Why So Sad? Summer ’22 | Post 1

 

 

Why So Sad?

Exploring How Childhood Experiences Affect Our Brain’s Response to the Stresses of Adult Life  

10-minute read:

May 8, 2022: Heads up, this story touches on the subject of suicide. If you, or someone you know, is going through a mental health crisis please reach out to your local support line.

Section 1: The Thing that Hurts You So…

Early in 2018, seven years after Katrina died, I was eating lunch alone.

The good thing about being alone is it affords you time to quietly learn. Today I’m eating ramen noodles while listening to a conversation with Dr Rangan Chattergee and Johann Hari, author of Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions.

The reason I’m listening to this conversation, and the reason I’d read Hari’s book in the first place and found it so helpful, was because Katrina, my sister, died by suicide.

Right after that, in 2011, I travel back to Scotland to be with mum and stumble through the hurricane of tears that is the funeral. One of the things we do is visit Katrina’s psychotherapist. Consciously or not, we are attempting to find some logic, some reason. Why? We are trying to build even a moderately coherent narrative that will help us make sense of this lethal act Katrina has engaged in. An act that so many other humans have also tragically found themselves playing through.

The funny thing is, as I’m asking the Doctor questions about the circumstances—the amitriptyline prescription, the pain killers, the episodes of paranoia that Katrina displayed—the Doctor bluntly recommends we should, “not attempt to make sense of this.”

She proposes that we can never know why people snap and cross over into that state of total resolve to self-annihilate. It’s not the type of thinking I ever expect from a person of science— brick-wall thinking. I am not convinced. I think that she must be tired. I think maybe—as a professional dealing with this so often—she has constructed a psychological barrier to protect herself. Deeply exploring the causes of suicide is a realm that exists outside her shield. Fair enough.

We leave and—to her point—I am in no state to pursue more understanding. I’m going to need a solid eight years of grief, a shattered wrist, a career change, a 2000-mile move, the birth of my son and my own nervous breakdown, SSRI prescription and path to recovery before I’ll be psychically ready to dig any further.

Talk about placing some emotional distance between you and the thing that hurts you so.

So, in 2018 I’m eating these ramen noodles listening to Dr Chattergee and Johann Hari discuss the causes of depression. Hari tells great stories about researching for his book. At one point he tells of his encounters with Dr Vincent Felitti and Dr Robert Anda—two of the physicians who developed the ACE study. If you’ve ever been to the Doctor presenting with a mental health challenge then they may well give you the ACE test, or Adverse Childhood Experience test. It’s a series of 10 questions about experiences in your early life. It asks about abuse, neglect, food insecurity, alcoholism, drug addiction and violence in the household where you grew up. A higher ACE score indicates a statistically higher risk for health challenges later in life. It’s worth noting that it is very possible to live a healthy life despite higher ACE scores by developing resilience through protective factors.¹

The lesson from Felitti and Anda’s work is the connection they made between adverse childhood experiences and subsequent negative outcomes in adults.²

Hari describes how Dr Anda phrased it, “when you are looking at depressed and anxious people, or obese people, or so many of these problems, we need to stop asking “what’s wrong with you?” and start asking “what happened to you?””

Section 2: Reframing the Problem…

The foundation in developing any strategy is clarity and agreement on what problem we are solving. When we agree on that, we’re going to need to identify the problem’s causes. That requires us to ask the right questions.

Personally, I wasn’t equipped to clearly state my own problem, or know what questions to ask myself, until I was in my late thirties, in 2017.

From the age of 13, my main goal had been to become a professional skater. With that achieved and now receding in the rear-view mirror, it was no small task to re-think myself in terms of…the rest of life. I hadn’t planned beyond 30. My vision of the future had gone dark.¹

A couple of things happen that trigger a descent back into a very poor state of mind. I realize I have outlived my old man². At the same time there is  upheaval, change & loss in my professional life. Long-story short, I end up back in the clinic filling in an ACE test, being screened for mental health issues. I am diagnosed. I suffer from “depression”.

I had thought I suffered from this throughout my life, but this is the first time a medical professional has run me through an assessment and formally stated it. “Depression”.

Finally! The problem agreed upon. Now, how to solve it?

Ok. “Depression”. I am depressed. Why? What has caused this? At this point, confused, scared, sitting in this small beige room in the local urgent care—smelling of disinfectant, with the potted fern and the biohazard sharps containment box on the grey Formica countertop there—I know next to nothing about this subject. I am also incapable of reading & learning due to the frantic, corkscrewing, rollercoaster-ghost-train of thoughts racing through my depression-addled brain.

At one point, as I describe my situation, the Doc turns to my wife and asks, “Hmm. Delusions of persecution. How long has he been suffering from this?”

“Delusions!?” I think, incredulous. “How rude!” I think. “He clearly has no idea what’s going on!”

I have become deeply paranoid. We will need time and space for this to subside before I am ready to learn anything new. After a course of anti-depressants, some time to adjust to the new situation and develop some supporting relationships, I find myself with a more manageable brain, better equipped to learn and grow. I begin to plan again. To imagine a worthwhile future.

In reading about mental & emotional health & wellbeing, I find my way to the work of neurobiologist, Dr Bruce Perry.³ Perry’s work builds on the findings that the ACE study uncovered. His recent book—in partnership with Oprah Winfrey—is completely based on reframing the problem statement so we can better zero in on its root causes. The Doctor in the urgent care had helped answer the question, “what’s wrong with me?”  Like, right now. We answered that and we treated the current symptoms. The more important question to then ask is, “what happened to me?” In effect, why does my adult brain respond the way it does to life’s stresses?⁴

One way Perry’s work builds on the findings of the ACE study is to look at the biomechanics of our brains. He specifically studies the sequence in which all our bodies process the cacophony of information the world throws at us every moment—our brains’ specific order of operations.

My personal, armchair-psycho-therapist interpretation of the findings so far is as follows: basically, everything we think is based on what we experience through our senses. Everything comes in through sight, sound, taste, smell, touch—including signals from inside our body, like hunger and thirst. The first port of call is the oldest part of our brain, the brainstem. The so-called “lizard brain”. Before we even think a thought, our brainstem will get us into a state of readiness, deploying neurochemicals like adrenaline and cortisol. Input first, then output. In the language we may be familiar with, we are placed into some level of the “fight or flight” response⁵.

How intensely we experience that state of readiness is dependent on all the scary moments— the doses of stress—we experienced as children. It is then that the brain learned to do this. It is that feedback system that has kept us alive. All eight billion of us.

The point here is that stress is ok. We need some stress in life to learn and develop resilience. The problems arise when we get too much stress too often and our autonomic response system gets all over-sensitized.

Practically, “over-sensitized” means a more intense fight-flight response. As that response intensifies so our ability to think rationally—and respond logically—decreases. Or the more we experience an overblown stress response without knowing what’s going on, the crazier we feel—while in a state where our ability to think rationally is hampered by all the stress chemicals our over-reactive brain is firing off in its effort to help us survive. It’s important to remember that we have all had different experiences growing up and therefore will respond differently to the same input.

That’s the basic overview.⁶

Long story short, Dr Perry has focused on answering the question, “what’s wrong with me?”, by first asking the question, “what happened to you?”

What did happen? How did my brain, or my friend or loved one’s brain, get like this? And can we learn to manage it? How?

We’ll get to that in the next essay. If you want to jump ahead, you can read or listen to the book⁶ and/or this series of videos by Bruce Perry is fascinating. [Neurosequential Stress & Trauma Series]

 

Footnotes to section 1:

1. You can read more about the ACE test, and its limits, on the page Harvard University have on their site.
2. This also correlates with the themes Richard Heckler identifies in his book, Waking Up, Alive.

Footnotes to Section 2:

1. This is one of the symptoms of a brain that has reached that state we call depression.
2. He had died, after a few years of chaos, when he was 39. I was 13 and Katrina was 9.
3. Thanks to a friend I initially met at the Pushing Borders conference who works at a trauma-informed child development center in Canada and uses skateboarding as one of their therapeutic tools. And then further thanks to Oprah Winfrey who has been a champion advocate for trauma awareness much more broadly.
4. Stresses other people seem to deal with just fine, or at least without getting to the point of almost destroying a marriage and the need for intervention from the pharmaceutical industry.
5. The full range of states we can land in is more like: “reflect” when we’re good and thinking normally up in our big-brain neocortex; “flock” where we get a bit more wary and search for safety; “freeze” where we start to experience alarm and dissociation; then flight and fight when the brainstem is basically in charge. This is my understanding, feel free to debate.
6. I highly recommend you read the book What Happened to You? By Bruce Perry and Oprah Winfrey if you want to get a deeper understanding of this whole process. It’s been a game-changer for me. I hope it can help you too.