Thursday, August 29, 2013

Memory Functioning in Depressive Disorders and Bipolar Depression




Content removed until further notice


Support Taming the Polar Bears

 

If you enjoy or benefit from the information you gain from this blog, or see the importance of it for yourself or for others in understanding and working on your/their mental health conditions or if you're in the mental health professions or otherwise see the importance of the work done and presented in this blog, please consider donating and supporting it. 

All the writing and research is done by a single individual - Brad Esau - who himself has been disabled due to the long term effects of his condition and who lives on a very minimal pension and thus has great difficulty supporting himself. 

For a one time donation, you can simply follow this link and instructions there - https://www.paypal.me/TamingThePolarBears

Don't have a PayPal account? No worries, getting one is fast and free.

Your donation goes to a fund controlled by a third party team who support Brad and his Taming the Polar Bears project (Gregory Esau is his brother and the fund bank account is in his name). 

Or if you'd like to make a regular small monthly contribution, please contact this email address - lanina1101@gmail.com - and include in the subject line: monthly donation with the amount you wish to donate on a monthly basis. 

Please state your PayPal address and name in the email.


Thank you so much for your support!





Tuesday, August 13, 2013

My Positive Difference Making Fundamentals

Positive Difference Making
Things That CAN be Done




Positive difference making fundamentals

After a brief hiatus and taking down a lot of the Taming the Polar Bears material, I'm getting back in the saddle so to speak. The focus this year has been videos and webinars.  


A lot of new readers have discovered my story, whether it's through videos on my Taming the Polar Bears YouTube channel or through a recent appearance I made in a webinar through the good folks at GlobalNet21

People have read only parts of my story in posts like Life as a Living Hell or what advanced state Type I bipolar is like in the very brief introduction Mental Health Disorder in Focus - Bipolar Disorder or maybe here and there elsewhere in old archived posts or heard my story through one of the webinars above.



And the question everybody asks or wants to know is "how on earth did you do it?" or even "how are you still alive?"

Well, the following is more or less it. This is what I do. Every day. To some degree. None of it is as simple as outlined here - I'll be getting to all of these points in greater detail in future columns, but this is the basics that I worked on, still work on, and will continue to work on. Every day. Maybe not every one, but I will chip away at at least a few of these every day. EveryDay. No exceptions. Even - especially - when I was living outdoors with no heat in -20C degree weather (0F) and living with all kinds of other challenges that come with the long term effects of living with bipolar disorder and the stigma it attracts.


Look, there is no way to just "turn off" a major psychiatric disorder. Nope, it's a long, long turn to change the direction of this ship. It is one of the things anyone with a major disorder has to face and accept - their life is going to require a lot of work performed daily in order to either get better or live a higher quality life. 

Nor is there any way to turn around whatever mood disorder or long term state of poor mental health, however "major" it's considered by psychiatry or society or your friends, coworkers and family (which is likely not very major - a big part of our problems, right? Nobody takes us seriously. But that's grist for another mill for another day). 

Almost everything here is based on neuroplasticity. Neuroplasticity - which I briefly introduce here - is a term referring to the brain's malleable ability to change form, how it arranges its wiring, what section controls what motor movement or sensory function, even down the inner workings of individual neurons, and, most relevant here, how it controls behaviour. The brain can do this naturally on its own when, for example, a certain area is damaged and it takes over another part of the brain to compensate or when a sense such as eyesight is lost the areas responsible for hearing and touch will grow. 

While this is interesting enough and has long been known, it's when I learned the more recent knowledge that specific mental and physical exercises and activities could change the shape of specific regions of the brain that a massive light bulb went off in my head.  

This, I strongly felt, was the answer to dealing with neuropsychiatric disorders. It occurred to me that my mental health problems, especially the issue of suicide, was a problem of the wiring in my brain being out of wack (I refer to these as broken brain loops) and certain regions being either hyper-active or under-active and that neuroplasticity meant that I could change that wiring and those regions. [I have since come across massive amounts of research to support this] 

The question then became how.

The answers, it turns out, aren't rocket science. While they're simple they're not, however, easy. Nonetheless, here we go.

Meditation. 

It works. This can be proven with brain scan technology that shows that meditation can make plastic changes on certain regions of the brain. There are various methods but there are simple ones that can be learned and practised relatively easily. Like with anything though, it takes daily practice. I sometimes do well with this, sometimes not so well. But I keep at it. I may miss it for several days or longer but then I'll remember and get back into it. Meditation can have a profound effect on how the brain works and processes input.

Most people think you have to become some sort of guru or practice complicated, advanced forms. Nothing could be further from the truth. The two most effective for brain and mental state improvement and are most relevant to those with mild depression problems or even more severe conditions like mine. And those are mindfulness meditation and a simple meditative focus practice that involves simply paying attention to and counting your breathes. Just practicing these two several minutes a day had massive and profound benefits and improvements in my ability to manage my mental states and outlook. 

introduce my approach to meditation in this post. It is the first of what eventually will be a series on meditation specifically designed for recovering from mental health disorders. 


I work on my habits. 

It's very simple; bad habits equal bad outcomes and good habits equal good outcomes (or as good as you can be). Almost everything we do is habitual including how our brain works. If we change our habits we transform how our brain works and therefore our lives. But it takes work and this work is not easy because habits, as we all know, are NOT easy to break. My go to book for habit change is one by behavioural change expert Kelly McGonigal who teaches a wildly popular course on change at Stanford University. Her book The Willpower Instinct is a must have book for changing habits. Her methods are based on solid neuroscience and the latest knowledge about how the brain works. She has one simple concept that works amazingly well. They're called “will” steps, “won't” steps and “want” steps. For example, I had a goal of changing my diet for the better (I knew that my very poor diet was having an effect on my mental health) so I used her will, won't and want method for changing my diet. It's easy because it can work in the tiniest doable little steps to start with. Within not too long, I'd changed my diet much for the better. The same little steps can be applied to many habits. She has lots of neat little methods for increasing our willpower as well (which goes towards changing our habits). Oh, and she's very big on meditation. HUGE difference maker.

I made big changes to my “data input”. 

One of the intriguing theories of what "we" are in the brain is that it's the collective memories built up over a lifetime and indeed there is a great deal of evidence pointing to this model which I get to in the post Memory Functioning in Major Depressive Disorders


Building on this premise, what are memories? 

Memories are built up from all the information our brains absorb from our environments starting in the womb until close to the time we draw our last breath. This information, this collection of "memories" - or "data" as I like to refer to it - forms the basis for your particular version of reality , IE: how you view and perceive the world which will be unique from anyone else's, your sense of mind, your beliefs and so on. These kinds of memories generally fall under what are called <episodic memories> or memories of our experiences. 

Another form of memory important for understanding what and who we are and how to change that are <procedural memories>. These are ingrained processes involved in physical skills and abilities which includes many of the things we do things on a day to day basis that we don't need to think about in order to do them; from the mundane like walking and talking (even at the same time!) to skills and tasks like driving a car, negotiating a mass transit system, or higher skills like playing the piano, etc. These can also be known as "automated" or autonomously running "programs".

Both of these memory systems will combine to form the basis of your daily thoughts and reactions and decisions in response to life around you and how you navigate through life plus - plus! - all the emotional aspects attached to how you "store" memories and "retrieve" them. This is really important to understand. 

We'll think of all this collective memory "data". We then need to understand that the great majority of our thoughts what this is and does and how it guides our thoughts, emotions and action and behaviours base on or guided by this data. 

A way I'd like you to think of how "data" affects the brain and thus "who we are" is based on the principle of put garbage in, garbage will come out. Put quality in, quality will come out. Consume negative input, negativity will come out. Consume positive input, positiveness will come out. 

It doesn't make any sense then to attempt to change our selves - our thoughts, feelings and behaviours - without working on changing the "data" we input into ourselves every day. 

When I became fully cognizant of this I became much more careful about what I read, watch, listen to or who I spend time with. The better the quality of all of these things, the better the brain both produces our thoughts, feelings, and behaviours and deals with them.

Changing data input necessitates and induces plastic changes in the brain. It will change the wiring, it will change its thoughts and thought patterns. But this can be for good or bad. Bad data in, worse brain functioning and worse mental models and states. Better data in, better brain functioning and thus improved mental models and states. Better data input makes a huge difference in moving away from negative brain functioning to positive functioning. Obviously with suicidal depression this is a big area to work on. I stay very aware of this and work at it. I tailor my online experience, my reading, the company I keep, everything to producing better data input. As I wrote before about memory functioning and depression, negative "data input" can really impact what's in our memory and thus how our memory affects our mental states and our mind projects our future. So you really want to minimize negative or garbage input and maximize positive input. Improving my data input HAS made a huge difference.


I've learned a lot about letting go. 

We all need to move forward in life and moving forward is a lot more difficult when dragging a fifty ton sack of yesterday's shit around. So I learned to let go. Sometimes this is easy, sometimes it's not. I work at it all the time. Letting go of the past, or letting go of negative things and events in your life, is amazingly enlightening and disencumbering. 

Letting go is also letting go of many things, ideas and possessions that you are convinced are "vital" and that you "can't live without". I had to go through this process dozens and dozens of times. When I was melting down over something, I had to stop myself and think (this is where practicing the above mentioned meditation techniques pays off big time) "is this really that important? Do I really need this?". Turns out, most of them aren't really as important or vital as one would think nor as needed. So let them go. 

Letting go very much ties into the Buddhist tenet of "staying in the now" which leads us to:

Living One Day at a Time (or Staying in the Now)   


This sounds like one of those simplistic snippets of advice we get or read in some shiny-happy graphic on social media that can drive us bonkers when we're in the midst of overwhelm meltdown. But this may be the most life saving mental habit of all. 

Living one day at a time sounds counter-intuitive and it sort of is. There's lots of things from our past we need to remember and certainly we have to plan for the future. But in times of overwhelm - I get to more about what goes on in the brain in these times of overwhelm and why in the more detailed post on Staying in the Now - carrying around the weight of a thousand yesterdays and a thousand tomorrows is literally mentally crippling and a monster source of body and soul destroying stress (which is why we break down). You can't deal with that. NOBODY can. Anyone in a position of power and authority and has to deal with dozens if not hundreds of crucial decisions must learn to master dealing with the current day and the current day only. 

This is not only a Buddhist tenet (making it 2,500 years old), literature pertaining to mental stability going back centuries talks about and urges the same thing - deal with each day on its own and each day only. It is of course not easy - trust me, I know it's very challenging at times - but as with all new and better habits, it gets easier with time.

It is also tied to "staying in the now", one of the underlying principles of mindfulness; that is, just focusing on the task at hand and nothing else.

As far as I know, no one has invented time travel so we can't go back and change the past, folks. And NO ONE can predict the future so there's not much use in dwelling on what that may or may not be. So it is best to stay in the now. 
<oooohhhhmmmm>


Changes in latitudes, changes in attitudes. 

I've worked very hard at changing my mindset. This ties back to habits and input. I want the most positive mindset and attitude possible. This is vital for fighting ANY illness and this is well documented. It's vital, therefore, for fighting mine. I slip and I forget at times but I do generally work at this a lot. When the darkness of depression descends this can be really challenging but I'm convinced that working at this makes a difference.

Learning to learn and Creating a Growth Mindset


There is nothing better you can do for your brain than learning something new. It will create new neurons, new connections between current neurons, it will open new areas of neuronal real estate or liven up old areas. And it's more than just learning, it's learning to learn. If you can learn to become an awesome learner - and I'll get to a post about how to do this - and create in your brain the habit of learning, your brain will just become better and better at learning almost anything you really want it to do.

This is another huge way that I create better moods and get myself re-centered after some big blow and getting into a dark and bad place. Refocusing on learning and the process of learning is how I do all the research that goes into writing this blog, it gives me something positive to focus on and it literally trains my brain for how I can better come up with creative solutions and get myself past stuck places. Not to mention, it's a great way of building confidence and hope and improved esteem that's built on a solid foundation. It creates what is known as a growth mindset instead of a fixed mindset - a growth mindset can better understand and solve problems, a fixed mindset tends to get stuck and is more prone to overwhelm and melt down. 

Massive difference maker

I discuss growth mindset in this video on my YouTube channel with University of Oklahoma instructor Laura Gibbs who's developed a superb and popular course teaching the concepts and methods of growth mindset. 

Positive visualization

This ties back to meditation. This is important for moving forward and feeling more positive about that. It's exactly as the words imply; visualizing something positive such as a positive outcome for something I desire. The method is meditative in nature and again, it can produce positive plastic changes on the brain. And while you can't predict or form the future, you can visualize the most positive outcomes for future events that you can. Positive visulization also exercises very key areas in the brain for more positive mindsets in general. 

Something important to accept is that a lot of what we visualize won't happen the way we "script it" in our minds. While this is normal, things not going the way we visualized, planned, expected, wanted and hoped for can be a significant trigger for a "defeat" model of depressive episodes and anxiety about the future. So this has to be something we work on - better attuning our positive visions to our skills, abilities and probabilities in our life plus the corollary of working on our skills and abilities to better achieve what we envision and hope for. This again is not something we're going to master at once or quickly but just another daily habit to cultivate and work on and simply strive to retain the core principle of trying to visualize the best possible outcomes and doing the best we can on a give day to achieve or work towards them.

Getting better quality rest. 

I learned early on in my research into bipolar that good sleep was vital so I work on this a lot. I learned simple meditative breathing techniques for calming my mind and getting to sleep. I also do little meditative rest breaks throughout the day. Giving your brain proper rest and breaks is proven to be vital to proper brain functionality so obviously is vital for dealing with my illness. So I actually work at getting better rest. My being more aware of this has made a huge difference. I know that when my brain is starting to wobble that I need to shut it down and give it some rest (which is a lot these days).

Being spiritual. 

Humans are actually pretty hard wired for spirituality (uber amounts of evidence and brain science on this) and in today's world many of us have become too disconnected from spiritual connections and on a deep subconscious level the brain doesn't like this. I am not religious so this is a challenge. There are other ways, I believe, to be spiritual, however, and I try to do these things. Part of that is to connect to other people in the most positive, empathetic way possible. Be a good person, the idea geoes, and you'll get good stuff back. I need good stuff to happen in my life to help make me and my life better so it just makes good sense to be the best person possible to help make that happen. That's my spirituality. As well, there's some impressive recent science that shows that we can have a spiritual connection with nature and that this has very positive benefits on our brains and thus our states of mind. So I also try to stay connected with nature as much as I can. You should too. Yes, I know how "busy" you are - MAKE time. 



Learning and practicing empathy, compassion and forgiveness. 

This ties back into being spiritual. Being empathetic to your fellow humans – 
regardless of race, colour, nationality, gender or class – will do some amazing things to the brain. Your brain needs lots of exercise to stay healthy. This is a superb way to give it that exercise. See The Compassionate Brain for some of the science on this. This has been the easiest of all my methods to practice. It plain feels good and this will make your brain feel better. There's some crossover with positive visualization that can be practiced here too. Oh, and most importantly, I learned a lot about practicing compassion and forgiveness with myself. Hugely important. 

Please see Positive Difference Making Fundamentals in Focus - Spirituality for more on spirituality and practicing compassion and gratitude.  

Believe, just believe, baby. 

This is often HUGELY challenging for me. When I (or anyone) am in the throes of bipolar depression – which, again, is a massively dark place – my brain scoffs at the idea of belief. It almost literally says, “believe??? Look at your messed up life! Believe in what, you fucking moron?!” This part of the brain (or whatever is going on in there) is really in control during bipolar or major depression so this makes belief really challenging. But I keep at it and if I keep at it, a tiny little part of my subconscious will hang on to belief and will give hope in even the blackest periods of inner darkness and hell. You would not believe what I have survived and it was ONLY because some little corner of my mind clung to belief. So no matter what, I work on belief. You - no matter whether you have a mental health disorder or not - have to work on belief. 

Belief is also a great stress buster; if we can believe - have faith, however you want to put it - this can greatly aid in putting our minds more at ease to handle the present day and to stay in the now and thus reduce overwhelm stress. 

Exercise. 

There's just crazy amounts of science on this - going back a hundred and fifty years. Exercise is good for your brain and is essential to mental wellness. This is hard for me, because my body has broken down and the crippling fatigue that often comes with long term disorders (see link next paragraph), but I poke away at it and try at least to get out for walks. With exercise every little bit helps. Any little bit you can do is something. You just have to try keep increasing whatever you do a little bit every week.

Many of us who've suffered from mental health disorders for many years will almost certainly be dealing chronic fatigue issues (about which I wrote a very well researched three part series starting here). What most people think of as exercise is therefore very difficult for us. I developed some simple exercises based on some basic yoga and tai chi principles involving gentle movement but combined with breathing techniques can stretch and exercise our muscles, oxygenate our blood and stimulate key brain regions. I'll be doing a video series on this as soon as I can (which may yet be some months, admittedly).


Music Therapy.  

The power and healing benefits of music on the brain are now well documented. I use all kinds of music, but meditation music, classic jazz and classical music work best for calming. The latter two, because of their more complex structures, produce positive neuroplastic changes on the brain leading to enhanced creativity and cognitive abilities. I listen to a lot of jazz and classical music in focused, attentive way. Upbeat music is great for lifting one's mood. Huge, huge difference maker.   

Please see An Introduction to Music Therapy to learn more. 

Purpose. 

Having a sense of purpose is very, very huge. The best thing any of my eighteen or so psychiatrists (!) ever said to me was, “Brad, you have no purpose in your life. You can't live like that. NO ONE can”. Boy, was this a big wake up call for me. The more I thought about it the truer I knew his words were. So I learned to work really hard at this. Right now, for better or worse, my purpose is my writing and research. These things too become very challenging during the darker periods of bipolar depression. But I make myself do it, even if just a little bit per day. It keeps me connected to a greater sense of purpose and this makes a big difference. 

My Brain Training Exercises 


I have been practicing these for about a year and half, having developed them during my worst periods of bipolar depression and fatigue. I introduce them in this post but briefly they are designed to help us exercise key brain areas involved with planning and mental states and attitudes while helping us reduce negative self talk, self sabotage and replace it with more positive inner dialogue and narratives.  


All of these things are very challenging in that place of darkness, despair and hell. 

As well, with energy and fatigue issues and other pressures it can be really hard to work on our selves. But this why I put together a list of many things to work on. Life remains hard and challenging but I find I am able to work on at least a few of these every day. They are designed so that no matter how beat down we are and how much things seem to be swirling around us, it is still possible to find at least a little time to work on one of these life changing fundamentals. 


I'll write about this in more detail in a future post but the biggest thing I found in gaining more mastery over my mind, my mental states and - most importantly - stress triggers and stress in general is that the more tools we have the more power we can gain, the more we can take control over little moments in our lives and then expand that control to bigger moments and then days and then our lives and it is this power that we learn in tiny little incremental steps that gives us power over our mind and our lives. 

We just have to commit to making little steps each day, staying within the day or the moment and dealing with that as best we can. These fundamentals give you some of the tools you can use daily and moment by moment to give you more power. 


Support Taming the Polar Bears

 

If you enjoy or benefit from the information you gain from this blog, or see the importance of it for yourself or for others in understanding and working on your/their mental health conditions or if you're in the mental health professions or otherwise see the importance of the work done and presented in this blog, please consider donating and supporting it. 

All the writing and research is done by a single individual - Brad Esau - who himself has been disabled due to the long term effects of his condition and who lives on a very minimal pension and thus has great difficulty supporting himself. 

For a one time donation, you can simply follow this link and instructions: paypal.me/BradEsau

Don't have a PayPal account? No worries, getting one is fast and free.

Your donation goes to a fund controlled by a third party team who support Brad and his Taming the Polar Bears project. 

Or if you'd like to make a regular small monthly contribution, please contact this email address -TamingThePolarBears@gmail.com - and include in the subject line: monthly donation with the amount you wish to donate on a monthly basis. 

Please state your PayPal address and name in the email.

Thank you so much for your support from the Taming the Polar Bears team!



Saturday, August 10, 2013

The Myths of the "Benefits" of Psychiatric Drugs



Note - this post has been edited since its original writing to include links to source materials and for further reading. BGE - February 5, 2014


It is unlikely you will believe in the information I am about to give here. For the vast majority of people information of this kind strikes a strong cognitive dissonance within them. For people love their drugs. People believe in their drugs. People want to believe there are magic bullets in a pill that are going to make things better. (1) But this is a myth. According to a McLean's magazine article earlier this year prescription drugs lead to 100,000 deaths a year in the US and 10,000 in Canada, many of these from psychiatric drugs.

I am a psychiatric survivor. When I survived the worst of what was several horrific episodes of suicidal psychosis and then found that the very drugs I was given by doctors to “make me better” were in large part responsible, I vowed to do what I could to dispel the myths – I might say propaganda – that pharmaceutical drugs produce better outcomes for psychiatric illnesses. I devote my book Dancing in the Dark – Why?  to dispelling these myths and now I will devote more space in this blog.

Myth #1 – schizophrenics have to stay on their medications. Even after starting my research into psychiatric drugs I still believed this one but many studies show better long term outcomes with non-medicated treatment than with medicated treatment. The key term is long term. Drugs can knock down psychosis in the short term but will produce worsening outcomes over the long term. “Outcome” means being able to get back to a normal life. There are several reasons for this, not the least of which is the damage drugs will have on cognitive functioning and on motor movement. Anti-psychotics have been shown in long term studies to increase psychosis. A fifteen year study done at the University of Illinois comparing medicated and non-medicated schizophrenics found that forty percent of non-medicated patients recovered versus only six percent for medicated. Not only that but the “poor outcome” category was much higher on anti-psychotics than for non-medicated, forty-nine percent versus only sixteen percent. In the 1970's a Dr Mosher started a schizophrenia treatment centre called Soteria House in which no medications were used. A five year follow up of patients showed that seventy percent were able to return to normal lives, an astonishing success rate. In addition I came across many personal stories of sufferers of schizophrenia who didn't start getting better until after they stopped taking their medications and got out of psychiatric hospitals. 

A full paper on the Soteria House project and the results can be found here - http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/

The Harrow long term study on medicated and non-medicated outcomes for those with the diagnosis of schizophrenia can be found here

Not only that, but research by renowned neuroscientist Nancy Andreasen  has found that long term use of anti-psychotics causes loss of brain tissue

I had a single incidence of suicidal psychosis prior to being put on anti-psychotics. The  number and severity of incidences increased while I was on anti-psychotics. I had the one most severe episode since I stopped (the effects stay in the brain for some time even after stopping) and none since that time.

Myth #2 – psychiatric illnesses are caused by “chemical imbalances”. This was a theory several decades ago but it's one for which there is no proof despite decades of efforts to produce proof. That it is still believed by a majority of people is a byproduct of pharmaceutical company propaganda and our own desire to believe in the properties of magic bullet fixes for conditions like depression. You can try as you might, but you will find no study or discovery proving that any psychiatric illness is caused by a chemical imbalance. Actually, you will find no study or discovery proving any cause or etiology of any of the major psychiatric illnesses. If you find one, head straight to the Nobel prize committee because that would be major medical news. A good primer for some background reading on the history of the chemical imbalance theory and the media's role in its promotion can be found here - The Media and the Chemical Imbalance Theory of Depression

Myth #3 – anti-depressants “fix” a chemical imbalance and thus “lift” depression. One, there is no such thing as a chemical imbalance so how could anti-depressants fix one in your brain? Two, there are countless studies showing that anti-depressants fail to outperform placebos. There are studies that show just a pill the same colour and shape as an anti-depressant will have positive benefits. Three, there are studies that show links between anti-depressant use and increased and prolonged depression, an effect I can personally attest to.





Myth #4 – psychiatric drugs are “safe”. I can personally attest that they are not. People who know me and saw my worsening condition can attest they are not. But numerous studies using brain scan technology show detrimental changes in brain tissue with psychiatric drug use. There are numerous studies linking anti-depressants to suicide and even murder. A brief summary of this can be found here - Psychiatric Drugs and Violence. And something that needs to be understood is that anything that receives a government warning is only the tip of the iceberg and a toned down version of actual cases. 

Anti-psychotics impair or damage the basal ganglia leading to tardive dyskinesia, an involuntary muscle movement disorder which then ironically is assumed to be a symptom of schizophrenia. Brain researcher Nancy Andreasen's long term studies showed irrefutable evidence that anti-psychotic use leads to shrinkage of brain volume with the extent of the damage being dose related. In other words, the higher the dosage, the more damage was recorded over time. 

There are also many studies connecting anti-depressants to increased risk of suicide, an effect I can personally attest to. Researcher David Healy is a leader in this field of study, establishing both the links between SSRI use and increased suicides

Myth #5 - The FDA and Health Canada tightly regulate drugs. One of the things I found out early on when I started researching psychiatric drugs was how shocking the approval process was. In Canada it's virtually run by the industry itself. The FDA board is dominated by ex pharmaceutical executives. Doctor, researcher and writer Ben Goldacre in his book Bad Pharma exposes how drug companies rig tests and outcomes of drug trials. Since the start of the pharmacological era drug trials have never been as rigorous as you might imagine and that is true to this day. If you believe that pharmaceutical drugs are safe when they hit the market, you have a lot to learn. 

Myth #6 – pharmaceutical drugs are improving our lives and saving lives. This is the biggest myth of them all. As mentioned, tens of thousands of deaths per year are related to pharmaceutical drugs. I heard a statistic about one in five people having a psychiatric disorder. But we are consuming pharmaceutical drugs to the tune of billions of dollars per year. If drugs “improve lives” why then are so many people still ill? Pulitizer Prize nominated science writer Robert Whitaker has devoted himself to researching these questions. He's produced two books and writes a column for Psychology Today. He looked into disability numbers for psychiatric illnesses and found a correlating rise in disability rates with the start of the pharmacological era of psychiatric treatment. If drugs make us “better”, why are more – dramatically more – people being permanently disabled by illnesses such as schizophrenia, bipolar and depression? Whitaker's research showed that long term outcomes for all of those illnesses were better before the pharmacological era (which started in the late fifties).


For me, bipolar has been no picnic. I have had some good episodes of creative mania but also a lot of struggles. But absolutely by far the worst of those struggles and the worst of my suicidal risk came while I was under the care of psychiatrists and taking a large variety of psychiatric drugs. Prior to my experience I believed the myths, I believed in “better living through pharmacology”. That belief almost cost me my life. That belief does cost many people their lives. 


















(1) - If you are currently taking psychiatric drugs for any condition, please do NOT consider stopping them without first consulting a doctor who specializes in dealing with psychiatric drug withdrawal nor before drawing up a careful plan to improve your mental health.



Tuesday, August 6, 2013

Realities Continued




Some general stuff and some personal perspectives.

These concepts of the "realities" that schizophrenia and bipolar create in sufferers' minds are hard for anyone to conceptualize. People want to believe that it's just "thoughts" or some state of mind you can make go away if you just try hard enough or worse that it's something you're just bringing on yourself. This is incredible frustrating. The implications are twofold; one is that it's somehow a choice as to what we have in our heads or how our heads are operating and two, that it's not "real". There's a third one but I'll get to that at the end.

I have some fascinating material from the Hearing Voices Network regarding people who hear voices and their frustrations and distrust of the folks in the white coats. Unfortunately, as I'm not currently living in a home of my own and all my things were packed away for me (during my latest hospitalization), I don't have access to the material but I'll muddle along as best I can with my imperfect memory. It was from research into schizophrenics by famed Dutch psychiatrist Marius Romme. What he went on to discover was that hearing voices was something separate from or not necessarily connected to schizophrenia (despite this being more than 20 years ago and the now incredible body of evidence the clods at the American Psychiatric Association refuse to acknowledge this). Without getting into the politics of psychiatry (which I easily could!) what Romme found among those who hear voices is an incredible frustration with the psychiatric profession and/or other doctors. Number one is that the people knew they were not schizophrenic, only - and "only" is not a great word here - that they heard voices. Romme uncovered - in sort of a literal sense of the word - hundreds of "hearing voices people" who'd gone underground with their problem because of this frustration with with the professions. They were regular people with regular jobs and lives who just happened to hear voices and the profession wanted to label them, put them in hospitals and drug them. Worse, the profession showed no understanding of the issue of hearing voices. Doctors would, invariably, insist that the voices were not real. Well no, the people would strongly feel, they absolutely are real. And back and forth it would go and the doctors only recourse would be to prescribe drugs which they insisted would make the voices go away. The drugs didn't make the voices go away. The people became so frustrated and displeased that they, as mentioned, simply went underground and found methods on their own to cope. It was Romme's work and discovery of this group that would lead to their banding together and the founding of the Hearing Voices Network, a peer to peer group for people to talk about any kind of inner mind phenomenon that uncomprehending pencil pushing doctors don't understand. I've attended local meetings of this group and I nearly cried it felt so good to be around people who get the weirdness that goes on inside my head. They listen, they understand, they don't judge, they don't try to tell you that you're "just imagining it". They GET IT.

Oh dear, I did get carried away there, didn't I. The point was, however, to further the concept of different inner realities through the use of hearing voices. For hearing voices people the voices they hear are NOT their imagination and they don't simply just go away (with lots of work for many people they can), the voices ARE real. The other point is how frustrating it can be to be told this stuff going on in your head is not real or that it's just your imagination or that drugs make it go away or that you're just not trying hard enough and so on. As I said, after dealing with so many people who told me the most hurtful things (while attempting to be well meaning, I know, but still), it felt so wonderfully good to be with and talk with people who got what I was experiencing. They are a wonderful, wonderful group and organization. It was through attending these groups that I FINALLY understood my suicidal psychosis episodes, something that the dimwits in the white coats never listened to me about or explained. I shouldn't say dimwits, I know, but after a baker's dozen of them, all with different views, methods and so on ranging from nothing's wrong to the worst case of bipolar and continuing to get WORSE and then finally finding out on my own what was going on and getting far better through my own efforts (not unlike the hearing voices people who finally, fed up, went underground), sorry, I think they're dimwits. And that's by far the mildest term I can think of. You should hear me when I get wound up about what I really think. Trust me, I'd peel paint off the walls with my language. There are people who saw, and were horrified, by what I went through that would too.

Oh, one of the standard treatments for schizophrenic and bipolar peeps is antipsychotics. "Anti" + "psychotic" = something that reduces psychosis, right? (well, they don't prescribe it for that in bipolar peeps really. They just have this vague idea that it helps "knock down" mania). Well, it turns out that it can actually make psychosis worse. Something that I personally discovered myself. Not fun. I'll give you the studies and the science on this another day though. But back to inner realities.

Bipolar creates a lot of inner realities. I'm not even sure I can describe them all. As I said in a previous column, bipolar (and schizophrenia as well, I suspect) are whatever it is plus your own personality. I have plenty of my own personality quirks and bipolar just takes those and magnifies them (sometimes this is good though). How this all works is an utter and complete mystery (and trust me that it is a mystery, I am extremely well read on this not to mention all my own "data" in my head plus interviewing several bipolar people). I've had many manic episodes in my life, no two of them the same (though some similar). Sometimes they're great, sometimes they're horrible. I'm pretty sure that my suicidal psychotic episodes were just twisted variations on my mania and manic visions. That would rate as pretty bad. Other manic episodes played visions of lovely stories in my head that were literally like watching a movie in my mind. Not like a dream, very different from that. Like a movie, like a vision. An hour or more long. I just "sat back and watched". In one manic episode I was going to be a head coach for a team in the top professional hockey league in the world, in another I was going to take over and save a major corporation that was going through difficulties. None of this is conjured up by any effort from me. It just comes. From where, no one knows. Why? No one knows. It just comes and completely takes over my brain.

Depression visits upon me some horrible times. Again, it just comes. I don't make it happen, I don't wish it to happen, nothing happens. It just comes. The mind just works very darkly during these times. I cannot control it, I cannot make it go away. Now, with years and years of experience, I can have have some insight but only perhaps after some time can I realize what's going on. Maybe. It's a LOT of work.

Mania, depression, mixed episodes, all kinds of variations in between, these just happen and when they happen that's my - or any sufferer's - reality for that day, or week or month or moment. There's nothing we can do about it, that's what you have to understand. Awareness can help, yes, but only maybe. It depends on how strong any given event is. Most often it's only after that we can look back and think, "right. that was <insert the type> episode. It's passed now and I can settle down". Or many, many, many variations of such.

It's a myth that drugs make things "all bettah". People have the nerve to tell me - based on what, I can only imagine - that all I have to do is "get the right combination of medications" or "tweak my medications". I know they're being well meaning and only want to give me hope but honestly. I've had - my latest count - eighteen psychiatrists or residents. I've been on every combo there is. And I just got horrifically, horrifically worse. So don't tell me about meds. I spend about four chapters and a hundred thousand words in my book dispelling those myths so I won't get into that here.

I think there are methods. Peer to peer counseling is one. (I'll no longer deal with people who haven't been through this before). Meditation is another. I'm pretty deeply read in neuroscience. I think there are signs of hope there, especially in neuroplasticity.

I also know that I am in the highest risk group there is for bipolar. I'm older and have had it all my life and have cycled through countless cycles of mania and depression. This is well understood in the literature. All the literature that talks about hope talks about young people, those who've only had a cycle or two. Like any illness, it's much better when caught early. Twenty percent of bipolar sufferers will commit suicide. I'm in the the high risk group for that, something that I looked into in a series of three earlier posts. I know I have some very serious challenges ahead, something that would be stupid to ignore.

People write to me and tell me that they've been through this or that and survived. That's sweet. But it misses the point. Illnesses of the brain are different. When your body is sick you still have the most important weapon available to you - your brain. When you're sick with a brain disorder, your most valuable weapon - your brain - is the very thing that's not healthy. I don't know how to get across how much more challenging this makes things. Not to mention that the brain is one of the most mysterious structures in the universe (ask a neuroscientist like David Eagleman). Honestly. We understand more about distant stars than we do about the human brain. This is not to say that major illnesses such as cancer are somehow easier to deal with. Of course they're not. And I'm grateful that generally I have have my health. I'm just saying that brain illness are not only tough but they're tough because the power of the brain is what we need most to get better from anything.

I've heard people compare brain illnesses to cancer and such. Which is a nice try. I'd argue, however, that they're possibly worse (especially the worst cases of schizophrenia and bipolar). I say worse because we know so little about the brain and don't for a moment believe that "doctors" really understand what schizophrenia and bipolar are. They don't. Don't let their impressive web sites fool you. They don't, as I've been trying to get across, know where schizophrenia or bipolar come from or why they happen or where any of the visions and different realities come from. All they have, and know, is an incomplete understanding of behaviours and some crude drugs with which to try (all of which produce worse long term outcomes).

But onward and upward. There ARE things to work on and I will get to those at some point.

Sunday, August 4, 2013

Mental Health Disorders and "Reality"



This isn't going to be what I'd like it to be because I don't, in my current state of residence, have access to all my notes and books nor do I have the mental energy to go through and search online to find all the stuff I'd previously researched and try to reconstruct it. So we'll just have to make do with what I can do on the fly. Which is probably a good thing because what I'd like this to be would run three thousand plus words or so, not something anyone has the time nor interest to plow through.

As I made at least somewhat clear in the previous post, we all have our own realities and those realities change as our brains change which is like ... all the time. But that's normal human change almost everyone goes through. As I was building to in the previous post, which I hope you have read as a prerequisite  of this post, the state changes and reality changes experienced by those with schizophrenia and bipolar are rather different from that. I can only briefly touch on each of these today but hopefully it's enough to start opening some minds.

Schizophrenia:

Schizophrenia is many things, many probably not quite as how you imagine them. For one thing it is NOT hearing voices. The phenomenon of hearing voices is quite different and not - or at least not necessarily - anything to do with schizophrenia. This is a massive myth, unfortunately one that is propagated by educated people with "Dr" in front of their names. But go to a meeting of Hearing Voices Network and/or read through the copious amount of material they could give you and you'll find out something very different from mainstream medical opinion. This does not mean that some people with schizophrenia may not experience, as part of their delusions, hearing voices, only that hearing voices does not necessarily equate with being schizophrenic. So let's set that aside right away. What we are talking about are delusions which are described somewhat incompletely here. 

Rather than try to broadly describe schizophrenic delusions - which can vary greatly from person to person - I'll work instead with a very well known case study: that of one John A Beautiful Mind Nash. John Nash, if you don't care to follow the link and learn more about him, was - probably still is at the age of 85 - a mathematician. But not just a mathematician; he was one of the most brilliant mathematicians among a collection of the many of the most brilliant mathematicians on the planet at the time (the late 40's to mid 50's of the last century at Princeton University). He would win a Nobel Prize for his ground breaking work in game theory. And it wasn't just that he was brilliant, it was how he was brilliant. He could, it was said, simply do things with his brain that no one else could do (part of his brilliance was in being a maverick among his peers). So we're talking one very smart man here. And not long after this wonderfully brilliant man developed game theory he began, around 1959 or so, to experience delusions (if you have seen the movie on Nash's life you'll have to set that aside as it was really rather fictional I can tell you). It is hard, even for the most excellent biographer of Nash Sylvia Nasar (the more accurate portrayal of his life and experience with schizophrenia), to describe Nash's delusions because he never actually gave an interview to her so instead all there is to go by is his behaviour and second party accounts from family and former colleagues. 

It is not possible to completely describe here within the constraints of a small column all of what Nash experienced and did while delusions took possession of his mind. In 1958 he was working on extremely advanced mathematics. Then the inner realities of Nash began to change. It started mildly. He started to feel that all men who wore red ties were part of a communist conspiracy against him. Not long later he was chasing around Europe as an "attache" of aliens in charge of contacting embassies on a new world order and world government that was coming. And this was, it's important to understand, completely and one hundred percent real to him in his mind. He believed it was real, as he told a colleague some years later, because it came from the same place in his mind as his math theories did. His behaviour changed completely and utterly to follow his new reality. He became for all intents and purpose unemployable. He more or less lost all interest in mathematics as the new "realities" took over. He was institutionalized undergoing treatment that included the barbaric insulin shock therapy which had untold and long term effects on his mind (he would later refuse any  institution or treatment and his wife was said to have rejected electroconvulsive therapy for him because she feared what it'd do to his mind).

The take away here is that schizophrenia can produce new inner realities over which the sufferer has no control. No one knows for sure where the delusions come from or why. Schizophrenic delusions can happen to almost anyone from any background. While Nash gradually, over many years (and famously without medications), was able to distinguish his delusions as not real and get back to "real" reality, for most people this is extremely difficult. The delusions can come and go over the years and each time they're absolutely real. It is a reality virtually no one outside the sufferer can imagine. Which is part of what makes it so difficult for the sufferer - they're the only one that can "see" it and this can be extremely frustrating (and this frustration, I argue in my book, becomes a huge part of the "illness"). I once talked to a man "to whom Jesus spoke" and gave him tasks to do. He was absolutely sincere in how real this was yet no one would listen to him. Though he'd gotten used to this rejection and appeared very nonplussed about it, I could still sense the frustration in his voice, not to mention his bewilderment at why no one wanted to hear, through him, what Jesus had to say. He thought it so important and couldn't grasp why no news services wanted to interview him on this. 

Bipolar:

Bipolar can be quite similar to schizophrenia in that it can produce delusional thinking and indeed one can be misdiagnosed as the other. Kurt Vonnegut's son Mark in his book Just Like Someone Without Mental Illness, Only More So describes what sounds much more like schizophrenia to me but he was diagnosed with and treated for bipolar. Whatever it was, he managed to deal with it quite well having gotten accepted at Harvard Medical school (albeit against very long odds) and became a successful doctor (except for the relapse time). Like schizophrenia, bipolar can create some pretty wacky stuff in one's mind all of which is one hundred percent absolutely real to the person in whose brain it's happening. I can personally attest to this. The younger Vonnegut doesn't describe swings of mental states or manic depressive episodes (I use the term "manic depressive episodes" to denote the depressed state of bipolar, a condition I think is different from unipolar depression), something which further makes his diagnosis suspect to me. 

Bipolar is essentially swings in state (I dislike the word "mood") between mania and depression. Mania is many things so it's hard to precisely define here. I once described it as whatever one's personality is with manic chemistry layered over top of that. If you tend towards creativity, you'll be manically creative. If you tend to do stupid stuff, you'll do manically (and epically) stupid stuff. If you're an abusive a-hole, you'll be a manically epic abusive a-hole who can do violent things. I don't know where to begin and end in describing mania. I could describe mine but it's different from many people's. My mania is very often different from itself. They're like some boxes of chocolates; no two are alike. Whatever it is, it'll be an elevated state in which you are impelled to do stuff very different from what you'd normally do (or maybe, like some creative bipolars, your normal stuff much better than you ever do). This - for however long it lasts - will be your reality. And what mania does as part of making this your reality is remove all insight or judgment. No matter how lunatic whatever it is you're doing, it will make absolute sense to you at the time. Including, tragically, maybe jumping off of a building because you're convinced you're Superman. Yes, it can be like that. Like with schizophrenic delusions, no one knows where these manic bouts come from or why. It just happens. Just like that <snaps fingers>. There are thought to be triggers but these don't always necessarily happen first. 

Then the worst sufferers (though not all apparently) of bipolar will experience an abrupt change from this "up and energetic" state down to the absolute blackest, deepest, darkest depths of depression humanly imaginable. Just. Like. That. (or at least many times for me anyway). Then this becomes the new reality. Like with the highs, there will be very impaired insight. This is part of what makes manic depression such a suicide danger - killing oneself makes absolute sense (never mind the desire to escape the darkness and psychic pain) and your mind will be in complete agreement. Rather than the runaway optimism of mania, manic depression is all about the darkest negativity and pessimism you can imagine. As great as you thought you were when manic, you'll think you're as awful when in the grip of manic depression. It'll be like an oil derrick pumping your worst memories and thoughts into your mind. And because you're robbed of insight and it's just the way manic depression works, this negative darkeness will be your reality. It is completely and utterly hideous. And yet so real. And you can't do anything about it. It's hard to tell which lack of insight is worse - that at the high end or that at the low end. 

Then there are "mixed episodes". This is a whole different reality altogether again. This is the nuclear power of mania coupled with the darkness of depression. Or maybe just acting like a totally out of control (because you are out of control) asshole. Because your mind has been taken over by something else and that's your reality for that particular time and you're just quite sensibly acting on that reality. 

You can "rapid cycle" through these highly different states in kind of an internal roller coaster or yo-yo where your entire mental state - or reality - is changing from one to the other and back again so fast you have no idea what is what. You'll want to put a gun to your head and pull the trigger just to make them stop. Trust me, they will drive you that insane (don't worry, most people don't get to that state). The longer this happens in your life the harder it is to treat and the worse your long term prognosis is.

None of these states - these inner realities - you have any control over. They just happen. Generally you'll be utterly unaware of them coming; it'll just be how your brain is for those weeks or months. With therapy and great effort one can learn to be more self-aware and deal with them better. Or not. It depends.

Medication kind of helps but only by turning you into a zombie, yet another inner reality to get used to. (this is for many though not all people ... medications WILL change you though and only maybe for the better ... this is a deep and controversial subject, however, though it is a favourite of mine). 

Oh - and aside from these wild reality changes that schizophrenia and bipolar can bring, we still get all those normal changes that everyone else gets which we looked at in the last column. Just like you, we can be grumpy, moody, giddy and all that stuff. In the case of bipolar, that might just get amped up several gazillion watts. You just never know. It's all kind of like having your mind run by a roulette wheel; who knows where the ball stops. It's important here now to understand just how different these changes in inner realities are from "normal" changes in reality. We're not talking changes due to feeling grumpy or happy or things like that. And you can have insight into those changes; you can tell "oh, I'm just crabby today. I'll feel better tomorrow". Not so with schizophrenia or bipolar. Lack of insight is a big part of these disorders (at least for the higher ends). So if, from the previous piece on reality, you thought your hold on it was tenuous, just imagine what it's like for schizophrenic or bipolar peeps!

This is not to sound negative, only to give some ideas as to the difficulties that those with schizophrenia and bipolar go through. Both these disorders literally take over a brain and make it something else, producing wildly different realities. But there is hope. That, however, is for another column.