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Now we could spend forever poking around among the astronomically (sort of
literally) complicated brain looking for answers out of countless (almost
literally) possibilities, but today we're just going to examine dopamine because
a) it is one of the best understood neurotransmitters and b) its role in our moods
and behaviours is probably most pertinent to us long suffering mental health
peeps.
To be clear up front, I am not saying that what we look at here today is the thing
with, for example, a particularly entrenched or "treatment resistant" case of
depression but it is, as we'll see, a very important aspect to understand, consider
and ultimately work at.
There are a number of things about neurochemicals that are vitally important to
understanding a good number of other things we're eventually (or have already
started) going to look at as well - such as memory function, brain fatigue and
cognitive difficulties, neuroplasticity and the stress response system among
others - so I thought this morning that it was high time we got to this. I
understand that this may all look rather intimidating to some, but we're going to
set that aside, let ourselves believe that "I got this" and we'll get ourselves to a
better understanding of how all this works and why it's important.
There are all kinds of things us mental health peeps will be experiencing as part
of whatever it is we're suffering from (my main guess would be depression, but
our topic here today is also critically important to understanding bipolar
disorder, schizophrenia, ADD/ADHD, and others). Two main things we will be
suffering is difficulty in experiencing pleasure and being motivated, the two
very things that are major functions of dopamine pathways.
We hear a lot about "brain chemicals" and the reason for this is how the popular
press has picked up on and repeated the psychiatric and pharmacological
explanations for "mental illnesses" which in a nutshell is explained as "chemical
imbalances". This explanation has reached virtually mythical proportions since
this enticing idea first took wing back in the sixties. Unfortunately, a) there
remains no conclusive proof that any mental illness is due to a chemical
imbalance, b) decades of subsequent neuroscience research has revealed that all
human behaviours and mental experiences are vastly more complex and involve
possibly dozens of other brain functions other than "brain chemicals" alone.
As mentioned, we have billions and billions of neurons. There are many kinds of
neurons with many specialized jobs. Whatever their job, neurons are
like infinitesimally complicated "storage devices". Regular readers will
remember that whatever is stored in a neuron or a given set of neurons is useless
to the "big picture" if they cannot pass on what they "know" or "want to do" to
neighbouring neurons or neuronal groups. Neurons communicate with each
other via axons and dendrites. Axons send "data packets", dendrites receive.
Some of you may recall what old switchboards look like and how they worked.
For those of you who don't, they looked like this:
As you can see, we have wires and all kinds of possible circuit combinations.
You see that thing in her hand? That's a jack. That's going to connect a wire
from one circuit to another. Until that is plugged in, there's no connection, no
transmission from one party to the other. Or once it's unplugged, the connection
is broken and the transmission stops. So we can think of a synapse as that thing
in her hand, a jack of sorts. Except that in the brain, it's a two step process. First
we have to create a connecting point, a jack and a socket - that's the two sides of
the synapse. The second process is once the connection is made, the actual
transmission of information from one party to the other will be a chemical
process (which is the norm throughout animal and plant cellular structures that
need to somehow communicate and coordinate).
What happens between neurons when they want to communicate is that one will
get all excited, get all jacked up, and want to send messages to all kinds of
neuron buddies near and far to get something going and then will send an
electric impulse down its axon or axons (in what I likened before to Morse code)
which will stimulate the release of the neurochemical to complete the
transmission to possibly tens or hundreds of thousands of neurons, those in turn
pass all the exciting news on to hundreds of thousands more neurons and thus
big thoughts or memories and all kinds of things happen. Kind of like sending
out a mass Twitter message to thousands of receivers.
Your brain only has a few more "jack and socket" connections than that
switchboard above; like several hundred trillion more.
Okay, so that's the small end of this neurochemical business and several hundred
trillion is a crazy big number, so we'd better further clarify what's going on with
dopamine and break that down to size.
Let's have a look at the broader picture of the roles dopamine play.
I chose this image because it shows serotonin as well. Serotonin has become
practically a household word because of advertising's and popular press's roles
in making SSRI (selective serotonin reuptake inhibitors) based antidepressants
one of the most popular drugs in the western world. We take a closer look at
serotonin functioning elsewhere so we're going to leave that aside for now. We'll
instead focus on the left. There are a few key brain regions illustrated there as
well that are critical to our understanding of the big picture of dopamine's roles
in the brain and our behaviours so we will look at those in more detail.
motivation
pleasure
motor function
compulsion
perseveration
Pleasure is what we feel when we achieve something that our brain considers
rewarding. Like motivation, however, this could be a good thing or bad thing.
But pleasure feelings, like motivation feelings, can keep us locked on to or
driven toward a task or goal in anticipation of that all delicious "reward" hit the
dopamine gives us. Motivation and pleasure are intrinsically linked in what we'll
call our "drives". Again, however, what gets locked in as "pleasure" or
pleasurable could also very well be out of alignment with modern social norms,
values and so on.
The dopamine pathways are a very old (as in hundreds of millions of years old)
part of our brain hardware and systems. All animals have essentially the same
system from reptiles up to birds to all mammals. Its role was and remains very
simple - keep a creature doing something critical to its survival. Find a great
source of food? Bam, a dopamine hit helps insure that the creature remembers
and goes back for more. Successfully mate? Bam, a dopamine hit makes sure it
remembers that and to do it again.
It is not, I'm afraid to report, for the most part a whole lot different among us
members of the homo sapien species. Just more sophisticated behaviours and
"goals" involved.
For example, a mouse might be trained to pull a lever in order to get a treat. To
start, it will get a treat each time it pulls the lever to condition into it the
expectation of a reward (the treat). What's happening here is that dopamine
pathways and (very important) feedback loops are being tuned towards
associating the dopamine hit with this specific task and reward. Afterwards, the
treats can be reduced to only being released every tenth time. But the mouse,
once conditioned, will keep pulling on that lever until it gets the treat (and thus
the big dopamine hit). It will get to the point that you can remove the treat
element all together and it'll keep pulling that lever over and over and over again
until it drops with exhaustion.
Well, it seems silly until you go to Las Vegas (or any casino) and watch people
sit at slot machines. They, like the mouse, will sit there pulling that lever (or
press buttons in modern machines) in anticipation of a reward despite
astronomical odds against that reward happening. They will eschew food, going
to the bathroom, going home to their families and all kinds of other essentials
for a proper life to sit at that machine and what keeps them glued there, my
friends, is our dopamine reward system. "Silly" mouse indeed. At least the
mouse isn't pissing away the family fortune.
But laugh not. Many if not most people will have similar "dopamine kick"
addictions. Or compulsive behaviours and so on. Nobody gets to play judge
here. Shopping is like this. Buying and eating food. Buying a new vehicle. Our
paycheque. A college degree. Going to heaven. You name it. When we feel
turned on and motivated about and towards something, this very old system is
very much at the root of it. (1)
About the only difference in humans is the variety of things we'll do in order to
achieve that reward and the time we'll take to achieve it. Not to mention what
we'll put up with to achieve it. We can stay locked on a dopamine anticipation
loop for years. That's the "planning and judgment" parts of our vaunted frontal
lobes that plays a role.
Now to us depressed, demotivated peeps who struggle with feeling pleasure and
sticking with things.
What's up there?
Now is the time to understand that we're somewhat more complex than mice (or
primates or lizards or birds or ...) after all.
To understand "us", let's go back to the diagram. You can see that these all
important motivation and pleasure pathways originate in a deep brain nodule
called the Ventral Tegmental Area.
We can think of the VTA as a "switchboard" lady like we saw in the image
above.
Now, what's extremely unfortunate in virtually all the images we see depicting
the dopamine pathways (and serotonin, for that matter ... or any region of the
brain) is that they do not show the massively complicated feedback loops
connected to the VTA. The VTA switchboard lady doesn't just sit there all by
herself ringing up our frontal lobes and whatnot getting us all excited and
motivated all on her own volition. No, no, no. That's more akin to lizard level
dopamine pathways. Our "human grade" VTA Lady has dozens and dozens of
incoming circuitry sending information packets or demands of varying sorts.
She takes an incoming call - "shoe sale ahead!", for example - and connects that
to the pleasure/reward destinations in the brain.
These calls can come from all over the brain. Which, despite our remarkable
similarities to lizards, baboons, birds, dogs and all other animal species, is what
makes humans vastly more complicated and varied for all the circuitry that can
potentially stimulate the VTM (Lady) is an incredibly complex set of networks
(yes, yes, I know what many of you are thinking but really, we are more
complicated, even the persons you may regard as simpletons).
It's these incoming calls that we want to better understand. What rings up VTA
Lady? What rings her bell? Or, to understand lack of motivation and pleasure,
what does not ring her bell?
Okay, mentally suffering peeps, this is where the rubber meets the road in our
understanding of our moods and this deep brain system involved with them.
I talk in numerous posts a lot about belief. Various brain circuits involved in
creating and disseminating back to us our beliefs are a huge feedback loop to
the Ventral Tegmental Area (hereafter known as "VTA Lady"). Belief and
imagination are tightly linked and it is the belief of good things to come and the
strong imagination thereof that will often keep us moving forward despite
possibly great odds against us or obstacles in our way. This can be seen
throughout our evolutionary history (and is thus tightly linked to religious
beliefs and the comforting and motivating thoughts of going to heaven). A lot of
what we think is "good behaviour", for example, is really just having a really
strong connection to VTA Lady keeping that pleasure/reward system locked on
to a goal related to beliefs associated with religious morals (sorry, morally
superior feeling people).
We don't get "depressed" and demotivated out of the blue for no reason (though
I know it feels that way; this is the big disconnect between our subconscious
brain mechanisms - like this one - and our conscious awareness or experience
that I often refer to). If you look back on your life, all kinds of painful events
will have pounded the living shit out of your beliefs. So, often your greatest
beliefs and desires have been crushed by life. We often keep going, but for a
variety of possible reasons, we get crushed again and again. This will begin to
have effects on all the circuitry involved in motivation and pleasure we're
looking at here today. The feedback system to VTA Lady just keeps sending too
many painful messages. Pain becomes too associated with desired rewards. VTA
Lady just gets to the point where she says "fuck this shit, I'm not taking any
more calls from that belief area". And after a while, all the lines of
communication between various brain areas associated with beliefs and VTA
Lady begin to atrophy (literally). Worse yet, the areas in the brain associated
with feeling the hits of dopamine and thus pleasure and motivation because of a
lack of stimulation begin to atrophy as well. This is part of the "dark side" of
neuroplasticity.
And this same process can happen with many of our goals and desires as we
experience defeat, disappointment, hurt and other negative impacts and results
for things we started out feeling excited and motivated about.
There are people who are more resilient to this, but for many of us for a number
of reasons this is a huge part of the process that creates the sense of "giving up"
that we so strongly experience so often.
So there's that.
But we may also notice other painful experiences associated with what we'd
normally think of as motivating and pleasurable and this too will send negative
feedback information to VTA Lady and again, after a while she just throws in
the towel and stops taking calls from those areas. And slowly, bit by bit, almost
without being aware of it, we find ourselves getting more and more down and
demotivated and less and less able to feel pleasure. There will probably have
been major blows and a good number of smaller ones. Either way, gradually our
abilities to feel motivated and pleasure are eroded. We "lose interest" in many
activities. This is not our imaginations, this is the result of actual changes in vital
brain circuitry, the circuitry outlined here in the dopamine motivation/reward
system.
However, in a good number of people where pain and pleasure get "crosswired"
in key areas of the brain they actually become motivated to seek pain and their
dopamine pathways become somewhat tragically dialed into these behaviours.
Something to consider when we try to understand seemingly incomprehensible
behaviours like cutting, carving or why people keep returning to abusive
relationships and other what appear to be destructive behaviours. This is a very
dark side to neuroplasticity indeed (I may at some point get to recounting some
very interesting case studies and the inspiring resolution of them).
Or - OR! - this system may get "hijacked" and drive us towards behaviours that
seemingly dull our pain by giving us pleasure elsewhere. Hello almost all
addictive behaviours. There is some very good recent clinical and real world
research (2) that is now more deeply understanding the very strong relations
between pain and trauma, the dopamine reward system and destructive/addictive
behaviours of all kinds. Very important to understand and keep in mind.
Okay, now that we have a better understanding of all that - or at least the seed of
understanding planted - we come to the $64,000 question. What the hell to do
about it?
Regular readers should see the first two coming - we begin with self-forgiveness
and compassion for ourselves. For if you are struggling in any of the ways we
looked at here, that is not "you", but instead very deep and powerful brain
systems that for all kinds of very strong reasons have gone awry. "You" don't
just reach in there and magically fix that. Nor does "helpful" advise from well
meaning friends and relatives. This is why you can't just "cheer up" on demand.
Deep stuff is not as it should be.
So can we get it back to, or at least closer to, what it "should be"?
Yes.
This is what I have successfully done and continue on the road to doing. This is
why I talk about the importance of belief, thoughts, spirituality, brain training,
the concept and power of neuroplasticity and so on. For it is small daily tasks
that will slowly dampen down the pain circuits and rebuild better hope and
belief circuits that will begin to reawaken motivation and pleasure regions
involved. This is why I work on at least some or even just one or two, of my
positive difference making fundamentals daily - all of those can help to repair
and rebuild what we briefly looked at here today.
In other words, what we need to do, in essence, is rebuild the dormant or broken
down communication lines to VTA Lady who will in turn start to "ring up" and
connect us to the feelings of motivation and pleasure that we so often struggle
with.
We will look more deeply at how meditation and mindfulness CBT can help,
how certain positive visualization exercises can help, how specific mental and
physical "letting go" exercises can help and much more.
And I know - I deeply know - that it is not easy. But I can assure you one
hundred percent through my experience, that of dozens of case studies and just
by the pure science of how it all works that is possible. Even for you. Yes, you.
But step by step, day by day, if we take the right steps, we can get there.