It’s Saturday, but I’m not in the park, and it’s definitely not the 4^th of July.  It’s actually the 10^th of September.  Oh, and this is 2022 AD (or CE).

I don’t think yesterday’s post was very well-received.  It was probably too dreary for most readers.  This is often the case when a relatively healthy person encounters the thoughts of one who suffers from depression.

I remember it being said in medical school that depression is, in a certain sense, contagious.  That’s not meant literally, of course, but it makes the point that, when interacting with someone who is depressed, one tends to feel one’s own mood pulled down.  In fact, it can sometimes be a diagnostic aid; even if the person to whom you’re speaking isn’t openly declaring depression, if you find yourself feeling depressed yourself after speaking with them*, they may be depressed in some clinically significant sense.

So, if people feel down after reading my writing, I apologize.  I don’t mean to bring anyone else into the fold, so to speak, or worsen the mental situation of someone who is already struggling.  There is a very small proportion of people in the world I think could be improved—from a societal standpoint anyway—by being depressed.

But it is true that, when I’ve read popular works about depression, and about the experience of depression, I don’t tend to get a strong sense of what the writers were feeling when depressed.  Most of the time, the works are written well after the particular bout of depression, and it can be hard to recreate the moods and thoughts that the condition engenders when one is not mired in it.  Just as one who is depressed can feel that the depression has always existed and always will, when one is out of depression it can (apparently) be hard to reenter the worldview that it entails.

Some of this is probably defensive.  Who, having successfully gotten past depression, would want to relive the experience?  I’d hazard a guess that the answer is “no one”.

I remember a time when, briefly, my (now-ex) wife went through a period of reactive depression near the end of a pregnancy, and shortly after it.  This is not an uncommon occurrence, though thankfully most women are spared.  Anyway, at the time, she said that she would never get angry with me when I was depressed again, that she understood now how terrible it was and how difficult, and how it’s not simply a matter of attitude or choice to feel it or not.  I’m quite sure that she meant it with all her heart.  Thankfully, her experience was short-lived, it responded to treatment and time rather rapidly, and she returned to her usual, extremely formidable and impressive self.  But she also lost at least some of her sense of empathy for the depression, unfortunately.

That’s okay.  I like her better when she’s healthy and joyful and fierce.

My personality—and probably my undiagnosed ASD, which contributes to the fact that I can’t convey emotion well, and have a hard time seeking or accepting emotional support—and the sheer persistence of the problem make me hard to bear for anyone, for very long, I think.  It makes me hard to bear even for me.  The advent of my chronic pain, and its affect on my ability to work well**, contributed to that difficulty mightily.

But maybe someone someday will find my musings when I’m depressed useful for at least getting into the mindset of someone suffering from depression.  Maybe not.  I think my thoughts are far from typical even for the depressed, though my tone is probably pretty “normal” for someone with longstanding chronic depression.  Maybe my words will be useful for people studying depression in adults with undiagnosed autism spectrum disorder, which I’m almost certain I have, having studied it now for a while since the possibility first revealed itself.

As a bit of a tangent, it’s rather frustrating to me that I recently saw a very good video that discussed the fact that it seems depression was never caused directly by a deficiency of serotonin, a so-called chemical imbalance.  The maker of this video clearly knows it was never this simple, but there is a popular notion that such a thing is the case, and that has always irritated me.  The brain is not some stew made of a big collection of ingredients cooking together in the skull, which doesn’t come out well if a particular ingredient is missing or is present in too-great quantities.

The brain is a huge and unimaginably complex information-processing system, immensely parallel in its structure, with a staggering amount of feedback and crossover between subunits of the system; even each individual neuron of the hundred billion-ish present is more complicated than one can readily grasp.  It has more in common with a vast weather pattern of sorts, influenced by both local and global environmental factors but also internally influenced by other parts of itself, so that some patterns become self-sustaining and destructive, like a hurricane in the mind that feeds and strengthens itself when conditions are right, and which cannot easily just be broken once it has formed.

So, serotonin was never some mere quantity that was deficient, like iron deficiency leading to anemia.  The nerve cells that signal using serotonin manufacture that neurotransmitter themselves.  It’s simply that part of depression is instantiated (in many) in the underactivity or poor responsiveness of certain parts of the brain that signal via serotonin, and increasing the activity in those regions can sometimes decrease the tendency of the system as a whole to get into the self-reinforcing state that depression is.

It’s rather like the notion that we could, for instance, decrease the likelihood of hurricanes by decreasing the amount of moisture in the local atmosphere.  It’s not that hurricanes are simply caused by high humidity, but just that the high humidity contributes to their production, and decreasing it could, in principle, decrease the likelihood of hurricane formation, or at least decrease their strength and thus their destructive effects.

I don’t want to push the metaphor too far, since the brain is obviously different from weather—for one thing, it is far more meticulous, precise, and in some senses (but not all) more complex and constrained.  There are roughly a quadrillion synapses in a typical brain, but it’s not just the number that really makes the difference, anymore than one can just randomly wire up a hundred billion transistors and make a supercomputer.  Weather is a bit more free form, though it involves a great many more atoms interacting than any one brain.  But analogies can point out similarities at different levels of various systems, and more usefully, they can help try to convey something of the sense, if not the specifics, of an idea.

But depression is a dangerous storm of the mind indeed; it’s frequently a terminal illness.  And one cannot simply slap a hurricane and yell “Snap out of it!” and expect it to have any effect at all.  We understand the nature of autism spectrum disorders even more poorly than we understand mood disorders—trust me, I’ve looked for good neuroscientific, neuroanatomical, structural, and functional investigations of the disorders without much satisfaction so far.  The interaction of mood disorders with ASDs is probably just going to make things still more complicated.  Unfortunately, the only computer with the processing power adequate to modeling the processes so far is reality itself, but we can’t just lift up the hood or look at the source code or whatever metaphor you want to use for that.  We have to figure it out as it goes along.

For that reason, it may not be such a bad thing for me to share my thoughts, however dismal they are and however gloomy and dispirited they may make my readers feel, when I’m in the throes of my malfunctions.  Think of them as indicator lights, or pressure gauges, or even a Windows™ Control Panel readout from the system.  At least they might give some insight into what the system is doing at that time, or what state it’s in.  It won’t necessarily allow one to prevent total system crash; some systems just have too many faults and bugs to keep running.  But maybe at least from an eventual mortality and morbidity conference point of view, they might be useful.

It would be nice to be useful.

*Assuming you weren’t already.

**As an aside, when I was in practice, I also found that I had great difficulty charting using Dictaphones or their equivalents.  This is partly because it was not at all how I charted during training, but I suspect it’s more related to my ASD.  I can write extemporaneously quite well, or at least quite handily, as these blog posts demonstrate, but speaking aloud as a matter of keeping records such as “SOAP notes” is very uncomfortable and even feels physically blocked at times.  Between that and my chronic pain, I had more than one occasion of getting far behind on charting, which caused frustration for my colleagues and my spouse alike.  I’m not lazy.  Not by a long shot.  I think it really was mainly an Asperger’s thing, but at the time I just hated myself for being so weak; I was motivated to do it, but just couldn’t seem to carry it off without it feeling like torture.