Saturday, April 29, 2017

The Neuroscience of Music Therapy

The Neuroscience of Music Therapy

Recently, while re-posting Positive Difference Making Fundamentals - an Introduction to Music Therapy, I said that "If you were to be ensnared by me in conversation about all this brain and mental health stuff, there is almost nothing I enjoy more than talking about music and the brain". And it's true, I can get pretty animated and passionate about it (as a couple of young people who were thus ensnared by me not long ago found out).

As many of you know, the world of brain and mental health struggles is both my outer world (what I study and work within) and my inner world (what I often deal with myself). It's a difficult field in many ways. Dealing with people's struggles and pain is what I do. It can, as you might imagine, get a person down. 

It can all become quite a weight to carry on top of the struggles in my personal life so I have to be very careful with my own mental states <understatement>. As you all know (or I hope you do), I rely mostly on the 
Positive Difference Making Fundamentals for working on and trying to maintain the best mental state balance I can. This is not a perfect process, I think you should know - I can falter like anybody else. It might be due to a sudden impact trigger or the accumulative effects of many things, large and small or both.

In any case, I realized this past week (after having a lot of fun talking to that young couple about music and the brain) that for me it's not enough to only practice the fundamentals like music therapy, I sometimes have to remind myself of all the fun brain stuff that got me jazzed about them in the first place. And it's not only about why 
I get jazzed about it, I have to remind myself how important these things are for you and your brain and mental health. I have to tell myself that I have to be much firmer about teaching these things and getting you to implement them. 

Most of you know (and for those who don't, you will know in time) that one of my other great passions about the study of brains is the concept of 
neuroplasticity. It is not only a great passion, it is the cornerstone for everything I believe about your ability to change and grow and learn and move forward from where you are now. Neuroplasticity and music are very closely related in the brain so it is important to touch on that here to form the basis for our understanding of what music therapy can do for you.

What I refer to as "positive change" neuroplasticity (there is a dark side to the brain's ability to adapt and change itself, we must bear in mind) needs a spark. It doesn't just happen out of the blue. It needs certain things to initiate the process. There are many ways we might think about this but for now let's think of it as part of the process of baking bread. For bread to become light and fluffy the way we like it - to expand, in other words - it needs yeast to start the process of rising. So to help get this process of positive neuroplasticity going, we need a "yeast" to begin this "leavening" of your brain and mind. 

Enter music. Music is a "yeast" that's going to get this magical process of neuroplasticity going. It's not the only "yeast" - there are many others - but I'll argue it's the most important because it is the most enjoyable and "easiest" way for us to stimulate our brains into neuroplastic activity and change. 

I'm going to talk in another post about why I believe in you so much (yes 
you. Not that other person you think I'm talking to, but you). I can - and will - wax on in shear rhapsody why I believe in you and your potential and believe you can get past where you are right now (wherever and however that might be) but I want to touch on that belief a bit here now. 

It's easy to talk about belief but for many it's woo-woo blowing rainbow unicorn farts up your butt stuff. As you all by now should know, that's not me. You don't need woo-woo "it's all going to be alright if you just believe" rainbow unicorn farts blown up your butt. It wasn't - and isn't - good enough for me and it's not good enough for you. My belief has to come from a very solid foundation of science and evidence. My job then - the job of this blog (and coming talks) - is to pass that along to you so 
your belief is built on solid foundations, not woo-woo unicorn farts that will shift or blow away with every passing breeze (not to mention storms!). No, no, no, we need something much more solid than that to weather all the crap we go through. 

Back in the post on 
an introduction to belief I talked about evidence based belief. This here is what I was talking about and why. When I say I believe in you, I can look into your brain and vividly imagine all the potential you may have there waiting to be discovered, unlocked and nurtured. Again, this is not woo-woo imagination, this is imagination based on fantastic amounts of current knowledge on brains, how they work and their enormous potential power and capabilities. This, folks, is why I love studying neuroscience - to not only know about the potential that lies within you, but the very neuroanatomical basis for it all. 

So, my fine feathered mental health suffering friends, if your belief is not there yet, I'm going to ask you to put your trust in my belief in you - deal?

As regular readers and followers will know, my posts seldom take form without some kind of long Bradonian preamble so without any further ado, let's proceed. 

Music and the Brain

Before I start talking about this in more detail, here's where we brush up a bit on our basic brain anatomy  with this handy 'road map' of some of the brain regions related to music therapy that we'll look at and discuss here today. 

In the introductory post I mentioned that nothing stimulates more regions of the brain than music. This is especially true for playing music, of course, but it is also true when we are listening to music. This gives us a good idea of what I meant by that. 

Let's look at these in more detail to get a better understanding of each and their importance in a well designed music therapy program. 

Let's start with the obvious - the auditory cortex

Auditory issues will be a problem in many cases of depression and anxiety along with ageing. Due to various inner and external stressors, this area can become over sensitized and misfire leading to irritability with sounds around us (even ones that would not normally be irritating). New evidence is emerging that tinnitus that often accompanies cases of depression and anxiety (and indeed will become a significant contributing factor) may be due to - as those in the brain biz would say - 
maladaptive auditory cortex reorganization or "unfavourable plastic changes" (part of the "dark side" of neuroplasticity that I often refer to). Certain ageing related hearing loss may well be due to what's going on in the auditory cortex rather than the "signal gathering devices" (IE: your outer and inner ear). 

That aside, it is the auditory cortex and tracts that will analyze the more intricate components of music like tones, intervals, melodies, timbre and rhythm. 

These are aspects and factors we want to keep in mind when selecting music and musical sounds for a music therapy program. 

Next, let's look at the corpus callosum 

Our brains have two hemispheres (I talk about these in some detail in 
this post in my neuroscience blog). Over there I debunk the myth of "left brain" and "right brain" people and personality traits, nonetheless there is a great deal of quite distinct "division of labour" between the hemispheres. It is vital for balanced thinking and perspectives that these two regions work well together. I've spoken often of the main "trunk lines" of white matter (bundles of axons, AKA our connectome) and the corpus callosum is one of the key bundles as it is what connects the two hemispheres. Enormous amounts of "data traffic" must pass back and forth through it. 

It's not hard to imagine, then, that the right kind of stimulation for this all important axon bundle can be tremendously beneficial to overall brain function. 

Moving downwards and to the rear of our brain we will find the "little brain", the cerebellum 

This humble and rather ancient part of our brain "hardware" is of enormous interest to us here when it comes to music therapy. It is here that the great majority of planning and execution of movements takes place. How well this region functions and is connected to the rest of the brain is crucial to all our physical movements. We take these things for granted but it is finer motor skills that decline with age and eventually lead to falls and general "clumsiness". As we age, however, we tend to not only be less active, but our movements tend to become more routine putting less demand on this region to "stay sharp". One of the tenets of neuroplasticity is "use it or lose it", meaning that critical connections within the cerebellum plus networks connecting it to other regions of the brain such as the sensory and motor cortex

We will address the sensory and motor cortex together here rather than separately as their activity is so closely connected to that of the cerebellum. Within these two regions are mini-regions that correspond to all parts of the skeletal-muscular parts of your body. It is these regions that when damaged by a stroke will result in paralysis. These areas too then are very important for body movement and tactile sensations related to parts of the body. 

The cerebellum and motor cortex must maintain vast connection networks for your body movements to work properly. But again, keeping in mind "use it or lose it", these will become less strongly connected if we do not regularly move our bodies in challenging ways (as opposed to simple routine walking, for example). We see this not only as we age but as I brought up in the 
lecture on depression, psychomotor retardation can occur along with vegetative states and fatigue (all related, I believe). These all impair a patient's physical ability to move and we will see a negative cycle of the less one can move the more impairment there will be. 

As music demonstrably stimulates all these regions and the connections between them, for this reason alone music therapy is an absolutely essential part of any treatment or recovery program for depression or any major psychiatric or mood disorder. 

But the importance and roles of the cerebellum doesn't end there. 

A good body of research over the past twenty-five years shows strong evidence that the cerebellum has significant connections to brain areas involved in higher cognitive functions, including the prefrontal cortex (see more below). The cerebellum appears to play important roles in both coordinating and helping motor cortex areas automate cognitive functions (thus making them more efficient and easier). 

These networks are crucial to stimulate as much as possible.  

Let's now leap forward (sort of literally) to the prefrontal cortex

The term most associated with the prefrontal cortex area is "executive function" which, briefly, relates to abilities to differentiate among conflicting thoughts (1), determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social "control" (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes).

What I found of great interest is that a good deal of study has indicated an integral link between a person's will to live and PFC activity, something that obviously is critically important in many cases of depression. It has also been strongly tied to planning complex cognitive behavioiur, personality expression and decision making. We can think of the general "job" of this region to be orchestration of thoughts and actions in accordance with internal goals. 

For a number of reasons, impairment of or difficulty in many of these functions will be associated with virtually all mood and psychiatric disorders. I need to get to this in more detail in another post but briefly activation of the PFC becomes reduced (though I do touch on this a bit in 
this post). And again, with the basic brain principle of "use it or lose it", the less stimulation there is of a region, the more it and brain wide network connections will atrophy or weaken. 

I think we can now see how crucial it is to 
positively stimulate this region and related networks as much as we can! 

Let's look at the 
hippocampusamygdala and nucleus accumbens collectively. By now we are becoming more familiar with the former two in our looks at the limbic region of the brain in relation to stress and emotional responses. The hippocampus is greatly involved in encoding and retrieval of memories of experience (episodic memory) and the amygdala is central to how we experience and react to emotions, fears, dangers and threats. Both of these will be involved in depression, bipolar disorder and other psychiatric and mood disorders. 

The nucleus accumbens is a key "relay hub" in dopamine pathways related to reward and pleasure. It is located "upstream" from the Ventral Tegmental Area (where dopamine pathways originate). Activation here is critical for passing along dopamine signalling from the VTA to the pre-frontal cortex where it may be involved in a number of higher functions such as long term motivation and reward. 

The right kind of music therapy has positive affects on all these brain nodules and there is even some compelling evidence that listening to music can stimulate 
neurogenesis in the hippocampus, which is kind of the holy grail of neuroplasticity. 

Now, it's not only these specific regions that are activated and stimulated by music. 

Let's first look closer within them to get a better idea of what kind of neuroplasticity we're kicking into gear. 

Music and Neuroplasticity in the Brain - the Finer Details

Okay, now we have to think back on and recall some 
neuroscience 101 stuff. Here we have our neuron illustration from back then.

For many neurons, their jobs are to "encode stuff" - all the tiny fragments of details that make up all kinds of memory and higher cognitive functions. The "stuff" of these neurons isn't static - it changes according to input and even our very thoughts. Other specialized neurons are involved in perception and learning. These too are not static and respond to new experiences and learning. In neuroscience 101 I said that the activity in a single neuron has been compared to that of an entire city (I really must get to that in some detail some day - fascinating stuff, I can assure you!). 

When we "input" new information or "put in a call" for existing information, there will be furious amounts of activity within neurons relative to that task all in real time.

So just within individual neurons in many, many critical regions related to higher cognition, perception and memory they are stimulated in very important ways. This is just one aspect of the 'positive' neuroplasticity stimulated by music. 

Neurons will get excited as all hell with this activity and get all 
fired up to connect to other related neurons or even unrelated neurons that may "be interested" in this juicy new stuff (or even juicy old stuff! - neurons can be great gossips). Which takes us to the next step of all this neuroplasticity we're kicking into motion. 

As I've said numerous times in various posts, all that information and activity within individual neurons is "useless" if they cannot connect to and pass that information along to networks of other neurons to complete "big picture" processes of cognitive functions, memory formation and recall, etc. 

Along those lines, it's important to understand that a single neuron can play many roles in several different senses and cognitive, memory and perception functions. 

Let's look at the next illustration. This gives a rough idea of the "flow" of information through a network of neurons. 

Let's imagine that that single neuron on the left is the one from the above illustration and it's all full of fun and exciting stuff. We want that baby connected! 

The bursts of information flow along axons (the direction of the arrows) and are received by dendrites (the little spikes reaching out towards the axons). At the point they connect are the synapses that I've been writing about. Let's have another quick look. 

The connections between axons that are sending the information take place at dendrites and synapses. I don't want to get into the details of this again here today (I get into quite a bit of detail about these connections 
here  and there elsewhere) but briefly and generally speaking for keeping positive aspects of brain functioning sharper, the more dendrites and synapses the better. 

The number and quality of these connections are an enormous part of neuroplasticity as well and this is precisely the kind a well designed music therapy program will stimulate. 

Now, I'm going to show you how important this is. 

These phases are considerably more complex than that and there's more to the time lines of them but this gives us a good general idea. As well, please ignore at the bottom where it says "conscious front portion of the brain" as that is quite misleading. What we want to pay attention to is that middle peak part. That's generally what we want - lots of dense connections (though not 100% necessarily - more in a moment). What I need you to 
really pay attention to is to the right. For most people that's what will happen. That's what cognitive and memory decline looks like. Note that there are still lots of neurons - they actually do pretty well with this whole aging thing - it's the connections that are lost. Lose connections and memories and cognitive functions are impaired, slowed and perhaps lost. Not good, folks. 

That shows decline in older age but in many cases of depression, bipolar disorder, schizophrenia, mood disorders in general, both cognitive and memory function decline are often part of the long term symptoms. In mood and psychiatric disorders the reasons and causes of these are a bit more involved though also very similar. Either way, a good deal of what is happening is the lost connections illustrated at right.

But - but! - and I need you to really drill this into your head: it does not have to go that way. Repeat: 
does not have to go that way. 

One more time: it 

There are a number of reasons for the mass "pruning back" and loss of connections we see on the right but the greatest, most likely and most common reason is because one of the most fundamental principles to brain function - use it or lose it. And that on the right, folks, is what "lose it" looks like. 

When you read or hear of "grey matter" in the brain and the loss thereof, this is a great deal of what that means. The denser connections and the building of them is what is happening when we hear of "increasing" grey matter. 

Okay, so what then does "use it" look like? Simply put it means regular stimulation. So what does that look like? There again are a number of possibilities but the two best known for maintaining connections and growing new ones are learning and new experiences. 

So what then do learning and new experiences look like? 

Well, the possibilities there are sort of endless but of course today we are looking at the effects of music on the brain. 

Music in general will stimulate more areas of the brain and more connections within them than almost any other activity.

One way to understand why music stimulates the brain so much is to understand how complex sound waves are. 

According to 
Dr Jon Lieff in Searching for the Mind, even the Fourier transform equations used by Einstein to analyze light fall far short of being able explain the brain's ability to analyze sound waves. Each note is made up of extremely complex series of vibrations, IE; the harmonics or overtones (these entail enormously involved mathematical ratios). 

Yet the brain takes all this and sorts into all the notes and so on that you experience as the sound of music. 

And while everything involved in the brain is going to be tremendously stimulated by that alone, that's not quite enough - we need learning and new experience. 

And that, folks, is why I emphasized in the 
original piece introducing music therapy that it is very important as part of designing your program that you include not only as much new music as possible, but the complexity of the composition is important as well.

To give an idea of that, let's look at that a bit.  

It's figuring all that out and storing it away that's going stimulate so many brain wide regions and networks. 

And it doesn't end there!

It's not just neurons and all those connections that are stimulated, it's that big beautiful "wiring harness" or connectome of ours that will also be greatly involved and stimulated. The connectome is all the "long distance" wiring that connects all these regions we've been looking at. 

Just check out this beautiful illustration! 

This too can experience loss with age and/or lack of good stimulation and key bundles of axons will be very actively stimulated as your brain roars around all over dancing to the beat of all kinds of music. 

And the benefits of music don't end there!

While all this stimulation of neurons and spurring connections and growth all over the brain is fantastic, there are actually several key areas we want to 
de-stimulate. We want those regions and networks to calm down and not be so connected to our overall brain activity that creates our conscious experiences. 

These will be areas in the amygdala and hippocampus associated with fearful memories, difficult emotions or emotional responses and so on plus their related places throughout the brain. The right kind of music can calm those down and reduce their activity and thus their roles in our behaviours, moods and reactions to outside and inner stimuli. 

As well, there are powerful areas in the brain involved in ruminative negative thinking (recall that we looked at these back in the post on 
Staying in the Now). This is where many people get trapped in depressive episodes and part of what's happening is the build up of too much activity and connectivity within these areas and long distance connections to other parts of the brain. This is the kind of "use it" we don't want! This is more what we want under the "lose it" end of neuroplasticity, IE; we want these areas deactivated and calmed down more and to not be so much a part of what is producing our thoughts, emotions and general conscious experience. 

And a well designed music therapy program will help us there as well. When we feel ourselves slipping into those times of ruminating negative thoughts (and probably lots of negative self-appraisal and beating ourselves up thoughts and morose, pessimistic visions and ideas of ourselves and the future) if we instead switch to certain kinds of music, we can get our brains away from activating those areas and get stimulation and activation going in all the areas we looked at above, instead. In addition to de-stimulating those specific areas, we are also reducing the activity in the connectome that that "wires" those regions into our overall mental activities and states thus reducing their "hold" on us. It takes time, but gradually this 
will make a difference. 

A well designed music therapy program done in concert with (a little play on words there) some variation of my 
brain training exercises in which we're learning to focus on positive self-talk, problem solving and looking for the best outcomes possible will be very, very powerful in all kinds of positive neuroplasticity and thus building better mental states and long term cognitive and emotional regulation functions. 

I think now we have a very strong understanding of why this 
Positive Difference Making Fundamental is so vital. As I said in the original post, when we are hammered by the fatigue and everything seems so impossible and exhausting to do, it can be really, really challenging to do any of the things we know are important for getting better. And it is prolonged stretches of this fatigue, mental fog and so on that will greatly contribute to the loss of connections we looked at above and thus create the symptoms of loss of cognitive and memory functioning. This is a huge reason why music therapy is so important to you - you absolutely must exercise your brain in some way to increase the chances of getting better and music can do that better than anything else you can do. 

What's most exciting about what music does for the brain and positive neuroplasticity, is that all this brain wide stimulation really helps "set the table" or "activates the yeast" for all kinds of other neuroplasticity for learning, creativity, better more positive imagination and so on (known as 

Phew, that's a lot! I know that's a great deal of information to take in but trust me, your brain is soaking it up. Just reading posts like this is positive stimulation!

Stay tuned and thanks for reading!

(1) When we are practicing mindfulness CBT this is one of the brain regions we're activating, "building up" and strengthening its connections to other parts of the brain.

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


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 between written communication and oral communication is quite different. 

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. 

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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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