I’m thrilled to have my memoir, Crash, reviewed on the Mad in America Blog by the fine reporter, writer, and storyteller Amy Biancolli.
Crash: A Memoir of Overmedication and Recovery by Ann Bracken (Charing Cross Press)
“Have you ever done everything a doctor told you, only to find yourself sicker than before you began treatment?”
So asks Bracken in the first paragraph of her memoir, a devastatingly honest, ultimately hopeful account of personal and family anguish marked by crashes both literal and figurative. She zips back and forth in time, describing both her mother’s decades in the system and her own long arc of anguish and recovery—and touching on her daughter’s story as well.
The multigenerational saga begins in 1959, with her mother’s hospitalization for depression, and cycles through a decades-long ordeal that led to 37 ECT sessions (with minimal anesthesia) and psych drug upon psych drug upon psych drug. As a kid, Bracken had questions (where’s mom? why are the grownups whispering?); as an adult, she found answers in 30 years’ worth of medical documents meticulously preserved by her father.
The revelations were many. A full list of Helen Dempsey’s meds in the appendix includes barbiturates. Amphetamines. Tranquilizers. Antidepressants. The benzodiazepine Dalmane. The anticonvulsant Dilantin. Beyond all those medications and ECT, Dempsey also received some talk therapy—“but I’m not sure how helpful it was for my mother to talk with her male psychiatrists,” Bracken writes, “especially given the medical establishment and cultural attitudes toward women at the time.”
You can read the rest of Amy’s review here, and check out the other books featured this month as well.
You may have seen my blog post announcing my new book, Crash: A Memoir of Overmedication and Healing. Now you’d like to know what the book is about before you consider reading it. Here are a few details:
Crash is about a little girl whose mother disappeared, and no one would tell her where she’d gone.
Ann’s first day of school
Crash is about a woman who did everything her doctors told her, and yet she never got well.
Crash is about the woman’s daughter who vowed she’d never be like her mother only to find herself trapped in a similar cycle of overmedication, numerous doctors, and intractable physical and emotional pain.
Crash is a story of one woman’s determination and optimism when it seemed like all of her traditional remedies and supports had failed her.
When all of the other remedies had failed, I looked for another explanation for my pain.
Because I have a deep belief in many forms of healing, I began to embrace a similar path to the one that mythologist and author Michale Meade advocates. Here’s what he as to say about facing your darkness (depression and pain) and healing:
“Wholeness and unity are what all healing seeks, but a genuine transformation requires a descent to the underworld of the soul. There we find that our woundedness is not a static state, but rather a dynamic condition through which we incarnate more fully. In going through the wound the greater self within us is revealed.”
Register here for the book launch on October 13th, 7pm ET on Zoom. Hope to see you there!
I’m pleased to announce that my memoir, Crash,is available for purchase on the following platforms: Bookshop, Amazon, and Barnes & Noble, & Ebook Versions, as well as here on my website. Putting this book together was like assembling a giant jigsaw puzzle—fitting experiences together with research helped me to develop a deeper understanding of what happened to me when I sought help for a severe depression and chronic migraine. Contrary to many of the upbeat and happy images you see in the commercials for antidepressants, my journey was one of trying one drug after another, yet never finding relief. The research I did for the book revealed that I was far from alone in that experience–only about 15% of the people who take antidepressants experience improvement greater than what’s accounted for beyond the placebo effect.
Book cover
Part of the reason I’m so interested in the topic is because I grew up in a home with a mother who suffered from chronic, unremitting depression for nearly 40 years. Mom did everything the doctors told her, yet she could never escape the heavy pall of darkness. I kept wondering: Why could I recover and Mom couldn’t? I found the answers buried in an old folder in my sister’s attic. Crash braids my story with my mother’s to explore her journey using Dad’s detailed records from 30 years of her care, interwoven with research and vignettes from my past.
All through my illnesses, “I’ll never be like my mother,” was my fervent mantra. I vowed to escape her fate despite year after year of unsuccessful treatments with numerous drugs and many rounds of electroconvulsive therapy. Crash is the story of what I learned about treating depression and chronic pain and the steps I took to finally recover. My memoir serves as a missive to women struggling to heal, carve their own path, and demand better care.
Here’s what some noted people in the field of psychiatric reform had to say about Crash:
“Ann Bracken’s evocative memoir powerfully tells of how psychiatry’s diagnoses and treatments can lead to loss, illness, and despair, and how escaping from that paradigm of care can be a starting point for a full and robust recovery.”
~Robert Whitaker, Author of Anatomy of an Epidemic
“Ann Bracken artfully braids her path out of chronic pain and major depression, while questioning the system designed to help her, and reaching back into her mother’s history to find a way to help her as well. Bracken gives us permission to ask questions about our current mental health treatment; read and educate ourselves on the risks, benefits, and alternatives to psychiatry’s status quo; and above all, not to quit until we find our own path to a healed life.”
~Angela Peacock, MSW, mental health advocate and featured in award-winning documentary, Medicating Normal
“A fascinating memoir of two generations of medical and psychiatric mismanagement and suffering, and how one brave woman figured out what was happening and successfully took control of her health and well being… and prevented a third generation from following the same path.”
~Stuart Shipko, MD, author of Surviving Panic Disorder and Xanax Withdrawal
In a few days, I’ll begin readings from my third poetry collection Once You’re Inside: Poems Exploring Incarceration. I’ve been thinking a lot about the trajectory of my three books and how they each reveal an aspect of something I care deeply about.
The Altar of Innocence, my first collection, deals with my experiences growing up in a home where my mother struggled with depression and alcohol abuse and then my own journey through depression and chronic pain which opened the portal to leaving my abusive husband. My second collection, No Barking in the Hallways: Poems from the Classroom, takes a deep-dive into the lives of teachers and children who are navigating the pitfalls and whirlpools of the current education system. Shorthand for themes: abuse, emotional distress, and education challenges.
Those themes of abuse, emotional distress, and education challenges coalesce in my third book Once You’re Inside: Poems Exploring Incarceration. Here’s what one of the counselors told me about the general state of the current prison population:
“Most incarcerated people have a number of factors in common—abuse, for one. Sexual, verbal, physical, emotional— add in hearty helpings of neglect, abandonment, illiteracy, and dropping out of school.” Suffering inflicted at the hands of caregivers. Pain and rage stored deep inside, erupting in every direction. “A lot of folks struggle mightily over how to live in the world without earning money illegally. Some report anxiety attacks thinking about how they can be in the world without pimping and selling drugs.”
So there’s the connection. I guess you could say I recognized the pain that the incarcerated people carry because I’ve been around that kind of pain since I was a child. All three books are my attempt to tell the stories that need to be told. The depressed mother who can’t cope. The child who’s frightened because she doesn’t know how to help her mother. The student who’s very bright, but struggles to learn to read. The teen who’s despondent because of all the pain he lives with. The incarcerated person who feels abandoned.
There are many ways to bring about change in society–many pressure points, as I like to call them–legislation, demonstrations, articles, plays, novels, and poems. Most especially poems because they carry to weight of powerful emotions and stories in concentrated form.
Here’s the title poem. I hope you’ll find the poems in the collection both moving and informative. Maybe you’ll even be moved to find a pressure point where you can take some action.
Hope on Hold
Once you’re inside
ignore the wreckage of time,
the lined faces of men gray with age,
the once-cagey 16-year-old,
the disorganized shuffle of papers, of rules, of feet.
The torpor of boredom
thick as dreams of honey on toast.
Once you’re inside every smile is suspect,
every glance a risk.
Even hope tucks into a corner
when these doors groan closed.
Join me for my launch reading on October 6th at 7pm.
It’s my hope that by sharing stories about the men and women I met in prison, I can help to create a dialog among my readers to reimagine how we treat people who break the law. After working in the prisons for awhile, I could see that what the founder of the Equal Justice Initiative Bryan Stevenson says is well worth all of us remembering:
“Each of us is more than the worst thing we’ve ever done.”
In honor of National Poetry Month, I’m posting a couple of columns that can help you see often-neglected uses for poetry. Besides its great beauty and ability to capture emotions, poetry can be a useful tool in many aspects of life–like dealing with depression.
How can poetry help depression? Aren’t medication and therapy the best ways to treat the illness? My story may surprise you.
When I suffered from depression in the early 1990s, Prozac was the new “miracle drug.” Along with this so-called “miracle drug came a physical explanation of causation: that depression is caused by a chemical imbalance in the brain. This thesis is still widely promulgated, though much research is coming to light that disputes and even negates this biomedical explanation for the darkness that is so prevalent in our modern world. More information on the research side can be found at the website Mad in America, curated by science reporter Robert Whitaker. As part of Whitaker’s work to educate the public, he invites doctors, psychologists, counselors, and patients from all over the world to share research, essays, and personal experiences on the issues of depression and its treatment.
Even in the 1990s when I struggled to climb out of depression and tried numerous medications for several years with no results, the idea that the chemicals in my brain were out of whack did not provide a solid answer. Instead, I pursued a more metaphysical explanation for the questions that haunted me: “Why am I depressed?” and “What longings are unfulfilled?”
And that’s what led me to poetry.
One of the most valuable resources I found to aid in making sense of the gifts of depression is poet David Whyte’s 1992 CD entitled The Poetry of Self Compassion. Whyte’s recitation of Mary Oliver’s “The Journey” confirmed my feelings of being on a perilous but necessary journey through darkness and confusion. And I was deeply confused by the all-encompassing darkness that I was experiencing. But once I heard Whyte recite “The Journey,” I knew that someone understood a piece of what I was experiencing. And that the way I was feeling had nothing to do with messed up brain chemistry. My depression had everything to do with self-discovery and taking charge of my life.
The Journey
One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice–though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”each voice cried.
But you didn’t stop.You knew what you had to do,
though the wind pried
with its stiff fingersat the very foundations,
though their melancholy
was terrible.It was already lateenough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.
~Mary OliverI remember listening to the poem over and over–as if rolling around a mysterious new food in my mouth, trying to figure out what it tasted like that was familiar. What was it I was determined to do? What else besides raise my children, serve my community, and be a good wife? I just knew there was more. And Mary Oliver’s words gave me the courage to make the journey that would save my life.
The answer was slow in coming, but I gradually began to realize that my struggles with depression and a migraine headache exacerbated my ex-husband’s verbal abuse to the point where I could finally see it. Depression and chronic pain became my crucible for change and my pathway to a new life. Poetry became my way to unlock the profound secrets that illness led me to discover. Poetry helped me to have compassion for my journey and for all the mistakes I had made along the way.
Whyte ends on a note of great compassion in the poem “The Faces at Braga” as he compares surrendering to the fire of depression and embracing your flaws in this way: “If only we could give ourselves to the blows of the carver’s hands, the lines in our faces would be the trace lines of rivers feeding the sea” and we would “gather all our flaws in celebration, to merge with them perfectly…” What a compelling call–to celebrate one’s flaws. What a gift of healing.
Author’s note: This essay forms the foundation for my memoir-in-search-of-a-publisher, Putting the Pieces Together: A Story of Overmedication and Recovery.
In 1959, my mother suffered what people commonly referred to as a nervous breakdown after my youngest sister’s birth. Mom spent six months in a local, Catholic psychiatric hospital while Dad and Grandma assumed command of the household. I was seven years old, the second-oldest of five children. Eventually, Mom visited us a few times on Sundays, and then returned home in November, presumably ready to assume her duties as a wife and mother. Sadly, Mom remained gripped by depression for the rest of her life.
Because my memories of that time are wrapped in thick layers of gauze, I’ve had to rely on others to fill in the gaps. My father, grandmother, and Mom’s close friends believed that Mom experienced postpartum depression, starting after my birth, and worsening with each successive child. My older brother shared this memory about a year ago when I asked what he remembered about Mom’s 1959 illness: “I came home from college and found her in the basement, banging her head against the wall, moaning, ‘I can’t take it anymore.’”
My heart ached when I heard that story, but I still puzzled over why Mom never recovered. Until I found Dad’s collection of records in a dusty box stashed in my sister’s attic. Old insurance and medication records, newspaper and magazine articles, and letters to doctors were neatly organized in an unassuming manila folder. As I leafed through the contents, intuition whispered that I’d finally have the missing puzzle pieces I’d searched for all my life.
Some of the most valuable clues were in a letter, typed on onion skin paper, that sat on top of the file. It was dated 1-17-83 and addressed to Dr. L., one of Mom’s many doctors. Dad wrote the following notes:
5th child born Feb.59. Normal birth and she carried baby in good spirits. About mid-April started having problems and had first visit with psychiatrist of May 8, 1959. Between then and June 22nd, ’59, he treated her with Amytal, Ritalin, Nardil, Trilafen, NaBu-4, Dexamyl tabs and spansules, and Tofranil. By the end of May ‘59 she was so bad, that even to my nonprofessional eye, I didn’t see how she could avoid hospitalization… She remained there to late Nov. 59. During this time, she received medicine and numerous EST [electroshock therapy] treatments.
The only drug I recognized in that long list was Ritalin, an amphetamine that had been widely prescribed for depression in the 1950s and ’60s. I quickly set to work looking up the rest, all the while screaming inside, How could anyone give a nursing mother with three small children and a newborn so many drugs in such a short period of time? A quick search on the website drugs.com helped me to understand the other drugs my mother took when she first got depressed. Amytal is a long-acting barbiturate; Nardil is an MAO-inhibitor (a type of antidepressant); Trilafon is an antipsychotic; Nembutal is a barbiturate used as a sedative; Tofranil is a tricyclic antidepressant; and Dexamyl is a combination of an amphetamine and a barbiturate.
Grab-bag of antidepressants and pain meds
It was easy enough for me to find the commonly listed effects of all of those drugs, and I wondered how Mom’s doctor could have prescribed all of them in such a short time. Dad’s records don’t indicate if she took all of them together, but even if she took a few, discontinued them, and started a few others, the chemical load must have overwhelmed her system. What struck me in looking at the effects of all the medications was that many of them could cause anxiety, sleeplessness, and agitation—three things I clearly remember my mother struggling with.
Now my brother’s story made more sense—I think Mom was banging her head on the wall because she couldn’t tolerate what the drugs did to her. Her doctor told a different story in the diagnosis that my father noted: “This psychiatrist [Dr. S.] diagnosed it [Mom’s illness] as severe depression with agitation and not due to childbirth.” The doctor’s assessment rang true in one sense—it seemed pretty clear to me that Mom’s severe depression with agitation was due to the massive amounts of drugs she was taking and was, indeed, not related to childbirth. But somehow, I don’t think that’s what the doctor meant. While I have no doubt that my mother struggled against overwhelming feelings of sadness and fatigue, which led to the initial appointment with Dr. S., I believe Mom’s breakdown was probably chemically-induced due to overprescription of drugs.
Dad had also kept some of the original prescription bills related to Mom’s 1959 hospitalization, and between August and October, she took Thorazine, Nembutal, and Tofranil on a regular basis, in addition to receiving an undisclosed number of electroshock therapy treatments. When she came home, the doctor had her on a regimen of Phenobarbital, Miltown (an antianxiety drug), and the tricyclic Tofranil. Dad supplemented that regimen with carefully measured decanters of white wine that I once caught him cutting with water. When he saw me watching, he cautioned, “Don’t ever tell your mother what you saw.” Nowhere in the thirty years of records is there any indication of Mom’s drinking, which all of us tacitly accepted as a significant part of her daily routine.
I also found homemade spreadsheets where Dad listed the dates and medication amounts for Mom’s drugs, often annotated with notes about her responses. The information in those charts prompted me to investigate possible medication effects that may have influenced Mom’s internal state which led her to attempt suicide in 1967. At the time, she was taking a combination of Aventyl (a tricyclic which can cause restlessness, agitation, and anxiety), Dexamyl (amphetamine and barbiturate combination), and Phenobarbital (a barbiturate which is linked to nightmares, nervousness, depression, and anxiety). The effects of all of these medications, combined with Mom’s continued daily drinking, probably led to the intense feelings of despair that drove her to slit her wrists in December. Dad found her in the bathroom that night. I accompanied my parents to the hospital, while my two siblings, ages twelve and thirteen, stayed home and cleaned up the bathroom. None of us ever spoke of that night again.
What about therapy, I wondered, and how did Mom’s psychiatrist treat her after that tragic night? One would think the doctor should have increased Mom’s routine visits to keep a closer watch on her. But according to Dad’s records, that’s not what happened. In fact, Mom’s doctor saw her twice a month, beginning in January of 1960, only about two months after she was released from the hospital, and continuing through June of 1968. However, in the weeks immediately following her suicide attempt in 1967, he did not see her more frequently, a fact which seems to indicate a lack of support and concern. By August of 1968, Dad’s notes indicate that Dr. S. wanted to hospitalize my mother. Dad’s notes and the conversations I can remember ring with the angry charge that “Dr. S. just threw up his hands and gave up on her.”
Because Dad was adamant about keeping Mom out of the hospital, he sought out Dr. M., a well-known psychiatrist who performed electroconvulsive therapy (ECT) treatments in his office. Between August of 1968 and June of 1970, Dr. M. administered thirty-nine ECT treatments to my mother, sometimes giving her as many as five treatments in a month. The one time I remember accompanying my father to help him bring Mom home, I was shocked by her dazed look and unsteady walk. I remember her sleeping through the next day and experiencing memory loss from that time forward. Dad told me that Dr. M. did the procedure without anesthesia, but from some of the reading I’ve done on earlier ECT administration, it seems likely that Dr. M. probably used a short-acting barbiturate to sedate Mom. Otherwise, how could she submit to so many treatments? And how could Dad willingly put her through that pain? I think both of them must have been more desperate for relief than any of us kids could have guessed.
I wish I could say that Mom got better after all of that ECT, but she never attained such a reward for all of her efforts and suffering. In 1973, after suffering from mysterious dental pain for several months and finding no relief, a neurologist helped Mom and Dad to see that she was suffering from depression. Mom was hospitalized for at least a month and endured detox for both barbiturates and alcohol, but she was unable to maintain her sobriety once she came home. I was sickened to learn that Mom’s doctors routinely prescribed Thorazine for her from 1969 to 1983, a practice which would explain why she suffered from tardive dyskinesia and later from severe full-body trembling, possibly akathisia. Mom was hospitalized again for several weeks in 1993, and for the first time, her psychiatrist confronted the family about her alcohol dependence and informed all of us that her MRIs showed evidence of small strokes and blood in the brain. He asked all of us to pledge to refrain from serving alcohol at family gatherings, but we were split on the issue of whether Mom had a problem or not, so she continued to drink along with all of her medications until her death in 2002.
I remember my mother suffering from horrible, visceral anxiety where she would take deep, fast breaths and then wring her hands as if she were Lady Macbeth. Now that I understand more about her medications, I realize how impossible it is to determine if my mother was actuallyvery depressed and anxious or if she was one of the early victims of polypharmacy, trapped in physical and emotional pain due to overmedication and a lack of supportive therapy. It seems clear from the records that Mom’s doctors saw her condition as biochemical and treated her accordingly, tweaking the pills as they went along, and in a sense, resigning themselves to maintaining her “treatment resistant” condition with the only tools they believed in.
Despite all of her sedating and numbing medications, Mom lived a rich and meaningful life. She cared for us, made sure we had regular, nutritious meals and provided a supportive presence when we needed help. Mom hosted her bridge group, participated in a book club, and made weekly trips to talks at the local art museum with one of my aunts. She was also a gifted artist with a degree in costume design from Maryland Institute College of Art, but her talent never matured once all of us were born. Sadly, she never picked up a paint brush in all the years I knew her.
As a child, I made two vows: to help my mother get well and to never be like her.
Want to read the rest of the story? Please hop on over to the Mad in America blog where this essay was originally publishedin May of 2019.
In 2015, my first book, The Altar of Innocence, was published. I remember my excitement when the first shipment of books arrived. My friend Beth was here, and she immediately had me pose with my book. A few days later, along with my wonderful children, Brian and Christella, many of my friends came to the launch reading at Zu Coffee in Annapolis to help me celebrate.
The day my books arrived
“Why did you write a book?” is one of the first questions people ask when they find out that I’m a writer. The main reason is that I couldn’t keep the story inside any longer. When I was growing up and even when I experienced my own episodes of depression, I felt intense shame. And my mother felt the shame and isolation even more in the 50s and 60s. I’d been haunted by a question nearly my whole life–Why didn’t my mother ever recover from depression? And later on I could add the caveat–when I could.
My mother designed and painted the dress on the cover of my book, but I didn’t find her artwork until the late 1990s when Mom was elderly and in a nursing home. I discovered her paintings one day in the basement of the family home, and then took them to a shop to have them matted and framed. When I showed the framed designs to my mother, she said, “Thank you for appreciating me. I always wanted to be a fashion designer.” Mom had never spoken of her dreams to anyone before that moment, at least not anyone that I asked. Even my siblings had no idea of Mom’s amazing talent until I discovered the paintings.
Years after Mom had died, I sat in my living room and stared at her paintings, remembering how I used to watch her struggle with depression and anxiety and tell myself, I’ll never be like my mother. In that moment, I realized that if I didn’t write poetry, I would be just like Mom, burying my art in the basement of my life.
With Mom’s paintings as an inspiration, I began to conjecture about possible causes for her chronic depression and wondered if the loss of a dream could so profoundly alter the course of one’s life. And if following one’s dream and having the benefit of a societal shift in the roles of women and women’s autonomy could have so profoundly affected my outcome.
One woman spent more than half of her life battling the darkness. One woman overcame the same darkness. Maybe that’s why our story continues to speak to people five years after the book was released. If you decide to read The Altar of Innocence, I hope it will speak to you.
Here’s a link to me reading one of my favorite poems from the collection: “Adultery”.
Pain is an important signal. We feel something hot and pull our hand away. A knee hurts and we ice it. Pain is the body’s way of telling us to pay attention to something and give it some attention. But what if pain also tells us about our emotions? Mad in America recently published my essay entitled “Learning to Speak the Subtle Language of Pain.” My hope is that someone with an experience like mine will find comfort and resonance in my story.
The River of Uncertainty
Here’s an excerpt: “It gradually dawned on me that my back pain was another mask that depression wore. Instead of crying and feeling overwhelmed or giving up, my body was sending distress signals to help me realize that I was in a difficult spot.”
Kelly Brogan is a psychiatrist practicing in New York city who approaches depression in a holistic fashion. Not only does she listen to your symptoms, but she takes a wide-angle view of a patient’s life to help each person find the appropriate treatments. I have done a lot of reading on the causes of depression, and based on what I’ve learned, I completely reject the notion of brain-based chemical imbalances. Depression, from all that I have learned, is a much more complex reaction to life-situations than a simple chemical imbalance. I agree with what Kelly says near the end of this article,”…taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire.” Read on to discover the myriad of causes for the fires inside.
What Is Depression?
Is depression a flat mood, an inability to participate in ‘normal life activities,’ or unexplained bouts of sadness? In spite of its singular clinical classification, depression looks different for each person. Like Leo Tolstoy noted in his famous novel Anna Karenina, “All happy families are alike; each unhappy family is unhappy in its own way.”
While all happy families aren’t necessarily alike, this adage speaks truth in terms of depression. Each person’s depressive symptoms – remember, depression is a symptom, not a disease – depend on their unique circumstances, bodily health, emotional history, and held beliefs. As the serotonin model of depression continues to lose its hold on mainstream psychiatry, a theory of depression as evolutionary mismatch has emerged. In this theory, depression is the result of modern living; we did not evolve in the context of environmental toxins, isolated living, and near-constant stress. Some argue that depression is a response to this mismatch, also called paleo-deficit disorder, and depression is simply a message from our bodies trying to protect us from the madness of the modern world.
However, even the evolutionary mismatch theory of depression relies on the dangerous assumption that all depression is the same: that depression is one disease, with one origin and a universal set of symptoms. Anyone who has been affected by depression will challenge this assumption. Depression can be caused by a constellation of factors that cause chronic inflammation – inflammatory foods, medications like the birth control pill, reduced sunlight exposure, and loneliness, to name a few – and manifest differently in different people. Some of the symptoms that qualify a person for a diagnosis of depression seem downright paradoxical: increased and decreased appetite, insomnia or fatigue, motor agitation or impairment. Even in one person, different depressive symptoms can appear at different times.
A recent scientific review article entitled ‘Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions’ attempts to re-classify depression into twelve subtypes.1 For each of these subtypes, researchers propose different causes for depressive symptoms, as well as potential reasons that these subtypes evolved and purposes they serve. In this framework, depression may be (1) an beneficial adaptation that effectively addresses a specific problem (2) an adaptation that does not solve the problem (3) a byproduct of other adaptations or (4) a general pathological state that serves no purpose and is harmful.
The proposed twelve subtypes of depression
Twelve Causes of Depression, Explained by Scientists
In infection-induced depression, symptoms result from underlying inflammation. This classification is supported by studies showing that anti-inflammatory agents reduce symptoms of depression.2 Further, the ‘sickness behavior’ of chronic inflammation, including social withdrawal, might worsen depression.
Long-term stress activates the immune system, leading to chronic inflammation that creates depressive symptoms. Why would stress activate the immune system? For a good reason, actually – in our evolutionary history, stress meant a higher chance of being wounded, and our immune systems ramped up to protect from infections that could result from those wounds. But nowadays, stress is rarely caused by true danger. Instead, stress comes from working long hours (against circadian rhythms), feeling pressured to meet deadlines, and financial worries.3 The response of inflammation to stress seems to be an evolutionary mismatch; the immune response that served us for centuries is no longer beneficial.
In the ancestral world, loneliness literally meant death. If you were separated from the tribe, you were vulnerable to predators and other forces of nature. Loneliness is a powerful and protective message that impels us to seek the company of others, which was crucial to survival for many generations. While loneliness is admittedly less dangerous now, this fear remains imprinted on us and leads to loneliness-induced depression.
People who have experienced significantly traumatic events are more likely to be diagnosed with depression, which researchers call trauma-induced depression. In fact, one study of almost 700 randomly-selected patients with depression found that 36% of them were also diagnosed with post-traumatic stress disorder (PTSD),4 and a large meta-analysis of 57 studies revealed that the comorbidity of depression and PTSD was 52%.5 Like those suffering from loneliness, people with PTSD show elevated levels of pro-inflammatory markers.6
Depressive symptoms can result from conflicts in modern hierarchies, such as the workplace, social groups, and families. Humans and social animals establish hierarchies, and those at the top enjoy many benefits. Therefore, we all want to be at a comfortable hierarchical position to meet our needs. If we don’t reach our desired place in the hierarchy, our self-esteem suffers.
Hierarchy conflicts, such as unemployment,7 bullying,8 and striving for unreachable career goals9 are all associated with depression.
Grief is a common driver of depression diagnoses. Up to 20% of people who lose a loved one and are grieving are saddled with the label of depression. Even in animals, losing a mate, sibling, or offspring leads to depressive symptoms. 10
Similarly, romantic rejection can cause depressive symptoms. Researchers found that after two months, 40% of people who had been left by their romantic partners showed symptoms of clinical depression.11 The sadness following a breakup may indicate true love and disappointment, and these feelings might also help make more aligned choices in future romantic relationships.
Six months after childbirth, 10-15% of women are diagnosed with postpartum depression. Symptoms of postpartum depression include crying, hopelessness, anger, and loss of interest in the new baby. Many studies indicate that mothers who feel that they are receiving inadequate childcare support from the father or her family are more likely to be diagnosed with postpartum depression.12 That is, a mother’s feelings of overwhelm, tiredness, and depletion are often categorized as postpartum depression. It has been hypothesized that the symptoms of postpartum depression may serve as a signal that the mother requires more support.
Seasonal Affective Disorder (SAD), also called seasonal depression, is a mood disorder that strikes a person at the same time each year, usually in the winter. A person diagnosed with SAD exhibits general fatigue, decreased libido, and increased appetite for starchy foods. SAD is more frequent in people with evening chronotypes, and light therapy can help resolve the symptoms.
Chemically-induced depression is a subtype of depression that results from substance abuse, such as alcohol or cocaine, or a side effect of medications like benzodiazepines. Yes, a side effect of anti-anxiety and antidepressant medications may be more depression. This type of depression appears to resolve when people stop ingesting the drugs or alcohol.13 Furthermore, as many people who feel sad self-medicate with alcohol, alcohol abuse may confound other drivers of depressive symptoms.
Interestingly, evidence is piling up that environmental toxicants, such as heavy metals, neurotoxic compounds, plastics, and pesticides may cause depressive symptoms.1415
Being diagnosed with a disease like Alzheimer’s, migraine, and cancer increases the risk of also being diagnosed with depression. In fact, almost two-thirds of women who suffer from breast cancer are also diagnosed with depression.16 Of course, the diagnosis of cancer is traumatic and causes many types of anxieties, ranging from financial to emotional, and cancer treatments may cause further injury that adds to the stress burden.
Overall, depression is a meaningless label until you find its personal meaning.
This peer-reviewed article presents 12 research-backed possibilities that could be root cause drivers of depressive symptoms – and there are likely more than twelve. Scientific evidence continues to show that depression is a sign of imbalance, not an inherited genetic condition that you are powerless to change. Imbalances can be caused by inflammatory foods, toxins, medications, life events like trauma, and stress – and taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire. Release the fear and move into curiosity. Commit to lean into your symptoms, realizing that they’re only messages, reduce your toxic exposures, turn down the noise, and explore the root cause of these symptoms for true healing.
Three hots and a cot. A casual phrase, but one that provokes an immediate, visceral reaction for me. The first time I ever heard anyone use the phrase was when I taught freshman composition at a local community college. I had assigned my students an article to read about prison reform or unjust sentencing, and the class was discussing the author’s ideas. One young man defended the existing state of prisons and concluded by saying something along these lines, “Look, they get three hots and a cot, TV, and a workout room. In lots of ways, life in prison is better than where those people come from.”
The River of Uncertainty
Those people. The very anonymity of the description renders imprisoned people faceless shells of who they actually are. And for the past three years, I’ve volunteered in a local prison and gotten to know a lot of “those people.” Getting to know several of the men and women who are incarcerated in our state prisons has erased any stereotypes I previously held of who they might be. And the food and living conditions in our prisons are far from being better than where anyone came from, at least in my experience.
So when I heard a new friend use the phrase “three hots and a cot” in relation to patients in a psychiatric hospital, I was shocked into silence. To be fair, this woman, a physician’s assistant, was talking about the need for in-patient psych facilities run by the state as opposed to our current situation that leaves many people wandering the streets or being imprisoned. But again, the phrase was casually tossed into the conversation where she advocated for “three hots and a cot, a safe place to regroup, counseling, and meds for two to three weeks to help people get back on their feet.”
My reaction was instinctive, but I was mute. I listened and pondered what I could say. “Better than putting those people in prison, which is what we do now,” one woman said. And while I agree that we have a need for more care for people who suffer from trauma-induced emotional distress (I refuse use the term depression because of what it connotes), I know that the solution is not as simple as providing in-patient facilities for emergency care. And I wondered if any of the women in my circle had ever been psychiatric patients themselves. Like I had been. Like my mother had been. But I was silent.
I didn’t want to get emotional–passionate, really–with my response. This is what I wanted to say:
No, we can’t just medicate people, hospitalize them for a week or so (if you are very, very lucky) and then discharge them without addressing the environment that they will be returning to. Have any of you ever read about what psych drugs can do to people over the long-term? Do you know about the dangers and difficulties of discontinuing psych drugs once you start? Do you know there is no scientific proof that a lack of serotonin or an excess of dopamine causes depression, schizophrenia, or bipolar disorder? Do you know that sometimes taking antidepressants can actually cause bipolar disorder?
And how about this admission (excerpted from “More on the Chemical Imbalance Theory” on the Mad in America website) from Dr. Ronald Pies, a highly-regarded psychiatrist?
The “little white lie” is, of course, a reference to the2014 article by the very eminent and influential psychiatrist Ronald Pies, MD. In that article, Dr. Pies characterizes the chemical imbalance theory as “…this little white lie…”
Dr. Pies has also insisted – arguably delusionally – that psychiatry never promoted the chemical imbalance theory of mental illness. In a2011 article he wrote:
“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”
But Dr. Pies’ words haven’t filtered down into mainstream knowledge. Part of the reason I didn’t speak up is because I meet so much resistance when I present the information about lack of evidence for the chemical imbalance theory and the harm that can come from psychiatric drugs. But I am convinced, based all the books and articles that I’ve read over the past five or more years. And I’m convinced by my own life-experiences and the experiences of other people that I know.
Because I know that there is a desperate need for compassionate, community-based care, I’ll be posting a blog on what would I advocate for in the next few weeks. In the meantime, here is a poem of mine, recently published on the Mad in America website, about my experience visiting a friend in a local psychiatric hospital and recalling my own experience.
A Therapeutic Environment
I bring a small basket of flowers
for my friend in the psych unit,
the nurse buzzes me in.
She silently yanks
the plastic card-holder,
then chides me, It has a pointy end.
My friend tells me later,
“No one gets flowers here.”
My friend wears
blue paper pajamas—the only thing that will fit over her cast—
until I bring new sweatpants
“No drawstrings,” she tells me. “The nurses will take them out.”
Other patients wander
as if in an endless maze
blankets over their heads,
eyes trained on the ground.
The nurses stare into computer screens
behind thick walls of safety glass
—barricaded against what danger?
Perhaps mindful that one day they too
might be lost
like the wandering “others”
in the blue paper pajamas.
My friend is hospitalized
because she tried
to hang herself. She had stopped eating. Has your appetite returned? I ask.
“We had fish sticks for lunch.
They were so hard I couldn’t chew them.”
She recites the meds in her psych-cocktail—
Lexapro, Topomax, Prozac, and Zanax.
She shrugs and whispers
“I don’t feel any better,
and the weekend doctor
wants me to add Ritalin.”
We move into the dayroom
and I step across a stream of time
to the same place I left in 1997.
The same tattered furniture,
the same dull green walls,
punctuated by a lone picture hanging
crooked and uncentered.
Board games thrown on the shelves—
lids with no bottoms,
scattered pieces from the “Game of Life.”
“No one bothers
to start a puzzle—
we can’t find all the pieces,”
my friend tells me.
A bin of crayons
sits on the shelf,
but there’s no paper.
When I see the flip chart,
I flash back 18 years and remember
the goals’ group twice a day,
but still no art classes.
No dance, no movement
except the aimless wandering
of the blanket people.
No way to shape the confusion
churning inside.
No play dough.
No glue.
Two nursing assistants
fill chairs on the perimeter of the room.
They poke their heads up quickly,
like prairie dogs scanning for predators,
then return to the games
on their mobile phones.
References for further reading:
See The Hidden Epidemicby Robert Whitakerfor more information on the history of developing psychiatric drugs, long-and-short-term effects, trends in rates of mental illness and disability, and alternative treatments.
See Psychiatry Under the Influenceby Robert Whitaker & Lisa Cosgrove for an exploration of the mutually-beneficial relationship between the pharmaceutical industry and the psychiatric community, including medical schools and professional development.
See Prozac Backlashby Joseph Glenmullenfor research on the clinical trials related to antidepressants and the numerous side-effects that patients experience. The book also includes a section on alternative treatments for emotional distress (depression).
