Thursday, February 25, 2016

Neurochemical in Focus - Dopamine




Way, way, way back in 
Neuroanatomy 101 I mentioned briefly neurotransmitters and the neurotransmitter dopamine (pronounced DOUGH-pah-mean). I've also written about dopamine in my other blog in a post called Dopamine the Bus Driver (which was a very popular post among my neuroscience and brain nerd buds back in its day, or at least among those who liked fun ways of explaining something complex) and it came to me this morning that it was about time we had a closer look at neurotransmitters like I promised back then.

As I've talked about ad nauseum, whatever it is we are experiencing, or are able to do or not do, or all of our behaviours good or bad, compulsive, impulsive or planned, all of our thoughts and emotions and motivations, everything - in other words - about "you" and who and what you are, even your very soul - is all one hundred percent created by our brains. So when we want to know what's going on when we are experiencing difficulty or witnessing someone else who is, it is understanding how our brains work where the answers lie. Which is why I am so motivated to study neuroscience and then - tada! - crunch all the complicated stuff down into something that makes sense to mental health suffering peeps following this blog and those who want to know how to get themselves to move forward. 

The brain does a lot of thing as it hums away 24/7 from not long after conception to not long after you draw your last breath, all of which requires communication of one kind or another among the eighty-six billion or so neurons you have and among the hundreds of small and large individual and highly specialized regions that must be coordinated to produce "you" and guide you through life. There are several different modes of communication and coordination that the brain utilizes but today we're going to look at the critical and essential role of neurotransmitters or neurochemicals (so called because a) they help to transmit information and b) they are made of chemicals). 

Now we could spend forever poking around among the astronomically (sort of literally) complicated brain looking for answers out of countless (almost literally) possibilities, but today we're just going to examine dopamine because a) it is one of the best understood neurotransmitters and b) its role in our moods and behaviours is probably most pertinent to us long suffering mental health peeps. 

To be clear up front, I am not saying that what we look at here today is the thing with, for example, a particularly entrenched or "treatment resistant" case of depression but it is, as we'll see, a very important aspect to understand, consider and ultimately work at.

There are a number of things about neurochemicals that are vitally important to understanding a good number of other things we're eventually (or have already started) going to look at as well - such as memory function, brain fatigue and cognitive difficulties, neuroplasticity and the stress response system among others - so I thought this morning that it was high time we got to this. I understand that this may all look rather intimidating to some, but we're going to set that aside, let ourselves believe that "I got this" and we'll get ourselves to a better understanding of how all this works and why it's important. 

Okay, first let's get to the why this is important part. 

There are all kinds of things us mental health peeps will be experiencing as part of whatever it is we're suffering from (my main guess would be depression, but our topic here today is also critically important to understanding bipolar disorder, schizophrenia, ADD/ADHD, and others). Two main things we will be suffering is difficulty in experiencing pleasure and being motivated, the two very things that are major functions of dopamine pathways. 

We hear a lot about "brain chemicals" and the reason for this is how the popular press has picked up on and repeated the psychiatric and pharmacological explanations for "mental illnesses" which in a nutshell is explained as "chemical imbalances". This explanation has reached virtually mythical proportions since this enticing idea first took wing back in the sixties. Unfortunately, a) there remains no conclusive proof that any mental illness is due to a chemical imbalance, b) decades of subsequent neuroscience research has revealed that all human behaviours and mental experiences are vastly more complex and involve possibly dozens of other brain functions other than "brain chemicals" alone.

Nonetheless, neurotransmitters are unquestionably important, but we must understand them in broader contexts and that they are only a part of a enormously complicated set of processes. 

Okay, let's now look at what neurotransmitters do. 

As mentioned, we have billions and billions of neurons. There are many kinds of neurons with many specialized jobs. Whatever their job, neurons are like infinitesimally complicated "storage devices". Regular readers will remember that whatever is stored in a neuron or a given set of neurons is useless to the "big picture" if they cannot pass on what they "know" or "want to do" to neighbouring neurons or neuronal groups. Neurons communicate with each other via axons and dendrites. Axons send "data packets", dendrites receive.

These look something like this:




Okay, so there are a couple of neuron cell bodies, an axon sent from one to the other, and a number of receiving dendrites. This is a highly simplified artist's rendering, of course, but it allows us to see the basic idea. The neuron on the left is sending, the electrical pulse is depicted going towards the receiving neuron and you can see that the axon branches out to contact many dendrites. In actuality, however, a single neuron will have many axons branching out and may have up to ten thousand such connections with neurons near and far (depending on its job(s)). Now, you can have all the wiring you want running all over the place, but without a very key "connector", nothing is going to go from one set of wires to another. No transmission will take place. 

And in the brain, those "connectors" are called synapses. 

A synapse looks something like this:



We don't need to understand that in too much detail, but you can see that at the axon end of things (sending) you have little sacks of neurochemicals and on the other side of the "cleft" (that little space between the two sides, about 20 nanometers across) you have little receptors. 

Some of you may recall what old switchboards look like and how they worked. For those of you who don't, they looked like this:



As you can see, we have wires and all kinds of possible circuit combinations. You see that thing in her hand? That's a jack. That's going to connect a wire from one circuit to another. Until that is plugged in, there's no connection, no transmission from one party to the other. Or once it's unplugged, the connection is broken and the transmission stops. So we can think of a synapse as that thing in her hand, a jack of sorts. Except that in the brain, it's a two step process. First we have to create a connecting point, a jack and a socket - that's the two sides of the synapse. The second process is once the connection is made, the actual transmission of information from one party to the other will be a chemical process (which is the norm throughout animal and plant cellular structures that need to somehow communicate and coordinate). 

What happens between neurons when they want to communicate is that one will get all excited, get all jacked up, and want to send messages to all kinds of neuron buddies near and far to get something going and then will send an electric impulse down its axon or axons (in what I likened before to Morse code) which will stimulate the release of the neurochemical to complete the transmission to possibly tens or hundreds of thousands of neurons, those in turn pass all the exciting news on to hundreds of thousands more neurons and thus big thoughts or memories and all kinds of things happen. Kind of like sending out a mass Twitter message to thousands of receivers. 

Your brain only has a few more "jack and socket" connections than that switchboard above; like several hundred trillion more. 

Okay, so that's the small end of this neurochemical business and several hundred trillion is a crazy big number, so we'd better further clarify what's going on with dopamine and break that down to size. 

Each neurochemical will have one or a few specialized communication roles (but only roles) to play that involve specific brain (and thus behaviour) functions.

Let's have a look at the broader picture of the roles dopamine play.




I chose this image because it shows serotonin as well. Serotonin has become practically a household word because of advertising's and popular press's roles in making SSRI (selective serotonin reuptake inhibitors) based antidepressants one of the most popular drugs in the western world. This is something we must really examine more closely but that will require a dedicated post on its own so we're going to leave that aside for now. We'll instead focus on the left. There are a few key brain regions illustrated there as well that are critical to our understanding of the big picture of dopamine's roles in the brain and our behaviours so we will look at those in more detail. 

Let's first look at functions. We have (as you can see):

  • motivation
  • pleasure
  • motor function
  • compulsion 
  • perseveration 

Motivation is what keeps us driving towards a goal. When we are feeling driven, or "locked on", that's dopamine at play. It's involved in a complex signaling system that makes sure we stay locked on to that. Sounds great, right? Not so fast. Unfortunately, what your brain decides is a "goal" may not be in alignment with what goals are best for you. This is absolutely critical for understanding many addictive behaviours and other undesirable behaviours. More later.

Pleasure is what we feel when we achieve something that our brain considers rewarding. Like motivation, however, this could be a good thing or bad thing. But pleasure feelings, like motivation feelings, can keep us locked on to or driven toward a task or goal in anticipation of that all delicious "reward" hit the dopamine gives us. Motivation and pleasure are intrinsically linked in what we'll call our "drives".

Motor function are what's involved in our coordinated physical movements (both conscious and unconscious) that are in part controlled by a set of nuclei located in the limbic region. This region is connected to very important brain stem regions and the cerebral cortex. It's critical for all kinds of fine motor control functions. This area - and dopamine - are at the root of Parkinson's disease. When we look closer at the dangers of long term pharmacological treatments of various psychiatric disorders and the use of anti-psychotics, we'll learn why these are so damaging. The most commonly used class of anti-psychotics "dampen" dopamine circuitry and synaptic transmissions which can cause all kinds of havoc in the long term. 

While somewhat different, I'm going to group compulsion and perseveration together because to most observers they will appear very similar. Both refer to some sort of repeated behaviour that goes against our greater good. I'll make it quite clear why this is below. 

The dopamine pathways are a very old (as in hundreds of millions of years old) part of our brain hardware and systems. All animals have essentially the same system from reptiles up to birds to all mammals. Its role was and remains very simple - keep a creature doing something critical to its survival. Find a great source of food? Bam, a dopamine hit helps insure that the creature remembers and goes back for more. Successfully mate? Bam, a dopamine hit makes sure it remembers that and to do it again.

It is not, I'm afraid to report, for the most part much different among us members of the homo sapien species. Just more sophisticated behaviours and "goals" involved. 

And, as world renowned neurobiology and human and animal behavioural expert Robert Sapolsky has demonstrated, it's not just the "hit", it's the anticipation of the hit that keeps this system jacked. 

For example, a mouse might be trained to pull a lever in order to get a treat. To start, it will get a treat each time it pulls the lever to condition into it the expectation of a reward (the treat). What's happening here is that dopamine pathways and (very important) feedback loops are being tuned towards associating the dopamine hit with this specific task and reward. Afterwards, the treats can be reduced to only being released every tenth time. But the mouse, once conditioned, will keep pulling on that lever until it gets the treat (and thus the big dopamine hit). It will get to the point that you can remove the treat element all together and it'll keep pulling that lever over and over and over again until it drops with exhaustion.

Silly mouse, right? 

Well, it seems silly until you go to Las Vegas (or any casino) and watch people sit at slot machines. They, like the mouse, will sit there pulling that lever (or press buttons in modern machines) in anticipation of a reward despite astronomical odds against that reward happening. They will eschew food, going to the bathroom, going home to their families and all kinds of other essentials for a proper life to sit at that machine and what keeps them glued there, my friends, is our dopamine reward system. "Silly" mouse indeed. At least the mouse isn't pissing away the family fortune.

Thus we can also see the connection to compulsive behaviours or perseveration. 

But laugh not. Many if not most people will have similar "dopamine kick" addictions. Or compulsive behaviours and so on. Nobody gets to play judge here. Shopping is like this. Buying and eating food. Buying a new vehicle. Our paycheque. A college degree. Going to heaven. You name it. When we feel turned on and motivated about and towards something, this very old system is very much at the root of it. (1)

About the only difference in humans is the variety of things we'll do in order to achieve that reward and the time we'll take to achieve it. Not to mention what we'll put up with to achieve it. We can stay locked on a dopamine anticipation loop for years. That's the "planning and judgment" parts of our vaunted frontal lobes that plays a role. 

Okay, so there's the "up side". 

Now to us depressed, demotivated peeps who struggle with feeling pleasure and sticking with things.

What's up there?

Now is the time to understand that we're somewhat more complex than mice (or primates or lizards or birds or ...) after all.

To understand "us", let's go back to the diagram. You can see that these all important motivation and pleasure pathways originate in a deep brain nodule called the Ventral Tegmental Area. 

Let's look at a more isolated image showing the VTA. 


That's where dopamine originates (a process the details of which we'll leave to more advanced brain nerdery). 

We can think of the VTA as a "switchboard" lady like we saw in the image above. 

Now, what's extremely unfortunate in virtually all the images we see depicting the dopamine pathways (and serotonin, for that matter ... or any region of the brain) is that they do not show the massively complicated feedback loops connected to the VTA. The VTA switchboard lady doesn't just sit there all by herself ringing up our frontal lobes and whatnot getting us all excited and motivated all on her own volition. No, no, no. That's more akin to lizard level dopamine pathways. Our "human grade" VTA Lady has dozens and dozens of incoming circuitry sending information packets or demands of varying sorts. She takes an incoming call - "shoe sale ahead!", for example - and connects that to the pleasure/reward destinations in the brain. 

These calls can come from all over the brain. Which, despite our remarkable similarities to lizards, baboons, birds, dogs and all other animal species, is what makes humans vastly more complicated and varied for all the circuitry that can potentially stimulate the VTM (Lady) is an incredibly complex set of networks (yes, yes, I know what many of you are thinking but really, we are more complicated, even the persons you may regard as simpletons). 

It's these incoming calls that we want to better understand. What rings up VTA Lady? What rings her bell? Or, to understand lack of motivation and pleasure, what does not ring her bell?

Okay, mentally suffering peeps, this is where the rubber meets the road in our understanding of our moods and this deep brain system involved with them. 

I talk in numerous posts a lot about belief. Various brain circuits involved in creating and disseminating back to us our beliefs are a huge feedback loop to the Ventral Tegmental Area (hereafter known as "VTA Lady"). Belief and imagination are tightly linked and it is the belief of good things to come and the strong imagination thereof that will often keep us moving forward despite possibly great odds against us or obstacles in our way. This can be seen throughout our evolutionary history (and is thus tightly linked to religious beliefs and the comforting and motivating thoughts of going to heaven). A lot of what we think is "good behaviour", for example, is really just having a really strong connection to VTA Lady keeping that pleasure/reward system locked on to a goal related to beliefs associated with religious morals (sorry, morally superior feeling people).


So, let's look at this through the lens of our experience. 

We don't get "depressed" and demotivated out of the blue for no reason (though I know it feels that way; this is the big disconnect between our subconscious brain mechanisms - like this one - and our conscious awareness or experience that I often refer to). If you look back on your life, all kinds of painful events will have pounded the living shit out of your beliefs. So often your greatest beliefs and desires have been crushed by life. We often keep going, but for a variety of possible reasons, we get crushed again and again. This will begin to have effects on all the circuitry involved in motivation and pleasure we're looking at here today. The feedback system to VTA Lady just keeps sending too many painful messages. Pain becomes too associated with desired rewards. VTA Lady just gets to the point where she says "fuck this shit, I'm not taking any more calls from that belief area". And after a while, all the lines of communication between various brain areas associated with beliefs and VTA Lady begin to atrophy (literally). Worse yet, the areas in the brain associated with feeling the hits of dopamine and thus pleasure and motivation because of a lack of stimulation begin to atrophy as well. This is part of the "dark side" of neuroplasticity. 

And this same process can happen with many of our goals and desires as we experience defeat, disappointment, hurt and other negative impacts and results for things we started out feeling excited and motivated about.

There are people who are more resilient to this, but for many of us for a number of reasons this is a huge part of the process that creates the sense of "giving up" that we so strongly experience so often. 

So there's that. 

But we may also notice other painful experiences associated with what we'd normally think of as motivating and pleasurable and this too will send negative feedback information to VTA Lady and again, after a while she just throws in the towel and stops taking calls from those areas. And slowly, bit by bit, almost without being aware of it, we find ourselves getting more and more down and demotivated and less and less able to feel pleasure. There will probably have been major blows and a good number of smaller ones. Either way, gradually our abilities to feel motivated and pleasure are eroded. This is not our imaginations, this is the result of actual changes in vital brain circuitry, the circuitry outlined here in the dopamine motivation/reward system. 

However, in a good number of people where pain and pleasure get "crosswired" in key areas of the brain they actually become motivated to seek pain and their dopamine pathways become somewhat tragically dialed into these behaviours. Something to consider when we try to understand seemingly incomprehensible behaviours like cutting, carving or why people keep returning to abusive relationships and other what appear to be destructive behaviours. This is a very dark side to neuroplasticity indeed (I may at some point get to recounting some very interesting case studies and the inspiring resolution of them).  

Or - OR! - this system may get "hijacked" and drive us towards behaviours that seemingly dull our pain by giving us pleasure elsewhere. Hello almost all addictive behaviours. There is some very good recent clinical and real world research (2) that is now more deeply understanding the very strong relations between pain and trauma, the dopamine reward system and destructive/addictive behaviours of all kinds. Very important to understand and keep in mind. 

Okay, now that we have a better understanding of all that - or at least the seed of understanding planted - we come to the $64,000 question. What the hell to do about it?

Regular readers should see the first two coming - we begin with self-forgiveness and compassion for ourselves. For if you are struggling in any of the ways we looked at here, that is not "you", but instead very deep and powerful brain systems that for all kinds of very strong reasons have gone awry. "You" don't just reach in there and magically fix that. Nor does "helpful" advise from well meaning friends and relatives. This is why you can't just "cheer up" on demand. Deep stuff is not as it should be. 

So can we get it back to, or at least closer to, what it "should be"? 

Yes.

This is what I have successfully done and continue on the road to doing. This is why I talk about the importance of belief, thoughts, spirituality, brain training, the concept and power of neuroplasticity and so on. For it is small daily tasks that will slowly dampen down the pain circuits and rebuild better hope and belief circuits that will begin to reawaken motivation and pleasure regions involved. This is why I work on at least some or even just one or two, of my positive difference making fundamentals daily - all of those can help to repair and rebuild what we briefly looked at here today. 

In other words, what we need to do, in essence, is rebuild the dormant or broken down communication lines to VTA Lady who will in turn start to "ring up" and connect us to the feelings of motivation and pleasure that we so often struggle with. 

We will look more deeply at how meditation and mindfulness CBT can help, how certain positive visualization exercises can help, how specific mental and physical "letting go" exercises can help and much more. 

And I know - I deeply know - that it is not easy. But I can assure you one hundred percent through my experience, that of dozens of case studies and just by the pure science of how it all works that is possible. Even for you. Yes, you.

What's important to know and understand, however, is that we can never go back to who we were and what we had before. This is why the practice of letting go is so important. We must learn to set our aims to new horizons, to slowly build new and pleasurable memories. We learn to let go of painful events of the past. Again, I deeply know how hard that is.

But step by step, day by day, if we take the right steps, we can get there. 

Yes. We. Can. 

Thank you as always for reading. 



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, February 20, 2016

Positive Difference Making Fundamentals in Focus - Habit Change




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. 

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 from the Polar Bears team!







Friday, February 12, 2016

Endorsements from Professional Associates and Readers





The world of mental health, both clinical diagnosis and treatment, is bewildering at best. Complicating the picture further are the stereotypes imposed on those who most need support from their families and communities. While well meaning community leaders, scientists and mental health practitioners can press forward with changing the quality of lives for those challenged by the extremes of mental experiences, it takes the honesty, bravery and intellect of someone like Brad Esau to bridge the gap for those in need of understanding and guidance. Brad isn't a trained scientist or clinician. Brad is a compassionate and intelligent individual who can speak directly to the experiences of some diagnosed with a mental illness. Whatever your diagnosis or lack thereof, there's something about the raw honesty and well thought out advice in Brad's conversations that will help raise the quality of your life. I recommend that you add Brad's work to your reading regimen.



Jeffery Mercer,
Clinical Psychologist



I came across Brad and his blog about two years ago (fall of 2013) and have known him and followed his blog since then. From the enormous creativeness of the blog's name to the meticulous and well worded prose translated from very difficult science content, there is nothing not to love about Brad Esau's blog, Taming the Polar Bears.

Working with neuroscientists on a daily basis, I've been taught to distinguish the real from the fake and to appreciate the enormous abilities it requires to sort through the paths of the mind as well as searching for the truths that explain many of our lives. 

Brad explores bipolar and other mental health disorders with a rarely seen authenticity of mind, spirit and scientific integrity. In my opinion, his material is worth archiving and you can't get any better than that.

Christy Johnson, Business Manager, Society for Mind and Brain Sciences





Brad Esau is one of the most remarkable persons in the neuroscience scene dealing with mental health disorders. It's his personal perspective and experience, powered by a tremendous amount of neuroscience knowledge, that invite the reader to walk in his shoes and to better understand what so-called mental health disorders are and what they mean.

It's not primarily a scientific interest to understand the matter. Brad's "Taming The Polar Bears" is first and foremost written based on the burning desire to understand what's going on in his brain and to develop and share principles and models how to live with those mental health disorders.

Brad's unique perspective of neuroscience, knowledge, experience and expertise, and his wisdom from walking the path - leveraged by his passion for writing - make a huge difference and create a very specific value for the readers of Taming The Polar Bears."



From my first interactions with Brad in early 2013, I could sense his passion for neuroscience.  Over the last several years I have seen him take that passion and blend it with an unmatched discipline to delve deep into the world of understanding the brain, its functions and human behaviour.  Brad leverages his own personal history of bipolar disorder as a resource as he takes readers on a first person tour of the working of the mind on his blog Taming the Polar Bears.  He has done years of meticulous research into the disorder and other aspects of neuroscience through a combination of reading research articles and daily conversations with the leading minds in the field.  I continue to be impressed with his insights and daily diligence and look forward to his continued contributions to the field.


Mani Saint-Victor, M.D.



I heartily recommend Brad Esau's wonderful and courageous blog full of wisdom, insight, compassion, and brilliance. We all struggle with something or another in our lives. Brad lays bare his own journey so that we can learn and grow alongside him. I am moved to the very core of my being by Brad's courage and generosity. 



One of the things that impresses me most about Brad is the inexhaustible personal integrity he brings to his struggles and his efforts to understand them as fully and deeply as possible. Brad plumbs the depths of neuroscience literature, consults experts, and subjects conventional pharmacological treatment approaches and his own thought processes to equally fierce scrutiny. He is unflinching in his honesty, unflagging in his persistence, and deeply committed to sharing his hard won understanding of the complex, interconnected biological and psychological processes that drive bipolar disorder, schizophrenia, and mitochondrial disease. 

Rebecca McMillan

Founder, The Brain Cafe

Senior Editor | The Creativity Post

Founder & Ambassador, GHF Online


It's difficult to translate the complexities of the brain to layman's language so I read how different people do it and get ideas on how to frame things in the classroom to make it understandable. Yours (Brad's) is a good approach. So many people - smart people like yourself - are brought into the neurosciences because they wrestle with depression or something that affects them and I pay attention to their interpretation because they are motivated from the heart instead of some obscure, even academic interest. You are closely linked to understanding neuroscience and your passion shows. I encourage you to continue on your path and share your thoughts with the world.

Gerald Paul Kozlowski, Ph.D., BCN                                             
Board Certified Senior Fellow in Neurofeedback
Department of Clinical Psychology, Saybrook University

 
Brad Esau and Taming the Polar Bears

I have been a reader of Brad Esau’s essays in Taming the Polar Bears since he began the project. I myself am trained communication scholar with a Ph.D. Though while not a psychologist, I feel very capable of evaluating Brad’s work. In reading his work I have learned a great deal about the brain, human behaviour and mental health and have constantly been impressed with the thoroughness of his scholarship and growing expertise in the subjects he tackles. While Brad certainly has his own standpoints, he is also careful to take into consideration other evidence and present balanced views. I can recommend Brad's “Taming the Polar Bears” approach to anyone wanting a better understanding of mental health issues and how to deal with them.

Jim Parker, Ph.D



Brad Esau generously shares his knowledge, experiences, and wide-ranging research with the world at large both through his excellent blog and and also through his presence at the Google+ network, which is where we first connected years ago. Thanks to all that Brad shares online, I am able to reshare what he has learned with my students, helping them to better understand their brains, their emotions, and the ups and downs of their complicated and often stressful lives. And it's not only Brad who has been helping: his intrepid cat, Mrs. Bean, is well known to my students too! I've made memes with Brad's gorgeous photographs of Mrs.-Bean-in-the-wild that encourage my students to practice mindfulness, fearlessness, and empathy. My online classes have benefited from Brad's contributions, directly and indirectly, in so many ways, and I am deeply grateful.

  • Laura Gibbs, Ph.D., Online Instructor, University of Oklahoma

Your posts are excellent, informative, well written and honed to your audience.

Jon Lieff, M.D. Yale, Harvard, author of top ranked neuroscience blog, Searching for the Mind

 
TAMING THE POLAR BEARS by Brad Esau is a great mental health education blog.

This post gives an outstanding introduction to brain science, Brad! It's a great piece of writing for an intelligent general audience, and it is directly relevant to people's lives. The figures are very cool and exactly the right ones.

I've written two college textbooks on cognitive neuroscience with Nicole Gage, and we constantly try to bridge the gap that you are navigating so well.

It takes a lot of work and talent, and I appreciate your ability to reach out with it.

--- Bernard J Baars, PhD
Affiliate Fellow
The Neurosciences Institute
La Jolla, CA

Sunday, February 7, 2016

The War Over our Minds and We the Victims




This morning I came across a piece from The Guardian titled Psychiatrists Under Fire in Mental Health Battle (more on the wording of this title to come). Tomorrow - Monday, February the 8th - the British Psychological Society's division of clinical psychology will release a statement declaring that "given the lack of evidence, it is time for a "paradigm shift" in how the issues of mental health are understood."

The piece goes on to add, "The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out "reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems", used by psychiatry". 


And furthermore that "There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful."

This is actually nothing new and is all very consistent with the general positions of psychology that I came across three years ago in my big quest to understand why thirty months under psychiatric care failed me so badly and failed tens of thousands of others so badly.

We'll return to this later.



When I'm not studying or writing about disorders such as bipolar or depression or schizophrenia, I greatly enjoy just studying neuroscience, cognitive neuroscience, evolutionary psychology and human behaviour in general. 

I am especially fond of studying the human brain through its evolutionary past and its great similarities to animal brains. It has been established beyond a doubt that the human brain evolved from earlier primate brains (the division began to take place, I believe, some 200,000 years ago) and there remains many essentially identical anatomical structures to that of most higher mammals. 

There are of course some very key differences, mostly in the ability to learn, languages, higher executive functions, more sophisticated theory of mind and so on (to get into the details would be much more than we have time for today), but at our core, we are the same. And research shows that far more signalling traffic travels from the core up to the higher executive functions than the other way around. In other words, the core has more say in our behaviour than our higher executive functions. In times of frustration with and despair for humanity and what we do to each other, I have declared that humans are nothing more than more sophisticated baboons (and for the most part, I still hold fast to that position). 

And if you overlap the various fields of behavioural sciences, you will find remarkable similarities between human behaviour and animal behaviour. And deep in our animal past and throughout human evolutionary history to this day (both in the physical and cultural senses) you will find tribal behaviours, IE: tribalism. 

Tribalism can briefly be defined for our purposes here today as "the state or fact of being organized in a tribe or tribes" or "the behavior and attitudes that stem from strong loyalty to one's own tribe or social group". 

And indeed if we were to take a look at how humans mostly default to organizing themselves, we would see for the most part deeply divided groups or tribes. I was going to list some examples, but the mind reels at the sheer number of them. You see it in politics, sports, nationalism, gender wars, between and within all scientific fields, in virtually every job place, in regions (and even a general list could go on and on). 

So when I started my investigation into anything and everything to do with mental health three years ago, looking at every side and aspect I could, the war between the tribes of psychology and psychiatry became blazingly clear to me. These are two sides - and we're talking at the top levels here, not necessarily at the "front lines" level - have virtually no common ground whatsoever. 
At the time I was very angry with psychiatry (for reasons we needn't get into here but which I very briefly outline in the essays Psychiatry - The Emperor with No Clothes and The Myths of the Benefits of Psychiatric Drugs) so I found myself siding with positions that were against psychiatry (and those remain very well founded reasons).

In his ground breaking book Anatomy of an Epidemic, noted and Pulitzer Prize nominated science writer 
Robert Whitaker recounts the histories of psychology and psychiatry and showed how while they at one time were more similarly trained. However, as "medical treatments" began to be discovered in the 50's that appeared to be effective in treating hardcore cases of schizophrenia and depression (those who'd become disabled enough by their disorders to end up in institutions), the great divide began. As psychiatrists were trained to be closer to medical doctors and were thus able to legally prescribe drugs, their alliance with the pharmaceutical industry began to grow, the list of disorders that would qualify for "medical treatment" began to grow (as listed in the Diagnostic and Statistical Manual) and the rest, as they say, is history (and Whitaker's book is a very good read to get a better understanding of this history). 

Through the 60's and 70's as more drugs promising cures began to hit the market, people began to flood to psychiatrists and doctors to get medications which they were promised would cure their minds. No longer did one need to spend hours on the couch (and thousands of dollars to lie there) to get one's mind in order, a simple and fast prescription would do. Medical explanations for psychiatric or mood disorders that sounded extremely well founded began to hit popular media with impressive descriptions about synapses and neurochemicals and how mental health difficulties were caused by imbalances in these neurochemicals and how drugs corrected the balance of these. Balance your neurochemicals, balance your mind and get on with life. It all sounded so convincing and psychology was pushed more and more aside and were increasingly left out of the "mind biz" and even marginalized and dismissed as quacks depending on "pseudoscience" (which, to be frank, is not something I would argue against).

This outright dismissal of psychology would be a wake up call - and it was a necessary one - which spurred general psychology into action and new fields within psychology delved more and more into neuroscience and its related fields to better understand the neurological basis for human behaviours, a process that roughly took place from the 90's on (though of course there were beginning roots preceding that time). Psychology began to fire back and question the scientific validity of the psychiatric and pharmacological approach to healing the human mind. 

It was the summaries of psychology's findings that I began to come across three years ago as I worked to understand why psychiatry and pharmacology was failing so badly. 

As I looked more and more into factors that would lead to mental health breakdowns, I found all kinds of psychological, societal, socio-economic factors involved (and have begun a series of essays outlining those which can be found in the Table of Contents and Reading Guide). 

Further in the press release reported in the Guardian piece above, it goes on to say that "
there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse". 

That is a rather simple and short list but a look into any mental  breakdown involving or stemming from anxiety and depression to schizophrenia to bipolar will indeed find those or other psychological factors running through every case. This has been the position this blog has taken since I began coming to similar conclusions in the summer of 2013. And this is what I found when I looked into why psychiatry and pharmacology were failing so many people - psychiatry inexcusably overlooks so many factors involved in human lives and reduced all their treatment protocol to merely prescribing often dangerous and addictive psycho-active drugs. 

So this newly stated position of the British Psychological Society (and the American Psycholigical Association's position is very similar) would appear to be very affirming of the Taming the Polar Bears position, right?

Well, wait, not so fast, for it is not so simple (nothing ever is, I'm afraid).

I spent a good deal of 2013 pounding away at psychiatry and the pharmacological approach (as evidenced from some of my posts of that period). As well, I spent the first half of that year vehemently denying mental illness, at one point even declaring the concept of mental illness a "myth". What I desperately wanted to believe, however, was that 
I wasn't "mentally ill". 

However, as I studied science, I had to adhere to the principles of science and make sure I did not succumb too much to confirmation bias and therefor I always tried to keep an open mind to opposing views and evidence and indeed I kept in my circles of sources members of what I'll refer to as "the other side". I read countless stories recounting the anguish of depression or bipolar and how drugs had helped them. This, I found, could not be ignored. Some of my best sources of science held to the position of pharmacological treatments and studies they cited could not be ignored, either. 

At the same time, the thing that I could least ignore was my own continuing breakdowns. 
Something was clearly going on to cause my own disordered mind (I think I have some very credible ideas which I am furiously trying to get outlined and written down). 

And what I especially could not ignore was that while various psychology societies and associations could convincingly launch well founded attacks on the validity of pharmacological psychiatry's approach to defining and treating mental health disorders, I couldn't help notice 
they didn't seem to be coming up with any kind of effective definitions, explanations and treatment protocols either

Looking long and carefully at all sides and angles involved in psychiatric and mood disorders led me to a conclusion and position that I have wished to write about for about two years now but until now couldn't quite find the right foundation and with tomorrow's pending announcement from the British Psychological Society, I think the time has come. 

For this, my dear Polar Bears readers, is the truth of what's going on in mental health - psychology and psychiatry are two polemically opposed tribes in a titanic battle over the same territory. 

And that territory, people, is our minds. And we, people, are the battlefield. And we, people, are the victims. 

In truth, neither of these two tribes really gives a shit about us. They're too locked onto their battles with the opposite side to even see those of us suffering and the depth and pain of that suffering, let alone really care about us. They are generals in ivory towers pushing pieces around on a board. They are two armies at war. And as in any war, there are victims on the ground that the generals cannot see and in this war those victims are us. 

While I spend an enormous amount of time studying and researching and searching for clues and answers, I also have spent and continue to spend a good deal of time in "the trenches". I talk to people on the streets, I talk to others fighting disorders, I have talked to dozens of people in psychiatric hospitals and I have talked to dozens of people I have met through this blog.

And quite frankly, I don't see either psychology or psychiatry helping 
any of us as they war away in their baboon like territorial battle over our minds. The overwhelming evidence I found was that neither of them really seemed to understand what was going on and why or, worse yet, know what to do. 

And we the victims continue to suffer in ever increasing numbers. 

While to attack psychiatry and come out and boldly declare that "
current psychiatric diagnoses such as bipolar and schizophrenia are useless" seems reasonable from psychology's point of view, to do so without offering any kind of scientifically valid alternative is, well, not only utterly and absolutely useless itself, it's outright irresponsible and dangerous. 

For while these high and mighty generals ensconced safely away in their ivory towers can easily launch their verbal missiles at one another, without supplying effective alternatives to the "troops" on the ground (psychologists and psychiatrists) who are dealing with the mounting numbers of victims (us), they serve only themselves. 

And meanwhile the bodies literally continue to stack up (suicide numbers and tens of thousands of others who suffer mentally and end up dying of overdoses or slow deaths from substance abuse) and almost literal refugees who have nowhere to go (those of us who do not die, but who are also not able to effectively get back into society or those who must hide their conditions and suffer silently because they are too ashamed and confused to seek treatment). 

When I first began to break down in the summer of 2008 and began to think about seeking treatment, what I encountered most was complete and utter confusion and no clear path to finding understanding and treatment. Some people swore up and down about this, others swore up and down about that. So I did nothing until I completely broke down and was hospitalized in the summer of 2010.

And this confusion is what I see over and over and over again in countless cases while both psychology and psychiatry, in their blinkered war with each other, are blind to the confusion we must endure with many ultimately ending up dying as a consequence or at the least must continue with near unbearable suffering. Any objective and broad look at the current mental health situation would tell you this. 

So what do I think is the answer?

In truth, it is not conclusively known at this point what causes any disorder. While psychological factors are unquestionably important in 
triggering behavioural changes and symptoms, it would be entirely incorrect to say that they are the root cause either. Evidence is mounting for key yet complex anatomical differences in brain structures as being the underlying basis for most disorders. Neurobiological changes and physiological changes absolutely occur in the brain and the body in both long term and short term mental health cases from depression to bipolar to schizophrenia to anxiety to various compulsive disorders. 

So to take an entirely psychological approach is not correct either.

Furthermore, at this time, tens of millions of people depend on the current psychiatric definitions of disorders and pharmacological treatments, yours truly to an extent as well (while I do not rely on medications, understanding that I am bipolar absolutely helps me deal with how my mind works, enabling me to cope with it. As well, a medical designation is the basis for the pension I rely on, without which I would have absolutely no means of supporting myself. This is also the case for thousands of others like me). And while I remain opposed to the general position of psychiatry and its pharmalogical approach to treatment, t
o just suddenly declare the psychological position the "winner" and pull this rug out from underneath these millions of people without a vast new infrastructure to take its place would be utterly disastrous and unspeakably cruel.

So as of now, psychology can offer nothing concrete in ways of understanding and diagnosing disorders, let alone any kind of treatment and care infrastructure. 

Yet to only continue on the same path of the pure psychiatric course is clearly not working either. 

So what to do?

This is the approach I believe may be best. 

If you study drug treatment, it is undeniable that drugs will show short term improvement and stabilization for great numbers of people (though not all). While it is far from perfect, for many it is absolutely necessary. 

Where drug treatment demonstrably falls short or fails is in long term results.

So what if we were to look at psychiatry and psychology this way?

What if we were to think of psychiatry as the mental health equivalent of emergency rooms and short term hospitalization? Just as with a medical emergency, an acute mental health crisis case would go to the emergency room (the infrastructure for this is already in place) and drugs would be administered to stabilize the patient. Some short term hospitalization and further short term drug treatment may also be necessary. 

Then what if we were to think of psychology as the rehab part of the equation? Once the patients were stabilized, it would be up to psychology to understand and treat the root causes and put in place long term  mental "rehab" strategies along with helping to facilitate perhaps the long term lifestyle change or adaption strategies. 

And I have seen enough evidence to suggest that this is indeed the best long term course that produces the best long term results. 

What I strongly and passionately believe is that it's time for these two sides to put aside their baboon like territorial battle and begin to function more like the highly advanced humans we can potentially be and work in better harmony for us. 

For while there are a great number of reasons for our suffering, the absolute 
#1 reason I found in all my research is the confusion resulting from this inexcusable and, frankly, immature battle between the fields of psychology and psychiatry over our minds and mental health. 

In future pieces, I hope to outline clearer strategies for negotiating this mess and I will try to provide links to other sources that help with similar strategies. 

While I obviously strongly believe the understandings of the mind and that strategies for change I teach in 
Taming the Polar Bears can work for or greatly benefit anyone, it would be dishonest of me to believe or declare they were the only way. People are enormously varied and what works for one may not necessarily work for the other. What our core beliefs are will greatly affect what may work and how (something I briefly outlined in the essay In Praise of Quick Fixes).

At this point in time I don't think we can trust the institutions of psychiatry and psychology; they are just too far removed from us as people, as humans, as individuals. This is not to say all members of these societies (in the organizational sense of the word) are bad or that perhaps one could find someone from either profession who may provide some useful help, but the odds, I must frankly say, are against it.  

If you are reading here it is quite possible that you too are in some way a victim of this battle over our minds and the resultant confusion and lack of clarity over what to do. However, dear reader, it is possible for you to make it through, there 
are ways. 

It takes a lot of bravery and personal responsibility but I created this blog and contents to give you some guidance and something to work with. I'd wished to do more, but in the end it was all I could do.