Michael teaches yoga and meditation, practises bodywork, and does philosophy relating to the mind, body, and yoga.

depression (part 3 of 2, or a case of mistaken category)

Last week I mentioned that the yoga school in which I received my education, Ishta Yoga, stems from a monist (non-dualist) lineage known as tantra. Tantra’s philosophy posits that matter and spirit are not separate entities, but rather two sides of the same coin. This point have view has always resonated with me. It feels incredibly counterintuitive to deny the importance of the physical body. But by the same token, the conscious experiences we have, and the qualia which accompany them, are so intensely obvious that we often become blind to them. This is precisely why Daniel Dennett has described qualia as “an unfamiliar term for something that could not be more familiar to each of us: the ways things seem to us.”

Though their vocabularies may differ, a large number of spiritual traditions express the goal of experiencing qualia in their purest form. And although this might strike you as an especially Eastern way of thinking, Western psychologists such as Richard Harvey have dedicated serious inquiry into the notion that the very reason for the existence of the richness of qualia may be that they conspicuously “flag” the present moment, so that the mind does not confuse what is happening right now with a memory or an anticipated event. This present-moment richness is precisely what the mindfulness teacher wants you to do when she asks you to “notice without judging” the experience you are having. It is what the Zen master wants you to awaken to when he talks about living in the “suchness” of this moment. The immediate qualia of the now—something indivisibly subjective within your individual consciousness—serve, in these traditions, as a gateway to the most indivisible, universal, and transcendent truths about the nature of reality.

Yet for all of their mental (and/or spiritual) import, we cannot conceive of experiencing qualia without the use of our physical senses. Nor can we imagine having senses without qualia. You might try, for example, to imagine processing all of the information in the world around you in binary code, Matrix-style. However, in doing so, you are probably visualising the digits in a specific colour, and with specific shapes, against perhaps a black background which I would argue is not an absence of qualia, but a specific quale in and of itself.

All of the problems that arise from attempting either “to extract mind from matter by tortuous logical means” or “to dissolve matter into mind” led to the formation of a relatively obscure yet illuminating Western school of thought known as neutral monism. A physicist named Ernst Mach put forth the earliest form of this model, which acknowledges the oneness of the material and the mental (which makes it monist) without privileging one above the other (which makes it neutral). Let’s take another look at last week’s inconsistent tetrad:

  1. The mind is a non-physical thing.
  2. The body is a physical thing.
  3. The mind and the body interact.
  4. Physical and non-physical things cannot interact.

The key to understanding neutral monism is that proposition (1) makes what Gilbert Ryle would term a “category mistake” by stating that the mind is a non-physical thing.

While it feels entirely correct to think about the mind as non-physical, close reflection can show that considering the mind a “thing” in the same category as the body begets a warped way of looking at reality. Jonathan Westphal, neutral monism’s most recent champion, illustrates this misconception with the example of a pair of gloves:

A pair of gloves is not a glove, nor is a glove an abstract object like a pair. This is why we cannot say, ‘I have a left-hand glove, a right-hand glove and a pair of gloves.’ The easy way to see this is that if the sentence were true I would have to count three things. But I only have two things.  The pair of gloves would not exist without the left glove, and the left glove cannot exist in relationship with the right glove without constituting a pair of gloves.

We can see the elegance of the analogy when we transfer the terms into our inconsistent tetrad, which Westphal has also done for us:

  1. The pair of gloves is non-physical (because it is an abstract set).
  2. The left-hand glove and the right-hand glove are physical.
  3. The left-hand glove and the right-hand glove and the pair of gloves interact. (If I make a “lesion” in the pair of gloves, then there is an effect in one or both of the gloves.)
  4. Physical and non-physical things cannot interact.

Neutral monism posits, in essence, indivisible, qualia-like units comprise both bodies and minds, which essentially serve as different forms of expressing these constituent aspects of reality. Looking at the mind and brain as fitting into two separate (often overlapping) categories makes it easier to understand how they can “interact.” In fact, it sheds a great deal of light on what philosophers call “upward” and “downward” causation—the fact that physical states can lead to mental changes, and that mental states can lead to physical changes, respectively. 

For example, in the Nautilus article that inspired my post from two weeks ago, Matthew Hutson pointed out a fascinating study supporting the social bargaining theory. Women tend to be twice as likely as men are to struggle with depression, which might make sense in the context of this model: because women tend to be smaller and less muscular than men, depression might have provided a subconscious means for women to recruit whatever social aid might have been necessary. Fascinatingly, this study demonstrates the negative correlation between upper body strength and a tendency for depression—most of the men in the study had a greater amount of physical strength and were also less likely to be depressed. However, when the researchers controlled for strength, depression rates became equal for men and women. If gains in physical strength can decrease the experience of depression, this exemplifies “upward causation.”

In his brilliant book Waking, Dreaming, BeingEvan Thompson eloquently describes the neuroplastic phenomena of “downward causation” as “affecting the brain through intention and volition.” One salient example comes from studies showing that long-term meditation practice might change the physical structure of the brain

Considering the mind and the brain not as two separate things but as belonging to two different categories helps us to explain how they “interact” with one another. Just as we find it completely obvious that tearing the left glove in a pair of gloves will affect the pair, or that destroying the pair of gloves will have certain consequences for the individual gloves themselves, it becomes equally obvious that whatever affects the mind would, in all likelihood, result in repercussions for the body as well. And vice versa.

Consider the placebo effect. We know that it works, but nobody quite knows how. Many people who take a tablet for a headache, for example, will experience relief from that headache, even when there are absolutely no active ingredients on the chemical level. As Jo Marchant notes in Cure:

Big pills tend to be more effective than small ones...Two pills at once work better than one. A pill with a recognisable brand name stamped across the front is more effective than one without. Coloured pills tend to work better than white ones, although which colour is best depends upon the effect that you are trying to create. Blue tends to help sleep, whereas red is good for relieving pain. Green pills work best for anxiety...In general, surgery is better than injections, which are better than capsules, which are better than pills.

That’s right: placebo surgeries—in which a doctor carves open the patient’s body and stitches it back up again without doing anything at all in between—are actually a thing. Clinical trials of a certain type of spinal surgery ("vertebroplasty"), for example, have indicated that they are equally effective than placebo; that is to say, both have high success rates. And what I find even more surprising is that even the knowledge that a given form of treatment is a placebo does not diminish its healing effects. In fact, the professional who administers the treatment can say to the subject “Take this pill, it is a placebo—there are no active ingredients—but I am giving it to you for your headache,” and it will remain just as effective

(In case you are wondering, there are indeed companies who will very willingly sell you a placebo. If you find these websites, don’t be shocked by the price tag slapped onto what are obviously cheap raw materials. The literature on the placebo effect demonstrates that they become more effective when the patient pays more for them.)

Placebo serves as just one example of the mysterious “interplay” between mind and body. We can also look at evidence which seems to suggest that hypnosis provides some of the most effective relief of irritable bowel syndrome, or that many burn victims find that virtual reality programs can be even more powerful pain relief than morphine. But we need not get too creative in order to see similar patterns in the more mainstream forms of treatment. Studies seem to indicate that antidepressants, for example, are no more effective themselves than placebo. Yet they remain, somehow, in rates of use that we can only describe as alarming—in 2008, for example 19,045 children under 5 in the US received antipsychotic medication through Medicaid.  This is particularly alarming when we consider the list of side effects that a certain percentage of people tend to encounter as a result of these drugs. Yet the idea that antidepressants’ rate of effectiveness matches that of placebo might not be so surprising when we consider the fact that, much like the placebo effect, scientists are not entirely sure how antidepressants actually work.

But while (like anything) they are subject to abuse, I would like to present a defence of pharmaceutical treatment for depression, in the hopes of relieving the guilt that many depressives bear when taking or even considering their use. Many people have told me—and I have, at various times, subscribed to this notion myself—that overcoming depression through yoga, or therapy, or “natural” herbs is more noble than resorting to pharmaceuticals. Yet would we dream of saying this to a type-one-diabetic, whose health and life depend upon his willingness and ability to receive insulin treatment? Would we attempt to convince him of the greater degree of nobility in practising yoga in order to manage his disease, or that meditation is a preferable alternative to conventional medicine? We all understand that an individual who followed such advice would be signing his own death warrant. 

Some might object that my comparison strains the limits of pure analogy. For example, we know of no other effective way to treat the symptoms of diabetes than by means of insulin injection, but there are other effective treatments for depressive disorder. For instance, many studies on depression have found a correlation between depressive disorder and low levels of a neurotransmitter called gamma-aminobutyric acid (GABA). One study has shown that practising an hour of yoga āsana alone could increase GABA levels by an average of 28 percent; moreover, the more often subjects practised yoga, the greater the increase of GABA—up to 80 percent in one case. In such a light, might we not be justified in criticising use of a group of substances whose effectiveness against depression merely matches placebo, when insulin certainly far outperforms placebo against diabetes? 

Part of the answer lies in the fact that many of the people now included in the trials for SSRIs have only mild depression—and the drugs are simply not effective for this type of individual. This might lead us to conclude that those with major depressive disorder have a significantly higher success rate with antidepressants. Furthermore, it remains true that no “alternative” form of treatment can claim 100 percent efficacy against such mental imbalances as depression. While I personally have found yoga, meditation, nutritional & lifestyle changes, and talk therapy essential over the last fifteen years, I have still found myself dangerously close to the edge a number of times. Since I know I’m not alone in this experience. the idea of privileging one form of treatment over another feels highly unfair—an imbalance that finds a new context in neutral monism, where mind and body stand on equal footing. In all walks of life, and especially in serious disorders such as major depression, we should be willing to consider all available means in order to ensure that those affected can enjoy both “physical” health and a qualitative sense of well-being. 

Some may fear being tied to a chemical substance forever. If your life depends on it, this may be a reality to come to terms with: if depression is simply due to the balance of hormones and/or neurotransmitters in the brain, they very well may return to pre-medication levels after you stop taking them. Yet the depressive who (like myself) responds positively to medical treatment may not require the drug for the rest of her life. We must be open to the idea that the treatment might give the patient a qualitative platform upon which to obtain other, more stable changes. As an illustration, if the subject does not feel motivated to meditate (downward causation) or to begin a strength-training program (upward causation), such practices have no chance at furnishing any degree of qualitative relief from the illness. However, if the patient experiences a sufficient lift in mood as a result of the treatment, her improved motivation and focus can possibly create a regularity in both mental and physical practice, which might eventually lead to physical changes in her brain/body, which very well may lead to a degree of mental stability, which might allow the physician and the patient to decide together to reduce dosage, or to terminate treatment entirely. If the individual is able to continue the patterns of practice, perhaps the likelihood of relapse may be greatly diminished. I’m presenting a wholly hypothetical scenario of course, cooked up in the mad laboratory of my own mind; nevertheless, it seems to me an entirely plausible chain of events.

We must of course consider the expertise which experienced medical professionals can give us with regard to suitability, dosage, and how to notice, avoid, or address certain undesired side effects. However, we can say the same thing about any form of treatment. I’m sure we all know somebody who has hurt themselves whilst practising yoga—sometimes quite seriously. Can we say that anything is completely free of the potential to harm? There are those who might say that there is no harm in trying alternative, more “natural” forms of therapy; nevertheless, we must keep in mind that there are many (including, supposedly, Steve Jobs), who might have continued living healthy lives if they had not waited so long before accepting conventional treatments. 

Because qualitative disorders are inherently more subjective than physically measurable diseases such as diabetes, it follows that we must approach treatment in a way that clears certain hurdles—both subjective and empirical. It is my opinion that we can do this without resorting to categorising any given state as purely physical or mental. In treating depression as purely mental, we overlook the fact that it is a form of stress with a long list of serious physical health risks. And in privileging the physical state over the mental, we run the risk of neglecting the thing about depression that makes it so important: plainly, that being depressed feels so awful. This particular quale, in whatever form or forms it might come, colours depression with precisely what makes people go to such extreme measures to escape it. It is, therefore, absolutely essential that we avoid shoehorning any illness into one category or the other, in the context of a reality where both the physical and the mental are too important to ignore. 

...and the whole world laughs with you

depression, an interlude (or, minding the body)