[Excerpt from book Diaries of My Older Sister]
II: What Creates Our Mind’s Stories
In this section, we cover the myriad of factors that may be the origin of our mind’s stories and obsessive rumination. We may need to dig deeper into the intersection of neuroscience, biology, psychology, cultural influences, childhood experiences and more.
Chapter 7: Our Brain (Part I)
The human brain is an incredible tool for performing all kinds of complex activities, such as planning for the future, remembering the past, playing a musical instrument, painting, dancing, catching a football in the touchdown zone and a million more. But human evolution seems to have failed in preparing us for when our brain starts malfunctioning from all this complexity, for example, in the form of ruminating or obsessive thinking. Rumination may essentially be a disease of the overactive mind. In this case, our most advanced asset, the brain, is harming us instead of helping us in our daily lives.
Studies show that genes and family history are strong predictors of depression. Some of us may be born with a genetic predisposition that puts us at a higher risk for major depression later in life. There’s a twofold to threefold increase in lifetime risk of developing major depression among first-degree relatives or anyone with a sibling or parent with depression. I can attest to this through my own family history; not only did my sister and I experience major depression, but so did many relatives from both my mother’s and father’s side of the family. We cannot deny the significance of genetic “cards we are dealt” at birth when it comes to the risk of developing depression.
However, that doesn’t mean that we should label depression as a result of some genetic defect or a random malfunctioning of the brain that we have no control over. My belief is that a large percentage of individuals who experience major depression or suicidal ideation in recent times are not born with a fundamental defect in their neurochemistry that causes depression with no apparent reason at all. Granted, this is difficult to prove because depression is another case of the “Nature versus Nurture,” “Chicken or the egg” debate. How can we be sure if depression is resulting from the direct experiences of a person’s life or from their fixed genetic destiny? Was the person’s brain impacted by some external event that ended up causing depression or was the person innately born with the risk of developing depression? Although more conclusive studies are needed, it may be safe to assume that there’s a complex interdependence between genes and environment. There may be a specific subcategory of depression where genes play a part in making us more susceptible to depression, and then the actual experiences during a person’s life may trigger that susceptibility, causing symptoms of major depression to surface as a result.
Then again, not all cases of depression or suicidal ideation may follow this pattern. Even if the surface-level symptoms are the same across two different patients of depression (such as a loss of interest in daily activities, a change in eating or sleeping patterns, fatigue, a lack of motivation, difficulty concentrating, etc.), a clear distinction has to be made between Patient A who may have recently suffered the loss of her entire family in a car accident, and Patient B who has no history of trauma or recent loss but instead has been suffering from years of obsessive rumination. It may not be far-fetched to say that a major portion of depression in recent times fits into this latter category. Some of us might have always carried the “dormant potential” for depression in our lives, and that potential may become awakened as a result of some stressful life event that we face. This is also why I believe that people who suffer from depression should not be judged as “weak” or “deficient.” There may be a complicated mix of factors at play that may or may not trigger a person to fall into a depressed state that has nothing to do with the person’s mental strength or fortitude. I think these reasons are what makes depression so confusing and difficult to understand or prevent. The actual trigger of depression for one group of people might be due to one similar set of reasons, but for some people, it might due to completely different, unrelated reasons.
For the subset of depression that I referred to as the “dormant potential” category, in which I include myself and Katie, it might be possible that some of us are naturally born with an abnormally high sensitivity to certain triggers that could lead to an overactivity of the brain. Some people simply knock this off as an “over-sensitive personality”; I personally compare this condition to allergies. Like a person whose physical immune system reacts hyper-sensitively to pollen or other allergens, a person born with a rumination-prone brain might be suffering from an over-sensitive mental reaction system that manifests itself in the form of obsessive, repetitive thoughts in response to stressful emotions, social situations or life events. And those stressful thought patterns may sound very much like the different examples we covered in the first section: self-loathing, regret, comparison, catastrophizing, self-judgment, labeling and more.
I would like to mention that I detest the commonly used “chemical imbalance in the brain” explanation of depression. Yes, there may be a neurochemical imbalance in people who are showing symptoms of depression, but the real question is, why did that imbalance arise in the first place? Because depending on the particular individual, the answer to that question may vary greatly even if the symptom cluster and affected neurotransmitter levels might look similar. And unless we answer that question of why, we will always end up treating the brain as a black box that we are unable to crack, while resorting to surface-level solutions that treat the symptoms alone.
Like we discussed before, the imbalance might have been caused by a laundry list of different reasons, perhaps something biological or over time by some other external factors. A doctor saying that a person is depressed because of a chemical imbalance in the brain is almost like a car mechanic telling you that your car is broken because there is something wrong with the engine, and then not telling you anything else. Okay, can anybody tell us how and why the car engine ended up that way so that we can prevent the car from breaking down again, so that we are not at the complete mercy of this random disaster? If the answer is no, then it puts more responsibility back on us. We don’t have to give up all our power and potential as individuals to try to understand what might have gone wrong with our own brains. And then we can work together to find the why instead of jumping at band-aid solutions.
Articles published by the Harvard Health Publishing of the Harvard Medical School echo the sentiments that “the onset of depression is more complex than a brain chemical imbalance” and “[that] figure of speech doesn’t capture how complex the disease is.” Research suggests that rather, “there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. […] Several of these forces interact to bring on depression.”  So if depression turns out to be much more complex than just a biological complication, like many of us suspect, how can we do a better job of discovering the true causes behind the curtain? Is the existing system that heavily relies on medication going to help us discover the root causes of this issue, or are we just sweeping much bigger issues under the rug?
I would like to emphasize that I do not claim to understand all the different subsets or variations of depression. I assume that this is a very specific type of depression that I’ve been focusing on throughout this book, the type that Katie and I experienced. For example, all the mindfulness tips or cognitive behavioral tips in the world may not be able to help a person who was born with a severe neurochemical imbalance that only medication can address or has experienced a physical trauma to the brain that’s dramatically altered his physiology. Every individual’s explanation for depression may be different in that way, and therefore, we cannot rely on a single, static answer for every episode of depression (although general patterns may exist depending on the cause). That is why Dr. Daniel Amen, a renowned author of the book Change Your Brain, Change Your Life, talks about the importance of using visual neuroimaging techniques and brain scans to see and pinpoint what kind of electrical activity might be actually occurring inside a depressed person’s brain instead of trying to guess their psychological condition through conversational evaluations. He makes the valid point that undiagnosed brain injuries or physiological issues inside the brain can lead to symptoms of mental illnesses, and using these visual means can help us rule out “biological” factors that might be causing psychological problems, and recognize general patterns within the brain. Generally speaking, any advanced technology that allows us to unravel the black box of the human brain by giving us additional qualitative or quantitative data points may help us significantly improve our understanding and diagnosis of depression.
All in all, I strongly disagree with the school of thought that it is some “faulty gene” that causes depression or the fault of some weak character. Instead, the answer may be far more complicated. For example, studies indicate a possible correlation between high creativity (as well as IQ) and elevated risk for mood disorders and depression, hinting that the brain’s capacity for depression and creativity may be linked. This is not a surprising hypothesis, considering that some of the brilliant minds in history, such as Vincent Van Gogh, John Nash, Abraham Lincoln, Beethoven, Kafka and Freud, were presumed to have suffered from mental illnesses. My belief (shared by many others) is that the same parts of the brain that cause excessive rumination are also closely linked to the areas responsible for creativity, memory, empathy, focus and problem-solving. And it may be up to us to channel our brain’s focus toward the right direction so that we are able to use it for constructive creativity and empathy rather than self-destructive rumination. Yes, the downside of a depression-prone brain is a high sensitivity to stressful stimuli that can tip you into mental suffering. However, we can learn to embrace the sensitivities of our brain totally, and understand how to coexist with them.