Monday, October 28, 2013

Zombies and Bipolar Depression




Updated October 2014 - BGE



It's been weeks since I've written anything of note. Well, anything period. But this actually segues well into what I want to talk about in this post. 

I've been stuck in mental molasses for weeks (actually make that months) and it appears to be worsening. Being in the depressive phase of manic depression (that is the classic definition of alternating between manic highs and depressive lows as opposed to the seemingly one size fits all definition of bipolar disorder which seems to cover a wide range of behavioural issues) is where I'm at these days. 

Few people, and that includes medical people, can comprehend what this means or what it's like. I am physically, emotionally and mentally gassed 98% of the time. Not even people who suffer from occasional bouts of depression understand what this is like (except for severe cases that end up in hospitals). The depressive phase of manic depression can be many things and I happen to think I'm winning the battle against a lot of those things (and I have no problem giving full credit to my positive difference making fundamentals ). I am no longer pummeled by negative self talk all the time (occasionally but nothing like before). It's not as dark and hopeless as it was before (though I still hit the suicidal darkness skids sometimes). It's not a lot of things you'd normally associate with depression. It's mostly an astonishing lack of energy (and motivation, passion, drive and other things but I want to focus on the energy component this week). 

And there's sweet tweet to be done about it. Honestly. Trust me. It's not a nutrition issue or an exercise issue or a not having a shiny happy people attitude issue. It's an unavoidable part of the cycle. And it is a cycle, a cycle that's as sure as the phases of the moon or the rise and fall of the tides; one will surely follow the other. And this is not a self fulfilling prophecy. I have moved mountains in the past in effort to ward it off and constructed super sonic levels of belief that surely the depression would not return. But it does. Every. Single. Time. That's kind of why it's considered a disorder - there's nothing you can do to stop it or make make it go away once it hits (alleviate it, perhaps, but not make it go away). Anyway, I'm not going to waste my time arguing about that (and believe me, many people try to). 

I keep telling myself that this is a normal phase of manic depression and that it'll pass. I tell myself that but the evidence is not stacking up very well. With the exception of my five week run of mania to kick off 2013 (five weeks to the day of almost zero sleep and off the charts mental energy) and about two months of something approaching "normal" energy, I've been in virtually a non-stop depressive state since spring of 2010 (much of that, I believe, induced by psychiatric drugs meant to "stabilize" me but I'll grind that ax another day). Throw in the manic phase that kicked off the eighteen month phase of "Photomania" (long story) late in 2007 along with the rapid cycling that took place during that time period and we're just not talking a whole lot of mental stability (AKA "normal", I guess) in recent years. 

This does not portend well. According to the book Taming Bipolar, as a fifty-four year old man who's lived with it all his life undiagnosed, I am in the worst category for "treatment resistant" bipolar (of course we must define "treatment" ... this is talking about traditional - and backwards - psychiatric treatment). There's a lot I disagree with in the book (traditional drug therapy for one, of course) but I think a lot of the basic research about the disorder is well founded and based on long term observations. Each cycle, the thought goes, that one goes through of mania and depression, the more entrenched the disorder becomes (and theories of neuroplasticity would support this. The more you go through it, the more "hard wired" it becomes). Also, rapid cyclers are thought to be harder hit. I'll put my hand up to support that. So, having gone through - what, close to twenty cycles? - and having done a lot of rapid cycling and living with it untamed for so long puts me in ... the shittiest of categories we'll say. 

But that's all water past the dam. Plus it's based on old models of understanding and treatment. I honestly believe I'm moving past that. This does not by any means mean I think I've got anything "beat" - far, far from it. I've got way too many been-there-done-that t-shirts for false flags of thinking this was in my past (like early this year for example when I boldly proclaimed myself free from mental illness and ready to conquer the world) but in relation to how bad the depressive phase can be (which Kay Jamison describes so well in her book An Unquiet Mind and about which I am well researched elsewhere), I think I am displaying remarkable improvement over that of the average sufferer and that of my own past. If it weren't for this energy shortage. This is definitely - and alarmingly - getting worse. An hour, two hours max is all I can go doing anything - light work, reading, writing, thinking, walking, socializing - and I'm thoroughly gassed. That's if I can do anything at all. Any kind of deep thinking and writing is almost out of the question. Hence the quiet blog of late. 

But enough of that depressing talk. Or at least let's look at it a bit differently. Your intrepid mental health blogger-reporter has not let this opportunity go to waste. I have been faithfully observing and logging my depressed mental state and putting it under the microscope as it were. All the while wondering "why the hell does my brain do this to me?" and in a habit I picked up earlier this year, when I wonder "why?" about something to do with mental health, I demand answers and won't stop digging until I find them. 

I read, as you may have noticed, much about neuroscience. I follow the most superb blog Searching for the Mind by Dr. Jon Lieff and many other neuroscience blogs and websites. I read or have read several books put out by renowned neuroscientists and I hang out online with a small number of neuroscientists who, knowing what I'm up to, send me all kinds of research papers. It's not like I lack for resources (nor, I'll point out, the ability to understand a great deal of it). But there are not a lot of answers out there. I actually was in email contact with Dr. Lieff about this and this is what he told me: "There are literally thousands of scientists trying to understand the neuroscience of bipolar disorder. At this time in history, it is too complex for our present tools. Everything is currently speculation." Not exactly brimming with optimistic outlook for someone looking for answers, is it? 

But I am not to be deterred. One thing manic depressives have going for us is that we tend to think outside the box and we go in different directions from the mainstream. At least this manic depressive does (and I've interviewed others who do as well ... we'll get to this in more detail another time though) and that's what I do - I search outside of mainstream ideas for answers. After that long preamble, we finally get to the topic - zombies and bipolar depression. Which I'll tie into this mental and physical fatigue. 

There are several possible biological reasons for the fatigue that we won't explore at this time. These are hard to explore because they just don't appear to have found them or nailed them down (see Lieff's quote above). One area that looks interesting, however, is the critical role of glia cells in brain functioning (which Lieff touches on here). There is research to suggest (which I can't seem to find in my horror show of a filing "system") that sleep is essential to glia cells doing their thing. Not to mention sleep appearing to be critical for neuronal and synaptic housecleaning (yet more research for which I can't find the link which I was sure I'd saved ... sigh). 

During phases of mania we don't sleep. How much damage does this cause and how long does it take to "catch up"? Is this part of the reason for the depressive/low energy phase? Alas, clear answers are not currently forthcoming. But I have some other ideas I'd like to put forward for now, ideas that I strongly believe, based on my observations of my current depressive phase and current understandings of how brains work, have some merit. Which finally brings us to zombies - or more specifically, renowned neuroscientist David Eagleman's concept of "zombie systems"; the subconscious and automated brain functions that really drive who we are, what we do and how we do it. 

I touched on these two posts ago in my introduction of neuroscience 101 (<self-promote> which, by the way, got a big thumbs up from Jon Lieff and my Google+ neuroscience buddy </self-promote>) and I'd like to delve into them a bit more. It is, as I said before and which I'll repeat, critical to understand how little conscious control we have over our actions. Massive amounts of research shows that before an "idea" or "decision" hits our conscious mind - located in our frontal lobes - much deeper brain systems have already chewed on the data (key memories that the brain has stored unawares to "you") and presented it to "you". Chances are if you've had a "brilliant" idea that you think is "original" it's something (or various bits of thereof) your subconscious noted from somewhere else and filed away. In other words, you stole it from somewhere else (but don't worry, your subconscious will also create a story for you that it really is your idea). 

This is but one example. Your five senses are constantly testing the waters for anything that is of possible use to you or a danger to you (which is virtually everything from food to sex to rivals for those ... sorry, but yeah, we are that simple). All this runs mostly through our primitive lizard brains and limbic systems. Which, to remind, look roughly like this:



Our fancy-smancy mammalian neocortexes highlighted there in purple do lots of fancy stuff but that fancy stuff is mostly just adding and compiling and crunching more data that will also get run through the more basic hardware in green and pink - IE; simply running more sophisticated zombie systems (like math for example). And it's all this that "decides" what we do, not "we" (though we have no problem at all taking the credit). 

Zombie systems run most of what we do for a few reasons. One is because having automated programs that can run with no conscious input (and we do have some) is the most energy efficient way for the brain to operate (and energy efficiency is a super key driver of evolutionary progress - the more energy efficient, the better the chance of survival). 

Eagleman tells a fascinating story of the energy efficiency of chess master Gary Kasparov's brain (which they measured) during his famous chess match with the computer Big Blue. Big Blue may have been his equal on the chess board but it was no match for Kasparov's mental efficiency (he was humming along at about 20 watts while his machine counterpart was burning through thousands of watts and was almost literally melting down). 

While chess strategy is in the domain of our neocortex (reptiles can't play chess after all!), Kasparov's real mastery was of internalizing thousands of moves and counter moves into zombie programs so that his brain could run them automatically and thus very energy efficiently (and this is why many young chess prodigies eventually burn out out - they don't master this). Please make careful note of this because energy efficiency is an extremely major underlying functionality of the brain that will be my key point today.

Two is that this is simply how brains run - automated functions. This is how fruit fly neural circuitry runs, this is how round worm neural circuitry runs, this is how reptile circuitry runs, this is how more advanced mammal circuitry runs, this is how all creatures' neuronal circuitry runs, including that of homo sapiens. We're just further up the evolutionary scale. The underlying basics, however, are essentially the same. This is why neuroscience finds so much to learn about how our brain functions by studying simpler animal forms (I, in my initial ignorance, used to scoff at this but we do indeed have things in common with such simple things as fruit flies and there is much to learn, for another example, from studying the "connectome" (the wiring) of the simple round worm). 

A good deal of the programming comes "pre-installed" (basic organ functions such as breathing and pumping blood for example but, it turns out, also more "advanced" things such as human facial recognition) but the majority is learned "behaviour" (and "behaviour" is really just these subconsciously generated and run automated systems). The average human has hundreds if not thousands of programmed automated systems that guide the conscious you through your life. These would include virtually everything about what you do physically, what you "think", "decide", avoid, strive for, your "morality", philosophy about life and so on and so on. 

Even what you believe to be big life changing "decisions" were probably just barfed up by a complex combination of various subconscious zombie systems that may have been chewing on the problem for weeks, months or even years that are designed to nudge you this way or that through life. In other words, how well your life is going is completely controlled by forces mostly beyond your conscious awareness or control and depend entirely on how well your various autonomous systems were formed through genetics and environmental factors. 

Three is the simplest and most obvious. There isn't a living creature on earth that could get through any day if it had to actually "think" about what it did. And so it is for humans; it's far better to leave all the daily functions - large and small - to the three pound mass of tens of billions of neurons and more synaptic connections in one square centimeter of cortex tissue than there are stars in the Milky Way. 

That machine of yours contains awesome (in the true meaning of the word) amounts of computing and processing power and it's far better for conscious "you" to just stay out of its way and let it do the job that evolution brilliantly designed it to do (well, there do seem to be endless examples of brains that seem not so brilliantly designed to guide their hosts through survival but lets leave that aside for now). 

So what does all this about zombie systems - AKA, automated neuronal circuitry - have to do with bipolar depression? Well, a lot I believe. If how well your life is going, or has gone, depends entirely on subconscious automated systems, then by golly you'd better hope those systems are working well. And what working well is depends on two basic things: one, is some semblance of routine from day to day and two, and perhaps more critically, is how well and consistently your brain constructs your "reality". It doesn't really matter how "normal" either of these are, only that they are relatively consistent from day to day. And a bad case of long running bipolar disorder - like mine for example - decimates a) routine and b) your concepts of "reality". 

Bipolar disorder will, in true cases anyway (there are exceptions we'll get to another day), disrupt your life. Internal disruptions will lead to external disruptions which will lead to more internal disruptions which will lead to more external disruptions and on and on in a vicious cycle. I wrote some months ago a three part series about realities and the minds of bipolars and schizophrenics starting here

Between the various states of bipolar - mania, depression and mixed episodes - your brain will construct entirely different realities. In other words, when in these vastly differing states you will see the world in vastly differing ways. "Reality" one day might be to become the coach of a professional hockey team (as I once believed I would do) or "reality" might be that it's perfectly sensible to put a gun to your head and blow your brains out (as a particularly bad episode of psychosis was driving me to do or other self termination options presented as "reality" during episodes of mixed episode mania). It might be to be the most agreeable and seemingly nicest person in the world or it might be an almost unstoppable drive to punch the shit out of the guy in the car next to you. I've often said, roll the roulette wheel that day and get a different reality. 

The brain does not like this. It likes routine. This is why we call people "creatures of habit". It's because brains - AKA "us" - like it that way (as do all creatures of course). Even if it's a bad habit it's better than having your realities scrambled every second day. By saying your brain doesn't like it what I really mean is your zombie systems don't like it. Automated systems - even actual machine ones - need routine. And when your zombie systems start running amok, you start running amok. And because these are deep systems well, well beyond your conscious control, there's sweet tweet you can do about it. Fun, what?! It's not, of course, and this is where we get to the horrors - and they are horrors - of bipolar depression. 

As I said, the most fundamental problem with the depressive phase of manic depression is the complete and utter loss of energy. There are, I think is obvious, biological reasons for this (IE: actual brain damage (more later on this, I promise)). But a large part of the problem, I am now quite convinced, is discombobulated zombie systems thrown into complete disarray by constantly shifting routines and realities. Now let's go back to the paragraph about zombie systems and mental energy efficiency. If those systems aren't running smoothly then you will be burning a lot of energy just trying to do the most simple of things. 

Myself, when I started to think about them, I realized I have so many zombie systems that have been completely thrown off the rails, that I have almost nothing running smoothly and energy efficiently. And here's another thing about the brain. What starts to run amok in one place can cascade through others (Norman Doidge touches on this in The Brain That Changes Itself - it can go both ways, for good or for bad; it's part of neuroplasticity). 

One of our most fundamental zombie systems is our belief system; what we believe about ourselves and the world around us. Another is our system of thought. It is absolutely 100% critical to have confidence in these. For me, my last six years of bipolar zaniness has decimated these (the previous twenty to thirty years also are in the mix but it's mostly the most recent six years). Take my thoughts for example. Bipolar brains become very disordered. We will be presented with a constant barrage of what are known as "cognitive distortions" (part of what I mean by constantly alternating "realities"). These run from moderate to extreme paranoia to thinking it perfectly reasonable to prematurely terminate one's life to extreme grandiose thoughts and so on. 

I cannot trust a single thought in my head. Literally. Honestly. A single seemingly innocent incident (to you) can kick in some kind of discombobulated zombie system that will have me down by train tracks desperately waiting for a train to come along. Just. Like. That. <snaps fingers> Or that I'm the greatest thing since sliced bread and should run for PM of Canada. I am not in the least exaggerating. Or throw in frequent hallucinations, hearing voices, psychotic episodes and you no longer have any idea what "reality" "is". And it is these inner "realities" that generate your "thoughts". That's just what brains do - they generate a reality for you (yes, you ... all of our realities are internally generated by our brains). So I cannot allow my thoughts to run, as you can, on auto-pilot. I have to examine Every. Single. One. It is - excuse my French - utterly fucking exhausting. 

And this is just one example. Almost nothing runs automatically for me anymore. Not driving a car (something I've done since I was fourteen with almost no effort at all), not doing simple carpentry work, not socializing, nothing. I can be plucking away at seemingly the most simple thing in the world and suddenly hit overwhelm Just. Like. That. <again snaps fingers> Whatever I'm doing wherever I am I simply have to just stop and run my meditation program to try and empty my mind and let it reboot. This is utterly fucking exhausting. I wrote earlier about ego defense systems. These are yet more zombie systems (Eagleman touches on some of them - the stories we tell ourselves - in his book, Incognito) that are in complete disarray in me. I don't even know where to begin to put them back together again. Ego defense systems are designed to protect us from the big bad world out there (yours work so well that you are 99% unlikely to even be aware of their existence and what they do for you) and this I have to pick through one by one to try make sense of. This is exhausting. 

Oh, and then there's the little fact that all this disorder and mental chaos becomes a zombie system in itself. So you have to, once you learn awareness, fight all that. This is super deep hard wired stuff that you don't exactly just spin around on a dime. This is exhausting. 

There are, as I've said, other reasons for the well documented (for those of us who've researched it) exhaustion of the depressive cycle. Why, for example, when manic do we have nuclear amounts of off the charts energy? What generates that and how does that just "turn off" (or burn out more likely)? Why does the energy level slide so badly in the other direction? Many questions, almost no answers. But I firmly believe that having our deep and critical subconscious automated operating systems so messed up and their energy efficiency go out the window with that is a big part of the puzzle. And there are many, many days when it feels like all the king's horses and all the king's men can't put Humpty Dumpty back together again. 


Update, October, 2014

I can't believe it's been a year since I wrote this nor can I believe that I am still battling the relentless fatigue. But I must say that I've done enormous amounts of (exhausting) work to move past many of the issues I've described here. I think I have mental and physical routines down better and the mind scrambling (and exhausting) inner chaos settled down to a great degree. So things are improving. 

As well, thanks to a tip from Jon Lieff (mentioned and linked to above), I learned much about the physiology of the depressive phase fatigue which I summarized in a brilliant three part series. You can access them by clicking on the links below:

The Neuroscience of Bipolar and Major Depression Fatigue - Part One

Part Two

Part Three


5 comments:

  1. That is a great and keenly insightful point, +Brad Esau, regarding how bipolarism messes with the 'natural' functions normally handled by the zombie part of the brain. Most people aren't aware of just how much of their day to day activities are automated. And by having them unautomated, the tremendous tax on energy that entails.

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  2. It's only a part of the puzzle, Greg, but not an unimportant one I believe. I'd really like to pursue the idea further (IE: do some actual research).

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  3. This is very insightful and interesting. I may have missed the answer to this question because my concentration hasn't been so great but why do you not believe in the regular course of meds from psych? I know that sometimes that have awful side effects but I actually don't mind them because I am a complete crazy without them. And I do agree that are highs / manic /mania makes us super exhausted. That isn't really a question to me. I think it really messes with our brains and causes a dysfunctional kind of transmitting to happen in the brain, backfiring on us when we are depressive. It's strange though I take tramadol for chronic pain and it releases serotonin and I think that.Is part of the reason why when I am off my psych meds I am not as depressed as I could be but don't let me deceive you- I become so depressed I won't move off the couch unless I have to go to the bathroom or go outside for a smoke. I'm sure you may have seen the post on my blog I think in the Insider's perspective 1 where I talk about my worst depressive state. It would be interesting to know exactly was causes all these issues and why they happen to rather young people (like when you finally reach the mental breaking point and you lose it- although I have been 'losing it' since I was a teen. My doctors literally attributed it to fibromyalgia - fucking really guy? Which made my diagnosis lag behind. It was worse as a teen and real early 20's because I would demolish shot, I broke a guys window trying to get into his house to beat this girl who just jumped my friend to a pulp- you know shit like that- and I would get very hostile very quick- and when I finally got my diagnosis it was like a god send because I started to slowly learn to control some symptoms- serious hostility first. But I appreciate this post because it is an interesting and perceptive post. I like that you do your research and indulge us with what you think. It's great to see your perspective. Honestly today I feel manic and depressed and I feel like skipping my classes, which it looks like I am missing my deadline to drive to class on time right now. It's obnoxious because I feel to shifty to go but at the same time I feel annoyed that I feel too shifty to go. I should write a blog post on this. I see I am rambling now- oops sorry the brain is being tricky lol. Thanks for posting and I did reply to you on my blog post you commented on! Thanks Brad

    Lea

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    1. Hi, Lea.

      I hope you see this. I'm so sorry that I didn't see your comment until now.

      Boy, you have a lot to address!

      Fibromyalgia actually isn't a bad diagnosis in that the exhaustion is similar and, if I understand it correctly, there are similar underlying causes. But that is not a young person's disorder and, obviously, completely missed the mark of your fatigue being depression/bipolar related.

      Since writing this piece I have done enormous amounts of additional research into the fatigue. I wrote up a three part series on it starting with this post - http://tamingthepolarbears.blogspot.ca/2014/05/the-neuroscience-of-bipolar.html


      There are two basic reasons I don't do psychiatric medications - one is is that they made my life and mental states immeasurably worse - more depression, deeper depression, total loss of soul, more psychosis, worse psychosis and increased suicidal drive. In researching why that was, I found not only is that a common experience among many who've been forced to take psychiatric drugs, but also that no data exists that demonstrate long term better outcomes and efficacy for psychiatric drugs. In fact, all the literature points to worsening outcomes over time. So I do the natural work I do. :)

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  4. Thanks for sharing an informative and useful post on Bipolar Depression Treatment. To Know more Information Click on Here: Outpatient Treatment.

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