As a psychiatrist, one way I determine how sick my patients feel is to try and discover to what degree they identify with their illness. Specifically, I listen for whether they say “I feel sick.” vs. “I am sick.” Whether they say “I feel depressed.” vs. “I am depressed.” To identify with the illness is a red flag that they are sicker than they need be.
Ms W. threw me for a loop. Looking for all the world like the potted plant that no one watered, she shuffled into my office and wilted into the chair beside my desk. I asked how I might be of assistance and waited for her to catch her breath. At length, with the weariest of sighs she revealed: “I am a sad patient.” Instantly, I began to formulate a response calculated to encourage her not to identify with her illness. Before I could do so, she mercifully interrupted me and my assumption by elaborating: “You do treat SAD, don’t you? You know, seasonal affective disorder…”
Ahh. The first of a hoard of SAD patients. I knew I would find you good people here in the great Northwet. In leaving the security of my New England practice, many well-intended professional colleagues tried to discourage my migration west by warning me: “Why do you want to go out to
Who are the SAD patients? Well, consider your office co-worker who hangs around the photo-copier staring longingly into the blinding light. Or your friend who sits closer than usual the one-eyed God of the living room whose blue light appears even more mesmerizing now that the sun steals away before dinner time. Or how about that mate of yours who keeps wending his or her way to the refrigerator only to crouch there in front of the open door suddenly indecisive regarding what he or she craves. In each case, what these people crave is the light. Their pineal gland, once considered by Descartes to be the seat of the soul and now perched just below the skull bone atop the head, is as desperate for light sensation as a tobacco addict on Day One of quitting.
The SAD syndrome looks to all the world like clinical depression complete with neurovegetative signs including altered appetite and libido, fatigue, frustration, helplessness, hopelessness, anger, impatience, low self-esteem, guilt and despair. However, these feelings become overwhelming in the fall as the days shorten and light is scarce. Then, come spring and the lengthening of the days, people suffering with SAD demonstrate a relative euphoria commonly known as “spring fever”.
So, here you are stranded far from last summer’s incomparable cloudless days but still out of sight spring’s bright promise. Are you going to make it? Can you relate to Gustav Mahler’s tortured letter to a friend written from the dead of winter, January 1883? In it he scribes:” Simply can not find time to write you properly. Sending the stuff soon. My address is… am extremely depressed. Yours Gustav.” Yow! Been there? Done that? Can it get any rougher? You need to find people who understand you. Try Billy Shakespeare. He knew what you are going through. He nails it when he writes: “That time of year thou may’st in me behold when yellow leaves, or none, or few, do hang upon those boughs which shake against the cold, bare ruined choirs, where late the sweet birds sang…” Ow! How do we survive? How can we persevere?
Consider Dylan Thomas writing to his dying father (but apparently to residents of the Northwet as well): “Do not go gentle into that good night. Rage , rage against the dying of the light.” But attitude is frequently not sufficient. We need to satisfy the mysterious pineal gland also.
The pineal gland is a pea-sized gland sitting atop a neuronal stalk sitting up against the skull bone directly under where your hair spiral originates. Hmmm. Neat stuff, eh? It has been described as the third eye by ancient alchemists. Descartes believed it to be the seat of the soul. Zoologists discovered that salamanders use it to sense their surroundings and to alter their own skin pigment. Indeed, medical folks have learned that the pineal gland is the only gland that receives light impulses which are signals for the production of a special hormone called melatonin.
The secretion of melatonin is a key chemical message that regulates seasonal rhythms in animals. It also is a naturally occurring sleeping agent since it is elevated in darkness and we are “hard-wired” to fall asleep when it is dark. Elevated levels of melatonin (again, typically in darkness) are associated with sluggish mood and behavior often described as “hibernation mode”. In addition, the nerves which carry the light impulses to the pineal pass through parts of the human brain that are involved in regulation of many physiological functions that are disturbed in depression. These include appetite, libido, weight control, mood and energy. Since bright light suppresses the secretion of melatonin, light itself can be considered an anti-depressant. That isn’t the whole story. People with SAD can have deficient adrenal stress responses, defective visual processing of light, neurotransmitter deficiencies (serotonin, norepinephrine, prolactin) and altered general metabolic rate. What they DON’T have, however, is a problem that can be discounted as being “all in your head”.
Science sometimes is blinded by the obvious. Curious behavior on our part. Of course light effects our mood. To even argue this point is as ludicrous as arguing whether TV effects childhood behavior. Nolo contendere.
“Mehr Licht” cried Goethe on his death bed and his words “More Light” have resonated down through the years into the hearts of patients like Mrs. W. who after appropriate treatment was feeling considerably less sad and being less SAD too. I knew we were making progress when she returned for a session but lead with a suggestion for what she termed “accelerated SAD treatment”. I thought to share it with you readers because her suggestion was as reasonable as it was novel. Furthermore, in the best of all possible worlds, I hope that it would be covered under any future health care reform laws.
To your Health!