It’s an indisputable fact that everyone dies eventually. But knowing it and directly experiencing it are two different things; you can “know” that it hurts to get shot, but this doesn’t mean you know how getting shot feels. Similarly, we know that everyone close to us will expire eventually, but it’s still an emotional gut punch when it happens. We’ve seen how the brain has evolved to form strong and lasting relationships with people, but the down side is how much it hurts when those relationships come to an end. And there’s no “end” more final than when someone dies.
As bad as this is, there’s an extra dose of awfulness when a loved one ends their own life. How and why someone ends up believing suicide is the only viable option is impossible for us to know for certain, but whatever the reasoning it’s devastating to those left behind. These people are the ones the rest of us get to see. As a result, it’s understandable why people often form negative opinions of the deceased—they might have successfully ended their own suffering, but they’ve caused it in many others.
As we saw in Chapter 7, the brain performs serious mental gymnastics to avoid feeling sorry for victims, and another possible manifestation of this is the labeling of those who end their own lives as “selfish.” It’s a bitterly ironic coincidence that one of the most common factors leading to suicide is clinical depression, as people with it are also regularly labeled as “selfish,” “lazy” or with other disparaging adjectives. This may be the brain’s egocentric self-defence kicking in again; acknowledging a mood disorder so severe that ending it all is an acceptable solution technically means acknowledging, at some level, that it might happen to you. An unpleasant thought. But if someone’s just self-indulgent or callously selfish, that’s their problem. It won’t happen to you, and thus you get to feel better about yourself.
That’s one explanation. Another is that some people are just ignorant jerks.
Labeling those with depression and/or those who die by suicide as selfish is a bleakly common occurrence, most prominently seen when applied to someone even slightly famous. The sad passing of Robin Williams, international superstar and beloved actor and comedian, provides the most obvious recent example.
Amid the glowing and tearful tributes, the media and Internet were still awash with comments like, “Doing that to your family is just selfish,” or, “To commit suicide when you’ve got so much going for you is pure selfishness,” and so on. These comments weren’t restricted to anonymous online types; such sentiments came from high-profile celebrities and numerous news networks not exactly known for compassion, such as Fox News.
If you are someone who has expressed these views or similar, sorry—but you’re wrong. Quirks of the brain’s workings may explain part of it, but ignorance and misinformation can’t be ignored. Granted, our brains don’t like uncertainty and unpleasantness, but most mental disorders provide ample amounts of both. Depression is a genuine and serious problem that deserves empathy and respect, not dismissal and scorn.
Depression manifests in many different ways. It’s a mood disorder, so mood is affected, but how it’s affected varies. Some end up with unshakeable despair; others experience intense anxiety, resulting in feelings of impending doom and alarm. Other people have no mood to speak of, just feel empty and emotionless regardless of what’s happening. Some (mostly men) become constantly angry and restless.
This is part of why it’s proven difficult to establish an underlying cause of depression. For some time, the most widespread theory was the monoamine hypothesis.3 Many neurotransmitters used by the brain are types of monoamines, and people with depression seem to have reduced levels of them. This affects the brain’s activity, in a manner that may lead to depression. Most well-known antidepressants increase the availability of monoamines in the brain. The currently most widely used antidepressants are selective serotonin reuptake inhibitors (SSRI). Serotonin (a monoamine) is a neurotransmitter involved in processing anxiety, mood, sleep and so on. It’s also believed to help regulate other neurotransmitter systems, so altering its levels could have a “knock-on” effect. SSRIs work by stopping the removal of serotonin from synapses after it’s released, increasing overall levels. Other antidepressants do similar things with monoamines such as dopamine or noradrenaline.
However, the monoamine hypothesis is meeting increasing criticism. It doesn’t really explain what’s happening; it’s like restoring an old painting and saying it “needs more green”; that might well be the case, but it’s not specific enough to tell you what you actually need to do.
Also, SSRIs raise serotonin levels immediately, but beneficial effects take weeks to be felt. Exactly why this is has yet to be established (although there are theories, as we’ll see), but it’s like filling your car’s empty tank with gas and it working again only a month later; “no fuel” may have been a problem, but it’s clearly not the only problem. Add to this the lack of evidence showing a specific monoamine system that’s impaired in depression, and that some effective antidepressants don’t interact with monoamines at all, and clearly there’s more to depression than a simple chemical imbalance.
Other possibilities abound. Sleep and depression also seem interlinked4—serotonin is a key neurotransmitter in regulating circadian rhythms, and depression causes disturbed sleep patterns. The first chapter showed sleep disruption is problematic; maybe depression is another consequence?
The anterior cingulate cortex has also been implicated in depression.5 It’s a part of the frontal lobe that seems to have many functions, from monitoring heart rate to anticipating reward, decision-making, empathy, controlling impulses and so on. It’s essentially a cerebral Swiss Army knife. It’s also been shown to be more active in depressed patients. One explanation is it’s responsible for cognitive experience of suffering. If it is responsible for anticipation of reward then it makes sense that it would be involved in perceiving pleasure or, more pertinently, a complete lack thereof.