996: pp. 163 ? 164. Reinhold: p. 140. Styron, William. Darkness Visible: a memoir of madness. London, 1991: p. 38. Karp: p. 14. Keats, John. Lamia, 1820: part 2, lines 234 ? 237. Paine, Thomas. "The American Crisis" [part 1]. Pennsylvania Journal, 23 Dec. 1776. - Nigel H. Sinnott Originally written 5th June 1998 Retyped, revised and list of referances added, 21-23 August 1999
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