Having the joy sucked out of my life
Having the joy sucked out of my life
By Lizzie Gardiner
LONDON: I suffer from clinical depression and have done on and
off since my teens. The current episode has lasted more than five
years and it looks quite likely that I shall always have a
predisposition for the big gloom. I am one of the 20 percents of
the U.K. population who live with this invisible illness and
whose core symptoms include anhedonia.
This is a little-studied area of depression. It was first
observed by the Victorians, but has prompted little investigation
since. Someone suffering from it has little or no ability to feel
pleasure from normally pleasurable experiences. Basically, it
sucks the joy out of most things that make life worth living -
food, sex, relationships and achievements. They no longer make
sense as something which would prompt an emotional response. It's
emotional dyslexia, if you like. You know what the occasion is;
you just can't rise to it.
My own depression came with a variety of symptoms, few of
which could be measured effectively and most of which have
shifted and changed as the condition has become chronic. It's an
illness which other people can't see, and unless they've
experienced it first hand they sometimes view a sufferer as not
helping themselves, as becoming a "victim of their own misery"
and basically not even trying. Plenty of well-meaning people have
said this to me in so many words and I can remember, to my shame,
that I once said it myself to a depressed friend.
At the time I couldn't understand why she wouldn't just drop
it; if she couldn't get a life at least she could try a hobby to
help her get a grip. Now I know - when I am at my lowest, I
couldn't "drop" my depression if the pope asked nicely, and I
could no sooner get a grip than fly.
Depression can be triggered by specific life events, a
physical illness, or a chemical imbalance in the brain. It seems
likely that my present onset was prompted by a series of common
disasters mugging me. My depression can be devastating. It can
take every ounce of energy I have just to sit still; it requires
every bit of spirit I possess to do anything. Anhedonia leaves me
impassive and joyless. My responses become shallow and mechanical
and I'm left feeling completely isolated and adrift from the
world.
Even now that I'm better able to manage my symptoms, I still
have to listen to other people's reactions to my achievements
before my autopilot kicks in and I can at least appear more
convincingly pleased.
There are people who just don't believe in depression. It's a
subjective issue, of course, and with no visual aids and only the
word of sufferers, it's hardly surprising.
There is hope, however. Dr. Tonmay Sharma, a consultant
psychiatrist at the Institute of Psychiatry in London, heads a
team presently investigating the organic nature of depressive
illness by conducting a study into anhedonia and depression
through brain imaging. Functional magnetic resonance imaging -
fMRI- has given researchers the opportunity to visualize the
effects of depression on the brain.
His findings suggest that a tangible change occurs in the
hippo- campus (an area of the brain which deals with emotion):
it's often smaller in people with depression and anhedonia.
Lesions and changes in brain metabolism have also been noted.
Dr. Sharma's study has shown that the network which modulates
mood in the brain of an anhedonia sufferer shows no activity when
presented with pleasing or positive images, whereas in the brain
of a person with no anhedonic symptoms such stimulation causes
the network to light up.
"This is a crucial juncture in research into depression. The
emergence of new technology is allowing us to map the brain,"
says Sharma.
The team is hoping that being able to show physical evidence
in the brain will also encourage depression and anhedonia
sufferers to obtain treatment earlier. He points out that if
someone breaks an arm they will generally go straight to
casualty, whereas someone with anhedonia might well delay asking
for help in the hope that their symptoms will go away on their
own.
Anhedonia responds well to treatment in most patients -
whether it's drugs or therapy - and it's thought a delay of this
sort can cause further dynamic changes in the brain, making the
condition more difficult to treat.
Enjoyment is a basic requirement for a full and happy life. We
know that happy people live longer, and they generally cope
better with illness and pressure along the way. The loss of this
function can be truly crushing. Rats placed under unpredictable
mild stress exhibit signs of anhedonia by a reduction in their
response to reward.
Laughter and pleasurable experiences in humans are known to
decrease levels of the stress hormone cortisol and help fight off
respiratory complaints by increasing the level of immunoglobulin
in our system. People find their larger pleasures in myriad ways
but anhedonics lose a sense of joy in even the most basic of
everyday comforts. A really excellent bacon sandwich, a glass of
wine or a loving hug no longer provide sufficient inducement or
reward to keep them fully functioning.
Learning to live with anhedonia is a strange and tedious
business. I hadn't imagined for a moment that I might have to
relearn one of the most basic of human experiences and it's a
great deal harder than you might imagine. I've had to learn
actively to take pleasure in the small things of life: clean
cotton sheets; Ella Fitzgerald beginning to see the light with
The Ink Spots; or chatting to the cat.
I'm moving on to achievements next and will slowly work my way
up to blowing my own trumpet. Or polishing it at the very least.
I'm learning to look for enjoyment in my day. I practice and
reward myself by working towards small goals with the incentives
that work for me - I do the Hoovering and win Desert Island
Discs, a cup of tea and a fig roll, for instance.
-- Guardian News Service