Saturday, December 21, 2013

Visions for the Future of Mental Health Care

Updated and partially re-written, July 2015

In the nineteen or so months since I first wrote this I have seen nothing to show me that the need for a facility of my vision has declined at all, in fact I just see more and more people slipping through the cracks of the mental health care system. 

I say mental health care but I don't really mean that. What I mean wouldn't fit neatly into a headline, though. What I mean by mental health care is advanced care for those specifically with schizophrenia, advanced bipolar disorder and major depressive disorder. You know, the hard cases. These are the people that the current system is failing so badly. The numbers speak for themselves. I won't get into them but research the numbers of suicides related to these three, research the numbers of people on the streets related to these three and research the numbers of people on permanent disability related to these three. Spend some time doing that - with a little old fashioned gumshoe street work thrown in to put faces to the numbers - and tell me how the current system is not failing these people. You can add my face to the numbers as well if you like - I am a textbook example of how the inept mental health "care" system - one based on drug therapy that's been proven in long term studies to not only be ineffective but also cause long term brain damage - has been utterly failing a very large number of people. 

There are other reasons people slip through the cracks that social scientists and those in the mental health care system simply do not understand.

Many of them will fit into two categories:

One, they will reject traditional diagnostic methods and drug treatment for their disorders. There are long reasons for this which I'll have to dedicate a separate post to but going on my own experience, the many people I have met in psychiatric hospitals and got to know as human beings (rather than "psych patients") and in talking to street people, these people become very hurt by and deeply mistrustful of the mental health care system, psychiatrists and drug therapy (which for them will be forced drug therapy). So they avoid the system even if at some level they know they need help.

Two, is that they tend to be very proud, independent people who want to be self-reliant and feel deep uncomfortable living on hand outs. They want mostly to take care of themselves in their own ways. This does NOT mean, as many mistakenly assume, that they "choose" the streets, it's just that all the alternatives are too difficult for them to bear and to negotiate. 

I have spoken to many of these people (and met them and got to know them) and they are at their core good, good people. But between mental health issues, the stigma and rejection of society and the cycle they become trapped in, they end up in untenable situations. 

My vision is for specialized long term treatment facilities for those disabled by one of these three disorders or those as I described above. The facility of my vision offers the best hope for people in this category of mental health problems. 

I can't even begin to tell you the mountains of research and reading I put into this, not to mention my not inconsiderable experience of being "on the inside" of the current mental health "care" system. 

This is what I want my true legacy to be - to see this vision realized. It would take massive efforts and real courage but it's doable. As government agencies are too closely tied to pharmacological and mainstream psychiatric models, it'd have to be privately run and funded. 

In the grand tradition of visions for the future, I bootstrap off of past or present successful models. They are as follows:

Soteria House:

Founded by Dr. Loren Mosher in the early 70s, Soteria House was a long term treatment facility for those diagnosed with schizophrenia. No medications, no doctors. NONE. And this was one of the most successful schizophrenia treatment programs in history. Patients lived there and interacted with each other and grad students (I believe ... not professionals at any rate) who received a bit of training. The patients could live in a low stress and embracing environment where they were free to talk out the workings of their inner minds in a non-judgmental environment. And patients by and large got better (which is defined by being able to return to work, raise a family and other basic societal norms). This is not the case with most people diagnosed with schizophrenia today. 

Hearing Voices Network:

I have personal experience working with a local chapter of the Hearing Voices Network. HVN provides a network of chapters that provide peer to peer counselling for those who, as their subheading reads, "hear voices, see visions or have other unusual perceptions" in a non-medical, non-judgmental setting. There is nothing, I can tell you, like peer to peer discussions about the mental phenomenon we experience for working through these issues and not be made to feel "wrong" or "broken" or "diseased" or otherwise judged. Unlike in talking with various "doctors" from the mental health care industry (psychiatrists, psychologists, medical doctors, and others), you talk with people who actually know what it feels like and who take a non-diseased approach to unusual mind phenomenon. My facility would provide a similar atmosphere and approach.  

Delancey Street Foundation:

Founded by Mimi Silbert in the 70s, Delancey Street Foundation has been doing the impossible for thousands of people for four decades. It takes the worst dregs of society - people labeled by "the establishment" as psychopaths, sociopaths and hopeless career criminals - and makes functioning human beings out of them that return to society. We're talking career prostitute drug addicts, pimps, gang members and all manner of "human garbage" that society seeks to lock away for ever then completely rehabilitating them and re-integrating them into society. Her success rate is vastly, vastly superior to the prison system. And get this - she does it alone. No staff, no doctors, no guards, no warden, no bars, no cells - nothing. She stands maybe 5' 1" and she handles about 1,500 of these career "scumbags" at a time by herself. No, I am not making this up. Mz Silbert and the Delancey Street Foundation is easily one of the most inspiring examples of what's possible for human recovery you could possibly find. 

Dr Dean Ornish's program:

Dr. Ornish also does the impossible - he turns around heart disease among those for whom triple or quadruple bypass surgery is the only option for living. Other than himself, there are no doctors, no hospital, no drugs, no surgery - nothing. It's all diet, meditation, yoga and a few other simple lifestyle changes. 

There are a few things that all of these have in common. One is that they are amazing examples of and inspiration for what is possible in human change and recovery. Two is that they are all long term residential facilities or programs. People stay in them for long periods under guided care. Ornish's is the shortest - about six weeks if memory serves - but it has long term follow up. Silbert's is the longest; a minimum of two years. The common theme is that the patients are in a structured environment tailored to their needs. I'll return to this in a moment. First I have to introduce:


The brain is not set. It can and will change itself. It will rewire around horrifically damaged areas (like in stroke victims) or in the cases of blindness, it'll "remap" and restructure areas to boost other brain functions to compensate. It'll do this naturally on its own but that does not always lead to the desired results. It works best in structured environments (do you see where I'm going with this?). Neuroplasticity is a sexy popular term that gets thrown around a lot now. But the rub is that it needs structure and repetition - neurons that fire together wire together is how it essentially works. And it needs that "fire together" to happen repeatedly and in close time proximity, two things for which a structured environment and program work best. Hence the above three facilities. Silbert doesn't know this, but her program produces massive plastic change in the brains of her wards - that's how they change from sociopathic criminals into empathetic mainstream citizens. 

Edward Taub of the Edward Taub Clinic pioneered a unique therapy for stroke victims based on the principles of neuroplasticity and this too, I believe, serves as a good model. Again, the patients stay in the facility for extended periods receiving much personal help and encouragement. 

Now, my own thoughts. 

For people with major mental illnesses, the only course of hope is to move forward. But here's the rock and hard place catch-22: A) they cannot do it alone and B) their very brain conditions rob them of the mental faculties to move forward. In order to move forward, they need to be able to work and take care of themselves. Living normally like this is what true recovery is but they can't take care of themselves or work due to their mental conditions and society's view of them (which is not dissimilar to how society views the career criminals that Silbert turns around and enters into society) so they're stuck. 

The only way these people can truly be helped is in a long term facility that A) heals their minds, brains and souls and B) teaches them job and life skills that will help them return to functioning within society. I am not aware of any facility like this. Psychiatric wards certainly don't do this (ask anyone with one of the illnesses I listed who has spent time in one). Public mental health programs try to help with job skills but don't provide long term living and treatment facilities. It's a real crack in the system. When you hear of people "falling through the cracks of the system", this is the massive chasm into which they fall. 

The facility I envision would be the net at the bottom of that chasm. 

In the facility I envision people would get a highly specialized program designed to heal their minds through neuroplasticity, would have a safe, peer supported environment in which to recover from the rigors of life in a society that has rejected them and heal their ravaged souls, and they'd learn job skills that would help them build dignity and esteem and get truly back on their feet again. The program would involve specialized forms of yoga and meditation specifically designed to "build up" the brain regions that are misfunctioning or underfunctioning or, in the case of the ever overactive amygdala in the majority of people with difficult cases of mental illness, calm down brain regions. Jeffery M. Schwartz deals with OCD and other disorders very much in this way, using no medications. There would be much peer to peer group work and individualized therapy. 

The Delancey Street Foundation provides the financial model; aside from doing all this remarkable work by herself, Silbert's program is - get this - completely self funding. She gets no government grants, no private grants or funding - nothing. The program entirely pays for itself (which is why it works). 

The present dominant paradigm of mental health care as run by the alliance between the psychiatric and pharmaceutical industries are not making mental health problems better. Statistics bear out that things are instead getting far worse (and all predictions are for that trend to continue). It is time for widespread alternatives to psychiatric hospitals and forced drug therapy. My vision is an attempt to give an idea of what one alternative might look like. 

Additional notes added June, 2014

A great deal of the daily activities of the program I envision to help heal these people minds and to help their ravaged cells in their brains and bodies recover would revolve around the following:

  • Music therapy. There's just an enormous amount of evidence pouring in from the fields of neuroscience that show the kinds of benefits for the brain that come from regular and carefully directed music therapy
  • Dance therapy. Same benefits as music but with an additional physical component
  • Art therapy. Like music and dance, it opens up and stimulates vast areas of the brain that can help facilitate emotional, spiritual and physical recovery 
  • Yoga, meditation and qi-gong. All of these have been demonstrated for thousands of years (and now through more scientific research involving advanced brain scan techniques) to greatly ease and reverse the damage from chronic stress (which will be a major part of what all mental health patients will be battling) along with building healthy new attitudes and outlooks as well as establishing essential daily physical exercise routines
  • Lifestyle management skills. This would involve specific meal preparation skills in which patients would learn nutritional therapy from shopping to meal preparation
  • Cooking therapy would be part of the above. Learning the joys of preparing oneself nutritional, tasty and inexpensive meals. Proper diet is a huge issue and shortfall in many suffering long term mental health issues
  • Peer to peer counseling and support based on understanding and compassion, rather than the stigmatizing judgment most people are subjected to
All of these daily activities and routines would be built on the foundation of rebuilding the esteem and souls that have been decimated by years of living with one's mind torn apart by inner turmoil, being rejected by society and kicked to the curb of life. 

It is simply not necessary for these lives to be wasted in this way. A great deal of recovery can be achieved and a return to productive society attained.

As of this writing in July 2015, a small groundswell of support has begun to start bringing this vision to fruition. 

Taming the Polar Bears is going to be registered as a charitable foundation able to take in donations for and do fund raising for establishing this much, much needed facility. 

I am hoping an announcement regarding this will be forthcoming in the next few months (though I am in the midst of considerable challenges myself). 

Bradley Esau

Tuesday, December 17, 2013

Mania and the Story of Icarus and Daedalus

This post is from a special request from a bipolar bud of mine who follows this blog. In a conversation with him the story of Icarus came up and I mentioned that I'd researched that story in relation to bipolar and found that there was indeed a link. He in turn mentioned that he'd greatly appreciate reading what I'd found in a Polar Bears blog post. So this is for him. Here's to you, bro. 

The following is an excerpt from my (unpublished) book manuscript.

Excerpt from Dancing in the Dark - Why?
March, 2013

The hallmark of true bipolar is mania – and let's try to strike from your mind all the descriptions you've ever read about bipolar, or if you are “bipolar”, your own concepts of your experiences – so let's try start with a clean slate. I think to understand anything, we have to drill down into what this poorly understood phenomenon is. Let's go back a few years and see what we can find pre-pharmacological era (IE: pre-drug tainted era and pre-run away diagnosis era (1)). Let's set aside all these unscientific observations of behaviours, the so called “symptoms” and get down to the bare bones of “mania”. If we can find that, perhaps we can solve some of the mystery of bipolar.

The earliest reference I could find of mania is in the story of Icarus. From Wikipedia, the story from Greek mythology: 

Daedalus (his father) fashioned two pairs of wings out of wax and feathers for himself and his son. Daedalus tried his wings first, but before taking off from the island, warned his son not to fly too close to the sun, nor too close to the sea, but to follow his path of flight. Overcome by the giddiness that flying lent him, Icarus soared through the sky curiously, but in the process he came too close to the sun, which melted the wax. Icarus kept flapping his wings but soon realized that he had no feathers left and that he was only flapping his bare arms, and so Icarus fell into the sea.

When I again started to try to figure out clearer what bipolar was all about and, more importantly how mania actually affected me personally, the story of Icarus for some reason leaped to mind. Well, that's not true, I know the reason. It came to me when I was writing The Roller Coaster chapter (2) and these flights of fantasy of mine followed by hard crashes reminded me suddenly of the story of Icarus and his flight too close to the sun (getting too high) and then crashing to earth (the inevitable emotional crash following mania). I then decided to look up the story, read the Wikipedia entry and bingo – this, under Interpretation:

Literary interpretation has found in the myth the structure and consequence of personal over-ambition. An Icarus-related study of the Daedalus myth was published by the French hellenist Françoise Frontisi-Ducroux. In psychology there have been synthetic studies of the Icarus complex with respect to the alleged relationship between fascination for fire,enuresis, high ambition, and ascensionism. In the psychiatric mind features of disease were perceived in the shape of the pendulous emotional ecstatic-high and depressive-low of bi-polar disorder. Henry Murray having proposed the term Icarus complex, apparently found symptoms particularly in mania where a person is fond of heights, fascinated by both fire and water,narcissistic and observed with fantastical or far-fetched-imaginary cognition.

So here we go, this is good stuff. Frontisi-Ducroux studied mythology and not modern psychiatry and his work was published in 1975 pre-dating all of today's nonsense notions of bipolar. Henry Alexander Murray (May 13, 1893 – June 23, 1988) was an American psychologist who taught for over 30 years at Harvard. He was Director of the Harvard Psychological Clinic in the School of Arts and Sciences after 1930. So again, a pre-modern era thinker and I think we can gain some insight from his interpretations of the legend of Icarus and the phenomenon of bipolar and mania that is not tainted by today's run amok notions.

First we see mention of over-ambition or high ambition. Yes, this fits well with the older concept I've had of mania and matches my own experiences from the 1991 to 1994 years when my "ambitions" included taking over the head of a large corporation, taking over as head coach of the Ottawa Senators NHL team, trying out for the BC Lions professional football team (at the ripe old age of 34 and with zero prior professional experience) and of trying out for the vacant lead singer spot of an internationally known rock group (along with a few other “up there” delusional ideas). Yes, I think these definitely qualify as “overly-ambitious”. We see mention too of the “pendulous emotional ecstatic-high and depressive-low” of bipolar disorder. Well, that describes my worst periods of rapid cycling to a 't'. 

Now as for fondness of heights, fascination with both fire and water, I can't say any of those fit me. (3) I can't recall any particular interest in any of those. I have though read of others with mania feeling like “superman” and wanting to explore heights (Icarus like) and that these literal ascensions to heights often lead to deaths from either believing they could fly and trying to or from accidental falls. Narcism and “fantastical or far-fetched imaginary cognition” again fits my model to a 't' though. I certainly fell in love with myself and my ideas, my fantastical “grandiose thoughts” and my thinking then was certainly far fetched imaginary cognition. My cognitive powers got way too carried away.

But let's examine this portrayal of mania more closely. Now in the story, Daedalus constructed two pairs of wings. Now this suggests that Daedalus wanted his son to fly higher, in other words was encouraging Icarus to have ambition. Now if we return again to The Roller Coaster and look at my how my concepts of ambition were influenced by the short story Jonathon Livingston Seagull, we can again see the metaphor of flight and “flying high” and that at that point of that chapter that I saw nothing wrong with this ambition. 

Is there anything wrong with ambition? No, this is what makes humans what they are. This is what leads to all discoveries. This is what put men on the moon. Ambition is one of the – back to the human brain for a moment – fundamental things that separate the human mind from the animal mind (or at least we've taken it far farther than animals can. We can see some signs of ambition in the animal world as well). 

But – but! - Daedalus also warned his son not to fly too high, not too close to the sun. In other words, not to get overly ambitious. Daedalus understood the dangers here (from his own previous experience?) And look at what the description says – Icarus got “giddy from flying too high” and that he “soared through the air curiously”, and got carried away and could not control his flight and he got too high, got “burned” by being too high and thus crashed back to to the sea where he drowned (the metaphor here for depression... how we seem to “drown” in the sea of depression). So is “mania” just a form of ambition, of ambition being carried away by giddiness, by, in other words, over excitement? Of “soaring through the air too curiously”? This is an extremely important part of our examination here and we're going to drill down into this with as much detail as I can muster.

Over excitement, giddiness, again is as age old a normal behaviour as mankind. Nothing new under the sun here. So is “mania” excitement and giddiness run amok and carried to extremes? Again, this could describe many, many people. Where is the line between “mania” and excitement driven passion? Once again, and I'll just keep hammering this point home, are we looking at normal human behaviour and not a pathology of an “illness”?

But let's carry on. My “why?” is not done with this yet. So here we go, we have this basic concept of excitement and giddiness leading to getting “too high”. Now, again, is this a bad thing? I think we here have to explore the part of mania that has been buried in the mad modern rush to medicalize it and drug people into a coma to “control” it. Here we explore the up side of “mania”.

Mania has long been linked to creativity and, as we've seen, ambition. A look at famous figures thought to be “bipolar” (or manic depressive) is impressive. Since creativity and ambition are part of the mix of what's thought to be mania, this naturally leads to some famous people with big accomplishments. But again, in my drive for pure data, we have to go back to pre-pharmacological revolution figures. I can't trust any diagnosis or manifestation of mania (and hence bipolar) in the drug era (50's onward). In fact, it's hard to trust any of them because “self-medication” has always been a problem associated with bipolar like symptoms. This puts a fly in my ointment of seeking purely raw data (IE: unmedicated subjects) so I'm in a bit of a dilemma here. 

Ernest Hemingway, for example, I see is on my list of “bipolar” people. We all know how creative Hemingway was and also we can see a very adventurous life – two things that I certainly can attest for signs of possible mania in a person – but he was also a famously ferocious drinker and alcohol is rather notorious for mood alterations in people. Many people, it has long been observed, lose their inhibitions when high on alcohol and do stupid things – exactly as we see in accusations of “manic” behaviour. Alcohol can also deepen depression, the other side of mania. So it is impossible to know with ol' Ernest, outside of pure speculation, whether the metaphorical chicken or the egg came first here – did alcohol use trigger mania and/or depression, or did he drink to control the moods? Impossible to know. And once we introduce any foreign substances to the brain, we know that all bets are off as we saw in our examination of psychiatric and so called recreational drugs back in Analysis of Prescription. (4) It is just, therefore, too hard to know where the lines of the mental phenomenon of manic depression and signs of alcoholism are, the lines become too blurred. So let's move on. 

End of Excerpt

I then went on to explore the lives of several famous people from the past (including Isaac Newton) but that gets too long to include here. Perhaps another time. 

(1) There is a lot of back story here as I wrote several massively long chapters tearing down modern psychiatry's notions of "mental illnesses". These were not my own creations but instead sought to consolidate enormous amounts of academic literature and the works of science research writer Robert Whitaker. It was all, in other words, very well founded evidence. 

Whitaker's Anatomy of an Epidemic is absolutely must reading. In the chapter Bipolar Boom he very firmly establishes that many, many cases of "bipolar" that he investigated (and he is a Pulitzer Prize nominated and highly respected science investigator and writer) were either connected to recreational or psychiatric drug use (IE: the "bipolar" cleared up when the drug use stopped) and he presents very strong medical evidence for this and some case studies. He also very firmly establishes the massive "catch basin" for bipolar diagnosis that the pharmacological/psychiatric alliance established in order to write as many life long prescriptions as possible. His work is extremely well researched and scientifically established.

(2) The Roller Coaster is a chapter in my book in which I describe a period of some particularly insidious rapid cycling that lasted roughly 1992-ish to the fall of '94. If you are bipolar and have never experienced true rapid cycling, consider yourself extremely lucky. I wouldn't wish it on my worst enemy. 

(3) This is not exactly true. Later, when I ruminated on my various periods of high suicidality in my life, there were many times I was incredibly - and nearly uncontrollably - drawn to water. These were bizarre, almost hallucinogenic or mildly psychotic experiences (hearing voices, commands) that implored me to come into the water and go under to join this voice calling to me. It was like it was asking me to join an underwater world. I am quite convinced that many people who commit suicide by drowning (something very, very hard to do due to very powerful instinctive reflex actions, by the way) by succumbing to voices and commands very much like I experienced. 

(4) Anatomy of a Prescription was a long chapter in my book manuscript on the science, supposed pathways of efficacy and function, and side effects and brain damage of psychiatric medications. Again, these were NOT my findings, but merely a collection and summary of related academic data and research by psychiatrists dedicated to non-pharmacological methods of mental illness treatment. It was all very well supported by long term empirical research analysis and medical research data. 

Final note: this portion of my manuscript was written when I was desperately trying to believe that bipolar was not as serious of a mental health condition as psychiatry believed and presents to the public and I was exploring all aspects and angles of several major mental health disorders. I was also desperately trying to believe that mania was not "bad" (and I was very manic at the time of this writing). Nonetheless, I still strongly support all the views I put forward in this chapter of my book manuscript. I still maintain that much of what is understood about "bipolar" is nonsense put forward by the pharmacological/psychiatric alliance almost purely in the interests of profit, a point I'll further establish another time.

Whether mania is "bad" or not will have to wait for a future blog post. (Hint: in true bipolar disorder it probably is). 

Monday, October 28, 2013

Zombies and Bipolar Depression

Updated October 2014 - BGE

It's been weeks since I've written anything of note. Well, anything period. But this actually segues well into what I want to talk about in this post. 

I've been stuck in mental molasses for weeks (actually make that months) and it appears to be worsening. Being in the depressive phase of manic depression (that is the classic definition of alternating between manic highs and depressive lows as opposed to the seemingly one size fits all definition of bipolar disorder which seems to cover a wide range of behavioural issues) is where I'm at these days. 

Few people, and that includes medical people, can comprehend what this means or what it's like. I am physically, emotionally and mentally gassed 98% of the time. Not even people who suffer from occasional bouts of depression understand what this is like (except for severe cases that end up in hospitals). The depressive phase of manic depression can be many things and I happen to think I'm winning the battle against a lot of those things (and I have no problem giving full credit to my positive difference making fundamentals ). I am no longer pummeled by negative self talk all the time (occasionally but nothing like before). It's not as dark and hopeless as it was before (though I still hit the suicidal darkness skids sometimes). It's not a lot of things you'd normally associate with depression. It's mostly an astonishing lack of energy (and motivation, passion, drive and other things but I want to focus on the energy component this week). 

And there's sweet tweet to be done about it. Honestly. Trust me. It's not a nutrition issue or an exercise issue or a not having a shiny happy people attitude issue. It's an unavoidable part of the cycle. And it is a cycle, a cycle that's as sure as the phases of the moon or the rise and fall of the tides; one will surely follow the other. And this is not a self fulfilling prophecy. I have moved mountains in the past in effort to ward it off and constructed super sonic levels of belief that surely the depression would not return. But it does. Every. Single. Time. That's kind of why it's considered a disorder - there's nothing you can do to stop it or make make it go away once it hits (alleviate it, perhaps, but not make it go away). Anyway, I'm not going to waste my time arguing about that (and believe me, many people try to). 

I keep telling myself that this is a normal phase of manic depression and that it'll pass. I tell myself that but the evidence is not stacking up very well. With the exception of my five week run of mania to kick off 2013 (five weeks to the day of almost zero sleep and off the charts mental energy) and about two months of something approaching "normal" energy, I've been in virtually a non-stop depressive state since spring of 2010 (much of that, I believe, induced by psychiatric drugs meant to "stabilize" me but I'll grind that ax another day). Throw in the manic phase that kicked off the eighteen month phase of "Photomania" (long story) late in 2007 along with the rapid cycling that took place during that time period and we're just not talking a whole lot of mental stability (AKA "normal", I guess) in recent years. 

This does not portend well. According to the book Taming Bipolar, as a fifty-four year old man who's lived with it all his life undiagnosed, I am in the worst category for "treatment resistant" bipolar (of course we must define "treatment" ... this is talking about traditional - and backwards - psychiatric treatment). There's a lot I disagree with in the book (traditional drug therapy for one, of course) but I think a lot of the basic research about the disorder is well founded and based on long term observations. Each cycle, the thought goes, that one goes through of mania and depression, the more entrenched the disorder becomes (and theories of neuroplasticity would support this. The more you go through it, the more "hard wired" it becomes). Also, rapid cyclers are thought to be harder hit. I'll put my hand up to support that. So, having gone through - what, close to twenty cycles? - and having done a lot of rapid cycling and living with it untamed for so long puts me in ... the shittiest of categories we'll say. 

But that's all water past the dam. Plus it's based on old models of understanding and treatment. I honestly believe I'm moving past that. This does not by any means mean I think I've got anything "beat" - far, far from it. I've got way too many been-there-done-that t-shirts for false flags of thinking this was in my past (like early this year for example when I boldly proclaimed myself free from mental illness and ready to conquer the world) but in relation to how bad the depressive phase can be (which Kay Jamison describes so well in her book An Unquiet Mind and about which I am well researched elsewhere), I think I am displaying remarkable improvement over that of the average sufferer and that of my own past. If it weren't for this energy shortage. This is definitely - and alarmingly - getting worse. An hour, two hours max is all I can go doing anything - light work, reading, writing, thinking, walking, socializing - and I'm thoroughly gassed. That's if I can do anything at all. Any kind of deep thinking and writing is almost out of the question. Hence the quiet blog of late. 

But enough of that depressing talk. Or at least let's look at it a bit differently. Your intrepid mental health blogger-reporter has not let this opportunity go to waste. I have been faithfully observing and logging my depressed mental state and putting it under the microscope as it were. All the while wondering "why the hell does my brain do this to me?" and in a habit I picked up earlier this year, when I wonder "why?" about something to do with mental health, I demand answers and won't stop digging until I find them. 

I read, as you may have noticed, much about neuroscience. I follow the most superb blog Searching for the Mind by Dr. Jon Lieff and many other neuroscience blogs and websites. I read or have read several books put out by renowned neuroscientists and I hang out online with a small number of neuroscientists who, knowing what I'm up to, send me all kinds of research papers. It's not like I lack for resources (nor, I'll point out, the ability to understand a great deal of it). But there are not a lot of answers out there. I actually was in email contact with Dr. Lieff about this and this is what he told me: "There are literally thousands of scientists trying to understand the neuroscience of bipolar disorder. At this time in history, it is too complex for our present tools. Everything is currently speculation." Not exactly brimming with optimistic outlook for someone looking for answers, is it? 

But I am not to be deterred. One thing manic depressives have going for us is that we tend to think outside the box and we go in different directions from the mainstream. At least this manic depressive does (and I've interviewed others who do as well ... we'll get to this in more detail another time though) and that's what I do - I search outside of mainstream ideas for answers. After that long preamble, we finally get to the topic - zombies and bipolar depression. Which I'll tie into this mental and physical fatigue. 

There are several possible biological reasons for the fatigue that we won't explore at this time. These are hard to explore because they just don't appear to have found them or nailed them down (see Lieff's quote above). One area that looks interesting, however, is the critical role of glia cells in brain functioning (which Lieff touches on here). There is research to suggest (which I can't seem to find in my horror show of a filing "system") that sleep is essential to glia cells doing their thing. Not to mention sleep appearing to be critical for neuronal and synaptic housecleaning (yet more research for which I can't find the link which I was sure I'd saved ... sigh). 

During phases of mania we don't sleep. How much damage does this cause and how long does it take to "catch up"? Is this part of the reason for the depressive/low energy phase? Alas, clear answers are not currently forthcoming. But I have some other ideas I'd like to put forward for now, ideas that I strongly believe, based on my observations of my current depressive phase and current understandings of how brains work, have some merit. Which finally brings us to zombies - or more specifically, renowned neuroscientist David Eagleman's concept of "zombie systems"; the subconscious and automated brain functions that really drive who we are, what we do and how we do it. 

I touched on these two posts ago in my introduction of neuroscience 101 (<self-promote> which, by the way, got a big thumbs up from Jon Lieff and my Google+ neuroscience buddy </self-promote>) and I'd like to delve into them a bit more. It is, as I said before and which I'll repeat, critical to understand how little conscious control we have over our actions. Massive amounts of research shows that before an "idea" or "decision" hits our conscious mind - located in our frontal lobes - much deeper brain systems have already chewed on the data (key memories that the brain has stored unawares to "you") and presented it to "you". Chances are if you've had a "brilliant" idea that you think is "original" it's something (or various bits of thereof) your subconscious noted from somewhere else and filed away. In other words, you stole it from somewhere else (but don't worry, your subconscious will also create a story for you that it really is your idea). 

This is but one example. Your five senses are constantly testing the waters for anything that is of possible use to you or a danger to you (which is virtually everything from food to sex to rivals for those ... sorry, but yeah, we are that simple). All this runs mostly through our primitive lizard brains and limbic systems. Which, to remind, look roughly like this:

Our fancy-smancy mammalian neocortexes highlighted there in purple do lots of fancy stuff but that fancy stuff is mostly just adding and compiling and crunching more data that will also get run through the more basic hardware in green and pink - IE; simply running more sophisticated zombie systems (like math for example). And it's all this that "decides" what we do, not "we" (though we have no problem at all taking the credit). 

Zombie systems run most of what we do for a few reasons. One is because having automated programs that can run with no conscious input (and we do have some) is the most energy efficient way for the brain to operate (and energy efficiency is a super key driver of evolutionary progress - the more energy efficient, the better the chance of survival). 

Eagleman tells a fascinating story of the energy efficiency of chess master Gary Kasparov's brain (which they measured) during his famous chess match with the computer Big Blue. Big Blue may have been his equal on the chess board but it was no match for Kasparov's mental efficiency (he was humming along at about 20 watts while his machine counterpart was burning through thousands of watts and was almost literally melting down). 

While chess strategy is in the domain of our neocortex (reptiles can't play chess after all!), Kasparov's real mastery was of internalizing thousands of moves and counter moves into zombie programs so that his brain could run them automatically and thus very energy efficiently (and this is why many young chess prodigies eventually burn out out - they don't master this). Please make careful note of this because energy efficiency is an extremely major underlying functionality of the brain that will be my key point today.

Two is that this is simply how brains run - automated functions. This is how fruit fly neural circuitry runs, this is how round worm neural circuitry runs, this is how reptile circuitry runs, this is how more advanced mammal circuitry runs, this is how all creatures' neuronal circuitry runs, including that of homo sapiens. We're just further up the evolutionary scale. The underlying basics, however, are essentially the same. This is why neuroscience finds so much to learn about how our brain functions by studying simpler animal forms (I, in my initial ignorance, used to scoff at this but we do indeed have things in common with such simple things as fruit flies and there is much to learn, for another example, from studying the "connectome" (the wiring) of the simple round worm). 

A good deal of the programming comes "pre-installed" (basic organ functions such as breathing and pumping blood for example but, it turns out, also more "advanced" things such as human facial recognition) but the majority is learned "behaviour" (and "behaviour" is really just these subconsciously generated and run automated systems). The average human has hundreds if not thousands of programmed automated systems that guide the conscious you through your life. These would include virtually everything about what you do physically, what you "think", "decide", avoid, strive for, your "morality", philosophy about life and so on and so on. 

Even what you believe to be big life changing "decisions" were probably just barfed up by a complex combination of various subconscious zombie systems that may have been chewing on the problem for weeks, months or even years that are designed to nudge you this way or that through life. In other words, how well your life is going is completely controlled by forces mostly beyond your conscious awareness or control and depend entirely on how well your various autonomous systems were formed through genetics and environmental factors. 

Three is the simplest and most obvious. There isn't a living creature on earth that could get through any day if it had to actually "think" about what it did. And so it is for humans; it's far better to leave all the daily functions - large and small - to the three pound mass of tens of billions of neurons and more synaptic connections in one square centimeter of cortex tissue than there are stars in the Milky Way. 

That machine of yours contains awesome (in the true meaning of the word) amounts of computing and processing power and it's far better for conscious "you" to just stay out of its way and let it do the job that evolution brilliantly designed it to do (well, there do seem to be endless examples of brains that seem not so brilliantly designed to guide their hosts through survival but lets leave that aside for now). 

So what does all this about zombie systems - AKA, automated neuronal circuitry - have to do with bipolar depression? Well, a lot I believe. If how well your life is going, or has gone, depends entirely on subconscious automated systems, then by golly you'd better hope those systems are working well. And what working well is depends on two basic things: one, is some semblance of routine from day to day and two, and perhaps more critically, is how well and consistently your brain constructs your "reality". It doesn't really matter how "normal" either of these are, only that they are relatively consistent from day to day. And a bad case of long running bipolar disorder - like mine for example - decimates a) routine and b) your concepts of "reality". 

Bipolar disorder will, in true cases anyway (there are exceptions we'll get to another day), disrupt your life. Internal disruptions will lead to external disruptions which will lead to more internal disruptions which will lead to more external disruptions and on and on in a vicious cycle. I wrote some months ago a three part series about realities and the minds of bipolars and schizophrenics starting here

Between the various states of bipolar - mania, depression and mixed episodes - your brain will construct entirely different realities. In other words, when in these vastly differing states you will see the world in vastly differing ways. "Reality" one day might be to become the coach of a professional hockey team (as I once believed I would do) or "reality" might be that it's perfectly sensible to put a gun to your head and blow your brains out (as a particularly bad episode of psychosis was driving me to do or other self termination options presented as "reality" during episodes of mixed episode mania). It might be to be the most agreeable and seemingly nicest person in the world or it might be an almost unstoppable drive to punch the shit out of the guy in the car next to you. I've often said, roll the roulette wheel that day and get a different reality. 

The brain does not like this. It likes routine. This is why we call people "creatures of habit". It's because brains - AKA "us" - like it that way (as do all creatures of course). Even if it's a bad habit it's better than having your realities scrambled every second day. By saying your brain doesn't like it what I really mean is your zombie systems don't like it. Automated systems - even actual machine ones - need routine. And when your zombie systems start running amok, you start running amok. And because these are deep systems well, well beyond your conscious control, there's sweet tweet you can do about it. Fun, what?! It's not, of course, and this is where we get to the horrors - and they are horrors - of bipolar depression. 

As I said, the most fundamental problem with the depressive phase of manic depression is the complete and utter loss of energy. There are, I think is obvious, biological reasons for this (IE: actual brain damage (more later on this, I promise)). But a large part of the problem, I am now quite convinced, is discombobulated zombie systems thrown into complete disarray by constantly shifting routines and realities. Now let's go back to the paragraph about zombie systems and mental energy efficiency. If those systems aren't running smoothly then you will be burning a lot of energy just trying to do the most simple of things. 

Myself, when I started to think about them, I realized I have so many zombie systems that have been completely thrown off the rails, that I have almost nothing running smoothly and energy efficiently. And here's another thing about the brain. What starts to run amok in one place can cascade through others (Norman Doidge touches on this in The Brain That Changes Itself - it can go both ways, for good or for bad; it's part of neuroplasticity). 

One of our most fundamental zombie systems is our belief system; what we believe about ourselves and the world around us. Another is our system of thought. It is absolutely 100% critical to have confidence in these. For me, my last six years of bipolar zaniness has decimated these (the previous twenty to thirty years also are in the mix but it's mostly the most recent six years). Take my thoughts for example. Bipolar brains become very disordered. We will be presented with a constant barrage of what are known as "cognitive distortions" (part of what I mean by constantly alternating "realities"). These run from moderate to extreme paranoia to thinking it perfectly reasonable to prematurely terminate one's life to extreme grandiose thoughts and so on. 

I cannot trust a single thought in my head. Literally. Honestly. A single seemingly innocent incident (to you) can kick in some kind of discombobulated zombie system that will have me down by train tracks desperately waiting for a train to come along. Just. Like. That. <snaps fingers> Or that I'm the greatest thing since sliced bread and should run for PM of Canada. I am not in the least exaggerating. Or throw in frequent hallucinations, hearing voices, psychotic episodes and you no longer have any idea what "reality" "is". And it is these inner "realities" that generate your "thoughts". That's just what brains do - they generate a reality for you (yes, you ... all of our realities are internally generated by our brains). So I cannot allow my thoughts to run, as you can, on auto-pilot. I have to examine Every. Single. One. It is - excuse my French - utterly fucking exhausting. 

And this is just one example. Almost nothing runs automatically for me anymore. Not driving a car (something I've done since I was fourteen with almost no effort at all), not doing simple carpentry work, not socializing, nothing. I can be plucking away at seemingly the most simple thing in the world and suddenly hit overwhelm Just. Like. That. <again snaps fingers> Whatever I'm doing wherever I am I simply have to just stop and run my meditation program to try and empty my mind and let it reboot. This is utterly fucking exhausting. I wrote earlier about ego defense systems. These are yet more zombie systems (Eagleman touches on some of them - the stories we tell ourselves - in his book, Incognito) that are in complete disarray in me. I don't even know where to begin to put them back together again. Ego defense systems are designed to protect us from the big bad world out there (yours work so well that you are 99% unlikely to even be aware of their existence and what they do for you) and this I have to pick through one by one to try make sense of. This is exhausting. 

Oh, and then there's the little fact that all this disorder and mental chaos becomes a zombie system in itself. So you have to, once you learn awareness, fight all that. This is super deep hard wired stuff that you don't exactly just spin around on a dime. This is exhausting. 

There are, as I've said, other reasons for the well documented (for those of us who've researched it) exhaustion of the depressive cycle. Why, for example, when manic do we have nuclear amounts of off the charts energy? What generates that and how does that just "turn off" (or burn out more likely)? Why does the energy level slide so badly in the other direction? Many questions, almost no answers. But I firmly believe that having our deep and critical subconscious automated operating systems so messed up and their energy efficiency go out the window with that is a big part of the puzzle. And there are many, many days when it feels like all the king's horses and all the king's men can't put Humpty Dumpty back together again. 

Update, October, 2014

I can't believe it's been a year since I wrote this nor can I believe that I am still battling the relentless fatigue. But I must say that I've done enormous amounts of (exhausting) work to move past many of the issues I've described here. I think I have mental and physical routines down better and the mind scrambling (and exhausting) inner chaos settled down to a great degree. So things are improving. 

As well, thanks to a tip from Jon Lieff (mentioned and linked to above), I learned much about the physiology of the depressive phase fatigue which I summarized in a brilliant three part series. You can access them by clicking on the links below:

The Neuroscience of Bipolar and Major Depression Fatigue - Part One

Part Two

Part Three

Saturday, October 26, 2013

Stories From the Inside

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

Weird Scenes Inside the Goldmine 

- Jim Morrison, 1970


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

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

Then one day the Taliban came.

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

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

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

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

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

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

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

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

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

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

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

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

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

Friday, September 13, 2013

Psychiatry - the Emperor with No Clothes

This may come as a surprise to you but there actually is no medically based diagnostic test for any psychiatric illness. The second sobering thing to understand is that the diagnostic process that is used for any psychiatric illness cannot in any way be described as "accurate" and upon closer inspection certainly not scientific. "Diagnosis" - if it can be called that - is performed by observing "behaviours" and then checking them off a list. The behaviours are described in the DSM - the diagnostic and statistical manual, the "bible" of psychiatric diagnosis. To understand psychiatric diagnosis, we first have to understand this manual and how it gets put together. 

This is from the Neuroskeptic

In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.
Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.
It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.
Others were worse. Depression, had a frankly crap kappa of 0.28, and the new ‘Mixed Anxiety-Depressive Disorder’ came in at -0.004 (sic). It was completely meaningless.

This, by the way, was performed and compiled by the DSM-V committee in which the psychiatrists were hand picked. What this essentially boils down to is that the people who are authoring the manual upon which psychiatric diagnoses are based can't even accurately diagnose anything using their own criteria. Let me repeat that for you - the very people responsible for compiling the new (and since released) diagnostic manual that psychiatrists around the western world will depend on for diagnostic guidance and criteria cannot diagnose anything accurately based on their own diagnostic criteria. 

You might also be surprised at how "disorders" get included in the manual; they're voted in by - get this - a show of hands. 

Canadian psychologist Tana Dineen reports, “Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM-IV [and ICD-10] are terms arrived at through peer consensus”—literally, a vote by APA committee members—and designed largely for billing purposes.

The “science-by-vote” procedure is as surprising to a layperson as it is to other health professionals, who have witnessed DSM voting meetings. “Mental disorders are established without scientific basis and procedure,”
[my bold - brad] a psychologist attending the DSM hearings said. “The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. Then it’s typed into the computer. It may reflect on our naiveté, but it was our belief that there would be an attempt to look at the things scientifically.” [my bold - brad]

In 1987, a “self-defeating personality disorder” was voted in as a provisional label. Used to describe “self-sacrificing” people, especially women, who supposedly choose careers or relationships that are likely to cause disappointment, the “disorder” met with such protest from women it was subsequently voted out of DSM-IV.

Yes, you read that correctly; "disorders" can be voted in and then, on the basis of a protest, be voted out again. There is nothing medically scientific about voting "disorders" in and out of existence. Homosexuality was once a "disorder" that was only removed (for the 1980 edition) after strong protest from gay activists. 

And there's more. This from lead DSM-IV committee member Allen Frances, who in a (year) 2000 interview with Wired magazine, declared,

"There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it." ... "These concepts [of distinct mental disorders] are virtually impossible to define precisely with bright lines at the borders."

Frances became so alarmed at where the new DSM-V was going that he has become an outspoken critic of the entire diagnostic process and of psychiatry itself. 

And finally, the lead psychiatrist over the formulating of the DSM-V openly admits that there is little or inadequate "scientific research" done to back up the diagnostic claims in the DSM.

"A primary purpose of this group then, was to determine why progress has been so limited and to offer strategic insights that may lead to a more etiologically-based diagnostic system. The group ultimately concluded that given the current state of technological limitations, the field is years, and possibly decades, away from having a fully explicated etiology- and pathophysiology-based classification system for psychiatry." [bold all mine - brad]

Michael B. First, M.D. A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers. Published in May 2002.

So not only is there no clear etiology for any psychiatric disorder, by their own admission they're possibly decades away from having one (granted this quote is from eleven years ago and neuro-imaging technology has advanced considerably since then).

And this isn't mentioning the ties to drug companies that many DSM committee members have or how much funding the pharmaceutical industry supplies to the American Psychiatric Association

And just to give further idea, there's this. This was from a neuroscience paper the source for which I no longer have. My apologies. 

neuropsychiatric (NP) disorders ... can still be viewed as part of the most complex disorders that are of unknown etiology and incomprehensible pathophysiology. The complexity of NP disorders arises from their etiologic heterogeneity and the concurrent influence of environmental and genetic factors. In addition, the absence of rigid boundaries between the normal and diseased state, the remarkable overlap of symptoms among conditions, the high inter-individual and inter-population variations, and the absence of discriminative molecular and/or imaging biomarkers for these diseases makes difficult an accurate diagnosis.”

This is essentially neuroscience confirming what Dr. Frances admitted - that "there are no bright lines between the borders" and that they have no idea what causes anything. 

I will repeat - any neuroscientist will tell you that the human brain is the most complex device in the known universe. Even with the most mind boggling advanced and highly tuned instruments yet devised, bleeding edge neuroscience doesn't even really fully comprehend what is going on in there and why. Do you honestly believe that someone going by a corrupted and highly unscientific check list is going to know? I'll say again - I was seen by about twenty psychiatrists. None of them had the same thing to say. None of them could explain anything to me. None of them gave any indications they understood why these things were happening to me in my mind. Aside from a routine CAT scan to rule out concussion damage and a test to analyze my brain activity while sleeping, no actual medical tests were ever performed. And this will be true of anyone ever "diagnosed" with a mood or psychiatric disorder. This is not medical diagnosis, not even close. It's modern day voodoo at best. I'd go with a tarot card reading before I ever put myself in these people's hands again. They have about the same scientific basis. 

And then - then! - these people, after this simple check list "diagnosis", are going to pull out a prescription pad and prescribe either a drug or more likely a combination of drugs to "fix" what they "think" is "wrong". Drugs which, as I've written before, lack any kind of scientific validity for long term efficacy, drugs which could induce suicide or violent behaviour or cause critical structural changes to the brain including tissue loss.

Back to the four year old who was killed by a "psychiatrist" and for whom Tufts Medical Center felt "The care we provided was appropriate and within responsible professional standards" (60 Minutes, 2009). Seriously? Drugging a four year old to death is "within reasonable professional standards"? Where were these people during brain anatomy classes? Read any neuroscience book. The brain is still in rapid development stage at that age. Not only are behavioural issues common at that age as the developing brain struggles to make sense of and adapt to a seemingly bizarre world but it is beyond comprehension that brain altering chemicals could ethically be given to children whose brains are still developing. Yet "paediatric bipolar disorder" is now a common diagnosis and infants as young as three or four are put on cocktails of powerful drugs. And brain development goes right up past adolescence (the brain also undergoes massive changes during the teen years) and this age class is increasingly drugged (and off label at that - the drugs were never approved for non-adult use). And this isn't "Billy Bob Psychiatry" hanging a shingle out in some back water town, this is a major medical centre. And this is who we trust with our one and only precious brains?

No. I say no. And this is only the tiny, tiny tip of the iceberg of what I found for psychiatric misdeeds, the financial ties between the pharmaceutical industry, the FDA and the American Psychiatric Association and what is available for long term studies and research into psychiatric drugs (and thus psychiatry itself) efficacy. You might want to watch some of former drug company sales rep Gwen Olsen videos in which she describes how drugs are pushed to psychiatrists' and doctors' offices, old age homes and schools in order to "gain market share" and "make sales quotas" like they were widgets or some other kind of everyday product and not something that we trust to treat our brains. 

Psychiatry doesn't have a shred of clothing to wear. They have no scientific basis for diagnosis and they prescribe medications that have no scientific validity whatsoever. These are drugs that the effects of which are unobservable in the human brain (unlike medications for other medical conditions) "treating" conditions for which no biological etiology has ever been established and accepted (please try to find one - I'd be interested in seeing it. But head to the Nobel Prize committee first; they'd be interested in this discovery). I see no validation whatsoever for the "Dr" in front of their names that they so proudly flaunt. They get by entirely by the infamous "God complex" - they simply believe they "know". By what criteria? Nobody knows. A reading of psychiatric history is a reading into some of the worst horrors ever inflicted on innocent people (psychology is not innocent of this either). The barbaric practices of ice pick lobotomies and insulin shock therapy (you'd have to read about this to believe it) are not far in their past. Under their watch we have seen an explosion of people debilitated by psychiatric illnesses, including a thirty-five fold increase among children.

Personally, I wouldn't trust them to treat a headache. Anyone who's been successfully "treated" by mainstream psychiatry most likely did so through belief in their doctor and placebo effects which makes it no different or better than the shamans and witch doctors that still operate in many cultures (my friends in the Filipino community told me some fascinating stories of this). If someone claims to have been successfully treated, I'd ask for the before and after medical tests that prove that. There are none. "Successful treatment" just means that you were one of the lucky ones. Or the condition just passed normally as they did for thousands of years before "modern" psychiatry began getting involved in our brains and behaviours.

Given the hundreds of "disorders" in the DSM that cover just about every human behaviour imaginable and the completely sham system of diagnosis (described by many as merely a system to justify insurance claims and writing prescriptions) or the medicalizing of perfectly normal human behaviours (bereavement following the death of a loved one is now considered a "disorder" in the new DSM-V), I find myself highly sceptical of anyone claiming a psychiatric disorder (and given the distinct possibility that the drugs to treat it are actually prolonging or worsening it). 

This is NOT to say that psychiatric disorders do not exist or that there are not people who genuinely suffer from them, only that there's a good chance one was misdiagnosed (over diagnosis is a widely recognized problem ... a story possibly for another day but "ADHD" would be one that would be firmly in the cross hairs) or that one is simply "suffering" from being human and therefore not perfect. Situational unhappiness, temper tantrums, mood swings, acting out and dozens of other behaviours were not "disorders" until a combination of perfectionist seeking society started overreacting to them and modern psychiatry, backed by the profit seeking pharmaceutical industry (and statistics will show that "disorders" sky rocketed after these two linked up about five decades ago), decided - and I do mean decided, see again the vote by a show of hands - that so much of normal human behaviour is an "illness" that can be made to go away by a simple pill (or likely a cocktail of them).

This is an industry that has no clothes. And I see no sign of them acquiring any any time soon.  

[I apologize again for the formatting issues. It all looks normal and the same in my composition box but when I post it, the formatting is all strange - brad]