None of us is stranger to suicide and mental illness. We all know someone who is suffering from some sort of mental illness or someone who has committed suicide. It is so common that more people die of suicide than through homicide.
How fragile are our hearts, how vulnerable are our lives, our hearts, and how easily we can lose our souls? At any moment in time, something unfortunate might happen and we may cease to exist. Such uncertain is life. Even though there is truth to all this but it is such a pessimistic outlook towards life. Life is full of wonderful experiences, filled with the delightful moments that we spend with our loved ones, having adventures, partying with friends, wanting to make loads of money and experience the joys of carnal pleasures. One day we’ll all die but till then we should live and enjoy life to its fullest. Life is a gift after all which shouldn’t be chucked away. We should see life with such optimism.
In these two points of view towards life, the pessimistic asks: How long are you going party? How long can you have adventures?How there will be cheer and joy in your life? what if something goes wrong and misfortune strikes? How will you feel when you are old and sickly? For some of us, things work out the way we want but not for all. In olden days we used to categorize people as fortunate and the unfortunate ones. Now a days we believe that everyone can live a very cheerful life with higher standards of living if we work hard and smart. Luck does play its part in our lives but so not without ourselves working towards our goals. Sooner or later, we will have to face the blows of life, growing old, losing our dear ones, getting diseased, etc. But again, the gospel rings, live in the present and not in the past, don’t worry too much about the future. Why worry? Whatever will be, will be. Que será, será.
Let us keep aside these rhetorics and get to the point. What exactly is depression and why do people commit suicide? Short answer: We still don’t know everything about it yet. I am not a mental health expert. These are my views, my understanding of the subject and my personal experiences with depression.
Existential philosophers have put in a lot of thoughts into this subject matter of depression and suicide. They have discussed in length on the meaning of life, how to live, how to deal with an existential crisis, etc. Their thoughts are insightful and a necessary narrative for us to pay attention. But the field of medical sciences differs a lot from the perspective of the existential philosophers. The medical sciences call these “mental states“, mental illnesses. Illness, implies, that something is wrong and requires remedies or treatment. Whereas, the existentialists, see depression as a side effect of the “human condition“.
I will attempt to bridge the gaps between the philosophers and clinical psychologists in this post. Let us for our convinience term the depression described by the philosophers as “philosophical depression” and that by the medical sciences as “clinical depression”.
Everything is made of atoms and molecules, even our bodies. We are organisms. Organs in turns are made of cells. Cells are composed of water, inorganic ions, and carbon-containing (organic) molecules. 70% of each cell consisting of water. Our brains are made up of cells. Our brain cells are a bit different from the cells that form our other organs. The structure of the cells which form our kidneys are different from those that form our lungs. The brain and spinal cord are made up of many cells, including neurons and glial cells. Neurons are cells that send and receive electro-chemical signals to and from the brain and also form the nervous system. There are about 100 billion neurons in the brain. There are many more glial cells; they provide support functions for the neurons and are far more numerous than neurons.
There are many types of neurons. Neurons are nerve cells that transmit nerve signals to and from the brain. The neuron consists of a cell body (or soma) with branching dendrites (signal receivers) and a projection called an axon, which conducts the nerve signal. At the other end of the axon, the axon terminals transmit the electrochemical signal across a synapse (the gap between the axon terminal and the receiving cell).
This is the mechanical part of the brain. In the simplistic form, we can say that the brain is an electrochemical electrical circuitry. The circuitry is like a huge grid of interconnected switches that turn on and off as per the signal they receive. Human beings have one of the most complex brain forms on the planet. Existential philosophers have little interest in the mechanics of the brain. But in order to understand depression we have to pay heed to the mechanical aspects as well.
Imagine, if you are presented with an infinite amount of switches and wires and asked to connect them in a fashion that the circuit becomes conscious of it’s self and existence how would you proceed? Immediately, you realize the complexity of this task. We human beings have built machines like the computer which carry out functions similar to what we do but a conscious machine is yet out of our reach. We are conscious beings and also intelligent beings but we struggle to understand consciousness itself. What is consciousness and how does it emerge out of the network of neurons? The answer remains unknown.
Our mysterious brain has a certain dualism to it. One is the organ brain consisting of tissues and the other is the mind which is devoid of matter itself. The mind is the conscious entity and realizes its identity. The mind knows the “I”. The mind is usually seen as an entity with various degrees of consciousness. They are fully conscious, semi conscious, subconscious and the unconscious. The brain, on the other hand, consists of various parts or areas responsible for certain functions. Some part of the brain deals with bodily movements, some part deals with memory, some with thoughts, some with emotions, certain parts with language, etc. There are overlaps in the functions that the brain does. For example, the language areas of our brains are overlapped with memory areas and limbic areas. The mind is not independent of the brain and how the regions of our brains function. Poets have different brain wiring than those who have language learning difficulties. The structuring and wirings of every brain are different. This gives rise to uniqueness to individuals. Also, the brain’s wiring is not constant. The brain of a newborn is not fully developed and the brain grows along with the baby and develops over time. With time, the functioning of our brains also starts deteriorating like we find in the case of the elderly who suffer from problems like dementia which causes memory loss and diminished brain function.
Brain cells form and deteriorate all the time and are replaced by newer cells. The brain circuitry is ever-altering. Creation of new memories, having a headache, dreaming, learning to play a musical instrument, etc are activities altering the brain’s circuitry all the time. This phenomenon is called neuroplasticity.
Now with the basic understanding of the brain, we will move towards our subject matter and try to understand (so-called) mental illnesses. Why do we call these mental states and certain behavior patterns as mental illness? Is it justified to call them illness? To call someone ill we have to compare it with someone healthy. As we know it, every brain wiring is different and that makes each of us unique so there is “not one standard” brain to which we can compare. But we can have a collection of brains to which we can compare and term these brains as standard functioning brains. So in this way, we can have extrovert individuals as well as introvert individuals and term them as “normal brains”. Our bodily functions operate within certain ranges and we term them as normal if the measured value falls within those standard ranges. For example, there’s a range of body temperature. Anything below or above that range is considered abnormal. For human behavior, we do not have direct means of measurements but a set of norms that we consider as normal behavior. Certain behavior can be considered normal within one culture whereas might be termed as abnormal in another. For example, cannibalism will be seen completely normal within a cannibalistic tribe whereas considered an abnormal behavior in civil societies. So there are exceptions and variations in what we term as normal behavior.
Our mind forms concepts and perceptions. Through them, we interpret reality or our surroundings. Our cultures, traditions, education, beliefs, etc are “values” which form these concepts and perceptions in our minds. Even if our values differ between different minds, we cannot term them as abnormal brain functioning. One of the concepts that we cherish is that of happiness. We have been bombarded with the idea that cheerfulness, optimism, and pursuit of happiness are acceptable virtues to have. Thus, in recent times pessimism is considered a negative trait to have. Pessimism is not a mental disease. Our minds, constantly judge our surroundings and events taking place arround us and assign them values. Our minds have preconceived biases and outlooks towards the way we deal with future outcomes. We perceive risks and opportunities differently. Two different individuals may value something at two different levels. These are entirely normal behavior.
Pessimism is not depression. Pessimism is rather a personality trait and at times even outlook towards life and the world. Nor is depression sadness. Nor a period of grief or bereauvment can be termed as depression. Heartaches are not depression either. Depression is a term given to a set of mental illnesses. It is an illness because the mind operates differently from that of a healthy mind. Depression is a disabling illness. A person with diabetes can go along with daily activities with some changes to their lifestyles but it is entirely different for those suffering from depression. They may be incapable of performing mundane tasks. The life of a person suffering from depression becomes very difficult due to the lack of awareness among us and also because its a disabling disease, things might spiral out of hand pretty soon. There are social stigmas attached to depression and a plethora of myths surrounding depression. The biggest problem is to accept that a person has depression and seek treatment. The consequences of depression can be fatal. There are several statistics that tell us how common and severe the problem of depression and suicide is. Having said that, there are plenty of psychiatrists and medical professionals who diagnose every mental condition/mental disturbances as a mental illness and do more harm than good.
The human brain is the most studied organ and the human mind the most mysterious. We do not understand many of its inner workings. But depression is not just a mental disease but it can also be due to biological factors. Besides the brain, there are other organs at play. The endocrine system plays a role in our well being. For example, symptoms of hypothyroidism (under-functioning thyroid glands secreting more TSH than normal) show symptoms similar to that of depression. Hormonal imbalances can throw a person into depression. But as I said earlier, that the malfunctioning endocrine system might be just one of the factors. The brain itself may have abnormalities that give rise to depression. Areas of the brain that play a significant role in depression are the amygdala, the thalamus, and the hippocampus. In short
Amygdala: The amygdala is part of the limbic system, a group of structures deep in the brain that’s associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. The amygdala is activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or depressed. This increased activity continues even after recovery from depression.
Thalamus: The thalamus receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning. Some research suggests that bipolar disorder may result from problems in the thalamus, which helps link sensory input to pleasant and unpleasant feelings.
Hippocampus: The hippocampus is part of the limbic system and has a central role in processing long-term memory and recollection. The interplay between the hippocampus and the amygdala might account for the adage “once bitten, twice shy.” It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of nerve cells in this part of the brain.
Brain cells usually produce levels of neurotransmitters that keep senses, learning, movements, and moods perking along. But in some people who are severely depressed or manic, the complex systems that accomplish this go awry. For example, receptors may be oversensitive or insensitive to a specific neurotransmitter, causing their response to its release to be excessive or inadequate
Kinds of neurotransmitters: Scientists have identified many different neurotransmitters. Here is a description of a few believed to play a role in depression:
Acetylcholine enhances memory and is involved in learning and recall.
Serotonin helps regulate sleep, appetite, and mood and inhibits pain. Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin byproduct have been linked to a higher risk for suicide.
Norepinephrine constricts blood vessels, raising blood pressure. It may trigger anxiety and be involved in some types of depression. It also seems to help determine motivation and reward.
Dopamine is essential to movement. It also influences motivation and plays a role in how a person perceives reality. Problems in dopamine transmission have been associated with psychosis, a severe form of distorted thinking characterized by hallucinations or delusions. It’s also involved in the brain’s reward system, so it is thought to play a role in substance abuse.
Glutamate is a small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia. Lithium carbonate, a well-known mood stabilizer used to treat bipolar disorder, helps prevent damage to neurons in the brains of rats exposed to high levels of glutamate. Other animal research suggests that lithium might stabilize glutamate reuptake, a mechanism that may explain how the drug smooths out the highs of mania and the lows of depression in the long term.
Gamma-aminobutyric acid (GABA) is an amino acid that researchers believe acts as an inhibitory neurotransmitter. It is thought to help quell anxiety.
There are genetic causes of depression. However, having genes for depression doesn’t always mean that the gene will be expressed and the individual will experience depression. On the other hand, stressful events taking place in our lives and the way we tackle it leaves an imprint on our genes as well. Thus, it may be that a stressful episode that an individual is undergoing now may be seen getting expressed as depression down with one of their coming generations.
Feelings, emotions, moods, thoughts, euphoria, pain, hallucinations, seizures, anxiety etc are thus neurocircuitry and neuro activities within our brain. As we have discussed earlier that the circuitry keeps changing or maybe wired differently right from the start. There are a set of factors that contribute to a person’s mental illness. Traumatic episodes, stressful occupations, relationship failures, disabilities, diseases, financial difficulties, etc are obvious ones. But, it may also be a philosophical depression. Some individuals may find no meaning or purpose to live. It may seem to them as everything is temporary and in the end, it’s not worth chasing ambitions and desires. Sometimes the pleasure centers of the brain go numb altogether or there is a reduction in their function. This makes it difficult for the person to have “experiences”. Lack of experience makes life mundane and dull. Boredom creeps in. Social relationships take a blow. And the person spirals into isolation. As Schopenhauer puts in that “a man cannot will what he wants to will”. Our likes, dislikes, motivations, ambitions, desires, the will towards life and survival arises from the instinctive subconscious parts of our minds. Sometimes these wills simply don’t have enough strength to drive the person. And they simply can’t snap out of it.
Not all depressed people end their lives. However, in the phase of depression, a person undergoes severe mental stress and even pain. They wish to break out of the phase of feeling miserable. Life feels suffocating. With all the wills fallen silent, there is just noise filled inside the mind. Like someone constantly yelling inside you. They feel despair. Burdensome and dependent. They feel tired all the time. Simple tasks like grooming, tidying the room, fetching groceries, hanging out with friends, socializing, etc feels like a huge task. With increased levels of stress, the immune system also breaks down as well as the endocrine system. A depressed person will develop insomnia or will sleep excessively, having eating disorders, fall sick often and show signs of diminishing health. Their minds are obsessed with getting out of a miserable situation. They feel like a burden to their family and friends. A sense of worthlessness creeps in. They feel that things would be better if they cease to exist. Or that it doesn’t matter if they live or die. No one notices them anyway. These are some thoughts that turn them towards suicidal thoughts. This is called as suicide ideation. Depressed people obsessively feel hopelessness, isolation, unwanted, disregarded, suffocated, out of energy and think about ending their lives. They think of jumping ahead of a running car or a train, overdose themselves with pills, drown themselves, set themselves on fire, fire a bullet in their heads to silence it or hang themselves. Depressed people have episodes where they suffer from anxiety attack episodes and tend to overdose and sometimes die by overdosing. Some indulge in self-harm and they tend to make themselves believe that the pain of ending their life is something they can withstand. They might experiment by hurting themselves a little bit every now and then. But once their mind is made up and they feel that they can’t take it anymore, they’ll go for it.
A depressed person basically finds themselves trapped. Trapped within themselves. It takes medical treatment and support and understanding from our fellow beings to save these souls. There are social stigmas attached to suicide. Many countries have criminalized suicide. It’s not a sin. Every individual has the right to chose what they should do with their own life, even if it is to end it. One must, however, grant them the dignity to make that choice if that’s the only option they see deem fit for themselves. If you are suffering from mental illness or feeling suicidal, please speak out and seek help. There is no shame in helping and getting help. That’s why we are social animals, capable enough to look after the well being of each other.