I find this a hard topic to write about, but since honesty demands it, I’ll give it a go. When OCD completely determined my life, I had developed characteristics that were pretty terrible for myself. I did not really feel part of society. I lived in that other universe. My studies were ground to a halt. Everything of importance seemed to be drifting away from me at a rapid pace.
At first I began to talk about myself in an ironic, self-deprecating fashion to others. That is not such a bad trait, I love folks that are not pompous and can show a bit of self-effacing. Such modesty can mean a great deal in contact with others.
But this habit became overbearing, up to the point that I made myself so ‘small’ in a dialogue with other people, that I really hurt myself in a bad way most of the times. It was: insulting myself, effectively, bullying myself. I was not a worthy person anymore, in my own eyes.
This, combined with all the efforts that OCD asked from me, was responsible for the fact that I began to drink too much alcohol. Luckily enough, that happened only late in the evening. It eased my mind, and made me receptive to good books, films, and beautiful music. I could temporarily forget my inner torments.
Knowing that I am a man with talents (as is everyone), yet feeling that I was not as worthy as others, was another of the deep, deep rifts that may occur in OCD. Perhaps my habit of verbally attacking myself caused onset of major depression eventually. See: major depressive disorder (MDD) can in fact happen as a result of bullying, of putting a person in a situation of chronic stress. It is a scientific fact that chronic stress leads to depression.
The response to a single stress situation is beneficial, in the evolutionary sense of the word. Starting in a brain region named the hypothalamus, a cascade of hormone releases occurs, eventually resulting in the release of the stress hormone cortisol. Cortisol prepares us for sudden activity, by setting free blood sugar that can deliver the energy for direct reactions against a dangerous situation: fight or flight. Muscles can be used to good effect. We can attempt to survive, in severe circumstances.
However, if cortisol is set free too frequently and for too long (chronic), then its effects become deleterious, because normal negative feedback systems don’t work properly anymore. Depression sets in, because in our brain undesirable effects of high cortisol take place. For instance, our brain area dealing with moods and memory, the hippocampus, gets under attack. Nerve cell contacts in that region are compromised: their numbers decrease, and also the branches of those nerve cells decrease in number. Moreover, the hippocampus itself gets smaller. This means that our mood is severely lowered, and we become much more rigid, inflexible: we can’t jump out of that bad mood, we develop no ideas for rewarding action, we start to ruminate on death and decay, and other sad themes, and we don’t really respond in a vivid manner to other people. We isolate ourselves, and things that used to delight us (movies, music, books, playing games, a vacation) fail to be of any attraction to us. We don’t enjoy good food. We sleep very badly. The sum total of these changed feelings is called: anhedonia (lack of being able to enjoy); and also sickness behaviour (being withdrawn, inactive, and of a very sad mood for a prolonged time).
I for one am convinced that feeling very low about oneself, and bullying oneself as I described above, can elicit MDD via the mechanism I described above.
So there’s a lesson in this that may be helpful: if you see a person who is all too submissive, who can speak about him/herself only in derogatory, demeaning terms, and who is beginning to get withdrawn and sad all of the time, MDD may be well on the horizon. You could ask a couple of questions sensitively: is everything OK? That kind of thing. I bet that that person will start to ‘act’ initially: oh, I’m doing fine, thanks for asking. But, without wanting to be pressing, I would strongly recommend to delve a bit deeper into that guy/girl’s feelings, in a respectful way. Too many people commit suicide eventually because their isolation and loss of self-respect made the feelings inherent in MDD stronger and stronger over time.
It is a scientific fact that moderately depressed people can improve by being in a social context (they don’t have to be ‘the leader of the gang’ at all, mind); by exploring new environments on a regular basis, by a healthy diet (no McDonald’s, please! Avoid much sugar and fat), by physical exercise, and by a well-regulated life, with structure.
The following simplified diagram presents the hormonal cascade I mentioned above. Commonly it is known as the hypothalamo-pituitary-adrenal axis (HPA-axis). The regions involved are: the hypothalamus, the anterior pituitary, and the adrenal cortex (the latter not being a brain region). The hormones are: corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and cortisol (CORT). As I said, in chronic stress the negative feedback (see the loops in the picture) is compromised; the system keeps on running, with bad consequences (CORT being chronically high). After one instance of stress, the system shuts down after the stress response.