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. 

If you enjoy or benefit from the information you gain from this blog, or see the importance of it for yourself or for others in understanding and working on your/their mental health conditions or if you're in the mental health professions or otherwise see the importance of the work done and presented in this blog, please consider donating and supporting it. 

All the writing and research is done by a single individual - Brad Esau - who himself has been disabled due to the long term effects of his condition and who lives on a very minimal pension and thus has great difficulty supporting himself. 

For a one time donation, you can simply follow this link and instructions: paypal.me/BradEsau

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Let's Talk - To Whom?

It is again time for Bell Canada's annual Let's Talk campaign. Its very laudable goal is to reduce stigma around mental health disorders and to encourage people to "talk", to "speak up" and that this will help you feel better. There are some famous spokespersons and they will give personal testimony to how talking about depression helped them (one of whom - and the face of the campaign - is Clara Hughes, one of my very favourite Canadian athletes and Canadians in general whom I greatly admire). If you were to follow the link to their site or see their ads on Canadian TV or hear them on radio, you'd find a very feel good vibe to the whole thing, a sort of "hey, this all isn't so bad, it feels good to speak up and talk" feeling. 

And there's no question that suffering alone, lost in confusion and unbearable pain, will almost always lead to worse outcomes. A recent study - conducted in Canada - found strong evidence that those experiencing suicidal thoughts were seven times more likely to recover if they had someone to confide in. 

However, as good as it all feels, as good as they try to make it feel, as helpful as it could be, most of us know this is not - yet - the reality. In our world the reality remains - talk to whom?

What I would like to see - and I'm sure many of you from our world would agree - is not a "Let's Talk" campaign, but how about a "Let's Listen" campaign? For until we have a society that is better trained to listen - to truly compassionately listen while controlling the natural compulsions to jump in and judge and give "advice" and so on - then "talking" for most of us will be a futile and painful exercise. 

I've never been shy about my condition. I have talked to literally dozens and dozens of people. I have talked to dozens of psychiatrists and psychologists and health care workers. And out of all of those - and we're talking about close to a hundred people - only one really and truly listened and heard me, "B", the therapist assigned to me through a local program to give university psychologists in training some "seat time" experience. 

However, our sessions wrapped up with the end of the university year (we'd met weekly from September to May). I was told to call and register again in the fall but when I called to do so I was told my case was too hard, that there was no one in their program who could handle it. This from the chief (and very experienced and hard nosed) psychologist who oversaw the program. 

As for psychiatrists, they will nod, hum, maybe mention this or that but at the end of the few minutes you have with them, all they will do is pull out their prescription pad and prescribe yet more drugs. No people, this is not a solution. Why it's not a solution, however, will have to wait for a separate piece (among the dozens and dozens on my "to-do" list). 

So that's at the professionally trained end of things. 

As for "talking" with friends, family and so on, what one with serious depression or suicidal thinking will face will almost invariably be some of the very worst of what stigma has to offer. There is a very good chance you will get gas lighted to some degree. You will be told you're just being selfish. You will be told many people have worse problems so suck it up. People will get into "my problems are worse than your problems" arguments. People will tell you that your depression doesn't hold a candle to theirs, so suck it up. People will cut you off and talk over you. People will actually argue with you that your problems don't even exist. People may appear to listen but then you find out they're saying awful things behind your back about what you told them. People will make jokes. And on and on. 

I once tried what everyone tells you to do - dial a suicide help line. The woman on the line sounded bored and restless after a few minutes. I'm one of those people who are super sensitive to tones like that so I had to hang up. Granted, I can think of fewer worse jobs on earth but just to add some insight into what that "let's talk" outlet can be like.

And if you try to tell anybody about all these awful experiences, they'll tell you that you must be exaggerating. 

I really do need to get to an in depth look at stigma in a separate piece (yet more for that long "to-do" list) but I can tell you from an enormous amount of personal experience, from listening to dozens and dozens of personal stories, from reading at least a hundred case studies and from deeply researching stigma in general, that "talking" is almost certain to expose one to stigma and possible character assassination that will drive a person deeper in the hole.

I apologize if this doesn't sound too heartening or encouraging. But this is the bare bones truth from my world. And one of the truths is that it's very easy to post these things on social media and sound "hip" to the problem and pretend to be spreading "awareness", but it's a whooooooole different ball game to actually do, to actually "listen", to actually hear what the person is trying to say, to actually walk the walk and not just talk the talk. 

And for anyone needing to talk, it is excruciatingly hard to talk about these things. There is literally nothing that makes you more vulnerable than opening up about these horrors in your mind. I can say with one hundred percent validity, that there is a very good chance that what you say "can and will be used against you". This is not just my experience, I've seen this documented in numerous papers looking at this whole business of mental illness and stigma. There is an enormously high chance that you will lose friends, job opportunities (if not actually lose jobs), be outcast, or at the very minimum, people will look at you differently, in a lesser kind of way. 

So again, "Let's Talk" - but to whom? Who is this mythical person we're supposed to reach out and talk to? What if our problems persist and aren't something that will go away with a simple "talk"?

Yet ... 

I do know it's hard, really hard to just listen.

Through Taming the Polar Bears dozens and dozens of people have reached out to me in one form or another. I've heard some very hard stories. I'm in a unique position to be able to listen and offer solid insight and actual useful things to do. As both a peer (someone who truly gets what they're saying) and someone who's researched so much into what to do and why, I'm in a better position to help. But even then, it can get tremendously emotionally draining. 

So for people who are not at all equipped to help (read: 99% or more of people), it is very, very difficult to just sit and listen. 

So what do I think the answers are? Frankly, I have no idea. But what I've learned since starting all this research (exactly four years ago now) and since writing this blog, is that you nor I nor anyone in particular is going to change how all this works in the world. 

So what it comes down to is the person reading this post - what are you going to do? That's all that matters, what are you going to do? 

And what I can tell you, or suggest to you, is to look into yourself - if someone close to you called you out of the blue (or texted or emailed) and spoke of being in a very dark place and maybe spoke in round about ways about ending it, what would you do? Are you ready for that? Could you just listen without shaming them or judging them or putting them down? Statistically speaking, I have to doubt it. 

So start with yourself. Learn about stigma, learn about what and what not to say, but mostly, learn out how to shut your mind off and just listen and hear what another human being has to say through their eyes. 

Learn to do that and you might just save a life, a life very important to you. 

Learn to do that, then you can talk about "Let's Talk".

It's Okay

Here we are at the dawn of 2017. If at the dawn of 2013 (or the dawn of any year I existed prior to that, for that matter) you'd have said that I'd be considered a sort of expert (that word should be taken with at least a bit of a grain of salt) on the brain, human behaviour and mental health, it would have been a pretty, well, crazy notion. 

For nothing that I know that goes into this blog or what people now know me for existed prior to four years ago. I keep saying I really must get to the story of all how this came about (though some long time readers and those who know me through certain online circles are more aware) but for now there are many other more pressing concerns. 

In any case, the blog now has hundreds of readers around the globe and I have this 'reputation'. As such people write to me from every continent on earth save the Antarctic asking all kinds of questions that pertain to behaviours or mental health. People are upset, people are scared, people are worried, people are on the verge of or are already melting down. Though no one comes right out and says this (save for one notable exception), I know they're scared. I know this because it is scary. I've been there.

When our minds start to go off the rails and we feel we're on the very knife edge of life itself, frightening thoughts are racing through our head, we can't sleep and we don't know what to do or where to turn, it's scary. Real scary. Those who aren't scared have interesting psychological features to delude themselves so they're sort of blissfully unaware (a whole different sort of mental health kettle of fish, but we won't digress). I know it's scary because I'll never forget how scared I was, and still can be. 

So you know what? It's okay to be scared. We can get past scared but it's absolutely alright to be scared. I can one hundred percent assure you that there's nothing shameful about being scared. 

Let me tell you something. I'm 6 foot 2 (184cms) and most of my life I was "built". I worked in hard scary jobs, I played tough sports. I road motorcycles over some of the scariest roads on earth and through some of the most chaotic dangerous traffic there is. I faced and conquered a lot of scary stuff. But when my mind started going off the rails and I began having psychotic episodes and my life started falling apart, I can tell you, I was scared. Nothing I'd seen or experienced in my life was scarier. Nothing. I've met people tougher than me who were scared when going through something similar. 

So right now you're feeling a lot of things that are causing anxiety and depressed feelings and this is all really frightening and there are good reasons for you to be feeling these things, but we're not going to feel any less of ourselves or ashamed of ourselves because we feel scared. It's okay. We'll be surrounded by people who will heap shame on us for feeling this way, but right here, in here in this space, we're going to know that it's okay. It really truly is. 

Now, about breaking down. 

We live in the most complex, fast paced and fast changing and densely populated time in the history of the planet. As I present and argue in Evolution, Life and Why Our Brains Developed the Way They Are, our brains spent millions of years evolving for conditions that bear absolutely no resemblance to today's world. We daily must deal with cultural and societal and family unit complexities that have no precedent in history. 

Knowledge is doubling at the rate of every thirteen months. Technology changes yearly. We are exposed to the ails of the world and human suffering in ways and at a scale that are unprecedented in human history. 

So are people going to break down under those conditions? Yes. On a scale that is again unprecedented in human history. 

So if you are breaking down (or have been breaking down or have been broken down for some time) or are are feeling anxious and depressed (or all of these things at once) you know what? It's okay. There are literally millions of people around the world breaking down (and each day many won't live to see the next day). I don't mean it's okay these things are happening to you - it's not - but it's okay in the sense that you are not some Particularly Flawed Human Being for breaking down. So yes, it's okay. It really is. 

Your brain is the most complex biological organ in the four billion year history of life on earth. It operates on levels of complexity that defy any current understanding or ability to explain it, despite the efforts of thousands upon thousands of the most highly trained people on earth using the most advanced instruments in human history. It has to operate 24/7 for every second you draw breath. Even some of its most basic functions would cripple the most advanced supercomputer on earth. 

A simple watch is going to break down under certain (and far less stressful) conditions. So I think we can assume that it's pretty unreasonable to expect that this unfathomably complex organ between your ears isn't going to break down under some of the most trying conditions in history. So yes, it's okay that you're breaking down. Again, I don't mean it's okay that it's happening to you, but it's okay that your brain is experiencing some 'wobbles'. You aren't "weak" or a "wimp" or in any way a lesser human being. You are very normal and it really is okay for this to be happening. 

Now when I say "it's okay", it's not in the fluff "everything's going to be okay" way we see and hear passed around as "advice". For in truth, if your mental health problems are serious, then if certain things don't happen, I can assure you on no uncertain terms that there's an unacceptably high chance that no, it won't all be "okay". I can tell you this from studying countless case studies of what happens when certain efforts aren't undertaken to make things better, not to mention from my own very difficult case. Long time readers will know - and appreciate - that I'm not of the type to blow rainbows and moonbeams up your butt and tell you "it's okay, it'll all work out" because frankly, that sort of fluff gets too many people killed or keeps them in unacceptable conditions.

I mean it's okay in the sense that you are a perfectly normal human being who's not going handle everything perfectly. We can beat ourselves up about a lot of things but we're not going to beat ourselves up about this. It's okay. It really is. 

Understanding the Mind - Cognitive Distortions and Other "Brain Bugs"

Understanding the Mind

Brain Bugs and Cognitive Distortions

If you were to go to the mirror and look at your skull (ignoring for now all those facial and hair details we usually fuss and fret over), from the top of your skull down to roughly your mouth line and from your right ear to your left, what you have inside there is the most complex biological organism in the four billion year history of evolution and within the known universe.

The approximately 3.2 pound jello like blob that resides in that above described space operates 24/7 from your first breathe to your last on levels of such complexity and intricacy that despite enormous advances in its study over the past century by thousands upon thousands of neuroscientists, physicists, biochemists, mathematicians, and other advanced fields using some of the most cutting-edge scientific tools and study methods ever devised, not a single solitary one of them could say with any complete certainty precisely how it all works. This is not to say that some extraordinary advances in its understanding by spectacularly brilliant scientists have not been made - the brain is simply that fantastically complex.

It must deal with streams of incoming sensory information that would cripple the most advanced super computers on earth and it must do this seamlessly and largely below your awareness. It must take everything in the highly advanced skelotomuscular structure that is your body - which itself is a true engineering marvel - and coordinate hundreds of large and small muscle groups moving hundreds of bones to create all your physical movements. Ponder for a moment what is required for a concert level pianist to play complex Mozart compositions or for a major league batter to swing a piece of round wood and solidly meet a small round object traveling at over 90 mph. What is required for your brain to assemble what you experience as sight and sound and to coordinate them (a feat much more difficult and important to your daily function than you might imagine) is well, well beyond any form of artificial intelligence and requires incredibly complex cooperation between very different brain regions.

Of all species on earth and in its evolutionary history, there are no more complex social and cultural structures than that of humans. This too requires tremendously elaborate brain functioning as your senses feed streams and reams of data to various regions of your brain to make sense of the speech, body and facial language, scents and so on that are involved in the near endlessly intricate structures involved in short and long human interactions and to generate responses and strategies for navigating "you" through all of that. Furthermore, no other species is as aware of its own sense of self and its mental states and functioning as we homo sapiens and this too requires near unfathomably complex brain networks and systems.

Your brain can look back into past events throughout your life and imagine far into the future in ways no other species can. It can hold information that in computer storage terms would amount to millions of megabytes.

Your brain is capable of almost science fiction like abilities to self-heal and create new networking functions should damage occur.

However, despite all these wondrous capabilities, the human brain is filled with many "bugs". "Brain bugs" are the subject of study of many a neuroscientist or cognitive neuroscientist (the former being about the nuts and bolts of the brain, the latter being more how those nuts and bolts produce the mind, cognition, emotions, etc) and which the neuroscientist Dean Buonomano has neatly compiled and wonderfully narrated in his book Brain Bugs.

All brains have "brain bugs"; faulty reasoning, irrational or even delusional beliefs, unjustified fears, cognitive biases, poor thinking habits, are capable of producing false memories and so on. No exceptions. Yours, mine, the "batty" people from all over the political spectrum with whom you disagree, scientists, or anyone else you can think of - everyone. Almost all people are quite capable of being perfectly sound in their reasoning and judgment in one area and completely irrational and biased in another. In fact, one of the most common cognitive biases is that of an individual being convinced that everyone else is flawed with cognitive biases and faulty reasoning while they are not (trust me, there will be people reading along here nodding in recognition of what they can see in others around them but completely blind to it in themselves). On the other hand, an almost just as common cognitive bias is the belief that everyone else's brains are working fine and that ours is the only one that is flawed.

However, a broad understanding of all the bugs of the human brain and how those affect all you can see in the world around you is not our interest here today. If you are reading here it is quite likely that your brain is malfunctioning in ways that is producing some sort of short or long term mental state or mental difficulties or "moods" that fall somewhere under the umbrella of a "mental illness". For our purposes here today we need to understand how many of these "brain bugs" are affecting - or even creating - the mental states and moods that are driving us batty.

What is of essential importance from this introduction on general brain bugs is that you understand and accept that nearly all brains will contain flaws and bugs and not just yours. And this, dear readers, is where we employ some self-compassion and forgiveness. When we are in those dark places we can become convinced that we are the only one who is so terribly flawed. Furthermore, we can take to beating ourselves up very badly for these flaws.

One of the greatest accomplishments I wish to achieve with this blog is to remove judgment and stigma when looking to understand all human behaviour but most especially your behaviour or pernicious mental states. We must learn not to judge others nor ourselves. We must learn not to blame others or ourselves. We are all about understanding and learning here. We learn, we better understand, then we work at building something improved or better.

Now, let's delve into a better understanding of concepts such as cognitive biases, cognitive distortions and other "brain bugs". From there we'll move on to a better understanding of what may be going on in your mind and most importantly, what to do about it.

First off, let's look at the term "cognitive". Cognitive of course relates to "cognition" which is:

is the mental action or process of acquiring knowledge and understanding through thought, experience and the senses. It encompasses processes such as knowledge, attention, memory and working memory, judgment and evaluation, reasoning and "computation", problem solving and decision making, comprehension and production of knowledge.

Human cognition can be conscious or unconscious, concrete or abstract, as well as intuitive (like knowledge of a language, for example) and conceptual (like a model of a language). Cognitive processes use existing knowledge and generate new knowledge.

- Wikipedia

We generally separate cognitive processes from emotional processes but in fact they are more closely intertwined than most of us would like to believe. Which is not to say that they aren't separate processes in the brain and involve different brain regions and networks but each can or will influence the other. For our purposes here for now though, we'll think of "cognitive" as the higher human thought processes we looked above as opposed to strict emotional reactions.

Now, for biases. Biases are prejudices in our ways of thinking about or evaluating things, concepts, groups or individual people - or, as we're going to look at today, even ourselves! Biases can be conscious or unconscious (though the great majority are of the latter). A cognitive bias therefor would be a line of cognitive reasoning based on prejudicial ideals, beliefs of all kinds (political and religious beliefs would top this list), perceptions and so on that create incorrect or faulty views or mental models as viewed against purely objective measures. They are defined as "tendencies to think in certain ways that lead to systematic deviation from standards of rationality and good judgment". Biased thinking will literally alter what we see and don't see, what we hear and don't hear, even what we feel and don't feel. You want to know what the biggest cognitive bias is? It's the belief that you don't have prejudicial biases or the belief that these don't affect your thinking, decision making and judgments. Trust me, this is all very deeply studied and endless tests have been devised and utilized to demonstrate hidden prejudices and biases in virtually all people's cognitive processeses. All human brains are capable of prejudiced or biased cognitive processes of one kind or another.

Furthermore, all brains will "filter" information based on these biases and prejudices. All brains will subconsciously filter out facts and information that do not support our values, views, theories and beliefs while allowing in information that supports our values, views, theories and beliefs, something known as "confirmation bias". And once again, there are very, very few exceptions to this, regardless how much you or anyone else swears they don't do this. It doesn't feel like we do this because of how deeply subconscious these processes are and how natural they work but all brains do this. Selective filtering and confirmation bias can be observed in all people and peoples, even in highly trained scientists.

There are many, many reasons for this. Firstly, we must go back to all the "data" your brain must process; sensory data, factual knowledge and information from what we are hearing or reading and almost endless so on. It is literally and simply not possible to process all this information, sifting through every bit of it for how verifiable it is, what's right or wrong, how pertinent it is, etc. All brains will create shortcuts for doing this. Some of these are good and rational shortcuts, consciously learning to objectively disregard what is not important or pertinent to the task at hand, for example, while many others are prejudiced and selectively biased rationale built in subconsciously over a lifetime without our realizing it. Mental shortcuts and selective biases are a necessary albeit often imperfect process.

How and where we're raised and taught will have an enormous influence, of course. We may be implicitly taught many prejudiced lines of thinking and judgment or we may have absorbed them from family, public figures and others of influence within the sphere of our lives as we grew up.

As well, in a fast paced world where we daily face such enormous amounts of incoming data which our brains must process and create decisions, reactions, judgments and so on (and these can range from the mundane such as which cheese to choose from a shelf of dozens of choices to whether or not to talk to the person standing next to you in the lineup to pay for that cheese to larger processes involved in jobs, careers, long term planning, etc) our brains tend to naturally default to the quick. We often admire someone who boldly makes "quick decisions" which we may then emulate. Often it may feel like we have no choice and have to make a split second decision. In a deeper way of understanding how brains work, all cognitive processes chew up valuable energy resources in the brain and deep subconscious brain mechanisms will often default your brain towards the quick decision - or cognitive shortcut - in order to conserve energy.
[Nobel Prize winner Daniel Kahneman covers these basic premises in his renowned work Thinking Fast and Slow]

Lastly for now, pure objectivity is hard - really hard. It takes an enormous amount of training, knowledge and working closely with those who can accurately critique our ideas, processes and conclusions. It's a very difficult - and energy and time consuming - process. So our brain generally defaults to cognitive shortcuts and selective biases, often without our awareness and despite how conscientiously we may be trying to view or work things through objectively.


Now, again, we're not here to judge cognitive biases one way or the other and get into all kinds of thinking of how people on the other side of the political spectrum do this and your side doesn't or how this affects gender politics, or any of that. We're just here to understand that all brains will create cognitive biases. We're just here to establish as a matter of fact that in many ways brains can operate imperfectly in how they process information and form judgments and evaluations and make decisions based on cognitive biases and/or faulty reasoning. Certainly some groups are demonstrably worse than others but in truth all people and peoples are prone to one degree or another. What we need to understand for our purposes here today is that all brains are capable of being wrong - often spectacularly so - based on faulty or biased cognitive processes. Again, there are no exceptions to this.

Another term we often hear which is also very relevant here today is "cognitive dissonance". Cognitive dissonance is a deeply uncomfortable mental and emotional tension we feel when we are faced with information and/or facts or a situational dilemma that go against a deeply held view, position, value, theory or belief we have. The rather amusing thing (to me) is how many people believe other people suffer cognitive dissonance but they don't. They be all like, "oh, haha, look at that person in that group over there that I disagree with get all cognitive dissonant over these "facts" that I'm bombarding them with" yet somehow believe they are in some way immune to experiencing it or that there are not plenty of facts and information that would go against whatever cherished beliefs they have.

In truth, all brains are capable of both cognitive dissonance and denial of facts (the latter generally following the former) that don't fit our views and beliefs and furthermore for almost any belief or worldview or even most scientific theories, there will be facts and information that either don't support or which may even disprove them in whole or in part. You, me, people of all political and religious or atheist stripes, even highly trained scientists are capable of cognitive dissonance. Again, there are very few exceptions to this. It's just what brains do. It's sort of a bug and sort of isn't. It isn't in the sense that it's a perfectly natural and often necessary mental reaction and process to jump to the defense of what we deeply believe. It is a brain bug when it blocks further understanding, dialog or cooperation in resolving issues between opposite parties. It's also a bug when we are trying to better understand ourselves and to learn and grow.

One last factor to consider here is the power of imagination, which we look at in this post on understanding and taming imagination. What our minds create - all of our minds, not just yours - is often very "buggy" and can have enormous effects on our cognitive processes, mental states, understanding of events around us and so on.

All of this is to set the table for what we really must work on to understand better in ourselves and in understanding our mental health - cognitive distortions.

All mental illnesses will involve cognitive distortions or distorted thinking. All. There will be many reasons for them and they will take many different forms along a whole spectrum from mild to severe, but no matter the particular mental illness you are struggling with, it will involve cognitive distortions. Not only that, a great deal of your suffering will be on account of cognitive distortions.

What this means, I'm afraid to say, is that some of the things that your mind is doing, some of what it's telling you is not "real" but is a result of cognitive distortions. It could very well be, in fact, that your mental illness is largely created by cognitive distortions.

This is very, very uncomfortable territory for most people (see cognitive dissonance above). We are all very, very inclined to believe that whatever is going on in our brains and minds, that how we're perceiving the world around us and the people we must deal with, that our very thoughts are all "true", "real" and are hard "facts". It is extremely hard for us to believe and accept that many or all these things going on in our minds might be "distortions" or that distorted thinking may be leading our minds down the harmful path it's on.

To start to get past this, we must understand that when we are learning about cognitive distortions in our minds that it does NOT mean we are "crazy", "stupid" or anything like that. It simply means another form of "brain bug" like we've been looking at here today. All brains are capable of them in one form or another and most people will have cognitive distortions to one degree or another.

As I've also discussed at length in specific posts and here and there throughout this blog, "you" didn't put these thought processes there or deliberately "choose" them (nor did anyone else for that matter). All our thought processes are created by very complex brain regions and networks that developed over our lifetimes. Sometimes there are little brain differences that can create a distorted image of ourselves. In any case, what created them was a long complicated process that probably started early in life. "You" are not at fault for them being there or influencing your thought processes.

I have talked in the past about how I believe much of any given case of mental illness is greatly produced by our "conscious experience" - that which we are consciously experiencing. Cognitive processes of all kinds will play a part in producing what you are consciously experiencing and the fact is that some of those processes will be distorted.

Let's have a bit more of a look at them to see what they are.

A list and outline of fifteen most common cognitive distortions can be found here.

Let's take a few of what I think are the most important of those to recognize and understand and look at them more closely here.

Filtering

Filtering is when our brains "filter" negative and positive aspects about our selves and/or our situations in life. It is one of the many ways our brains can form the kind of "selective biases" we looked at earlier in this piece. In cases of depression and anxiety, often what our brains are doing is filtering out positive aspects and "seeing" too much negative in our selves and in our lives. If our brains do this too much, it will create a distorted reality in quite a literal sense.

Polarized or Black and White Thinking

This is the tendency to see things at extreme ends, to see things in either "black" or "white", in either/or frameworks. Things are either a success or a failure, beautiful or ugly, attractive or repulsive and so on. There is a difficulty in being able to see things along a gradient or a spectrum, to not be able to see the many shades between black and white. Things go a little wrong and we "suck" or are "stupid". While perfectionist thinking is a bit of a different kettle of fish, it will play a role in this distorted form of thinking.

Jumping to Conclusions


Again, this relates back to what we were earlier looking at with how our brains tend to default to shortcuts or the quicker "decision" or "evaluation". It is common to almost all people's thinking processes. But in mental health problems it works in particular ways that are more harmful to us. Someone may express anger with us and we'll automatically jump to conclusions about the reasons and implications of this. A little thing goes wrong and we'll jump to the conclusion that this is proof of our "stupidity". Or even jumping to the conclusion that a glance our way is full of threatening meaning.


Catastrophizing


This refers to a tendency to see some sort of catastrophe around every corner or creating catastrophes out of mistakes or events that may in fact be quite manageable or perhaps are even not all that significant. Or we might project a short term (and real) catastrophe into our entire future ("I screwed up and got fired! My whole life is over!"). Colloquially, this is often referred to as "making mountains out of molehills" (something we really hate to be told).


A few not on the list at the above link but which I have observed in my own thinking and that of nearly everyone whose cases I've heard and have worked with are "predicting the future" and "making assumptions".

Predicting the future

A cognitive error that is almost sure to create massive anxiety and depressed mental states is "predicting the future" or "predicting outcomes"; taking the past or the present and projecting a dark future or future outcome based on those. This is a very easy mental trap to fall into because our human brains are very "wired" to have strong predictive functions.


Making Assumptions


This is another very common cognitive trap which can take many forms. Almost all people are guilty of the habit of making assumptions. In those with anxiety and depression, these generally take the form of "assume the worst" and can greatly impact mental health and decision making. It's another brain bug "shortcut" that may be necessary at times but which can become a habit that will greatly affect mental states and our entire way of thinking and decision making.

There are several other common cognitive distortions or unhealthy thinking habits and I'll have to encourage you to begin looking into them and understanding them on your own or through other means (I'll give some suggestions below). But I need to get a few things straight first.


Nobody likes being accused of these things. And many of our friends and family will do just that. These accusations will absolutely feel hurtful. Not brought up or handled properly, having people throw these in your face will bring up instinctive defenses and make it even harder for us to see them, all of which is simply going to make matters worse in the short and long term.

Two, again nobody willfully creates these in their minds and mental processes. Nobody. Where do they come from? It could be many places. There could be an inherited aspect that affects different brain regions and how they process information and create mental models, processes and inner dialog. It could be our upbringing and family influences. They could very well be the result of very real things that have gone wrong in your life - real tragic events, real trauma and so on.

And to repeat, none of this means you are "stupid", an "idiot" and other things we beat ourselves up with. This is another pattern we may fall into; on some level we may know our thinking and decision making isn't "right", we repeat past mistakes, get angry with ourselves and then beat ourselves up for being so "stupid" or "such an idiot". It certainly feels that way, but in fact you are a perfectly normal human being struggling with various "brain bugs" that virtually all people have. You certainly are your unique "you" with your very own unique life and set of problems but you are not A Particularly Bad Person for having this buggy brain of yours. All brains are like this to one degree or another.

Another critical thing to understand here is that nobody - certainly not me - can say that what you are experiencing in your mind is not real. Your subjective experience absolutely is real. The anxiety you feel is real, the dark destructive thoughts are real, all of it. So please don't think that when we discuss things like cognitive distortions that we are saying what you are experiencing is not real. It is. Trust me, I know this from personal experience and the study of cognitive neuroscience.

What can happen is a vicious cycle like this:

Real events or life situations impact mental states and thinking, thinking becomes stressed and distorted, stressed distorted thinking further impacts mental states, mental states then begin influencing thought and other cognitive processes, these thought and cognitive processes affect our lives in negative ways, these further impact mental states and so on and so on. As all of this becomes more entrenched, it all feels more and more like our reality.

In any mental health crisis or chronic case, stress is going to play a major role. Some stress we are aware of - probably excessively aware of it (major anxiety, panic attacks, etc over things in our lives) - but much of it is below our conscious awareness. Chronic and/or acute stress will affect our thinking, mental states and mental models.

Okay, now what to do.

What we have to first get past is any notion of blame - the blaming of others or ourselves. It serves no practical purpose and will invariably make things worse. I view the tendency to blame and judge a cognitive error in itself.


We begin then with working on self-compassion and forgiveness. This is not easy for many of you but it is a necessary step. It is a necessary daily step. That is to say, it must become habit.


In any kind of self-work, recognition and acceptance is very important. In the case of cognitive distortions, recognizing and accepting that a good deal of our thinking processes could be distorted and further adding to our anxiety or dark depression is a huge - and brave - step.

Next, we're going to look at this term of psychology "cognitive distortions" a little differently. In my study of neuroscience and mental health disorders, I quickly recognized that "we" don't create these mental patterns nor are they easy to stop just because we read about them or are told about them. Our brains create these patterns, which is why I include them under the general heading of "brain bugs". So we're going to call them "cognitive habits" instead and think of them simply as habits that are not serving us well and that have to be changed over time and replaced by different habits.

In almost any case of mental illness there are going to be real events, real trauma and real threats that are impacting our mental states and there are going to be cognitive distortions.

What our job is then is to start the process of learning to sort through what's real in the outside objective sense and what's distorted thinking.

This can be very, very difficult to do alone. It can be very hard to understand our own minds. It can be very hard to learn how to take an objective outside perspective of our minds and lives. A primary purpose of this blog is to help you in this process, to give you the best grounding and tools I can, but often it is very useful if you can find outside help with a skilled therapist or group therapy (I was quite blessed in this sense).

Saving that, what we can start working on is creating better mental habits. This was the very purpose of creating my Positive Difference Making Fundamentals. This is one of my most widely read posts and has been recognized by those in fields of mental health and improving the mind as universally positive steps in building a better mind, building improved inner peace and better long term mental health.

We will not change our long term mental health overnight (though there are times it can feel like we do). In our worst states it will feel like we can do absolutely nothing to change anything.

I created that list of fundamentals with the express purpose of giving us little things we can "chip away" at daily no matter how bad we're feeling plus as ways to help cope with and calm stress. Can't do this one on a particular day? Then try this other one. Can't do that one? Then try this one here. You'll find that there is always something you can do on a particular day, no matter how bad it is.

A key thing I discovered while studying cognitive neuroscience was that it was not always necessary for us to "break a bad habit". Often just beginning to work on new mental habits is enough. This is a big part of what my Positive Difference Making Fundamentals are all about.

The most valuable post for working on what we learned here today is Mindfulness Meditation Cognitive Behaviour Therapy. I strongly encourage you to read through that post for a deeper understanding of what we looked at here today and to begin learning a very powerful tool to begin implementing into a daily habit.

I built my whole concept of Brain Training Exercises as a simple, easy and fun way to work on our inner dialog and mental habits. On those days when it feels you've got absolutely nothing, we can do these. Simple but very powerful over the long run.

And no matter what, there are almost no days when we cannot listen to music. This is why Music Therapy is so great. We have to be careful about the music we choose to build our music therapy program, but even in our very most exhausted, worn out and fed up states we can listen to music. Music has amazing (and now very solidly scientifically proven) healing powers.

The absolute most powerful and necessary habit we must cultivate, however, is that we must learn to stay and work within the present day. Not the past, not the future, but the present day only. Of all the Positive Difference Making Fundamentals, this is the oldest (it has been found in texts thousands of years old) and the most universal (the understanding of this mental health principle has been found in virtually every culture around the globe).

A final reminder and a final take-away for today, dear reader, are these:

While you are your unique you, you are not alone in this, you are not the only one to have a brain that is "buggy". So please stop beating yourself up about that and practice some self-compassion. Yes, I know how "corny" this sounds but it really is a necessary step. And yes, I know how hard this step is.

I truly and deeply know how hard all of this is. I really and truly do. I know how much this feels that this is "just the way you are" and how helpless it all makes you feel. But you do not have to be this way. This does not have to be your life, your future. As buggy as brains can be, all brains can change. Thus your brain can change and thus your life can change.

You can change, it can change.

Yes you can.



Thank you as always for reading.

Neurochemical in Focus - Serotonin

In a previous Neurochemical in Focus piece we looked a bit at dopamine, its pathways and its affects on our moods and behaviours. Today we're going to look at another very long overdue neurochemical and topic - serotonin.

Neurochemicals and their roles in brain functions are the very foundation and core of pharma-psychiatry's "chemical imbalance" theory for "mental illnesses" and are the basis for every prescription written to treat depression, bipolar, schizophrenia, anxiety disorders, OCD and ADHD.

The initial focus of this blog was to take apart and demolish the chemical imbalance theories of mood and psychiatric disorders but I don't want to get into that too much here today. My aim for this piece today is to build towards a better understanding of serotonin and its roles in brain behaviours (and thus our moods and behaviours) and look into how popular drugs for depression are alleged to work. 

While I've since done a good deal of my own reading and study into our topic today, I owe a great debt of gratitude to Robert Whitaker and his landmark book Anatomy of an Epidemic for not only spurring and inspiring my interest in neuroscience, but for introducing me to the understanding of attempting to treat psychiatric and mood disorders at the synapses of the brain with the use of drugs. 

I'd come across his book early in 2013 and then had the great fortune to attend a lecture he was giving in Vancouver where I was able to meet and talk with him at some length. It was that talk and that meeting which led to a great deal of what Taming the Polar Bears would eventually become. Robert's high integrity methods to his research and writing and his early encouragement of my efforts were very instrumental in my approach to understanding and writing about science and the brain as well as my research methods. He very patiently read and critiqued some of my early efforts (along with the famed (and somewhat rebel) psychologist Bruce E. Levine) which greatly aided in steering me in the right direction. 



As with all neurochemicals, the roles of serotonin in the brain and body are greatly more complex than that presented by the pharmaceutical industry in their ads and narratives for the antidepressants they market.

Let's have a bit of a look. 

Serotonin or 5-hydroxytryptamine (5-HT) is biochemically derived from tryptophan. Serotonin is a monoamine neurotransmitter primarily found in the gastrointestinal tract (GI tract), blood platelets, and the central nervous system (CNS) of animals, including humans. It is popularly thought to be a contributor to feelings of well-being and happiness

Approximately 90% of the human body's total serotonin is located in the enterochromaffin cells in the GI tract, where it is used to regulate intestinal movements. The serotonin is secreted luminally and basolaterally which leads to increased serotonin uptake by circulating platelets and activation after stimulation, which gives increased stimulation of myenteric neurons and gastrointestinal motility. The remainder is synthesized in serotonergic neurons of the CNS, where it has various functions. These include the regulation of mood, appetite, and sleep. Serotonin also has some cognitive functions, including memory and learning. 

- Wikipedia (with some editing for clarity and brevity)

That's a very basic introduction into serotonin. Now, let's unpack that a bit and look more into what's relevant to us mental health peeps. 

The discovery and genesis of the understanding of neurochemicals' roles in brain function took place in the mid-fifties. Synapses and their basic functions had just been discovered yet it remained unknown how exactly information was "handed off" between communicating neurons at the synaptic level. Some argued for an electrical basis (which is partially correct as we'll see) while others proposed that chemicals were involved. As noted science historian Elliot Valenstein characterized it, it was "a war between the sparks and the soups". 

Further experiments were conducted which discovered that synaptic communication was indeed carried out by chemical messengers and subsequently a number of them were identified and further experiments showed that the "moods" and behaviours of animals could be altered or affected by introducing drugs that in some way modulated the levels of these neurotransmitters (as they would come to be known). 

And it was from these seeds that the "chemical imbalance" theories for mood and psychiatric disorders began to emerge with dopamine, monoamines (including serotonin) along with a third major neurotransmitter called norapinephrine being identified as the lead "culprits".

As noted in that Wikipedia excerpt, serotonin is part of a group of neurotransmitters in the class of monoamine. Some of the earliest pharmaceutical produced antidepressants were based on attempting to modulate monoamine and were called monoamine oxidase inhibitors or MAOIs and new variations on those are still prescribed and used today. 

Later research, primarily carried out or was funded by the pharmaceutical industry, isolated serotonin as having more specific effects on our moods and with great fanfare, SSRI antidepressants were introduced to the world with the release of Prozac by the pharmaceutical giant Eli Lilly in 1986.

If you walk into a doctor's office today complaining of depression or are admitted to a psychiatric facility to be "treated" for depression (a word I use very loosely), there is a very good chance you will be prescribed an SSRI antidepressant. 

SSRI stands for selective serotonin reuptake inhibitor. As our goal in this blog is to better understand our mental states, the reasons behind them and how they can be treated, a better understanding of this is going to be very pertinent to us. 

First of all, let's take a closer look at serotonin pathways in the brain and a little bit about what those are all about. 

That gives a pretty decent idea as to where the pathways originate and some of the destinations. I liked this particular illustration because it gives a rough brain view plus that little "flow chart" at the bottom helps give us a better idea. 

As we learned in the post on dopamine pathways, none of this works in isolation. As with dopamine originating in specialized nuclei called the Ventral Tegmental Area (or VTM), serotonin has an originating nuclei (or group of specialized neurons) that is responsible for sending out serotonin related signalling. Serotonin pathways originate in the raphe nuclei. These are located in the brain stem, a very old (and original) part of our brains in evolutionary terms and indeed serotonin plays key roles in many life forms, even the humble round worm (C. Elegans, a favourite of neuroscience types to poke and prod and experiment with). 

As for the destination end of things, we have the thalamus and hypothalumus, two key nodules that we briefly visited in the introduction to the stress response system, then the caudate neucleus which plays key roles in motor and non-motor functions and as such is of keen interest in Parkinson's and Obsessive Compulsive Disorder. The hippocampus is also a destination (this sea horse shaped pair of nodules (one in each hemisphere) plays the role in episodic memory formation) and then we go up into the frontal lobes of our fancy neocortex and other areas of the cortex (the very outer layer of the brain). 

The cerebellum as a destination is quite interesting, I believe. We've touched on the role of this very ancient bit of brain hardware in Neuroanatomy 101, where we saw it was greatly responsible for much of our physical movements and coordination and in An Introduction to Music Therapy where we learned that more recent research shows that it is involved with the coordination of all kinds of higher cognitive functions and is very involved with both the playing and appreciation of music. 

For reasons I could not say, not in that illustration or chart as a destination is the nucleus accumbens, a rather significant region that has much to do with cognitive processing of aversion, pleasure, reward, and reinforcement learning.

Still with me? I hope so! We're getting to the crux of the biscuit soon. 

Okay, so what does serotonin do? What does any neurotransmitter do for that matter? We probably have all heard the narrative that serotonin is responsible for feelings of happiness and well being and that a depletion of serotonin makes us "depressed" and hence the need for pharmacological aids to "increase" levels of serotonin which in theory "treats" our depression. 

Well, I hate to break it to you but serotonin - or any neurochemical for that matter - doesn't really "do" anything, or at least not in the sense of the narrative that we've been told in regards to "moods".

Let's have a look at what I mean by that. 

Once again, let's revisit some basic brain anatomy. We'll call this diagram A.

Look first to the left side of the illustration. If you've been following along (and somehow I suspect nobody really follows along with all of these, but on we forge), you'll see we have some cell bodies (neurons), axons and dendrites. Axons carry signals near and far to other neurons and dendrites that receive incoming signals. This is one way (though only one way, I must emphasize) in which neurons communicate to do all the myriad things our brains do like call up a memory (of how to do something or a face or almost endless so on), feel and process emotions, form the "moving picture show" that is our sight and vast amounts of etcetera.

It is in the neurons that stuff is stored and happens and neurons communicate their little micro bits of stuff with tens of thousands to millions to billions of other neurons to make up bigger bits of mental, cognitive, emotional, etc stuff that makes us what we are or controls what we're doing, thinking or feeling, or initiating and controlling every single physical movement we do. 

So it's the neurons, or more accurately, groups and networks of neurons that do stuff, not neurotransmitters. 

But - but! - the neurons can't do their thing with billions of other networked neuron buddies if neurotransmitters don't do their thing so let's take a closer look at this thing neurotransmitters do.

At the point where axon (sending) meets dendrite (receiving), we have a synapse. I have a better illustration for serotonin related synapses here (diagram B):

We have a transmitting, or sending, neuron represented in yellow above (which is actually the very end tip of an axon) and receiving in green below (which, in this case, is actually the tip of a dendrite). Where it says "synapse" with that large bracket is more often known as the synaptic cleft, a gap that is a mere 20 nanometers across. 

There are some really key bits to that illustration for us to understand here. There's no need to look into those items listed in the sending end of things (unless you're a true neurobiology geek of the chemical bent - but briefly, it's just the process for creating serotonin). What we want to learn here is the vesicles containing serotonin (represented by the little red dots) on the sending side and the receptors on the receiving side. 

A given neurochemical (serotonin in this case, or dopamine, or any of a hundred or more other neurotransmitting chemicals) is like a key and the receptor is like a lock. The lock won't receive if the key isn't right and the key won't fit if the lock isn't right. (Very important for understanding not only neurotransmitting chemicals, but also how both many prescription drugs and pain killers and so called street drugs work.) The neurotransmitters crossing the synaptic cleft and fitting into the receptors is what completes the communication between neurons. 

So while they don't actually "do" anything in themselves, neurotransmitters are obviously an essential part of the process of coordinated neuronal activity of all kinds.

Let's quickly review what's involved with inter-neuron communication. (diagram C)

So we have some neurons with some exciting info they want to spread around. If the info is exciting enough the neurons doing the sending will reach a level of excitement called action potential which will then send a series of electrical pulses down the axon. It is these electrical pulses which stimulate those little balloon like sacks (the vesicles) of neurotransmitter chemicals so they travel across the synaptic cleft to fit into the "locks" or receptors in the dendrite, or receiving, end and thus the "info packet" will get handed off to other neurons (and hence the electrical theory of synaptic function (of the "sparks vs soup" battle we looked at above) proving partially correct). 

To give an idea of the scale of these bursts of nano-activity, recall that we have somewhere in the neighbourhood of two hundred and fifty trillion synapses performing these infinitesimally intricate transactions the firing of each of which is measured in hundreds of a second. With every thought, with every move, with every sense processed, with every action your brain must perform, billions upon billions upon billions of these synaptic functions must go smoothly in order that billions of neurons at any given mili-second can do their jobs smoothly. 

In the case of serotonin, again it doesn't "do" anything in creating mental states or mental processes. what it does do is play a critical role in the firing of key brain regions in coordinated ways so that they can do things. If we look back at the brain regions in the serotonin pathways, it's the functioning of those regions that are critical for creating mental states and processes and not only the individual regions, but that they are working properly within larger brain-wide networks. 

I think it's not hard to imagine that such fine transactions that need to take place trillions of times per mili-second may not always go all that smoothly, thus networked brain regions and nodules may not go smoothly and thus we will not always go that smoothly. 

Now we get to the crux of the biscuit regarding serotonin, moods and SSRI antidepressants. ::reaches out to gently nudge readers awake from their slumber:: (I've ten years experience in the classroom, I know how this works)

If you go back and look at Diagram B, you will see in the sending side of synaptic cleft what are labeled serotonin reuptake transporters. (There are reuptake transporters for all the various neurotransmitters in the synapses of their relative pathways.) 

These are one of the "recyclers" of the brain. You see, not every little molecule of serotonin (or other neurotransmitters) in every burst of communication gets used - it doesn't all fit into the receptors - so some will always be left floating around in the synaptic cleft. So what the repuptake transporters do is sort of "vacuum" up the excess neurotransmitter molecules for future use. Very clever, what?! (Though other excess neurotransmitter material will get gobbled up by special waste disposal enzymes)

This is all an almost unfathomably complex set of transactions that evolved over literally billions of years. But for reasons that I will have to leave to explain elsewhere, modern researchers and scientists figured they could be more clever than the several billion year evolutionary process that produced this nearly unfathomably complex procedure (which works the same way in all animal life, by the way. The plant world communicates via chemical signaling as well, albeit somewhat differently). 

Because it was proposed - though never conclusively proven - that serotonin was "responsible" for feelings of pleasure and well being (and presumably thus "happiness") it was further proposed that a depletion of serotonin was responsible for "depression" - you know, being unable to experience pleasure, well being (and presumably "happiness"). So researchers and scientists (who just so happened to be in the employ of multi-billion dollar transnational pharmaceutical companies whose shareholders were giving them grief about their bottom lines) got to doing some tinkering around. What they came up with was the idea that "hey, maybe the problem with "low moods" is that there isn't enough serotonin in the synaptic cleft to create pleasurable and happy feelings". From there they looked into the reuptake transporters and thought, "hey, what if we blocked these reuptake transporters so that there'd be more serotonin in the synaptic cleft and this will make people happier and less depressed?". (Yes, I know I am being breathtakingly and somewhat dismissively brief but it really did go something along those lines.)

These lines of thought, and others, were part of the reasoning that went into "chemical imbalance" theories for mood and psychiatric disorders. The "imbalance" proposed here was that serotonin was in short supply (and thus out of balance), these imbalances were creating mood disturbances, and if we (psychiatrists and medical doctors) could just restore this balance, normal (whatever "normal" is) moods would return. In the case of serotonin, the process of blocking the reuptake transporters would restore the balance by leaving more serotonin in the synaptic cleft to do its thing. 

And thus Selective Serotonin Reuptake Inhibitors were born.

What all antidepressants in the SSRI class do is in some way hinder the reuptake pumps or transporters from doing their jobs. This is the entire premise of these class of antidepressants. 

Which sounded pretty good in theory, I guess (you might sense my skepticism ringing through). 

The idea of the "selective" part is that SSRI drugs would only target a certain type of receptor in serotonin pathways (the 5-HT system). 

But there have always been a great number of problems with both this theory for depression and the process of tinkering with something so highly evolved and as complex as neurotransmitter activity that takes place trillions of times per mili-second for every second you draw breath. 

Let me outline a few.

Firstly, in Anatomy of an Epidemic (pages 79-81), Whitaker describes in great deal how investigators found that drugs like fluoxetine (Prozac, Sarafem, etc) designed to block reuptake pumps (or SERTS - Serotonin Reuptake Transports) greatly altered both pre and post synaptic function and their very structures with profound - and unintended - affects resulting in abnormal functioning.

Furthermore, neurotransmitters are but one aspect of synaptic function. If you look back up at Diagram C, you will see mitochondria represented there. As I outlined in part three of "Bipolar, the Brain and Energy", mitochondria plays extremely critical roles in axon and synaptic signaling functions. If mitochondria is damaged and cannot function, which we also established in that series as a possible result of chronic stress, then inter-neuronal communication is going to be impacted all along the axons and at the synapses themselves thus affecting inter-neuronal communication brain-wide. So what could be happening with poor synaptic functioning is that it is a result of mitochondrial dysfunction. 

Grossly overlooked is synaptic pruning and growth that we first looked at in An Introduction to Neuroplasticity. As we learned there, synapses are in constant flux for both good and bad. It is blazingly obvious to point out that no communication between neurons can take place if synapses for some reason are not there. If we look at what's related to mood in relation to synaptic functioning within specific brain regions and we view this with the understanding of the basic neuroplasticity principle of "use it or lose it", then we might well propose that regions of the brain related to mood are not functioning properly because synapses have been pruned back and thus these regions are not communicating strongly within other brain networks contributing to our moods.

As well, not all brain activity and coordination is conducted through axons, dendrites and synapses. Neurons and groups of neurons also use brain waves to communicate and coordinate activity. Neuroscience is just scratching the surface for understanding this critical form of brain activity and how, for example, the hippocampus uses specific brain waves  to transmit memory information to different regions of the brain. 

Aside from this is the fact that of the total amount of serotonin in the brain and body, only a small percentage (less than 5%) is involved in the brain's serotonin pathways involved in "mood" as well as what we looked at above - that serotonin destinations involve many critical and widespread functions aside from "mood".

The processes for creating any one kind of mental state or function of any kind is now understood to be vastly, vastly more complex and involves brain wide regions that are not related strictly to those along the serotonin pathways we looked at above. The idea that simply artificially blocking the reuptake pumps we looked at above would magically restore "balanced moods" is hopelessly simplistic. 

The principle for the basis of both the "chemical imbalance" theory of mood disorders and neurotransmitter altering pharmaceutical antidepressant treatments is based on understandings of synaptic functioning that are now decades out of date. Despite decades of independent study, the process and precise mechanisms of how neurons release neurotransmitters remains mysterious and is much more complex than previously thought and is not quite as pharmaceutical researchers would present. 

But perhaps more importantly regarding serotonin pathways and their roles in mental states and cognitive functioning, is what we first looked at in the piece on dopamine pathways. Like dopamine pathways origins in the Ventral Tegmental Area, serotonin originates in the raphe nuclei. And like the VTM, the raphe nuclei are part of vastly complex feedback networks. If there is a serotonin "imbalance" (never conclusively proven) and this "imbalance" is affecting mood (definitely never conclusively proven), then we should also consider that this depletion is happening at the nuclei of origin and not at the end synapses. Perhaps it's a question of what's happening in feedback networks to the raphe nuclei and that this nuclei are receiving insufficient stimulation and thus under performing serotonin pathyways.  

But most importantly and vital to understand and take away from this piece is that an honest and thorough look into all the symptoms involved in more severe and long term cases of depression could not possibly be understood or explained by the model of "serotonin imbalance" as put forward by the pharmaceutical industry. This model of understanding complex mood disorders and the treatment of them is completely inadequate and overly simplistic. 

Looking into these questions and problems in more detail will have to wait until we begin to investigate the disaster that became vastly widespread SSRI use, a good deal of it "off label". These problems include long term inefficacy, extremely dangerous side effects not the least of which was greatly increased suicide risk and completed suicides and wildly changing behaviour. 

All this being besides the fact that there are numerous, numerous and enormously complicated processes in the brain that affect our moods, mental states, and behaviours besides neurotransmitters alone (which I have touched on in numerous posts in this blog). 

Today, however, I just wanted to give a brief and simple introduction into what all this business about the now famed serotonin is all about.