Best of, cont'd: Depression, Obesity and the Lizard Brain

From 11/5/06:


Yesterday was a bad day. I had at least three weepy/weeping spells, two of them on the cliff across from the sea lions that made for a passable poem. What really made me cry was the idea of God and an attempt at prayer. I have such feelings of rejection from the Almighty, and the idea of approaching him fills me with such a sense of unworthiness I can’t begin to describe it. I feel like a bug under glass, but smaller. It’s a feeling of primal abandonment which likely goes back to infant bonding issues with my mother, and is subsequently projected on that great screen, God. It’s a grief over a vacuum that persists from my adolescence and young adulthood. Back then I was such a fanatic I felt I had to have a message from God to do nearly anything of consequence.

For some strange reason I received the impression at the age of 17 that God wanted me to become a doctor. When I didn’t get in to medical school the first year with a 4.0 from UCLA, I felt betrayed—“Look, God, I’ve done all this work for you getting through college, working three jobs and the rest, and then you thwart the ambition you gave me?” I later realized this was the sin of presumption. But just when being a doctor began to make sense in the third year of my psychiatry residency, I fell into a severe depression that caused me to drop out. There went my hope to make something of being a doctor, something I could bear, as psychiatry dovetailed with the humanities. After this debacle, my primitive thinking was: “I tried to do God’s will, but he screwed me.” How could I be so special that God would screw me? All this demonstrates the narcissism of the depressive. When an infant does not have enough human bonding, he makes up people in his head, and his life revolves around his head instead of society. To the degree you were isolated in your earliest years, to that degree will your head fill with chatter as a substitute.

I know that my feelings toward God are opposed to Christian theology, but I can’t help how I feel. If I have a relationship with God it must be infantile on my part. Especially in depressions, prayer only makes me sadder. Yes, I did pray for myself yesterday. There’s no harm in that. But any emotional wholeness from a perceived contact with God is something I’ve never experienced. I wish for healing, of course, but at my age I settle for acceptance. This is how I’m built. My emotional wounds go way back to infancy. I project them on authority figures, even an authority figure presumably on my side.

Mental illness lends itself to hyperreligiosity and religious psychoses, in which I was an avid participant, though to be fair, I didn’t know of the illness that possessed me until I was 30.

One more thing: When I am well I like to say, “It is not I who have a relationship with God, it is he who has a relationship with me.” Let the burden be on the Almighty. He can take it, one assumes.

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From 11/7/06:


In depression minor issues become major ones and long-term problems become immediate crises. When I crossed the border from Mexico in February of this year I weighed 245, which made me technically overweight but not obese. In no time at all I blossomed into my present weight of 270, the heaviest I’ve ever been in my life. When I get the courage to look at myself in the mirror after a shower, my appearance gives me cognitive dissonance: I can’t believe I’m that fat. My belly protrudes, the definition in my arm muscles is barely discernible, and the new padding of the groin makes some items look smaller.

When I talked about this with my pain management doctor in April, while deeply depressed, she said, wisely: “That’s the last thing you need to worry about now.” Indeed. But that doesn’t make the depressive mindset let go of the issue. In depression we play with our defects like cats with dead mice. We pick at them like scabs. We revolve on a carousel from one defect to another. Here’s a list of some of my specific self-accusations in depression:

1) You’ve never done anything in your life.

2) You’re so fat how could anyone love you?

3) You’ve done nothing about retirement, do you want to be penniless?

4) You don’t deserve disability; you’re a mooching fraud.

5) Why don’t you go to the gym? Why don’t you swim?

6) You drink too much and it’s ruining your brain. You’ve permanently damaged your brain, especially with all the medications you take.

7) You’re a wimp to take so many medications. Why not just flush them and tough it out?

8) You’ve blasphemed against God and are beyond salvation.

9) Your children don’t care about you because they don’t call.

10) You call yourself a poet but you’re a fraud. You have three unpublished manuscripts that nobody wants. You’re afraid to get out there and do the real work of competition because secretly you know you’re not good enough. Poetry is a thin excuse to keep you occupied in your no-account life.

I could probably list a hundred of these and it would not be enough. When self turns against self it’s as if a stick were whittling itself-- whittling, belittling. All this is what I call “the chatter of the lizard brain.”

In depression the primary problem is mood. The depressive mood arises from primitive brain areas we share with reptiles. Thus our frontal cortex, the seat of thought, is directed by the lizard brain to spew all this self-denigrating chatter, because if only our accusations were true it would explain our depression and satisfy our need for causality.

In other words, in depression, the lizard brain is the horse and the frontal cortex is the cart. You can’t fight your lizard brain. It’s too primitive. Treatment requires medication, supportive therapy, and time, and if this does not suffice, possibly electroconvulsive therapy.

Some depressions are not just biochemically based, but mixed with psychology. In these cases cognitive-behavioral therapy can be helpful. But to a pure biochemical depressive, like a bipolar I, talk therapy can actually worsen the symptoms. After all, you have a new person to disappoint: your therapist. I’ve never had strict cognitive-behavioral therapy, but analytic therapy and ego-centered therapy have definitely made me worse. Anything beyond supportive therapy I find damaging. A biochemical depression is probably the worst time to try to make changes in your personality.

Back to obesity. I’m on medications (antipsychotics, lithium) that cause weight gain and fluid retention. The antipsychotic also takes all my stamina away, so I gasp going up stairs. I’ve found it terribly hard to exercise on my present medication regimen.

Like all fat people, I hope someday to be thin again, as I have been the majority of my life (until my early 40’s after failed back surgery). But as my doctor advised, it’s not something I should worry about now. For now I do two things: 1) try to accept that I’m sick; 2) try to stay busy. While writing this I’m doing the wash, for instance. Afterwards I have the kitchen to clean up. Then I want to start writing my book review, and later, perhaps, work more on my html course. That I can do these things shows that my depression is not as deep as it could be. Indeed, I could pass for normal.


At 3 kilorats,

Craig Erick