Book Feature: Demons and Devils by Amanda Jayne Forbes

This is a compelling story about the evil that lives among us from day to day. There are many demons and devils. You may ask how one may know the difference. To most people, you may not, but I have realized from a young age that I have an exceptional ability to see through people—I mean, right through people. Sometimes it was as if they were not there at all. Then I realized this was some sort of block from that particular being. I would go, like, completely blind. It would be like a warning that this person is from what we call the dark side.

Book Feature: Great Objectives by Robert Finch

In his book Utilitarianism, John Stuart Mill refers to the great objects of human life. We may assume that that what Mill calls an object is the same as an objective in modern parlance. The examples of great objectives that Mill cites include power, fame, and money. One wonders how seriously Mill was actually endorsing such aims to be the overarching objectives of living or whether he was simply expressing his finding that many people actually do take such aims as these for life. The contention is that Mill was indeed recognizing that people do choose such goals in life. After all, happiness has been recognized as an objective of life at least since the time of Aristotle, and virtue has a similarly ancient pedigree. It is quite common for ordinary people to adopt such mottos as “Healthy, wealthy, and wise” as aims for life. But we know that having more than one such value can lead to conflicts. This had been a concern to Sidgwick as well as other nineteenth-century moralists. A resolution to the problem was found by the time of the twentieth century, when it was realized that we should not try to achieve definite objectives, but instead look to some other procedure, such as a variety of evolution, to shape our objectives. In that case, we make plans and evaluate them, as we proceed. We should use our values, as Dewey recommended, for guideposts. The book discusses the methods of arriving at such plans and weighs some of the ethical and moral problems an individual or a society might face at the present time.

Robert Finch is the author of five collections of essays and co-editor of The Norton Book of Nature Writing. He broadcasts a weekly commentary on NPR and serves on the faculty of the MFA in Writing Program at Spalding University in Louisville, KY. He lives in Wellfleet, MA.

Guest Post from Dr. Patrick Mbaya, author of My Brain is Out of Control

Although Dr. Patrick Mbaya’s illness caused a lot distress and nearly took his life, the emotional symptoms of the depression he developed helped him understand and empathize with patients and how they feel when they become ill. In My Brain is Out of Control, Mbaya, fifty-five and at the peak of his career, shares a personal story of how he suffered from a brain infection in 2010 that caused loss of speech, right-sided weakness, and subsequent depression. He tells how he also dealt with the antibiotics complications of low white cell count and hepatitis. He narrates his experiences as a patient, the neurological and psychiatric complications he encountered, how he coped, and his journey to recovery. Presenting a personal perspective of Mbaya’s illness from the other side of the bed, My Brain is Out of Control, offers profound insight into battling a serious illness.

GUEST POST

CLINICAL DEPRESSION

 Clinical Depression is a common illness, different from ordinary sadness, which is a normal reaction. It can affect anyone, including doctors like myself, and indeed I suffered from this, during my illness. It is not a weakness.

It may occur spontaneously in vulnerable individuals, like someone with a family history of depression. Severe stress or traumatic events in childhood, may also make an individual vulnerable to developing depressive illness, later on in life. Recent research has shown that this could be due to the effect of stress hormone cortisol, on the developing brain. Severe stress or loss events (like losing a family member) can cause (precipitate) it. In my case the brain infection I suffered, affected the limbic/emotional brain (see below).

Emotions, and certain behaviours are controlled by the limbic (emotional) brain. This is like a circuit comprising of connections from the brain stem (stem of the brain), to the front part of the brain (prefrontal cortex, the part in front of the motor cortex), then to the medial (inner side) of the temporal lobe structures like amygdala and hippocampus. In my case, it is the left prefrontal cortex, which is next to the motor cortex (which caused weakness on my right side) and the speech (Broca’s) area.

There are different theories about the biological causes of depression within the brain. However, there is a lot of clinical, and research evidence that depression is associated altered levels of chemicals (neurotransmitters) that control emotions, and behaviours. The two main chemicals (neurotransmitters) being serotonin and noradrenaline (also known as norepinephrine). These chemicals are made by the brain from the food we eat, like bananas (I asked my daughter to get me bananas during my recovery phase). Emotions and behaviours like mood, sleep, appetite, enjoyment, concentration, short-term memory, energy, and some forms of thinking are controlled by these chemicals.

There is both clinical, and research evidence that these chemicals become imbalanced, causing symptoms of clinical depression including persistent low mood, tearfulness, poor sleep, lack of enjoyment, poor concentration, short term memory, reduced interest in things, poor appetite, feeling negative (like focussing on past traumatic or unhappy events, or being emotionally affected by current sad events) up to including suicidal thoughts. (Recent research has shown that amygdala become very active in clinical depression, negative traumatic past events tend to re-surface and the individual becomes pre-occupied with these events, feels hopeless, worthless, and has suicidal thoughts, and these symptoms are reversed by effective treatment of depression). These symptoms tend to be worse in the morning (diurnal variation, possibly related to high levels of the stress hormone cortisol) and can improve later on during the day. Like in my case, my mood was worse in the morning. “I was emotional and found myself crying without a moment’s notice.”

As depressive illness can affect confidence, energy, motivation, concentration, short term memory, level of functioning is impaired (the ability to carry out activities of daily living, even to the point of being unable to work, socialise or to go to school). The World Health Organization (WHO) found out in a study (1990), comparing medical illnesses, that depression was four in the league table, as a cause of health-related disability. They estimated that by 2020, it will rank second to heart disease!

Current research has shown that severe stress increases the levels of stress hormone cortisol, which in turn reduces serotonin, noradrenaline, and brain-derived neurotrophic factor (BDNF, also known as brain fertilizer, which protects against cell death by cortisol), in the brain, causing depression.

Antidepressants work by increasing these chemicals/neurotransmitters (improving symptoms, and level of functioning), and may protect against severe stress causing depression. Psychological treatment like cognitive behavior therapy (CBT), is also effective in depression, especially in combination with antidepressants. Current guidelines recommend psychological treatment for mild to moderate depression, and antidepressant medication, plus psychological treatment for moderate to severe depression.

Dr Patrick Mbaya MD FRCPsych.

www.drpatrickmbaya.com

References: Cancel reply

Duman Ronald. Depression: a cause of neuronal life and death. Biological Psychiatry, 1 August 2004, vol.56:140-145  Cancel reply

Global Burden of Disease, World Health Organization, 1990.

Mbaya Patrick. My Brain Is Out Of Control. Author House. September, 2016

Shimizu Fiji et al.  Cancel replyAlterations of serum levels of brain-derived neurotrophic factor (BDNF) in depressed patients with or without antidepressants; Biological Psychiatry, 1 July 2003,Vol 54(1): 70-75

Stahl Stephen M. Essential Psychopharmacology, Neuroscientific Basis and Practical Applications. Second Edition.  Cambridge University Press.

Stress and Plasticity in Limbic System, Robert M. Sapolsky; Neurochemical Research, Vol. 28, No. 11.

Dr. Patrick Mbaya is a medical doctor specializing in psychiatry. He is a consultant psychiatrist and honorary clinical lecturer in psychiatry at the University of Manchester, United Kingdom. He has a special interest in mood and addiction disorders.