Getting My Brain Back -- In Praise of BDNF
Following #bipolar on Twitter for the last few years, I am often dismayed. So many people seem to spend so much time struggling with their medications and so little time focused on anything else that could help.
Don't get me wrong. Medication is an important tool for managing bipolar disorder. But it can't do the whole job. Education and life style changes are crucial for getting off the roller coaster of constant med adjustments to address the episode du jour.
I decided it was time to revisit my 2011 review of Ellen Frank's Treating Bipolar Disorder. It was a four-part review. The last three posts describe the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.
Lately I have been reposting my 2011 review of Treating Bipolar Disorder by Ellen Frank. It was originally recommended to me by a friend who was researching hypomania. Part I described the basis of Interpersonal Social Rhythms Therapy (IPSRT) in circadian rhythms that control the many physiological symptoms of mood disorders. Part II outlined the Social Zeitgeber Theory and described the early stages of the therapy process, history taking and stabilizing social rhythms. Today I pick up with the later stages, interpersonal therapy and maintenance.
This -- this system is the gift I wish I could give to the people I meet on Twitter who struggle with their bipolar, who are in endless rounds of medication adjustments and medication failures and medication despair. Medication isn't the only thing you can do. I'm not saying quit your meds. I'm saying, add social rhythms therapy. Originally posted in 2011:
So you have bipolar. You know you have bipolar. You are way past the denial stage. You are into the pulling out your hair, screaming with frustration stage. Or maybe moved on to despair stage. Because:
Ellen Frank changed my life. When I was diagnosed on the bipolar spectrum, and hadn't found a medication regime that I could tolerate, her Interpersonal and Social Rhythms Therapy gave me a way to get a handle on my wildly fluctuating condition.
She and I corresponded in 2011, as I was writing a four-part review of her book and her therapy. I published with her assurance that I got it right.
I was over the moon when she agreed to endorse Prozac Monologues: A Voice from the Edge. She wrote:
Pretty cool, huh! She even wrote privately to her listserv to recommend it.
So many people I read on Twitter struggle to manage their bipolar disorder. I figure it's time to bring this four part series out again. So here is Part 1 - from April 4, 2011.
Quick - What does a lemon taste like?
I know what a lemon tastes like. Tell me something else instead:
What just happened inside your mouth?
David Hoffeld asks another one: Want to know what your brain does when it hears a question?
His article from the website FastCompany.com explores the neurological consequences of hearing a question. Questions temporarily hijack the brain. Did you immediately think about lemons? First, serotonin is released, causing the brain to relax. Next you get a hit of dopamine. The question takes over your thought processes while you think about the answer. The technical term is instinctive elaboration.
The hijacking doesn't last forever. The person who was asked the question can choose to ignore it, can argue against it, can go off on a tangent - though for people with ADHD or bipolar disorder, a question that interrupts our train of thought may cause us to derail.
But Hoffeld cites a number of research studies that document when you ask somebody whether they are going to do something, you increase the probability that they will do it - buy a car, vote in an upcoming election, even donate blood.
Questions not only alter your perception. They can even alter your chemistry. Chances are, when you read the lemon question, you started to salivate.The Science of Selling. It uses neuroscience, social psychology, and behavioral economics to teach a more scientific approach to sales. That's his interest in instinctive elaboration, getting people to buy things or ideas.
Me, my interest in instinctive elaboration is more about mental health:
Questions work their magic by engaging the brain. A recent Twitter thread asks, Therapists, what's your favorite question to ask clients?
That's my favorite part of therapy, my therapist's opening gambit. It brings me into the room and puts me to work. It takes the muddle of my brain and begins the sorting process.
So, what's your favorite question?
photo of lemon by Ivar Leidus, used under creative commons license
For some of us, these meditation exercises, "close your eyes, focus on your breath..." are difficult, frustrating, and stress inducing. Particularly for people with a trauma history or ADHD, mindfulness can be a land mine.
For others, the whole enterprise sounds like woo-woo mental health. Add some essential oils and affirmations - who needs therapy or, God forbid, medication?
But there's more to mindfulness than nonsense.
The same Mayo Clinic article identifies several mindfulness practices. Three could be taken as basic concepts:
My first book, Prozac Monologues, began with a hypomanic episode during an earlier trip to Costa Rica. I wrote a series of comedic monologues in an effort to not be mindful. The monologues danced around the memory of a recent Prozac-induced traumatic experience. It began with a bizarre thought, and moved on to some other weird stuff: dissociation, thought broadcasting, paranoia, and the like.
Years later, once I was correctly diagnosed with bipolar disorder, I added edgy essays about that experience and everything I learned about bipolar disorder while trying to figure out what the hell happened to my brain. Like many memoirs, Prozac Monologues is a hybrid of my story and my issue. Sheila Hamilton's podcast, Beyond Well, captures it. Here's the link. It's also a great read and now available on audio.
So what about Bar Tales of Costa Rica? My second book is exactly what the title promises: the stories I heard while sitting in bars in Costa Rica. That sounds like a very different book. Am I a genre hopper?
Yes and no.
Still, it is a sequel. It picks up where the monologues left off. In the first book, my wife Helen and I thought about moving to Costa Rica. Several months later, we did buy a little house in Playas del Coco. Didn't quite move there, but we spend several weeks there every year.
You could call the second book a segue to the first. I turn a corner. That would be a right turn that leads me out of my neighborhood Los Canales, on to the Boulevard de Iguanas, and over to a whole new cast of characters: Patricia, Bruce, Andy, Sydney, Monique and André. Bar Tales is about their stories.
As I am polishing these tales for publication in the spring of 2024, I spent several weeks in Coco for research. Research.
I wasn't sitting in bars, gathering tales - though inevitably a couple got added to the collection. This time I was gathering sensations. Physical sensations.
Sensations - these are at the heart of my mindfulness technique.
Each of these are ways that we lose or escape the here and now. I think of here and now as my worst subject.
The thing is - here and now is where joy lives.
Let me repeat that.
Here and now is where joy lives.
So my research, gathering sensations, experiences in the present, kept me anchored in here and now.
And it filled me with joy.
What color are the rooster's feathers? - bronze head and breast, black legs, wings of teal and red.
What sound do the geckos make? - chk, chk, chk. How about the howler monkey? muffler dragging on concrete!
What do mangoes smell like when they are sitting in the field near my house in the hot sun? - like a fortified sweet wine.
What does carne en salsa taste like? Beef stewed in a rich vegetable sauce with hints of smoke when Juan cooks it all day in an iron pot over a wood fire under the mango tree.
What does it feel like to walk in the surf? Caressing waves, then grit in my sandals.
I walked around town with my phone in my hand, making voice memos, describing these sights, sounds, smells, tastes, and sensations. My mind fixed on the present, there was no room there for regrets about the past or anxiety about the future.
Mindful meditation has been demonstrated to reduce anxiety, depression, stress, pain, insomnia, and high blood pressure.
There are many ways to do mindfulness. A review of literature published in Clinical Psychology Review, Effects of Mindfulness on Psychological Health, summarizes the context of mindfulness practice in its Eastern and Western versions and its application in a variety of psychological treatments.
What I offer here is one simplified self-help practice for addressing panic and anxiety, a disciplined version of what I called my research:
Focus on your environment.
The point is to redirect the catastrophizing brain, to pull it into the here and now. Remember - here and now is where joy lives.
This practice isn't the cure all to my mental health issues. And I doubt it will cure yours. But it gives our poor brains, exhausted by the three alarm fires that usually occupy them, a break. It turns down the temperature and lets a different input in.
And that's a good thing.
Am I the oldest new member of the ADHD club? At age sixty-nine, why bother with a diagnosis and treatment?
As I said, former care provider.
But back to that question - why bother?
Treatment for ADHD worksSure, over those many years I developed some workarounds, ways of coping with the challenges of my neurologically divergent (ND) brain.
My workarounds got me a certificate in congregational development. But I am not the Rev. DOCTOR Willa Goodfellow, because - I couldn't.
And yet today, I still have more I want to do, big things for which my workarounds have not been sufficient in the past and are not now.
But that pill, that tiny pill, that fraction of a pill after I cut it with my pill splitter, because for me it never takes much. . .
It was like the window opened, the sky was clear, I sat down, like I am right this very minute. . .
That's all. I didn't speed. I didn't stay up late. I didn't go down to the schoolhouse to score some more tabs off a sixth grader.
I simply worked. My brain was clear and in gear. And I got the job done.
There are things I want to do, books I want to write and promote, podcasts on which I want to be a guest, deadlines I want to meet. And one little fraction of a pill has opened the window for me.
Community for people with ADHD helps
That's the second reason to get diagnosed, community. Just like any other challenging condition, the people who have it can help each other. Breast cancer, kidney cancer, Parkinson's, depression, bipolar, alcoholism, arthritis, eating disorders - whatever you've got, hanging out with others who have it too is huge. Community offers support, reassurance, information, and resources.
And then I discovered others.
Twitter is a godsend for all things diverse, including neurologically diverse. It's where you find the people like you. Because there are people like you.
So if you have or wonder if you have ADHD, head for the bird app. This link will take you to the posts that people have tagged with #ADHD. That's a start.
And this link will take you to Jesse Anderson on Twitter.
Jesse has a newsletter filled with ideas and strategies to help people with ADHD manage our time, energy, and motivation - those workarounds that we all supposedly discover on our own by the time we are sixty-nine. We don't all have to reinvent the wheel by ourselves!
Jesse has a podcast called ADHD Nerds that's just getting started. Personally, I am glad that they come in at around thirty minutes. Because who has the attention span for those ninety minute podcasts? - Not somebody with ADHD! Four episodes so far. I hope he finds it interesting enough to keep it going, because I find it interesting enough to keep listening.
And he's writing a book, Refocus: A Practical Guide to Adult ADHD. Not out yet. When it is, I'll drop a review. But get this - he is inviting input about what should be included. So go to that website; see what's already in the table of contents; send him your own thoughts.
photo of old lady and last meme from memes.com
photo of window to the sky, taken in the Dingle_Peninsula,_Co._Kerry,_Ireland by Maoileann, used under creative commons license
photo of handshake by shark, used under GNU license
First step: Get started.
That was the topic of my last blogpost, dealing with the activation aspect of ADHD.
Oops, damn. Just took a break to eat a banana. And then I started a timer on one of my games. And now I'm remembering it's a friend's birthday and I haven't sent a card yet.
NO! I will get back to the blogpost. Ugh. Even with a med on board, this is hard.
So. How do I keep working when my friend really deserves a birthday card and I really want to send it?
Here are my tricks:
Screens for ADHD measure five clusters of symptoms:
There is a reason why I haven't posted in months. My latest diagnosis -- ADHD -- Attention Deficit Hyperactivity Syndrome -- the adult version.
I have a fistful of posts in my draft file that were never finished before they seemed beside the point. That is not an unusual state for me. Many years ago my brilliant brain was unable to write the doctoral thesis for which I had already conducted extensive field research and had a thorough outline. Periodically I would write whole chapters in my head. But when the laptop was in front of me...
I was stuck.
We'll see how this post goes.
Wait a minute. Don't I have bipolar disorder? Where did this new diagnosis come from? What are the chances a person could have both?