Wednesday, January 23, 2019

Understanding the Mind - Consciousness

Image result for consciousness

The great question of understanding consciousness became another of my favourite avenues of self directed scholarly study some years ago when I started this whole journey of research and discovery into the human brain and what drives "us". As with everything that goes into this blog, this was for two basic reasons; one was a pure joy and passion I found in studying the topic and taking part in or following discussions and sharing of information on what was happening in the world of consciousness studies and two, it became my very firm belief that a better understanding of consciousness was vital for better understanding the various mental experiences that make up any one case of a mental health disorder. We'll return to that in a moment. 

Better understanding consciousness is also the foundation for better understanding much of who "we" are; how we think, how we perceive, how we act, how we decide - or how (and why) we not do any of those. Any discussion on or understanding of the question of self-agency, AKA "free will", is not possible without a solid grasp of consciousness. The concept, study and understanding of consciousness is the very crux of what it is and means to be human. 

It is has been my driving passion for six years now to learn and understand as much as possible about the neurological basis for such things as thoughts, mental phenomenon, behaviours and even subjective reality as it will be various combinations of these "going awry" that will make up the symptoms of - and the suffering thereof - any mental health disorder (or what I am increasingly regarding as a neurological disorder). And so it has been in my pursuit of understanding consciousness and what it means to us

The study and understanding of consciousness - like all my study of the brain and human behaviour - is more than just an idle philosophical dalliance for me. Because I take all and every aspect of mental health so seriously, and because I so firmly believe that mental health disorders are so linked with our conscious experience, I take it - I think - more seriously or with greater urgency than most. For me there is very, very tangible real world "skin in the game". Endless debate and virtually empty discussion over the various competing theories that give us no kind of concrete understanding that we can apply to our lives are meaningless to me. I find, I confess, abstract philosophical discussion simply frustrating. 

As such, it has come to be my very firm position that we must let go of notions rooted long in the past, such as dualism; the pervasive and persisting belief most famously put forward by Descartes nearly 350 years ago that mind and conscious thought are somehow separate from the body and brain. An enormous amount has been learned in the fields of neuroscience and cognitive neuroscience in the past twenty to thirty years (let alone since Descartes' time!) and it this veritable wealth of new information upon which we must base our modern understanding. 

There are libraries full of literature on this topic from the world of philosophy going back 2,000+ years along with thousands of research papers from the various (and often fiercely competing) fields of neuroscience. Needless to say even the briefest of summaries of all that has been written would stretch the boundaries of what we can fit into this piece. As interesting as a lot of that may be (and it certainly is), we are going to cheerfully (I hope) skip past the great majority of past musings and draw mostly from what the most advanced brain research in history and the modern neurological approach has discovered. Even that is rather voluminous but I shall endeavor to keep it as concise as I can while leading us to the most informed and illuminated understanding we can hope for from within the limited confines of space and time (not to mention mental bandwidth) we have available to us here.

I must add, before we move into the thick of things, that while I believe there is much to learn about the evolution of our consciousness by studying animal consciousness we are only going to be looking at human consciousness in this piece.

Without further ado then, let's bravely leap in. 

What is Consciousness?

Welcome to the question that has vexed the human mind for several millennia and which led to those libraries of volumes containing our long philosophical exploration of the question along with the more recent investigation using some of the most advanced scientific research methods in our history in quest of the answer.

Which is, in a word, elusive. 

To understand a bit more about why the answer eludes us so, to consider the general nature of "consciousness" is to explore the very essence of concepts such as "thought(s)", "mind", "subjective experience", "perspective", "attention", "mental states" and perhaps even "reality" itself. All of these, you will note, have no readily apparent concrete physicality to them, they are abstract concepts (all in parentheses, by the way, because each in itself is a rather fluid term lacking consensus definitions). Though speculative claims are sometimes made, there is no one place in the brain for any of them for us to point at and say "Ah-ha! There it is!" 

This is greatly disconcerting to the scientific mind (of which our dear Descartes above was one) or any mind that tends to need hard knowable answers. The classical scientific mind is driven to reduce all problems down to knowable laws of physics, chemistry and mathematics. On the one hand this draws cries of "reductionism foul" or failing that what has led down the path to declaring some form of "dualism" (essentially that abstract aspects of the human mind or consciousness for which there is no apparent physical "spot" thus must somehow exist separate from our physical makeup).

Therefore consciousness widely being regarded - by some of the most brilliant minds we have, mind you - as the "hard problem"

The renowned British psychologist Stuart Sutherland, perhaps in a less generous mood during one of his phases (1), once wrote of consciousness in the International Dictionary of Psychology, "The term is impossible to define without a grasp of what consciousness means ... nothing worth reading has been written about it".

Nonetheless, we must remain undaunted so on we tread.

As I sometimes like to do in looking to grasp something difficult, to better understand what consciousness is let's touch a bit on what it isn't. For that it is required to understand a little about two concepts: the subconscious and what it is to be unconscious. While these terms are often used interchangeably (along with preconscious and nonconscious) for our understanding here today we need to think of them differently. 

Let's start with "unconscious". To be unconscious is to be unaware of most if not all outside stimuli (sight, sound, smells, touch) such as when we are sleeping (though this varies somewhat depending on the phase of sleep) and even inner stimuli (IE: thoughts, feelings, imagination, etc). This can also be as a result of fainting or a concussion during which a person will be "blacked out" and unresponsive to any stimuli nor have any memory of the time while unconscious or it can be while we are under general anesthetic for surgery or, most seriously, in a coma. 

To not be in any of those states then is to be conscious, which is to be experiencing varying levels of awareness of what all five of our senses plus that increasingly well known "second brain" in the gut are bringing in along with the "stuff of mind"; thoughts (much of which is random), imagination, reasoning, mental tasks such as mathematics, composing and writing, specific directed thoughts on myriad aspects of our lives, the world, problems, purposeful interactions with others and so on.

What we generally refer to as the "subconscious" is rather a different matter.

It is impossible to overstate just how much of what's going on in our brains that drives our behaviours, decisions, thoughts and so on lies "beneath the surface" (hence "sub") of our conscious awareness and control. This is just in the brain itself, never mind how much goes on between the brain and body and even the brain and its environment at any given point. The ratio of subconscious goings on to what we are consciously aware of and/or working on at any one time is staggeringly high. Whatever consciousness is, however we define it or whatever we do with it or how we experience it at any one time, it is a very thin veneer on top of an enormously complex and deep amount of subconscious brain activity. 

To even tap slightly beneath the surface of that veneer would really overtax our time and space here so for the time being we're just going to take at face value what virtually all of neuroscience and cognitive psychology study has revealed in enormous amounts of research and experiments in the last several decades - all that is "you" and whatever you experience is made up by and controlled by the astronomically tangled and complex anatomy and biology that is our brain activity along with nearly unfathomably intricate and ever ongoing interplay between our DNA and environment (Eagleman, Dahaene, Sapolsky, and countless others). 

Somehow what we experience as consciousness both "emerges" from all that brain activity yet paradoxically seems not quite part of it either. You should now be starting to appreciate more why it's the "hard problem". 

I think then that it may be more useful for us to not think of what it "is" but more what it "seems to be". 

Let's begin then with some (very) brief summaries of how some of the current great minds in neuroscience approach this wacky elusive brain and mental phenomenon we call "consciousness". 

The popular neuroscientist David Eagleman in his book Incognito took what I think is one of the more practical and straight forward approaches to explaining consciousness so we're going to start there and build on that. To repeat (and perhaps rephrase somewhat) what I wrote in a previous piece regarding consciousness, Eagleman simplifies the essential purpose of the brain by stating that "the brain is in the business of gathering information and steering behaviour appropriately" and, to that end, that "consciousness developed because it was advantageous (in the classic evolutionary success sense), but advantageous only in limited amounts".

We shall revisit that a little later but to flesh out better what it is about consciousness that makes it "advantageous" let's dig a bit deeper.

Some years ago the neuroscientists Francis Crick (he of the double helix structure of DNA fame) and Christof Koch wondered why, if our brains are just a bunch of specialized autonomous "programs" burned into our neuronal circuitry, are we aware of anything at all. Their answer, and Eagleman would build on this, was that consciousness existed as a means to "control" or "distribute control" over all the various "programs" our brains could run at any one time in response to any given situation as opposed to countless other species whose brains' circuitry and "programs" work remarkably similar fashion to ours. 

[Beware the use of the word "control" here, however; neither Crick and Koch nor Eagleman mean that word in the sense that is used regarding "free will" control.]

They, and others, see consciousness as a sort of "CEO" of the "large corporation" that is our brain (many different departments, levels and machinations, etc), or we might think of it as the "conductor" of the "orchestra" of our brain activities. Note that both a corporation or an orchestra can operate on their own but a CEO or conductor are necessary to exert "executive control" to give all the parts a concerted direction, coordination and smooth operation. We'll come back to this notion of "executive control" a little later in the more cognitive neuroscience sense of the term. 

Let's now consider some of the more highly regarded theories of consciousness which explore its role a little deeper.

First put forward in 1999, we have Antonio Damasio's three layered model of consciousness which works on a hierarchy from most basic to a highest level that I feel ties in well with our evolutionary development. We start with what he terms the "protoself" in which the brain seeks the basic elements required for survival and homeostatis on a moment by moment basis, something shared by most species. At a higher order, we have what he calls "core consciousness" where there is an awareness of feelings associated with changes in body state (or homeostatis). At this level the organism is capable of a greater sense of "self" (this is where we begin the argument for animal consciousness) as it responds to internal and external stimuli and feelings and moves from largely unconscious states and reactions to experiencing patterns of images that "float into the organism's awareness". From this the organism's mind is able to create and respond to a greater sense of relation to its self and objects around it albeit limited to the here and now present. This level is shared by many species and does not require language nor does it involve long term memory or a sense of past or future (personal note, I think there's something from the studies of animal consciousness and cognition to add here). 

Atop of protoself and core consciousness we have "extended consciousness" which requires vastly different memory capacity and function, a full sense of past, present and future, along with much higher order cognition. It would appear that we homo sapiens stand alone with this level (though we are capable of operating at all three levels). 

While Damasio's model is useful for understanding how our present level of human consciousness got to where it is (and if you dig deeper into this hierarchy, you'll see the three levels match up to the three levels of the Triune Brain), it still doesn't adequately sate our hunger for a deeper understanding of what it is that we experience as consciousness. 

To look a little more into that we will now consider one of the most enduring and widely cited theories of consciousness, that of Bernard Baars's Global Workspace. (2) In this model consciousness is a form of brain-wide "information sharing" brought together in a "workspace" where it is attended to (in ways we'll look at a little more below). This model fits in well with the aforementioned concepts of "top down CEO control" put forward by Eagleman, Crick and Koch and others. 

While intimately related, Baars also carefully distinguishes attention from consciousness; the former being more of a "bottom up" process for sifting through the tremendous amount of "data" brought to our brains via our sensory equipment and prioritizing what needs to be attended to whereas the latter is the higher order "top down" executive functions of how to attend to a prioritized matter of attention - plan, decide between options and so on - and to set other areas of the brain into action. For the former think mostly the limbic region, for the latter we're talking mostly prefrontal cortex. Or using Damasio's model, awareness is more at the "core consciousness" level, the conscious processing Baars proposes being "extended consciousness". 

Though not to be confused with Baars' theory, similarly titled and similar in concept, is Stanislas Dehaene's Global Neuronal Workspace model of consciousness. His work very much pays homage to and builds on Baars' ideas of global information access and broadcasting.

He brings some clarity to the aforementioned "confused state of affairs" by asserting that contemporary science distinguishes a minimum of three concepts: "vigilance" - the state of wakefulness which varies when we fall asleep or wake up; "attention" - the focusing of our mental resources onto a specific piece of internal or environmental information; and "conscious access" - the fact that some of the attended information rises from the unknown subliminal processing entering our awareness to become "reportable". He firmly argues that it is this "conscious access" where the rubber meets the road in defining the human experience of consciousness, furthermore that it can easily be studied in the laboratory. He along with his research partners have for more than two decades put enormous amounts of highly sophisticated lab work into demonstrating just that - how subconscious brain wide neuronal "information sharing and processing" moves from the subliminal to the conscious "workspace" of our minds. His work is very impressive and very compelling. We'll touch on a bit of that below. 

In his view it is this basic element of "conscious access" that is the gateway to the more complex forms of conscious experience many of us think of and which have inspired so much philosophical navel gazing (our sense of self, this "I" that can look down on itself, comment on itself and so on, knows what it knows and doesn't know). He happily reports that even these higher order meanings are no longer inaccessible to the lab. 
In each of these models for human consciousness we too see suggested an element of "control" and organization and direction over our cognitive and emotional capacities along with plans, actions and so on based on those. 

Now, if that all seems like it's making sense and you're breathing a sigh of relief thinking "phew, I am a conscious being after all", we must consider this; there are those from the arenas of philosophy who argue - quite compellingly - that consciousness may well be an illusion (for many similar reasons as to why "free will" is an illusion). These include philosophers such as Daniel Dennet and Thomas Nagel. Given how much of what we individually perceive as "reality" is an illusion and how difficult this whole business is of pinning down any physical basis for consciousness and how much our conscious experience is related to our sense of reality, it would appear to be pretty hard to argue against this. 

Yet, as even the consciousness as an illusion proponents will say, it's a necessary illusion (at least for we homo sapiens) and our individual subjective realism is real enough to us. As is the reality that goes on all around us as we try to navigate through our life spans on earth.

Those who question the very existence of consciousness notwithstanding, it seems to be this odd metacognition sense of "self" that we have (hence subconscious pioneer Sigmund Freud's concept of "ego") and self-awareness ("I think therefore I am"), a more highly aware "arena" in which we "think or plan things through" (theories by Baars and Dehaenes cited above), a higher sense of our feelings and thoughts and experiences and what those mean to not only ourselves but those around us, a vastly more sophisticated view of our surroundings and environments in comparison to other creatures' conscious abilities (or lack thereof), a vastly more complex sense of time past, present and future and abilities to plan actions based on those, higher cognitive abilities, greatly more sophisticated means of communication, to imagine - and then create - things that do not or did not exist and so on. 

So whether or not consciousness is "a thing" (physically identifiable and thus not an illusion), it is, to come back to Eagleman's pragmatic understanding, "advantageous" to our day to day actions and survival and it does (or can) help in how our brains "gather information and steer behaviour appropriately" as we move from cradle to grave. I think too that by now you may be sensing a growing appreciation for the kinds of all out "turf wars" there are in the fields of consciousness studies.

That said, speaking of identifying consciousness physically, 

Where does consciousness come from?

Haha! This makes the problem of defining consciousness look like child's play. Searching for the physical properties in the brain (and body) of consciousness has created - quite literally - a multi-billion dollar industry (there's gold in them thar hills!). 

Nonetheless, in a process that mirrors evolutionary progress itself, "successes" do emerge from the chaos and failures. 

As I've stated from the beginning, whatever we are, whoever we are, or who we imagine we are, or how we think, act, emote, bond, etcetera or not do any of those things will all be "created" by that 3.1 blob of tofu like substance between our ears which is (and I don't doubt there are those that are tiring of me saying this) the most complex organism in the four billion year history of life on earth and in the known (emphasis on known) universe. 

There simply exists no credible evidence to indicate anything else. 

Now, as we look at the neurological factors that are possibly involved in "giving rise to consciousness" and/or "conscious experience" I'd ask you to bear in mind that those are two related but distinctly different concepts we're talking about. Recall that to "be conscious" is the opposite of being in a state of unconscious, IE: in deep sleep, blacked out from a fainting spell or blow to the head, under an anesthetic or possibly in a coma. "Conscious experience" is that "moving picture show" and ongoing dialog in your head that comes "to life" when you are conscious. 

To be conscious is at least somewhat straightforward. 

For these types of "seats" and "switches" for consciousness we must journey deep down into the lower limbic region and brain stem to look at two such possibilities (among others). It is here where we'll find the thalamus which a great deal of research has closely implicated as being key to "switching off" consciousness (such as when anesthetized).

Deeper yet we will find a very small nodule with a rather cumbersome name, the rostral dorsolateral pontine tegmentumResearch on brain lesions in this area revealed that damage here resulted in coma or lack of consciousness. No consciousness, obviously no conscious experience. Hurrah, we have our "seat of consciousness" (or seats if we also include the thalamus). 

Not so fast. We share these two nodules with all mammals so while these may well be the "seats" of consciousness in the sense of being fully awake, aware and functioning, this is not precisely the sense of consciousness that gives rise to "I think therefore I am" that has vexed us so. 

For that sense of consciousness, it is, as we'll see and as I say about many mental functions, "everywhere and nowhere". 

As I originally conceived this piece and how to demonstrate that, I thought we'd look at a number of neuroanatomical and neurobiological features and functions of the brain and imagine what would happen if we "subtracted" those or made them disappear from our brains. 

Forgive me in advance if this seems to mirror much of what we saw in Neuroanatomy 101

The best known feature of the brain is neurons. It'd be a bit silly to imagine subtracting all neurons from the brain because there simply wouldn't be a brain at all (let alone a conscious one). There are many types of neurons, however, some more critical to the higher sense of consciousness we're examining than others. For brevity's sake we'll focus today on the pyramidal neurons. These are among the largest neurons in the brain and have unique and often very far reaching axon and dendrite extensions as well as being some of the most widely connected neurons. Research both old and new demonstrates that they are critical for higher cognitive processing. As they are the most populous of the excititory class of neurons (as opposed to inhibitory neurons), they have been demonstrated to be key to something known as "global ignition" - a mass of brain cells reaching action potential in large coordinated ways leading to - tada - us consciously experiencing a piece of heretofore subliminal brain activity (Dehaenes). 

Damage to these neurons is highly implicated in several neurological diseases and cognitive decline or impairment. 

Next in the very basics of neuroanatomy is the "wiring" and "connections": axons, dendrites and synapses. You could have a brain with all 86-odd billion neurons in brilliant good functioning health but if they aren't connected to one another, needless to say not a lot is going to happen; including, obviously, consciousness (of any kind). Thus if we see synaptic connections disappear, we'll see memory loss, cognitive decline, along with many of the other mental phenomenon we associate with conscious experience. No need to point out that the myriad of neurobiology involved in making synaptic connections "work" each and all play critical roles without which, again, we have no consciousness at all, never mind the experience of such. 

At a larger "wiring" scale, we have the brain's white matter or "connectome". This "wiring harness" of long axons carries or directs signalling between all brain regions (which are neuronal groups and nodules large and small). Connectome expert the neuroscientist Sebastian Seung argues quite passionately (naturally, it being his specialty) that while many brain areas are important for consciousness the connectome is the "stream bed" of consciousness. That's pretty hard to argue against given that without lightening fast brain wide communication through hundreds of channels between hundreds of brain regions you wouldn't experience much of anything and certainly nothing resembling normal consciousness. 

Yes, I know, these elementary basics may all seems tediously obvious but it is just to drive home the point that there is no one "seat" of consciousness. 

One more elementary brain area and function then we'll get onto some "sexier" brain stuff involved in consciousness. 

That would be everything to do with the stress response system. 


Let's say you're driving along in your car on an average day. As your stream of conscious experience tends to all kinds of trivial matters, your subconscious "zombie programs" are busily taking care of almost everything to do with navigating your car through traffic. So, you're humming away to that tune on the radio, with thoughts of work on your mind, an earlier argument with your partner, the previous night's baseball scores and on and on. 

Suddenly, ahead of you, a large semi trailer unit has lurched sideways and a 300 pound truck tire is rolling and bouncing straight for your car. Before you consciously perceive this, your stress response system has already "taken the wheel" - literally and figuratively - and several hundred thousands of a second before the danger has penetrated your conscious access your feet and hands have already begun to respond. From there "you" are not in control (as much as it may "feel" like you are) but all kinds of deep burned in brain circuitry, now fully guided by the stress response system, in reflex action is doing everything possible to avoid that truck tire. 

Your car brakes and veers, the tire and other traffic is miraculously avoided and "you" find yourself safely pulled to the side of the road breathing very heavily and perhaps wondering what the hell just happened. 

It is here where we see what Eagleman meant by consciousness being "advantageous only in limited amounts". It is these kinds of situations where conscious focus elsewhere gives you a good chance of getting killed and thus not very advantageous in the evolutionary sense. 

So if part of consciousness means what our brains put on our "conscious awareness plate", millions of years of evolutionary forces have shaped our stress response system to "take the wheel" of conscious control in times of danger. 

If we are in the camp that human consciousness is different or more evolved than animal consciousness, it then behooves us to look at and consider some anatomical features that set the human brain apart from all others. 

If we were to compare the cerebral cortex of several higher order mammal species and that of homo sapiens, we would see in the latter very pronounced bumps and fissures known as sulci and gyri respectively that are not seen in the former. These are the result of the unique way that the outer cortex of the human brain develops and is "folded" into the skull. What this means is that a far greater volume of the higher functioning cerebral cortex fits into the smaller space of the human skull. It is also believed that these folds allow different lobes to "communicate" or coordinate with each other more efficiently and quickly through brain waves. 

Following that it is quite possible that this feature of the human brain helps give rise to human conscious functioning.

Also unique from our evolutionary forebears is the most advanced bit of "brain ware" in existence - the vaunted prefrontal cortex of we homo sapiens. It is here that we find what cognitive neuroscientists refer to as "executive function"; the abilities to differentiate among conflicting thoughts, determine comparatives (good and bad, better and best for example), future consequences of present activities and higher predictive abilities, goal directed actions and expectations based thereon, and social control (the ability to suppress urges that could lead to socially unacceptable outcomes). It is here that "willpower" is exercised or not and, quite interestingly, the "will to live".

So, if we return to where we started with the theories of consciousness that suggest "control" or "planning" and cognitive processes that we see in Global Workspace theory and similar theories, is the prefrontal cortex the "seat of consciousness"? Some in the fields of conscious study say so. But proper PFC functioning depends on healthy neurons and synaptic connections, strong connectivity through the connectome and ... well, every other detail we've touched on (not to mention oceans of finer detailed neuro-activity). Indeed, when we see neurodegeneration in these areas, we see marked decline in conscious processing and even experience.  

Theories on the purpose of and function of consciousness in the human brain often refer to learning processes or conscious effort in problem solving (and planning, etc) or various types of deliberation involved in decisions . Learning might be a new skill or routine; driving a car or a different commuting route to a new job, for example. At work or at home we may have to find solutions to problems or issues, take part in short and long term planning and make minor and major decisions. In each many aspects may have to be weighed all of which requires much conscious deliberation. Learning something new (in)famously can take much conscious effort before the skills and new information is "burned into" our neuronal circuitry where it begins to come more "naturally" without so much conscious effort.  

If we apply Baars' Global Workspace theory, these processes will heavily involve working memory, not to mention other executive function "cognitive tools" we saw above in the PFC. Working memory, sometimes referred to as short term memory, itself has a neuronal basis and areas in the brain and both "recalls" and "stores" information related to the task. As such there will be great interplay between it and long term memory for which we must return to the limbic region and the hippocampus from and through which all manner of information is "stored and recalled" throughout the brain. Higher cognitive tasks such as we see in GWT seldom work in an emotional vacuum, therefor many brain regions to do with emotions will also be activated in these conscious processes. Motivation and possible reward will also play roles as we soldier through higher conscious processes and that brings into play dopamine related pathways that stretch from the brain stem right up the frontal lobes (and many "stops" in between). Imagination is often greatly applied to conscious processes as we visualize this solution or that plan and so on. This too draws on brain wide neuronal networks. 

So even in a relatively precise model of consciousness like Baars' (and/or related or similar models) we can see it would appear to be rather a hopeless task to pin down any "seat" or "center" of consciousness as so much coordinated neuronal activity between far flung brain regions is involved, hence the "global" aspect of the theory.  

Aaahh, but let's look a little deeper at this idea of "coordinated neuronal activity". We can only touch on a few examples here. 

Located in the general area of the insula (roughly in front of the tops of your ears) is an enigmatic and seemingly nondescript sheet like neuronal structure called the claustrum. (For some of the best research work on the claustrum and consciousness we must return to our dynamic duo of Crick & Koch). Unimposing in structure, it occupies a mere one quarter of one percent of our cerebral cortex. Yet - yet! - remarkably, it turns out it's "very well connected" as it receives input from almost all areas of the cortex and projects back to almost all areas of the cortex. 

Again, if are looking at globally coordinated brain activity as being critical to the human experience of consciousness and consciously directed effort, this inconspicuous sheet of "brain ware" appears to be a significant "orchestrater".

To depart from strict neuronal basis of consciousness and/or conscious experience or activity, a very interesting approach to explaining consciousness "came across my desk" a few weeks ago based on energy. While the model of that theory may seem a bit "out there" I can imagine little argument against the fact of how energy dependent the brain is. Individual neurons don't "fire" without energy, let alone any task specific group of neurons or coordinated activity between them nor can axons do their thing without enormous amounts of energy. Very very elementary, dear Watson. From there then we must include everything in our body that brings energy to the brain - nutrients and oxygen to name two elementary basics - and most importantly those little "energy engines" of all cells and most critically, brain cells - mitochondria (a personal favourite of mine). I hardly need to point out then that any kind of brain function, let alone consciousness, will grind to a darkened halt without energy. 

Related to energy, we cannot ignore the role(s) of brain waves in conscious processes and experiences. While not without controversy (granted, nothing about any kind of brain function is without controversy, if not outright academic wars), growing bodies of research - such as those cited and summarized here - indicated that beta and gamma wave activity are strongly associated with - tada - the kind of brain wide coordination of neuronal activity that gives rise conscious perception of previously subliminal brain activity as well as selection and flow of neuronal based information. Research from MIT has found evidence that low frequency beta waves help control "what we think" and working memory which leads back to the theories of consciousness from Baars and Lehaene we briefly looked at. 

Electrical activity in the brain takes us into the arena of physics which is a whole other ball of wax that is quite beyond our space here today.

There are of course dozens of other theories and approaches for understanding consciousness from those involving quantum mechanics to panpsychism to collective consciousness that while worth looking at, we just can't get to today. 

I think, however, that one may now get the idea that consciousness and conscious experience are "everywhere and nowhere" in the brain; it's all global brain activity involving virtually all aspects of brain matter and function (everywhere) with no one "seat" or "center" responsible for all of what it is (nowhere). 

For the record, I am of the belief that as intractable a problem understanding human consciousness is it is solvable. Researchers from (again) Crick & Koch to Dehaene and many others are of this mind as well.

Also for the record, I am exceedingly (and painfully) aware - or conscious of, if you will - that I could only touch on some major theories in the briefest manner possible and as such could not do them the justice they deserve. With that in mind, I can only hope the piece was thought provoking and inspires further reading into those mentioned here. There are also vast amounts of fascinating and highly relevant neuroanatomical and neurobiological detail that I had to leave out as well. Perhaps another time soon.


If you made it this far, I applaud you yet you're probably wondering why the hell you should care about all this philosophical and neuroscientific obsession with something nobody can "see" or come to any consensus understanding. To try answer that I am going to reiterate what the position of this blog has been since the outset. 

One, we do not create our conscious experiences and behaviours. All the evidence - and I do mean all - points to those being created in a vastly complex relationship between brain activity, on going genetic activity and environmental conditions and circumstances (to put it as concisely as possible). The less we understand this, the more we deny this (as individuals, as a society, as a species) the more we will fruitlessly blame ourselves and others for thoughts, actions, reactions, behaviours, inabilities and so on that are very difficult to control, the less chance we have of leading people - and you - out of the woods of everything from mental health disorders to all kinds to addictions to a great deal of what is considered "criminal" behaviour. 

Two, it has been a long percolating theory of mine that most if not all "mental illnesses" are in fact "disordered conscious experiences"; a fully healthy functioning brain gives rise to healthy conscious experience and the ability to properly regulate unhealthy mental states, thoughts and behaviours, a brain that is somehow not functioning at optimal levels gives rise to an unhealthy or disordered conscious experience and increasing difficulties to properly regulate unhealthy mental states, thoughts and behaviours, or in other words everything that makes up the symptoms of a given psychiatric disorder or might be involved in other behaviours that run against the grain of modern society. 

Three, I strongly suggest that learning to better understand consciousness and your subjective (or individual) conscious experience is to better understand all the shifting mental states, reactions and behaviours and their power over "you" that make up whatever psychiatric or mood disorder you may be dealing with and more importantly how you can gain more "top down executive control" over them. 

It is at this intersection of subconscious brain activity and consciousness experience and conscious "executive control" where we learn what we can control and what we have difficulty controlling. It is at the intersection of the almost infinitely varied human brain and subjective conscious experience that we must learn to truly understand individual differences. Everything I have done to improve my own mental states, thoughts and behaviours - and life - have been based on exactly this.

Thank you as always for reading. 

1 - As great as he was in the emerging field of cognitive psychology, Stuart Sutherland also lived with manic depressive disorder (today known as bipolar disorder) and like many of us, suffered from - and the resultant reputation brought on by - fearsome swings of mental states. Which makes him rather a kindred spirit. 

2 - On a personal note regarding Bernard Baars; for a magical time in early to mid 2016 I had the great fortune and honour of not only "meeting" him via online means (his personal assistant was a long good online friend of mine) but developing a collaborative relationship (for a project that unfortunately did not come to fruition) in which he also tutored me on the meaning and exploration of consciousness. However, this relationship had nothing to do with the inclusion of his theory here; it simply remains one of the most widely cited and influential theories of consciousness. 

Thursday, October 25, 2018

Goodbye From Taming the Polar Bears

I am wrapping up Taming the Polar Bears. 

This week the blog passed 175,000 page views. It has gained a certain amount of respect by readers of all kinds from regular folks to professional organizations, health care professionals, academics and so on. 

I would like to say I'm proud of this but I'm not. 

I did not set out on this journey of what would become this blog at the dawn of 2013 to be "popular". I set out to really change lives, to work with people to change their lives. I set out to create something that took a compassionate and compassionately scientific view of human behaviours of all kinds and how people's lives can end up in debilitating mental health disorders, addiction of all kinds or even criminal behaviour. 

But after five years, one gets tired of pushing boulders uphill. 

I wanted to create a model of hope based on the very best science I could find and write about it in ways that could relate and be understood by almost anyone. 

I wanted to create a model of self recovery that did not rely on substances of any kind. 

I wanted to prove it could be done. 

But what close to five years of pushing what I felt was the best objective science for understanding human behaviour and mental health disorders in a compassionate way has taught me is that very few people are actually interested in science and facts. 

Even fewer people are interested in taking ownership for themselves and following a long term plan for better mental health and living. 

Beliefs will trump science and facts every time. People prefer unfounded speculation to truth. 

Magic short term quick fixes will trump the longer harder road every time. 

Page views, readers*, kind comments and the like are nice but that's not what I set out to do. 

Five+ years of trying to be an advocate for understanding human struggle compassionately and through the best scientific lens I could manage takes its toll. 

I may write more on this in the coming days but as of now I will not be writing or publishing anymore material. 

There are too many people to thank who helped contribute to this blog over the nearly six years since I first conceived of all the basic framework but please know and accept how deeply grateful I am to each and every one of you. 

- BGE, October 26, 2018

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. 

Another mind/body phenomenon we can also consider to better understand the nocebo effect is psychosomatic disorders or psychosomatic pain. This has also been long observed which has led to a great body of literature as well. An examination of the evidence and literature here will also reveal very strong suggestions of mind influencing the body. 

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 and so on makes a difference to our mental health and well being 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.

Nor am I suggesting that mind influenced physical symptoms are "just your imagination" and not to be taken seriously or that the experience of possible nocebo or psychosomatic pain is not real.

What it does mean is that in learning to understand our symptoms and working to alleviate if not eliminate them, the mind/body phenomenon we briefly looked at here today is vital to accept as something significant to consider as part of the overall picture of your particular case or that of a loved one.   

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