My Journey Toward Mindfulness

The Chemistry of Joy : A Three-Step Program for Overcoming Depression Through Western Science and Eastern Wisdom
by Henry Emmons, M.D.

(Page 2 of 2)

My own journey toward a more integrated approach to depression began almost as soon as I had entered medical school. To some extent, this effort to integrate physical, emotional, and spiritual treatments comes from a lifelong habit of liking to synthesize, to bring apparently separate concepts into a single, dynamic framework. But I also had a very practical reason for seeking a new approach. It seemed very clear to me, from the moment I began my studies, that our treatment of depression was sadly lacking. People were suffering, and the conventional approaches to their condition just couldn't help them — not enough. The kinds of medications that were offered, the kinds of therapy that were traditionally done, just weren't solving the problem. And the suffering went on.

Throughout my training, I'd sought for ways to integrate a psychological and spiritual approach into the predominantly biological worldview I encountered. I studied Jungian psychology, family systems, and a type of pastoral counseling called "spiritual direction," which I explored at a divinity school in Rochester, New York, the town where I was also doing my psychiatry training.

After I finished my residency, I returned to my native Midwest and took a job at a large HMO in Minneapolis, where I had the opportunity to treat literally hundreds of people. It was a fantastic learning experience — but I eventually came to see it as a rather industrialized approach to medicine. It ultimately wasn't satisfying for me, and I didn't think it was very good for my patients, either.

For a while, I joined another practice, but I kept encountering the same assembly-line mentality and reductionist philosophy. For a field that had begun with such a broad view of human nature, psychiatry seemed to have devolved into a mechanistic vision of brain chemicals and medications.

Then one day I happened to catch a Bill Moyers special called Healing and the Mind, featuring the pioneering work of Jon Kabat-Zinn. A researcher and scientist, Kabat-Zinn had realized that medical science was missing an important aspect of healing. He developed his "mindfulness-based stress reduction program," which eventually became an extraordinary eight-week course integrating Buddhist principles with medical science. Jon's focus was on chronic medical concerns, but I saw that his approach would be extremely helpful to psychiatric patients as well.

I was lucky enough to be one of the first doctors to train with Jon, who has gone on to teach his course to literally hundreds of physicians and health professionals. It's not an exaggeration to say that he and his colleague Saki Santorelli have transformed U.S. medicine, particularly as it approaches chronic diseases. Jon demonstrated that meditation could not only help reduce stress but could also affect the course of a disease, not to mention a patient's experience of his or her condition. I've spent over a decade now teaching mindfulness-based classes in all kinds of different settings. Gradually, I've developed the three-step method that I share in this book, an integration of Western biochemistry and Eastern wisdom that offers a radically new approach to overcoming depression.

Why is this integrated approach important? First, because the Western biochemical diagnosis, while crucial to understanding the nature of depression, goes only so far. Although we know something about the physical needs and personality types that corresponded to these biochemical categories, Western psychiatry's focus has become limited to an understanding of chemistry.

Second, each of the Eastern perspectives adds a different dimension to our understanding of the three types of depression. Ayurvedic Mind-Body typing is based on an elaborate set of dietary, exercise, and lifestyle prescriptions — recommendations that I soon found were of enormous help to my patients. Once I began thinking of my patients as Air, Fire, or Earth types, I could offer them suggestions that corresponded to but went far beyond Western-based recommendations for nutrition, exercise, and lifestyle. I could also bring a spiritual perspective to my suggestions, seeing Air types as needing to be grounded, Fire types as needing to be cooled and soothed, and Earth types as requiring stimulation and movement. I found this imagery helped me hear my patients' stories on a deeper level, while better directing my own attention to the question of what would help them restore balance in their lives. Even when I'd only considered Western biochemistry, I wanted to help my patients balance their brain chemistry. Now I was able to put that intention into a larger framework.

Likewise, having access to the Buddhist notions of Emotional types helped me to further articulate the issues with which my patients struggled. Buddhist psychology helped me form diagnoses even as it helped my patients approach their problems in a new way. While I continue to make use of the Western psychological tradition, I have come to rely equally on the notion of mindfulness and its focus on the observing self. If you can observe yourself — even in distress — without blame, without judgment, and then choose, calmly, a wise response to whatever situation you're in, you begin to see that depression, however painful, is not insurmountable. Helping my patients replace automatic, unconscious reactions with intentional, conscious responses has opened the door to many people who could not be helped by traditional psychotherapy — or who could be helped more when mindfulness was added to the mix.

Finally, integrating all three perspectives has enabled me to distinguish between a short- and a long-term approach to depression. Now when patients come to me in the throes of depression, I offer them immediate intervention in the form of physical changes — diet, exercise, supplements, and the like, as well as medications if they need them. I help them refine their lifestyle choices, using the well-articulated Ayurvedic Mind-Body system to extend their understanding of what their bodies need.

But the mental and spiritual aspects of Ayurveda are already pointing toward the future, in which Buddhist psychology and mindfulness practices can become a long-term strategy to prevent future episodes of depression by reorienting a person's entire worldview. To my mind, depression is a profound learning experience, offering us the opportunity to reconsider the choices we've made and strike out for new goals. But in order to be enlarged rather than diminished by the experience, we need a spiritual perspective. Buddhist psychology and the practice of mindfulness seemed to offer such an outlook.

The Enemies of Joy

The incidence of depression has been increasing at an alarming rate. According to the Cross-National Collaborative Group, the number of people struggling with depression has increased by about 10 percent every decade since 1910 — and despite the pharmaceutical explosion of the past two decades, the increase shows no sign of slowing. If anything, the rate is going up faster than ever, making depression the leading cause of disability in the United States.

When I report this alarming statistic to the physicians, social workers, and other health professionals who attend my classes and workshops, I'll usually hear someone say, "Oh, it's not that depression itself is increasing, but only that people are reporting it more often."

But in fact, the statistics are not based on either patients' self-descriptions or doctors' diagnoses. Rather, researchers over the years have investigated the U.S. population from an epidemiological viewpoint — seeking evidence for the existence of depression out in the community rather than in statistics from clinics, doctors, or hospitals. The data come from a representative sampling of the population with whom researchers have done structured interviews designed to ferret out the symptoms of depression: low mood; impaired sleep and appetite; loss of energy, interest, motivation, and pleasure. In other words, no matter how individuals described their own psychological condition or whether they had ever been formally diagnosed, researchers have been able to infer that the incidence of depression was on the rise.

Not only is the rate of depression higher but it is occurring at an ever-earlier age. The problem is spreading worldwide, too, so that the World Health Organization (WHO) estimates that depression will be the single greatest cause of disability worldwide by the year 2020. WHO attributes the epidemic to the fact that more and more nations are "Westernizing." Clearly, something about our modern way of life is making us sick.

What, then, are the enemies of joy, the factors in our lives and our society that literally depress us? In my opinion, they are three:

1. Physical Imbalance and Toxicity. Even though I come from a psychological and spiritual perspective, as a physician, I can never ignore the role of the body. I know that we're all born with a certain genetic makeup that may cause more problems for some of us than others. Our inborn levels of resilience are simply different, and people with low levels of resilience can more easily fall into depression.

   But beyond what we're born with come the choices we make and the world we're surrounded by. The poor quality of food available to most of us — vegetables and fruits grown in mineral-depleted soil; animal products laced with hormones; processed foods laden with refined sugars and saturated in unhealthy fats; industrial, agricultural, and environmental toxins — threatens our mental as well as our physical health. Our brain is literally affected by the poisons that surround us, which promote inflammation, impede adrenal gland function, and burden our brain chemistry in a thousand different ways.

   As if that weren't enough, our speeded-up economic life subjects most of us to enormous levels of work-related stress, while the lack of social safety nets means that most of us are constantly worried about money. Lack of sleep, tension at home and at work, the insistence on a constant round of activity unrelieved by rest — all of these are major contributors to depression.

2. The Mind Runs Rampant. Depression is not only a disease of the body, however. It's also a disease of the mind. If our minds are allowed free rein, if they are allowed to run away with us, fretting endlessly over worries about the future, seething constantly with resentment against real or imagined grievances, or shutting down entirely in response to stress, we will sooner or later pay the price in depression.

   Moreover, most of us don't understand our mind's role in creating our emotions, our experience of life, our mood, and even our physical health. Our lack of awareness means that we can't find good strategies for dealing with our fearful, angry, or confused minds. Instead, we confuse our mind's perceptions with reality, and we allow our unwise mental strategies — worry, anxiety, blame, retaliation, denial, confusion — to determine the course of our lives. It's a depressing way to live — and we are, accordingly, depressed.

3. The Illusion of Separation. At the most profound level, we're only human in community. Think of a poor, isolated soul on a desert island, with no one to talk to for years at a time. Do you imagine that person — even if he or she never had to worry about food, shelter, or basic survival — would survive such an experience mentally, emotionally, and spiritually intact? It doesn't seem likely. We're meant to be part of one another's lives, and we need to share in each other's humanity. But in our modern culture, with its focus on individualism and separate achievement, we lose the sense of connectedness that keeps us sane — and depression is often the result.

   It's not only connectedness to other humans that we need. We're part of the natural world, and losing that lifeline can also depress us more than we realize. We need, too, a link to the divine — to the universe itself — a sense of the higher purpose of which we are a part. Without the sense that the universe is a friendly place to which we belong as to a family, we have great difficulty not to become depressed.

   I don't want to romanticize the past. Certainly the world has always been a violent and frightening place, and the extended families and tight-knit communities that once characterized most of humankind were often claustrophobic, repressive, and cruel. Perhaps there is no healthy alternative in the past — but that doesn't mean the present is healthy, either. Our isolated, alienated world is a breeding ground for depression — and the rapid rise of this painful disorder is the sad result.

Surrounded as we are by these enemies of joy, outside as well as within us, we need healing more than we ever have. In my observation, the kind of therapy usually offered in our modern system of HMOs and short-term treatments is simply not enough for many people. Given the crisis in our health-care system — a crisis that extends to both patients and the system itself — shouldn't we be looking for creative solutions to these thorny problems? Integrating Western science with Eastern wisdom is my own attempt to find a new paradigm within which we might seek healing.

The Chemistry of Joy

When I first explained my three-step program to my patient Melanie, she balked at considering her depression in terms of brain chemistry. "I hate thinking of myself as just a collection of chemicals," she told me bluntly. "I'd like to feel as though I had more control over my life and emotions than that. 'Put in one chemical, and I'll react one way; put in another chemical and I'll react another way' — it makes me feel as though I'm just some puppet, some victim of my own brain."

My patient Martin had the opposite reaction. A man with a great respect for science, Martin found profound relief in understanding the role that physical factors played in his depression. But he didn't understand why I suggested that he meditate, practice conscious breathing, and engage in "heart-opening" exercises.

"Just prescribe me the meds I need, tell me what to eat, and I'll be on my way," Martin told me. "I'm not interested in all that spiritual mumbo jumbo."

I tried to explain to both Melanie and Martin that my approach was based in an integration of body, mind, and spirit. Indeed, my best understanding as a scientist is that how we feel, what we eat, the choices we make, and the levels of biochemicals in our brains are all profoundly interactive. True, low levels of the chemical serotonin are correlated with certain types of depression, as we'll see in Chapter 2. But what causes the low levels of serotonin? Diet, genetic background, exercise habits, life events, early childhood experiences, and our daily habits of thought all play a role in the level of this vital chemical in our brains. Moreover, each of these factors affects every other factor. The right diet can give us more energy to exercise; a new meditation may motivate us to change our diet; a productive therapy session can, at least temporarily, flood our brains with helpful chemicals indicating that, at least for a while, we've found a measure of calm and well-being.

Likewise, Martin's resistance to "mumbo jumbo," while understandable, leaves out the profoundly transformative role that our thoughts, feelings, and beliefs can have on our brain chemistry. To take a trivial example, consider the experience of a long, boring, indefinite wait, perhaps in a stuffy airport or out under the blazing summer sun. Standing in line under such circumstances can be excruciating if our thoughts have nothing better to do than bubble with annoyance — and our serotonin levels would drop accordingly, in response to the heat and stress.

Now imagine the same long wait with a long-lost friend or a fascinating mystery novel to help you pass the time. Suddenly your awareness of the physical discomfort vanishes because your mind has another focus. And the pleasure you take in talking or reading will likewise be reflected in your brain chemistry.

So when we think of all the different factors that go into creating or overcoming our depression, we should think less of a row of dominoes, set off by a single push, and more of a complicated pinball machine in which several balls are released in response to the first pull of the trigger. Picture the way a pinball machine seems to take on a life of its own, the way each little movement of the ball triggers a half-dozen other bells, lights, and new balls. You don't have complete control over what happens — if you shake or hit the machine, it will simply turn off. But you do have some control over keeping the balls in play, and you can learn — at least to some extent — to "dance" with all the simultaneous actions instead of trying to slow down and analyze each event.

Our brains — and our lives — are more complicated than any pinball machine, and we're only beginning to understand all the different factors that create our energy, our well-being, and our mood. In this book, you'll have the opportunity to learn more about some of what I've come to consider the key factors — brain chemistry, diet, exercise, mental outlook, and openness of spirit. Working with any one of these factors can make a huge difference in overcoming your depression. Working with all of them at once can create a kind of quantum improvement that may, over time, astonish you. This potential for both slow transformation and quantum leaps is to me the true value of the chemistry of joy.

Copyright © 2006 by Henry Emmons

About the Author

Dr. Henry Emmons is a psychiatrist who uses mind-body and alternative therapies in his clinical work. He has conducted workshops and retreats for health care professionals on psychopharmacology, natural therapies for depression, the use of mindfulness meditation and health realization in medicine, resilience training and the evolution from clinician to healer. Dr. Emmons has received training in Mindfulness Based Stress Reduction from Dr. Jon Kabat-Zinn and completed a Bush fellowship studying the integration of natural and alternative therapies in psychiatry.