Have you ever heard someone say that sickness is a mental game? Well, believe it or not, they are not completely wrong. Lisa Feldman Barret, a psychologist and neuroscientist, challenges the classical view of emotions that most of us are conditioned to believe as true. This classical view of emotions sees and understand emotions as automatic, universal, and hardwired in different regions of the brain (Barrett x). Barrett proposes the constructed view of emotions; emotions are constructions of our past, beliefs, feelings, and attitudes (Barrett xii-xiii). It takes our body, brain, and culture to construct an emotion. If we hold this new view of emotions to be true, then this changes how we look at everything from social reality to the law to understanding animals to illness. For the purpose of this blog, I am going to look at depression and how the constructed view of emotions can bring about new approaches to treatment.
Barrett says that emotions are a constructions. Emotions are not one thing; they are a multitude of things. So let’s use her example of getting a cold. Most people, including myself, view a cold as a virus and a weakened immune system. Barrett says that while that may be true, then what could explain the findings from a study where scientists placed a cold virus to the nose of 100 people, yet only 25-40% of participants got sick? Barrett does not deny that the cold virus is part of the reason you may get a cold, but she also introduces your predictive brain and your body budget as key factors.
Before we dive into the puzzle of depression, we should look at what a predictive brain and body budget are. A predictive brain is just as it says, a brain that predicts. Your brain uses the past and your knowledge of things to construct and predict how you will respond. For example, imagine that you and a friend are playing checkers. You have played the game many times before, meaning that you have some past experience and you know how the game should be played. Based on a move you make, you can predict the move of your opponent, allowing you to play out your next move in your head. This is your predictive brain. Now, your body budget is the ability of your body, mind, and brain to cope with input. Imagine that you just got over a cold and then two weeks later, you get another. You blame this cold on your roommate who never cleans and also on your own immune system for being crappy. You are not coping very well with having a cold, allowing your body budget to become more out of balance than it would be if you simply had a cold and thought no more of it.
Now with what we know about how much our predictive brain and our body budget play a role in our wellbeing, why do we continue to look at depression as an isolated event and not connected to our feelings, emotions, and past events? When your body budget is unbalanced for an extended period of time, your brain mispredicts that you need more and more energy, sending your body into a downward spiral. This chronic misbudgeting calls forth your body’s “debt collectors”, which are part of your immune system (Barrett 200). It seems to be basic knowledge that your immune system is a positive thing, and it is, but when your body budget is chronically misaligned, then your immune system ends up causing your illness. The “diagram” below shows the cause of depression, in regards to Barrett’s view.
Depression = brain mispredicting → unbalanced body budget → cortisol increase → increase in proinflammatory cytokines (in the blood) → inflammation flare up → devoid of energy
Now here’s the puzzle: depression is classified as a mental disorder which requires medical treatment. More than 17 million U.S adults had at least one depressive episode within the past year, as of August 2017 (NAMI). Twenty-seven million Americans take daily antidepressants, but more than 70% of them continue to have depressive symptoms (Barrett 209). Medicines seem to not be as effective as we want them to be, yet we still prescribe and use them. The traditional view of depression is that our negative thoughts are what cause our negative feelings. But, what if it is the other way around? Barret proposes that it is the other way around. Your feelings will drive your next thought, perceptions, and predictions (Barrett 210). This aims to show that depression is not just one thing; it is a concept with many-to-one pathways. There is not one area of the brain or one part of your life that causes depression. It is time to stop looking at genetics or the neurology of depression, but rather it is time we begin looking at depression in terms of it being a disorder of misbudgeting and prediction.
The National Alliance on Mental Illness has produced a list of the common symptoms of depression which include: changes in sleep, lack of interest, loss of appetite, and feelings of guilt and hopelessness. These are all things that we experience so what makes them signature of depression? These symptoms are persistent for two or more weeks. These symptoms started because you made a misprediction about something and then your body budget tried to correct that by overextending energy, depleting you. You took that one moment of misprediction and turned your feelings negative. These negative feelings that you harbor create negative thoughts which create negative predictions which creates a vicious cycle of misbudgeting and mispredictions, better known as depression.
So since we know what depression is, how do we fix it? Medical professionals would suggest that once you have been seen and examined, some form of medication and therapy would work best (NAMI). The most common antidepressant medications are selective serotonin reuptake inhibitors (SSRI’s) and the most common form of therapy is psychotherapy (NAMI). As someone who suffered from a depressive episode roughly six years ago and suffers from Generalized Anxiety Disorder, I can attest to the workings of an SSRI. But, I still experience symptoms and if I do not find ways to handle my symptoms, I can fall into a vicious cycle of, you guessed it, misbudgeting and misprediction.
Helen S. Mayberg, a neurologist, has worked on electrically stimulating the brains of massively depressed patients. Upon the electrical stimulation, relief was instantaneous. This is said to be because “the patient’s brain shifts from all-consuming internal focus to the external world, so it can predict and process prediction error normally.” (Barrett 211). Barrett hopes that this breakthrough can help other scientists see depression in a new light and work towards creating not too conventional treatments. Simply put, according to Barrett and her constructed view of emotions, the best way to treat depression is to break the cycle of misbudgeting and allowing your interoceptive predictions to be more in line with what is going on around you.
Now if you are like me and told that medicine fixes most everything, then you are probably wondering how to even begin fixing your body budget. Well, lucky for us, Barrett dedicates a whole chapter in her groundbreaking book, How Emotions are Made: The Secret Life of the Brain, on how to manage your body budget. Below are six tips from her:
1.Eat healthy, exercise regularly, and get enough sleep
2.Modify your physical comfort
3.Do yoga
4.Go spend time in quiet and natural places
5.Read a book
6.Practice gratitude (giving and receiving)
With the understanding that depression is not just sad thoughts, or lack of happy thoughts, we can begin to see depression as manageable. Understanding that depression is your body saying that it is mispredicting and depleting you of energy as a way to compensate, we have hope that depression can be much more treatable.
Works Cited:
Barrett, F. L. (2017). How Emotions Are Made: The Secret Life of the Brain. (1st ed.). Boston, MA: Mariner Books.
“NAMI.” NAMI, 2017, www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Overview.
Shared by: Madison Roope