Saturday, December 21, 2013

Vision for the Future of Humane Rehabilitation

Updated March, 2018. 

Just a little over five years since I conceived this, nearly fifty-one months since I originally wrote this. 

In that time I could see the need for this vision growing. It is nearly impossible to articulate how much I wanted to see this come to fruition but I realized over and over again that my own means were limited and that all I could do was keep plugging away at my blog exploring the underlying causes that would lead to mental health issues so catastrophic that sufferers would end up existing on the streets without homes, being incarcerated, being addicted to drugs (legal and/or "illicit") and caught in notoriously difficult to break cycles. 

The cost of this to individuals, families and to society is virtually incalculable.

Inexplicably, "modern" society stubbornly stays locked into  "dealing" with these issues using "systems" that have have not essentially changed in hundreds of years. The underlying attitudes that create "modern day" incarceration have in fact not advanced since Biblical times (no, I'm not exaggerating, I will make this clear in future posts). 

For our brief space here it would be too exhaustive (for both myself and readers) for me to recount just how in depth I looked into everything to do with many mental health disorders where so many difficult cases or individuals without the good fortune to have long ongoing support from family and/or friends or who fall through the cracks of the mental health care system end up on the street or in the criminal justice system or both. Or tragically addicted resulting in bouncing between the criminal justice system and the streets. Or dead. 

Through personal interviews I conducted or from countless case studies that I researched one thing struck me again and again:

This outcome was not necessary

This was preventable

Nobody chooses to end up like that. Nobody

For five years now I have been inordinately driven to learn as much as possible about the neurology, socio-economic conditions and life defining circumstances of the souls who end up in such cycles. 

My work through the blog and the access to people it's given me, along with dozens of other sources told me the same story in virtually every case:

- Various traumatic events in their lives and socio-economic conditions that created the neurological conditions which in turn led to the behaviours and life choices that led to their situations.

Some of this I outlined very briefly in Genetic and Environmental Conditions in Individual Brain Development.

There are many genetic and environmental conditions (by that I mean all conditions an individual grows up in from conception through early adulthood) that will add up to creating what I refer to as their "neuro-history".

Since then I have made numerous valuable contacts among academics in related fields who not only agree with this, but can provide enormous amounts of research data and case studies. 

For five years I have envisioned long term live in treatment and rehabilitation facilities where people's neurology - this "neuro-history" - would be treated and rehabilitated. As part of that process many other aspects of life and skill building would be taught along with job and work skills. It would all take place in facilities of a compassionate and understanding atmosphere, one where individuals can explore their true potential and not simply be "punished" and beat back down or "housed" temporarily until they're shoved back out to start the cycle again. 

No form of incarceration, temporary housing or "rehab" does currently does that. 

Everything I envision for treatment is based on the best compassion based neurological understanding of human behaviour and minds available. It is based on cutting edge understanding of neuroplasticity. 

There are, however, some past or present successful models to prove what different approaches can accomplish. 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 who end up trapped in these cycles, the only course of hope is to move forward. At the heart of every living soul is the desire to move forward. But here's the rock and hard place catch-22: A) they cannot do it alone, B) their very brain conditions rob them of the mental faculties to move forward, C) "traditional" methods of "dealing" with these people have proven over time not to work, D) the oppressive forces of societal stigma. 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 the Taming the Polar Bears Foundation envisions would be the net at the bottom of that chasm. 

In the facility we 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 March 2018, many things have changed to  begin to start bringing this vision to fruition. 

I have partnered with someone who not only sees the need for such facilities the same as I do, but who has the business skills to create the model to make it happen. Not only that, but he is a long experienced and greatly skilled web builder. 

Taming the Polar Bears has been registered as a non-profit foundation able to take in donations for and do fund raising for establishing this much, much needed facility. Additionally, the Taming the Polar Bears blog will be given a new web home, one that we envision, and my partner has the ability to build, will in time become the best resource on the web for those in all kinds of mental health needs. There is much exciting news to come on this

The new web home is scheduled to go live April 1st, 2018.  

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). 

Monday, December 2, 2013

The Neuroscience of Depression

I should begin by saying that the biological explanation for psychiatric disorders - IE: the "chemical imbalance" explanations - is certainly neuroscience. The roles of neurotransmitters such as dopamine and serotonin (the two most implicated in the imbalance theory) are certainly important factors in brain behaviour (and thus our behaviour) and are part of neuroscientific research. It's just that no exact biological marker has been found for any psychiatric disorder and the chemical imbalance theories have been discredited (having never really been proven in the first place) as well as now appearing overly simplistic. While neurotransmitters are a big part, there are many other factors involved in brain operations as well such as 
the connectome - IE: the crucial wiring between brain regions - electrical activity or brain waves, neuronal activity or lack thereof in specific regions, the concept of neuroplasticity (the constant growing and pruning back of the connections (dendrites and synapses) between neurons) and how neurons undergo tremendous change with just a single thought (a simplified synopsis of the information of that link can be found here) and so on. Neuroscience is deepening its understanding of the brain almost daily and enormous resources are now being poured into better understanding how it works. 

All of which leaves the chemical imbalance ideas - the bedrock of and the dominant paradigm of today's psychiatry - well in the dust. It was not a bad idea at the time but it's one that is decades out of date. That treatments based on these outdated notions are the front line treatment for all psychiatric disorders and are still heavily promoted by websites such as WebMD and the Mayo Clinic, not to mention mainstream media, is a tragedy that I had to personally find out and which costs the very lives or severely impacts the quality of life for tens of thousands of people (or even hundreds of thousands depending on how you quantify it). Discovering this tragedy and wanting to know why led me to studying neuroscience which has been my passion ever since. 

It is theoretically possible, by the way, to "tweak" certain human behaviours with artificial chemicals but today's current treatment model has been likened by 
renowned neurobiologist David Anderson to "adding oil to a car by pouring it all over the outside and hoping that some seeps into the right spot (the oil pan)". Current drug delivery methods, in other words, are unacceptably crude and cause too much collateral damage. That is if neurochemicals are alone responsible for complicated disorders such as schizophrenia, bipolar and major depressive disorder in the first place. My argument is that they're not. One of my problems with mainstream psychiatry is that they remain locked on a single facet of brain operations - neurotransmitters - and ignore almost all else, and this is always very dangerous in the world of medical science when lives are at stake. Which is why I study neuroscience in order to understand what's going on in the brain with our various disorders (my main interests are bipolar, major depression and schizophrenia).

What we'll look at today are some of the brain regions that appear to be involved in major depressive disorder and, we'll assume for today, the depressive phase of manic depression (or bipolar to some). [there is some confusion as to the difference between manic depression and bipolar disorder as the latter has been expanded to include what look an awful lot like schizophrenia symptoms and behaviour to me but we'll leave that for another day. When I refer to bipolar, I mean the classic manic-depression swings of mental states and brain functions.]

neuroimaging technology has its limits, enough research through the study of brain damage and the resultant specific human behavioural and ability changes, not to mention physical studies (as opposed to imaging studies) on animal brains, has been done for many decades to establish that individual brain regions are responsible for many behaviours and abilities in humans and animals and, more importantly to us, that specific stimulation to these regions can cause plastic changes and thus change or improve behaviours and habits. 

On Depression

In her book Mapping the Mind, Rita Carter describes clinical depression as:

singularly life diminishing. Its symptoms of despair, guilt, exhaustion, anxiety, pain and cognitive retardation often makes sufferers wish they were dead and one in  seven of those who are severely afflicted fulfill that desire through suicide.
 She goes on to say that:

depression is more than just a "mood" - it also brings on physical symptoms like fatigue, pain, sleep and appetite disturbances. Memory is affected and thinking is slowed. 

And then this:

Major depression is not a single disorder but a symptom of several different conditions, each of which probably has a slightly different brain abnormality at its root. The picture is still incomplete (do you hear that, psychiatric industry?), and brain imaging studies have shown that trying to pinpoint the exact mechanisms that are involved in mood disorders ("love" that term) is very difficult indeed. 

Now on to some of the brain regions that appear to be involved. 

First up is the Anterior Cingulate Cortex, or ACC. This is an older piece of cortical hardware and is more strongly connected to the limbic system where all the more ancient hardware exists and a great deal of traffic (urges, desires, wordless memories, among others) passes through the ACC. You can see its position and proximity to the limbic region here:

The ACC generates "self-willed" actions (such as they are) and plays a central part in creating the feeling of "agency" that goes along with self-willed behaviour. It also appears to be responsible for the feeling of "aliveness" we sense and which most people take for granted. Studies show conflicting information of over and under activation in depressed people in the ACC in people with depression and bipolar so some sort of discombobulation is happening there and this discombobulation will have a certain amount of affect in how we experience and sense "being alive". When we just cannot experience any zest for life, it appears that it is some sort of disfunction in the ACC that is responsible for this sensation. And mileage, as they say, would certainly vary as there would be no "one size fits all" for either how this region was endowed genetically or in how it was affected by environmental factors during its critical development period (which is true of all brain regions of course). Therefore, how this area was impacted along with how much "say" it gets in our moods would vary from person to person from mild to severe.

Other "dead" areas in depressed people include parts of the parietal and upper temporal lobes that are associated with attention, and particularly with attending to what's going on in the outside world. That feeling of being in our own little worlds we get when we're depressed isn't just our imagination, it's specific brain areas that are under or over activated, or perhaps we could say misdirected. The lateral prefrontal lobe is thought to hold sad memories in mind, and basic limbic system components the thalumus and amygdala are also "in the loop". 

As for that "power outage" that we feel, that complete lack of energy and/or interupted sleep patterns, here is some bleeding edge research that may give us valuable insight into what's going on there. This involves the Locus Ceoruleus, the major noradrenergic nucleus of the brain which gives rise to fibres innervating extensive areas throughout the neuraxis. The LC is a major awakeness-promoting nucleus. The pathways of the noradrenergic systems (transimitted via the neurochemical norepinephrine) are as thus:

Its location is in the brain stem which is as basic as brain hardware gets. Aside from routing through critical daily function areas such as the thalamus, amygdala, hippocampus and cerabellum, you can see its pathways go all through the neocortex as well (which is where all our higher brain functions reside). Any interruption in this ultra-key and fundamental system is going to throw our energy levels for a loop and greatly impact the energy levels in many of our basic and higher functions.

Norepinephrine also acts as a key hormone in our stress response system (AKA: fight or flight response) which sends along key quick energy boosts to all the various areas in your brain and body that need to respond quickly and energetically to a perceived threat. Constant stress then, often implicated in major depressive disorder and bipolar, would put this system under a major strain and, perhaps, just wear it out leaving us feeling drained and lethargic.

Update from August, 2014:

Since writing this piece I researched the "power outage" that often comes with an episode of bipolar depression and it appears that the key physiological problem involved is mitochondria dysfunction which I nicely lay out and explain in a three part series starting here. 

So what does all this mean? None of this is *the* answer to depression of course. And I don't expect anyone to memorize this and go around saying, to explain their depression, that their anterior who's-he-what's-it and locus thingy-me-bobber are out of wack. What I do hope is to give a better idea of what's going on with those of us so afflicted by major depressive disorder or bipolar depression and that it's not just a matter of the "suck it up, buttercup" bullshit advice that we always get. What's going on are major disruptions in both deep brain systems that are well, well beyond our conscious control, and areas of higher cognitive function, stuff that's beyond just "sucking it up" and "braving on" (though of course we do try to do those things anyway, with very limited result). If anyone can get over their depression with suck it up shiny-happy stuff, then guess what?! You didn't have major depressive disorder and certainly not bipolar depression. Lucky you! Not "strong", but lucky, pure and simple. 

And more importantly, what to do about all these discombobulated brain regions that are beyond our conscious control? Well, I'd be a bit of a you-know-what-hole if I didn't give some idea about what to do about it. And it just so happens that neuroscience has something to say about that as well. Stay tuned. 


Mapping the Mind  by Rita Carter

This paper at via my "brain bud", neuroscientist Mani. 

Glossary of terms:

Amygdala - the "seat of emotions". The amygdala is involved in almost all of our basic functions. All our outside data (brought in through the five senses) runs through the amygdala which both "tastes" it for emotional content and adds emotional content. It plays a very large role in all major psychiatric disorders. 

Thalamus - the thalamus is a large, dual lobe mass located in the limbic region (our basic sub-cortex group of hardware). It is involved in sensory perception and regulation of motor functions. As a regulator of sensory information, it also controls sleep and awake states of consciousness.

Hippocampus - is a key cog in memory forming and organization, and storage thereof. 

Cerebellum - a very, very basic bit of hardware common to all animals from the lizard on up. It's where where body movements are coordinated, where your abilities of balance and body posture are held and equilibrium is controlled


When I first started researching bipolar three and a half years ago, I came across a scholarly paper on hippocampal damage that showed a marked decrease in healthy tissue and an overall shrinkage in hippocampal volume in those with bipolar disorder. The study was carried out on suicide victims, meaning it was done through brain autopsies which further means that the results can be accepted as accurate as opposed to results from imaging scans on living subjects which may or may not be accurate.

Later, I came across other sources that showed the same results. I thought, "OK, there appears to be physical damage to the brain in bipolar disorder. That's interesting". I was in a very bad state back then, however - not to mention very, very confused, scared and upset (this was following my first psychosis driven suicide attempt) - so I didn't give it much further thought as I had, at that time, bigger fish to fry. 

Fast forward to this year, when I went into hyper-manic (no, I do not mean hypo-manic) research mode and I began studying neuroscience. I still didn't put much thought into those studies regarding the hippocampus as I was so involved in so many other avenues of research (1). I did try to find the original study I'd read three years earlier but couldn't find it (I do recall many of the details clearly, though, and that it was carried out at McGill University) so I let it drop. 

Fast forward a few more months to yesterday when I came across a video lecture by the highly, highly regarded 
Robert Sapolsky. (2) In the lecture, he was presenting the neurobiology of stress, neurodegeneration, and individual differences and BAM, guess what came up? Clear and specific damage to the hippocampus. Sapolsky showed indisputable and irrefutable linkage in excruciating detail between stress and a great deal of hippocampal damage. Furthermore, he showed how this occured in brains of those with major depression. And in what state to bipolar people spend most of their time? Depression. Severe long lasting and repetitive and cyclical depression. Finally, I had my smoking gun.

So what does this mean to us long term bipolar peeps? (I disclude those that have perhaps had only one cycle which may or may not - and a strong possibility of not - actually be "bipolar"). First, let's have a look at the hippocampus and its functions in our brains and thus ourselves. 

This is the hippocampus:

It's a major part of our limbic system and a very busy part of it indeed. That yellow nodule at the front of it is the amygdala, critical to so much of our emotional functions and regulation. It and the hippocampus, as one would expect from their immediate proximity to one another, very much work in cahoots. Much of our incoming sensory data routes through the amygdala (which will both sense it for emotional content and attach emotional content) which will then shuffle it off to the hippocampus for longer term storage. 

We are, 
as I've written before, our memories. By that, I don't just mean phone numbers, names, days at the beach, that special Christmas, your first kiss and so on, but critical procedural memories and all kinds of "data" that your brain needs in order to navigate you through life. It needs to file away all kinds of things in order for your brain to remember what to do when confronted with any given situation. Basically, it's all our experiences - good and bad - that we have gone through in life. Therefore, the hippocampus plays a major, major part in Who We Are and how we play our cards in life. It plays such an important role in the "filing system" of your brain, a filing system utterly crucial to how you live your life, it could be said that the hippocampus plays a great role in dealing your cards in life. Robust growth of the amygdala and hippocampus during infancy highlights the importance of this region for functional development (these two regions have been implicated in autism and Asperger's). In Alzheimer's and dementia, it is in the hippocampus that the damage first appears.

 So damage here is something to take very seriously. 

And the depressing news (sorry to be the bearer of bad news) is that this damage by all accounts is permanent. 

So what causes this damage in bipolar depression? In a word - stress. Stress plays such a huge role in schizophrenia, bipolar and major depression that I will have to devote a separate post to it - perhaps two - but I'll go over it briefly for now. 

Stress is part of our flight or fight response. In this mode, activated when we (our amygdala that is ... that's its job) perceive danger, the brain is flooded with stress hormones designed to a) shut down extraneous brain regions (including your frontal lobes ... facing a lion isn't the time to ponder life) in order to give energy priority to critical areas and b) deliver high octane fuel in the necessary brain regions and to your heart, lungs and major muscle groups. The evolutionary purpose of this was designed to run away from, for example, a lion and was meant to last minutes. In situations of acute danger, it's a life saver. When it gets locked on, as it so often does in today's wacky world, it is, literally, a killer. 

So before I get into all the detail of how all this works, what can we do about it? Obviously, if there's irreversible damage, there's no sense crying over spilled milk. The task then switches to minimizing any further damage.

Obviously, if you are "lucky" enough to have one of the disorders I listed, stress reduction is Job One for you. What's one of the best ways to reduce stress? Meditation (though there are others I'll get to in a post or two). That's meditation with a "t", baby, not medication with a "c". As I ever so briefly touched on in the 
previous post, there is just a crazy amount of bleeding edge science that shows the benefits of meditation at the synaptic, neuronal and wiring levels of the brain. Plus, as I mentioned, it's only been the most effective way of calming minds for 2,500 years. Meditation will calm the signals entering your amygdala and thus the input into your hippocampus. Calm those down, and you stop the release of stress hormones in their tracks.  

And besides meditation, sleep. I have a different long and detailed post on the neuroscience of sleep rumbling around in the bowels of my mind but briefly, just take my word for it - you really, really, really need your beauty sleep. Have trouble sleeping? Back to meditation. This was one of the first things I learned when I finally confronted my bipolar - I had to learn how to calm my ever racing mind and get more, and better, sleep. So I worked like hell at this. And it works. I learned some basic, very easy to do meditative techniques and my sleep duration and quality improved immeasurably. 

(1) When I say "research", I of course don't mean I go off to a fancy lab somewhere, wear a cool white smock, and poke around into brains and stuff. I just mean deep reading in science books, science journals, watching video lectures and so on in a very directed way.

(2) I am extremely wary of sources and will ruthlessly root out bullshit science, research papers and claims (just ask some of my online neuroscience buddies). So when I come across a new source, such as Sapolsky, I'll spend a day or two looking into him as much as possible and cross referencing his/her credentials. I'll get into the details of this another day, but there are way, way too many bullshit sources out there regarding neuropsychiatric disorders and the medicating thereof, bullshit that nearly cost me my life and the lives of very, very many other people. So I am utterly and absolutely ruthless about sources now. 

Sources and further reading:

Searching for the Mind by Jon Lieff

The Brain Book   by Rita Carter

The Willpower Instinct by Kelly McGonigal

Saturday, October 26, 2013

Stories From the Inside

I'm working on the next blog post in the more science bases series that I started but in the meantime I'd like to start a series of stories about people I met while staying on psychiatric wards. Part of the purpose of this blog is to educate others about the world of mental illness and this is part of that education. 

Weird Scenes Inside the Goldmine 

- Jim Morrison, 1970


Z was about twenty-one or twenty-two years of age in March of 2011. She had the beautiful high, hooked nose that many people of her native Afghanistan have, along with high cheekbones and eyes of a pretty hue of brown that were so deep you swear you could swim in them. She was small and frail. If her five foot frame weighed ninety pounds I'd be surprised. If I'm not mistaken, she was the youngest or one of the youngest in her family. She may have had a younger brother, I can't remember now. She did have, I know from her family's visits and through Z's stories, lots of older siblings, about evenly divided between brothers and sisters.

Z and her family were from one of the more southern areas of Afghanistan. I can't recall the name of the area. I think, though, that it was a suburb of Kabul. Nor can I recall Z's family's exact religious affiliation. I didn't get the impression that it was important to her. It didn't seem to be to any of her siblings when they came to visit either. Z and all of her family dressed and acted very progressively and with modern sophistication and style. Her father had been a gold merchant (not bulk gold but of the jewelry variety, something very important in Afghani culture). Her family was not rich but of upper middle class well off means. Z and her family lived well. Their family was well known and respected in their neighbourhood. Z told of her father being a generous man, one who didn't mind rubbing shoulders and sharing tea with anyone. The life of Z's family was good. They had everything they needed and were all ambitious as far as education goes, they were expected to gain a higher education and become doctors or other such gentrified positions.

Then one day the Taliban came.

One day Z's family was “in”, the next day it was “out”. The Taliban, as Z told it, had targeted her kind of family as “out”. I don't know what your knowledge of the Taliban is but at that period in Afghanistan's history, you did not want to be “out” with the Taliban. So, as with tens of thousands of other similar people at that time, they were left with little choice but to flee. Z would have been about eight at this time. Her life went from one of sheltered upper middle class with everything she and her family needed to one on the road with whatever possessions they could carry.

For weeks they traveled over dirty and barren roads through scorching hot valleys and harrowing mountain passes. All this while her family and those that they were traveling with had to keep an eye out for the Taliban and their sympathizers and to look out for bands of thieves. Much of the gold they'd brought along had to be bartered away for their safe passage. Several months later, they had crossed the Pakistan border and had found a refugee camp. As refugee camps go, it was no different than any such camp around the world. Relief organizations had done their best to erect tent cities and provide as much as they could. It was dirty, water was rare and precious, there was little food and there wasn't a speck of shade outside of the tents to give any relief to the daily 40C temperatures that seared down on them in summer. Nor was there much protection from the harsh mountain winds that sent temperatures plunging in winter. From playing with beautiful dolls in air-conditioned rooms, Z went to playing with sticks and rocks and balls of rags in ad-hoc games played with other children in small, barren, stone strewn patches of hard, sun baked soil. From being taken care of by a nanny, she went to having daily chores of scrounging for food and water. She went from having the finest clothes to wearing nothing more than whatever rags were left from what they could bring and what they could now find. Everywhere you looked, there were tents and other large families like hers. No one had much of anything.

This was to be Z's home for the next eleven years.

Z's family were cut from sturdy cloth, however. Somehow through all of this, they not only survived, but somehow managed to relatively thrive. And through relatives who'd long ago emigrated to other countries, connections were made, money saved, refugee relief procedures navigated. And Z, her mother and father, and most of her siblings found themselves in Vancouver, BC. Z didn't really know how all of this happened. She was young and unconcerned with such things. She just knew her father, mother and family had made it happen. As she was expected to, Z was entered immediately in school, in a school in an strange English speaking world where she barely knew a single word of English.

But, as immigrants have done for centuries in sink or swim situations in new lands, in new cultures and among strange people and a new language, she learned and she learned fast. Within a year she had a part time job at McDonald's. Within six months, she had mastered everything there was to know about working in that McDonald's and all of the English needed to boot. She was promoted to an assistant manager position. At the same time, she'd graduated high school and had been enrolled in college.

Throughout those eleven years in the refugee camp and the ensuing several years adjusting to Canada, Z's family's expectations for their children had never faltered. They were still expected to get the highest education possible and the best careers possible. Not jobs, but careers. Z's expectations were no different.

All of her siblings had done well and Z loved and admired them all but she had special love and admiration for an older sister, “M”. M had not, for reasons I can't recall, fled with the rest of the family when the Taliban arrived. I believe she may had already left for university and been well into her education and that that part of Afghanistan perhaps had remained in more liberal hands. At any rate, she stayed there, had become a doctor and in the now more liberated post-Taliban Afghanistan was practicing medicine specializing in women's needs (which was in very, very sore need among Afghanistan women). M was Z's hero and when Z spoke of M, her voice and beautiful deep brown eyes made this abundantly clear. Z said that they spoke often on the phone or through Skype. Z wanted very much to be like M.

She therefore put on herself, aside from the pressure her family put on her, a enormous amount of pressure to live up to the standard set by M. But she struggled with school. College was not like the simple courses of high school. The vocabulary and demands were much higher. In college she wasn't sheltered in an ESL program like she had been in high school. The stakes were higher. The workload to keep up with normal homework and to continue learning English at ever higher levels and to hold down her part time job at McDonald's was knee buckling. Delicate and frail Z was having a very hard time keeping up with it all. She began to suffer anxiety and couldn't sleep. She saw a doctor and was put on medications to ease her anxiety and help her sleep.

Then one day, while suffering from exhaustion, Z had failed a critical test at college. Utterly distraught and humiliated, she returned home and wept in despair. And then, and she couldn't clearly remember why or explain it at all, she took her freshly renewed prescription bottles and downed their entire contents, about a hundred pills in all. It was not long before she collapsed. One hundred pills in a body as slight and tiny as Z's will go to work fast and when her mother and sister found her, the toxins were already well within her system and were shutting organs down. She was already incoherent and lapsing into a coma. Her right hand had already frozen into a death grip around the bottle of pills she'd emptied. 911 was called, she was rushed to hospital and put on life support. Through some sort of miracle she survived. She spent several weeks in ICU.

And this is what brought Z to the chair next to mine to where our very disparate paths met in the TV room of the psyche ward of Royal Columbian Hospital where she had been telling me all of this in snatches of time in the long, boring, pointless days that we had to pass. She told her story with such humility, with such lack of self-pity and with such utter charm and humour, that at times my eyes stung with tears. The only times her voice showed much emotion was when she told of how fast she'd risen in McDonald's and had learned English. She was very proud of that and rightfully so. I've taught English to many, many people in the last twenty years and the level of English with which she was speaking to me was astonishing for the short amount of time that she'd been using it. She scarcely even betrayed a trace of an accent. For all I knew, she'd grown up here. The other time was when she spoke of M. It's not that her voice was flat otherwise, it wasn't, it was very animated (and of course it would be ... she comes from country with a thousands of years old tradition of oral story telling). It's just that there were those times that her voice told of a special emotion.

It was in the TV room that we'd met and we had become bosom buddies over the Vancouver Canucks of whom she was an avid and passionate fan (the Canucks are Vancouver's professional hockey team). The Canucks were on what would be a special run that season and the city was really fired up and the psyche ward of RCH was no different. Z and several of us gathered each night of a Canucks broadcast in the TV room and raucously cheered on our boys.

Z was therefore in the psychiatric wing of Royal Columbian Hospital because of a suicide attempt. She hadn't been depressed. There wasn't a trace of depression or of feeling sorry for herself when I talked with her. She had told me a lot of detail of what had been a very difficult life and had never shown a speck of sorrow or of self-pity. Talking to her, she was as vibrant, humorous and joyful a human being as you could want to meet. Positive life force verily radiated from her. She had been under a lot of recent pressure and stress however. I have no idea what her “diagnosis” might have been. She had been, however, obviously under a great deal of stress. 

The story of Z is one of several I'd like to tell of people I met "on the inside". I'd like to tell these stories for a number of reasons but chiefly to give an idea of the kind of people one will find on a typical psychiatric ward. I met dozens of people in my four stays in psychiatric wards no two of them alike. Readers of this blog also will know that I have a particular interest in suicide and the reasons behind it so I also think of Z as an interesting case study. We'll come back to this story, and others, later.