Saturday, December 21, 2013

Visions for the Future of Mental Health Care

Updated and partially re-written, July 2015

In the nineteen or so months since I first wrote this I have seen nothing to show me that the need for a facility of my vision has declined at all, in fact I just see more and more people slipping through the cracks of the mental health care system. 

I say mental health care but I don't really mean that. What I mean wouldn't fit neatly into a headline, though. What I mean by mental health care is advanced care for those specifically with schizophrenia, advanced bipolar disorder and major depressive disorder. You know, the hard cases. These are the people that the current system is failing so badly. The numbers speak for themselves. I won't get into them but research the numbers of suicides related to these three, research the numbers of people on the streets related to these three and research the numbers of people on permanent disability related to these three. Spend some time doing that - with a little old fashioned gumshoe street work thrown in to put faces to the numbers - and tell me how the current system is not failing these people. You can add my face to the numbers as well if you like - I am a textbook example of how the inept mental health "care" system - one based on drug therapy that's been proven in long term studies to not only be ineffective but also cause long term brain damage - has been utterly failing a very large number of people. 

There are other reasons people slip through the cracks that social scientists and those in the mental health care system simply do not understand.

Many of them will fit into two categories:

One, they will reject traditional diagnostic methods and drug treatment for their disorders. There are long reasons for this which I'll have to dedicate a separate post to but going on my own experience, the many people I have met in psychiatric hospitals and got to know as human beings (rather than "psych patients") and in talking to street people, these people become very hurt by and deeply mistrustful of the mental health care system, psychiatrists and drug therapy (which for them will be forced drug therapy). So they avoid the system even if at some level they know they need help.

Two, is that they tend to be very proud, independent people who want to be self-reliant and feel deep uncomfortable living on hand outs. They want mostly to take care of themselves in their own ways. This does NOT mean, as many mistakenly assume, that they "choose" the streets, it's just that all the alternatives are too difficult for them to bear and to negotiate. 

I have spoken to many of these people (and met them and got to know them) and they are at their core good, good people. But between mental health issues, the stigma and rejection of society and the cycle they become trapped in, they end up in untenable situations. 

My vision is for specialized long term treatment facilities for those disabled by one of these three disorders or those as I described above. The facility of my vision offers the best hope for people in this category of mental health problems. 

I can't even begin to tell you the mountains of research and reading I put into this, not to mention my not inconsiderable experience of being "on the inside" of the current mental health "care" system. 

This is what I want my true legacy to be - to see this vision realized. It would take massive efforts and real courage but it's doable. As government agencies are too closely tied to pharmacological and mainstream psychiatric models, it'd have to be privately run and funded. 

In the grand tradition of visions for the future, I bootstrap off of past or present successful models. They are as follows:

Soteria House:

Founded by Dr. Loren Mosher in the early 70s, Soteria House was a long term treatment facility for those diagnosed with schizophrenia. No medications, no doctors. NONE. And this was one of the most successful schizophrenia treatment programs in history. Patients lived there and interacted with each other and grad students (I believe ... not professionals at any rate) who received a bit of training. The patients could live in a low stress and embracing environment where they were free to talk out the workings of their inner minds in a non-judgmental environment. And patients by and large got better (which is defined by being able to return to work, raise a family and other basic societal norms). This is not the case with most people diagnosed with schizophrenia today. 

Hearing Voices Network:

I have personal experience working with a local chapter of the Hearing Voices Network. HVN provides a network of chapters that provide peer to peer counselling for those who, as their subheading reads, "hear voices, see visions or have other unusual perceptions" in a non-medical, non-judgmental setting. There is nothing, I can tell you, like peer to peer discussions about the mental phenomenon we experience for working through these issues and not be made to feel "wrong" or "broken" or "diseased" or otherwise judged. Unlike in talking with various "doctors" from the mental health care industry (psychiatrists, psychologists, medical doctors, and others), you talk with people who actually know what it feels like and who take a non-diseased approach to unusual mind phenomenon. My facility would provide a similar atmosphere and approach.  

Delancey Street Foundation:

Founded by Mimi Silbert in the 70s, Delancey Street Foundation has been doing the impossible for thousands of people for four decades. It takes the worst dregs of society - people labeled by "the establishment" as psychopaths, sociopaths and hopeless career criminals - and makes functioning human beings out of them that return to society. We're talking career prostitute drug addicts, pimps, gang members and all manner of "human garbage" that society seeks to lock away for ever then completely rehabilitating them and re-integrating them into society. Her success rate is vastly, vastly superior to the prison system. And get this - she does it alone. No staff, no doctors, no guards, no warden, no bars, no cells - nothing. She stands maybe 5' 1" and she handles about 1,500 of these career "scumbags" at a time by herself. No, I am not making this up. Mz Silbert and the Delancey Street Foundation is easily one of the most inspiring examples of what's possible for human recovery you could possibly find. 

Dr Dean Ornish's program:

Dr. Ornish also does the impossible - he turns around heart disease among those for whom triple or quadruple bypass surgery is the only option for living. Other than himself, there are no doctors, no hospital, no drugs, no surgery - nothing. It's all diet, meditation, yoga and a few other simple lifestyle changes. 

There are a few things that all of these have in common. One is that they are amazing examples of and inspiration for what is possible in human change and recovery. Two is that they are all long term residential facilities or programs. People stay in them for long periods under guided care. Ornish's is the shortest - about six weeks if memory serves - but it has long term follow up. Silbert's is the longest; a minimum of two years. The common theme is that the patients are in a structured environment tailored to their needs. I'll return to this in a moment. First I have to introduce:


The brain is not set. It can and will change itself. It will rewire around horrifically damaged areas (like in stroke victims) or in the cases of blindness, it'll "remap" and restructure areas to boost other brain functions to compensate. It'll do this naturally on its own but that does not always lead to the desired results. It works best in structured environments (do you see where I'm going with this?). Neuroplasticity is a sexy popular term that gets thrown around a lot now. But the rub is that it needs structure and repetition - neurons that fire together wire together is how it essentially works. And it needs that "fire together" to happen repeatedly and in close time proximity, two things for which a structured environment and program work best. Hence the above three facilities. Silbert doesn't know this, but her program produces massive plastic change in the brains of her wards - that's how they change from sociopathic criminals into empathetic mainstream citizens. 

Edward Taub of the Edward Taub Clinic pioneered a unique therapy for stroke victims based on the principles of neuroplasticity and this too, I believe, serves as a good model. Again, the patients stay in the facility for extended periods receiving much personal help and encouragement. 

Now, my own thoughts. 

For people with major mental illnesses, the only course of hope is to move forward. But here's the rock and hard place catch-22: A) they cannot do it alone and B) their very brain conditions rob them of the mental faculties to move forward. In order to move forward, they need to be able to work and take care of themselves. Living normally like this is what true recovery is but they can't take care of themselves or work due to their mental conditions and society's view of them (which is not dissimilar to how society views the career criminals that Silbert turns around and enters into society) so they're stuck. 

The only way these people can truly be helped is in a long term facility that A) heals their minds, brains and souls and B) teaches them job and life skills that will help them return to functioning within society. I am not aware of any facility like this. Psychiatric wards certainly don't do this (ask anyone with one of the illnesses I listed who has spent time in one). Public mental health programs try to help with job skills but don't provide long term living and treatment facilities. It's a real crack in the system. When you hear of people "falling through the cracks of the system", this is the massive chasm into which they fall. 

The facility I envision would be the net at the bottom of that chasm. 

In the facility I envision people would get a highly specialized program designed to heal their minds through neuroplasticity, would have a safe, peer supported environment in which to recover from the rigors of life in a society that has rejected them and heal their ravaged souls, and they'd learn job skills that would help them build dignity and esteem and get truly back on their feet again. The program would involve specialized forms of yoga and meditation specifically designed to "build up" the brain regions that are misfunctioning or underfunctioning or, in the case of the ever overactive amygdala in the majority of people with difficult cases of mental illness, calm down brain regions. Jeffery M. Schwartz deals with OCD and other disorders very much in this way, using no medications. There would be much peer to peer group work and individualized therapy. 

The Delancey Street Foundation provides the financial model; aside from doing all this remarkable work by herself, Silbert's program is - get this - completely self funding. She gets no government grants, no private grants or funding - nothing. The program entirely pays for itself (which is why it works). 

The present dominant paradigm of mental health care as run by the alliance between the psychiatric and pharmaceutical industries are not making mental health problems better. Statistics bear out that things are instead getting far worse (and all predictions are for that trend to continue). It is time for widespread alternatives to psychiatric hospitals and forced drug therapy. My vision is an attempt to give an idea of what one alternative might look like. 

Additional notes added June, 2014

A great deal of the daily activities of the program I envision to help heal these people minds and to help their ravaged cells in their brains and bodies recover would revolve around the following:

  • Music therapy. There's just an enormous amount of evidence pouring in from the fields of neuroscience that show the kinds of benefits for the brain that come from regular and carefully directed music therapy
  • Dance therapy. Same benefits as music but with an additional physical component
  • Art therapy. Like music and dance, it opens up and stimulates vast areas of the brain that can help facilitate emotional, spiritual and physical recovery 
  • Yoga, meditation and qi-gong. All of these have been demonstrated for thousands of years (and now through more scientific research involving advanced brain scan techniques) to greatly ease and reverse the damage from chronic stress (which will be a major part of what all mental health patients will be battling) along with building healthy new attitudes and outlooks as well as establishing essential daily physical exercise routines
  • Lifestyle management skills. This would involve specific meal preparation skills in which patients would learn nutritional therapy from shopping to meal preparation
  • Cooking therapy would be part of the above. Learning the joys of preparing oneself nutritional, tasty and inexpensive meals. Proper diet is a huge issue and shortfall in many suffering long term mental health issues
  • Peer to peer counseling and support based on understanding and compassion, rather than the stigmatizing judgment most people are subjected to
All of these daily activities and routines would be built on the foundation of rebuilding the esteem and souls that have been decimated by years of living with one's mind torn apart by inner turmoil, being rejected by society and kicked to the curb of life. 

It is simply not necessary for these lives to be wasted in this way. A great deal of recovery can be achieved and a return to productive society attained.

As of this writing in July 2015, a small groundswell of support has begun to start bringing this vision to fruition. 

Taming the Polar Bears is going to be registered as a charitable foundation able to take in donations for and do fund raising for establishing this much, much needed facility. 

I am hoping an announcement regarding this will be forthcoming in the next few months (though I am in the midst of considerable challenges myself). 

Bradley Esau

Tuesday, December 17, 2013

Mania and the Story of Icarus and Daedalus

This post is from a special request from a bipolar bud of mine who follows this blog. In a conversation with him the story of Icarus came up and I mentioned that I'd researched that story in relation to bipolar and found that there was indeed a link. He in turn mentioned that he'd greatly appreciate reading what I'd found in a Polar Bears blog post. So this is for him. Here's to you, bro. 

The following is an excerpt from my (unpublished) book manuscript.

Excerpt from Dancing in the Dark - Why?
March, 2013

The hallmark of true bipolar is mania – and let's try to strike from your mind all the descriptions you've ever read about bipolar, or if you are “bipolar”, your own concepts of your experiences – so let's try start with a clean slate. I think to understand anything, we have to drill down into what this poorly understood phenomenon is. Let's go back a few years and see what we can find pre-pharmacological era (IE: pre-drug tainted era and pre-run away diagnosis era (1)). Let's set aside all these unscientific observations of behaviours, the so called “symptoms” and get down to the bare bones of “mania”. If we can find that, perhaps we can solve some of the mystery of bipolar.

The earliest reference I could find of mania is in the story of Icarus. From Wikipedia, the story from Greek mythology: 

Daedalus (his father) fashioned two pairs of wings out of wax and feathers for himself and his son. Daedalus tried his wings first, but before taking off from the island, warned his son not to fly too close to the sun, nor too close to the sea, but to follow his path of flight. Overcome by the giddiness that flying lent him, Icarus soared through the sky curiously, but in the process he came too close to the sun, which melted the wax. Icarus kept flapping his wings but soon realized that he had no feathers left and that he was only flapping his bare arms, and so Icarus fell into the sea.

When I again started to try to figure out clearer what bipolar was all about and, more importantly how mania actually affected me personally, the story of Icarus for some reason leaped to mind. Well, that's not true, I know the reason. It came to me when I was writing The Roller Coaster chapter (2) and these flights of fantasy of mine followed by hard crashes reminded me suddenly of the story of Icarus and his flight too close to the sun (getting too high) and then crashing to earth (the inevitable emotional crash following mania). I then decided to look up the story, read the Wikipedia entry and bingo – this, under Interpretation:

Literary interpretation has found in the myth the structure and consequence of personal over-ambition. An Icarus-related study of the Daedalus myth was published by the French hellenist Fran├žoise Frontisi-Ducroux. In psychology there have been synthetic studies of the Icarus complex with respect to the alleged relationship between fascination for fire,enuresis, high ambition, and ascensionism. In the psychiatric mind features of disease were perceived in the shape of the pendulous emotional ecstatic-high and depressive-low of bi-polar disorder. Henry Murray having proposed the term Icarus complex, apparently found symptoms particularly in mania where a person is fond of heights, fascinated by both fire and water,narcissistic and observed with fantastical or far-fetched-imaginary cognition.

So here we go, this is good stuff. Frontisi-Ducroux studied mythology and not modern psychiatry and his work was published in 1975 pre-dating all of today's nonsense notions of bipolar. Henry Alexander Murray (May 13, 1893 – June 23, 1988) was an American psychologist who taught for over 30 years at Harvard. He was Director of the Harvard Psychological Clinic in the School of Arts and Sciences after 1930. So again, a pre-modern era thinker and I think we can gain some insight from his interpretations of the legend of Icarus and the phenomenon of bipolar and mania that is not tainted by today's run amok notions.

First we see mention of over-ambition or high ambition. Yes, this fits well with the older concept I've had of mania and matches my own experiences from the 1991 to 1994 years when my "ambitions" included taking over the head of a large corporation, taking over as head coach of the Ottawa Senators NHL team, trying out for the BC Lions professional football team (at the ripe old age of 34 and with zero prior professional experience) and of trying out for the vacant lead singer spot of an internationally known rock group (along with a few other “up there” delusional ideas). Yes, I think these definitely qualify as “overly-ambitious”. We see mention too of the “pendulous emotional ecstatic-high and depressive-low” of bipolar disorder. Well, that describes my worst periods of rapid cycling to a 't'. 

Now as for fondness of heights, fascination with both fire and water, I can't say any of those fit me. (3) I can't recall any particular interest in any of those. I have though read of others with mania feeling like “superman” and wanting to explore heights (Icarus like) and that these literal ascensions to heights often lead to deaths from either believing they could fly and trying to or from accidental falls. Narcism and “fantastical or far-fetched imaginary cognition” again fits my model to a 't' though. I certainly fell in love with myself and my ideas, my fantastical “grandiose thoughts” and my thinking then was certainly far fetched imaginary cognition. My cognitive powers got way too carried away.

But let's examine this portrayal of mania more closely. Now in the story, Daedalus constructed two pairs of wings. Now this suggests that Daedalus wanted his son to fly higher, in other words was encouraging Icarus to have ambition. Now if we return again to The Roller Coaster and look at my how my concepts of ambition were influenced by the short story Jonathon Livingston Seagull, we can again see the metaphor of flight and “flying high” and that at that point of that chapter that I saw nothing wrong with this ambition. 

Is there anything wrong with ambition? No, this is what makes humans what they are. This is what leads to all discoveries. This is what put men on the moon. Ambition is one of the – back to the human brain for a moment – fundamental things that separate the human mind from the animal mind (or at least we've taken it far farther than animals can. We can see some signs of ambition in the animal world as well). 

But – but! - Daedalus also warned his son not to fly too high, not too close to the sun. In other words, not to get overly ambitious. Daedalus understood the dangers here (from his own previous experience?) And look at what the description says – Icarus got “giddy from flying too high” and that he “soared through the air curiously”, and got carried away and could not control his flight and he got too high, got “burned” by being too high and thus crashed back to to the sea where he drowned (the metaphor here for depression... how we seem to “drown” in the sea of depression). So is “mania” just a form of ambition, of ambition being carried away by giddiness, by, in other words, over excitement? Of “soaring through the air too curiously”? This is an extremely important part of our examination here and we're going to drill down into this with as much detail as I can muster.

Over excitement, giddiness, again is as age old a normal behaviour as mankind. Nothing new under the sun here. So is “mania” excitement and giddiness run amok and carried to extremes? Again, this could describe many, many people. Where is the line between “mania” and excitement driven passion? Once again, and I'll just keep hammering this point home, are we looking at normal human behaviour and not a pathology of an “illness”?

But let's carry on. My “why?” is not done with this yet. So here we go, we have this basic concept of excitement and giddiness leading to getting “too high”. Now, again, is this a bad thing? I think we here have to explore the part of mania that has been buried in the mad modern rush to medicalize it and drug people into a coma to “control” it. Here we explore the up side of “mania”.

Mania has long been linked to creativity and, as we've seen, ambition. A look at famous figures thought to be “bipolar” (or manic depressive) is impressive. Since creativity and ambition are part of the mix of what's thought to be mania, this naturally leads to some famous people with big accomplishments. But again, in my drive for pure data, we have to go back to pre-pharmacological revolution figures. I can't trust any diagnosis or manifestation of mania (and hence bipolar) in the drug era (50's onward). In fact, it's hard to trust any of them because “self-medication” has always been a problem associated with bipolar like symptoms. This puts a fly in my ointment of seeking purely raw data (IE: unmedicated subjects) so I'm in a bit of a dilemma here. 

Ernest Hemingway, for example, I see is on my list of “bipolar” people. We all know how creative Hemingway was and also we can see a very adventurous life – two things that I certainly can attest for signs of possible mania in a person – but he was also a famously ferocious drinker and alcohol is rather notorious for mood alterations in people. Many people, it has long been observed, lose their inhibitions when high on alcohol and do stupid things – exactly as we see in accusations of “manic” behaviour. Alcohol can also deepen depression, the other side of mania. So it is impossible to know with ol' Ernest, outside of pure speculation, whether the metaphorical chicken or the egg came first here – did alcohol use trigger mania and/or depression, or did he drink to control the moods? Impossible to know. And once we introduce any foreign substances to the brain, we know that all bets are off as we saw in our examination of psychiatric and so called recreational drugs back in Analysis of Prescription. (4) It is just, therefore, too hard to know where the lines of the mental phenomenon of manic depression and signs of alcoholism are, the lines become too blurred. So let's move on. 

End of Excerpt

I then went on to explore the lives of several famous people from the past (including Isaac Newton) but that gets too long to include here. Perhaps another time. 

(1) There is a lot of back story here as I wrote several massively long chapters tearing down modern psychiatry's notions of "mental illnesses". These were not my own creations but instead sought to consolidate enormous amounts of academic literature and the works of science research writer Robert Whitaker. It was all, in other words, very well founded evidence. 

Whitaker's Anatomy of an Epidemic is absolutely must reading. In the chapter Bipolar Boom he very firmly establishes that many, many cases of "bipolar" that he investigated (and he is a Pulitzer Prize nominated and highly respected science investigator and writer) were either connected to recreational or psychiatric drug use (IE: the "bipolar" cleared up when the drug use stopped) and he presents very strong medical evidence for this and some case studies. He also very firmly establishes the massive "catch basin" for bipolar diagnosis that the pharmacological/psychiatric alliance established in order to write as many life long prescriptions as possible. His work is extremely well researched and scientifically established.

(2) The Roller Coaster is a chapter in my book in which I describe a period of some particularly insidious rapid cycling that lasted roughly 1992-ish to the fall of '94. If you are bipolar and have never experienced true rapid cycling, consider yourself extremely lucky. I wouldn't wish it on my worst enemy. 

(3) This is not exactly true. Later, when I ruminated on my various periods of high suicidality in my life, there were many times I was incredibly - and nearly uncontrollably - drawn to water. These were bizarre, almost hallucinogenic or mildly psychotic experiences (hearing voices, commands) that implored me to come into the water and go under to join this voice calling to me. It was like it was asking me to join an underwater world. I am quite convinced that many people who commit suicide by drowning (something very, very hard to do due to very powerful instinctive reflex actions, by the way) by succumbing to voices and commands very much like I experienced. 

(4) Anatomy of a Prescription was a long chapter in my book manuscript on the science, supposed pathways of efficacy and function, and side effects and brain damage of psychiatric medications. Again, these were NOT my findings, but merely a collection and summary of related academic data and research by psychiatrists dedicated to non-pharmacological methods of mental illness treatment. It was all very well supported by long term empirical research analysis and medical research data. 

Final note: this portion of my manuscript was written when I was desperately trying to believe that bipolar was not as serious of a mental health condition as psychiatry believed and presents to the public and I was exploring all aspects and angles of several major mental health disorders. I was also desperately trying to believe that mania was not "bad" (and I was very manic at the time of this writing). Nonetheless, I still strongly support all the views I put forward in this chapter of my book manuscript. I still maintain that much of what is understood about "bipolar" is nonsense put forward by the pharmacological/psychiatric alliance almost purely in the interests of profit, a point I'll further establish another time.

Whether mania is "bad" or not will have to wait for a future blog post. (Hint: in true bipolar disorder it probably is).