Emotional pain typically drives the quest for psychotherapy.  Pain, after all, is nature’s signal that an organism’s welfare, and survival, are threatened.  Hence, taking action to identify the cause of the pain and to eliminate it are adaptive.  Any psychotherapist, and anyone who has undertaken psychotherapy, will tell you that it is not always easy to identify the cause of the pain and treat it — unlike how we diagnose and treat bacterial infections with antibiotics.  We have no clinically-available biological markers for emotional distress: no blood tests, brain scans, or urine assays.  The pain is no less real than that experienced elsewhere in the body, but explaining it is orders of magnitude trickier and requires more indirect methods of assessment.

Just try finding a word to describe the experience of an emotional ache.  The exercise renders most of us speechless for minutes.  Patient: “It feels bad.”  Therapist: “Yes, but which bad feeling is it?”  Patient: “I don’t know.”  And so the patient and therapist begin the excavation of the layers of his/her emotions and emotional learning history, down the layers of time as far as we can go — working to identify the feeling, its duration, its triggers in real time, and its roots in emotional history.

New research suggests that those layers of emotional learning may go deeper than we might expect.  In a recent study, psychological scientists demonstrated that 1-year-old infants seem to be capable of registering the emotions resulting from social interactions.  After performing a puppet show for the infants, researchers found that the infants could discern when one puppet was mistreated by another.  They could even discern when the mistreatment was accidental or deliberate.  In essence, the infants “…had strong feelings…” about the way the puppets should have treated each other.

Psychotherapists often speculate that some emotional reactions were learned, or emotional raw spots created, so early in life that they are not recorded as explicit memories, that is, memories that are “tagged” with information such as time and place of acquisition.  Rather, some emotional reactions seem to be recorded as implicit memories, typically experienced as something one just “knows” or experiences as “this is just me” without the ability to explain how it came to be.  The observations from this new study offer some tantalizing hints about the information infants can process and understand in their social – emotional worlds and could partially explain the challenge of putting feelings into words.  Some feelings could have been experienced before language development.  The study’s findings may also shine some light on the darkness of our understanding of how the emotional atmosphere of a family leaves its mark.

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A recent study using mice to mimic stress and depression in adolescents suggests that the teenage years are a particularly vulnerable time for the brain.  Working with mice who carried an introduced human gene mutation for depression, the researchers exposed some of the adolescent mice to social stress (isolation for three weeks) and kept a control group of mice stress-free.  There were two important findings.  First, the gene mutation for depression had no effect on mouse behavior except among the stressed mice.  Second, they found that the behavior change may be mediated by increases in cortisol (a stress hormone) and decreases in dopamine (a neurotransmitter in the brain).  Morever, after they returned the stressed mice to their preferred social environment, the behavioral abnormalities remained.  This study, and others like it, suggest that once activated during adolescence, the neuro-biological pathway active in depression does not turn off, even after the stressor has passed.

The take-home message?  We have another reason to increase our efforts at promoting healthy family environments for our children, and another reason that insurance companies should stop refusing to pay for marriage counseling.  A loving and secure attachment between married partners is the foundation for well-adjusted and resilient children.  …and possibly a buffer against a life suffering with depression.

Check out a more detailed summary of the study: http://www.hopkinsmedicine.org/news/publications/psychiatry_newsletter/hopkins_brainwise_spring_2013/stress_can_it_bring_more_than_teen_angst

or the study itself: http://www.sciencemag.org/content/339/6117/335.long

It is scary to be diagnosed with depression.  However, it’s a lot less scary to be diagnosed with depression when you know that your grandmother and your uncle on your mother’s side also had it.  We may live in the age of biological psychiatry, and the NIH may have just announced their plan to map the human brain http://www.neuroscienceblueprint.nih.gov/connectome/, but we are still haunted by a view of brain illnesses that led our forefathers to drill holes in the skulls of depressed persons to let out the evil spirits.  Stigma is alive and well.  But its impact is reduced by the realization that, “It’s not my fault.”  Moreover, people diagnosed with the illness may be more open to the proven treatments (talk therapy combined with medication) when shown evidence that the predisposition is inherited, not a function of personal failure.   Most of my new patients with the illness have no idea that they are suffering from depression; they just know that they are suffering — sometimes for 30 years.  Without treatment.  Blaming themselves.  Concluding that they are worthless and that their situation is hopeless.

If depression runs in your family, do your children a favor.  Save them potentially years of suffering.  Tell them about it.

In my psychotherapy practice in Baltimore, I see a great deal of emotional pain caused by the view that life is a series of pass / fail tests.  “I chose the wrong job, the wrong wife, the wrong plants for the garden. Hence, I am a failure.”  This attitude is reinforced by the most optimistic adage we have for less-than-optimal outcomes:  Learn from your mistakes.  Even worse, people can become paralyzed in making any decisions if undesired outcomes are generally framed as mistakes.  I propose an alternative viewpoint:

Life is a series of experiments.

Do some experiments and learn about yourself.  Unlike the simplest electronic gadgets, a human body has no user’s guide – no guide for how to create success and contentment.  Creating a satisfying life using our biological endowment and learning history requires experimenting to find out with what we’re good at and what we’re not, what works for us and what doesn’t, what makes us happy and what doesn’t.

Do some experiments.  Make a decision and collect data about the outcome:  I like this / I don’t like this.  Regardless of the outcome, you haven’t passed or failed:  you’ve learned something new about yourself.

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