Category Archives: Anxiety-Depression

Nicotine Gum for Depression and Anxiety

(This article was reprinted in the online magazine of the Institute for Ethics & Emerging Technologies, May 5, 2016.)

(Disclaimer – I’m not a medical doctor. For more info on these topics consult an M.D.)

I was thinking about a friend who quit smoking about 10 years ago with the help of nicotine gum. She eventually kicked the nicotine gum habit too, although she claimed that it was about as difficult to quit the gum as it was the cigarettes. She did notice that her ability to deal with anxiety was reduced after quitting the gum, and she also became more depressed. As a result, she has considered starting to chew gum again.

Her main arguments against chewing the gum are: 1) the cost of the gum; 2) the worry that will come with always having to make sure she has enough gum; 3) possible dental issues caused by the gum; and 4) the sense of failure she feels in not being able to live without this crutch. Moreover, there is no guarantee that the gum will minimize her anxiety or depression, although there is some reason to think it will.

The main argument for chewing the gum is the reduction in anxiety and depression. (There are good reasons to think nicotine can help.) The thing to remember about this benefit, if it occurs, is that it is substantial and multi-faceted. Not only would she feel better—because her anxiety and depression would be minimized at all times—but she would be able to participate in and better enjoy other things that would make her life go better, like social relationships and productive work. Moreover, this reduction in anxiety and depressive symptoms would have good consequences for her physical health. (This assumes there are no negative health risks from chewing small doses of nicotine. As best as I can determine, there are no health risks.) So nicotine gum might both minimize her negative symptoms and make it more likely that she participates in activities that help her symptoms. You don’t want to join a group or do productive work if you are anxious and depressed.

Now let’s consider her arguments against using the gum. If you can’t afford it, then you can’t buy the gum. In her case she can afford it, although the $60 or so a month is costly. The worry about having the gum readily available is a reasonable one, although it isn’t any different from worry about having any other kind of medicine with you. That is a small price to pay for a medicine that is effective. As for oral health, the evidence suggest it has no ill effects  at least as far as I can tell.

The fourth argument is particularly interesting, but I think ultimately fallacious. There are many “crutches” people use to get by including but not limited to: alcohol, tobacco, food, sex, religion, therapy and exercise. We also depend on things for our well-being like air, water, medicine, and more. If something helps you live better and doesn’t hurt anyone else, why not utilize the help? In fact, given that our behavior affects others, we may be morally obligated to do what’s necessary to help ourselves so as to be in a better position to help others. So if someone tells me they need to take some medicine or other drugs to physically or psychologically function, or they need to go the therapist or to church or for a long jog, I say … go for it. And those who say otherwise are probably motivated by their own guilt or perfectionism, or the desire to control other people.

To place this issue in a philosophical context consider that we are all thrown into this world without our consent. We must live in a world about which ultimately we know very little. We don’t know what to believe or what we should do. All we can do then, is do our best. The philosopher and psychologist William James, who was himself tormented by depression, expressed these sentiments beautifully:

We stand on a mountain pass in the midst of whirling snow and blinding mist, through which we get glimpses now and then of paths which may be deceptive. If we stand still we shall be frozen to death. If we take the wrong road we may be dashed to pieces. We do not certainly know whether there is any right one. What must we do? ‘Be strong, and of good courage.’ Act for the best, hope for the best, and take what comes. If death ends all, we cannot meet death better.

Marijuana for Anxiety

(This article was reprinted in the online magazine of Institute for Ethics & Emerging Technologies, March 13, 2015. )

A few days ago there was an interesting article in the New York Times, “The Feel-Good Gene,” by a professor of clinical psychiatry at Weill Cornell Medical College. The author wonders why some people are predisposed to anxiety which doesn’t have obvious environmental causes, and which is thus not helped by psychotherapy; while others are immune to such anxiety.

Not surprisingly, the answer is that “a genetic variation in the brain makes some people inherently less anxious, and more able to forget fearful and unpleasant experiences. This lucky genetic mutation produces higher levels of anandamide — the so-called bliss molecule and our own natural marijuana — in our brains.” Those who have this mutation are also “less likely to become addicted to marijuana and, possibly, other drugs — presumably because they don’t need the calming effects that marijuana provides.” Unfortunately only about 20% people have the mutation.

For those without the lucky genetic variation, the author has found that marijuana is generally effective for anxiety, and the reasons for this are physiological.  It turns out that marijuana targets “the endocannabinoid system [which] is closely related to the brain’s own anandamide.” And when anandamide “binds to the cannabinoid receptor, it has a calming effect … We all have anandamide, but those who have won the lucky gene have more of it because they have less of an enzyme called FAAH, which deactivates anandamide. It is a mutation in the FAAH gene that leads to more of the bliss molecule anandamide bathing the brain.”

So the evidence strongly supports that the mutation doesn’t just correlate with less anxiety, it causes people to have less anxiety. The author’s moral conclusion is that “there is more to abstinence than grit and moral fiber: Having a double dose of a gene mutation gives you a big advantage in being able to “just say no.” Of course the author notes that “… these studies should not be taken to mean that biology calls all the shots … The environment plays a critical role and can sometimes even trump genetics.”

As for the use of marijuana to treat anxiety the author is skeptical.

The problem is that cannabis swamps and overpowers the brain’s cannabinoid system, and there is evidence that chronic use may not just relieve anxiety but interfere with learning and memory. What we really need is a drug that can boost anandamide — our bliss molecule — for those who are genetically disadvantaged.

Reflections – I have written recently about issues of freedom and responsibility regarding anxiety and depression. I think we should accept that many things are out of control, especially the past, while accepting that we have influence on the present and future. So I agree with the author’s claim that such diseases have a strong genetic influence.

As for marijuana, while I have never been a user myself, I disagree with the author’s conclusion. However, before I continue let me issue two disclaimers: (Disclaimer #1 – I am not a medical doctor. Disclaimer #2 – I do not advocate using marijuana if it is against state law.)

Alcohol, cigarettes,  tylenol, antidepressants, antipsychotics and benzodiazepines have more bad side-effects and are more dangerous than marijuana by  a considerable amount. This is a fact. So in a cost-benefit analysis between marijuana and persistent anxiety, or marijuana and these other drugs, marijuana win easily. Ask yourself this. Do you want cortisol coursing through your veins? Do you want the awful side-effects that accompany so many of the mainstream anxiety medications? Do you want to drink alcohol or smoke cigarettes? Do you want to experience life-effecting and possibly life-destroying anxiety? Or do you want to feel better with some possible minor cost?

I think the rational choice is clear. If marijuana is legal where you live, as it is today in Washington and Colorado, then there is little cost and much benefit in trying it for anxiety. (I include the legality constraint because people are still incarcerated for marijuana use, although that is patently unjust.) Yes what your psychiatrist and psychotherapist say is true; there is no demonstrable scientific evidence for marijuana helping with major anxiety. But this is because the government classifies marijuana and a Stage I drug, and it is thus not available for normal research.

And while I’m at it I think nicotine gum would be a better, safer alternative than most of the psychopharmaceutical  drugs currently in use.

Critique of Epictetus and Stockdale

A line drawing of Epictetus writing at a table with a crutch draped across his lap and shoulder

I recently wrote about the story of James B. Stockdale, who survived as a prisoner of war with the help of the philosophy of Epictetus. Since writing that piece I came across a more negative view of Stoicism, particularly as it is embraced by the American military, in a New York Times piece, “A Crack in the Stoic’s Armor.” It was penned by Nancy  Sherman, University Professor of Philosophy at Georgetown and the first Distinguished Chair in Ethics at the U.S. Naval Academy.

Sherman notes that “In the military, even those who have never laid eyes on a page of Epictetus, still live as if they have.” In other words, many military personnel embrace the Stoic doctrine of being undisturbed by external events. In short, they tough it out as best they can to deal with various stressors. But Sherman found, after interviewing soldiers, that many wished “to let go of the Stoic armor.” They were tired of sucking it up, and wanted to deal with “feelings blocked off by idealized notions of Stoic purity and strength that leave little room for moral conflict and its painful residue.”

Even Cicero, after losing his daughter in childbirth, said: “It is not within our power to forget or gloss over circumstances which we believe to be evil…They tear at us, buffet us, goad us, scorch us, stifle us — and you tell us to forget about them?” Many soldiers told Sherman the same thing about the experience of war. And I think many of us would benefit from removing our armor. Many tough it out until they break, trying to be good Stoics, but the strongest minds can be broken. At some point physiological change ensues, at which point more than willpower is necessary for psychological health.

It is one thing for Epictetus to say “he was never freer than when on the rack,” but that is a high standard for most of us to achieve.1 We shouldn’t consider ourselves failures if we don’t live up to such standards.

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1. Aristotle quotes this variously attributed proverb in the Nicomachean Ethics, pp. 7, 13, but he disagrees with it.

Alan Watts: Anxiety and the Self

A few days ago I wrote a post about the thought of Alan Watts, and yesterday I wrote about depression and anxiety. These posts reminded me that Watts wrote about anxiety too.

Watts believed that Western culture as a whole was neurotic. (A theme in Freud as well.) The primary reason for this, Watts argued, was that in Western cultures many people work which bring little happiness. They often do work they don’t like for money but, “If you say that money is the most important thing, you’ll spend your life completely wasting your time: You’ll be doing things you don’t like doing in order to go on living, that is, in order to go on doing things you don’t like doing — which is stupid!”

But A primary source of anxiety is the ego. We want to buttress and hang on to the ego, but we can’t hang on to an illusion. For, as we pointed out in a previous post, for Watts there is no enduring self or ego, an idea promulgated by the empiricist David Hume as well:

For my part, when I enter most intimately into what I call myself, I always stumble on some particular perception or other, of heat or cold, light or shade, love or hatred, pain or pleasure. I never can catch myself at any time without a perception, and never can observe any thing but the perception…. If any one, upon serious and unprejudic’d reflection thinks he has a different notion of himself, I must confess I can reason no longer with him.

Watts said that most of us think our self exists between our ears and behind our eyes in the middle of our head, and is encased by our bodies. But Watts asked, why do we end where our bodies do? After all, our skin is porous and interacts with the environment. We can’t survive for more than a few minutes without the air, so why isn’t the air as much a part of us as our legs or arms?   And there is no breathable air without plants, so why aren’t they a part of us? In fact, our existence depends on the earth’s ecosystem and the sun. Following this line of thinking, we ultimately depend on the entire universe for our existence.

So perhaps we aren’t egos inside bags of skin, or even separate egos at all. Maybe we are like windows or apertures or vortexes through which the universe is conscious of itself for a brief moment. While we are fond of saying things like “I came into this world,” isn’t it more accurate to say, “I came out of the universe?” Don’t people come out of the universe like leaves come out of trees or waves come out of oceans? Or as Watts asks, doesn’t the universe just “people?”

Watts believed that letting go of the illusion of the self, we will eliminate much anxiety. We would no longer be concerned with puffing up our egos, or worry about their destruction. Here the great philosopher Bertrand Russell expressed a similar idea when talking about death:

[T]he fear of death is somewhat abject and ignoble. The best way to overcome it –so at least it seems to me– is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life. An individual human existence should be like a river –small at first, narrowly contained within its banks, and rushing passionately past boulders and over waterfalls. Gradually the river grows wider, the banks recede, the waters flow more quietly, and in the end, without any visible break, they become merged in the sea, and painlessly lose their individual being. The man who, in old age, can see his life in this way, will not suffer from the fear of death, since the things he cares for will continue. And if, with the decay of vitality, weariness increases, the thought of rest will be not unwelcome.

I think Watts is right. We suffer from anxiety for many reasons but we would do better if we less concerned with our little egos—which are illusory anyway.

Depression & Anxiety: Freedom Without Responsibility

(This article was reprinted in the online magazine of the Institute for Ethics & Emerging Technologies, March 1, 2014)

Consider these two questions: 1) Are you responsible for being depressed or anxious? And 2) Should you feel guilty or ashamed of being depressed or anxious? Let’s consider the first question.

Here are four possibilities:

1) You’re not free, and thus you are not responsible for being depressed;
2) You’re free, and thus you are responsible for being depressed;
3) You’re not free, but you are still responsible for being depressed;
4) You’re free, but you are not responsible for being depressed.

Consider the benefits and costs to each option:

  • The benefit of adopting #1 is that you don’t feel responsible for your situation; the cost is that you don’t feel free to change your situation.
  • The benefit of #2 is that you do feel free to change your situation; the cost is that you feel responsible for your situation.
  • This view only has costs; you don’t feel free to change your situation, and you do hold yourself responsible for your situation.
  • This view only has benefits; you feel free to change your situation, and you don’t feel responsible for your situation.

From a cost/benefit analysis you should choose #4. Why don’t people do this? Probably because they don’t think #4 makes sense. Most people think that either #1 or #2 is true. But #3 and #4 are possibilities too. We might live in a determined world where people should be held responsible (#3). Our mental states might be determined, but we are responsible for taking drugs or going to counseling to change those states. Or we might live in a free world where people shouldn’t be held responsible (#4). We might be free to choose our actions and mental states, but not be responsible for them because determinism is very strong.

I’m not saying which if any of these options best represents the state of the world, I’m just saying we don’t know which one is best. We can’t definitely answer the question, “Am I responsible for being depressed or anxious?” What we can say is that you might as well believe #4. To do this just accept that the past is determined, it is closed—you can’t affect it. But the future is not determined, it is open—you can affect it. (These claims could be wrong if backward causation is possible, or if fatalism is true. But almost no professional philosophers hold such views.) So it is easy to believe that we are free but not responsible.

Now consider the second question: Should you feel guilty for being depressed or anxious? Here an insight from Stoicism is invaluable—we can’t change the way some things are, but we can change our view of those things. Guilt and shame are attitudes toward reality that we can reject. So just say, “I will not feel guilt or shame.” Of course we can choose shame and guilt, and if we do we shouldn’t feel guilty about that either. But we can choose not to do this too. We can say, to hell with guilt! So go ahead and say it. To hell with guilt! Remember, guilt is something that other people or organizations use so that they can control you. Don’t let them manipulate you. Control your view of things.

Now suppose you try to change your attitude, but a week or a month or a year later you still feel guilty about being depressed. I say keep trying, but don’t feel guilty about feeling guilty. Remember, you’re only free, if at all, regarding your actions in the present! And the present recedes into the past instantaneously. So just keep telling yourself: “right now I’m free to try to reject guilt, and if I’m not successful I won’t feel guilty.”

But don’t try to hard either. Things take time, patience is a virtue. Relax, accept yourself, and let the guilt slowly recede. Remember that everything changes, and you will too. Go with the flow, change with the universe, and don’t fight too hard. Flow as peacefully as possible down the river of life.

In other words, don’t forget the Taoist concept of wu wei. Wu wei literally means “without action”, “without effort”, or “without control.” It also means “action without action” or “effortless doing” or “action that does not involve struggle or excessive effort.” This doesn’t mean that we shouldn’t act or that the will is bad, but that we should place our will and actions in harmony with nature. And sometimes nature will take time to cure our ailments. Sometimes we just have to wait for things to pass. And all things will pass.