‘Appigenetics

April 1, 2011 at 7:53 pm (By Amba)

I owe the title of this post to The Anchoress, whose first son, when he was little, would peer into his parents’ faces and ask, “Are you ‘appy?”

The Anchoress writes a provocative post about that question, which two nuns with microphones asked random people on the streets of Chicago in 1968 (clips from the resultant documentary are in Elizabeth’s post, along with the schedule for the documentary itself on Chicago’s PBS station).  It turned out not to be such an easy question to answer.  The Anchoress provides one answer, though, that I strongly relate to:  she links happiness to gratitude.

I e-mailed her (forgive me for being lazy and pasting instead of posting; it’s actually because I have so much else to do):

It’s a marvelous question, and suggested answer.  Definitely, focusing on how much has been given, rather than how much has been (and will be) taken away, is a reliable formula for happiness.  I wonder whether it is a matter of will and choice, or temperament.  Some people just chronically think the other way.  Is it just a habit?  How does that originate?  Maybe there’s a neurochemical predisposition, but at some point the habit gets established — possibly because it works as a twisted strategy for getting one’s needs fulfilled as best one can in situations where the direct approach is verboten.  “Poor me” can be a perversely gratifying identity.  And then the habit changes the neurochemistry.

Epigenetics is now demonstrating that our experiences and choices can change us right down to the genes: that is, the interplay between our experiences and habits actually alters gene expression.  And it seems likely that changing our habits can actually change gene expression.  (I suspect that practicing karate has changed me that deeply.)  Could chronically unhappy people — who may be resigned to “This is just the way I am,” either because of inborn temperament, indelible trauma, or ingrained adaptive strategies — change themselves through a practice of gratitude?  (This is what is implied by the Japanese form of psychotherapy called Naikan.)

The current mainstream assumption is that people are at the mercy of their given neurochemistry — whether given by nature, nurture, or both — and often the intervention of first resort is pharmaceutical.

I’m sure Pfizer et al. are grateful.

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27 Comments

  1. Ron said,

    Gratitude is the way you tell yourself how important other people are in your life. It has a kind of bell-like resonance for me.

  2. Donna B. said,

    One reason I’m a fan of drug therapy is that I’ve witnessed what can happen when people whose brains/bodies apparently cannot produce what is needed for feelings of happiness and worthiness no matter how hard they try or how supportive their family and friends are.

    Part of what I’ve witnessed (and experienced, still experiencing) is what happens when something goes wrong with the brain. So far in my immediate family this has been from accidental closed head injuries, strokes, tumors, and most recently hydrocephaly.

    I also know first hand that experiences that don’t necessarily produce a “visible” brain injury certainly have an effect on brain chemistry. PTSD is a beginning diagnosis to finding out what’s going on with brain chemistry here… and one of the most intriguing findings (to me, so far) is that treatment with pain-killing drugs immediately following whatever incident dramatically decreases the probability of long-term difficulties.

    Finally at an advanced age I’ve learned that what is emotionally bearable for me might not be so for some one else. I’ve also learned that I’m not emotionally invincible and that some of my “coping” techniques might have been immediately successful and longterm hurtful.

    So… yeah, I toughed it out. Instead of anti-depressants or other controlled drug therapies, I toughed it out with nicotine, alcohol, and suppressed anger. And a few other “coping” skills I’m not willing to discuss here.

    I am a member of a huge extended family. I have 19 aunts and uncles and more cousins than I can count. I have always known that I could ultimately go home to them and lick my wounds and they would still love me… but I have also always known that I want to make them proud of me.

    No… I want to be proud of me. They are anyway… they have always been.

    So… I ask, must one hit the bottom before being able to resurrect oneself? Is it that drugs prevent hitting bottom that makes them undesirable? Of course, that question assumes that drugs can prevent one from hitting the bottom. I suspect that drugs can help by cushioning the descent, perhaps preventing hitting the lowest department of the bottom. Perhaps… saving a life long enough to drift upward a bit.

    Is that a bad thing?

  3. amba12 said,

    treatment with pain-killing drugs immediately following whatever incident dramatically decreases the probability of long-term difficulties.

    I hadn’t heard that, that’s fascinating! What kind of pain-killing drugs? Opioids? NSAIDS?

    I don’t object to the use of drugs per se, and it would certainly be both arrogant and idiotic for me to object to them for everyone, or even most people, since everyone’s different. I think your comments about how destructive “unmedicated” (not! — self-medicated, in so many cases) coping strategies can be is fascinating and wise.

    What I object to is the indiscriminate use as a first resort of drugs (probably because they’re cheaper and quicker and more function-focused than therapy) that we really don’t know all that much about yet, particularly their long-term effects on the brain, particularly of young people. (Again, I do NOT mean to make an absolutist pronouncement.) A drug that we know somewhat more about (we don’t yet know enough about the brain even to fully understand old familiar drugs), cocaine, first brings a rush of powerful pleasure and later nearly destroys the brain’s ability to feel pleasure. Certain receptors are apparently downregulated. Can they come back? How long does it take? One is forever after in danger. Who really knows what happens if you continue to take SSRs for a long time? if you stop them? Don’t serotonin receptors get downregulated in the presence of more serotonin in the synapse? And then what?

    I say this from the perspective of someone who, if I were an adolescent today, surely would be medicated. No one thought back then that I should be medicated, partly because there wasn’t anything but tricyclics available, partly because I wasn’t able to articulate my distress — not only would I not have known how to explain it, I was ashamed of the hollow, worthless feelings that today would be labeled “depression.” They were not SO disabling that I wasn’t able to hide them and to at least do decently in school (which was all anyone cared about in those days; I once went to the Harvard health service inarticulately seeking some kind of help, and they said “Can you study?” and when I said yes, dismissed me). I don’t know that my coping strategies were “good.” Fortunately they were not flagrantly self-destructive; they were more like quiet desperation. I did finally get into psychotherapy, which was what, in those days, we all believed was what neurotics needed — only to meet Jacques and be prematurely pressured out of it by him, ostensibly because he thought I shouldn’t be spending my parents’ money that way, probably really because he didn’t want anyone getting a good look at HIM, even second-hand, or because he thought “the shrink” would advise me to get away from him. I had “Jacques therapy” instead — pun very much intended. It was suddenly sink or swim, and that was weirdly salutary. (He was both a very screwed up trauma survivor and a down-to-earth wise man, simultaneously.) Plus, he got me into karate which gave me the strength to cope with him — and which acted as a very effective antidepressant.

    So we bumbled through and wound up sort of healing each other, at the expense of nearly everything else we might have done with our lives, from being financially solvent to having children.

    And the moral of the story is? Some of us who are wounded, probably even neurochemically, can survive and get better without depending on drugs (legal or illegal). Life itself can destroy you but with patience and self-forgiveness it can also challenge, soothe, and heal you. All that is a good thing to find out. I might have had a more “normal” life, maybe, if I had been medicated. I might have missed some heights and depths that I wouldn’t have missed for the world.

    But drugs are like weapons; if you have them, you’ll find it hard not to use them. How can you deny a distressed young person drugs, especially when you know how precarious and impulsive young people’s despairs are? It’s frightening to have a depressed kid. Kids have no patience with themselves, and their parents are in a panic too. And therapy is too slow, dubious and expensive, and few people believe in it any more, which is enough to make it lose whatever power it ever had. I’m just kind of amazed by my next-generation friends who, when they are depressed, wonder what neurotransmitter is out of whack instead of what their depression means. Sometimes I feel as if I can see a possible meaning that they’re not at all interested in, possibly because facing its meaning really WOULD challenge their unproductive coping strategies! So much easier to take a pill than to say, “This relationship sucks” or “The emperor has no clothes on.” There’s a twist for you! “Functioning” (machine language, please note) has replaced meaning. Maybe, like physical pain, psychic pain is trying to tell you something, and drugs silence it so you don’t get the message.

    But then again, maybe what psychic pain is trying to tell you is that human life is an insoluble dilemma no matter what aids we resort to. And then you die.

  4. Icepick said,

    Life itself can destroy you but with patience and self-forgiveness it can also challenge, soothe, and heal you.

    Life can destroy one in ways that aren’t at all metaphorical. If one goes *SPLAT* on the pavement, that’s it. Not much of a learning opportunity!

    I might have had a more “normal” life, maybe, if I had been medicated. I might have missed some heights and depths that I wouldn’t have missed for the world.

    I’m not sure how depressed you were if that’s the case. When I finally quit fighting it on my own (in my mid-30s) and started taking buproprion my life changed. At that time I had arrived at a state where I had two emotions – a black rage against everything, and total despair. The black rage was the better mood of the two. At that time in my life everything was actually going well – I had no reason to be depressed. I had had it, and when my wife told me to go see someone, I did. Within two or three days of taking buproprion I felt like a human being again.

    This particular drug doesn’t make me happy – it just allows me to feel a normal range of emotions. (Or a more normal range, at least. So I can be sad, or happy, or annoyed, or just plain ‘blah’. But I get to feel, and that’s a helluva thing.

    So now, three years into an unemployed part of my life that won’t end, I feel “depressed”, which is nothing at all like what I was going through six years ago.

    I won’t say that drugs are the only way to go, but they’ve got their place. Popping a pill once a day is probably more fun than electro-shock therapy….

  5. amba12 said,

    I couldn’t agree more that they’ve got their place, and one of their places is obviously in your bloodstream and brain.

    I also don’t doubt that karate’s antidepressant effect on me is substantially neurochemical as well as psychological. It woudn’t work for everyone.

    I was pretty depressed and paralyzed in my mid-20s, but not like you describe. Psychotherapy probably would’ve been enough (especially plus exercise). My point is precisely that someone like me is now routinely medicated, and it is not the only option. Perhaps it’s the most efficient one, but at what unknown costs?

  6. amba12 said,

    In that I include costs in future neurochemical mood regulation; costs in self-concept — what you are and what you are capable of.

  7. Donna B. said,

    “But drugs are like weapons; if you have them, you’ll find it hard not to use them.”

    If you mean that having a hammer makes problems look like nails, I would agree. I think some doctors do operate that way where drugs are concerned, but it’s much more likely to occur with drugs like statins rather than SSRIs.

    Then there are doctors who will not prescribe certain drugs because they consider them too powerful a weapon regardless the proven need. My son battles constantly to get prescriptions for one such drug that combats the side effects of the drugs he has to have to regulate dopamine. (The substantia nigra was one part of his brain that was seriously injured.)

    Where you think you might have had success with talk therapy, I swear to you it can be quite destructive with long lasting side effects. There are a few therapists I’ve read on the internet that I think may be very good at what they do, but in the 30 years since my son’s injury, I’ve never run across one in real life – for myself or my son or family members with other problems.

    It’s much easier to stop taking a pill than it is to end a toxic relationship with a bad therapist.

    I’m not saying that pills are always the answer, rather I’m saying they are more likely to be an answer than talk therapy in a lot of cases. Karate as a therapy combines perhaps the best of pills and psychotherapy with both neurotransmitters and a safe, structured setting.

  8. amba12 said,

    I’ve always been personally suspicious of therapy because there’s something creepy about the idea of a one-sided, remedial, paid relationship — like emotional prostitution. When I did start to go, though, I searched doggedly for a therapist I liked; in fact, I got an appointment with a well-known one whose book I had liked, asked for recommendations, and then interviewed three — screwed up as I was. (And I was; I felt inhibited, remote, and unreal when talking to people, including all these therapists.) It sounds like such a luxury from an era when there were fewer people, more time, and more money. And yet, there was a belief in the riches and drama of the inner life that seems to have dried up. Good riddance? Mere narcissism?

  9. Donna B. said,

    Icepick – it’s good you got put on bupropion. It has been prescribed for me, my son, and my sister and it’s one that none of us can tolerate. In us, it tends to generate what it helped fix for you.

    One of the reasons I prefer not seeing a psychiatrist even for drugs is that they are more likely to say things like “you just didn’t give the drug time to work” when it is has an adverse side effect. A family doc or internist is much more likely to say “stop taking it and we’ll look for another way” much the same way they do when finding a drug therapy for high blood pressure.

    Amba – here’s one article about PTSD and opioids:
    http://www.time.com/time/health/article/0,8599,1964782-3,00.html

  10. Donna B. said,

    like emotional prostitution… hmm. Interesting. And is there a 3rd party pimp?

    We were raised in different cultures (mine rural, western & southern, poor) and the people who were interested in rich inner emotional lives and drama were often called “pot-stirrers”. I don’t think that’s what you’re referring to, but I’m not sure I have a reference point in common with yours.

  11. amba12 said,

    The people who were interested in rich inner lives were mostly urban, relatively affluent, educated, neurotic . . . I think psychoanalysis (with its risk of endless, fruitless Woody Allenesque self-involvement) replaced religion in liberal Jewish culture for a time. But it also goes back to the Romantics and bohemians. “Parasites” all :-P

  12. amba12 said,

    Still, the idea that insight can make a difference, can change behavior and feeling seems discredited … I watched the HBO show “In Treatment” for a while with some fascination. In it, the therapist eventually quit.

  13. amba12 said,

    That’s fascinating about the opioids. I can imagine the doctors saying, “What? You want to give addictive drugs to prevent later drug addiction??” Except in hospice, many doctors are reluctant to provide pain medications to terminal cancer patients for fear of addiction. It’s a crazy world.

  14. karen said,

    I love that you are exploring this topic and even more so that it’s an offshoot of A’s ~’appyness~ post. I thought of you and your family when i saw Chicago- and i love how you keep asking about habits when the videos are by two nuns in… habits:0).

    I could really get windy on this topic, but- i’m very sadly confused as to why things have to be so freaking difficult in life. My niece- whom i never knew had issues(she and my nephew live in Oregon) w/depression- tried to commit suicide when she left her shrink, filled her prescription for anti-depressants and then swallowed the whole bottle in her car in the parking lot. Someone saw her passed out and called the 911- and all i can think is wtf. Beautiful, smart, successful- great husband(and yes- i am biased) so, so confusing. Such a gift- so many people w/no choices about the time they have left and then- that. Why?

    It’s a hippo-campus thang- it’s a self thang- and it’s an isolating thing for both the family and the soul who is suffering. How to help?

    I, myself- refuse(or forget) to stay mad or sad- no depression for me– ADHD, possibly. I’m the kid that digs in the poop pile for the hopes of a pony. The other kids just see shit. I think my perma-grin pisses people off- i’ve seen more angry people grocery shopping than ever- and i take it personally. One guy glared at me- balefully. I think he was really Satan. I think Satan can’t stand me, either. I take that as a compliment:0). Each day is a new, clean slate for me and i say- thank God for the new chance to try and get it right.

    I think my husband may need some kind of meds in the future. His dad is on something and has been for 25 yrs. My man gets angry, he is never, ever truly happy. It worries me…. He is a perfectionist- living w/me is a trial, i admit. When i make him smile- i feel like i’ve won a valuable prize.

    i did get counseling for about a year for my terrible taste in men and felt like such a dunce that each new session was the identical of the last- until that ~Ah-freaking HAH!!!!~ moment and the ability to realize i could trust myself and my little voice. When a warning bell goes off in the woods- it does make a sound and i have learned to trust and listen to it.

    PBS has a great documentary on depression, too. Very in depth.

  15. amba12 said,

    Now there’s an example of what counseling/therapy is FOR.

  16. Donna B. said,

    karen — though distant, we may be kindred spirits.

  17. karen said,

    Donna– i feel that, too:0) Only difference is- you’re Western, Southern and i’m Northern. I think you do a great job, Donna- i really do.

  18. Icepick said,

    I’m the kid that digs in the poop pile for the hopes of a pony. The other kids just see shit.

    I see the pony and immediately thnk of the shit. Now THAT is messed up!

  19. amba12 said,

    Or is it? If you have a pony, you’d better be ready to deal with the shit.

  20. Icepick said,

    You’d better be ready to deal with it, but that probably shouldn’t be the first thought. It’s like seeing a new born kitten and thinking, “Well, there goes the furniture.” It takes a special kind of pessimism to think that way.

  21. amba12 said,

    Heh. Well said.

  22. Icepick said,

    Kind of the exact opposite of this. Both views are rather insane.

  23. karen said,

    You gave me such a great laugh, Ice!!!

    I honestly never see the negative 1st– i’ve picked up more stray kittens at my in-law’s farm over the years that are covered in lice or fleas- and cow crap- only to see the fluff and purr to come from a good bath and a warm saucer of milk. I would save myself so much sadness if i just respected the limits of my heart, you know? Farms sometimes aren’t the best places to have kittens.

    When it comes to shit- i’m an expert. The real shit, i mean. SPLAT is more than a sound effect on a farm. It’s a destination in an upward direction. It doesn’t bother me at all. Usually. Our 1st calf heifers have very long tails– they rest in the gutters where the crap is meant to go- and when they soak it good– and swing it around = not so good. Esp when across the face.

    I wonder- knowing the way of the furniture, if you allow yourself to still get conned into the kitty?

  24. karen said,

    ewww- now i know why i’ve never wanted to watch that movie–
    kinda blasphemous, eh? I likey the shit connection, though.

  25. amba12 said,

    I wonder- knowing the way of the furniture, if you allow yourself to still get conned into the kitty?

    Oh yes, he does. :)

  26. Icepick said,

    I was doing that just the other day… for a litle while at least. I’ll tell more when I’ve got two hands for typing.

  27. A said,

    “I’ve always been personally suspicious of therapy because there’s something creepy about the idea of a one-sided, remedial, paid relationship — like emotional prostitution”

    I completely agree with that, but put it in the same category as the drawbacks of psychoactive drugs, though the latter are so much more widely available that maybe
    it’s not a valid comparison.

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