Thursday, April 20, 2017

An Introduction to Depression - A Summary of Video Lecture




This post is a summary of the discussion points from the video lecture on an introduction to understanding depression. 




I spoke quite a bit about the semantics of the word "depression". Most people's natural tendency will be to frame their understanding of the condition through their own experience along with what makes up popularly held understandings of the term. This is very unhelpful for understanding any one case of depression - tragically perhaps most often in oneself or in close friends or loved ones - so I have to really emphasize that to get a better, deeper and broader understanding, I need to ask individuals to get past that (even if you understand a great deal of what I present here). There are simply too many variables in the individual, life conditions and body and brain biology and physiology for there to be any one definition of or framework for any one case. 

What I present in this talk is regarding the much more serious end of the scale.

I have many approaches to understanding the brain and the mind and how these produce the experience of depression. 

In the preliminary part of the talk I mentioned the following posts as relevant. These are references only. While it is not necessary to read through them all, they are handy to understand certain points I make during the lecture. 

A note first, however. Many people, I've found, tend to get intimidated by terms and concepts I present here. This is quite understandable but I feel very confident that you can do it. There are no tests or anything to get anxious about. So just relax, take your time and let your brain do its thing - if you let it, it'll absorb this in a way that works for you. 

Neuroanatomy 101 - this lays out some of the very basics of brain anatomy and some of the biology.

Brains as Reality Creators  - every brain creates a unique perception and view of the world. This is very important to grasp and accept when we try to understand other people's experiences and even our own mind and the different "realities" it can create. For example (and I mention this in the video), our "normal" state and a "depressed" state are like two different realities and change the way we perceive the world and our selves. 

An Introduction to Neuroplasticity - this is critical for understanding change and to build belief and confidence in the possibility of change within ourselves. 

An Introduction to the Stress Response System - I will make the argument as we go along that any case of depression or psychiatric disorder will involve or be rooted in the stress response system. As I mention in the video, I really need to ask everyone to put aside their previous notions of stress, how it's created and how it affects brain function and mood and open their minds to a new understanding. 

Genetic and Environmental Factors in Individual Brain Development - one of the main legs to my approach is getting past blame, guilt and shame for "who we are" and all these faults and states we beat ourselves up for. I wrote this post to give some understanding into the basic factors that create the brain that will in turn create "you" (as weird as this sounds, this is in fact what happens). This is my basis for compassion for myself - and for others going through difficulties. We did not create this, folks - this process did. 

Again, it is not necessary to read through all these (though I'd be so thrilled if you did!) but they are handy references to help understand a) the basis for my approach and b) to understand the points I make

Symptoms

These are some of the most significant symptoms. I realize these may not be all symptoms - I'm sure I missed some - but they are enough to give us a better basis for understanding. 

 
  • grief
  • guilt/rumination
  • distorted thinking/perspective
  • dark thoughts
  • sensory changes
  • intense introspection
  • sleep disruption (1)
  • fatigue
  • body aches
  • loss of general motivation and will
  • vegetative or catatonic states
  • anedonia
  • self-harm, suicidal ideation, suicidal planning, actions and attempts
  • loss of interest in self-care
  • psychomotor retardation


[(1) towards the end of the time I'm talking about sleep disruption I misspoke and said "sleep depression" when I of course meant to say sleep disruption] 

While I won't go over again here what I talked about in the broadcast, I do want to mention something about fatigue. This is another word loaded with semantic misunderstandings and I'm afraid I neglected to make that clear. By "fatigue" here, I am not talking about the normal everyday experience of it all people will have - this is a huge stumbling block for understanding the clinical fatigue in many people with depression and other mental health disorders. What I talk about here is something very different with different biological underpinnings. 

While I originally researched and wrote this series on the understanding of the well known symptom of fatigue in the depressive phase of bipolar disorder, I've since come across enough evidence to convince me that what I talk about in this series applies to many other disorders in which fatigue, psychomotor retardation, loss of motivation, issues with self-care, vegetative or catatonic states and so on are involved. 

What I briefly touch on is how "energy" is produced at the cellular level by mitochondria. This is a highly acclaimed series and will give you a very good basic understanding of mitochondrial dysfunction and its role in many of the symptoms discussed. 





Possible Factors



  • biological
  • anatomical differences in brain
  • genetic and environmental
  • current or past life events and/or circumstances
  • stress response
  • GI tract
  • energy
  • the human condition

I spoke of some of the biology and neurotransmitters. Here are the posts where I introduce these and look at two of the main ones thought to play roles in depression and other psychiatric disorders. 

Neurochemical in Focus - Serotonin  

Neurochemical in Focus - Dopamine  


Again, this list does not include every possible factor but outlines some of those commonly accepted as factors and some which my own study and research has shown may be significant. 

A point I feel is very important which I was trying to make at the end but which I see I failed to make clear was the distinction between depression as part of the human experience and the more serious clinical and medical cases.

What I see are cases that might be part of the human experience - as enormously difficult as they may be to experience and go through or to witness as a loved one - that are treated under the "disease model" and tragically become much worse and entrenched than they need to be. 

On the other hand, there are cases with biological and anatomical basis that are looked at as just part of the human experience and these become tragically untreated or treated in the wrong way which leads to enormous amounts of additional and unnecessary suffering. 

It's also possible that it could be a combination of the two (life experience plus biological and anatomical factors).

It's my position that without someone very skilled and knowledgeable in looking into a person's background and able to look into some of these factors, it's very hard to untangle what the best diagnosis and approach may be. 


I hope this was useful. If you have any questions, please join us for the webinar this coming Sunday! 



Below is the Sunday, April 23rd Q&A session following my talk introducing a new understanding of depression. This whole webinar thing is still very much in its infancy so the process for viewer questions hasn't quite emerged yet and as such no questions were asked in the broadcast itself. But I also receive questions via email, one of which I chose to address in this broadcast. The question was:


What can I do to avoid getting sooooo exhausted when there are other people around me? Even if it is just one old friend, it seems as if I spring a leak and my energy is just sucked out.
Is there a way to "shield" myself, from other people 's energy? In public places, for instance. 
I don't live somewhere where i can withdraw from people. No place I can find 'quiet' and I sometimes feel I am gonna explode. What can I do? Please help.  
I am always so tired. Too tired to pick up the remote 5 feet away. I will stare at the TV at something I don’t want to watch bc I can't move. It's a horrible feeling.


While at first glance one might wonder what this has to do with depression this actually ties in very much with the fatigue, vegetative states, and psychomotor retardation symptoms discussed in the talk I gave. Furthermore, it allows us to examine a very unique subset of depression and anxiety sufferers that come from what are known as "highly empathetic people" or "empaths". 

I also address the culture of silence around things like depression and the role of communication in mood and psychiatric disorders. 



Friday, April 7, 2017

Mental Illness and Communication



Mental Illness and Communication


Having been both a student of and a teacher of language (teaching English, learning Mandarin and studying a smattering of Japanese (1) when I lived and traveled in Asia and spent much time within those communities in my native Vancouver, BC) then becoming and being a writer and now as I prepare myself to become more of a speaker in communicating the ideas, concepts and methods that make up Taming the Polar Bears for different audiences, I feel I have a strong understanding of the power of communication - and its difficulties. 

I've long wanted to present my ideas and methods in live formats or settings but for a wide variety of reasons, factors and life circumstances, writing and communicating through blog form was what I could manage. Four years after the genesis of all that we now understand to be 
Taming the Polar Bears, I not only felt the time was right for finally working towards doing what I do "live", it was becoming necessary. 

It is very different to communicate one's ideas to live audiences rather than writing as I have done for the blog (and the book form I've also long had in mind and have been slowly working towards (painfully slowly)) so as I've prepared to do webinars online and speak to "real world" live audiences (however small), this has forced a total rethink of how I communicate. I have to both "hear" differently and think more carefully how I'm going to be heard and received as this works quite differently between written communication and oral communication. 

As a writer I've tried to communicate to as wide an audience as possible (while at the same time realizing the limitations of how many different types of audiences or individuals I could reach). I could take my time visualizing my possible readers and work out how I wanted to lay out a post, the word selection, flow of ideas and so on then edit them, rework them, etc. This kind of information is received passively and at the reader's leisure and discretion. I could put my ideas out there and leave it up to whomever came across them to either read them or not or how they received them. Though I could imagine my various audiences, there was no real direct connection between me the communicator and whomever the reader happened to be. I kind of had to put faith in the reader's desire and ability to gain and take away value. As well, time - the immediacy of the communication - was fluid; I could take my time creating, the audience could take their time reading, absorbing and creating their own value from it. 

But live audiences work quite differently. The connection is much more direct. The communication is much more immediate. Verbalizing ideas and responses becomes a different process requiring different skills. Verbalizing ideas comes more naturally to me than most (in great part because of my decade and a half of teaching experience) but as I've been preparing the last several months to do both online and live lectures and workshops, I had to think more on how my potential audiences could communicate their experiences, difficulties and questions to me and then my on the spot responses. 

As well, 
Taming the Polar Bears has ended up reaching audiences in lands and cultures I'd never imagined back when I started. This too I had to think through and try to prepare myself for. 

Working through all this the past several months I began to think of the whole world of communication in a different light and in different ways. I began to pay more attention to both how I communicate and how followers of Taming the Polar Bears communicate (once I know someone is a reader and follower of the blog, I will always pay careful attention to how they are posting and communicating) in order to try to imagine how we might connect "live". As well, I began experimenting with recording webinar like presentations and analyzing my speaking and communication skills in order to hone them. 

It was in the midst of all this new approach to thinking about the power of communication that an epiphany struck me this morning - the roles communication play in various forms of mental illness (a term those who are familiar with my approach know I don't like but for the sake of using it in a commonly understood manner for the time being, we'll let it stand). 

Communication is extremely important in the human mind and social interaction - it is, after all, what sets human social structure, cooperation and achievement apart from any other species (which is not to say that other species do not use different types of communication in order to cooperate on some level - they absolutely do - just not on the same scale as the human species). Our thoughts are the brain's way of communicating with "us" and how "we" communicate with it (as weird as this sounds, this is in fact what goes on). Verbal and written communication is how we connect with and form bonds - or not - with others in order to exchange our ideas, thoughts, feelings, desires, needs and so on. How we are able to do that - or not - is going to have massive effects on the courses of our lives and all the numerous degrees of successful outcomes we achieve or not. Examining this whole big business called "life", I think we can see that powerful or persuasive or effective communicators tend to be more successful than those less proficient or confident in it. 

*   *   *   *   *

It has long been at least partially understood that
 what happens in or the circumstances of an individual's social life will be a factor in various cases of mental illness. Four years ago as I started all my research and study into all the major mental health disorders (depression, anxiety, bipolar disorder and schizophrenia), I quickly identified it as not only a major factor, but as perhaps the central and defining factor. 

In this light, I think we can imagine how communication thus becomes an important part to consider as part of the picture in any one case or your situation. 

So for now, I'm going to put forward the importance of the roles communication play in mental illnesses. 

Let's briefly examine how this might work.

One obvious way is how difficult it is for us to communicate to others what's going on when we are experiencing mental health difficulties and we need either understanding or help. I can tell you from enormous amounts of personal experience and from listening to or working with dozens of people over the years (more the former than the latter, I must add), that it is not only tremendously difficult, it is acutely and chronically frustrating (and I've 
written before how I feel frustration is a great underlying aspect of and contributor to short and long term moods, mental states and disorders). 

For many people, they lack the words and very basis of language to understand what's going on in their own minds, let alone communicating that to someone else. 

But perhaps even before the mental health problems begin, what if we haven't learned to or are unable to communicate our very basic needs? This again may start in our own minds but more so with those who we need to hear us. Imagine not being able to communicate feelings of love, affection and desire. Imagine not being able to communicate other basic emotions that may strike us - anger, irritation, frustration or annoyance, disappointment, shame or guilt, fear, anxiety or dread, sorrow, hurt or pain. The list is long. 

The difficulty in conveying mental states, moods, emotions and so on and having them heard, acknowledged and understood may result in either silence or maybe worse, inappropriate outbursts that damage relationships. I strongly believe it's quite demonstrable that for many people being unable to communicate core needs or emotions could well be a major factor in starting the cycle of isolation and the pain of loneliness. 

So I'm going to propose that various difficulties with basic communication alone is not only going to greatly affect the course of a case of, for example, depression, it's going to play a great role in 
creating it. For it is this great gulf of communication with not only ourselves as we try to work out what's going on in our minds but even more so with others that is going to lead to a great deal of the anger, frustration, sadness, hopelessness, confusion and so on then the isolation and loneliness that drives us down and down, lower and lower. 

As our moods decline, we feel more isolated, as we feel more isolated we feel the pain of loneliness and thus our moods and mental states will become even worse, the worse we feel the less we even want to be around or talk to people, this furthers the isolation and the pain of loneliness (and thus isolation stress), the isolation contributes to worse feelings, inner pain, moods and mental states and we become ensnared in this downward cycle (to some degree of awareness or another). 

Think now of how it feels when we "hit gold" and find someone we feel can hear us in an understanding way - that "aaaaaaaaaahhhhhh" feeling, that feeling of being heard and understood (however fleeting). To understand how powerful and potentially life altering this can be, there are considerable bodies of evidence of how this can positively affect one who is considering taking their life and change their course of thoughts and action. 

But it's more than that, I believe. What if an inability to or difficulty with communicating with and thus forming connections with others is the very cause of the mental health disorder in the first place? 

Let me briefly try state what I mean. 

Very early in my studies, as I alluded to above, I identified social isolation and the resultant 
isolation stress and deep and damaging pain of loneliness as a major factor (the factor I'd argue, but not today) in both triggering the start of and the short and long term course of virtually any mental health disorder. I would also argue strongly and vehemently (though again, not today) that social isolation and isolation stress is one of the major factors that will define and alter the course of any given case of one who is on the autism spectrum or perhaps anyone who is simply "different" (there is a concept and term called neurodiversity which has somewhat recently emerged that I believe is very useful here). 

Having looked into dozens of cases and/or heard their stories, I can now look back and see how communication difficulties or barriers (and there would be a very large scale along with many aspects and circumstances to the degree of this) would have absolutely played a significant role in both creating the social isolation and then greatly exacerbating it. There are, of course, many other important factors but if we look at communication - the lack or difficulty thereof - and imagine how this would impact socialization and thus create isolation, I think we can see how this greatly influences not only the individual's sense of self but also how they connect with the world around them and thus the very course of their given disorder (not the best term, I know, but for lack of a better one right now) and their very lives. 

Now, I'm going to have to further establish the role isolation stress plays in mental health disorders or in the lives of those who are neurodivergent but for now I'd like to ask you to spend some time thinking through and imaging how communication difficulties would contribute to that. 

There is obviously much more to get to on this and several fronts on which to further develop this idea but for today I'm just putting this out there for consideration and to plant some seeds in your mind. I'll add to this in time, but for now I'd like to ask:

What if it were something as simple (2) as improving communication skills or lines of communication that could greatly improve the chances of one overcoming a mental illness or to live a better, more satisfying life? Or even to greatly avoiding the onset of a mood disorder or poor mental state - long term or short term - in the first place?

Now as regular readers or followers know, I very strongly believe that our own thoughts and how we communicate with 
ourselves are huge elements in not only what creates moods or mental states but will greatly affect their course for better or worse (and we've discussed to a fairly great degree how we must work on this). 

What I haven't discussed, however, or even really thought of enough until now, is how we communicate with each other (though I have touched on this a bit in the essay 
Let's Talk - to Whom?). This might include a complete lack of communication, difficulty in relaying our thoughts and feelings, the very language and words we use, the tones we use and so on. As I think back on some of the cases I've worked with or studied, I can see that communication difficulties were or could have been a significant facet of instigating and determining the manifestation of their mental health problems (and I realize I'm going to have to lay this argument out much more clearly than I am doing here today). 

Communication is of course a two way street. This means both the listener and the speaker have to improve - ultimately there has to be attempts from both sides to meet in middle. This means that family or friends dealing with someone with a mental health disorder have to become better listeners and those with the disorder have to become better at communicating. This is a process - and possibly an onerous one for many - but I believe it is a necessary part of the overall strategies we must learn and employ to either defeat or learn to better live with any mental health condition. 

This is or can be as you all know, or are beginning to realize, enormously difficult and frustrating. We're not going to solve that right now but again, I just want to put this idea here and - hehe - communicate it to you for future reference (and I'll work on expanding on these ideas in the future). 

(1) While I don't want to give the impression that I became fluent in either, I became greatly more conversant (and was able to read and write to some degree) in Mandarin than Japanese. But though I retained no ability at all in Japanese, the learning process I went through was important in the long run. 

(2) Simple of course does not mean easy. 





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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. 

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