Thursday, August 29, 2013

Memory Functioning in Depressive Disorders and Bipolar Depression




This is yet another post that I fervently would like to give an overhaul to but as various things continue to stand in the way, I'll have to let it stand as is. 

Before I begin, I want to be clear that I am talking about what we might call normal day to day memories of life and struggles and not severe traumatic memories. Traumatic memories, especially traumatic childhood memories, are quite different and as such I'll have to address them separately. [BGE - Dec. 2015]


To understand how memory plays a role in long term episodes of either uni-polar or bipolar depression and in how people can get "trapped" in these, we first have to understand how much memory plays a role in our daily functioning, how memory plays a role in our subconscious and, most importantly, how much our subconscious drives our daily behaviours, thoughts and decisions. 

I'm a born and bred do it yourselfer. If something can't be done right, then I'll just roll up my sleeves and do it myself. That's how I came to study neuroscience and how bipolar and depressive disorders work in the brain. I let the mental health care system have a go at it but they royally f**ked it right up - nearly killing me - and so I decided to take the bull by the horns and find out for myself what was going on in our brains that created these terrible mental states

When I started looking into why the mental health care system failed me - and so many others - so badly, I saw that the pharmaceutical and psychiatric industries (and I consider psychiatry an industry) were too simplistic in their pharmacological approaches; they overlooked so many other aspects that were obviously going on. In all my time in the mental health care system and psychiatric hospitals and under the care of psychiatrists and psychologists, it seemed that no one could explain to me what was going on and why.

So, deciding I wanted to override this suicidal drive that had taken up residence in my brain and that I wanted to live, I simply rolled up my sleeves, got to work, and started to figure it out myself. 

When I started coming across studies and models for how memory works in the brain and how much it drives our lives, I knew I had a major factor in what drives some, though not all, of the worst negative darkness in major depressive disorder or bipolar depression. My ideas have been supported by a couple of neuroscientist buddies of mine on the Google+ community so I know I'm on the right track. 

Studying my own "data" - learning to become highly aware of my mental states and why - and running "tests" has been further confirming my hypothesis - work on laying down positive new memory "tracks" and you'll take some very critical steps in turning your depression around. 

I realized that with a lot of my own depression in the past that my brain was running negatively all the time and that my negative thoughts were fueling yet more negative thoughts and state of mind. This of course all felt “out of my control” and that I “couldn't help it”. And I couldn't – all that stuff runs subconsciously, outside the apparent control of our conscious minds. If yours doesn't run negatively, then you happen to have a healthily running system. 

So what to do about it?

First of all, let's have a quick look at how memory works. Memory is more than just remembering where your keys are or the name attached to that familiar face you met in the supermarket or how to do long division. Memory runs virtually every subconscious function that runs you, your behaviour and your state of mind. From basic physical functions to all the myriad of data that you use in all your daily decisions, memory - impressions, procedures, reactions and all kinds of "data" pertinent to you getting through life acquired and stored up over a life time - play a role. 

What you experience as "decisions" aren't even conscious decisions. Before a "decision" has even entered your conscious mind, your subconscious has already "run the data" and made the decision for you. Your conscious mind is merely nodding along. This is what I mean about how memory partially (in addition to many neurobiological and other autonomous functions) "drives your bus" subconsciously and why it can so badly negatively affect our conscious states. It doesn't have to but we'll get to that momentarily. First, let's look at a diagram that roughly shows how this works (and I do mean roughly ... how this really works in your mind is beyond mind bogglingly complex). 





Through your five senses for your entire life, data (reams and reams and reams of sensory information), represented by the yellow arrows, is entered and shuffled through the process represented in the diagram and stored for future use. Everything about who you are has largely been formed by what your senses have brought in and how you perceived them, which itself is a product of how genetic and environmental factors formed your particular brain

As you grow, new input is matched to existing data - stuff in your memory - to help you understand the world around you. In everything you do day to day, your mind is going to be accessing that data to help you make decisions. This process, which runs like an auto-pilot without any thought or effort whatsoever on your part, plays a very large role in driving who you are, what your behaviour will be and - most importantly to us - your mental states and moods will be while running it through your own unique complex brain system of filters, checks and balances, a system that grew and developed in part in how "you" developed. How you react to something or how you feel is going to be a product of this system. 

Of particular note, see how the amygdala is involved in all memory input. It's going to attach an "emotional value" to whatever your senses pull in and run through the system. I've written in the past
 the huge role this little brain nodule plays in our behaviour and part of what's happening with negative memory input is this guy is way overactive. 

Now not shown in the chart, but is a large factor, is our own thoughts. Our own thoughts - generated by this system - are going to be recorded as well and this is also going to be accessed and used to create further thoughts, decisions and states of mind. It all becomes a large self generating feed back loop. And in major depression or bipolar depression, this loop is malfunctioning in a negative way. 

Negative memories - known as "aversive" memories - are not bad in their own right. In fact, they're a vital part of your internal guidance system as these memories help your subconscious to know what to avoid or what to handle differently. Negative impression of Mr. So 'n' So? Your brain registers this and even though you may not consciously think it, you'll probably avoid him in the future. The same with a negative food experience and so on and so on. In our evolutionary past, keeping a "file" of negative memories is part of what kept us alive or helped us avoid getting sick from eating something bad or kept us out of bad situations. Even someone with the sunniest disposition will have thousands of negative impressions stored away in their memory banks. In people with healthier mental states, this system runs normally and the negative impressions are not kept on the forefront. Part of what's wrong with those of who struggle with dark depression (whether uni-polar or bipolar depression) is that a) our memory building and filing hardware is building in too much negativity to our memories, b) our subconscious accesses the negative stuff too much or too often - or constantly - and c) we keep building negativity and darkness into our system.

As the negative feedback from our subconscious drives our mood down, our thoughts become predominantly negative. Our negative thoughts get fed back into the storage system where it matches to other negative data which feeds back to our thoughts and on and on in what I call a negative feedback loop system. The worse our mood gets, the darker our thoughts become, the darker our thoughts become the darker our "data base" gets and the worse the depression sets in. The data base, as you can see in that illustration above, has both short term and long term storage. The more we feed negative thoughts into the short term, the more will get transferred into the long term and as it gets set deeper into the long term memory the deeper the depression sets in. As the depression sets in, this starts to reflect itself in our behaviour and what we think and say and this re-enforces negativity and darkness and further attaches this to our memories of what we say and do and this furthers the loop. Soon everything gets dark and negative. 

But it gets worse. Our memory is also what drives our predictive function, IE; how our brain projects our concept of our future, a process that takes place largely outside of our conscious control. It just works automatically; it accesses past data in order to form a predictive model of your short and long term future. Now if your memory storage system is full of dark, negative material, guess what's going to get accessed by your predictive function? The dark negativity! Thus the future "appears" dark and negative. And this further re-enforces the negative feed back loop system that's driving your brain which is driving your state of mind. 

None of this is anything new of course. They've understood the role memory plays regarding our moods for a very long time. It's just that it's one of the things psychiatry overlooks in their drive to correct everything with simple pills. A pill is not going to make your memory function work differently. A pill might have a placebo affect and get it kicked in a better direction but by and large, for most people who really struggle with the darkness of depression a pill just ain't gonna cut the mustard. 

So the question is what to do.

Essentially what we have to do, I believe, is fourfold.

One, is that we have to be aware of what's happening. The concept of awareness is getting our conscious minds to take more control over how we're perceiving both the external world and our own internal thoughts and how this is playing into our memories and memory retrieval. 

Secondly, once we are more aware of what's happening, we have to “rewrite” our active memory. That is, we have to start laying down “new tracks”, new, more positive memories. I've done a LOT of work on this in my own program and I'll have to at some point get to a post on how I did - and continue - to do that.

Thirdly, we have to learn to deal with some of the old, and likely very powerful, negative memories. This requires creating different associations with those memories. The new associations may not exactly be "positive" but they don't have to be; they just have to have the negative associations removed and more "neutral" associations built in. Very difficult for many of us, I know, and the brain regions involved can very powerfully embed certain traumatic experiences, but there are ways to reprocess many if not most of our old memories. I've written a very well received post on Mindfulness Meditation Cognitive Behaviour Therapy that many have told me is very useful as a way to start working through negative associations. 

And lastly, we need to develop a better predictive function and to work on this we have to practice positive visualization through specific meditation techniques.

How to do all this I'll get to in future posts. 

I also need to address further how memory works at the neurological and brain region levels so we can better understand how memories are formed and retrieved and how certain traumatic memories get "seared in" to us and how these come to affect our long term mental states. While I need a whole dedicated column or more to address this, I can say that it is my firm belief after seeing countless studies on how memories are formed and what makes some more powerful (and haunting) than others, that there is a wide spectrum to what is clinically known as PTSD and that more people may be suffering on some lower, subconscious level of something very much like PTSD than we now understand. All of which is to say, that building new and better memories may be much more challenging for some than others. But - BUT! - I deeply believe, just more challenging, not impossible. And probably using more specific methods than my general guidelines here (though this is not to say that anyone could not benefit from these guidelines). 

For now I just want you to be aware of how your memory functioning plays such a strong role in your state of mind. It's important to be aware of this, I believe, so that you'll better understand why it's important to work on re-jigging your memory as part of the strategy for improving your state of mind. As for some basic tips on how to get started, refer for now to my Positive Difference Making Fundamentals. I'm hoping to get more detailed tips published soon. 

As for that overactive amygdala, daily practice of some simple meditative breathing techniques are going to go a long ways towards calming this little puppy down and thus calm down how your new memories are formed. There is enormous amounts of evidence that music therapy can also induce positive plastic change in the amygdala and amgydala function (yet another post I'll be getting to at some point)

Now memory and its role in negative self talk and negative self-perception is not all that's going on in major depressive disorder or bipolar depression - there could be serious issues with how the cells in your body and brain create energy along with other biological or brain region problems
, of course - but getting your memory function turned around is going to go a long ways towards turning your thought and perception processes into a more positive model and research shows that some "top down" mental work can start turning around the deeper brain regions where the biological factors originate as well. 

As well, much research shows that the more proactive we are on working on all the different parts of our complex puzzles, the stronger we'll get and the better results we'll get. So while working on our memories and how we form new ones is only a piece of the puzzle, it is one that either on one's own or with therapy help, one can work on.

Another big take away from this is that these methods can also help turn around negative self-talk or self-images as well. 


I will say up front though that despite working to form better memory functioning, you're still going to occasionally get blind-sided by episodes of darkness. But don't throw in the towel and think it's all "useless". Just take a break, just "be" for a while, then get back in the saddle and keep riding. These things always go in fits and starts so be aware of that. It's a journey, not a destination. :)

Update from May 2015:

Building new, positive memories has been for some time and continues to be a major cornerstone of my efforts to improve my mental health. Two years in to my self-designed and prescribed treatment program, I feel there is no doubt that my efforts to "lay down new memory tracks" has been a major factor in my ongoing improvement in my mental states, moods and ability to roll with life's challenges. 

And the challenges kept coming. From being asked to leave the apartment where I'd been establishing a new home
 and life to helping a lifelong dear friend through his own mental health crisis to having my minuscule pension cheque suddenly halved to being technically homeless through a Canadian winter, I continue to work to lay down the best "memory tracks" I can and to break the negative loop I described in my original writing of this post. 


Also linked to this is my daily efforts to let go of old memories and not "replay" them all the time, another very key step to rejigging our memory functions that I'll get to when I write a specific post on The Art of Letting Go. 


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Tuesday, August 13, 2013

My Positive Difference Making Fundamentals

Positive Difference Making
Things That CAN be Done




[New, updated introduction - April 4th, 2015 - BGE]

After a brief hiatus and blowing up Taming the Polar Bears and starting over , my readership is coming back and I get a lot of emails or messages regarding my story and what I did to get better. 

People have read only parts of my story in posts like Life as a Living Hell or what advanced state Type I bipolar is like in the very brief introduction Mental Health Disorder in Focus - Bipolar Disorder and maybe here and there elsewhere in old archived posts.

And the question everybody asks or wants to know is "how on earth did you do it?" or even "how are you still alive?"

Well, the following is more or less it. This is what I do. Every day. To some degree. None of it is as simple as outlined here - I'll be getting to all of these points in greater detail in future columns, but this is the basics that I worked on, still work on, and will continue to work on. Every day. Maybe not every one, but I will chip away at at least a few of these every day. Every. Day. No exceptions. Even - especially - when I was living outdoors with no heat in -20C degree weather (0F).


Look, there is no way to just "turn off" a major psychiatric disorder. Nope, it's a long, long turn to change the direction of this ship. It is one of the things anyone with a major disorder has to face and accept - their life is going to require a lot of work performed daily in order to either get better or live a higher quality life. 

Nor is there any way to turn around whatever mood disorder or long term state of poor mental health, however "major" it's considered by psychiatry or society or your friends, coworkers and family (which is likely not very major - a big part of our problems, right? Nobody takes us seriously. But that's grist for another mill for another day). 

Almost everything here is based on neuroplasticity. Neuroplasticity - which I briefly introduce here - is a term referring to the brain's malleable ability to change form, how it arranges its wiring, what section controls what motor movement or sensory function and, most relevant here, how it controls behaviour. The brain can do this naturally on its own when, for example, a certain area is damaged and it takes over another part of the brain to compensate or when a sense such as eyesight is lost the areas responsible for hearing and touch will grow. 

While this is interesting enough and has long been known, it's when I learned the more recent knowledge that specific mental and physical exercises and activities could change the shape of specific regions of the brain that a massive light bulb went off in my head.  

This, I strongly felt, was the answer to dealing with neuropsychiatric disorders. It occurred to me that my mental health problems, especially the issue of suicide, was a problem of the wiring in my brain being out of wack (I refer to these as broken brain loops) and certain regions being either hyper-active or under-active and that neuroplasticity meant that I could change that wiring and those regions. [I have since come across massive amounts of research to support this] 

The question then became how.

The answers, it turns out, aren't rocket science. While they're simple they're not, however, easy. Nonetheless, here we go.

Meditation. 

It works. This can be proven with brain scan technology that shows that meditation can make plastic changes on certain regions of the brain. There are various methods but there are simple ones that can be learned and practised relatively easily. Like with anything though, it takes daily practice. I sometimes do well with this, sometimes not so well. But I keep at it. I may miss it for several days or longer but then I'll remember and get back into it. Meditation can have a profound effect on how the brain works and processes input.

Most people think you have to become some sort of guru or practice complicated, advanced forms. Nothing could be further from the truth. The two most effective for brain and mental state improvement and are most relevant to those with mild depression problems or even more severe conditions like mine. And those are mindfulness meditation and a simple meditative focus practice that involves simply paying attention to and counting your breathes. Just practicing these two several minutes a day had massive and profound benefits and improvements in my ability to manage my mental states and outlook. 

introduce my approach to meditation in this post. It is the first of what eventually will be a series on meditation specifically designed for recovering from mental health disorders. 


I work on my habits. 

It's very simple; bad habits equal bad outcomes and good habits equal good outcomes (or as good as you can be). Almost everything we do is habitual including how our brain works. If we change our habits we transform how our brain works and therefore our lives. But it takes work and this work is not easy because habits, as we all know, are NOT easy to break. My go to book for habit change is one by behavioural change expert Kelly McGonigal who teaches a wildly popular course on change at Stanford University. Her book The Willpower Instinct is a must have book for changing habits. Her methods are based on solid neuroscience and the latest knowledge about how the brain works. She has one simple concept that works amazingly well. They're called “will” steps, “won't” steps and “want” steps. For example, I had a goal of changing my diet for the better (I knew that my very poor diet was having an effect on my mental health) so I used her will, won't and want method for changing my diet. It's easy because it can work in the tiniest doable little steps to start with. Within not too long, I'd changed my diet much for the better. The same little steps can be applied to many habits. She has lots of neat little methods for increasing our willpower as well (which goes towards changing our habits). Oh, and she's very big on meditation. HUGE difference maker.

I made big changes to my “data input”. 

How this affects the brain is based on the principle of put garbage in, garbage will come out. Put quality in, quality will come out. Consume negative input, negativity will come out. Consume positive input, positiveness will come out. This can have an amazing difference. I have to mention here that you ARE your subconscious – it drives you – and your subconscious is largely a product of the "data" you input. When I became fully cognizant of this I became much more careful about what I read, watch, listen to or who I spend time with. The better the quality of all of these things, the better the brain functions. It's that simple. Data input can produce plastic changes in the brain. It will change the wiring, it will change its thoughts and thought patterns. But this can be for good or bad. Bad data in, worse brain functioning and worse mental models and states. Better data in, better brain functioning and thus improved mental models and states. Better data input makes a huge difference in moving away from negative brain functioning to positive functioning. Obviously with suicidal depression this is a big area to work on. I stay very aware of this and work at it. I tailor my online experience, my reading, the company I keep, everything to producing better data input. As I wrote before about memory functioning and depression, negative "data input" can really impact what's in our memory and thus how our memory affects our mental states and our mind projects our future. So you really want to minimize negative or garbage input and maximize positive input. Improving my data input HAS made a huge difference.


I've learned a lot about letting go. 

We all need to move forward in life and moving forward is a lot more difficult when dragging a fifty ton sack of yesterday's shit around. So I learned to let go. Sometimes this is easy, sometimes it's not. I work at it all the time. Letting go of the past, or letting go of negative things and events in your life, is amazingly enlightening and disencumbering. 

Letting go is also letting go of many things, ideas and possessions that you are convinced are "vital" and that you "can't live without". I had to go through this process dozens and dozens of times. When I was melting down over something, I had to stop myself and think (this is where practicing the above mentioned meditation techniques pays off big time) "is this really that important? Do I really need this?". Turns out, most of them aren't really as important or vital as one would think nor as needed. So let them go. 

Letting go very much ties into the Buddhist tenet of "staying in the now" which leads us to:


Living One Day at a Time (or Staying in the Now)   

This sounds like one of those simplistic snippets of advice we get or read in some shiny-happy graphic on social media that can drive us bonkers when we're in the midst of overwhelm meltdown. But this may be the most life saving mental habit of all. 

Living one day at a time sounds counter-intuitive and it sort of is. There's lots of things from our past we need to remember and certainly we have to plan for the future. But in times of overwhelm - I get to more about what goes on in the brain in these times of overwhelm and why in the more detailed post on Staying in the Now - carrying around the weight of a thousand yesterdays and a thousand tomorrows is literally mentally crippling and a monster source of body and soul destroying stress (which is why we break down). You can't deal with that. NOBODY can. Anyone in a position of power and authority and has to deal with dozens if not hundreds of crucial decisions must learn to master dealing with the current day and the current day only. 

This is not only a Buddhist tenet (making it 2,500 years old), literature pertaining to mental stability going back centuries talks about and urges the same thing - deal with each day on its own and each day only. It is of course not easy - trust me, I know it's very challenging at times - but as with all new and better habits, it gets easier with time.

It is also tied to "staying in the now", one of the underlying principles of mindfulness; that is, just focusing on the task at hand and nothing else.

As far as I know, no one has invented time travel so we can't go back and change the past, folks. And NO ONE can predict the future so there's not much use in dwelling on what that may or may not be. So it is best to stay in the now. 
<oooohhhhmmmm>


Changes in latitudes, changes in attitudes. 

I've worked very hard at changing my mindset. This ties back to habits and input. I want the most positive mindset and attitude possible. This is vital for fighting ANY illness and this is well documented. It's vital, therefore, for fighting mine. I slip and I forget at times but I do generally work at this a lot. When the darkness of depression descends this can be really challenging but I'm convinced that working at this makes a difference.


Learning to learn and Creating a Growth Mindset


There is nothing better you can do for your brain than learning something new. It will create new neurons, new connections between current neurons, it will open new areas of neuronal real estate or liven up old areas. And it's more than just learning, it's learning to learn. If you can learn to become an awesome learner - and I'll get to a post about how to do this - and create in your brain the habit of learning, your brain will just become better and better at learning almost anything you really want it to do.

This is another huge way that I create better moods and get myself re-centered after some big blow and getting into a dark and bad place. Refocusing on learning and the process of learning is how I do all the research that goes into writing this blog, it gives me something positive to focus on and it literally trains my brain for how I can better come up with creative solutions and get myself past stuck places. Not to mention, it's a great way of building confidence and hope and improved esteem that's built on a solid foundation. It creates what is known as a growth mindset instead of a fixed mindset - a growth mindset can better understand and solve problems, a fixed mindset tends to get stuck and is more prone to overwhelm and melt down. 

Massive difference maker

Positive visualization

This ties back to meditation. This is important for moving forward and feeling more positive about that. It's exactly as the words imply; visualizing something positive such as a positive outcome for something I desire. The method is meditative in nature and again, it can produce positive plastic changes on the brain. And while you can't predict or form the future, you can visualize the most positive outcomes for future events that you can. Positive visulization also exercises very key areas in the brain for more positive mindsets in general. 

And hey, if they don't work out - and many won't, that's life, folks - you practice letting go and moving on. But we retain the core principle of trying to visualize the best possible outcomes.

Getting better quality rest. 

I learned early on in my research into bipolar that good sleep was vital so I work on this a lot. I learned simple meditative breathing techniques for calming my mind and getting to sleep. I also do little meditative rest breaks throughout the day. Giving your brain proper rest and breaks is proven to be vital to proper brain functionality so obviously is vital for dealing with my illness. So I actually work at getting better rest. My being more aware of this has made a huge difference. I know that when my brain is starting to wobble that I need to shut it down and give it some rest (which is a lot these days).

Being spiritual. 

Humans are actually pretty hard wired for spirituality (uber amounts of evidence and brain science on this) and in today's world many of us have become too disconnected from spiritual connections and on a deep subconscious level the brain doesn't like this. I am not religious so this is a challenge. There are other ways, I believe, to be spiritual, however, and I try to do these things. Part of that is to connect to other people in the most positive, empathetic way possible. Be a good person, the idea geoes, and you'll get good stuff back. I need good stuff to happen in my life to help make me and my life better so it just makes good sense to be the best person possible to help make that happen. That's my spirituality. As well, there's some impressive recent science that shows that we can have a spiritual connection with nature and that this has very positive benefits on our brains and thus our states of mind. So I also try to stay connected with nature as much as I can. You should too. Yes, I know how "busy" you are - MAKE time. 

 

Learning and practicing empathy, compassion and forgiveness. 

This ties back into being spiritual. Being empathetic to your fellow humans – regardless of race, colour, nationality, gender or class – will do some amazing things to the brain. Your brain needs lots of exercise to stay healthy. This is a superb way to give it that exercise. See The Compassionate Brain for some of the science on this. This has been the easiest of all my methods to practice. It plain feels good and this will make your brain feel better. There's some crossover with positive visualization that can be practiced here too. Oh, and most importantly, I learned a lot about practicing compassion and forgiveness with myself. Hugely important. 

Please see Positive Difference Making Fundamentals in Focus - Spirituality for more on spirituality and practicing compassion and gratitude.  

Believe, just believe, baby. 

This is often HUGELY challenging for me. When I (or anyone) am in the throes of bipolar depression – which, again, is a massively dark place – my brain scoffs at the idea of belief. It almost literally says, “believe??? Look at your messed up life! Believe in what, you fucking moron?!” This part of the brain (or whatever is going on in there) is really in control during bipolar or major depression so this makes belief really challenging. But I keep at it and if I keep at it, a tiny little part of my subconscious will hang on to belief and will give hope in even the blackest periods of inner darkness and hell. You would not believe what I have survived and it was ONLY because some little corner of my mind clung to belief. So no matter what, I work on belief. You - no matter whether you have a mental health disorder or not - have to work on belief. 

Belief is also a great stress buster; if we can believe - have faith, however you want to put it - this can greatly aid in putting our minds more at ease to handle the present day and to stay in the now and thus reduce overwhelm stress. 

Please see my brief introduction to the science and psychology of belief here.

Exercise. 

There's just crazy amounts of science on this - going back a hundred and fifty years. Exercise is good for your brain and is essential to mental wellness. This is hard for me, because my body has broken down and the crippling fatigue that often comes with long term disorders (see link next paragraph), but I poke away at it and try at least to get out for walks. With exercise every little bit helps. Any little bit you can do is something. You just have to try keep increasing whatever you do a little bit every week.

Many of us who've suffered from mental health disorders for many years will almost certainly be dealing chronic fatigue issues (about which I wrote a very well researched three part series starting here). What most people think of as exercise is therefore very difficult for us. I developed some simple exercises based on some basic yoga and tai chi principles involving gentle movement but combined with breathing techniques can stretch and exercise our muscles, oxygenate our blood and stimulate key brain regions. I'll be doing a video series on this as soon as I can (which may yet be some months, admittedly).


Music Therapy.  

The power and healing benefits of music on the brain are now well documented. I use all kinds of music, but meditation music, classic jazz and classical music work best for calming. The latter two, because of their more complex structures, produce positive neuroplastic changes on the brain leading to enhanced creativity and cognitive abilities. I listen to a lot of jazz and classical music in focused, attentive way. Upbeat music is great for lifting one's mood. Huge, huge difference maker.   

Please see An Introduction to Music Therapy to learn more. 

Purpose. 

Having a sense of purpose is very, very huge. The best thing any of my eighteen or so psychiatrists (!) ever said to me was, “Brad, you have no purpose in your life. You can't live like that. NO ONE can”. Boy, was this a big wake up call for me. The more I thought about it the truer I knew his words were. So I learned to work really hard at this. Right now, for better or worse, my purpose is my writing and research. These things too become very challenging during the darker periods of bipolar depression. But I make myself do it, even if just a little bit per day. It keeps me connected to a greater sense of purpose and this makes a big difference. 


My Brain Training Exercises 

I have been practicing these for about a year and half, having developed them during my worst periods of bipolar depression and fatigue. I introduce them in this post but briefly they are designed to help us exercise key brain areas involved with planning and mental states and attitudes while helping us reduce negative self talk, self sabotage and replace it with more positive inner dialogue and narratives.  



All of these things are very challenging in that place of darkness, despair and hell. 

As well, with energy and fatigue issues and other pressures it can be really hard to work on our selves. But this why I put together a list of many things to work on. Life remains hard and challenging but I find I am able to work on at least a few of these every day. They are designed so that no matter how beat down we are and how much things seem to be swirling around us, it is still possible to find at least a little time to work on one of these life changing fundamentals. 


I'll write about this in more detail in a future post but the biggest thing I found in gaining more mastery over my mind, my mental states and - most importantly - stress triggers and stress in general is that the more tools we have the more power we can gain, the more we can take control over little moments in our lives and then expand that control to bigger moments and then days and then our lives and it is this power that we learn in tiny little incremental steps that gives us power over our mind and our lives. 

We just have to commit to making little steps each day, staying within the day or the moment and dealing with that as best we can. These fundamentals give you some of the tools you can use daily and moment by moment to give you more power. 



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Saturday, August 10, 2013

The Myths of the "Benefits" of Psychiatric Drugs



Note - this post has been edited since its original writing to include links to source materials and for further reading. BGE - February 5, 2014


It is unlikely you will believe in the information I am about to give here. For the vast majority of people information of this kind strikes a strong cognitive dissonance within them. For people love their drugs. People believe in their drugs. People want to believe there are magic bullets in a pill that are going to make things better. (1) But this is a myth. According to a McLean's magazine article earlier this year prescription drugs lead to 100,000 deaths a year in the US and 10,000 in Canada, many of these from psychiatric drugs.

I am a psychiatric survivor. When I survived the worst of what was several horrific episodes of suicidal psychosis and then found that the very drugs I was given by doctors to “make me better” were in large part responsible, I vowed to do what I could to dispel the myths – I might say propaganda – that pharmaceutical drugs produce better outcomes for psychiatric illnesses. I devote my book Dancing in the Dark – Why?  to dispelling these myths and now I will devote more space in this blog.

Myth #1 – schizophrenics have to stay on their medications. Even after starting my research into psychiatric drugs I still believed this one but many studies show better long term outcomes with non-medicated treatment than with medicated treatment. The key term is long term. Drugs can knock down psychosis in the short term but will produce worsening outcomes over the long term. “Outcome” means being able to get back to a normal life. There are several reasons for this, not the least of which is the damage drugs will have on cognitive functioning and on motor movement. Anti-psychotics have been shown in long term studies to increase psychosis. A fifteen year study done at the University of Illinois comparing medicated and non-medicated schizophrenics found that forty percent of non-medicated patients recovered versus only six percent for medicated. Not only that but the “poor outcome” category was much higher on anti-psychotics than for non-medicated, forty-nine percent versus only sixteen percent. In the 1970's a Dr Mosher started a schizophrenia treatment centre called Soteria House in which no medications were used. A five year follow up of patients showed that seventy percent were able to return to normal lives, an astonishing success rate. In addition I came across many personal stories of sufferers of schizophrenia who didn't start getting better until after they stopped taking their medications and got out of psychiatric hospitals. 

A full paper on the Soteria House project and the results can be found here - http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/

The Harrow long term study on medicated and non-medicated outcomes for those with the diagnosis of schizophrenia can be found here

Not only that, but research by renowned neuroscientist Nancy Andreasen  has found that long term use of anti-psychotics causes loss of brain tissue

I had a single incidence of suicidal psychosis prior to being put on anti-psychotics. The  number and severity of incidences increased while I was on anti-psychotics. I had the one most severe episode since I stopped (the effects stay in the brain for some time even after stopping) and none since that time.

Myth #2 – psychiatric illnesses are caused by “chemical imbalances”. This was a theory several decades ago but it's one for which there is no proof despite decades of efforts to produce proof. That it is still believed by a majority of people is a byproduct of pharmaceutical company propaganda and our own desire to believe in the properties of magic bullet fixes for conditions like depression. You can try as you might, but you will find no study or discovery proving that any psychiatric illness is caused by a chemical imbalance. Actually, you will find no study or discovery proving any cause or etiology of any of the major psychiatric illnesses. If you find one, head straight to the Nobel prize committee because that would be major medical news. A good primer for some background reading on the history of the chemical imbalance theory and the media's role in its promotion can be found here - The Media and the Chemical Imbalance Theory of Depression

Myth #3 – anti-depressants “fix” a chemical imbalance and thus “lift” depression. One, there is no such thing as a chemical imbalance so how could anti-depressants fix one in your brain? Two, there are countless studies showing that anti-depressants fail to outperform placebos. There are studies that show just a pill the same colour and shape as an anti-depressant will have positive benefits. Three, there are studies that show links between anti-depressant use and increased and prolonged depression, an effect I can personally attest to.





Myth #4 – psychiatric drugs are “safe”. I can personally attest that they are not. People who know me and saw my worsening condition can attest they are not. But numerous studies using brain scan technology show detrimental changes in brain tissue with psychiatric drug use. There are numerous studies linking anti-depressants to suicide and even murder. A brief summary of this can be found here - Psychiatric Drugs and Violence. And something that needs to be understood is that anything that receives a government warning is only the tip of the iceberg and a toned down version of actual cases. 

Anti-psychotics impair or damage the basal ganglia leading to tardive dyskinesia, an involuntary muscle movement disorder which then ironically is assumed to be a symptom of schizophrenia. Brain researcher Nancy Andreasen's long term studies showed irrefutable evidence that anti-psychotic use leads to shrinkage of brain volume with the extent of the damage being dose related. In other words, the higher the dosage, the more damage was recorded over time. 

There are also many studies connecting anti-depressants to increased risk of suicide, an effect I can personally attest to. Researcher David Healy is a leader in this field of study, establishing both the links between SSRI use and increased suicides

Myth #5 - The FDA and Health Canada tightly regulate drugs. One of the things I found out early on when I started researching psychiatric drugs was how shocking the approval process was. In Canada it's virtually run by the industry itself. The FDA board is dominated by ex pharmaceutical executives. Doctor, researcher and writer Ben Goldacre in his book Bad Pharma exposes how drug companies rig tests and outcomes of drug trials. Since the start of the pharmacological era drug trials have never been as rigorous as you might imagine and that is true to this day. If you believe that pharmaceutical drugs are safe when they hit the market, you have a lot to learn. 

Myth #6 – pharmaceutical drugs are improving our lives and saving lives. This is the biggest myth of them all. As mentioned, tens of thousands of deaths per year are related to pharmaceutical drugs. I heard a statistic about one in five people having a psychiatric disorder. But we are consuming pharmaceutical drugs to the tune of billions of dollars per year. If drugs “improve lives” why then are so many people still ill? Pulitizer Prize nominated science writer Robert Whitaker has devoted himself to researching these questions. He's produced two books and writes a column for Psychology Today. He looked into disability numbers for psychiatric illnesses and found a correlating rise in disability rates with the start of the pharmacological era of psychiatric treatment. If drugs make us “better”, why are more – dramatically more – people being permanently disabled by illnesses such as schizophrenia, bipolar and depression? Whitaker's research showed that long term outcomes for all of those illnesses were better before the pharmacological era (which started in the late fifties).


For me, bipolar has been no picnic. I have had some good episodes of creative mania but also a lot of struggles. But absolutely by far the worst of those struggles and the worst of my suicidal risk came while I was under the care of psychiatrists and taking a large variety of psychiatric drugs. Prior to my experience I believed the myths, I believed in “better living through pharmacology”. That belief almost cost me my life. That belief does cost many people their lives. 


















(1) - If you are currently taking psychiatric drugs for any condition, please do NOT consider stopping them without first consulting a doctor who specializes in dealing with psychiatric drug withdrawal nor before drawing up a careful plan to improve your mental health.



Tuesday, August 6, 2013

Realities Continued




Some general stuff and some personal perspectives.

These concepts of the "realities" that schizophrenia and bipolar create in sufferers' minds are hard for anyone to conceptualize. People want to believe that it's just "thoughts" or some state of mind you can make go away if you just try hard enough or worse that it's something you're just bringing on yourself. This is incredible frustrating. The implications are twofold; one is that it's somehow a choice as to what we have in our heads or how our heads are operating and two, that it's not "real". There's a third one but I'll get to that at the end.

I have some fascinating material from the Hearing Voices Network regarding people who hear voices and their frustrations and distrust of the folks in the white coats. Unfortunately, as I'm not currently living in a home of my own and all my things were packed away for me (during my latest hospitalization), I don't have access to the material but I'll muddle along as best I can with my imperfect memory. It was from research into schizophrenics by famed Dutch psychiatrist Marius Romme. What he went on to discover was that hearing voices was something separate from or not necessarily connected to schizophrenia (despite this being more than 20 years ago and the now incredible body of evidence the clods at the American Psychiatric Association refuse to acknowledge this). Without getting into the politics of psychiatry (which I easily could!) what Romme found among those who hear voices is an incredible frustration with the psychiatric profession and/or other doctors. Number one is that the people knew they were not schizophrenic, only - and "only" is not a great word here - that they heard voices. Romme uncovered - in sort of a literal sense of the word - hundreds of "hearing voices people" who'd gone underground with their problem because of this frustration with with the professions. They were regular people with regular jobs and lives who just happened to hear voices and the profession wanted to label them, put them in hospitals and drug them. Worse, the profession showed no understanding of the issue of hearing voices. Doctors would, invariably, insist that the voices were not real. Well no, the people would strongly feel, they absolutely are real. And back and forth it would go and the doctors only recourse would be to prescribe drugs which they insisted would make the voices go away. The drugs didn't make the voices go away. The people became so frustrated and displeased that they, as mentioned, simply went underground and found methods on their own to cope. It was Romme's work and discovery of this group that would lead to their banding together and the founding of the Hearing Voices Network, a peer to peer group for people to talk about any kind of inner mind phenomenon that uncomprehending pencil pushing doctors don't understand. I've attended local meetings of this group and I nearly cried it felt so good to be around people who get the weirdness that goes on inside my head. They listen, they understand, they don't judge, they don't try to tell you that you're "just imagining it". They GET IT.

Oh dear, I did get carried away there, didn't I. The point was, however, to further the concept of different inner realities through the use of hearing voices. For hearing voices people the voices they hear are NOT their imagination and they don't simply just go away (with lots of work for many people they can), the voices ARE real. The other point is how frustrating it can be to be told this stuff going on in your head is not real or that it's just your imagination or that drugs make it go away or that you're just not trying hard enough and so on. As I said, after dealing with so many people who told me the most hurtful things (while attempting to be well meaning, I know, but still), it felt so wonderfully good to be with and talk with people who got what I was experiencing. They are a wonderful, wonderful group and organization. It was through attending these groups that I FINALLY understood my suicidal psychosis episodes, something that the dimwits in the white coats never listened to me about or explained. I shouldn't say dimwits, I know, but after a baker's dozen of them, all with different views, methods and so on ranging from nothing's wrong to the worst case of bipolar and continuing to get WORSE and then finally finding out on my own what was going on and getting far better through my own efforts (not unlike the hearing voices people who finally, fed up, went underground), sorry, I think they're dimwits. And that's by far the mildest term I can think of. You should hear me when I get wound up about what I really think. Trust me, I'd peel paint off the walls with my language. There are people who saw, and were horrified, by what I went through that would too.

Oh, one of the standard treatments for schizophrenic and bipolar peeps is antipsychotics. "Anti" + "psychotic" = something that reduces psychosis, right? (well, they don't prescribe it for that in bipolar peeps really. They just have this vague idea that it helps "knock down" mania). Well, it turns out that it can actually make psychosis worse. Something that I personally discovered myself. Not fun. I'll give you the studies and the science on this another day though. But back to inner realities.

Bipolar creates a lot of inner realities. I'm not even sure I can describe them all. As I said in a previous column, bipolar (and schizophrenia as well, I suspect) are whatever it is plus your own personality. I have plenty of my own personality quirks and bipolar just takes those and magnifies them (sometimes this is good though). How this all works is an utter and complete mystery (and trust me that it is a mystery, I am extremely well read on this not to mention all my own "data" in my head plus interviewing several bipolar people). I've had many manic episodes in my life, no two of them the same (though some similar). Sometimes they're great, sometimes they're horrible. I'm pretty sure that my suicidal psychotic episodes were just twisted variations on my mania and manic visions. That would rate as pretty bad. Other manic episodes played visions of lovely stories in my head that were literally like watching a movie in my mind. Not like a dream, very different from that. Like a movie, like a vision. An hour or more long. I just "sat back and watched". In one manic episode I was going to be a head coach for a team in the top professional hockey league in the world, in another I was going to take over and save a major corporation that was going through difficulties. None of this is conjured up by any effort from me. It just comes. From where, no one knows. Why? No one knows. It just comes and completely takes over my brain.

Depression visits upon me some horrible times. Again, it just comes. I don't make it happen, I don't wish it to happen, nothing happens. It just comes. The mind just works very darkly during these times. I cannot control it, I cannot make it go away. Now, with years and years of experience, I can have have some insight but only perhaps after some time can I realize what's going on. Maybe. It's a LOT of work.

Mania, depression, mixed episodes, all kinds of variations in between, these just happen and when they happen that's my - or any sufferer's - reality for that day, or week or month or moment. There's nothing we can do about it, that's what you have to understand. Awareness can help, yes, but only maybe. It depends on how strong any given event is. Most often it's only after that we can look back and think, "right. that was <insert the type> episode. It's passed now and I can settle down". Or many, many, many variations of such.

It's a myth that drugs make things "all bettah". People have the nerve to tell me - based on what, I can only imagine - that all I have to do is "get the right combination of medications" or "tweak my medications". I know they're being well meaning and only want to give me hope but honestly. I've had - my latest count - eighteen psychiatrists or residents. I've been on every combo there is. And I just got horrifically, horrifically worse. So don't tell me about meds. I spend about four chapters and a hundred thousand words in my book dispelling those myths so I won't get into that here.

I think there are methods. Peer to peer counseling is one. (I'll no longer deal with people who haven't been through this before). Meditation is another. I'm pretty deeply read in neuroscience. I think there are signs of hope there, especially in neuroplasticity.

I also know that I am in the highest risk group there is for bipolar. I'm older and have had it all my life and have cycled through countless cycles of mania and depression. This is well understood in the literature. All the literature that talks about hope talks about young people, those who've only had a cycle or two. Like any illness, it's much better when caught early. Twenty percent of bipolar sufferers will commit suicide. I'm in the the high risk group for that, something that I looked into in a series of three earlier posts. I know I have some very serious challenges ahead, something that would be stupid to ignore.

People write to me and tell me that they've been through this or that and survived. That's sweet. But it misses the point. Illnesses of the brain are different. When your body is sick you still have the most important weapon available to you - your brain. When you're sick with a brain disorder, your most valuable weapon - your brain - is the very thing that's not healthy. I don't know how to get across how much more challenging this makes things. Not to mention that the brain is one of the most mysterious structures in the universe (ask a neuroscientist like David Eagleman). Honestly. We understand more about distant stars than we do about the human brain. This is not to say that major illnesses such as cancer are somehow easier to deal with. Of course they're not. And I'm grateful that generally I have have my health. I'm just saying that brain illness are not only tough but they're tough because the power of the brain is what we need most to get better from anything.

I've heard people compare brain illnesses to cancer and such. Which is a nice try. I'd argue, however, that they're possibly worse (especially the worst cases of schizophrenia and bipolar). I say worse because we know so little about the brain and don't for a moment believe that "doctors" really understand what schizophrenia and bipolar are. They don't. Don't let their impressive web sites fool you. They don't, as I've been trying to get across, know where schizophrenia or bipolar come from or why they happen or where any of the visions and different realities come from. All they have, and know, is an incomplete understanding of behaviours and some crude drugs with which to try (all of which produce worse long term outcomes).

But onward and upward. There ARE things to work on and I will get to those at some point.