Real Mental Health Advocacy - We Have Begun

Okay, so I just blew away this week's post.  Sigh.

Instead, I will honor the people in Chicago, who have tried every form of education, conversation and persuasion they could devise to convince Mayor Rahm Emanuel not to close six of the city's twelve mental health centers.  Finally, they staged an occupation.  For seven hours, they held the Woodlawn Mental Health Center, while Occupy Chicago gave support from outside the clinic.

They are my heroes.

Read the remarkable details here.  The videos seem to be missing from the text.  Here is the link to the story as recorded in stages on youtube.

Narrative and the DSM

My therapist once picked up the DSM and said, This could be called The Book of Behaviors That Make Therapists Nervous.

An apt description.  It is filled with descriptors: adjectives, behaviors, impulses, thoughts, feelings that are all human adjectives, behaviors, impulses, thoughts and feelings.  Almost none of them are strange in and of themselves.  Almost all of them are familiar to all of us.

It's just that at some point, when these descriptors add up, somebody starts to get nervous.

Diagnosis -- Recognizing Deviation From The Norm

Manifesto: The Mad Farmer, Consumer, Blogger, Whatever

As in the days of Amos, John of Patmos, John of the Cross, it's the poets who will save us, those of us who have ears to hear.  For the rest, it's the poets who will preserve the evidence, in hope that there will yet be ears to hear.

So today, Wendell Berry's Manifesto: The Mad Farmer Liberation Front.

First, one liner note: Your mind will be punched in a card and shut away in a drawer.  In the early days of computers, data was recorded by punching holes into cards, literally, card stock, roughly 3"x7".  This was before web crawlers could find the word bread in a Facebook comment and then put up ads for kitchenware on your page.  The line in the poem, first published in 1970, is truer than ever.  The technology has simply got more efficient.

Manifesto: The Mad Farmer Liberation Front

Love the quick profit, the annual raise,
vacation with pay.  Want more
of everything ready-made.  Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more.  Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you.  When they want you
to die for profit they will let you know.

 

So, friends, every day do something
that won't compute.  Love the Lord.
Love the world.  Work for nothing.
Take all that you have and be poor.
Love somebody who does not deserve it.
Denounce the government and embrace
the flag.  Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand.  Praise ignorance, for what man
has not encountered he has not destroyed.

Ask the questions that have no answers.
Invest in the millennium.  Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit.  Prophesy such returns.

 

Put your faith in the two inches of humus
that will build under the trees every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world.  Laugh.
Laughter is immeasurable.  Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep of a woman near to giving birth?

Go with your love to the fields.
Lie down in the shade.  Rest your head
in her lap.  Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it.  Leave it as a sign
to mark the false trail, the way
you didn't go.  Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.

from The Selected Poems of Wendell Berry

And your homework for this week, gentle reader --

What does it mean to Practice resurrection?  What tuition will you pay?

Johannes der Evangelist in Patmos from a triptych by Hans Memling, 1479

photo of punched computer card by Litrefs used under the Creative CommonsAttribution-Share Alike 3.0 Unported license

photo of Immortal Tree, Humboldt Redwood State Park by Jan Kronsell, public domain

photo of fox from US Department of Interior, public domain
book cover from amazon.com

Jared Loughner -- It Doesn't Have To Work This Way

The man who wants to put Jared Loughner to death is concerned for his health.

The United States attorney for Arizona, Dennis K. Burke, wrote to the Ninth Circuit Court of Appeals that despite being under suicide watch, Loughner’s unmedicated behavior is endangering him. 

It has been determined that Jared suffers from schizophrenia, and is unable to participate in his defense against the 49 charges stemming from the Arizona shootings that left six people dead and thirteen wounded.  Now somebody wants to get this desperately sick young man some help.  Because if he can't stand trial, then he can't be prosecuted, convicted and executed.

Jared's attorneys think it is not in his interest, under the circumstances, to take Risperidone, a standard antipsychotic medication given to people who think that somebody is trying to kill them.  It might have been in his interest earlier on.  But the community college that noticed his bizarre behavior, including the speech salad that is the dead giveaway of schizophrenia, simply expelled him.

The Ninth Circuit Court of Appeals agreed with the prosecution, and Jared is now being forcibly medicated.

I intended to return to my NAMI Convention reporting this week.  But wow.  This story lands on my laptop, the very essence of the Prozac Monologues spirit.

There are so many layers of meaning here.  I don't think I am up to the task of analysis.  Instead I will tell another story, the original sequel to last week's rerun.

This is how a Christian community responded to the violent act of a mentally ill man. -- as they understand what it means to be Christian.  From January 21, 2010 --

The Miracle of Gheel

It was seventh century Ireland.  The Queen died.  King Damon's grief was so deep that it moved into depression and then psychosis.  He thought his daughter Dymphna was his queen.  Rather than submit to his advances, Dymphna fled to Belgium, to the town of Gheel.  But her father followed.  When she again rebuffed him, he killed her, cut off her head.  Dymphna was buried in the local church.

Six centuries later, her coffin was found during renovations.  Signs on the coffin demonstrated her holiness.  She began to be venerated.  Cures of the sick were attributed to her.  She was canonized in 1247 as the patron saint of the mentally ill.

Okay, here the one last bit of unrecovered Catholic in me demands to be heard, to note Rome's fascination with girls who prefer death to rape.  Even as a nine year old, that troubled me.

Abandoning The Mentally Ill -- Or Not

Moving on.  People came to Gheel for healing.  Many brought family members who were mentally ill.  Sometimes they left them there.  The priest housed these abandoned ones next to the church.  When the job of caring for them became too much for him, townspeople started bringing in food.  They built a hospital in the 14th century.  When it was full, the real miracle of St. Dymphna occurred, or rather, began.  Townspeople took some of the patients into their own homes, reserving the hospital only for those most ill.

All across Europe, people with mental illness were thought to be possessed.  They were exorcised, tortured and burned at the stake.  But not in Gheel.

Imagine it!  A psychotic foreigner commits a terrible deed.  But the townspeople do not close the borders.  No, they open their homes.

And they still do.  Through plagues, wars, revolutions, recessions, depressions, during the Napoleonic "Reform," when all the mentally ill people in the country were ordered into one big hospital, during the Nazi occupation, with their "final solution" for mental illness, during the latest reform when the U.S. of A. was/is dumping all our mentally ill people out of the hospitals, onto our streets and into our jails, the people of Gheel developed and continue genuine community-based mental health care.

What Community Care Looks Like

Today, there are 700 foster homes for 1000 people with mental illness.  A person will enter the hospital for evaluation and stabilization.  S/he meets the psychiatrist, psychologist, nurse, social worker and family practitioner who staff one of the five neighborhood community mental health centers.  Each of these staff people spends half a day each week in the hospital, so everybody gets to know everybody.  The potential foster family and patient meet at the hospital, then over tea at home, then over a meal, then over a weekend before placement.  Outpatient care, medication monitoring and therapy continue at the neighborhood center.  If possible, the biological family participates in the treatment plan.

Once part of the family, the person shares in family activities, chores and church.  The church doesn't have special bible studies, services or programs for the mentally ill.  They are fully integrated, regular readers, members of the choir, ushers, etc.

But What About Relapse?

What if the person's symptoms flair?  We say s/he is having a bad day.  Because the person lives in a family, not on the streets or alone in an apartment, problems are caught and addressed early, not after getting fired or evicted or arrested or in a bloody mess.  If needed, s/he can go back to the hospital for a while.  In fact, the hospital is not the place of last resort.  When the foster family has to go out of town, say, for a funeral, the person can stay at the hospital.  There is continuity of care.  There is care.

Three years ago I wrote a chapter for Deep Calling called, If This Were Cancer.  I detailed all the ways that hospice patients receive the support of others, and that people who have suicidal depression do not.  If this were cancer, there would be casseroles...  I imagined the total collapse of care for the mentally ill, under the weight of our crazy health care system.  In fact, it's happening as I write.

I imagined that the Church would step in to meet a desperate need, to create hospice for the mentally ill, as the Church originally created hospice and hospitals.  I claimed that the Church has the resources to organize for such care on a local basis.  It has the faith to imagine such a thing, the love to cast out fear, and the values to demand it.  I will have to rewrite that chapter.  I didn't know it had already been/is already being done.

I am ever so grateful to Janet, whose last name I don't remember, who gave me Souls in the Hands of a Tender God: Stories of the Search for Healing and Home on the Streets by Craig Rennebohm, the source of this story. 

Lord God, Who has graciously chosen Saint Dymphna to be the patroness of those afflicted with mental and nervous disorders, and has caused her to be an inspiration and a symbol of charity to the thousands who invoke her intercession, grant through the prayers of this pure, youthful martyr, relief and consolation to all who suffer from these disturbances, and especially to those for whom we now pray. (Here mention those for whom you wish to pray.)

We beg You to accept and grant the prayers of Saint Dymphna on our behalf. Grant to those we have particularly recommended patience in their sufferings and resignation to Your Divine Will. Fill them with hope and, if it is according to Your Divine Plan, bestow upon them the cure they so earnestly desire. Grant this through Christ Our Lord. Amen. 

... I think maybe Jared could use our prayers, too.

photo of Risperidone by V1ND3M14TR1X and used under the terms of the GNU Free Documentation License

image of Dymphna in the public domain

A Kitchen Interior by Joachim Beuckelaer, 16th c., in the public domain

book cover from amazon.com

Recovery In Progress -- My First NAMI Convention

Dr. Ken Duckworth's job at the Ask A Doctor about PTSD session was to make some opening remarks and then let people ask their questions.  He rattled off a list of treatments and said, The good news about PTSD is, we know what causes it -- trauma that was not able to be processed adequately.  The bad news is, the treatments just don't work so well.

Short and to the point.  Actually, I am not so negative (right this very minute, anyway) about treatment as Dr. Duckworth, because I am not looking for the magic med anymore.  I know about recovery.

Recovery is about collecting tools and pulling them out when the occasion requires.  I will illustrate.  But first the setting...

Last week I attended my first NAMI (National Alliance on Mental Illness) Convention in Chicago -- 2300+ people who have mental illnesses, family members, advocates, volunteers and caregivers, with a few scientists thrown in for good measure.  As a friend said to prepare me, A NAMI Convention has a certain kind of energy.  Yes, it does.

I have been to big conventions before, used to be a legislator (called Deputy) for the Episcopal Church, which gathers 8-10,000 or so Deputies, Bishops, exhibitors, visitors, volunteers and the like every three years.  I stopped doing that when I figured out that every three years General Convention tripped my hypomania and was followed hard on by a depressive episode.

So this was my largest gathering in some time, with plenaries, workshops, symposia, networking and ask-a-doctor sessions, drumming, theater, yoga and talent show, internet cafe and peer counselors, exhibitors, book sales and an information booth which was the best hidden spot of the whole damn Chicago Hilton.

You can expect a number of blogposts out of this event, including dueling comments between me and fellow blogger John McManamy.  Now that we have finally shared a beer, does that make us blogmates?  I began writing this piece in the hotel room, late after the last gasp, the rawest of my posts to come.

I knew it was a mistake to make Ask-The-Doctor-About-PTSD the last thing I attended.  It's just, that was the schedule.  Most helpful take-away: The brain is simply not designed to metabolize certain experiences.  PTSD is the result of incompletely metabolized traumas.  Bottom line, it is a normal response to an abnormal event or series of events.

The brain keeps trying to metabolize these unprocessed events/memories/emotions/bodily sensations.  They lurk beneath the surface, waiting for the next opportunity to emerge, when triggered by some reminder.

Oh, I was triggered, alright.  The last question of the day was about a particular symptom I don't talk about and religiously avoid.  I left the room reliving it, dizzy and disconnected.

Walking out, I heard the voice of my therapist, who once ended a session saying, The things we have talked about today probably have triggered your past traumas, and you will be dealing with the effects after you leave.  So how are you going to take care of yourself today?

Time to pull out that toolbox.

The Ask-A-Doctor doctor listed half a dozen treatment modalities for PTSD: meds, support groups, EMDR (Eye Movement Desensitization and Reprocessing), sleep regulation and aerobic exercise.  He mentioned Prazocin for nightmares.

First off, pop my anti-anxiety rescue med, put on my walking shoes and go get some aerobic exercise.  Work off that negative energy.

Just outside the door was Grant Park.  An art exhibit diverted me from my aerobics.  But art is good, very good.  Change the channel -- that's Cognitive Behavioral Therapy 101.

I stood still and drank in paintings inspired by water.  Not this painting, actually, which is exhibited just down the street.  But I thought of it.

Water is good.  It evens out the emotional turmoil. -- So says my other therapist, the one who does eastern-based energy work.  You see, when even the doctors acknowledge that western treatments (they don't call them western, because they don't speak of there being any other treatments) work poorly, I am not going to limit my tool box to only half the planet, especially not the more rigid half.

I spoke with the artist about perspective.  He paints on a flat surface, so doesn't think it matters which side is up.  I breathed into the here and now.  Thich Nhat Hanh taught me here and now.  But here and now is my worst subject.  And somebody interrupted to talk about showings and art business.  There were too many people -- had to reduce stimulation.

My energy therapist would recommend grounding.  I headed back to the gardens, flowers, trees, dirt, all good, all grounding.  Eating is good for grounding, too.  Maybe I should eat something.

From Alcoholics Anonymous: HALT = pay attention to when you are Hungry/Anxious/Lonely/Tired.  No, a martini is not in the recovery toolbox.

So I bought my inner child a strawberry ice cream -- a drippy cone instead of my usual adult cup.  Sugar isn't really the best choice, but it was red and a gift to my inner child.  Then I head off to find some meat.  Meat feeds the first chakra.  First chakra is about safety.  PTSD is about the amygdala is about safety is about the first chakra.

Still I was struggling.  I don't just have my own pain; I suck up the pain of every person with whom I have spent the last three days.  All those stories -- how can there be such a world?  How can I live in such a world?

I picked up my whole personal Book of Traumas, the traumas that never got resolved, that get retriggered today when I try to resolve them in therapy, the distrust I try to pretend does not exist toward the people who try to help me but they end up retriggering the traumas I can't resolve because they never seem to address that they are retriggering them and my retriggered shame prevents me from telling them and I truly believe the result will be retrauma anyway.

There are exceptions to that negative thought.  List the exceptions -- Cognitive Behavioral Therapy 102.  But how do I know who is for real...?

So I head back to the convention, walk over the train tracks.  And there is another trigger, another overpass, another trip to Chicago, another episode, another long time ago.  How quickly is that train traveling?  How far away?  How fast does a body fall that far?  How to time the collision of the two?  Velocity problems were the one thing that defeated me in high school math.

But I am not in the right spot anyway.  Geometry I got.  I need to be right -- there -- where -- a woman is pushing a baby stroller.

Oh.  Okay.  Not tonight.  I have an Iron Rule.  In a world filled with trauma, to the extent that it lies within my power, I will not cause trauma.  A two-year-old is sitting where my demon would call me.  The two-year-old wins.

God bless the internet that led me to David Conroy some years ago.  The first sentence of his book Out of the Nightmare brought sense out of the chaos that compounded the pain of my suicidal symptoms.  Suicide is not chosen; it happens when pain exceeds resources for coping with pain.

Tonight my pain was painful.  But I have survived worse, much worse.  And tonight my resources are many.  Tonight the thought was more than a mosquito, but it wasn't a tiger.  I do not underestimate the lethality of this disease.  One in five people with bipolar II do not survive it.  Tonight, I am still of the four.

I know people freak out over the suicidal ideation part of mental illnesses.  I apologize to my friends for causing them pain by bringing up the subject -- even though my need to protect you from this pain adds to my own.  I try not to bring it up, except with people who know what I am talking about.  But this is one of the tools in the Recovery Toolbox.  Those who do know what I am talking about need this tool.  And this post is for us.

Ironically, the state of the art treatment for people who have a lot of suicidal ideation and behavior, people with a diagnosis of Borderline Personality Disorder, is Dialactical Behavioral Therapy, radical acceptance.  Starting, not ending, but starting with acceptance even of that symptom that freaks out so many of you.

Yes, sometimes I have those thoughts.  They are well-worn grooves in my neurological pathways.  Any number of things will trip the cascade that leads there, including things you might not imagine, a cold sunny day, my doctor suggesting a new medication, an overpass.  These are not reasons.  Suicide is not about reasons.  These are triggers of neurological pathways that have a current of their own.

It is what it is.  Those five words sum up Dialectical Behavioral Therapy, an offshoot of CBT.  They were the chorus sung by one of the players in the lunchtime drama troupe.  Saturday night, I repeated them to myself.  Often when that thought appears, somewhere between a mosquito and a tiger, I say, There it is again.  That's all.  Mindfulness.  The thought doesn't have to freak me out, doesn't have to freak you out.  It is what it is.  Move on.

As I crossed the overpass, I felt a draw, a pull toward the hotel.  It was an energy, a spiritual energy on the side of life, two thousand people in that building, rooting for me, for my life, for one another, for you.  One of them even blowing a didgeridoo, accompanied by a flute, to be followed later by another who whistled Somewhere Over The Rainbow, all spiritual energy on the side of life.

The wisdom is ancient.  Two are better than one, because they have a good reward for their toil.  For if they fall, one will lift up the other; but woe to one who is alone and falls and does not have another to help.  Again, if two lie together, they keep warm; but how can one keep warm alone?  And though one might prevail against another, two will withstand one.  A threefold cord is not quickly broken.  [Ecclesiastes 4:9-12, New Revised Standard Version]

So that is my first report of my first NAMI Convention, the most confusing and most compassionate experience I have ever had with 2300 people.

(Find your local NAMI Chapter here.)

photo of toolbox by Per Erik Strandberg and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license

General Convention Seal for the Episcopal Church in public domain

Olaus Magnus's Sea Orm, 1555 in public domain

Water Lilies by Claude Monet, 1906, in public domain

photo of Grant Park in Chicago by Alan Scott Walker and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license

root chakra by Muladhara Chakra and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license

photo of Chicago Orange Line by Daniel Schwen and used under the Creative Commons Attribution-Share Alike 2.5 Generic license

photo of Coal Creek Falls by Walter Siegmund and used under the Creative CommonsAttribution-Share Alike 2.5 Generic license

fresco at the Karlskirche in Vienna by Johann Michael Rottmayr, in public domain

book covers by amazon.com

Getting My Brain Back -- In Praise of BDNF

Here is the star of Getting My Brain Back, the Neuron. I've got lots of neurons. So do you. They are our friends and we need to take care of them, so they take care of us. BDNF, brain-derived neurotrophic factor will help us do that. How BDNF is giving me my brain back is our story for the day.  But first...

Preface

Did you notice? I wrote a book report in April. If you are a regular reader, I guess that is obvious. Let me try again.

I read a book. Not just the one by Agatha Christie. Maybe you still don't get it. Never mind. Here is the story.

Introducing Neuron, The Brain Cell

 

Cognitive Deficits -- on the way to Getting My Brain Back

The speaker at our monthly NAMI meeting was tall, mid-60's, military bearing, a former ER doc who did a couple tours of duty in Iraq.  You know the type.  Only, a little less of that ER doc -- I'll call it self-assurance.

He showed us slides of the work he used to do, the before shots (which we really did not want to see) and the after shots of young people, kids he patched together at the medic stations.  He told us about the sticky dark trail running from the helicopter pad to the table, and what made it sticky dark.

His passion for his work lit the room.  We listened to stories of kids for whom he had after shots.  There weren't always after shots.

He told us about TBI's, traumatic brain injuries and PTSD and how war does damage to brains.

He was taking a break after two tours of duty, back in an ER state-side when he had the stroke.

Now it became a different story.

Stroke -- The Brain Is Part Of The Body

They told him it would be a long recovery.  Two months later, he was astounded at how long it was taking.  They told him again, it would be a long recovery.  Six months later, the frustration overwhelmed him.  His body was back, the use of his limbs, his balance, more or less.  But his brain wasn't.  And the rehab people said, This is good.  Rehab has begun.

See, we know a stroke is a physical event, something that happens inside the body.  But still we have trouble thinking of the brain as the body.  We have trouble thinking of the functions of the brain, like thinking, as physical functions.  The injured body has to rehabilitate.  We know that.  Doesn't the brain just come along for the ride?

But thinking is done by a body, the part of the body called the brain.  Thinking is a physical process, electrical charges tracing a pathway from one cell to the next, within an organ of the body called the brain.  And when the brain is injured, it has trouble performing its physical functions, like thinking.

Cognitive Deficits

This emergency medicine doctor with battle front experience can't work anymore.  He used the phrase cognitive deficits.

To illustrate, he told us about the work of an emergency room doctor.  When somebody comes into ER with a potential heart attack, there is a protocol.  There are 17 steps to this protocol.  [It might be 23 -- I wasn't taking notes.]  He told us the first step.  Check.  Then he told us the second.  The second step requires a certain mathematical calculation.  He told us what needs to be calculated, the ratio between two measurements.  [I didn't write them down.]  He knows how to do the calculation.  He can do it in 18 minutes.  The whole process is still in there, inside his brain.

The thing is, this entire 17 step protocol has to be done in 93 seconds.

So he can't work as an ER doc anymore.  His job is to do rehab for his cognitive deficits.  In rehab he is learning how to connect all the bits that are still in there.  His brain is finding new pathways around damaged areas to turn all those bits into coherent and accessible thoughts.

And I thought -- That's it!  That's my swiss cheese brain!

My Swiss Cheese Brain

I am told, now that I have lost half of my cognitive functioning, I am still smarter than 80% of the people in the room.  Well okay, between 10 and 11:30 on alternate Wednesday mornings.

All the bits are in there.  If only I could connect the dots.  I wander inside this brain like the hallways of Hogwarts, wondering what's behind those locked doors, getting caught on moving staircases that take me to places I shouldn't be, sitting cross-legged on the floor in front of the Room of Requirement, desperately requiring entrance, but not a clue how to get in.

Sometimes all the bits taunt me.  They light up like little Christmas tree lights, blink off and on.  But if I grab one, the whole chain goes out.  Other times, all of a sudden, it's back, my brain.  I can get it to take me exactly where I want to go.

You don't notice.  You don't see the day spent on a paragraph, the week that is lost when the wall will not yield.  It hurts to write.  But I don't know who else to be, if not a writer.

Brain Damage

I have been writing about this stuff for years now.  Listening to somebody recovering from stroke, it finally hit me, brain damage.  I have brain damage.  The source is not the same.  A stroke kills brain cells through oxygen deprivation.  Trauma kills brain cells through chemistry, a surge of catecholamines, depression of thyroid function and hypoxia... an outpouring of other neurotransmitters, neuropeptides, and hormones... heightened catecholamine endorphin secretion with eventual depletion... the secretion of corticotrophin releasing hormone (CRH), adrenocorticotrophic hormone (ACTH) and cortisol... always more cortisol...

All of which really screws your hippocampus, seat of memory.  Here is the source of my cognitive deficits.  They say that, unlike cancer or a broken bone, there is no picture of depression.  Actually, that is not true.  MRI's show that anxiety and mood disorders damage and shrink the hippocampus.  They do have the pictures.  It is real.  It is brain damage.

Traumatic Brain Injuries, Post Traumatic Stress Disorder and severe depression all do the same brain damage.  They look the same.  By that, I mean the same MRI's.  They act the same.  By that I mean the same dysfunctions.  And, what do you know, they respond to the same treatments.  [I wrote about this in more detail back on March 28, 2010, one of my most frequently viewed posts.]

You can rehabilitate brains damaged by TBI's, PTSD and depression, just as you can rehabilitate brains damaged by stroke.  Just like stroke, some damage is reversible, some is not.  And just like stroke, expect it to take a long time.

A Long Recovery

A friend who has been my mentor through this life transition of mine told me, Yes, your brain will come back.  Give it five years.

So then my brain did its half-full/half-empty thing.

Five years -- that takes the pressure off.  I can give myself a break, and give myself time.  I can have hope.  Maybe my brain will be brilliant like my friend's brain again.

Five years -- my career really is over.  I will be too old to go back.  There is no reclaiming what I lost.  The presenter will never work in the ER again, and I will never be Diocesan Ministry Developer again.

Both.

I do tend to focus on the half empty part.

But my brain stretches out to as healthy as I can imagine, if only for a moment --

So I will do something else, instead.

to be continued...

photo of army doctor during training in Baghdad in public domain, (not the speaker referred to in this post)
flair by facebook
reproduction of hippocampus from Gray's Anatomy in public domain
fresco of The Visitation from the 14th century, Museo Matris Domini in Bergamo Italy

Getting My Brain Back -- Neuroplasticity and Friends.

No, You Don't Already Have All Your Brain Cells

When we were kids they told us we already had all the brain cells we ever would have, that these brain cells would die off over the course of our lifetime, and if we killed them off early, we'd go senile.

Bummer.

I doubt this warning ever really kept anybody home from the kegger.

And as it happens, it is not true.  For those who survived the drive home, our brains were already hard at work, repairing the damage. 

Neuroplasticity

Neuroplasticity is the vocabulary word for the day.  It refers to the brain's ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.

BDNF

Think of neuroplasticity as the road repair function inside your head.  BDNF is the crew, a protein that helps the brain grow new brain cells and new connections between the brain cells.  BDNF is one of my very favorite brain things, even if I can never remember whether the D or the N comes first.  I will be writing more about it in the weeks to come. 

Epigenetics

Okay, one more vocabulary word for the day, epigenetics.  This word is about the nature/nurture debate.  Do you have a mental illness because you lost the genetic roll of the dice, or because a hurricane happened later?

Answer: Yes.

Evidently there are on/off switches installed in your genes.  After your DNA was poured, it still wasn't set.  Experiences after conception and into your life can determine which way the genes express themselves.

A few paragraphs above, I said your brain was already at work, repairing the damage you did to it at the kegger.  BDNF was patching holes.  Epigenetics means that unfortunately, the brain was also already at work, setting that damage in place.  Some of the substances consumed that night turned the switch in the direction you did not want it to go, especially if your roll of the genetic dice was already iffy.

Good News/Bad News

So your brain isn't finished forming.  And you have some control over what happens next.  Not absolute control.  But some control.

I tend to write about the bad news, how things go from bad to worse.  That's because I started this research trying to figure out what the hell happened.

But last month, I wrote a book report.  You may not have noticed.  But that was rather extraordinary.  Something new is happening.  I will be writing more about that in my new series, Getting My Brain Back.

Meanwhile, May is graduation month.  And graduation makes me think of Shel Silverstein.  Poetry, inspiration, you know.  Listen to the mustn't's, child; listen to the don't's...  But that poem isn't about neuroplasticity.  This one is.  Sort of.  Enjoy.

photo of Oktgoberfest at Fort Benning by Donna Hyatt, a US Army employee, and in the public domain

photo of sink hole by FEMA employee and in the public domain
flair by facebook

Treating Bipolar Disorder Part IV -- Summing Up

Intending to review Ellen Frank's Treating Bipolar Disorder, I spent most of April describing the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.

Part I laid the foundation in work done on the relationship between circadian rhythms (our interior physiological clocks) and mood disorders.

Part II outlined Frank's Social Zeitgeber Theory and the treatment that proceeds logically from it, a process of establishing regular daily rhythms that set our interior clocks and keep them running on time. (Zeitgeber means timekeeper.)

Part III explained how work on interpersonal issues helps people reduce stressors and prevent disruptions to their social rhythms.

This last post will pull together my appreciation, my reservations and my hopes for future directions.

Social Zeitgeber Theory

On the Road Again With NAMI Walks

In honor of Earth Day, this is the second annual Blog Post Recycling Day.  I think it is the second annual Blog Post Recycling Day.  Somebody declared one last year, and I recycled then, but I haven't actually seen anything about it this year.  Maybe because my Facebook friend who posts that kind of stuff is in church today?

Anyway, it's timely -- just one week from Johnson County, Iowa's NAMI Walk.  So my recycled blog from a month ago comes with one more plea to contribute to the organization that has contributed so much to me, making my contribution to you, dear readers, possible.

Please, please, please, click on the button to

To find out why, read:

 

Friday, March 25, 2011

On The Road Again -- NAMIWalks 2011

It's that time of year again.  Across the country people with mental illness, our friends, family, care providers, even law enforcement officials are pulling on our walking shoes to raise money for NAMI -- National Alliance on Mental Illness.  Last year soldiers in Iraq pulled on their hiking boots and their 40 lb. packs and ran while NAMI San Diego walked.

So what is this all about?  Here, my friends, is my testimony.

A couple years ago, I wrote a post on holiday gift giving for your favorite normal.  I asked my spouse, What would be a good present for the family member of somebody with a mental illness?

She didn't even look up from her computer.  Without missing a beat, she said, A cure.

A cure.  I know that mental illness is a family illness.  The whole family lives with it.  But her words caught me.  What she wanted was for both of us, a cure.

It's something she can't give me.  I can't give her.  My doctor can't.  You can't give it to the person you love.

We can, however, learn to manage symptoms.  We can claim the very best lives we can live.  We can live in recovery. 

Peer To Peer Program

I learned about recovery from NAMI, from their Peer to Peer program.  P2P is a ten-week course taught by people with a mental illness for people with mental illness about what we do after the doctor hands us a diagnosis and a prescription.

P2P teaches us how to live.  It is why I bust my butt for this walk.  It's not a cure.  But it's a lot.

That first class, I heard that I am not alone.  The very first note I took said, More unites us (our experiences) than divides us (our diagnoses.)

Next P2P showed me the immense dignity of those who live with mental illness.  It made me proud to know and be known by and be in community with others who live with mental illness.

It supplied tools like dialectical thinking, mindfulness, relapse prevention planning, techniques for emotional regulation and getting a good night's sleep, strategies for staying safe and coping with hospitalization.

P2P gave me something to do when medication didn't give me a cure.

And it opened for me a path into my future.  It reminded me that I am an advocate.  That is who I am.  I still have an identity, after all

So I bust my butt for this walk.  It is how I give back.

NAMI Walks

Now, the first time I did a NAMI walk, to tell the truth, I was scared.  Would it be grim?  A protest and a wailing against what is not possible, what we have lost and what we have to face?

If you have walked for NAMI, you are laughing here.  You know a NAMI Walk is so -- not grim.  It's a party!  With balloons and babies and dogs, music, belly dancers, football players, great food.  In Johnson County, Iowa, the Old Capitol City Roller Girls lead off the walk.  In San Diego, you are likely to hear a didgeridoo.

Bottom line, a NAMI walk is a gift.  It's a public demonstration to our families, friends, politicians, our neighbors, coworkers, the people in our places of worship, the viewing public -- a public demonstration that we are here for each other.  We take a break from all that wailing.  And throw a whale of a party.

At the same time, we raise funds for the programs that help us help ourselves and one another, the things that nobody else will pay for, for people who have fallen off the bottom of the budget.  NAMI does the stuff that makes a difference the day after the doctor hands us a diagnosis and a prescription.

Team Prozac Monologues debuted last year, with results that were not too shabby.  We raised $2640.  Mazie's sponsors contributed $250 toward that total.  Helen is walking in her stead this year.  Sponsors can contribute in Mazie's memory here.

Why I Walk

Me, I am walking for everybody who used to be on a three month wait list for an intake interiew at the local community mental health center; but this year that became a six month wait list at the center the next county over.  I am walking for everybody who used to  be on a four year wait list for sheltered housing; but this year the shelter shut down.

I am walking for those who are not crazy enough to pull out a gun and get the sheriff to buy their meds; they're just crazy enough to sleep in the alley behind the homeless shelter after they have stayed their ninety-day limit.

I am walking for family members who go to work wondering what is happening at home with their loved ones, now that the day program is closed.

I am walking for the resident on call in the ER who has to send home the merely suicidal, while the flaming psychotic waits for 36 hours in the hallway for the next available bed.  And for the newly diagnosed and dazed person who just got released with not enough meds to make it through the weekend, to make room for the flaming psychotic.

I am walking for the young people I know whose brains are even now being damaged in a war that we got into for oil.

I am walking in gratitude for law enforcement personnel who are trying to figure out how to do this new job, and need new training, to take care of those who have been discarded so that the very richest people in the world can get a tax cut.  I am walking in prayer for those who get caught up in somebody's suicide by cop.

This would be the place to note that the co-chairs of Johnson County's NAMI Walk this year are Janet Lyness, County Attorney, and Lonnie Pulkrabek, County Sheriff.  Props to them and to the competition between their two teams!

I did say that the Walk would be a party.  So even while I am angry that so much suffering comes not from the illness, but from the neglect, I will nevertheless celebrate those who do what they can do.  (That sentence would be an example of dialectical thinking, by the way -- see above, the curriculum of Peer to Peer.)

I am walking in wonder and amazement at the strength of the human spirit.  I am walking in deep appreciation for those who have helped me personally, for peer teachers, support group members, care providers, friends and family.

I will be walking with tears in my eyes, that my son and daughter-in-law will travel from Madison to Iowa City to walk beside me.

I am walking on April 30, 2011 in Iowa City, Iowa for all these reasons.  And I am walking also for you, dear reader.  I ask you to support me in this walk.  Click here to make your tax deductible, safe and quick contribution to NAMIWalks Johnson County.

Closing Shot

There are many versions of this song on Youtube.  I chose this one, despite the credits that run over it, because the ragged bunch of friends who sing it, some not sure of the words, illustrate the point.  We are a ragged bunch.  And pretty wonderful because of it.

The Scream by Edvard Munch in public domain
photo of Team Prozac Monologues by Judy Brickhaus
photo of homeless vet by Matthew Woitunski and used under the Creative Commons licencse
photo of New York City police officer by See-ming Lee, copyrighted and used by permission

Treating Bipolar Disorder Part III -- The Interpersonal Therapy Part

Lately I have been reviewing Treating Bipolar Disorder by Ellen Frank -- the recommendation of a friend who is 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.

Interpersonal Social Rhythms Therapy came to Ellen Frank in an epiphany on her birthday, July 14, 1990. Personally, I like that. I especially like that it was the day that she participated in a conference for people with bipolar, and listened to them.

Frank and her colleagues were already using interpersonal therapy for people with recurrent unipolar depression. Their theory was that certain life events, particularly losses could result in lost social zeitgebers, (timekeepers), with subsequent disruption of circadian rhythms, leading to eventual relapse into another episode of depression.

IPSRT took up from there as an adaptation specifically for people with bipolar disorder, integrating the work on issues (as in, you've got issues) with greater focus on behavioral changes to achieve and maintain daily rhythms, time of rising, time of first human contact, work, main meal, etc. The purpose of IPSRT is to help people achieve stability and then to avoid relapses into either depression or mania/hypomania. 

Why Do People Relapse?

On The Road Again -- NAMIWalks 2011

It's that time of year again.  Across the country people with mental illness, our friends, family, care providers, even law enforcement officials are pulling on our walking shoes to raise money for NAMI -- National Alliance on Mental Illness.  Last year soldiers in Iraq pulled on their hiking boots and their 40 lb. packs and ran while NAMI San Diego walked.

So what is this all about?  Here, my friends, is my testimony.

A couple years ago, I wrote a post on holiday gift giving for your favorite normal.  I asked my spouse, What would be a good present for the family member of somebody with a mental illness?

She didn't even look up from her computer.  Without missing a beat, she said, A cure.

A cure.  I know that mental illness is a family illness.  The whole family lives with it.  But her words caught me.  What she wanted was for both of us, a cure.

It's something she can't give me.  I can't give her.  My doctor can't.  You can't give it to the person you love.

We can, however, learn to manage symptoms.  We can claim the very best lives we can live.  We can live in recovery. 

Peer To Peer Program

I learned about recovery from NAMI, from their Peer to Peer program.  P2P is a ten-week course taught by people with a mental illness for people with mental illness about what we do after the doctor hands us a diagnosis and a prescription.

P2P teaches us how to live.  It is why I bust my butt for this walk.  It's not a cure.  But it's a lot.

That first class, I heard that I am not alone.  The very first note I took said, More unites us (our experiences) than divides us (our diagnoses.)

Next P2P showed me the immense dignity of those who live with mental illness.  It made me proud to know and be known by and be in community with others who live with mental illness.

It supplied tools like dialectical thinking, mindfulness, relapse prevention planning, techniques for emotional regulation and getting a good night's sleep, strategies for staying safe and coping with hospitalization.

P2P gave me something to do when medication didn't give me a cure.

And it opened for me a path into my future.  It reminded me that I am an advocate.  That is who I am.  I still have an identity, after all

So I bust my butt for this walk.  It is how I give back.

NAMI Walks

Now, the first time I did a NAMI walk, to tell the truth, I was scared.  Would it be grim?  A protest and a wailing against what is not possible, what we have lost and what we have to face?

If you have walked for NAMI, you are laughing here.  You know a NAMI Walk is so -- not grim.  It's a party!  With balloons and babies and dogs, music, belly dancers, football players, great food.  In Johnson County, Iowa, the Old Capitol City Roller Girls lead off the walk.  In San Diego, you are likely to hear a didgeridoo.

Bottom line, a NAMI walk is a gift.  It's a public demonstration to our families, friends, politicians, our neighbors, coworkers, the people in our places of worship, the viewing public -- a public demonstration that we are here for each other.  We take a break from all that wailing.  And throw a whale of a party.

At the same time, we raise funds for the programs that help us help ourselves and one another, the things that nobody else will pay for, for people who have fallen off the bottom of the budget.  NAMI does the stuff that makes a difference the day after the doctor hands us a diagnosis and a prescription.

Team Prozac Monologues debuted last year, with results that were not too shabby.  We raised $2640.  Mazie's sponsors contributed $250 toward that total.  Helen is walking in her stead this year.  Sponsors can contribute in Mazie's memory here.

Why I Walk

Me, I am walking for everybody who used to be on a three month wait list for an intake interiew at the local community mental health center; but this year that became a six month wait list at the center the next county over.  I am walking for everybody who used to  be on a four year wait list for sheltered housing; but this year the shelter shut down.

I am walking for those who are not crazy enough to pull out a gun and get the sheriff to buy their meds; they're just crazy enough to sleep in the alley behind the homeless shelter after they have stayed their ninety-day limit.

I am walking for family members who go to work wondering what is happening at home with their loved ones, now that the day program is closed.

I am walking for the resident on call in the ER who has to send home the merely suicidal, while the flaming psychotic waits for 36 hours in the hallway for the next available bed.  And for the newly diagnosed and dazed person who just got released with not enough meds to make it through the weekend, to make room for the flaming psychotic.

I am walking for the young people I know whose brains are even now being damaged in a war that we got into for oil.

I am walking in gratitude for law enforcement personnel who are trying to figure out how to do this new job, and need new training, to take care of those who have been discarded so that the very richest people in the world can get a tax cut.  I am walking in prayer for those who get caught up in somebody's suicide by cop.

This would be the place to note that the co-chairs of Johnson County's NAMI Walk this year are Janet Lyness, County Attorney, and Lonnie Pulkrabek, County Sheriff.  Props to them and to the competition between their two teams!

I did say that the Walk would be a party.  So even while I am angry that so much suffering comes not from the illness, but from the neglect, I will nevertheless celebrate those who do what they can do.  (That sentence would be an example of dialectical thinking, by the way -- see above, the curriculum of Peer to Peer.)

I am walking in wonder and amazement at the strength of the human spirit.  I am walking in deep appreciation for those who have helped me personally, for peer teachers, support group members, care providers, friends and family.

I will be walking with tears in my eyes, that my son and daughter-in-law will travel from Madison to Iowa City to walk beside me.

I am walking on April 30, 2011 in Iowa City, Iowa for all these reasons.  And I am walking also for you, dear reader.  I ask you to support me in this walk.  Click here to make your tax deductible, safe and quick contribution to NAMIWalks Johnson County. 

Closing Shot

There are many versions of this song on Youtube.  I chose this one, despite the credits that run over it, because the ragged bunch of friends who sing it, some not sure of the words, illustrate the point.  We are a ragged bunch.  And pretty wonderful because of it.

The Scream by Edvard Munch in public domain
photo of Team Prozac Monologues by Judy Brickhaus
photo of homeless vet by Matthew Woitunski and used under the Creative Commons licencse
photo of New York City police officer by See-ming Lee, copyrighted and used by permission