The Sprained Brain
When the Clinton White House held a conference on mental health, Steve Hyman, M.D. then head of the National Institutes of Mental Health, noted that “the brain is a real organ with real illnesses.” This deceptively simple insight, long accepted by neuroscientists worldwide, provides a framework for understanding depression and other common disorders that affect up to half of all adults in North America.

Much of the confusion surrounding depression clears once one understands that the brain is just another physical part of the human body. A fall while skiing may cause a back sprain in some people, and no injury in others. Similarly, a life stress like a divorce may cause a depression in some, but others endure it without incident. While back sprain may signal its presence through pain and stiffness, depression causes a type of pain of its own, typically manifesting as sadness, lack of motivation, and loss of interest in daily life.

Emotional Posture and Physical Therapy for the Brain
Despite the parallels between the pain of depression and other types of physical pain, however, in the Western world, most people react to each very differently. While people generally will avoid activities that cause pain, they often will respond to symptoms of depression by throwing themselves back into the very situations that are most stressful to them. Not surprisingly, this often worsens the depression. In fact, cognitive therapy, which is proven effective for depression, actively teaches clients how to decrease stress in their daily life. I encourage my own patients to develop “good emotional posture,” that is, to learn to identify and avoid situations or interactions that cause undue stress. I emphasize that for most people, avoiding stress does not mean staying home alone and doing nothing. People need people and stimulation. In general, it is isolation, not activity, that causes stress.

Just as the cause of depression is analogous to injuries to other parts of the body, so is its proper treatment. For a back injury, proper treatment combines an adjustment of physical activity to avoid further strain and strengthen supporting muscles, and medication to reduce pain and inflammation. Similarly, effective treatment for the depressed brain may combine good emotional posture to reduce stress, with medication to reduce emotional pain and speed recovery.