Friday, July 5, 2013

Blue Footed Boobies, Guano Rings, the S word and Isolation and Loneliness

According to the late evolutionary biologist Stephen Jay Gould, the blue footed booby of the Galapagos Islands does not build a nest in any sense of the word as we normally think of one. Instead, it merely stakes out a piece of ground then squirts guano (bird shit) in a circle and this defines the “nest” (as is so well illustrated above). Blue footed boobies lay one to three eggs depending on the abundance of food supplies in any given year or if food abundance is not apparent, two or three eggs may be laid and the siblings will sort out which gets fed the most if food gets scarce. If food is abundant, all will be well inside the guano ring. According to Gould, if food gets scarce, feedings more infrequent and portions smaller, the older (and larger) sibling will merely push the younger and smaller one(s) out of the nest so as to get more of the pie so to speak. Given that the nest is on the ground and the exiled younger sibling can merely have its parents push it back inside the nest this would not seem to be a problem. But a funny thing happens to the hapless younger booby chick once it's outside the guano ring; its parents will ignore it no matter how much it squawks and struggles. It seems the booby parents have a simple rule; if it's inside the ring, care for it, if it's outside the ring, don't care for it. Though it's only inches away from care, the exiled younger booby will die and none of its erstwhile nest mates will give it any mind whatsoever.

If this sounds cruel, this is merely the way nature works. There are no food stamps in the boobies' world nor any kind of government assistance to pick up the slack when times get tough. Nature then has evolved different ways to make sure the strong survive and the weak get culled out in times of difficulties and it is this deep instinctive process that takes place in the Blue Footed Booby's guano nest. One would like to think that humans have risen above this with our superior frontal cortex equipment and better developed emotional centers but I wouldn't be so sure. Yes, we've created social safety nets and other signs of progressive societal advancement but at our more primitive inner brain centers where most of the deeper evolutionary stuff resides I suspect we're not all that different from our distant Galapagos Island cousins. The way to test this is not by what people proclaim they believe in but in how they act when times are tough. Or when you are mentally ill.

One finds out a lot about human nature when you live with what I euphemistically term “brain wobbles” and “will to live issues”. Brain wobbles are mental health problems (the serious ones, not the many phony ones the APA cooks up for their bible of doom, the DSM) and will to live issues are the “S” word. We can't mention what the “S” word is because no one wants to know anything about it but for those who don't know, it's the act of voluntarily and prematurely removing oneself from the gene pool. People generally frown upon this act. Well, that's a bit of an understatement, isn't it? 

As I started to establish with the post The Psychology of Bipolar - Isolation and Loneliness, feelings of rejection can greatly increase one's anxiety and this anxiety can be so acute that it can trigger further - and perhaps the greatest - brain damage that comes with mental health disorders. I'll need another dedicated post - and help from my neuroscientist buddy Mani Saint Victor - to get into the details of this process. I can tell you, however, that not only is it well understood that stress hormones cause much of the break down of the brain, but that it is feelings of isolation, loneliness, rejection and ostracizing from society that are the source of the process and can greatly exacerbate it. What I want to talk about more today is how people with mental health issues and feelings of suicide will find themselves, like the rejected Blue Footed Booby chicks, outside the "guano ring" of society and that this will greatly contribute to both the course and outcome of their illness and the increased likelihood of carrying out plans or impulses of suicide. 

This trend [of sharply rising suicide rates] is striking without necessarily being surprising. As the University of Virginia sociologist Brad Wilcox pointed out recently, there’s a strong link between suicide and weakened social ties: people — and especially men — become more likely to kill themselves “when they get disconnected from society’s core institutions (e.g., marriage, religion) or when their economic prospects take a dive (e.g., unemployment).” That’s exactly what we’ve seen happen lately among the middle-aged male population, whose suicide rates have climbed the fastest: a retreat from family obligations, from civic and religious participation, and from full time paying work.

 What the Times piece doesn't delve into enough is why this isolation and disconnect is happening. I'd argue, perhaps in more detail another time, that loneliness itself starts to become a mental illness. Once the despair, and likely depression, from long term unemployment begin to set in one begins to withdraw from society. Both the depression, or lowered mood, cause this plus the shame of being unemployed. And of course being separated from employment removes what is most people's greatest source of social life - their work. This starts a long downward cycle of isolation and loneliness for once the person is unemployed and down about it, how society views them begins to change. Society will hold that person in less esteem and it's this loss of societal esteem that will cause the person to withdraw even further. In other words, the person begins to experience the "outside the guano ring" effect, an active rejection by society. 

Society, I can tell you from personal experience, has very little use for the mentally ill. Even a case of depression will get you kicked "outside the guano ring". Take this example from a piece by actress Glenn Close and Queen's University professor  Heather Stuart, overcoming mental illness means overcoming stigma,

When a colleague underwent cancer surgery, she received unprecedented support from her family and friends, complete with flowers, cards and visitors. When she was subsequently treated for depression, everything went coldly silent – not a card, not a flower, not a visitor. When she returned to work, her workmates made it so difficult for her that she eventually quit.
I can't even begin to express how unbelievably fucking typical this is. When you have a "legitimate" disease like cancer, everyone is on board with you. Display a little brain loopiness however, and you'll be avoided like the plague. Or kicked out of the guano nest. And worse, it is this isolation that worsens the condition. There is absolutely no doubt that the warmth of family and friends' support can greatly assist one in overcoming any major illness yet it is this support that is withdrawn from those suffering depression, schizophrenia or bipolar. 

But why is this?

To start, look at how people are taught to view anything negative. There are countless websites that counsel people to kick negative people out of their lives. And it's hard to argue against the reasons for doing this; being around negative people sucks for sure. But the shitty thing for those with mental health issues is that it's really fucking hard to be upbeat and shiny-happy people all the time or, for many, even any of the time. And most people don't need to be taught to reject negative people, they'll do it subconsciously as well. So people with mental health issues are hooped. Just when they need empathy and companionship the most is when they're most likely to lose that and get kicked out of the proverbial societal guano ring. 

The stigma against those with mental illness is strong. It is still viewed by most as a weakness which is not entirely untrue of course. When one is not mentally fit they certainly aren't strong. But it's the belief, the myth, that mental illness is a result of weakness that is widespread. When I was first hospitalized I was told to my face, and with a tone of disdain with the plain implication that I was being a wimp, that I "have to be strong". 

Evolution has an explanation for everything and I believe that people who avoid or reject those with mental health issues are succumbing to the evolutionary forces that exist deep in the brain's limbic system which, to come back to our blue footed boobies, is the same basic system in all animals and all animals have instincts to cull out the weak. We may have evolved systems for better taking care of the less well off of society but people's baser inner instincts will still govern much of their behaviour and that behaviour is to reject and avoid the weak. 

I think it could be argued that people avoid those with mental illnesses like the plague because they think we are like the plague, that mental illness is somehow contagious. Again, this is a deeper evolutionary force that tells us to avoid those who are sick in order to stay healthier ourselves.

Regardless of how or why it happens, societal and family rejection of those of us suffering from mental health issues will exacerbate the issues and this is especially true of those with suicidal tendencies. Between being rejected because of perceptions of being negative and being avoided because they're going through mental health issues this will start a downward and re-enforcing cycle. The more you're misunderstood, the more you'll be rejected, the more you're rejected the more you'll withdraw and the more you withdraw and are rejected the more isolated you'll feel. And this isolation will, as research will show, greatly increase the person's anxiety which will further disrupt brain function which will further grease the skids for the person's downhill slide into suicide.

Update, June 28th, 2014:

I attended a webinar on bipolar on bipolar, suicide and stigmatization. It was put on by CREST.BD, a somewhat interesting department at UBC which studies, according to their website, "psychosocial issues with bipolar disorder". The guest speaker was a Dr Stephen Hinshaw, a world wide recognized and leading authority on stigma and mental illness.

The following is a very brief summary of what I learned regarding the topic of the above blog post - stigmatization against those with a mental illness designation or who are suffering through a period of mental health disorders.

Stigmatization is common throughout the world. It basically wears the same clothes as racism and prejudice (towards minority groups). Much progress has been made over the past five decades or so in reducing these (which is not to say that backsliding is not taking place and that there are not great strides yet to be made. Hinshaw went into some interesting detail on this). However, and this was the main focus of the talk, there are three areas where virtually no progress has been made - no, wait, that's not true, he demonstrated that it's gotten quite a bit worse since the 50's. These three areas are: mental illness, homelessness and drug abuse. These are the three most stigmatized groups on the planet. (and if you allow that to sink in for a bit, you'll begin to fully comprehend the enormous difficulties that face the human souls that are the mentally ill Downtown East Side homeless drug addicts)

This came as no surprise to me as I'm already extremely well read on this topic, not to mention experienced (in the former, not the latter two though it is a very small leap for me to imagine what that's like. I have had a chance to meet many of these people throughout the system and get to know them quite well. Trust me, it fucking sucks. And this is the thing - they are people. People with hopes and dreams and desires just like any of us. But anyway).

But two things that did surprise me was a) the definition of stigma and b) the effects of education on stigma. I knew, of course, about the overt prejudices widely exhibited towards these groups (and Hinshaw's books get into fascinating detail about the history of this).

I had assumed that stigma was just this overt rejection by society. But when I typed in a question that asked for further clarification (which turned out to be the first question addressed in the Q&A following the talk), I was stunned by the response - it turns out that denial is not only a form of stigmatization, but it's the worst and most insidious form of stigmatization. Actually, the answer confirmed a lot of things I already knew, it's just that I didn't quite think of them under the term of stigmatization. This is known as covert stigmatization - and it's worse because people are not even aware that they are stigmatizing against, and thus worsening the condition of, the person with a mental illness designation. 

But 'b' was even more surprising and stunning to me. For eighteen months I've firmly believed - and assiduously worked towards - the idea and premise that if I could just educate people enough about mental illness, they'd be more understanding and stigmatization reduced. This is a massive premise on which my book is based. After all, education and knowledge has been proven over and over and over to reduce prejudice and stigmatization the world over. But it turns out that with mental illness, the more people are educated, the more their levels of stigmatizing behaviour will increase. Study after study after study has been done going back decades (and this is what Hinshaw documents in his books and own academic papers) that people's negative attitudes and behaviours of avoidance increase AFTER they've been better educated about the science of mental illness. 

That's right, the more we try to educate friends, family and society about the world of mental illness and what it's like for us to live in this world, the more stigma, isolation and shame we're likely to bring on ourselves (though of course there are exceptions). 

Pretty much puts us between a rock and a hard place, doesn't it? 

And if you happen not to have a mental illness designation, are YOU guilty of stigmatizing? I think that if you examined your attitudes and thoughts honestly, you'd be surprised to find out "yes". 

1 comment:

  1. In 2007, I suffered what was probably an acquired brain injury due to some toxicity -- shellfish poisoning maybe. It was like a stroke. Couldn't talk, couldn't recognize objects. Letters and numbers on a page didn't resolve as symbols. As an intellectual and a person with a cogsci background, this was pretty terrifying. The level of mental confusion made it hard to communicate how bad off I was, and when I managed to tell my PCP how confused and horrible I felt by sheer willpower, she told my housemate, "Oh, people who never get sick, you know, they get a tummy flu and they fall to pieces -- take her home and put her to bed, she's got gastroenteritis, she'll be fine in a couple days."

    Six years later, I seem to have emerged after random steroids for an injured back improved my condition -- but I spent six years with constant (like nearly every day) migraines, brain fog, epilepsy, executive function gone, just a mess in a hundred little ways. I still don't know what it was, still have some issues, and don't know how long what improved last month will last...:)

    But, in 2007 when everything went south -- I lost a lot of friends. And it wasn't because they ditched me because I was negative -- they were also just afraid. If this could happen to me when I was fine just the last time they saw me? It could happen to any of them. And that freaked them the hell out. I was walking, slurring proof that any of them could go from Einstein to little yellow bus without explanation and without medical science having a clue what to do about it.

    So yeah, I was something of a leper. I described myself as "the princess in the tower surrounded by briars" for six years. I could feel "me" intact inside my head, but I had no way out, and no way to produce consistent work, even though I could kind of conceive things -- I couldn't concentrate or stay on one thing. I had no stamina.

    I was in pain all the time, sometimes with 18h migraines every 24h and limp between (but also taking care of my mom, who had Parkinson's and dementia, because someone had to, during all this!).

    So I hear you with great compassion. I hope you do OK. I hope I do ok! See you on G+ :)