The Disordered Mind

The Disordered Mind: what unusual brains tell us about ourselves - Eric Kandel

What's the angle?
   Kandel is a neuroscientist and writer, whose work on learning and memory led to a Nobel Prize. He's also quite the art buff, and has written extensively about art and creativity. I loved this book, and his writing. It is textbooky: deliberate (he starts each chapter with a brief outline, then finishes with a brief summary), clear syntax and pace, lots of vocabulary - which he defines along the way. Only it isn't 1,000 pages with tiny cramped type, thank goodness. I especially enjoyed his careful combination of psychological and neurological research. The disciplines need each other, he stresses, and need to find some common language.

What is depression?
   Kandel writes that "depression is probably not one but several different disorders, with different degrees of severity and different biological mechanisms." Later in his discussion he describes depression and bipolar disorder as disruptions of the "connections between the brain structures responsible for emotion, thought, and memory." More or less, though, he proceeds without a definition of depression; I guess he basically assumes the DSM criteria. 
   He doesn't spend time trying to distinguish between "normal" down-times and depression episodes, or between grief and depression, or between environmental and biological "triggers." He's interested in a biological analysis of what depression looks like in action, in the brain, and he highlights the research of Helen Mayberg, who has identified a sort-of neural "circuit" for depression. Mayberg focuses on several "nodes" of this circuit, especially "cortical area 25." Kandel also mentions promising research into the stress-response system, the hypothalamic-pituitary-adrenal axis.
   He doesn't specifically hypothesize that one day, doctors will diagnose depression biologically rather than psychologically, but we could assume that would be theoretically possible, based on his vision of a more complete convergence of the two disciplines. More likely, in the nearer future, neuroscientists and geneticists will predict more and more accurately someone's risk for becoming depressed.

What are the genetics of depression?
   He doesn't say much about this, just that the "understanding of the genetics of depression and bipolar disorder is still in the early stages." He does cite some research into the likelihood of depression for an identical twin whose counterpart has depression, (40%) as compared to siblings (less than 8%), as compared to the general likelihood of having depression (6-8%).

How can you treat depression?
    Kandel doesn't recommend anything, but is optimistic about the ability of neuroscience to analyze the efficacy of drugs and therapies with new imaging techniques and animal models. He's also optimistic about the ability of scientists to identify new and better ways to intervene in the neural circuit(s) of depression.


notes

• modern studies of consciousness and its disorders suggest that consciousness is not a single, uniform function of the brain; instead, it is different states of mind in different contexts
• Philippe Pinel (late 18thc) - argued that psychiatric disorders strike people who have a hereditary disposition and who are exposed to excessive social or psychological stress
• Santiago Ramon y Cajal (late 19thc): cell has four parts
• body
• dentrites (receptors)
• axon (long arm)
• presynaptic terminal (synapse is area b/w terminal and dendrite)
• dynamic polarization - info flows only one way (from dendrite to body to axon to terminal)
• action potential - potential voltage between outside (+) and inside (-) cell body 
• when cell "fires" the ion channels open and charge switches
• action potential is all or none
• signal intensity is determined by number or frequency of "fires"
• can divide genetic illnesses into two groups: simple (Mendelian?) or complex
• Identical twins
• autism 90%, bipolar 70%, schiz 50%, depr 40%
• siblings
• 20%, 5-10%, 10%, <8%
• general pop
• 1-3%, 1%, 1%, 6-8%
• copy number variations - sections deleted or copied
• de novo mutations
• arise spontaneously in sperm
• number of mutations increases with paternal age
• 20 yr old - avg of 25 mutations; 40 yr old - avg of 65 mutations
• recent study revealed that teens with autism have too many synapses (not enough synpatic pruning)
• de novo mutations occur more frequently in genes that code for synaptic proteins
• as Darwin first pointed out, emotions are part of a preverbal system of communication that we share with other mammals
• Kraepelin used same diagnostic criteria from general medicine
• what are symptoms?
• what is course of disease?
• what is final outcome?
• he distinguished b/w disorders of thought and disorders of mood; dimentia praecox and manic-depressive illness
• the average length of remission in major depression is about three months
• depression is probably not one but several different disorders, with different degrees of severity and different biological mechanism
• hypothalamic-pituitary-adrenal axis
• excessive concentrations of cortisol destroy synaptic connections between neurons in the hippocampus, the region of the brain that is important in memory storage, and neurons in the prefrontal cortex, which regulates a person's will to live and influences a person's decision making and memory storage
• the amygdala determines what emotion is recruited, and the hypothalamus carries it out
• Helen Mayberg: neural circuit of depression has several nodes, two of which are particularly critical
• cortical area 25 (subcallosal cingulate cortex) - thought, motor control, and drive come together; also rich in neurons that produce serotonin transporters - proteins that remove serotonin from the synapes (these transporters are very active in depressed people)
• right anterior insula - receives info from senses about physiological state and helps generate emotions to respond
• serotonin and dopamine are modulatory transmitters - tunes whole circuits or regions
• mediating neurotransmitter - acts directly on target cell (excitatory or inhibitory)
• modulatory - fine-tunes action of mediating neurotransmitters
• studies of depression suggest that whenever area 25 becomes hyperactive, the components of the neural circuit concerned with emotion are literally disconnected from the thinking brain, leading to a loss of personal identity
• Freud's three key observaions
• children have sexual and aggressive behavioral instincts
• children suppress and render unconscious the conflicts between early needs and prohibitions, as well as early traumas
• the patient's relationship with the therapist reenacts the patient's early relationship (transference), and plays a central role in the therapeutic process
• Mayberg - used electrodes to slow firing rate in area 25
• about 25% of people with major depression go on to experience a manic episode
• differences in the brains of depressed and manic states have been difficult to document
• understanding of the genetics of depression and bipolar disorder is still in the early stages...they disrupt the connections between the brain structures responsible for emotion, thought, and memory
• the emerging view of schizophrenia as a neurodevelopmental disorder that, unlike autism, manifests itself later in life has arise from the considerable genetic research done on the disease
• positive symptoms of sch. - disordered volition and thinking
• negative symptoms - social withdrawal and lack of motivation
• many typical antipsychotics act by blocking dopamine receptors
• may involve problems in serotonergic and histaminergic pathways, as well as in dopaminergic pathways
• in schiz, synaptic pruning appears to go haywire during adolescence (too much pruning going on)
• polymorphism, common variation - more than 1% of world's pop; rare variation, or mutation, is less than 1%
• autism, schiz, and bipolar share some genetic variants
• about 30% with 22q11 deletion syndrome are diagnosed with psychiatric disorders
• overexpressed D2 receptors
• memory is the glue that holds our mental life together
• Larry Squire - two major memory systems
• explicit or declarative - conscious memory
• implicit or non-declarative - motor and perceptual skills, automatic
• both kinds can be stored short term or long term
• alzheimers, parkinsons, huntington - protein folding disorders, protiens clump up, kill neurons
• Alois Riegl - the beholder's share, creative process involved in viewing art
• creativity related to the lifting of inhibitions
• left and right hemispheres inhibit each other; damage to left side can actually enable more creative action of right side
• almost 30% of people on the autism spectrum exhibit special skills in music, memory, numerical and calendar calculations, drawing, or language
• creativity doesn't appear to be related to IQ
• sensory feedback neurons - create internal sense of body and relative position of limbs - proprioception
• in the broadest sense, the task of every circuit in the nervous system is to add up the total excitatory and inhibitory information it receives and determine whether to pass that information along. Sherrington called this principle "the intergrative action of the nervous system."
• prion - misfolded precursor protein - they self-propagate, cause other proteins to misfold
• emotions are states of readiness that arise in our brain in response to our surroundings
• the study of emotions and moods helps reveal the porous boundaries between unconscious and conscious mental processes
• 1st step of emotion - unconsious and outward; 2nd step - subjective and internal
• emotions classified along two axes
• valence - how good or bad something makes us feel on a spectrum from avoidance to approach
• intensity - degree of arousal
• four key areas for emotion
• hypothalamus - executor of emotion; controls instinctive behavior
• amygdala - orchestrates emotion; links unconscious and conscious aspects of an emotional experience
• striatum - habits
• prefrontal cortex - evaluates whether a particular emotional response is appropriate; interacts with and exerts some control over amygdala and striatum
• direct and indirect pathways to the amygdala
• emotion so important in decision making and morality; directs and narrow choices
• all positive or pleasurable emotions traced to dopamine
• a reward is any object or event that produces approach behavior and leads us to sped attention and energy on it
• heritability of addiction moderately high: roughly 50%
• addiction - pleasure decreases while memory/habit conditioning strengthens
• pharmaceutical companies have devoted very little effort to developing drugs to treat addiction
• sex and gender identity are determined separately, at different times in the course of development
• sex
• chromosomal - 23rd pair xy or xx
• anatomical - external genitalia and other visible differences
• gonadal - presence of male or female gonads - testes or ovaries
• gender specific behaviors triggered in different ways - humans particularly sensitive to visual and auditory cues, a fact successfully exploited by the pornography industry
• the neural circuits that control the gender specific behavior of each sex are present in both sexes
• sexual dimorphisms visible in the brain
• greater variation within each sex than between sexes
• since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in transsexuality
• those who identify as transgender in adolescence almost always do so permanently
• a nucleus or cluster or neurons in hypothalamus that contains mating neurons and fighting neurons and then some that can be involved in either
• consiousness
• level of arousal
• content of processing
• Searle - three key aspects of consiousness
• qualitative feeling
• subjectivity
• unity of experience
• reticular activating system - wakefulness
• Bernard Baars - global workspace theory; widespread dissemination of previously unconscious info
• without a good psychology of the conscious state we can't make progress in the biology of broadcasting information, and without the biology we will never understand the underlying mechanism of consiousness
• percept - mental representation of an object
• Benjamin Libet - readiness potential (before an action)
• the process of initiating a voluntary action occurs rapidly in an unconscious part of the brain; however, just before the action is begun, consciousness, which comes into play more slowly, approves or vetoes the action
• Kahneman - fast and slow thinking
• neurology and psychiatry will merge into a common clinical discipline that focuses increasingly on the patient as an individual with particular genetic predispositions to health and disease

A Virginia Family

A Virginia Family and Its Plantation Houses - Elizabeth Langhorne, K. Edward Lay, William D. Rieley

   This tells the story of several generations of Coles' in Virginia and the houses that they lived in. The authors' familiar and sometimes nostalgic tone was difficult to stomach, but it seemed to come from their sympathy and fondness for the Coles. Perhaps such sympathy is essential to analyzing the motivations and actions of historical characters?
   The enslaved Africans, however, were only peripheral characters in this telling. How they helped to build these houses, the time and tasks of maintenance, how the enslaved people would have interacted with the buildings day-to-day, their role in the development of the Cole's gardens, the details of their cash crop labor - all these questions went unanswered, but seem to me very important to an analysis of the Coles' history and their building habits. The authors did discuss slavery frequently, but mostly in economic terms - which is important and helpful, but insufficient to reach their stated goal of creating a "close-up view of four generations of one family of antebellum Virginia" and "a picture of plantation society." Only in Edward's story is there a Black character presented as a person, with mind and motivation, Ralph Crawford.
   I read this book to learn about John Coles the immigrant, but the meat of it has to do with his son, John II and his crew. In any case, it's a treasure chest of art and architecture and social history. I wish these authors had put their many talents into a fuller analysis of plantation life and building.

Profile of John Coles

• born circa 1705 to Walter Coles and Alice Philpot in Enniscorthy, Ireland
• grew up in the merchant class? His father was "port reeve" for 30 years in Enniscorthy
• Immigrated in 1730's?
• married Mary Ann Winston, daughter of Isaac Winston, a member of Cedar Creek Meeting
• 1739 appointed "Processioner," one who walks the bounds of property lines
• May 28, 1741, dines with Byrd II, not sure which house
• "Commissioner of the Peace"
• April 29, 1741, his request to ship 1500 lbs wheat to Lisbon is denied
• Growing tobacco also
• Also cattle, hogs, and horses - for profit?
• Spring 1742, proposes in Henrico Co. Council meeting that the collection of houses on the James by the falls should be incorporated as Richmond
• starts (or receives from inlaws?) plantation along Fork Creek in Louisa Co, near confluence with S.Anna River, near Fork Creek Meeting and his wife's family
• other lands: along Hunting Creek and Black Walnut Creek near the Staunton River (this may have been an active plantation by the time of his death); also in Brunswick Co along Staunton River, also in Albermarle Co on Green Mountain
• bought 15 plots from Byrd II in Richmond, as well as acreage north and along Gilly's creek
• builds "first house on Church Hill;" faces south with a view of the river
• On the vestry, appointed warden and building chairman
• Enslaved Africans in his will, "with all their future increase"
• Primus ("of Fork Creek")
• Phebey ("of Fork Creek")
• Three of their children "names not known to me"
• Cloe
• Beck
• Gabriel
• Primus Jun (Junior?)
• Billy
• Doll
• Lucy
• Jemmy
• Jenny
• Cate
• Abram
• Tamar
• Will
• London
• Dublin
• Nan
• Moll
• St. John
• Betty
• Tabey
• Sebrey
• Richmond
• Wexford
• England
• Phillis
• Bristol
• Sampson
• Scotland
• Cate
• Her young child
• Hannah
• Peter
• Bowston
• Scotland's child
• Dublin's child
• Ireland
• Harry
• Ceasar
• Pharoah
• Tom
• Aggy
• Sharlott
• Sarah
• Children
• Walter 1739
• Sarah Muter 1741
• Mary Tucker 1743
• John 1745
• Isaac 1747
• Friends mentioned in will, to oversee will
• Col Peter Randolph
• Isaac Winston Junr
• Col William Randolph
• wife Mary and brother Williams executors
• died 1747, buried at St John's "under the church"

notes

• on May 28, 1741, we find him dining with William Byrd, perhaps in Coles's own new house
• it was the first house built on Church Hill
• during this period, roughly between 1730 and 1750, planters were crossing the tide line, flocking in numbers into the new Piedmont country
• from the Journal of the Council of VA, which, on April 29, 1741 rejected Coles's request that he be allowed to ship his wheat to Lisbon
• Land and slaves went together
• The land that Coles favored most seems to have been in Lunenburg Co (now Halifax) on the Staunton River
• also land in brunswick co and albermarle
• fork creek, near Anna, near Fork Creek Meeting house, seemed to be home plantation
• possible claim house erected at other holdings, simple  log cabin
• it was coles, in fact, who stood up in the henrico county council meeting in the spring of 1742 and proposed that the small collection of houses on a river should be incorporated as the city of Richmond
• bought the most lots from byrd
• his house chosen by benedict arnold for barracks
• "at the time of his majority in 1769, Isaac was already established as a planter on his father's land in Halifax Co. He was glad to sell his Richmond property to his father's old friend, Col. Richard Adams."
• supposed to have view of river and town; Adams describes flood of 1771 from the porch of his house
• the names of slaves whom John Coles II inherited from his father echo the ties to the old world: S. John, Betty, Tabey, Sebrey, Richmond, Wexford, England, Phyllis, and Bristol.
• the existence of a Coles Rolling Road mentioned in the Albermarle Co Road Orders of 1791 and 1792 indicates that at least during the first years, slaves rolled the hogsheads of tobacco to a point on the James River, whence they could be floated on the flat-bottomed bateaux to the collection point at Westham
• bought a little land from neighbor John Fortune, who was a free black
• ...[Rebecca Travis (motherinlaw)]she paid her own way, as so many widowed and single women did, through the hire of slaves in her possession; many of them accompanied her to her soninlaws plantation
• financial/currency problems around revoluntion. Andrew Drummon, "that you intend, my good sir to lay out the vile trash, which we call money - in young Negroes is wisely determined, everybody's doing the same with us, and that there has been so many belonging to the absent Tories sold..."
• such large acquisitions of land required additional slaves. "required"?
• slave cabins at monticello - 12x14 ft, wooded, earthen floor, wooden chimney perhaps standing a bit apart so that it could be torn loose
• at all the coles houses we find english yew trees, a distinguishing feature of their gardens like the mayduke cherries of their orchards
• watson was paid in beef, pork, bacon, a bottle of rum, a bottle of brandy, a pound of wool, and eight days work of George
• read Memoirs of a Monticello Slave, Isaac
• pinion - small additional wing
• "It is my wish that my old and faithful servant Sally Carr, Fanny and Peter shall have the selection of their masters among my children"
• Virginia custom no longer followed the english law of primogeniture
• 1793, John still paying bounties on wolves, Isaac goes off to william and mary
• punkah, the great fan hung over the diningroom table and operated by a Negro boy pulling a rope, standing out of sight in the back hall
• In 1827 [John III], for example, the plantation showed a profit of 4572.79, about half of which came from the sale of tobacco. In this year he was working with thirty-seven slaves.
• Isaac was working Enniscorthy with thirteen slaves of his own and eighteen of his mother's, yielding in 1809 the not small return of 4340 for the year's work
• new law that freed slaves must leave the state
• 1808 Edward inherits land and slaves, 1819 travels west,
• at the request of his family, Edward had not revealed his plans for their freedom to Ralph and others before leaving Virginia
• "How will you live if you set us free?"
• "They seldom speak of their freedom," Edward noted, "without speaking, and that too rather in a consequential way, of their lands"
• Edward moves to Philly, Edward's son Robert fights for south and dies; Edward heartbroken
• "the age of the plantations had come to an end; of that past era only the buildings, and perhaps a lingering tradition, remain"   ??
• "it is, not one family alone, but a whole vanished culture that these houses represent" ??

Highway 59

Bluebird, Bluebird and Heaven, My Home - Attica Locke

   Last week I heard an interview with Attica Locke on the radio...I think it was during a mid-day errand, so maybe the interview was from "Here and Now"? I can't remember. But I do remember how fascinating her latest book, Heaven, My Home, sounded. 
   The seedbed of this series, she says, is the region itself, east Texas: scraggly pines and farms, ranches and bayous, stretched along Highway 59, Houston to Texarkana. She needed a character to plant in this soil, to show us around, and along came Darren Mathews - Black, Texan, Ranger. How do those three identifiers define him? inspire him? afflict him? confine him?
   Equally fundamental to the story is the social landscape, race and racism in the fall and winter of 2016, just after Trump's campaign and victory. What happened with Trumpism and racism? "Something feels different." Lots of people keep saying that, including myself, and "feel" is the word I most want to understand. Yes we know he emboldened folks to be more blatantly racist, but it has felt different in quality, not just quantity. Different. It's not just that the toxic racist soup we have left on the stove boiled over once again; there might be a new ingredient in there.
   The third leg of her story's stool is an ongoing argument between Darren's twin uncles, William (now deceased) - a Ranger - and Clayton - a lawyer and academic. Both men want to protect and serve their black family and community. William thinks that is best accomplished from inside the legal establishment. Clayton believes that the law and law enforcement are too fundamentally biased against black folks to be of any help. This argument continues in Darren's soul and career - do I protect black folks with the law? or do I protect black folks from the law?
   The plots of these two books are good, the characters are solid, the idioms are fun, and Locke can turn a most handsome phrase. But her sharp racial awareness is the gold leaf of these books; Locke illustrates race and racism a foot, in process, on the move, in the flesh. She can jump right into the sticky 'tar' of stereotypes without getting stuck; catch the butterfly of identity without breaking its wings; pin the tail on racism while still blindfolded-in-love with Texas.



Bluebird, Bluebird notes

• .In the wake of Obama, America had told on itself
• Southern fables usually went the other way around: a white woman killed or harmed in some way, real or imagined, and then, like the moon follows the sun, a black man ends up dead.
• ...for every story about a black mother, sister or wife crying over a man who was locked up for something he didn't do, there was a black mother, sister, wife, husband, father, or brother crying over the murder of a loved one for which no one was locked up. For black folks, injustice came from both sides of the law, a double-edged sword of heartache and pain.
• He got it confused sometimes, on which side of the law he belonged, couldn't always remember when it was safe for a black man to follow the rules.

Heaven, My Home

• Daily, he marveled with a befuddled anger at what a handful of scared white people could do to a nation.
• After Obama, it was forgiveness betrayed.
• ...It gave Darren an odd feeling of dislocation; for a second he actually didn't trust his visibility. He felt as if he'd wandered onto a movie set. He could see the actors, but Darren was reflected in non of the action around him.
• But Darren did not suffer from the peculiar affliction that felled many a well-meaning white person - an allergic reaction to race talk, emotional hives breaking out and closing the throat completely...
• "Don't let anybody steal your grace"
• ...because even here, even in the house where he'd grown up, home was always a reach back in time, glassed as it was in memory. It was still an idea he couldn't exactly touch. Food could sometimes reach it, a pot of peas and ham hocks on the stove. Stories too. But music did it every time. Texas blues were the way home.
• "There is no redemption, there is no future free from their past sins. You give 'em an inch, they'll take a town."
• "...the gilded-lily-white amnesia that is the tourism industry in this town."
• "Perpetuating and profiteering off a fraud - the friction of bloodless prosperity, an antebellum life of civility and grace - while conveniently forgetting the lives that made this town possible."

Acedia and Me

Acedia and Me: A Marriage, Monks, and A Writer's Life - Kathleen Norris

The Wisdom of the Desert - translated, edited, and introduced by Thomas Merton

What's the angle?
   Norris is a poet and writer, and dedicated student of the Christian monastic tradition. She investigates the role of "acedia" - some combination of despondency, listlessness, depression, restlessness, and irritability - in monastic literature, culture, and her own life.

What is depression?
   For Norris, depression is best understood in a modern sense, either as a disorder or illness: long periods of low mood, low energy, lack of motivation, worthlessness, and hopelessness potentially treatable with therapy and medication.
   She is very aware of the overlap in descriptions of "acedia" and "depression," not to mention "melancholia" and "ennui." But early on in the book she tries to distinguish them ethically: depression is not a temptation or vice, it's not something that you can turn from [repent] or refrain from; acedia on the other hand is the temptation to follow a well-worn trail of irritable and depressive thinking and behavior.
    Perhaps, if we take a cognitive-behavioral and desert wisdom approach, we could say that acedia is one possible cause or contributor to depression. And/or we could say that acedia is an especially tempting and destructive vice for people who are depressed or depressive.

How do you treat depression?
   In recounting her husband's many battles with depression, as well as her own depressive episodes, Norris recommends seeking help from many different angles. Talk therapies, medication, hospitalization, prayer, exercise, writing, rest, retreats, good relationships. The only type of treatment she's clearly against is heavy drinking.
   As for acedia - prayer, discernment, and faithfulness are the main remedies. 
- Prayer. First and last of all, keep praying. Ask God for help, or at least tell God that you feel despondent, disbelieving, frustrated, if you're tired of life and you've had enough of all this junk. 
- Discernment. If you can discern acedia in your thoughts and actions, then name it, or "confess" it. Ask for mercy and deliverance. This will help you resist and turn from it toward God. 
- Faithfulness. Stick to your calling. Keep your little "rule" as best you can. Be patient with God, with yourself, with those around you. Be diligent with your basic tasks and responsibilities. Be gentle.

The promise of acedia
   For the most part, the books I've read all agree on the basic contours of depression - weeks or months of low or bad mood, low energy, low motivation, sleep disturbances, suicidal thoughts or actions, hopelessness, worthlessness. The authors have agreed that there are a variety of safe treatment options but that it's not clear what works or not, or why it works or not. They have all agreed to some basic factors that make you more susceptible to depression: neurotic or anxious personality, negative experiences - especially in childhood, depression in the family, chronic pain or other chronic conditions.
   The sticky interlocking questions have been:

• Is depression an illness, a disorder, and/or simply a basic human behavior-feeling?
• Is there a main biological cause of depression?
• What's the best way to treat depression?
• To what extent, or in what way is depression behavioral or ethical?

   I think including acedia in my thinking about depression can help me to address the fourth question without heaps of shame and guilt.



notes

• the boundaries between depression and acedia are notoriously fluid; at the risk of oversimplifying, I would suggest that while depression is an illness treatable by counseling and medication, acedia is a vice that is best countered by spiritual practice and the discipline of prayer
• under these circumstances [monasticism] acedia's assault is not merely an occupational hazard - it is a given. It is also an interfaith phenomenon.
• a parody of leisure [restless tedium, lazy fidgety frustrated pointless]
• "aversion of the appetite from its own good" Wenzel
• despair - when God appealing but impossible; acedia - when God possible but unappealing
• anger as the seed of compassion
• both a sin and an ailment...Aquinas recommends a hot bath, a glass of wine, and a good night's sleep
• history suggests that we tend to be overconfident about what we know, and that we never know as much as we think we do
• acedia can flatten any place into a stark desert landscape and make hope a mirage
• "whose specialty it is to take a dislike to staying in one place"
• monastic wisdom insists that when we are most tempted to feel bored, apathetic, and despondent over the meaninglessness of life we are on the verge of discovering our true self in relation to God
• acedia's genius is to seize us precisely where our hope lies
• Reinhard Kuhn, The Demon of Noontide: Ennui in Western Literature
• Mary Margaret Funk, Thoughts Matter
• All the miracles are in the past, the people see only danger ahead
• This is truth as the devil tells it, using the lure of being free to be myself to enslave me in a sterile narcissism
• If the Church has made too much of the sin of pride, which seduces us into thinking too highly of ourselves, it has not made enough of the sin of sloth, which allows us to settle for being less that we can be, both as individuals and as society
• Godly grief vs worldy grief, "that comes from the enemy, full of mockery, which some call accidie. this spirit must be cast out, mainly by prayer and psalmody" Amma Syncletica
• "What God does in us always produces humility" Ruth Burrows
• conversatio morum
• acedia like "hitting the wall"
• one step toward that blessed receptivity for "the little things" is to discern which activities foster our spiritual freedom, and which do not
• "inside us, we bore acedia's dismal smoke./ we have this black mire now to be sullen in
• a fortunate selfconsiousness awakens in sin - Henri de Lubac
• to pray at the hinges of time, at morning, noon, and night, when we might be most open to God but are also susceptible to acedia and its attendant despairs
• Jesus reminds us, however, that it is not proficiency that heals us, but faith, and faith does not traffic with success or failure
• I could not make him want to live, but I could be his companion in making a life worth living
• the touchstone of God at work is the ability to recognize that God is trying to get us to accept a state where we have no assurance within that all is well...where no clear path lies before us, where there is no way..." Ruth Burrows
• Above all, Solomon encourages us to enlarge our capacity for enjoying the good times in life and to expect that rewards will come after pain
• When I return home I will face the same old battles with restlessness, impatience, and anger, and acedia will urge me to discount my monastery retreat as a shipboard romance
• "the monk perceives in the mirror of the psalter his need for reform" Dysinger
• If acedia is a distorting mirror, we might look for a truer reflection on the soul in what Evagrius calls 'apatheia'...a blessed state of equilibrium, free from distraction or regret. I doubt I will ever know apatheia as Evagrius describes it, but no matter: just the thought of it is enough...
• ...reminds me of what the late poet William Stafford used to say about writer's block. He claimed never to have experienced it, because as soon as he felt it coming on, he lowered his standards

Ruah books

The Holy Longing: The Search for a Christian Spirituality - Ronald Rolheiser

Care of Mind/Care of Spirit: A Psychiatrist Explores Spiritual Direction - Gerald May

   Ruah's back! And I hope to keep up better with the required reading this year.
   When I started the class, I assumed doing the reading would be one of my favorite parts, but I've been disappointed, or I've disappointed myself. Generally I've found the books (some of which I'd read before and deeply enjoyed) boring and frustrating. Overwritten. Uninspired. Blah Blah Blah. I'm projecting my depression onto them, I know! But, still, it's not like I haven't enjoyed other books over the past year.
   I think I'm in a mental and spiritual spot where theology is baloney, sermons are intolerable, nobody knows what they are talking about. I'm in the mood, spiritually, for specific instructions, silence, or riddles.
   All that said, these two books were good, if a bit wordy. Specifically I appreciated Rolheiser's main thesis, that spirituality is how we respond to our deepest desire, our divine madness, our natural maladjustment. We're not happy creatures that sometimes have problems, we're problematic creatures that sometimes get happy. Spirituality is about staying in touch with and channeling this deep longing in healthy ways.
   May's book is helpful in distinguishing between psychotherapy and spiritual direction, while maintaining links between the two. He is all for cross-pollination, but encourages practitioners to hone their specific purposes. Psycotherapy is geared toward identifying and solving psychological problems. Spiritual direction aims to help the directee to hear God in their life.
   May is both a psychiatrist and spiritual director, which is awesome and gives him great tools to write this book. But I'd love to read a book studying spiritual direction techniques and its effects written by a non-religious psychiatrist or behavioral scientist. Are there such books?



notes

Holy Longing

• God-given fire, desire, longing, madness, eros: what we do with that is spirituality, how we channel it
• "energy is not just difficult to access, it is just as difficult to contain once it enters"
• "pray, fast, and give alms"... 4 non-negotiables "a) private prayer and private morality; b) social justice; c) mellowness of heart and spirit; d) community as a constituitive element of true worship"
• "To be a saint is to be fueled by gratitude, nothing more and nothing less"
• "Our loved ones live where they have always lived and it is there that we will find them."
• "John Shea once suggested that the heavenly banquet table is open to everyone who is ready to sit down with everyone."
• "Shower those you love with flowers and affection while they are alive, not at their funerals."
• "To deal with Christ is to deal with church."
• Pascal cycle
• Name your deaths (crucifixion)
• Claim your births (resurrection)
• Grieve what you have lost and adjust to the new reality (40 days of appearances)
• Do not cling to the old, let it ascend and give you its blessing (ascension)
• accept the spirit of the life that you are in fact living (pentecost)
• "When we fail to mourn properly our incomplete lives then this incompleteness becomes a gnawing restlessness, a bitter center, that robs our lives of all delight."
• sexuality as basic fire: lead to creativity, co-creation with God
• "What Janis Joplin is saying is that, in our sexuality and our creativity, we are ultimately trying to make love to everyone."

Care of Mind/Care of Spirit

• "the primary danger in bringing these dimensions together [psychotherapy and spir direction] is that mental and emotional concerns may kidnap the gentle spiritual attentiveness required of both director and directee
• four forces in human spirituality
• longing for God
• God's longing for us
• internal fear and resistance
• evil
• unitive experiences - can't be aware of it in the moment (otherwise wouldn't be "unified"), can't achieve it or cause it 
• "in the absence of clearly identifiable disorder, it is terribly destructive to encourage the dulling or denial of this deepest existential discomfort, for this is one pain we are not meant to anesthetize ourselves to...
• basic trust and mistrust (Erikson)
• self-image
• strength - how stable and defined/fixed is self-image
• quality - how do you evaluate self (good or bad, high or low esteem)
• importance - how attached are you to it; how much do you depend on it
• "we maintain neuroses because hey represent an unconscious "solution" to deeper psychological threats
• attend to relationship between spiritual experience and social/family life
• required physical labor and voluntary exercise usu. have different psychological effects
• dark night experiences usu not associated with loss of functioning (as opposed to depression)
• "it is my belief that the primary task of spiritual directors is to encourage within themselves this moment-by-moment attention towards God as frequently as possible during spiritual direction sessions
• condensation - feelings condense around other feelings
• referals

Drugs, Diagnosis, and Despair

On Depression: Drugs, Diagnosis, and Despair in the Modern World - Nassir Ghaemi

What's the angle?
   Ghaemi is a practicing psychiatrist and researcher, also very well read in the western humanistic tradition. I really enjoyed all the history of psychology and medicine he included. His chapter on Hippocrates was one of my favorites, as was his chapter on Lester Havens, his teacher. 
   On the other hand, his "clinical picture" of post-modernism was vague, watery, a straw-man, so his arguments against it didn't go over well; like a grumpy old-man.

What is depression?
   Ghaemi would like for the mental health field to make a distinction between depression disease - whose hallmark is recurrence - and depression non-disease - perhaps resuscitating "neurotic depression" as an apt term. He doesn't draw a hard and fast line between the two - there must be overlap; but his goal is to distinguish, as far as possible, between biologically based depression and psychologically based depression.
   For depression disease, he identifies genetics and early life environment as the "first" causes (the things that make the disease possible) and adverse experiences or events as the "efficient" causes (the things that trigger the disease).

How do you treat depression?

1. Medicine
   Dr Ghaemi, like many of the authors I've read, think that anti-depressants are being overprescribed, but in principle he is in favor of medicating diseases. The key is accurate nosology, and Ghaemi thinks that the DSM has lumped too much into Major Depressive Disorder. He lays out some good rules of thumb (rule of thumbs?)

• As to diseases, make a habit of two things - to help, or at least to do no harm -Hippocrates. Is the disease curable? help. incurable? do no harm. self-limiting? do no harm. "...a Hippocratic approach would avoid medications as much as possible, except where we can clearly help the natural process of healing and with great attention to side effect."
• Osler's Rule: Treat diseases, not symptoms. "if we reject disease-oriented medicine, we are left at the mercy of social forces tending toward overmedication: patients themselves; the pharmaceutical industry; and doctors' own economic interest."
• Holmes's Rule: All medications are guilty until proven innocent. Medications "need not be proven harmful; they do need to be proven safe and effective."
• Use a diagnostic hierarchy: "certain diagnoses should not be made if other diagnoses are present...mood illnesses can produce not only depression and mania but almost any psychiatric symptom."

2. Psychotherapy
   Ghaemi reminds us that not too long ago psychiatrists primarily practiced psychotherapy. Freud and Kraepelin were the founding tree trunk, and various disciples and heretics branched out with theories and therapies. Ghaemi practices psychotherapy quite a bit, and his chapters on "guides" include many in the "existential" psychotherapeutic tradition.

• Victor Frankl: an abnormal reaction to an abnormal circumstance is normal.
• We must learn to suffer. "We must try to reduce needless evil and horrible suffering where possible, but we also need to learn, not only to accept, but to benefit from, whatever suffering remains.
• Rollo May: the therapist enters the circle of the patient's existence wherever the patient happens to be...Usually, the patient comes with a problem...Whatever the problem is, May teaches that the existential therapist meets it first as a person's experience, not as pathology, nor in any other theoretical way.
• Angst and the awareness of death
• Nudging the patient toward the "I am" experience
• Leston Havens: "soundings," probing comments rather than questions
• "motor empathy," using non-verbal communication to empathize
• hold opposing theories in your head at once
• therapy is "successive acts of liberation, not moving speeches or penetrating insights"
•  "I judge the success of psychotherapy in two ways. Does the patient's appearance change? Does he get new friends?"
• the therapeutic alliance; he was convinced that this relationship was the key treatment

 


notes

• depression a sign that we are at a dead end
• using depression to help understand normal problems
• I think the old term (neurotic) - now discarded for the fancier terms "dysthymia" and "generalized anxiety disorder" - was more true to reality
• depression disease vs non-disease
• recurrence key aspect of disease
• "first cause" - genetics (additive, not Mendelian) and early life environment
• "efficient cause" - life events as triggers
• mental health clinicians should be biased against common sense, because anything that comes their way has already failed to respond to it
• depression expressed as psychic vs physical pain, in diff cultures
• disease process vs clinical picture
• the feeling comes first, the rationalization comes later
• in usa, psychiatrists prescribe meds to 82 percent of patients
• psychiatric drugs second most profitable class (cardiology 1st)
• hippocrates - nature wants to heal, physician should aid nature,
• galen - illness is lack of humoral balance, always intervene
• Osler's Rule - treat diseases, not symptoms
• Holme's Rule - all medications are guilty until proven innocent
• recent study: half of people diagnosable with mental illness not in treatment, and half of people in treatment not diagnosable
• history of DSM and depression
• Frankl - an abnormal reaction to an abnormal circumstance is normal
• learn to suffer
• Havens - goal of therapy is "successive acts of liberation"
• Havens - work with comments, empathy, rather than questions
• Havens - "just as conventions and expectations can fix a lethal straitjacket on individual differences, so standards of health on the basis of admirable traits ignore the way human situations an call up the need for the most bizarre qualities"
• "norm" - what is typical in a group
• "normal" - absence of pathological
• "ideal" - theoretical standard
• Havens - "hold your formulations lightly, and let your imaginations grow, remembering that all formulations used to be imagination"

Conquering Depression

Heavenly Wisdom from God-illumined Teachers on Conquering Depression - St. Herman of Alaska Brotherhood

What's the angle?
   The library office at Richmond Hill has a dozen or so books from the press of St. Herman of Alaska Brotherhood, mostly Russian Orthodox stuff, or things based on the Philokalia. Really cool. 
   This book begins with a very brief testimonial about Maria of Gatchina, who, during a paralyzing illness, was blessed with the spiritual gift of "consolation of the sorrowing." People from all around came to her for illumination, comfort, and counsel. Later she was imprisoned for her faith and died a martyr.
   The rest of the book is made up of teachings and prayers about depression from the Orthodox tradition, from Paul, early Greek writers and desert fathers, on up to the 20th century. The bulk of the excerpts come from 18th-20th century Russian monks.

What is depression?
   I loved both the unity and variety of this book. Depression, dejection, despondency, insensibility, sorrow, grief, despair, gloom: the authors witness to all these and more. Is this depression in the modern, western sense? Definitely so, at least by DSM criteria.
   Mostly what the monks address are prolonged periods (weeks, months, or years) of low or sad mood, a feeling of spiritual disconnection, a loss of the hope or sensitivity to life, loss of energy for their normal activities, feeling like their lives are pointless, overwhelming guilt or shame. The only criterion that doesn't appear here is suicidal ideation or attempts (except when in reference to Judas).
   Despondency may be the word most used in this collection. I'm not sure, maybe dejection or depression. I'm guessing "acedia" or a Russian version of that is the key orthodox term in play.

What causes depression?
   Again there is diversity, with common threads. Here are some diagnoses:

• the devil or a demon of gloom is attacking you, draining you, clouding your spirit and dulling your mind, trying to convince you to give up the monastic life
• God is punishing or disciplining you for some sin
• God is testing your faith; will you love God in the bad times as well as the good?
• God is forming you with the hammer of suffering and deprivation
• you're thinking too much about yourself, about what you lack, or about your past sins.
• it's part of the natural up's and down's of monastic life

Practically, it might be your fault, it might be the devil's fault, or it might be God's fault, but one way or another depression is always defined or explained vis-a-vis God. For the monastic, God is the ultimate reference point, and every experience is caused or allowed by God and, to the eye of faith, leads to God.

How do you "conquer" depression?
   You don't. According to most of these writers, if you live right, then eventually it goes away, or God sends you consolation in the midst of it. I'm not sure why the editors chose "conquer." "We are more than conquerors." It fits with the spiritual battle language, but "resist" or "endure" appear more often here. Here are some treatments:

• Repent! Drop to you knees and pray for forgiveness and begin again. Perhaps you know you have sinned or been forgetful of God. Perhaps God will reveal a hidden sin to you. (this seems a dangerous tack for someone who is depressed, but I guess it worked for many of these folks) In any case, the monk's life is one of constantly (re)turning to God.
• Resist! Don't give into the despair. Don't leave your cell, or abandon your calling. Keep up your prayers, even in the sorrow or pointlessness. Eventually you will come out of the dark cloud.
• Be humble. Bear your cross patiently. "By your endurance you will save your souls." Jesus has "sanctified the road of suffering with his feet."