Yang deficiency or symptom of modern life?

With a focus on seasonal affective disorder, Anthony Sigrist explains why he thinks we’re missing the point with our individual approach to matters of mental health

Anthony Sigrist

Member: Cambridgeshire

Of all the spiritual, life affirming, existential philosophies that exist, I find the theory of yin and yang to be the most exquisite. Described succinctly by the great Giovanni Maciocia as ‘simple, yet very profound’ I find its lessons to be endless. In my practice and in my life it has become an indispensable anchor for me as I rationalise, analyse, reflect and discuss all aspects of life.

There have been times when I’ve wondered if this attachment to my earliest lessons in TCM was simply laziness. Then I step back and look at the frenetic pace of life around me, and I realise that the theory of yin and yang still has so much to give – not least in shedding some light on a global health ‘problem’ that shows little sign of improving, in spite of monumental shifts in societal understanding over the last five years. I’m talking about mental health, a subject central to my professional and personal journey for the last 15 years.

When I first entered the acupuncture profession as a student in 2010, I was very much in the midst of significant mental health struggles – a part of my story that started a few years previously at the point of diagnosis. In what I now understand to be fairly common practice, my struggles were framed as a regular chemical imbalance that could be rectified, in part, with drugs. At the time, I found a great deal of comfort in this straightforward practical explanation that I could understand and address with a chemical intervention.

Unfortunately, what I had been told not only turned out to be a gross oversimplification but may also have been inaccurate. The scientific credibility and provenance of the serotonin theory so commonly cited as the cause of mental ill health has been the source of much debate in recent months. And while it’s not a can of worms I wish to open myself, I do want to acknowledge the debate and highlight the importance of questioning and challenging its scientific integrity.

In the main I consider the current focus to be a distraction from what I believe to be the bigger picture in the conversation. Whether or not mental illness is linked to a chemical imbalance, the harder question to answer is one of cause or effect – and for acupuncturists this is the nub of the argument because our holistic approach centres around the root of illness, not just the branch.

Reading the signs

On my own journey I have travelled through biology, psychology and sociology. After years of recovery, researching, teaching and philosophising over the complexity of emotional suffering, I have come to understand that emotional health is a constantly evolving interplay between the individual and their environment. Multiple unique factors shape us as individuals, such as trauma, socioeconomic group, gender, race and parenting – all influencing but not predetermining how we may respond emotionally to challenges.

Yet while this biopsychosocial model is a useful template for identifying possible vulnerability, it still leans towards explaining a disorder at the level of the individual. However, the sheer numbers of people struggling with mental health issues – conservatively estimated at a quarter of the adult population annually – would suggest to me that the investigative net needs to be cast a little wider. When swathes of our population become unwell surely we should stop looking at the people themselves and look more closely at their environment?

In his book Sedated: How Modern Capitalism Created Our Mental Health Crisis, Dr James Davies discusses the proliferation of mental health diagnosis in the UK since the shift in economic ideology under the premiership of Margaret Thatcher. Antidepressants are currently prescribed to 8.3 million adults living in the UK. Davies presents strong arguments, supported by evidence, to suggest that some (not all) of this growth can be attributed to a medicalisation of normal suffering in the face of abnormal or unreasonable pressures that keep the commercial machine rolling.

I find this argument compelling. One of the enduring dilemmas I faced during the early days of clinical practice was how to support people who developed poor mental health because of situations they were engineering or tolerating themselves through misheld, socially conditioned beliefs: Typically, people in toxic working environments that they couldn’t or wouldn’t leave because of high levels of debt, often incurred as a result of excessive consumerism; poor relationships; lack of sleep and rest because of long hours and relentless, unrealistic deadlines. Sure, acupuncture could provide some respite, perhaps improve their capacity to cope – but what my patients really needed was a re-evaluation. Unfortunately for most, the relentless nature of modern life makes the cost of addressing the root causes of their problems just too great. It is easier to paper over the cracks and simply endure.

As an example of the potential medicalisation of normal suffering, I would like to examine a condition that in my opinion can often be reframed as a simple conflict in the balance of yin and yang caused by a failure to follow the natural order – seasonal affective disorder or SAD.

SAD example

Sometimes referred to as winter depression, SAD is best known for a seasonal presentation of symptoms as daylight hours shorten through autumn and winter. What really captures my interest about this specific disorder is the interplay between the symptoms, the hypothesised causes, and the development of now conventional treatment.

The condition was first named and described in the 1980s by Professor Norman E Rosenthal, a psychiatrist who observed the annual presentation of depressive symptoms in his patients and decided to investigate further. Rosenthal discovered that the prevalence of SAD increased the further people lived from the equator – he therefore hypothesised that a lack of environmental light was a key risk factor in its development.

SAD sits within the ‘depressive mood disorders’ category. As with all mental ill health its intensity is best considered on a continuum. Many of us will resonate with a seasonal dip in mood but to be considered a diagnosable disorder, the symptoms would be more severe, prolonged and encroach on normal life. I have met people who become bed bound as they fall into a deep and profound depression from where simple tasks become a monumental effort. Whilst lack of environmental light is cited as the primary cause of SAD, other predispositions such as gender, family history and stress are also said to increase risk.

One of the most well-known (and unique) ways to treat SAD is through light therapy. Depending on circumstances and severity of symptoms, such treatment can vary in intensity from recommending more natural exposure during daylight hours to a therapeutic approach of direct focused light therapy from a so-called SAD lamp. This scientifically led approach varies between products and manufacturers but essentially consists of sitting 16 to 24 inches from a lamp with a minimum output of 2,000 lux while allowing the light to fall on your eyes directly for 20-30 minutes.

How light therapy benefits us is unclear. Like most if not all mental health conditions there is no shortage of hypotheses, many of which centre on biological or hormonal changes such as adjustment of circadian rhythm or concentrations of hormones. They are however theories and exact mechanisms are unknown.

As a depressive mood disorder, SAD shares many common features with other depressive conditions such as persistent low mood and loss of pleasure or interest in everyday activities. Notably however, it has three key symptoms that are often early onset: • feeling lethargic and sleepy during the day • sleeping for longer than normal • craving carbohydrates and weight gain

Analysing SAD from a yin yang perspective we can see that all of these symptoms are very yin in nature. Slowness, lethargy and sleepiness are all indicative of a yang deficiency, so much so that we could be forgiven for moving straight into a remedial treatment plan that focuses on patient goals of energy and mood boosting. Conventional treatment through light therapy floods the patient with yang energy and in doing so restores the balance.

But to my mind this is a very simple way of looking at the problem. When we broaden the analysis and look beyond the individual to the environment in which their vulnerability increases – winter – the symptoms paint a different picture.

A wider sickness

When I see sleepiness, carb loading and winter in one sentence I don’t think disease, I think hibernation. Moving further from the equator, the change in daylight hours becomes part of a natural, seasonal cycle that follows a transition from the yang qualities of summer to the yin qualities of winter. Most animals that are vulnerable to such environmental changes will adapt, either physically, behaviourally or both – hibernation for many a key survival technique.

And it’s not just hibernation. Nature also follows a pattern of change. Birds migrate, trees enter dormancy, breeding and growth slows. It seems to me then that the human shift into a more lethargic, yin dominant state aligns perfectly with the external environment. The problem is that we tend not to move into this state because the world we’ve created does not allow us to.

We manipulate our environment to fabricate the yang qualities in which we are most productive so that we can plough on regardless. Manufactured heat to maintain a comfortable body temperature, manufactured light so that darkness doesn’t hinder our productivity, alarm clocks so that we can rise before the sun. And when our bodies protest? We even attempt to manufacture our own internal chemical environment, in this case by flooding it with yang in the shape of 2,000+ lux of white light for 20 minutes a day.

I would argue that SAD is only a disorder because we frame it as such. If society accepted, tolerated and accommodated a need in winter for more sleep, less movement and, in the early stages at least, extra carbohydrates, the incidence of reported SAD would drop dramatically.

The pattern of disharmony between ourselves and our environments can be seen across the whole spectrum of emotional suffering. Quite simply, the developed and developing world that most of us inhabit places disproportionate value on the yang aspects of life, so that is where we turn our focus. Conventional models of ‘success’ are wrapped around what we have achieved and accumulated. Key performance indicators, economic growth, sporting endeavours climbing the career ladders. People boast about how little they rest or sleep because they are admired more for not needing to. Moving, doing, achieving.

Negligible value is placed on the yin aspects of life. Resting, sleeping, being. In fact we often denigrate with insults those who do seek more balance. Lazy, unambitious, weird. It seems to me that the social world we have created utterly disregards the natural world in which it sits. We have developed a 24-hour always-on culture that is perpetuating monumental levels of societal stress by isolating us from the natural environment to which we belong. Quite simply, conditions of our own making have dehumanised us.

And the implications for our health of all this stress do not stop at emotional wellbeing. In his latest book The Myth of Normal, renowned author and physician Dr Gabor Maté catalogues the increasing evidence of an alarming relationship between stress and a host of life-changing health problems like cancer and autoimmune diseases.

How we can help

Of course, when considering our clinical approach to emotional problems we are presented with a problem – because in spite of its appeal as a holistically applied natural modality, acupuncture is nevertheless designed to address a disharmony within the individual. Yet I have argued here that the problem does not routinely reside within the individual but within their environment. The imbalance of yin and yang arises within us individually because meeting even our basic needs is built around social rules that render us unable or unwilling to surrender to what our bodies tell us is the natural order of things. How then can we prevail in a society that demands this consistently frenetic pace? As with so much of what I teach and observe, I have no easy answers. Even those who hear the call will struggle to follow their hearts in a society that lays out such a demanding and unwavering path. Living in full harmony with the seasons is not easily achieved in our society.

We can however embrace the small wins – look for balance where it exists, resist the unrealistic, adapt where we can, and encourage ourselves and others to listen to our bodies and try to follow what we need instead of what the world tells us is worth something.