Category Archives: Anxiety-Depression

Nicotine Gum for Depression and Anxiety

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(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 she’ll always have enough gum; 3) possible dental issues caused by the gum; and 4) the sense of failure she feels by relying on 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—but she would be able to participate in, and better enjoy, 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 alleviate 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 if a medicine is effective. As for oral health, the evidence suggests 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 things like guilt, perfectionism, or the desire to control others.

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 for certain what to believe or what we should do. All we can do then is 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

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(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 a type of 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 don’t advocate using marijuana if it is against the 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, 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 also be a better, safer alternative than most of the psychopharmaceutical  drugs currently in use.

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 of 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 still 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 correct. 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 even if I’m not successful I won’t feel guilty.”

But don’t try too 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.

Depression: Whose Fault Is It?

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I was recently involved in a discussion about someone who had committed suicide. I don’t know the details but evidently, the victim was a successful, mid-career man, suffering from depression. A major contributing factor was job stress.  Here is how the dialogue went. (I’m CG) :

A Tough Guy (TG)- The guy was stupid and weak-minded. He needed to master his thoughts. If his job was stressful, he should have gotten another one. If his thoughts were troubling, he should change them.  If you can’t stand the heat get out of the kitchen.

A Compassionate Guy (CG) – Depression can strike anyone, it is a disease. If you experience enough stress you can have a mental breakdown. Just spend a few hours in a war zone or a few years in a stressful job and you can find out for yourself. If possible you should avoid bad situations, but you can’t always do that. Depressed persons need compassion and professional help.

TG – If you really care about someone tell them not to put themselves in situations where they might get hurt.

CG – Sure. But if they’re already suffering from mental illness it’s too late.   By that time they are then in a situation which is beyond their control.  At that point free will, if it exists, can’t intervene.

A Former Depressed Guy (FS) – When you are suffering from depression you can’t think rationally, just like when you are physically ill you can’t perform certain physical tasks. Friends helped me get help before I had my own breakdown, but many aren’t that lucky.
A Social Scientist (SS) – It’s problematic to insinuate that the fault with depression or suicide lies within the person. One million people decide to take their lives every year, that’s 1.5% of all deaths worldwide. The problem is the system. Many want to get out of the kitchen, but they can’t because the kitchen is the whole world.  So we should destroy the kitchen, and rebuild it so that it doesn’t burn us anymore.
An Economist (E) – It’s clear that the developed world faces issues related to stress—largely driven by capitalistic modes of production which have reduced the value of individual human experience.  Here is an article about South Korea that makes the point.
TG – Don’t blame the world; blame yourself. You decided to become stressed. So change yourself.
SS – We need societal structural change which leads to individual change, which in turn leads to societal change. We need a society based on a new social contract that meets people’s biological and psychological needs. A world where people aren’t forced into competitive environments.  A cooperative society based more on social capital than economic capital. A society with work that is stable and psychologically fulfilling.
TG – Until then if you can’t stand the heat get out of the kitchen.
CG – That’s what this talented man did.  He followed your advice. That’s not an indictment of him, even by your own standards. It’s an indictment of the world. We need to rethink the world.