Last month, one of my readers, Crystal, asked me to write about anhedonia. You got it ...
First, I went to my secret research site - Wikipedia. There I read:
Paul Keedwell, MD, then of King's College, found that the brains of participants who were clinically depressed had to work harder to process rewarding experiences.
I checked the footnote only to discover someone was citing something I had written myself. Maybe I was the culprit, though I don’t remember (coming to your local blog - how depression affects memory).
Heck, why waste time on Wikipedia, I thought, when I can go straight to the source, two articles on my own website, mcmanweb? But first the story of how I came to write those articles. Back in 2005, I happened to pick up a neurology journal. I was just skimming, checking out the type of topics that neurologists get excited about. Neurology is the study of disorders of the nervous system. To vastly oversimplify, one could consider psychiatry a branch of neurology (Freud started his career as a neurologist), but neurology has far more emphasis on conditions where a clear cause and effect can be shown - such as a stroke or head or spinal cord injury or nerve cell degeneration.
One could argue that the second we are able to clearly identify the underlying neural mechanisms to depression, then the illness would become a neurological disorder rather than a psychiatric disorder. But depression refuses to lend itself to neurological simplicity, as we shall see in a minute.
Neurological conditions tend to involve a loss of motor control (such as Huntingtons) or thinking or memory (such as dementia or Alzheimer’s). Behavioral effects, if any, tend to be secondary to the disorder in question. One of these behavioral effects may be apathy. Sure enough, in the journal I was skimming, I came across an article on apathy. Hmm, I thought. Then I did a search of the psychiatric literature on apathy. Virtually nothing. This was really weird. Couldn’t apathy be considered part of depression? I went back to the neurology literature. No, the articles said in effect.
Didn’t sound right, I thought. Then again, who am I? Fast forward to the present. I went to the Wikipedia article on apathy. There I read:
Mental health journalist and author John McManamy argues that although psychiatrists do not explicitly deal with the condition of apathy, it is a psychological problem for some depressed people, in which they get a sense that "nothing matters", the "lack of will to go on and the inability to care about the consequences".
Oh crap! How did that get into Wikipedia? Okay, here is what was going through my mind back in 2005:
Think about when you’re depressed - when you don’t care enough to get out of bed, when you don’t care enough about the consequences of missing work or letting down your friends or not paying your bills. Think of apathy as lack of motivation. There simply had to be an apathy component to depression. The closest I could find was “anhedonia,” the inability to experience pleasure from activities we would normally regard as pleasurable.