[NOTE: The following selection comes from "Shades of Sadness" (subsequently
published as "Case Studies in Depression") by David McMillin. Copyright
© 1991 by David McMillin. Used with permission. All rights
reserved. "Case Studies in Depression" is currently available from
A.R.E. Press in Virginia Beach, Virginia. See
below for continuing
education credit for this material.]
CHAPTER ONE The Neurobiology of Depression
Depression is a morbid sadness. It may manifest in degrees of severity ranging from mild impairment to total debilitation. Depression is distinguished from grief, which is realistic and proportionate to personal loss. In recent decades, considerable advances have been made in understanding the causes of depression. Researchers have implicated a variety of psychological, interpersonal and biological factors while clinicians have authored an abundance of innovative therapeutic interventions. Thus, a considerable literature has accumulated resulting in a greater appreciation of the breadth and complexity of depression. In this and subsequent chapters, we will examine this literature and compare it to the psychic readings of Edgar Cayce. However before we engage in comparative studies, it may be helpful to define exactly what depression signifies in common terms. The word "depression" is commonly used to describe mood states ranging from mildly negative feelings of sadness to the most severe and debilitating psychiatric illnesses. Traditionally, the term melancholia has been used to designate depression. Even today, psychiatry utilizes this expression when distinguishing certain forms of depression. Regardless of the label, feelings of hopelessness and worthlessness are typically prominent. Excessive or inappropriate guilt is sometimes associated with depression. Depressed persons have difficulty experiencing pleasure and frequently report a loss of interest in the normal activities of life. The mental symptoms of depression include difficulty in concentrating, slowed thinking, and indecisiveness. Thoughts tend to center on self-reproach and negative self-evaluation. Memory may be impaired and the person may be easily distracted. Thoughts of death and suicide may be prevalent. Physical symptoms are also common in depression. Disturbed appetite and sleep patterns, coupled with numerous "somatic" complaints of various aches and pains give the impression of poor general health. "Somatic" is an important word in the psychiatric literature. It is derived from the Latin soma, meaning body. Thus, depression has a strong physical dimension which we will examine more closely when we discuss the medical model of mental illness. In fact, we will focus heavily on the somatic aspects depression in the first four chapters of this book. A depressed person may experience anxiety, tearfulness, irritability and excessive concern about their physical health. Depressed thoughts and feeling may be translated into behaviors such as "psychomotor agitation" or"psychomotor retardation." In other words, the person may either experience a restless, nervous energy leading to excessive movement. Or, little or no energy may be available resulting in an inappropriate lack of movement. In its most severe forms, depression may be mixed with psychosis. Psychosis refers to a loss of touch with reality. This form of depression is sometimes called psychotic depression or depression with psychotic features. For example, a person may experience sensory hallucinations such as "hearing voices." Or an individual may become delusional and believe that they are being persecuted because of some misdeed or personal inadequacy. As we shall see in Chapter Nine, bipolar disorder (manic-depressive illness) is a particular type of mood disorder in which mania can sometimes manifest as psychosis. While there have been an abundance of theories of
depression put forth to explain the causes of all of the symptoms just
mentioned, one approach is rapidly becoming predominant in western culture.
This theory is based upon the biochemistry of the body's cells, specifically
the cells in our nervous system. Going even further, this approach
focuses on the molecules within and between nerve cells as the source of
depressive symptoms. This fixation on the neurobiology of mental
and emotional symptoms has been called the medical model of mental illness.
The Medical Model of Mental Illness Psychiatry is the branch of medicine dealing with mental disorders. It has been undergoing a revolution during the last four decades. The tremendous growth in our understanding of the medical aspects of mental illness goes back to the mid-1950's. It was at that time that French physicians discovered the antipsychotic properties of a particular class of drugs called the phenothiazines. Specifically, it was a phenothiazine marketed under the trade name Thorazine which initiated the biological revolution in modern psychiatry. The story of this important discovery is fascinating and may help us to understand the process of medical research. Here are some of the facts. The French physician Henri Laborit was looking for a drug to prevent a drop in blood pressure during surgery. Although the drug he used failed in that respect, it did have noticeable sedative effects. The astute physician wondered if the drug could be useful in the treatment of mental and emotional disorders. Labori's curiosity paid off. Subsequent research by French psychiatrists was by trial and error - they gave the drug to persons suffering a wide range of disorders to see if it had any effect. The medication had powerful calming effects on agitated psychotic patients and thus: "The first powerful drug available to treat serious mental illness was discovered in much the same way as was penicillin: by accident. The discovery was the happy consequence of a chance finding being observed by a person with a fertile mind who could recognize its larger implications." The preceding observation was noted by Nancy Andreasen, M.D., Ph.D., a leading researcher in the field of mental illness. Just as the first antipsychotic medication was discovered by accident, one of our most useful mood altering drugs was likewise a gift of serendipity. Lithium carbonate, a naturally occurring salt widely used in the treatment of mood disorders such as bipolar disorder, was discovered by an Australian researcher seeking a neutral solution to serve as a control substance in experiments with rats. Fortunately, he was astute enough to notice that the substance intended to have no effect, actually affected the rats' behavior in specific ways. Like Laborit, he wondered if the calming effect of the substance could be helpful in the treatment of mental and emotional disorders. He had a difficult time convincing his colleagues to give lithium a try - it had been used in previous experiments with humans and its propensity for toxicity resulted in several deaths. Eventually, its therapeutic value was acknowledged and is now widely used by the medical profession in treating emotional disorders such as depression and mania. Finally, the use of "monoamine-oxidase inhibitors" (or MAOIs, a class of drugs used to treat depression) can also be traced to a lucky side-effect. One of the MAOIs is an antibiotic used to treat tuberculosis. Clinicians noted that the drug helped to relieve the depression which also plagued the patients. Subsequent trial and error experiments further refined the applications of this family of anti-depressant drugs. With the accidental discovery of these "wonder drugs" came a surge of research and development to expand their therapeutic efficacy and to understand how they worked. The ensuing research not only produced a multitude of new drugs for treating mental and emotional problems, but also helped to extend our comprehension of the biological dimension of mental illness. Specifically, this research focused on the way nerve impulses are transmitted from one cell to another, hence the term neurotransmission. To understand what neurotransmission is, let's look for a moment at how the nervous system works. The body's nervous systems have often been compared to electrical wiring. However there is one major difference. The various "circuits" in these systems make connections at junctures between individual nerve cells. These junctures are called synapses. Synapses are spaces between the cells in which special chemicals produced in the nerve cells act as messengers between the cells. The chemicals are known as neurotransmitters. I will point out an important anatomical detail which will become relevant later on when we discuss Edgar Cayce's view of neurobiology. While there are various types of nerve cells, most of these cells are composed of two main parts: the cell body which is called the gray matter in nerve tissue; and the axon or nerve fiber that extends out from the cell body to make contact with other nerve cells or muscle tissue. The axon or nerve fiber is generally surrounded by white fatty tissue called myelin sheathing. This fatty coating is sometimes described as a form of insulation, such as found surrounding an electrical wire. Although the myelin sheathing may serve multiple purposes, one of its most important contributions to the nervous system is facilitation of the nerve impulse along the axon. In other words, it helps the nerve impulse to travel faster, up to twenty time faster, than would otherwise be possible. Because of this fatty coating around the axon, this part of the nerve cell is called the white matter. If you were to look at brain sections in which the gray matter and white matter were differentiated, you would notice that the white matter seems to predominate. So if you should ever feel like calling someone a "fathead," you would at least be accurate strictly on anatomical grounds. Getting back to neurotransmission in mental illness, researchers have compiled substantial evidence in support of faulty neurotransmission in mental disorders. Many illnesses, including schizophrenia, depression, and anxiety disorders are thought to result from abnormal neurotransmission within the synapses of certain circuits of the brain. Specifically, the neurotransmitter dopamine is widely recognized to be involved in the symptoms of schizophrenia. Hence, drugs used to treat schizophrenia directly affect the activity of dopamine in the synapses between nerve cells in certain areas of the brain. Likewise, the various antidepressant medications are thought to affect certain key neurotransmitters within the brain. You may think of it this way. Depression may result from a deficiency of impulse between nerve cells. Perhaps there is a decrease in neurotransmission within certain circuits of the brain. Hence nerve activity is literally depressed or inhibited. Interestingly, Edgar Cayce sometimes spoke of a "lapse of nerve impulse" in cases of depression. Research appears to indicate that medications somehow change the chemistry within the synapses or within the nerve cells themselves to enhance neurotransmission. Two neurotransmitters have been strongly linked to depression: noradrenaline and serotonin. Antidepressant medications are thought to increase the activity in nerves which utilize these neurotransmitters. You may have heard of the drug Prozac. This widely used (and controversial) antidepressant is thought to therapeutically effect serotonin neurotransmission. There are two important points that I would make regarding this discussion of the neurobiology of mental illness. First, most of the major breakthroughs in this field resulted from accidental discoveries. Compared to these serendipities, the list of major therapeutic breakthroughs resulting from a concentrated study of a mental illness and thorough understanding of the problem is meager. The fact is, we still don't know for sure what causes these disorders or exactly how the drugs suppress the undesirable symptoms. So the image of successful research (i.e., a team of knowledgable researchers who produce an effective treatment based on a thorough understanding of the condition and millions of dollars in government funding) is not necessarily accurate or comforting. Consequently, the truth of the matter is, the cause or causes of mental illness (of any type) remains unknown. This includes depression. Secondly, all mental illnesses are presently incurable. The drugs (and other therapeutic interventions) only provide symptomatic relief. In many cases (particularly the more severe forms of psychopathology), the drugs must be taken regularly for long periods, or even a lifetime. When the medications are stopped, the symptoms usually return. I want to be clear about this. I am not saying
that drugs are wrong or that they don't work. To the contrary, I
think drugs can be very helpful in certain cases; particularly when they
are integrated into a more comprehensive treatment approach. I am
especially appreciative of the wonderful research that has been done into
the neurobiology of mental illness. Without doubt, most mental symptoms
involve significant pathology at the level of nerve cells. However,
as we shall see in this and subsequent chapters, neurobiology is only part
of the story of mental illnesses such as depression.
Edgar Cayce's Holistic Approach To gain an understanding of Cayce's approach to depression, including the neurobiological aspects which relate to the medical model, we must first consider the concept of holism. Within the context of the Cayce readings, holism refers to the inherent inner-connectedness of the triune aspects of the self. In other words, it signifies the intimate relationship between the physical, mental and spiritual dimensions of our being. This viewpoint is not particularly unique. Throughout the ages, various religious and philosophical systems have been created which recognize the multiple aspects of selfhood. For example, Plato used a triune model to explain human experience. He acknowledged that each human being represented a combination of three aspects: a divine (rational) aspect; a mortal, animal aspect and an intermediate, interactive aspect (will). The uniqueness of the Cayce readings, in this respect, is the depth and specificity with which the readings elaborate the interface of the triune aspects of selfhood. The physical body is associated with the organs of the body - literally, flesh and blood and the organs which sustain these vital substances. Not surprisingly, the mental aspect is correlated with the nervous systems. This is consonant with modern biology and other disciplines in the fields of medicine and psychology. However, Cayce's viewpoint on the spiritual connection within the body is a bit more unique. He cites the glands as primary spiritual "centers" within our anatomy. Here is an excerpt from a reading given for a thirty-year old woman suffering from severe mental symptoms (anxiety in the form of panic attacks and phobias). Reading 2114-1 clearly defines the triune aspects of self in anatomical terms while emphasizing the importance of viewing the whole person: ... it is well to consider the entity as a whole ... the entity finds
itself made up, as it were, of body, mind and soul ... There are centers
in the physical body through which all phases of the entity's being coordinate
with one another; as in the physical functioning there are the pulsations,
the heart beat, the lungs, the liver, and all the organs of the body.
They each have a function to perform. They each are dependent upon
the other, yet they function according to those directions of the mental
self - or the nervous systems.
Note that Cayce states that there is more to mind than the brain and nerve fibers. While these structures serve as the channel for mind to manifest in a physical body, mind is eternal. Mind both predates and survives individual human existence. Yet "it is through the nerve plasm that the nervous systems carry impulses to the various forces of the system." This reading was given on February 24, 1940. This was over a decade ahead of the pioneering medical research which linked faulty neurobiology to mental symptoms. Incidentally, Cayce went on to diagnose Ms. 2114's problem as a thyroid deficiency (a condition now acknowledged by medical practitioners as one of the sources of panic attacks). Cayce stated that proper glandular functioning was essential for a healthy nervous system. For instance, in reading 566-7 he described how, "All portions of the nervous system ... are affected by those activities of secretions through glandular forces of the body." Hence, the intimate relationship of mental and spiritual processes as manifested in a physical body through the nerves and glands of the body. We will look more closely at the importance of the glandular connection in depression in Chapter Two. At this point, I merely want to emphasize that Edgar Cayce was well out front in recognizing the neurobiological dimension of mental symptoms. As we shall soon see, years before medical research explored these connections, the readings described the cellular processes involved in depression and other mental disorders. Reading 241-1 contains one of the many explicit references to faulty neurobiology in cases of depression: Impulse in brain forces, or its reaction, are of two natures - the white and gray matter, as is ordinarily called. One an impulse, the other the active force that carries same. In the body, when the impulses come from the pressure as has been created in the forces seen to the brain itself, we have that of the activity without the impulse to carry same forward. Hence we have what is commonly known or called melancholia, or depression, or the inability to carry out the impulses of the body. Note the similarity to contemporary views of neurobiology in depression (i.e., the "medical model"). Cayce is describing a breakdown in the way the nerves transmit impulses. Keep in mind that this reading was given to a lay audience years before the discovery of neurotransmitters and the development of modern models of neuropathology. Reading 4519-1 provides another example of Cayce's ability to address depressive symptoms at the level of neurobiology: The melancholia [depression] has now become remorse. Still, we have the supplying nerve forces in their rebuilding protoplastic cells gives an action to the gray matter carrying in nerve tissue, that does not act with the white nerve forces and tissue, and as it is made up gives two separate actions. One is acted on by the expression of one of the senses of the body. Expression reaches the nerve center through one of the senses. As the action comes to the brain through the gray matter, the action of the brain to the body comes through the white. In this we have a lack of expression through the gray forces. Again, the emphasis was on a breakdown in nerve impulse
within the brain. Frequently, the readings referred to this condition
as simply a "lapse of nerve impulse," as we shall observe in the case study
which follows.
"I am no good" According to his mother, Mr. 3207 had a perfectly normal childhood. He was born in Paris, France in 1905 to a French father and American mother. Both parents were musically gifted and their son attempted to follow in their footsteps. As his mother's letter of June 1, 1943 reports, he was to encounter extreme disappointment in this and other areas of this life: ... his one bent was music - singing and violin - but he did not succeed in either as a professional. He worked two years in a music store, lost his job, married and after five years his wife left him for another man which resulted in his trying to take his life by monoxide gas. He had a complete nervous breakdown ... was in a sanitarium one year; was another year recovering and remained well for five years. In 1941 he showed signs of another nervous attack, but a trip south on a small boat seemed to benefit him until he went all to pieces and into a sanitarium for another year. I have him with me now. He eats and sleeps well, meets people and SEEMS normal but has obsessions, first one and then another and keeps saying, 'I am no good, Mother.' ... He is six feet [tall], well formed and of dark complexion, a very charming young man, but really AFRAID to meet the world. Doctors do not seem to understand his case. He is religious and told me quite frankly that the only thing that 'saved' him this time was prayer ... Three weeks later, the mother again wrote to Edgar Cayce describing the events leading up her son's severe depression: Up to five years ago he was a normal, fine, happy young man. His wife deserting him caused him to attempt suicide, but after a year he was alright again and for five years, until he was rejected from the Army. He is very depressed, talks of suicide, as an accident, so as not to cause me trouble, asks my permission to allow this to free him from this troubled mind. He eats and sleeps well and meets people as you and I would, but drops back into his tragic state and often drops his head as though there was something wrong. He has been with me two months, after a year in a sanitarium, and much prefers death to a return there. You will have to decide which reading fits his case. I am doing all in my power to give him help. I hope the reading can be soon, as I live in constant dread that he may take his life ... The third letter sent prior to 3207's reading reiterated the mother's concern for her depressed and suicidal son: He seems so well until he talks and then it is always, 'Mother, I can't live with myself any longer. I'm no good - perhaps the next world will give me a chance.' He says this over and over, often to himself in an undertone; he mumbles all the time. There must be some hidden reason for this that they have not discovered. He has a way of shaking his head that leads me to believe the trouble is mental. 'I am no good' he will always say when questioned. His one concern is my welfare and peace of mind, and he thinks by doing away with himself he will free me from all worry. I cannot erase this idea from his mind. I am holding the thought that he will not try again to do away with his life - and I accept the September 11th appointment ... The final letter before the psychic reading stated that 3207 wished "I could only bore a hole in my head and shake out something." According to his reading, this man's sense that something was wrong in his head - something so physical, so biological that it could be surgically removed, bore some degree of truth. A single reading was given for this thirty-eight year old man on September 11, 1943. The seriousness of this man's disorder was immediately addressed: Yes, we have the body, [3207]. As
we find, unless there can be the persuasion through suggestion in or from
the spiritual approach, little may be done to arouse this body from the
lethargy into which it has purposely driven itself.
Suggestions should be made from purely the spiritual angle, in conjunction with purely mechanical applications. These, if practiced in this particular case would bring relief. The reading went on to provide specific therapeutic recommendations which we will discuss later. However, first I would point out the holistic emphasis of this excerpt. There is a recognition of the physical level of pathology as mentioned in the "nerves lapses" producing incoordinations between the nervous systems. The mental or "psychopathic" dimension of the problem is also acknowledged. His mental reaction to the disappointments in his life was cited as the source of the breakdown within the nervous systems. We will further explore the destructive power of the mind in Chapter Five. For now, I will simply indicate the readings' consistent and even pervasive recognition of the "mind-body" connection. The relationship was seen as interactive. Mind affects body; body affects mind. In this particular case, the self-condemning contents of his mental processes actually programed the nervous systems to deteriorate in their functioning. The third aspect in this case, the spiritual dimension, was addressed in the treatment plan. Mr. 3207 was to be provided with a companion or attendant who would employ a technique called suggestive therapeutics. Specifically, the readings recommended a "Christian Science Reader" as an ideal companion. This was a common recommendation in cases of major mental illness where the person was dangerous to themselves or were incapable of functioning at a level necessary for implementing the treatment plan. Cases of severe depression (including bipolar disorder) and schizophrenia frequently called for companion therapy. The spirituality of the companion was emphasized in such cases. In this particular case, the companion was to give positive suggestions to Mr. 3207 at various times of the day. This application of suggestive therapeutics is essentially a form of natural hypnosis. Because most persons are unfamiliar with the techniques for inducing a hypnotic trance, the readings advised that suggestions be provided during the physical treatments while the person was in a relaxed, receptive state of mind. Thus during the physical therapies such as electrotherapy and massage the caregiver was directed to talk to the patient in a calm, firm voice; giving positive suggestions for physical, mental and spiritual healing. The suggestions could also be directed towards undesirable behaviors or lack of cooperation. The readings also frequently advised that bedtime be utilized as a time for suggestive therapeutics. During the first few minutes of sleep, a slumbering individual is in a hypnogogic state and is very open to suggestion. This form of suggestive therapeutics is sometimes referred to as presleep suggestions. As with all forms of suggestive therapeutics, presleep suggestions are made to the person's unconscious mind and should be positive and constructive in tone and content. In a sense, you can think of suggestive therapeutics as a form of mental programming similar to computer programming. Only in cases of chronic mental illness where there is actually nerve tissue pathology, the process is more complicated. It was as if both the "hardware" and the "software" of the system has to be corrected. The physical therapies focus on healing the "hardware" (the neurobiology of nerve tissue) while suggestive therapeutics serve as the "software" or program. In other words, the readings stated that as the nervous system was being healed, it was important to give it constructive information for its new "program." In the case of 3207, the mental programming would undoubtedly have addressed his self-condemnation, replacing with positive, affirming statements to his unconscious mind. However, the suggestions were also to focus on "awakening to possibilities in the outdoors, in nature, in things of Creative activity." In addition to companion therapy and suggestive therapeutics, Cayce recommended treatment with an electrical appliance called the Wet Cell Battery. This low form of electrical energy was occasionally mentioned in cases of mental illness such as depression. This form of electrotherapy was prescribed to address the "incoordinations" in the nervous systems. The electrical power from the battery is minute. In other words, its use is not comparable to electroconvulsive therapy (or ECT) which is sometimes used in the treatment of severe depression. A "gentle massage along the spine" was also advised in this case. Cayce stated that such a rub would help to relax the body and improve nerve functioning. Reading 3207-1 concluded on a positive note, indicating that if the treatment plan was faithfully followed this man's perilous decline could be turned around: And we will find we may supply the breaking up
of the nerve forces in this body. This will prevent the deterioration
or the regular conditions that ordinarily arise when such melancholy becomes
a part of the experience.
About two weeks after the reading, the mother responded to the content of the reading by writing "I received your reading of my son and feel that perhaps there is little hope of recovery." She was willing to hire a Christian Science healer to help her son but stated that "[I] do not feel that I can use, personally, the mechanical applications and that no one else here would be willing to." Thus the treatment plan was not implemented.
We do not know what the eventual outcome was in this case.
Some Key Points to Remember In this chapter we have looked at the neurobiological dimension of depression. The medical model of depression was presented and the importance of nerve impulse transmission between the cells of the brain (neurotransmission) was discussed. Cayce's holistic approach also acknowledged the importance of the neurobiological dimension in depression. Years before medical research focused on this aspect of mental symptoms, the readings explicitly described biological pathology in depression. However, the readings went beyond the physical dimension to describe the significance of the mental and spiritual aspects. In the case study presented in this chapter, mental factors figured heavily into the cause and treatment of depression. Self-condemnation was cited as the source of a breakdown within the nervous systems ("nerve lapses"). Thus in this particular case, Cayce's perspective of depression is consistent with the medical model - only it goes beyond this view. From the standpoint of the readings, the medical model is not necessarily "wrong," it is simply incomplete. It is part of the answer to understanding depression. As with many of the case studies which we will examine in the chapters which follow, the recommendations in the readings were not followed. Perhaps it was too much to expect that persons in the early decades of this century would appreciate the strong physical dimension of depression. With our current understanding of the neurobiological aspects of depression, perhaps we can better appreciate Cayce's integration of biology into his holistic approach to depression. The importance of physical causation and physical treatment will be strongly emphasized in the next three chapters which address this facet of depression.
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