Day 267: Shrapnel

Feeling frayed today. Overstimulated, overwhelmed, low. Pressing on though.

Here's some stuff I've been looking into while researching about depression. Want to write a big thing. Not sure when, or how, but certainly feeling the impulse, feeling a lot of swirling things I want to get down and lash together into a cogent whole, both for myself, and because it's stuff I really don't think we've got a handle on as a society. What depression is, why it arises, what can be done about it. That kind of thing.

Anyway, I've been looking into the ways in which psychic pain is similar to actual physical pain. It turns out it's pretty fucking similar. Substance P, a neurotransmitter associated with inflammation and the perception of pain, is released during the experience of psychic pain just as it is when you bash your leg. The same areas of the brain, the anterior insula and the anterior cingulate cortex, light up when you experience social rejection or look at a picture of a lost partner as when you stub your toe.

Essentially it looks like - and I'm just chatting today, so I'm not going to link my references, or worry being too precise, or about plagiarising - but it looks like as we evolved it was easier to streamline the perception of pain, whether emotional or physical, through one neural system - like it was easier to send urine and semen down one pipe than to evolve two separate ones. Actually, no, don't let's think about physical and emotional pain as being like urine and semen. Just... no.

Anyway. Here's another thing. Give people suffering emotional pain a course of paracetamol, and at the end of the course their brains will have activated less in those regions I mentioned than for people to whom you prescribed a placebo.

You can alleviate emotional pain with paracetamol.

That's wild. No wonder damaged people become heroin addicts, alcoholics, stoners, heavy porn users, phone scrollers, whatever. No wonder basically every time you look at the life of an addict you find a history of trauma.

These are people in pain, and they are gravitating towards things that take that pain away. And addictive substances and behaviours do do that - they do stop things that hurt from hurting. If your life is filled with emotional pain, if you've been abused, if the world damaged you, then the suffering you feel isn't in your imagination, it isn't wishy-washy, indistinct, made-up. It's as real as physical pain.

We pretty much all agree as a society that analgesics, palliatives, painkillers are appropriate to some levels of pain. You wouldn't tell someone whose leg had been chewed off by a combine harvester, or who had been hit by shrapnel fire in a war, that they should suck it up, get on with it, pull themselves together. The extent of that pain, we recognise, may be insurmountable - it will lay them out flat, and giving them some morphine while we fix the wound is no bad thing. The pain has done its job of alerting the patient to injury, and then the skilled doctor takes over, the pain is no longer necessary, and we dope the patient up while they recover. As humans we are more acutely aware of the suffering of pain, but we are also better at finding substances to assuage pain, and that seems to be the cosmic deal. Fine.

But and so what about someone who has suffered childhood abuse and parental neglect and now lives rough on the streets? All those traumas, those major life stressors, cause colossal psychic pain - which is felt in exactly the same way as physical pain. And yet when that person medicates with heroin we turn away in disgust, we judge, we say that they are weak and dirty and stupid.

You'd do the same. You'd fucking do the same. Yes, heroin, and cocaine, and weed, and spice, and booze, end up causing even more medium and long term pain than they assuage in the short term. But let me tell you, human beings do not orient themselves towards medium and long term happiness, not without immense structure and education and planning. We are driven to seek short term happiness. All the functioning of our cells, our lizard brains, our mammalian brains on top of that, these all instinctively push us to worry about now - and it's only the last and least integrated, most recently evolved top layer of human brain that modulates behaviour towards the longer term - and this only at the best of times, fighting a battle against deeper aspects of ourselves. But when you're in pain those deeper aspects are on high alert, they bypass the later human intellect, scramble to do something right now.

So I don't know. We need to be way more wise and sensible and compassionate about emotional pain. Someone with their guts hanging out will scream for all the morphine you can give them. An abused kid on the street will reach for the needle. Same difference.

Yes, the needle doesn't heal the underlying wound, and eventually it makes everything worse - just as taking paracetamol every day for a laceration that continually reopens and bleeds anew will only end up damaging the liver.

But the answer, as a society, is not at all what we are currently doing. What we are doing is wrong - practically as well as morally - it does not help. We are not viewing stupidity on our streets, but tragedy. When we see people in indescribable pain we shouldn't judge them for taking whatever is available to get through the next moment, and minute and day. And we should work at understanding more about how their wounds were caused, and what might heal them.

Because what we're doing now isn't working. It's a long fucking way from working.