Wednesday, March 28, 2018

Understanding the Mind - an Introduction to the Phenomenon of Placebo and Nocebo




Despite much recent intense study with some of the most remarkable scientific instruments and study methods yet devised for understanding brain function, much about the brain and mind remains mysterious. In understanding mood and psychiatric disorders, most study has focused on neuroanatomical and neurobiological factors that give rise to symptoms. We took a brief look at the basics of our brain anatomy and biology in neuroanatomy 101

When we think of ourselves, we generally think of our mind and not so much our brain. However, it is the brain that gives rise to the mind and, as we have been learning, it is deep brain regions that have so much "say" in our behaviours, actions, decisions, thoughts and so on. 

In this post, however, we are going to start looking at the power the mind can have over the brain; how thoughts, perceptions, beliefs, ideas and other apparent non-concrete phenomenon can produce amazing physiological changes in both the brain and body. 

As with all the topics I try to address, there is an enormous amount of present and past literature on today's topic and I can only hope to present a brief synopsis of what is known and, as is the purpose of this blog, how it applies to us mental health peeps. 

This is also going to be a difficult and probably somewhat controversial post as it will tread on some touchy ground for many if not all of us mental health peeps no matter our condition, our own experiences of it and our own treatment paths. 

Understanding the concepts placebo and nocebo is critical, however, for learning how mental perceptions will alter the physiology and outcomes of conditions like depression, bipolar, ADD/ADHD, anxiety and so on. It is also essential for a better understanding of how psychiatric medications may appear to work and how many other "treatments" may improve or appear to improve mental health outcomes or even physical health outcomes. 

Furthermore, it is also vital to understanding the damaging effects cognitive distortions or distorted thinking can have on our mental and physical health and why it's important to address these in our overall strategy for achieving better mental and physical health. 

As well, I'll also begin to tie these two concepts into our individual and subjective realities, how those are created and how we must learn to examine those and perhaps work to see them differently. 

Finally, if you have a clinical or professional interest in understanding psychiatric or mood disorders and all of their possible treatments this is yet another aspect of the human mind and brain that is absolutely essential to start learning to better understand. Without this you are for all intents and purposes lost at sea in trying to understand the vast puzzle that is the short and long term efficacy of any given course of treatments. 

That's a lot to get to in our limited space here today so let's dive in.


In his 2012 book Brain Wars, neuroscientist Dr Mario Beauregard introduces the chapter on placebo and nocebo with the sub-heading of "the power of belief to cure or kill". In a post on placebo in his award winning science blog Searching for the MindDr Jon Lieff writes that "mental activity, such as expectations, determine perception rather than just physical sensory information" and that "placebos demonstrate that perception alters physical health". 

These might appear to be astonishing - not to mention controversial - claims so we'd better first learn what each term means.


What is Placebo?


The word placebo comes from the Latin for "I will please". 

To begin to understand this important term and concept as it is used today, firstly we need to know that there are two ways to think of placebo; one is the placebo effect or response and the other is placebo medications or procedures for medical or medication trials. While what's going on in the brain is essentially or much the same, it's very important for our purpose here today to distinguish the differences in usages of the terms. 

Placebos in the field of medical or pharmaceutical trials is the use of a dummy pill or treatment to gauge the effectiveness of a new drug or treatment with the idea being that if the new treatment greatly outperforms the dummy pill or treatment - the placebo - then it's an effective treatment for a given medical or psychiatric condition via physiological means. If the new drug or treatment cannot outperform the placebo then it's judged (or should be) not an effective treatment in the sense that it has no actual physiological effect on the source of the condition (a tumour or the sources of a given pain for example). 

Placebo effect long predates the modern use of placebo medications or treatments in trials and could be from almost anything. 

As Beauregard stated, it comes from the power of belief or as Dr Lieff worded it, it is rooted in the power of our minds' perceptions and expectations and indeed our look today at placebo and nocebo effects in the mind and body are a look into the power of belief and mental perceptions and expectations of the mind, not to mention imagination

As for belief and what that means to the individual or a greater society or culture, Beauregard writes:
Belief, of course, is culturally specific. If you are an American believer in the power of Western medicine, a hypodermic needle, a striped capsule, or a sophisticated machine with several buttons may be the symbol of a powerful treatment. A member of a remote indigenous tribe might find the ingestion of a specific plant picked during the full moon much more credible. And regardless of the treatment, you may experience symptom relief. Because anything that enhances the credulity of a particular treatment will enhance the capacity of that treatment to evoke a placebo response. 

And by anything, that really could mean anything. As Beauregard further writes, "Mental processes and social contexts that facilitate faith and hope, positive expectations and feelings, motivation, and anticipation of improvement also appear to effect our brains, bodies, and behaviour". 

As Dr Lieff writes regarding placebo effect in Western society, "Placebos work through clinical rituals, symbols, and interactions with health care. The manner and explanations of doctors and other health care workers are also known to be a major aspect of the effect. It has long been noted that the manner in which doctors, therapists and nurses treat patients has a dramatic effect on whether they will improve or not".  

Not often seen in any discussion on placebo effect and the powers of belief and perception that creates the effect is the evolutionary basis for the powers of belief in the human mind. I introduced and somewhat addressed this in my post On Belief - an Introduction where I briefly outlined how the power of belief greatly ups a group's or individual's chance of survival and thus over the tens of thousands of years of our evolutionary development greater and greater capacity for belief became more and more a part of the neurobiological functioning in the human mind. 

And if we think back on the evolutionary history of homo sapiens, our species managed to survive and get by great injury or illness for many, many millenia before modern medicine. Not always, of course, but enough to survive. In the past when there were no means to treat injuries or diseases as there are today, almost the only way would have been through treatments in which the power of belief played the primary healing role (which we can see today by studying indigenous peoples and shaman administered treatments). 

Okay, that's a very brief introduction to placebo, let's now move on to nocebo. 


What is Nocebo?


As Beauregard (somewhat humorously) says, nocebo is placobo's "evil twin". It is Latin for "I will harm". Beauregard states that the term can be applied "whenever symptom aggravation follows negative beliefs and expectations without the administration of any inert treatment". As with placebo, a good deal of our modern medical understanding of the phenomenon comes from clinical trials of pharmaceutical drugs. Symptoms of side effects could arise from the negative beliefs and expectations of those even though the trial participants had received an inert substance (sugar pills are almost always used as the dummy pill). 

As another example, Beauregard reports that an average of twenty-five percent of participants in drug trials receiving the placebo will report negative symptoms associated with side effects for the trial medication (he then includes several case examples). In other words, what we are seeing here is, as Beauregard said regarding nocebo effect, "symptom aggravation following negative beliefs and expectations".

False positive medical test results such as X-rays and scans can also produce horrendous nocebo effects such as the case of a man who received a medical report indicating that he had widespread inoperable cancer of the esophagus. He displayed all the symptoms of the cancer and would eventually succumb to those symptoms and pass away. An autopsy, however, revealed that the report was based on false positive X-rays and in fact the level of cancer was very minor and should not have resulted in even much of an effect on health, let alone death. Again, in other words it was the patient's negative beliefs and expectations that created the deadly symptoms, not actual life threatening tumours. 

To return to indigenous peoples and nocebo effects of "curses", we'll look at an incident observed by a noted anthropologist studying a remote Australian aboriginal tribe. This involved the case in which a man accused of a tribal taboo had the tribe's shaman point a special bone at him and utter a curse:


The man who discovers he is being “boned” by the shaman is indeed a pitiful sight. He stands aghast, with his eyes staring at the treacherous pointer, and with his hands lifted as though to ward off the lethal medium, which he imagines is pouring into his body. His cheeks blanch and his eyes become glassy and the expression on his face becomes horribly distorted ... He attempts to shriek but the sound chokes off in his throat, and all that one might see is froth at his mouth. His body begins to tremble and the muscles twitch involuntarily. He sways backward and falls to the ground, and after a short time appears to be in mortal agony.

After a while he becomes very composed and crawls to his wurley (hut). From this time onward he sickens and frets, refusing to eat and keeping aloof from the daily affairs of the tribe. Unless help is forthcoming in the form of a counter charm administered by the village medicine man, his death is only a matter of a comparatively short time.

  • anthropologist Herbert Brooks in a 1925 account witnessed in his earlier observations of Australian tribes people


Nothing physically was done to the man nor were any poisons administered to him, only a simple bone pointed at him along with the utterance of some words. It was nothing more than the unquestioning belief in the omnipotent shaman's powers that created the deadly effect.

In one well known case study, a 26 year old male attempted suicide by taking what he assumed was an overdose of antidepressant pills. Along with other frightening symptoms, his blood pressure plunged to dangerously low levels. A friend rushed him to hospital where furious efforts were made to stabilize him. However, the patient had the pills as part of a clinical trial and in fact they were just dummy pills of sugar. When this was discovered and the patient informed, the dangerous symptoms cleared up within minutes. 


In 2012, the Technical University of Munich released one of the most thorough reviews of the literature on the nocebo effect in which they examined the underlying biological mechanisms and the problems these cause medical practitioner and clinicians. The conclusion: it is a surprisingly common and real phenomenon that should be taken seriously by the medical community on a daily basis. 


Okay, so those are some brief overviews as to what the terms placebo and nocebo mean and their outward effects. Let's now look a little deeper. 

As with so many leaps forward in medical understanding, some of the earliest known observations of the placebo response are from war zones. During WW II in a field hospital in Italy amidst a flurry of surgeries on injured soldiers, morphine supplies tragically ran short. With life saving surgeries imminent, a nurse assisting the anesthetist thought quickly and filled a syringe with a simple saline solution. Both the nurse and anesthetist carefully explained to the patient that he was receiving the powerful painkiller and the surgery proceeded with the patient remarkably experiencing little pain. 

That anesthetist, Dr Henry K. Beecher , would go on to publish the first known paper on the phenomenon The Powerful Placebo as well as becoming a leader in the field of its study (not to mention a highly respected leader in the field of medical ethics). 


The placebo effect or response can be so powerful that patients will report improving or disappearing symptoms of an illness or disorder even though it is clearly explained to them and that they clearly understand that they are taking the placebo of a trial medication; in other words, they knew they were taking only inert sugar pills. In an episode of the highly acclaimed Canadian Broadcasting Corporation series The Nature of Things called Brain Magic: The Power of Placebo, we also get some amazing examples and some in depth looks into how and why placebo works. In one portion of the program featuring Harvard Medical School's Ted Kaptchuk, a leading figure in the study of placebo effects, it recounts a study his department did on a new drug for Irritable Bowel Syndrome.

Eighty patients were involved; forty getting the active substance, forty getting a placebo. However, unlike a "blind" study, in which participants have no idea whether they're getting medications with active substances or a dummy placebo medication, in this study Dr Kaptchuk decided to make it an open label study - tell the placebo group openly, honestly and clearly that they were getting a placebo.

One woman who interviewed for the program had had Irritable Bowel Syndrome for twenty years and signed up for the trial because in her words she  "was desperate" and "willing to try anything". She describes how clear she was that she was getting a placebo and that she thought, "well, why not ... But I never, never, never thought it'd work".

As Kaptchuk recounts, "the important thing that we said was 'even if you have doubts, even if you think this is crazy, just take two pills twice a day. We think this will work'".

The woman followed the directions to a T and ... get this - after three days of knowingly taking a placebo her symptoms began to clear up. 

And that's not the most interesting part. In the end, twice as many patients who received the placebo pills reported significant improvement of symptoms as those who got the active ingredients. 

As Kaptchuk says in the program, "we got this incredible placebo response. We still can't believe it". 

The placebo effect is not limited to what sugar pills can do. In 2002 Dr Bruce Mosely, then of Baylor College of Medicine in Houston, Texas, received special (and rare) permission to investigate the effectiveness of placebo arthroscopic surgery for osteoarthritis of the knee. Three different procedures were performed on 160 patients; one third received the full normal arthroscopic repair, one third just a cleansing of the joint but no repair and another third in which only two incisions were made but no procedure at all was performed. All three groups went through the same pre and post operative procedures. 

Astonishingly, all three groups equally reported being pain free in a follow up two years later despite the nature of the study being revealed. 


So that's some very carefully and well conducted accumulation of powerful evidence. 


So what does this mean to us mental health peeps?

Several things. 

One, this has huge implications for the alleged efficacy of common antidepressants. This has long been a huge elephant in the room in every pharmaceutical company's boardroom. At no point since the release of the first antidepressant has any brand or formulation ever been able to outperform a placebo. This will require a separate post to better address this (and the literature on this is massively extensive), but the tragedy I've long seen (again, there is massive amounts of literature to support this) is that patients with serious underlying causes for their depressive symptoms will show initial improvement on antidepressants but then begin to decline over time. As I've said over and over again, there are many causes of depression and many of the symptoms that will simply not be addressed or "treated" by a simple pill (that can't even outperform placebos) that focuses on a tiny aspect of brain and body function. Thus literally tens of thousands of people become, as they say in the psychiatry business, "treatment resistant" and decline further and further. I have read dozens of case studies like these, talked to many people like this in psychiatric hospitals and since then interviewed many more. It is beyond heart breaking to see. 

But it's not just pharmaceutical drugs, it's any substance that becomes popular as an "effective treatment" for depression, anxiety or pain and so on. This means herbs of all kinds, so called homeopathic treatments, fancy looking treatments like "deep brain stimulation" (which I reported here failed to outperform sham treatments), you name it. 

It was always something that troubled me about looking for "cures" or "treatments" for mental health disorders; these desperate searches for some kind of magic bullet and the ongoing suffering because none of these ever actually address the true underlying causes of any one case. It was always heart breaking to me to see the hopes built up followed by the nearly inevitable let down and continued suffering made all the worse by yet another "failed treatment". 

I've argued this over and over again in many different posts; if we don't learn or recognize the underlying causes and work to address those, we will never escape the inner torment, the darkness, the pain, any of it. 

This has always been the biggest motivation for all my research of how brains work and how symptoms of so called "mental illnesses" are created. I wanted to know how everything worked in the brain, what caused any given symptom and most importantly how to address it and work on it with proven proactive methods that we can work on daily. 


Two, it gives us incredible real world well documented evidence into the power of the brain and body biology over the mind and the power of the mind over brain and body biology. Or in other words, the power of physiology over psychology and of psychology over physiology. Or to put it yet another way very, very important for us to understand - the power of suggestion, belief, perceptions, expectations, thoughts and yes, imagination can have over our physiology for both good or bad.  

As I've tried to hammer home in numerous pieces in this blog, there often is a very, very real brain and body physiology giving rise to the symptoms and mind phenomenon you experience. However, it is undeniable that it may well be mental experiences that create the physiology and this becomes a wicked cycle that is very, very hard to break with the mind influencing the brain and body physiology and the brain and body physiology influencing the mind and mental experiences (or conscious experience, as I like to say).

We must also be very clear about what placebo cannot do and what it does not mean. It does not shrink tumors, it does not heal broken bones or other wounds, it does not cure illnesses and conditions such as diabetes, heart disease, lung disease (and the list could run into the hundreds). It does not mean we can simply "will" ourselves to get better. 

Nor does it even remotely suggest that various conditions open to placebo effects are "all in your head" and no one who devotes their careers to studying these phenomenon would at all even imply that.

Dr Amir Raz of McGill University and noted authority in the studies of placebo responses firmly dispels these notions. 

As he explains, "Placebos instigate action, they change physiology. For real, not just for show". 

Some of this can be explained by how the brain creates anticipation based on memories of past events or experiences. Like many brain functions, they can be beneficial (this allows us to react quicker to danger, for example) or it may "trick us" by incorrectly anticipating something we "believe" will happen which in fact doesn't. This is part of what is known as the "conditioned response" which can be effectively demonstrated in numerous ways.

Kaptchuck puts it this way, "there are no pharmacological agents <in placebos> but the rituals and symbols of medicine activate neurotransmitters in relevant areas of the brain that change the experience of illness and alleviate symptoms."

An enormous body of evidence shows that placebo inducing treatments release the brain's natural endogenous opioids. The neurotransmitter dopamine is also heavily implicated which makes sense on a number of levels, chief of which is that it is this system that can keep us locked on to future hopeful targets and moving forward helping us block out obstacles (including negative mental states and pain). 

I strongly feel that both placebo and nocebo experiences would be very much tied into the harmful neurobiology of both acute and long term psychological stress with positive expectations mitigating the effects (placebo) or negative expectations, emotions, hopes, etc exacerbating them (nocebo). 


However, what we need to truthfully examine is the very real and powerful effect our thoughts, perceptions, expectations and even words have on our physical and mental health. 


When I started this whole journey back at the dawn of 2013 by thoroughly and honestly examining my own case history up until then, I felt strongly that some of my mental experience - particularly some of the dark hopelessness - may have been a result of the "expectations" I had had set by much of the literature I'd read stating the poor prognosis for those with my type of bipolar in my demographic (white male over 50 never diagnosed or treated) and the negative experiences of psychiatric and pharmacological care. 

When I came across and began study into the placebo and nocebo effects I felt I had the evidence that indeed some of my symptoms may have been nocebo effect and thus reversible. At that point I was also doing a lot of study into the power of belief and of the mind along with the interplay between brain, body and mind. 

"What if", I wondered "I could turn much of this around by learning to harness the power of my mind?" For this is what was very strongly suggested by the evidence from a great deal of the literature on belief, perceptions, expectations and placebo and nocebo and the findings of a sizable number of cognitive neuroscientists who investigate and research the power of mind. 

Over the ensuing years as I began to better and better understand the neurobiology and neuroanatomy of the brain and the interplay between brain, body and mind, the very real physiology of this in the brain and body became evident. 


So what, dear readers, am I suggesting here? 

What we allow in our minds matters. Undeniably so. The content of our thoughts, our beliefs, our expectations, our imagination, how we anticipate events absolutely makes a difference to our "mental health" (a term I feel is a very misleading and not very useful misnomer) and our physical health. 

What I am not suggesting is that defeating your symptoms is merely a question of "mind over matter". It is far from that simple. 

There is no way I could briefly describe or recount what a broken down wreck I was at the end of 2012 and again at the end of 2013 and few of those who know me today would believe it but everything I have accomplished in overcoming a long list of some of the worst symptoms there are involved in psychiatric disorders not to mention the brain damaging side effects of thirty months of psychiatric drug therapy came as a result of understanding the power of mind over our brains and bodies. 

All the daily habits I practice are to manage what is in my mind and any of the symptoms I may be experiencing at any one time. 

This is why I emphasize so much in so many posts how we must learn to control our thoughts and daily actions, not to mention how we view our selves and the world around us. 

This is why I worked so hard on meditation,  mindfulness meditation CBTmy brain training exercisesmusic therapy, being very aware of and careful of how my imagination is working, and to work very hard on common cognitive distortions.

In short, I work very hard daily on being very cognizant of what is in my head at any given point of the day and managing that quite simply because there is no doubt of the effects mind can have over brain and physical health. 


Now, you can learn to better understand this power within YOU or you can continue to be tossed at sea by these powers regardless of your willingness to accept these concepts or not (and the initial response of the vast majority of people both patients and professionals alike will be to deny these powers). 

Is it easy? 

No goddamned way. But that's life - it is not easy. 

Can you do it? 

I believe you can. 

It's a journey, it's a process and it takes time. And like all journeys no matter the personal difficulty and challenge, you move forward step by step, day by day.

But you're going forward in life regardless so you have nothing to lose by working on yourself and your mind. 

I know what you're thinking - "I'm not worth it". And I get that. I've been there countless times myself in brutally low ways. 

But ultimately that's not true. This is a conversation for a separate post but yes, 

YOU are worth it. 

Yes you are. 

Yes you can. 


Thank you as always for reading. 



Further reading resources:









McGill Talks Episode 7 - Prescriptions and Placebos

Wednesday, March 14, 2018

The Illusion of Free Will






Today's topic is, to say the least, controversial. Regular readers may have picked up the fact that I do not believe in "free will". I have danced around this topic since first beginning to write about neuroscience, the brain, life and "us" back in the fall of 2013 and feel it's time that I at last fully address it head on. 

First, however, I must attempt to make some things as clear as I can (I say "attempt to" for no matter how clear one states views there will be those who see it their own way regardless of what the writer or speaker writes or states).

This is not a "philosophical debate". 


I'm afraid I must say I have little to no interest in the traditional "philosophical stances" regarding free will. In my view, we may as well consult the book of Genesis to study geology and biology. Philosophical positions are little more than opinions based on one's own reasoning, which is largely based on similar reasoning from long expired philosophers. Virtually all philosophical "arguments" in favour of "free will" can be distilled down to abstract positions and who said what. Few of them - if any - actually examine the "territory" itself; the brain. Or in other words, the reasoning is based on flawed or incomplete premises. The best logical reasoning in the world will lead to wrong answers if based on faulty or incomplete premises

"Map vs territory" is something I'll have to leave for another day but briefly the vast majority of "studies" you will come across regarding human behaviour and concepts such as "free will" are "maps" - artificial constructs that reflect ideas and thoughts and impressions and theories but contain little of the actual "territory" itself. Imagine a city as complex as Tokyo, Hong Kong, New York or London. There is no one way to understand any of these cities. You could visit each a thousand times and come away with different perspectives and understandings with each visit depending on how you visited or with whom or the circumstances you fell into or how freely you explored each time. 

But what if your understanding of any of these great cities was only based on a simple map without ever having been to them? A map that reflected the map maker's mind and purpose? Or you do go and you allow your entire experience of the city to be shaped by the simple map? How could you argue that was an accurate depiction or understanding of the actual territory, the city itself and its nearly endless number of variables among neighbourhoods, peoples, lifestyles, infrastructures, the "flow" of each day according to weather and numerous other factors?

Again, this is a long and deep topic, but this is in fact what the vast majority of "studies" are; maps of understanding that reflect the mind of the map makers, be they philosophers, many (if not the majority) of scientists and so on. 

And so it is with the brain; the great majority of those who pretend to understand human behaviour study not neuroanatomy or neurobiology but are instead map makers who base their "maps" on previous (generally outdated) "maps" or maps of maps and on and on. 

If you truly want to understand the territory, then study the territory, not "maps".

Follow the evidence, not beliefs


It never fails to astonish me how much the vast majority of people want to match the evidence to the belief or set out with a belief and fit the evidence to it or ignore any evidence to the contrary. I am not talking religious "believers" here, though I would bet the farm that was the first thing that came to most of your minds. No, no, I'm talking a great deal of science, sociology, politics, mind sciences, business, and other fields populated, presumably, by very smart and well educated people. 

For the record, when I started studying all this brain stuff five years ago (very early in 2013), I felt very, very strongly in favour of free will. I felt - for the sake of corralling my brain and life - there had to be free will. I cannot tell you how much I wanted some sort of "free will" control over this often pernicious and wayward behaving noggin of mine. But evidence just kept trumping my need for my belief and the deeper I got into how the brain works, the enormous complexity of it all, the nearly incalculable number of variables at any given moment in a person's life that may steer them this way or that, it just hit me - "no way can we "control" any of that". 

Not only that, it was the complete absence of any hard evidence for free will. And I mean nil. 

This not an argument for determinism of any kind


It is very unfortunate that the first thing that comes to most people's minds when they hear a case against "free will" is that it is an argument for "determinism". 

Determinism is another term from philosophy which has long outlived its purpose, if it ever really had a purpose in the first place. 

Arguments for determinism are far, far too simplistic. Determinism implies that there are absolute predictable outcomes for given circumstance. Too often it is couched in "A" and "B" choices. 

In truth life on earth and the universe in which earth itself exists contains far too many unknowable variables for there ever to be any kind of "predetermined" outcome with absolute predictability. It's true that many circumstances will have predictable outcomes. An airplane that runs out of fuel at 36,000 feet outside of any kind of gliding range to a safe landing will fall from the sky at quite a predictable rate and the fate of all on board is, yes, "determined". But what led to that aircraft running out of fuel started with many, many unpredictable random events. 

Determinism invariably comes down to the humancentric need for "certainty" and "predictability", this need for absolute predictable outcomes. I argue that the belief in determinism is ludicrous, again, because life on earth and the ongoing events of the universe contain too many unknown and unpredictable variables. Certain things are predictable, yes, but all of life itself? Your life? 

No. Your "life" is not "determined" precisely by any one thing. Jt is true that our life span is somewhat determined if you want some sort of example of "determinism". You are made up of trillions upon trillions of microscopic biological organisms called cells and these will break down at a fairly (though not precisely) predictable rate and at some point you will expire naturally as all living things will. Or you may meet your end through various circumstances of incalculable variables. In any case, you can count on the fact that you will die by some means (as all life forms on earth invariably will, if not become extinct or be extinguished by some cataclysmic event of one kind or another (think asteroid strikes and dinosaurs). 

It's also true that many, many possible factors will determine to some degree various aspects of a given person's abilities and life choices. 

However, there is no such thing as any kind of grand determined predictable "fate". This model of "determinism" ignores the vast complexities of life and the widely varying spectrum of any one aspect of life. There is something called "chaos theory" which somewhat helps understand this.

So no, please, do not jump to the conclusion that "no free will" is an "argument" for "determinism". 

In fact this not an argument "for" anything. Nor, precisely, "against" anything. Since beginning my Odyssey into the study of the human brain and behaviour, I have simply followed the facts as they were, starting with general neuroanatomy, then finer and finer neuroanatomy, neurobiology, etc, etc. What this does, what it doesn't do, what generates this and what regulates it <endless etcetera>. Then on to the cognitive neurosciences where we depart somewhat from the "concrete" of "hard science" and enter the realm of more abstract study of such things as cognition, thoughts, imagination, dreams, "reality" and perception, beliefs (an area full of irony, I can tell you), self-perceptions and the grand Holy Grail of all of neuroscience and philosophy, consciousness, all of which is our humancentric drive to understand the age old question of "who am I?" and other such existential naval gazing questions. 

Then into the study of "actions" and "behaviours", all through the lens of my (sorta somewhat famous) quest for "why?". 

It started out wanting to answer the question of why people committed suicide. Why this person and not that person? Why this time and not all those prior times? And nearly endless questions along these lines, all of which led to further and further questions of why we do anything

And again, I did not want answers from the usual philosophical twaddle people are fond of espousing, nor from the vast majority of psychology and definitely not the totally lost field of psychiatry. These fields were and are full of "map people" with either no direct meaningful knowledge or understanding of the actual territory or in fact completely ignorant of it or led completely astray by predetermined beliefs based mostly on commercial needs (yes, psychiatry, I'm talking about you and your pharmaceutical partners). 

For reasons I will probably never be able to adequately explain, I just fell completely in love with studying pure, raw neuroscience. Few things excite me more than journeying through a single neuron and what makes it "tick" or not, how it connects with others, and on and on and on (for a super brief introduction to all this brain geekery, please see neuroanatomy 101). 

So yeah, for me it's just simply pointing out how things actually work, rather than our outdated notions of how most people want to think it works. 

Follow the evidence, not beliefs. 

What the hell is free will anyway?


As with any abstract concept, the semantics of the term itself gets rather fuzzy. And frankly, having now examined the evidence (the territory, remember) for this question in great depth for some years now, I'm not sure most people who argue about "free will" really understand what it means (yes, I am aware of all the rocks pelting off my windows from enraged free will proponents wanting to boil me in oil). 

Just setting the semantics of free will, the definition of it, could trail off towards untold numbers of dark alleys and dead ends (at best) or never ending long and winding roads (at worst) so we'd better come up with something somewhat satisfying so we all sorta know what we're examining. 

Proponents of free will seem to believe that there's this "I" that has some sort of "agency" over our actions, thoughts, decisions, behaviours, and so on. There are numerous possible needs for this belief, no shortage of them centered around this need to hold people culpable for whatever they do; in other words, it's about blame and punishment. In other words, it's rather Biblical.

On a personal - I would say egocentric - level, we just all want to believe that "we" are "in control". Admittedly, this is a seemingly handy thing to believe in. A sense of control is crucial for many people's sense of well being, their need to believe in their accomplishments, the fruits of their labours, their ideas, their creations, this sense that "they" did this and that. (a whole piece on the egocentric human is coming at some point)

So a great deal of this need to believe in free will seems to come down to this need to feel or believe in this "I" who is the agent of their life and this need for culpability which itself is rooted in our ancient (and I mean very ancient) needs to blame, judge and punish.

To me, however, it seems we should have grown past all that. To me it's the equivalent of believing the sun revolves around the earth (from our previous horrendously humancentric view of the universe).  

As necessary as it may seem to be, however, so called "free will" is an illusion, and like so many humancentric beliefs before it, the belief in this illusion needs to fall. 

And no, this will not lead to the collapse of civilization or any particular rise in bad behaviour at all. 

Au contraire, mon amies, I would argue that the stubborn belief in free will is actually dangerous, that is this belief that "we" are fully in control agents responsible for this or that action or decision is what is keeping us shackled to terribly outdated beliefs and notions of what does make people (or you) tick and furthermore, for correcting what we'll just call "socially incorrect" behaviours. 

Okay, to understand this, we need to look at a few basic things involved in this premise known - for better or worse - as "free will". 

Who are we? 


Who indeed is anyone. As regular readers will know, a great deal of this blog points out that whatever "we" are, it's created by or arises from that 3.1 tofu like blob between your ears, which for the vast, vast majority of you will be a fairly standard off the rack homo sapien version of literally millions upon millions of other versions of brains. As regular readers will also have been pummeled to death with, our spiffy modern homo sapien brain didn't just pop out of the oven spontaneously all by itself (Genesis adherents notwithstanding); it evolved from various of those millions upon millions of previous brain models in processes that themselves took millions upon millions of years. 

Take any human brain, cut away the "human parts" (the outer cortex of humans is quite unique and particularly the prefrontal cortex) and what you would find in there would be an even more standard off the rack brain that could be found in virtually any mammal species (yes, I know, takes a bit of the glamour out of this whole human business, doesn't it). 

And what would we find down there? Without getting into tedious neuroanatomical detail, we'd find pretty standard limbic region stuff and brain stem stuff, all of which does pretty mundane things like running a great deal of who "you" are; emotions, reactions, fears, regulation of responses to heat or cold, hunger, sex drives, and all kinds of instinctive drives that are pretty fundamental throughout the critter world. 

And what are some of those instinctive drives? 

We could gussy them up with all kinds of fancy terms that make we homo sapiens sound more sophisticated but basically they are:

- food

- shelter

- procreation (sex)

These three will drive the vast majority of human behaviours. Our more "advanced" and "sophisticated" modern selves of course have more interesting ways than baboons, for example, for acquiring them such as bartering (usually money of some kind) but at our cores, regardless of what we "think" we're doing, on some level we are satisfying these three fundamental needs. 

Many, many, many other behaviours, "thoughts" (for lack of a better term), actions, etc will in fact be driven by perceived or real "threats" to these or the means to keep them. 

Which, I must point out, is not really all that different from most other creatures with whom we share this planet. 

So as wonderfully "advanced" or "sophisticated" as we all think we are with our "smart phones" (a term I am not fond of), snazzy cars, Home and Garden homes, Vogue clothes (and on and on), or even the "higher educations" many feel so proud of, it's mostly all about those three things. 

Do we ever think of those three things as we go about all our "decisions"? Very likely not. Unless they're suddenly threatened or perceived to be threatened (usually by a "rival group" - hello politics and religions and racial discord). Then a whole lot of "thinking" kicks into gear. Or we're being driven by those deeper brain regions to acquire them. Or satisfying someone else's need to acquire them. 

Do we "control" any of that? What "decisions" did we make about any of these things we have, or where we live, or work, or eat - or anything?

What is a decision making process anyway?

For this we must have a basic understanding of conscious awareness. This is a little more abstract but let's have a look. 

When we start poking around in brains and seeing all these astronomically vast numbers of neurons, connections between them (often very tenuous connections), "wiring", neurochemicals, hormones and what these all "do", it quickly becomes clear that the average person has absolutely no idea what's "beneath the hood" of their skull. I mean not a clue. Other than a vague idea that there is "a brain" in there. 

What all that stuff is "up to" at any given point is way, way, way beyond our abilities of awareness, and that's presuming a higher level of self-awareness in the first place. 

And speaking of "you" or "I", where are "you" (or "me") in all of that?

The truth is nobody really knows. "You" just sort of "emerge" out of all that "neurostuff" which itself is connected to all kinds of "body stuff", all of which - your guts in particular (or gastrointestinal tract to be somewhat more formal) - probably have more "say" in what you do or "plan" than "you" do. 

Below the conscious "you" and whatever "thoughts" you may be aware of at any one point, all your sensory equipment and limbic region "hardware" is monitoring all that goes on around you, responding to smells, sounds, sights, tactile sensations, all well, well below your conscious awareness. And all of these regions are "talking" to other "higher" brain regions carefully steering "you" this way or that. 

The ever popular dopamine pathways (I know I love studying and writing about it) are always quietly keeping you tuned into - if not locked into - all kinds of "goals" (AKA; pleasure rewards), themselves mostly attuned to those basic survival needs.

We could go on for several hundred thousands more words about literally hundreds of neuroanatomical or neurobiological (read hormones and neurochemicals) factors that steer "you" this way or that, or create your "moods" this way or that way, 99.9% of which you have no awareness of whatsoever. 

Where, exactly, do the free will proponents think this "I" is in there? They literally have no idea and if they claim to they are being very dishonest. [the esteemed neurobiologist and primatologist Robert Sapolsky addresses this towards the end of his acclaimed tome on human behaviour Behave though countless other esteemed neuroscientists have also addressed this question]

Where does this "I" come from even? At what point does this "I" who is the "agent" of our actions and thoughts begin?

As we saw briefly in Genetic and Environmental Factors in Individual Brain Development, who any person "is" is the result of
nearly unfathomable numbers of factors utterly, utterly beyond anyone's awareness, let alone control.

At what point in that incredibly complex process involving virtually countless possible developmental variables does this agent known as "I" "take the wheel"?

Many would probably answer something along the lines of the age where an individual starts to experience metacognition (usually at some point just before or after puberty). 

This point of "self-awareness", this metacogntion, is often linked to such things as autonomy, self-regulation, self-evaluation, moral and ethical reasoning and regulation and so on. 

But where do these come from? 

This is all happens in the frontal lobes and prefrontal cortex. But do "we" control what goes on in there? 

We may experience it as "control" but it is in fact just your standard off the rack homo sapien brain doing exactly what it evolved, developed and adapted itself for - guiding and regulating "you". "You", however, had nothing to do with its development or lack thereof. 

What factors develop healthily functioning frontal lobes and prefrontal cortex? The same factors we saw in Genetic and Environmental Factors in Individual Brain Development. 

Or we might just call it luck. The luck of being born into privilege and good housing, nutrition, family and education (and even this is no guarantee to produce a "well behaved" individual). 

Look at any kind of poor behavioural regulation (read: ethical, moral, socially/culturally acceptable  behaviours, actions, thoughts, etc) and you will find maldevelopment in key frontal lobe or prefrontal areas or critical white matter connections. Or perhaps lesions. Or perhaps the kind of neurodegeneration found in Alzheimer's, different types of dementia, CTE, much of which appears to affect frontal lobes more than other areas. 

At the other end of the brain, as it were, we come back to that standard off the rack limbic region where fears originate. It is nearly impossible to overstate how much the great majority of people are governed and motivated by fear or fears of all kinds; some of them instinctive, many of them learned. Or pain and avoidance of it. Many of these from childhood experiences that could never fully be overcome. 

Anything about any given person's behaviour can be altered for the worse (but not for the better, I'm afraid) by "knocking out" key regulatory brain regions or the white matter between those and behaviour generating regions (limbic and brain stem). 

What about thoughts, you ask. 

Yes, what about thoughts? Or memories for that matter?

These are incredibly hard questions to answer and more is being discovered all the time but once again I am afraid "you" had next to no say in where any of that comes from. Hell, you had next to no "say" in the vast, vast majority of what went into your brain, let alone what it actually produces. There will be untold hundreds of possible influences into where the information in one's brain came from, how it influenced one, all of which just "happened" as we went about our childhoods, teen years, and early adulthood, the great majority of which resulted from cultural influences, the societal and family norms one grew up in and dozens and dozens of other possibilities. 

All of which bubbles up from deep subconscious regions and functions to produce what we consciously perceive and experience as "thoughts", "memories", "decisions" and anything else we "think" we "control". 

Yes, sobering, I know. 

But there it is. 


Why is "free will" unnecessary? 


Here we come back to my love and admiration for the human brain. It is, quite simply for now, the most remarkable biological organism ever to have evolved. All brains' purpose is to get their host organism through life. And the human brain is the most powerful "survival" organism that exists. It has powers that do not exist anywhere in the known universe nor in the history of life on earth. 

The human brain is wonderfully adept for the most part at navigating through life and adapting to circumstances and finding solutions. All brains do this, the human brain can do it better than any other. 

Presuming, of course, that it is fully healthy and all the brain regions necessary developed properly. And this is a very large - and dangerous - presumption. 

Why then is the illusion of free will dangerous?


For many reasons and this will take further explorations. 

My initial reason for studying what really creates moods and behaviours and dispelling the illusion of "free will" in people was to truly understand the real world struggle so many people have in overcoming their moods, understanding their "faults", the behaviours in themselves they don't like or consistently regret, the thoughts they have trouble controlling, the poor choices they made and all those other things so many of us struggle with, try so hard to overcome yet just, for whatever reason, cannot. And to lessen the suffering they experience from being blamed and beat up by others, or blaming or beating up themselves. 

But also because so much of society is about "blaming" and "judging" and worse, "punishing" with the vast, vast, vast majority of "punishment" having absolutely no redeeming value whatsoever - except in the mind of the punisher(s). 

There are many, many neuroscientists who see it this way as well. 


How can we as individuals improve ourselves if we don't understand the biological and physiological basis for what we are experiencing? 

What if poor brain health, or maldevelopment or damage of some kind has taken away individual "agency" over our actions, thoughts, behaviours and so on?

This, dear readers, is perhaps one of the most important issue facing us today. 

The belief, the assumption, that every individual has "free will" agency over all aspects of their lives, decisions, thoughts and so on is the very thing standing in the way of people asking for help, of seeking help. I would argue that it is a great part of what gives rise to denial. 

It is what stops society from accepting that many people need help, not punishment.

Many, many people struggle with feelings of helplessness and powerlessness. Imposing one all encompassing notion of "free will" on every individual is again a major roadblock for understanding the real struggles of so many people and for them seeking and getting what might best help them. 

How can we "correct" behaviours or improve lives if we don't know the real underlying root causes of the issues? 

The truth is that we can't. 

And any belief that we can is pure illusion. 

An illusion that is standing in the way of more humane and effective ways of treating and rehabilitating those who find themselves at the bottom of or "afoul" of society. 

Which, quite frankly, I simply find barbaric. 





Friday, March 2, 2018

Dilemmas, Decisions and Letting Go

Image result for decisions


The above image representing the "heart" and the "brain" is popularly used to represent a difficult "decision" or internal dilemma. The idea is that what we "feel" we associate with the "heart" - you know, all that "gut instinct" stuff (an image of your internal organs makes for a decidedly less compelling image though) - and what we think is represented by the "brain" - you know, all that "higher order" cognitive stuff. The sense is that these two are at odds with each other thus "we" (whatever "we" are) feel "torn". 

It is, of course, nothing like that though we do "feel" a lot of what we experience in these decision dilemmas as pangs in the heart and gut. This is stress response system related hormones charging about and kicking up a fuss here and there, however. What's really going on is a "war of the minds"; all kinds of brain regions battling for control in this "decision making" process that it's ostensibly well designed to do. Memory circuitry is of course much involved and that's very much rooted in the limbic region. Our more "passionate" selves can also more or less be found here and in the brain stem below that (it is in this area where all manner  of "brain hijacking" hormones get released and roar around, not to mention pleasure circuit neurotransmitters and so on). Way up in the brain, right behind our foreheads lies the vaunted homo sapien pre-frontal cortex, whose often hopeless task is to rein in all that merry making going on in your limbic region and brain stem (think doughnut vs diet as a simple but classic example). This is what is represented by the "brain" in the image above. 

It's vastly more involved than that, however, with dizzying numbers of neuronal networks connected by "wiring" so astronomically complex that no one could say with any certainty how the whole tangle connects or not all attempting to respond to this "make a decision" command that has come from somewhere (we'd like to think it is "us" but I'm afraid it's not).

Nobody likes to imagine all that (because so few actually can) so our endearing "heart" vs "brain" image will have to do. 

In any case, dear little moi is facing a dilemma and has to make some significant decisions. The pieces of the puzzle are complex, each seeped with enormous amount of emotion, each with great life changing effects. Add to an already complex puzzle a very interesting piece of recent news regarding "the troubles" of my own particular noggin.  


*   *   *   *   *

Regular readers may be aware that the disorder I live with is bipolar type I. I have never really completely written about all of my psychiatric history and the severe symptoms I experienced related to bipolar. I am not about to bore my dear readers and followers with that now. I must, however, touch on them briefly. 

As I have alluded to in various posts here and there, starting roughly in summer 2008 through to spring 2014 I experienced some of the most extreme mental and behavioural symptoms that might fall along the bipolar spectrum. As I hope regular readers will by now know, the vast majority of help available to me in the mental health care system and through the traditional pharmacological psychiatric treatment model not only couldn't control it, I got worse. Which is why five years ago I took up all the study that now goes into this blog; the neuroscience of human behaviour and mind phenomenon.

Through my study of everything to do with bipolar from the best sources I could find and through looking at dozens and dozens of cases and talking with or listening to dozens of people diagnosed as bipolar and carefully analyzing all of what I experienced, it was obvious that my case was at the extreme edges of an already fairly extreme mental health disorder (many people in the various fields of study and treating bipolar consider it the most difficult of all psychiatric disorders).

To think of my study of human behaviour and mind phenomenon in more detail, I wanted to look into every single symptom of the most difficult disorders which caused the most mental health and life impacts such as major depressive disorder, bipolar disorder, schizophrenia and major anxiety disorder and track down the neuroscience and neurobiology of each and every one of them, along with every possible genetic and environmental factor. If this sounds like a daunting endeavor, it is. (and to put my personal challenges into perspective, at various points over that six year span I would have met diagnostic criteria to be diagnosed with all four of those disorders). 

Not only that, I wanted to know how people could overcome all those symptoms without drugs.  

Then I set out to prove it could be done. One by one I ruthlessly tracked down each symptom and worked on it. One by one I tamed or slew them. 

Yet various things still persisted. 

One, I discovered in the early months of 2014, was mitochondrial disease. This affects the ability of every single cell in your body and brain to effectively produce energy. It was not hard to see that a great number of the common most difficult symptoms could be related to mitochondrial dysfunction. 

"Haha!", I thought, "finally I know the final piece of the puzzle. Now I've got this son of a bitch by the tail!"

So I set out to learn everything there was to know about that and deal with it as best I could.

One by one I tracked down anything and everything that could be involved in worsening mitochondrial disease and how to better manage energy. One by one of these I either dealt with myself or was graciously helped in solving all the environmental and living circumstances that could worsen it. In February 2016 it became possible for me to live in a large suite on my own that was utterly ideal for the needs of Mrs Bean and myself. 

I thought I was finally on my way and went at all my ambitions with great and joyous gusto in the first four months after moving in.  

Then came June. The all encompassing mental and physical fatigue struck again with a vengeance. It was as bad as ever. We're talking complete brain fog, catatonic states, being just able to get by in taking care of day to day physical needs. 

There was one more factor greatly lacking in my life and in early July of 2017 I made a big decision; I contacted a woman I knew was a great admirer of mine with whom I'd previously explored the possibility of being together (she had been a long time follower of Taming the Polar Bears, the Bean-mobile adventures, etc). Her feelings had not changed and so I decided to propose to her. She happily accepted. 

Oh joy! Love! Partnership! A loving, supportive partner who got everything I did with the Polar Bears and how I lived my life! 

What greater tonic could there be! 

Yet still various things persisted. And began to worsen. 

I can assure you that few people on the planet are more self-aware of and work on themselves more than I do (and have so much to work on). It was August of 2017 that I began to notice symptoms in my head that I had not noticed before. 

I am very, very careful about symptoms we observe in ourselves. I am exceedingly aware and cautious of reading too much into them and jumping to conclusions. Various observable and/or experienced symptoms can mean many things. These, however, were very unusual. I'd experienced severe headaches most of my life, mostly the usual tension ones. These headaches were very different from those. They did not match migraine symptoms. As well, there was something different about "brain fog" episodes, something I'd never noticed before; very odd sensations throughout my skull and down into my face. I had no idea what to make of them and I knew an average GP wouldn't either so I just made note of them and carried on. 

I focused on my new relationship and all the bureaucratic bother involved in getting her to Canada. 

Yet the "new" symptoms persisted. And began to worsen. 


*   *   *   *   *

It's nearly impossible to convey the love and passion and drive I had for studying neuroscience and anything and everything to do with the human brain and how that would affect behaviour. I won't recount that here but one of the areas I got greatly into (partially out of my love for neuroscience, partially out of my love for sports) was the newly emerged field of long term damage of and effects in later life of repeated concussions or head trauma early in life. This was an area where my two loves really merged and in fact it these two areas have to merge in order to even begin to understand the problem; for just about all information, data, case studies and so on are from athletes and sports, particularly high contact sports such as American football and ice hockey. I'd actually followed case studies and individual stories for at least ten years and when I got so deeply involved in neuroscience, I already had a pretty good body of understanding built up. 

What I saw from the neurological perspective and what was being found mortified me. I looked into it all very deeply among many different sources. Already having a solid grounding in so much about brain anatomy and the delicacy of the brain, I grasped it all very quickly and in depth. As much as I love both sports (football and hockey - I played both in my younger years), I could not conclude anything other than that it was very inadvisable to allow any child to play football as it's now taught in most schools and football programs across America and many in Canada. Brain damage can start very young and in every literal sense, be life altering and irreparable. 

This was all several years ago, and as I had so much other study on my plate, plus my own challenges and much else to focus on in writing for Taming the Polar Bears and managing all it was becoming, I moved on from studying concussion related neuroscience. 

In November of 2017 these new symptoms were worsening and becoming harder and harder to ignore. By chance I came across an article about concussions, post concussion syndrome and the long term effects of early life multiple concussions and head trauma. Lights of recognition lit up like a Christmas tree. It was staggering. The definitions of concussions, the symptoms experienced by many, many former and current athletes. Case studies and histories that I'd never seen in psychiatric disorders sounding like I could have been reading my own case history. 

For some days I began going back through my life from my teen years through the age of about forty-five. The first concussion came at age fifteen and was the most severe; I fell and struck my head on concrete. The last thing I remember was the sickening sound of skull meeting concrete. Then nothing. I'd been unconscious for at least an hour. Then began uncontrollable severe convulsions that lasted more than 24 hours. Back then we never knew what it was. Now I do. That was about as severe a concussion and symptoms as they get. 

There was another concussion playing hockey at around age sixteen. Again, full loss of consciousness and no memory of anything before or after (after getting up and "shaking it off", I played the rest of the game). 

Another severe concussion at age twenty in an industrial accident. Again, full loss of consciousness, convulsions and so on. I "shook it off" and went back to work the next day. 

Several more followed during my twenties. 

Another four or five came during my thirties and forties from motorcycle crashes and another industrial accident. 

The last one - in summer of 2006 - was when "everything began to change" for me and all my behavioural and personality changes along with mood and the most recent round of psychiatric disorder symptoms began (I had gone through them all before - particularly during my early to mid-thirties - but never anything like this).

All this time I've gone on the assumption that was all related to bipolar disorder and other comorbid conditions. 

But with everything I know about the brain, concussions and their damage plus the symptoms, it began to look more and more like all along I'd been dealing something much more than just bipolar. 

For some time I'd suspected that there had to be something else going on to make all my symptoms and what I experienced so much more strange and more intense than what you see in the vast majority of bipolar cases. It just didn't add up, it didn't make sense. I just could never put my finger on it. 

Now I could.

But I knew getting the kind of help I'd need would be very difficult. I knew this from my earlier study of concussions and long term effects in athletes. It's still a very new field. There's still lots of ignorance and denial, even - and perhaps especially so - in every field of practicing medicine. Very little is known about examining for it and diagnosing it. Most staff in hospitals only know about the effects of very recent concussions. The average GP is very poorly educated on it (this relates to the fact of how much all GPs get "trained" by pharmaceutical companies and reps and thus tend to ignore anything that falls outside of that narrow understanding). 

I wrestled with what to do. None of this is ever as clear cut or straight forward as you would imagine. 

Then, at the end of November, I met someone who found out about my story and wanted to makes something more with Taming the Polar Bears. He was a former businessman and web developer, he looked through my blog, found that so much of what I wrote matched his views on those who fall to the bottom of society, saw the worldwide popularity of it and wanted to partner up with me on taking it all to a new level. 

For a while this showed great promise and I poured a lot of energy into (though it the person and plans proved to not at all be viable)


Yet symptoms persisted. And worsened. And the periods of time of the worst of them lengthened. 

After one particularly unbearable 48 hour period, I went to the local ER to see what they could do. As I suspected - nothing. 

Finally I booked an appointment with my GP. This is more difficult than would appear as he is in my former town two hours away requiring a drive over the highway through hell during winter. My daughter ended up driving me (and naturally, through a raging snowstorm). 

My doctor and I have an unusually good relationship. He's young, progressive and was very empathetic to and sympathetic with all my homeless and living challenges of a few years ago. He also totally understood and respected my self directed approach to handling my bipolar disorder. Trust me, folks, a GP like this is pure gold. 

He asked what I was in to see him about and I told him what I suspected about long term concussion damage. "Well", he said, "you're a lucky man. I happen to one of the best doctors you'll meet in understanding all the latest about them". 

I'd prepared long detailed notes about my concussion history. I first described my symptoms; the unusual nature of the headaches, the other weird sensations I get in my head, the near endless throbbing pulsations, the dizzy spells, the brain fog, the periods of blurred vision. I got about a quarter of the way through describing my various concussions before he held up his hand. "That's all I need to hear", he said grimly. 

Tests need to be run to rule out a few other possibilities but he was very sure and unequivocal. 

He is almost certain we are looking at chronic trauma encephalopathy which is a fancy term for the unique type of brain degeneration that comes as a result of multiple untreated brain traumas earlier in life. Encephalopathy is a general term that means brain disease, damage, or malfunction, the specifics of which are notoriously hard to identify and apply to any one case. What is known is that the prognosis is not good. While many observable and experienced symptoms are similar, it should not be confused with Alzheimer's or Parkinson's.

So it turns out that all this time I've not only been dealing with arguably the most difficult psychiatric disorder there is and the crippling effects of mitochondrial dysfunction, but also CTE. 

Neither of these are curable. The mitochondrial disease I can sort of handle. I've gotten used to it. 

CTE is quite another matter, however. We are talking incurable and ravaging brain degeneration. It progressively gets harder and harder to deal with. The effects on the mind, behaviour, moods, cognition, memory - everything in short to do with Who We Are - is by now becoming extremely well documented (though not widely known or understood). 

Mitochondrial disease plus CTE? I dunno, folks. 

After forty years of literally scouring the face of the earth looking for love, I found the woman of my dreams. She will be here and we'll get married by this spring. 

After thirty-five years of literally scouring the face of the earth looking for a vocation that would make the best of my mind, talents and passionate interests, I find the partner of my dreams who could bring them to fruition in ways beyond my wildest dreams and would solve my chronic financial difficulties. 

Only to find out that I'm battling not one but two degenerative brain cell disorders. 

*   *   *   *   *

So, the dilemma. 

Managing the diseases, managing a wonderful new relationship and all the responsibilities of being a husband (for the first time in my life!) plus managing all the responsibilities that would come with building the non-profit organization and website of my partner's and my visions is not reasonable to expect. 

As I write this, the last four days have been particularly brutal. 

Something has to give. Life itself? Or the lives of my dreams?

At no point in my life has living ever meant just existing and drawing breath. Living to me has always meant drawing and wringing every last bit of life out of every day I've been blessed to have been given. It means wringing every bit out of every opportunity that comes my way. 

And for the first time in my rather colourful and adventurous life, that means fully enjoying and making all I can out of life with the woman of my dreams and the vocation of my dreams. 

Yet, what is going on in my brain and body cannot be ignored. 

Dilemmas, Decisions and Letting Go. 

Somewhere, some time, I have to decide what to let go. 

One of the "fun parts" of living with bipolar and, as it now turns out, the effects of CTE, is that I never wake up to the same person. Every day I have no idea "who" I'll wake up to be or "what" I'll wake up to be. This is another thing that I've had learn everything I could to get used to and "tame" over the past four and a half years. Despite all my best efforts, it's as true today as ever; I'm just better practiced at it. 

When I feel good, I'm as good as anyone. My mind can work far above average. 

Other days we're talking total shutdown and even simple conversation is challenging and draining. 

During the good stretches I feel I can handle it all - and I could - and feel I'd be a fool to turn down such an opportunity. It's more than just about me; it's about my family. It's about paying off large debts I owe them. It's about my daughter's future. It's about the future of my wife to be. It's about setting them up with financial security.

I cannot tell you how much I loved discussing with and planning the long term visions of the newly incorporated Taming the Polar Bears Foundation for that time. He did a lot of work on a new blog format and it was, for a time, incredibly exciting. 

But with that came high expectations and work and responsibility loads. When healthy it's all within my abilities, experience and confidence.

Then a bad stretch like the last four days hits. Then I'm struck with the harsh reality of what's going on in my brain. 

My mind can still get unfathomably dark. 

I redouble my efforts on all of Positive Difference Making Fundamentals. I rest for much of each day. Slowly things begin to "come back on stream". 

Then I remind myself (and/or am reminded by others):

I ain't your average bear. 

- to be continued