C’mon…It Can’t Really Be That Bad?

This is not a puff piece looking for your pity. The intent is to educate others about a subjective, yet real, experience - a human experience that is not uncommon but is commonly misunderstood.

If for nothing else, this episode is for my immediate and extended family, many of which have or will experience similar life symptoms. My first person account of weakness hopefully quickens their recognition of potential problems and even to some anticipated advantages.

Mood disorders, such as depression, are not experiences that people share easily because of the character flaws that are attached. Therefore, the inherent repression of information perpetuates the misunderstanding of the obvious and prevalent. 

It takes courage to share that which is ugliest about you. But nothing inspires courage like a chance to enable a loved one’s potential. So for those to whom it may inspire potential…here is my ugly. 

I initially wanted to cover several symptoms in one episode. But I quickly found doing so would not allow me to address important items as much as I felt they needed.  So this episode will address DOLAMKNE and the reward pathway in which it operates - and ANHEDONIA - a core symptom of major depression disorder. I found these a good starting point to explain how neural motivation works, and what happens when it does not as the two are connected physiologically. 

It may get a little scienc-ee, and I will use a few medical terms. But I have found the more I came to understand definitions and mechanisms the better I felt I could wrap my brain around my personal internal experience.  

It also helped immensely in communicating with my health care providers. Instead of using vague terms - “Hey doc - I feel crappy and weird”, I could communicate specifically the conditions I was experiencing. “Hey doc - When i sit down for longer than a minute I’m now experiencing this restless feeling I’ve never had before…Like I need to shift my body every few seconds or get up and walk around - I believe the term is akathisia.”

So with that all said, I’ll first dive into Anhedonia. Because if there’s something you use to your benefit, you most often don’t know how it works until it’s broken and requires fixing. 

In support of that point, understanding the term Anhedonia not only helped me better understand my emotional and physical condition, but also enlightened me to how a biochemical condition impacts the human spiritual experience.  

Anhedonia - A significantly reduced ability to experience pleasure or joy. 

A core feature of Major Depressive Disorder (MDD) 

 Remember the commercials for antidepressants where they ask Do you no longer enjoy doing the things you used to? - that’s anhedonia. 

And when it is severe it is torturous. 

Its characteristics have been associated with other neuropsychiatric disorders such as Parkinson’s disease substance abuse disorders, over-eating, schizophrenia and more. 

Like all psychiatric conditions, the science behind anhedonia is not well understood. Evaluating the brain’s activity is a bit more complicated than an ordinary physical exam.  Our current brain imaging methods are brilliant. But they are still only able to provide rudimentary information on pathologies of the living brain.  

Personally, my baseline disposition is a mild anhedonia 

- which is to say my reaction to just about everything is - “Meh - it's alright.” 

For most activities I’m merely attending out of obligation

or 

I’m participating because my family is involved 

and 

watching my family experience joy is one of those few things that elicits a positive emotion in me. 

Between the years 2018 and 2019 the level of anhedonia I experienced became SEVERE. 

At this level it becomes crippling. Pleasure is rarely if ever obtained. 

And when it is obtained, it only comes by high stimulus activities. 

During my time with severe anhedonia my high stimulus activity of choice was watching several episodes of “The Office” each evening with Lindsay. 

But even though this was the only time of day in which I felt relaxed, the pleasure I felt was still broadly blunted. 

So emotional blunting defines anhedonia. 

From there, it makes sense that people who experience it for prolonged periods often find themselves habitually looking for high stimulus activities. 

Hence people who suffer from mood disorders that exhibit anhedonia are at an increased risk for drug use, pornography use, alcohol addiction, sexual promiscuity and other high risk behaviors. Not only that, but many studies have indicated there’s a significant relationship between someone with suicidal ideation or even those who attempt suicide and a high level of anhedonia. 

In large part the symptom of decreased pleasure is associated with either low dopamine levels in the brain or the brain not being sensitive to normal dopamine levels. 

Now I’m going to use dopamine here as my general go to word just to keep the verbage simple. 

Knowing full well that doing so is physiologically innaccurate. 

Other neurotransmitters like serotonin, glutamate, epinephrine  and many more all play into this process. 

But dopamine is the major player in our discussion of anhedonia so I will use it as a general term here.  

Dopamine acts as a chemical signal between cells in the central nervous system 

- the nerd term for it - neurotransmitter. 

The commonly known action of dopamine is that it feels good. 

However, its total action is very complex, much more than just feeling good. 

To give it a full workup is far beyond a podcast - more on level of post-graduate level studies. 

However, one core aspect of dopamine not often appreciated is how it is involved in the rewards pathway. In this process it accelerates progression from memory to learning and from learning to consistent behavior. 

It develops our desires, our motivations and our learning skills without us putting a grain of thought to it. 

But it’s actually the way it forms those foundations that’s worth talking up a bit here.  

So imagine you're a newborn baby

or there is a baby

or whatever. 

So you're this baby and you see for the first time this unknown object creeping towards you

And then you realize this object has contacted your lips and you're like, 

Perfect - just where I wanted it.  

Cause of all your body parts your lips and tongue are the most skilled. And that is because they SUCK. 

And this is actually true, as the pediatric dentist in me contributes with a bit of embryology. 

Because shortly after forming the palate and tongue which is still in the first trimester, baby's can be seen sucking their thumbs in ultrasounds. 

Fully unprompted, fully innate. One of the first things we figure out how to do is SUCK.  

And we're doing this like 10 weeks into gestation. .

Which means you’ve still got six plus months in the chamber to develop this skill before it’s tested in real life.  

So now, six months later, you're a newborn and you're stoked this object has found your mouth. And so, of course, you do what you’ve been practicing all that time and you SUCK.  

And I can only imagine what the sensation must be like…

Well…maybe the best term for it would be EXISTENCE ALTERING. 

Because we probably have this kind of WoW! Moment Realization that "Hey!!! I am more ALIVE to existence than I was before"

and the sister discovery 

“What the…There is more to existence than I previously thought.”

So back to you and this object.  You are having this initial experience of acting upon something that then reacts in a way that gives your consciousness pleasure.

 And also, though you're not aware of it, this same feel good act is one of very few that is essential for your long-term survival. 

So now inside your wee brain is this cascade of events. You've seen this object. You've acted on this object. The object has acted upon you. In reaction, your brain has released dopamine - this I AM ALIVE chemical.

So now, how likely is it that you will forget the object and the new sensation over the next few hours. 

Should the object turn up again, what are the chances you’ll remember it. 

And this is one of the major roles of dopamine. 

It helps to solidify memories by associating them with intense emotion.

Of course,  this makes sense because if i were to ask you about your own strongest memories, you’d likely recall they are nearly all tied to profound sensations.

SO Dopamine - it helps with memory. 

So back to baby you…

After some time with this object you realize it’s not as great as it was at first.

You even get to the point where you’re like, I don’t want it any more, thank you. 

And then you almost involuntarily take a nap…

After an hour or two of sleep and maybe some time spent locked in a gaze with total strangers, 

that same object turns up again. And again it starts moving towards you in a manner similar  to before. 

And YOU RECOGNIZE IT 

Quickly two distinct thoughts jump through you. 

1. I know that thing 

and

2. I want it. 

And this is another significant role of dopamine - actually something I think we take for granted or maybe take too much personal character credit for as it is an autonomic response.  

But…MOTIVATION is a huge role of dopamine. 

Because in merely recognizing the object certain brain cells release dopamine. And the dopamine in this case isn’t serving the purpose to “feel pleasure” though it does still do that in part. 

But more so it creates EXCITEMENT...INITIATIVE.

In essence its saying  - get your butt ready to put in some effort.

And it does that because your previous interaction with the object resulted in reward. 

And that reward was worth the effort. 

This effect  is especially fun to see when babies get a little bit older: 

And this example happened with all of my kids…

Where I’d start prepping a bottle of formula 

which would usually involve some shaking of the bottle. 

And as soon as I’d start shaking the bottle

their eyes would get REALLY BIG. 

And this would happen even if the bottle was outside of the baby's sight 

They’d start looking around trying to get a visual of the bottle. 

And once they did, their arms and legs would start flailing around like crazy. To the point where, as a parent I’d think to myself, is there crack inside this formula?

This is the the recognition dopamine taking effect - motivating the baby. 

Its basically an “If This - Then That” system. 

You recognize the object 

which trigger’s memory of the previous reward

which triggers dopamine

which motivates you to act with effort 

to reproduce the reward. 

And from there you can imagine how dopamine over time enhances learning by increasing or accelerating reward in response to adjustments of behavior through repetition. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958859/

Arias-Carrión, Oscar et al. “Dopaminergic reward system: a short integrative review.” International archives of medicine vol. 3 24. 6 Oct. 2010, doi:10.1186/1755-7682-3-24 

Dopamine and Learning, and Dopamine and Reward Sections

So this dopamine process is pretty similar with most anything else the human being interacts with. We  not only learn outcomes from interacting with objects, but also from coming in contact with people. What we call socializing. So the same positive feedback loop by which we all learn to eat is the same mechanism in which we learn to appropriately interact with others.   

So having talked about that process, imagine a condition that creates a deficiency in dopamine – or maybe a diminished reactivity to it. 

This would be biochemically similar to type 1 or type 2 diabetes – but in place of insulin we are talking about dopamine and our target cells are now in the brain. 

Based on the dopamine rewards pathway a condition like this would probably show dysfunction in experiencing pleasure. It would affect memory and attention – motivation and learning - both academic and behavioral. 

Clearly, we are knocking on the door of attention-deficit disorder. 

Now please don’t think I am reducing the complication of ADD to merely what I’ve addressed here about dopamine. 

ADD is way more complex than I cover here. 

But if ADD is a 

It's just that many parents struggle to comprehend why the ONE of their four kids climbs on top the refrigerator at the age of 4. 

Why during grade school THAT SAME KID has frequent visits to the principals office. 

It is a genuinely hard idea to grasp that one child has a much greater threshold to experiencing pleasure – excitement – or motivation -  than the other three. 

It is difficult to quantify biochemistry’s influence on social interaction. 

It is easier to see things on an all or nothing spectrum. 

Because the far more plausible explanation is that this particular child simply has no self-control.  

I mean, who wouldn’t double-fist ice cream sandwiches several times a day if they could? Who doesn’t have an overall dislike for doing their homework? Who isn’t thinking to themselves at the moment their alarm goes off ___“I’d like more sleep please”?

But when you place sensitivity to dopamine on a biochemical spectrum, you begin to realize why this child does what he does. 

Now I’m going to try to give a quantified example.   More likely I’ll just confuse everyone__but that’s a risk I’m willing to take. 

Realize the numbers I use are purely to convey a principle. 

Because I actually have no idea how apples and twinkies compare in pleasure reaction. 

And I don’t know the effort comparison to opening a refrigerator vs. climbing on top of that refrigerator. 

However, the example used here most definitely is based on a real life experience. 

So — Let’s say you have 4 children

3 are dopamine average children

1 child, who we will call TEDD,  is dopamine resistant (the nerve receptors that react to dopamine are malformed in this child. So it it takes TEDD more dopamine than usual to get the same pleasure effect as a sibling with normal dopamine receptors. In this example I use a 2 to 1 ratio. 

TEDD needs twice as much dopamine as his siblings to experience the same amount of pleasure. 

Inside the refrigerator are apples. 

Above the refrigerator in a cabinet are twinkies. 

When any of the kids eat an apple their brain releases 100 units of dopamine.

Twinkies release 200 units of dopamine in each child.

For simplicity let’s say that the cost in effort for the 3 siblings to retrieve an apple from the refrigerator is the same cost of effort for TEDD to climb on top of the refrigerator. And, also, that the difference in effort between opening the refrigerator and climbing on top of it for TEDD is negligible (meaning it makes little difference to him whether he opens the fridge or climbs on top of it. I know this mathematically doesn’t jive with our given situation, but such skewed differentials actually do occur in real life. Just bear with me and my really dumb example. I’m only as good as my brain will allow at the given time.)

Anyway,

So, given these conditions, for TEDD to experience the same reward pleasure that his siblings experience eating an apple would require that he climb on top of the refrigerator and get a twinkie. 

So when you, the parent, walk into the room after switching the laundry three of your four kids are eating apples and the one is eating a twinkie. 

To which you react - “What the hell, TEDD?”  

And who would blame you for such a reaction. Cause it's hard to compute abstract spectrum experience to such a cut and dry outcome. And even if you managed to do so, how would you convince the 3 apple siblings of the pleasure differential experienced by their brother.  

It’s human nature and often just plain practical to exercise standardized expectations in moments like these. The effort to properly process the situation and its consequences emotionally, socially, and equitably far exceeds the importance of the event.  And that fact leads to the easier and far more practical evaluation that all experienced the situation at the same intensity. 

So, considering this Twinkie example, now take this same dopamine pathway principle to a level where a person experiences NO PLEASURE REACTION to ANY STIMULUS within social norms - ANHEDONIA!!!

Hey Todd, you wanna come over and watch the football game?

Meh…no thanks. 

Hey, Todd…want to go to dinner with a couple of friends?

Not interested. 

Hey Todd, do you want to go to Disneyland with the family?

I’d rather be dead…but I’ll go cause I love my kids…and also because I can then justify several servings of ice cream at the Cozy Cone. 

Now having heard those social proposals, most listeners feel bad that I experience repulsion towards these activities. Because to many, those activities sound delightful. And…if they are honest…likely don’t consider my responses Christ-like. 

And here’s the rub, because I DO actually care that the people around me have positive human experiences, regardless of my genuine feelings, in most cases I’ll participate. 

Because I KNOW that the social value of these interactions for those I care about overall outweighs my apathy…and that’s for-sure a Christly attribute. 

See…your depressed friends are actually more like Jesus than you think they are. 

Hopefully you can see how the social calculations of individual and group desire quickly become complicated. Complicated to the point that to follow the calculations to conclusion would computationally outweigh the worth of social interaction. 

With that in mind it is only reasonable that we are programmed to nearly always assess experiences as equally perceived among different individuals. 

To do otherwise would cause mankind to become computationally catatonic for social overload,  

OR, 

Send them in the opposite direction making them anti-social absolutists, refusing contact with any other human beings.  

On a quick separate but related

note, I would point out that our culture, Christian culture believes that God DOES judge according to the individual subjective experience. That His accounting only considers what the individual has experienced -  from an  individual’s unique reception sequencing of moral information to their specific perceivable biochemical situational reactions to their personal understanding of social economics - His atonement absolves us of all beyond our capable perception. 

But as mortal beings we don’t have that capability. 

So let’s then state the obvious. 

The idea that everyone has the same emotional, sensual and mental experience to any given activity is maybe the grossest generalization of all time. Such simple thinking is lazy and stupid and has been the justification for much bloodshed over the past century. 

But, on the other hand, to completely disregard social standards to accommodate every individual’s subjective whim is super-sized stupid and has also been the justification for much bloodshed. 

My point here is that LIFE IS HARD AND COMPLICATED. Well…for those who genuinely care LIFE is HARD and complicated. And it takes more than all or nothing ideologies to have meaning and growth.

It takes guts to acknowledge differences in ourselves and our loved ones - whether it be emotional, social, biological, whatever. And even more so, it takes courage and endurance to figure out WHY? Especially when the WHY isn’t easily evident. 

But the difficulty of life isn’t solved simply by appeasing those who are different or getting a free pass because of a weakness. Even for the most disabled person, living life without any expectations breeds entitlement, relinquishes responsibility and results in…well…something bad…like kids in Willy Wonka’s chocolate factory bad.  

So it takes time and effort to critically self-analyze. The old Greek Maxim “Know Thyself” is a nice way of saying “Don’t lie to yourself about where you are lame and how lame you actually are.” And that is a hard thing to do. But only when honestly and accurately assessed can one identify the adjustments needed to optimize progress. 

When talking about mood disorders the great difficulty is their subjective nature. So that when first assessing a person newly depressed, a loved one often thinks, “C’mon…it can’t really be that bad.” To which the obvious rebuttal is, “You have no idea!!!.”

 And for the sake of time I will save the progression from self-assessment to meaningful life for when I can properly address that subjective bag of cats.  

But, in short, you have to start somewhere. 

So, I would recommend starting at open-minded honesty - 

Just trust me. I promise that's the best place. 

Doing so will allow you to create realistic expectations of effort for yourself or your loved one. And those expectations, most importantly, help to offset emotional entitlement - the biggest hurdle to life’s purpose -which is building character.  

We should, whenever possible, encourage capability instead of entitlement, acknowledging that life is brutal - but that individual human character has the potential to best what is thrown at it.  

Long pause

Now…Admittedly…when you or your loved one finds life tortuous, this thought process is ESPECIALLYHARD. It is far from obvious or evident that simple deliverance from emotional hardship comes at great cost of character. I myself pleaded, not long ago, for immediate deliverance, wishing it was just that simple. And I experienced gross disappointment as a result. 

But that FALL of disappointment came with a gift of realizations. Realizations that, by their nature and sequencing, make them difficult to relay to others. Believe me, I’ve tried telling this in story form…and it takes about 5 hours. 

So, to relay some of important ideas I’ve created another God monologue. Again, addressed to myself, and of course delivered slight tongue in cheek (cause I wouldn’t do it any other way), but still good for the soul:

Hey, Todd. This is God. 

Got word that you’re depressed. 

Evidently depressed to the point where you prayed for a deadly car accident…?  

Bummer…you know cause I hate to see you sad and all…especially when you begin to think I’m a bad Dad…

You know, Todd…I don’t really cope well with my children feeling disappointed in me…So tell you what…Let’s get rid of this depression for you…No, I’m serious…

Watching you sit in church week in and week out, not because you enjoy the services, but because you KNOW you should be there. 

I don’t like that. 

I mean, if there is one thing that bothers me, it's watching my children exercise actions of love towards me that are based completely on knowledge and faith. 

Cause y’all know I far prefer actions to be emotionally driven.

Just kidding man…you know I like to tease you a bit.

Truthfully, my favorite day of the week is Sunday, watching you sit in church, just uncomfortable as can be, only there because of what you know, acting outside of emotion.  

You know, Todd, I think Batman…or maybe it was his girlfriend…anyway someone in a Batman movie once said it best with the following line:

“It’s not what you do,

But what you are underneath that defines you.”

Right? Like what you do… is not actually impor…Wait…Wait a minute…that can’t be…did I…sorry, I think I screwed the line up. Give me a minute

Okay… what Batman’s girlfriend actually said was:

“It’s not what you are underneath,

But what you do that defines you.”

I’m gonna say that again just to make sure I got it right. 

“It’s not what you are underneath,

But what you do that defines you.”

Yep…that’s it…the character’s name - Rachel Dawes…the movie - Batman Begins…That’s what she said. Got it right that time. 

And you know, now that I think about it — that is SO true. Not that feelings are always bad, but in many cases feelings get it wrong. You are only human after all and the Maker’s only as good as the material he has to work with. Anyway, you should think yourself lucky it’s just depression.  I just talked to someone down there who has chronic hiccups…Man, be glad you’re not THAT guy. 

But back to feelings…yeah they’re not as fool proof as they're made out to be.  That's why I gave y’all some reason…you know, the ability to critically analyze. Because feelings can get in the way. 

In truth, and maybe you didn’t know this, but feelings often distort the true level of commitment my children actually have for me. 

Now that’s a hard concept for an emotional being like yourself.

So, let me see if I can allegorize it for you. 

So Todd think of it this way, 

I’m the ice cream man and you claim to be My friend. 

So much a friend that you’ve proposed becoming My business partner. 

And then I ask myself, are you My friend, or are you just interested in my infinite ice cream?

As long as I’m giving you ice cream I will never really know. And more importantly neither will you.

So I decided to change up my product line and sell exclusively vinegar based items.

So now - Everything that I offer you is bitter. 

You know the bitterness is from My hand. 

Yet you’ve never refused what I’ve offered you before. 

Will you now refuse my offer and go somewhere elsewhere to get your sweetness? 

Or does my friendship and future partnership mean more to you than a need for something sweet - for feeling good?

Think upon that, Todd

Consider whether my worth to you extends beyond bitterness. 

Or, for that matter, whether my worth is even based on your ability to taste or feel at all.

Now that we’ve talked it through a bit more I’m choosing to leave you with the depression… for now. Let’s see what you make of it over time.

I’m curious…and hopefully you are too… 

Curious to know what you will do with the bitterness?

Remember - 

It’s not your experience underneath

But what you do with that experience that defines you.