Seasonal Affective Disorder

– by Lee Smith, Ph.D.

The leaves have turned and dropped, and perhaps our minds and spirits have followed as we say goodbye to yet another (alleged!) summer and gradually slip into winter. There are countless ways in which our minds and bodies change with changes in our environment. One of these is due to the fact that the further north we live the less light we receive through the winter. And the further north you go the greater the number of people in the population who suffer emotionally through the winter.

More serious than the winter distress of Leaf hockey fans, but perhaps just as predictable, is a form of depression called Seasonal Affective Disorder or SAD for short.

SAD includes increases in appetite and weight, more fatigue and sleepiness, problems concentrating, irritability, social avoidance and feelings of anxiety and despair. It sounds a little like our bodies are trying to hibernate. SAD may affect about 9% of us and about 25% more grump through winter with a milder form, the Winter Blues. There is no seasonal variation in other mood disorders such as bipolar disorder or post partum depression.

These general, categorical signs of SAD don’t give us a very vivid sense of what suffering SAD is like, just as a neat list of salmonella symptoms doesn’t touch the actual experience. Our experience of anything is always unique. Some people feel too withdrawn and flat to be festive through the holiday season, troubled with the question, “Why?” People say they feel “shut down”, “weighed down”, and “bleak”. It’s like living with an extra 50 pounds in your backpack; it quickly feels too hard to function at all and the wish to drop out of everything can take over.

How come? A brain hormone, melatonin, helps regulate our night-and-day rhythms, among many other things. Light may regulate the manufacturing of melatonin through connections from the eye to the pineal gland in the brain. Also, seasonal changes in retinal function are found in people who suffer SAD. People with SAD don’t build melanopsin, a photopigment chemical in our eyes, as effectively, but extra light seems to correct this genetic difference.

So it seems that light is a drug, an external agent that regulates our inner world. Since Dr. Norman Rosenthal first described SAD 25 years ago (his book, Winter Blues, was revised in 2006), light therapy has been shown to be very effective as a treatment. This involves sitting with a light therapy box that provides bright, full spectrum light for 30 – 60 minutes each day. Light in the morning may be best.

A study hot off the presses found that light therapy does only some of the job of addressing SAD. How we feel and think about winter itself plays a big role too. Many people just have a cheerless mental set when it comes to winter. This mental set creates a cold environment inside their head, full of chilly grumbling gloom (“friggin’ snow … I can’t stand this … what’s more miserable?”). Reducing our mental bellyaching and self-criticism significantly helps to relieve SAD.

What to practice? Light therapy is a good way to go. Do a little more research and look into the light boxes that are available on the internet market. Get out for a walk in the light of day, every day if you can. Lift your face to the sky and drink in the light. Definitely get more physically active, even if you don’t like it. And check your mind’s commentary and criticism, because SAD may be one more example of our mind making us miserable.


– by Lee Smith, Ph.D.

Spoiler alert: Psychiatric diagnosis is deeply problematic, in part because the cause of symptoms is difficult to find and to test for. But there’s more…

In a scene from the television series, Mad Men, which is about the people of a 1960’s Madison Avenue advertising company, a well-to-do woman shares with a shrug the upshot of her consultation with a psychiatrist, “I got my diagnosis: He says I’m bored”. There are more serious afflictions but the key here is the shrug.

Our affluent and safe society has the benefit of the best health care in the world. And yet we are more depressed and anxious than just about any other society. In Canada, after cardiovascular drugs, psychotherapeutic drugs are the most frequently dispensed, and depression and anxiety are the fourth and fifth most common reasons for physician visits.

Quite rightly, we consult a physician or a psychologist when we’re suffering psychological symptoms. We want to know what’s going on and to get help. And many people already have ideas about what to call their symptoms thanks to education from the media, including commercials.

For alot of people a diagnosis of depression or anxiety or ADHD becomes a completed step. But what has really been achieved?

Our brains love to name stuff and a name can feel like the same thing as an understanding. Even more, once we feel like we have an understanding, we tend to stop inquiring. And so, a psychiatric diagnosis can really become an illusion that we know and understand, just as so much of our thinking builds versions of our life that can be mistaken.

Consider this: In this sense of a diagnosis being a label and a concept, we might see that we ‘diagnose’ ourselves and others all the time. When we say “I’m bored”, “He’s an idiot”, “No one cares about me”, “I’m unhappy in my marriage”, we’re diagnosing. The problem again is just letting this concept or this label stand as if it’s adequate and complete.

The idea here is that when we obtain a diagnostic label, it activates this tendency of mind to embrace or get stuck on the label and to not look further.

Our reliance on medication and on diagnosis may lead to passivity and a degree of retreat from looking at our lives. We go to the doctor for something to make it better. The drug companies love it and it’s easier work for our doctors, but the evidence is that long-term resolution is infrequently achieved. We’re not a very happy culture. We’re the richest in the world but we’re suffering richly.

There is no adequate or equivalent substitute for paying honest and open attention to our lives. On receiving a diagnosis we may stop paying attention to the immediate and remote experiences that our mind and body have ingested or are ingesting still which could be a crucial part of our problem. We may stop paying attention, we may stop looking and knowing about our lives more deeply and how we are in relation to the things we’ve experienced. Our natural abilities to sort out our lives shut down if we don’t let our experiences ‘come on line’. Maybe sometimes that’s why we want some diagnosis, so that we can have the illusion of knowing and to then stop looking, and just shrug.

Being given a medication may have the same effect. It becomes about the drug working and how the drug is doing, and we go on vacation from ourselves.

So let’s say it again – we have to pay attention to our lives. And if we have children, we have to pay careful and honest attention to their lives, too.

Post-Traumatic Stress Disorder

– by Lee Smith, Ph.D.

Take a deep breath…

The profoundly dirty secret came out recently that upwards of 1000 U.S. Veterans attempt suicide every month. Post-Traumatic Stress Disorder (PTSD) and inadequate help are frequently a part of their misery. This tidy label, PTSD, references the horrendous human burden and infinite complication caused by witnessing and suffering the worst depravities on the surface of our planet – not only in war but at home, school, work.

The forms of trauma are as varied as life itself, including natural disasters through to interpersonal assaults. Physical, sexual, emotional and verbal abuse, accidents and injury, sudden loss, bullying, harassment, betrayal, rape, genocide, terrorism, war – it’s quite a list. Age, severity, frequency, history and variety of traumatic exposure, and interpersonal complexities all matter. Falling down the stairs is far more traumatic if you were pushed. Some victims marinade in abuse.

And much more happens psychologically in the injury from trauma than some recording of the event itself. The fact is, trauma may lead to a whole range of adjustment problems affecting our behaviour, emotions, thinking, relationships, physical health and life-course. Because everything is always unique about trauma, in that each unique person with their own unique history experiences some unique trauma in their own unique way, the impacts are personal and highly variable. Nonetheless, there do exist general similarities across sufferers.

The tidy list of PTSD symptoms includes (a) unwanted memories of the trauma popping up anytime, (b) our bodies leaping into stress reactions and living lodged in emergency mode, and (c) avoiding anything that might cause (a) or (b) to happen, including our own memories. And life is clouded with uneasiness, all the time. Even when the mind is asleep traumatic memories commandeer our dreaming and physiology. Trauma can relocate your mind and body to a world of felt threat, emergency and despair.

Our recall of our life is most typically an uncomplicated thing. Watch as you answer this: What did you have for breakfast this morning? You’ll probably notice that you had a feeling of recalling, and that what you recalled included images and details about which you could talk for some time. These kinds of autobiographical memories are also tagged by the mind-brain with a sense of person, place and time. No one could convince you that that breakfast actually happened yesterday or at some other location.

In contrast, emotional or traumatic memories are felt and relived more than recalled.

Let’s imagine taking a veteran of, say, the Vietnam war with us for a summer hike in Algonquin Park. What might our friend experience and do? He might just freak out in response to the dense foliage, the lack of sight lines, the felt sense of mortal vulnerability from possible traps on the trail and threats in the greenery. The experienced threat doesn’t match the ‘real’ risks in the park, but instead reflect the emotional memories that flood in from another time and place, inappropriately.

Unhealed trauma means that the mental tags for place and time are unborn. The neurobiological underpinnings of healing ultimately place trauma in our past, to great relief.

Healing trauma is complicated in part because of the immediate bind between undesirable alternatives. It is our tendency to avoid unpleasant things, which include terrifying memories. I like the metaphor of dealing with slivers. Avoidance, just leaving the slivers (horrible memories) in your arm alone and wrapping them up in dressings (avoiding any reminders), perhaps with some nice local anaesthetic like xylocaine (beer, doobies), gives immediate relief. After a while of one-armed living, punctuated by explosions of pain should the slivers get bumped (reminded), life lectures us that the only wise course is to have the slivers out (to face the memories).

Our incredibly associative mind-brain is a medium for the subtlest of triggers for traumatic memories, jumpy-startle and threat-based anger. Every moment can be seen through a lens of dread, with the threat feeling as real as real can get. And it’s so subtle and so unconscious.

Trauma victims may be touched by literally hundreds of thoughts and things each day that prick a memory, sending the mind spinning, the body bolting and life to the crapper.

I was recently talking with a Veteran of many tours, including Bosnia, and his wife about PTSD and these qualities of emotional memory. His wife then connected how he was unduly upset by his present-day neighbour’s unkempt lawn with the once mentioned threat of hidden landmines on tour. Bingo! When our mind connects these dots, relief follows because the connections are now seen, their origins located in time and subject to management.

Unfortunately, we don’t have any anaesthetics for emotional pain. Skillful courage and skillful support and skillful help to face and open up to past trauma are the right ingredients to heal trauma’s injuries. Talk about easier said than done! But suicide and the many other forms of avoidance are not the way.

Working on Mental Health

– by Lee Smith, Ph.D.

Okay, it’s time to do another survey.

“Hands up – who has a mind?” Hmmm, I thought so – everyone believes that they have a mind. “Okay, and now who among you has ever received any guidance or orientation or training in what it means to have a mind and how to work with it?”

When I ask a group this question there’s often a unanimous sense that we have never ever been taught or shown what having a mind is all about or how to work with our mind. These questions bring up a realization that there’s been this little bitty oversight by our culture – school offers sex-ed but no mind-ed. Actually, there seems to be a cultural taboo against knowing our feelings and against working on our mental health.

So, do you think it would make a difference? Do we need to? Do we want to?

On the latter question, it would seem that we’re awash in self-help books, shows and health gurus. These might be cultural indicators that there exists some prevalent condition and that people are hungry for guidance.

We also seem to be flush with psychopharmaceuticals that promise to do the job of adjusting our minds for us. Indeed, pharmaco-genetics is an emerging area of research attempting to develop antidepressants that are tailor-made to suit individual genetic variations.

But what if you prefer to DIY? Wouldn’t it be great to drop in to Mind Depot where they say, “You can do it, we can help?”

Given that mind and mental health embrace the working and content of our emotions, thoughts, perceptions, memory, behaviour and physical reactions, it’s a broad area that doesn’t lend itself to quick, fast-food remedy: “Ya, I’ll have a Big Insight, hold the Irony, a side of Wisdom and some Contentment, please.”

Our society doesn’t have a lot of difficulty with the idea, if not the practice, that getting into better physical condition takes work and dedication and time. Four weeks of effort is just a beginning. We accept the truism that a neglected body is more likely to be an unhealthier body, vulnerable to break down. The development of skills also entails repetitive work. To become adept at guitar or you name it, we have to arrange to practice, working patiently as little gains are earned.

There’s good reason to suggest that mental health is essentially similar. Neuroscience is effectively showing us that repeating some healthy (or unhealthy) activity over and over changes the brain tissue that mediates that activity. Want to like yourself better? Want to manage your anger or your depressive thinking?

Research shows that our abilities to hold and regulate emotion, heal trauma, and to pay attention are complexly rooted in a neurobiology that can be strengthened like a bicep. It might be that wisdom, intuition and compassion are skills that can be strengthened.

What might it be like to exercise the capacities of mind to see your mind and, really, to see your life, just as it is? What might it be like to learn to respect and listen to your emotion, rather than to avoid it?

Improving mental and physical health takes intention, practice and dedication. And mental health training takes courage, the emotional equivalent of resistance training, pushing against our massive tendency to avoid discomfort. Mental health won’t magically improve. Our relationships take work, our parenting takes work, loving ourselves takes work. If ‘being a good person’ is living in a way that reflects your deepest values, your potentials, your compassion, your heart, then that’s the work.

What Causes Depression and Anxiety?

– by Lee Smith, Ph.D.

What causes depression and anxiety? Many notions have seeped into our collective understanding about how we come to be depressed or anxious. The most common and deceptively simple idea is that these problems result from a chemical imbalance in the brain. Big Pharma promotes this idea so that we might flock to their products to gain relief from our misery, which we often do.

More sensibly for me, the current and promising state of our understanding of the development of depression and anxiety identifies the chronic experience of powerlessness, defeat and entrapment as a prime culprit.

Lots of evidence shows that animals respond physiologically and behaviourally in ways that look a lot like stress, depression and anxiety particularly when social standing is lost. This response is understood to be an adaptive way of dealing with being an underling. A subordinate monkey or wolf is in real danger of death if it signals any challenge to its dominant counterpart. Evolved ways of unplugging from being a threat to a bigger baboon are life-saving. The evidence is that social mammals have evolved wired-in defeat systems.

But when powerlessness becomes a constant in life, these defeat systems get jammed on (hello stress system!), actually causing emotional and physical illness.

How we human animals may come to feel powerless follows from many familiar and persisting external and internal conditions.

Intractable problems at your job, chronic pain and health problems, relationship and financial burdens, bullying and harassment, and so many other conditions can collapse hope.

Also, our consumer culture breathes life into defeat through all of the many unrelenting messages that imply that we aren’t rich enough, successful enough or good-enough looking – we can’t get no satisfaction! These chronic reminders are all around us, fuelling our wanting brain, and poke deeper insecurities about how we “should” be.

Internally, we may be very caught up in grim habitual ways of seeing and thinking about ourselves. Punishing messages and abuse during childhood and later traumatic events can unconsciously script our internal self-narrative in adulthood. Unresolved early abusive relationships make it more likely that we’ll feel and behave with similar powerlessness in our dealings in the adult world. It’s a subtle quality of mind, but a very powerful one.

Feeling and thinking chronically that we’re unworthy or inadequate are internal conditions that feel uncontrollable, unremitting and inescapable. Perpetually feeling trapped and defeated is a fundamental way in which depression and anxiety arise. And bad coping just keeps us stuck in additional ways and compounds our hopelessness.

It then follows that seeing your life as it actually and presently is can be incredibly liberating, and dissolves the conditions that support emotional problems. Wanting and cherishing what you already have and distinguishing between needs and truly empty wants turns media buy-in to something sadly funny instead of controlling. Seeing our actual situation at work and at home, instead of seeing the view we get stuck in, can reveal empowering options and alternatives.

Coming to terms with past abuse and loss reveals those old self-views to be unfortunate relics that are without present validity.

Strengthening our ability to be mindful enables a clear look at our life just as it is, a look that includes those parts of our life and mind that create the illusion of entrapment and defeat. It’s no wonder that mindfulness is being found to be a powerful approach to relieve anxiety and depression.

Mental health is a tough undertaking. We feel a huge inhibition to talk openly about these aspects of life. The shame we hold leads to a hushed privacy, a deep reluctance to face our life and mind and to explore them with the interest and tenacity and delight that they deserve and require.