Популярно, но очень аккуратно -- о депрессии (на английском языке)
Мне довольно часто попадались всякие памятки для широкой публики о том, как распознать симптомы инсульта или инфаркта, и как правильно оказать первую помощь. Эта статья о депрессии совсем не такая. Она очень длинная. Написана писателем, который сам перенёс тяжёлую форму с классическими симптомами и по "выздоровлении" решил разобраться в деталях этого заболевания. Статья перемежается очень down-to-earth автобиографическими описаниями собственного опыта, меткими цитатами, понятными описаниями био-химических процессов. Полезна как для тех, кто подозревает в себе склонность к депрессии, так и тем, кто подозревает склонность к депрессии у своих близких. Статья написана 12 лет назад и в ней много спотыкачек-опечаток, к сожалению. И всё же:
Anatomy of melancholy, By Andrew Solomon
Фрагменты, которые мне показались ценными (с оригинальными опечатками):
Once upon a time, depression was generally seen as a purely psychological disturbance. These days, people are likely to think of it as a tidy biological syndrome. In fact, it's hard to make sense of the distinction. Most depressive disorders are now though to involve a mixture of reactive (so-called neurotic) factors and internal ("endogenous") factors; depression is a seldom a simple genetic disease or a simple response to external troubles. Resolving the biological and the psychological understanding of depression is as difficult as reconciling predestination and free will. If you remember the beginning of this paragraph well enough to make sense of the end of it, that is a chemical process; love, faith, and despair all have chemical manifestations, and chemistry can make you feel things. Treatments have to accommodate this binary structure - the interplay between vulnerability and external events.
***
Accuracy of perception is not an evolutionary priority. Too optimistic a world view results in foolish risk-taking, but moderate optimism gives you a strong selective advantage. "Normal human though and perception, "Shelley Taylor writes in her 199 book, "Positive Illusions," "is marked not by accuracy but by positive self-enhancing illusions about the self, the world, and the future. Moreover…these illusions are not merely characteristic of human though; they appear actually to be adaptive." As she notes, "The mildly depressed appear to have more accurate views of themselves, the world, and the future than normal people. [They] clearly lack the illusions that in normal people promote mental health and buffer them against setbacks."
***
Brain-imaging scans have indicated that depression changes both the structure and the biochemistry of the brain. Medication-responsive patients may cease to respond over the long term if they cycle on and off the medications; with each episode, there is a ten percent increase in the risk that the depression will become chronic. 'It's analogous to a primary cancer that's very drug-responsive but once it transforms itself and metastasizes is less responsive," Bob Post explains. "People worry about side effects from staying on medication for a lifetime, but these effects seem in substantial compared with the lethality of undertreated depression. It would be like asking someone to go off his digitalis, seeing if he has another heart attack, and re-starting medication when his heart is too flabby to recuperate."
***
Anxiety is not paranoia; people with anxiety disorders assess their own position in the world much as people without them do. What changes in anxiety is how one feels about that assessment. It's possible to distinguish between anxiety and depression, but, according to Jim Ballenger, a leading expert on anxiety, "they're fraternal twins." George Brown, of the University of London, has said succinctly, "Depression is usually a response to a current loss. Anxiety is a response to a threat of future loss." About half the patients with anxiety or panic disorders develop major depression within five years. The diseases appear to have overlapping genotypes.
Depression exacerbated by anxiety has a much higher suicide rate than depression alone, and is much harder to recover from. "If you're having panic every day," Ballenger says, "it's gonna bring Hannibal to his knees". "One in ten Americans has a panic attack of some kind every year. Because the locus coeruleus in the brain, which controls much of norepinephrine production, has a strong influence on lower-bowel function (бабочки в животе), almost half of panic-disorder patients have irritable-bowel symptoms as well. "Two out of three times, life events are implicated in the onset of panic disorder, and it's always a loss of personal security," Ballenger says.
***
Therapy helps someone to make sense of the new self attained on meds and accept the loss of self that occurs during a breakdown.
***
We now identify as pathology many things that were previously accepted as personality. The supermodel has damaged our images of ourselves by setting unrealistic expectations, and the psychological supermodel is even more dangerous than the physical one. People are constantly examining their own minds and rejecting their own moods. The use of antidepressants is going up as people seek to normalize what used to be deemed normal. Thirty million people worldwide have been on Prozac, and millions more on the other SSRIs-not to mention a substantial number on non-SSRI antidepressants. SSRIs are now prescribed for homesickness, eating disorders, PMS, household pets who scratch too much, chronic joint pain, and ordinary grief. They are prescribed not only by psychiatrists but also by G.P.s and gynecologists, someone I met had been put on Prozac by his podiatrist. When TWA. Flight 800 went down, families waiting for news of their loved ones were offered drugs with the same palliative expression with which they might have been offered extra pillows or blankets.
***
The question of what functions depression serves is not the same as the question of what functions antidepressants are corning to serve. Are they restoring the normal self or are they changing the self? It's said that everyone has the virtues of his faults. If one eliminates the faults, do the virtues go as well? "We are only at the dawn of pharmacological exuberance," Nesse says. "New medications that are being developed may likely make it quick, easy, cheap, and safe to block many unwanted emotions. We should be there within the next generation. And I predict we'll go for it, because if people can make themselves feel better they usually do. I could imagine the world in a few decades being a pharmacological utopia, controlling viciousness, fear, and pain. I can equally imagine people so mellowed out that they neglected all their social and personal responsibilities." Robert Klitzman says, "Not since Copernicus have we faced so dramatic a transformation. In centuries to come, there may be new societies that look back at us as creatures that were slaves to and crippled by uncontrolled emotions."
***
The opposite of depression is not happiness but vitality[...]
Anatomy of melancholy, By Andrew Solomon
Фрагменты, которые мне показались ценными (с оригинальными опечатками):
Once upon a time, depression was generally seen as a purely psychological disturbance. These days, people are likely to think of it as a tidy biological syndrome. In fact, it's hard to make sense of the distinction. Most depressive disorders are now though to involve a mixture of reactive (so-called neurotic) factors and internal ("endogenous") factors; depression is a seldom a simple genetic disease or a simple response to external troubles. Resolving the biological and the psychological understanding of depression is as difficult as reconciling predestination and free will. If you remember the beginning of this paragraph well enough to make sense of the end of it, that is a chemical process; love, faith, and despair all have chemical manifestations, and chemistry can make you feel things. Treatments have to accommodate this binary structure - the interplay between vulnerability and external events.
***
Accuracy of perception is not an evolutionary priority. Too optimistic a world view results in foolish risk-taking, but moderate optimism gives you a strong selective advantage. "Normal human though and perception, "Shelley Taylor writes in her 199 book, "Positive Illusions," "is marked not by accuracy but by positive self-enhancing illusions about the self, the world, and the future. Moreover…these illusions are not merely characteristic of human though; they appear actually to be adaptive." As she notes, "The mildly depressed appear to have more accurate views of themselves, the world, and the future than normal people. [They] clearly lack the illusions that in normal people promote mental health and buffer them against setbacks."
***
Brain-imaging scans have indicated that depression changes both the structure and the biochemistry of the brain. Medication-responsive patients may cease to respond over the long term if they cycle on and off the medications; with each episode, there is a ten percent increase in the risk that the depression will become chronic. 'It's analogous to a primary cancer that's very drug-responsive but once it transforms itself and metastasizes is less responsive," Bob Post explains. "People worry about side effects from staying on medication for a lifetime, but these effects seem in substantial compared with the lethality of undertreated depression. It would be like asking someone to go off his digitalis, seeing if he has another heart attack, and re-starting medication when his heart is too flabby to recuperate."
***
Anxiety is not paranoia; people with anxiety disorders assess their own position in the world much as people without them do. What changes in anxiety is how one feels about that assessment. It's possible to distinguish between anxiety and depression, but, according to Jim Ballenger, a leading expert on anxiety, "they're fraternal twins." George Brown, of the University of London, has said succinctly, "Depression is usually a response to a current loss. Anxiety is a response to a threat of future loss." About half the patients with anxiety or panic disorders develop major depression within five years. The diseases appear to have overlapping genotypes.
Depression exacerbated by anxiety has a much higher suicide rate than depression alone, and is much harder to recover from. "If you're having panic every day," Ballenger says, "it's gonna bring Hannibal to his knees". "One in ten Americans has a panic attack of some kind every year. Because the locus coeruleus in the brain, which controls much of norepinephrine production, has a strong influence on lower-bowel function (бабочки в животе), almost half of panic-disorder patients have irritable-bowel symptoms as well. "Two out of three times, life events are implicated in the onset of panic disorder, and it's always a loss of personal security," Ballenger says.
***
Therapy helps someone to make sense of the new self attained on meds and accept the loss of self that occurs during a breakdown.
***
We now identify as pathology many things that were previously accepted as personality. The supermodel has damaged our images of ourselves by setting unrealistic expectations, and the psychological supermodel is even more dangerous than the physical one. People are constantly examining their own minds and rejecting their own moods. The use of antidepressants is going up as people seek to normalize what used to be deemed normal. Thirty million people worldwide have been on Prozac, and millions more on the other SSRIs-not to mention a substantial number on non-SSRI antidepressants. SSRIs are now prescribed for homesickness, eating disorders, PMS, household pets who scratch too much, chronic joint pain, and ordinary grief. They are prescribed not only by psychiatrists but also by G.P.s and gynecologists, someone I met had been put on Prozac by his podiatrist. When TWA. Flight 800 went down, families waiting for news of their loved ones were offered drugs with the same palliative expression with which they might have been offered extra pillows or blankets.
***
The question of what functions depression serves is not the same as the question of what functions antidepressants are corning to serve. Are they restoring the normal self or are they changing the self? It's said that everyone has the virtues of his faults. If one eliminates the faults, do the virtues go as well? "We are only at the dawn of pharmacological exuberance," Nesse says. "New medications that are being developed may likely make it quick, easy, cheap, and safe to block many unwanted emotions. We should be there within the next generation. And I predict we'll go for it, because if people can make themselves feel better they usually do. I could imagine the world in a few decades being a pharmacological utopia, controlling viciousness, fear, and pain. I can equally imagine people so mellowed out that they neglected all their social and personal responsibilities." Robert Klitzman says, "Not since Copernicus have we faced so dramatic a transformation. In centuries to come, there may be new societies that look back at us as creatures that were slaves to and crippled by uncontrolled emotions."
***
The opposite of depression is not happiness but vitality[...]