Showing posts with label mental illness. Show all posts
Showing posts with label mental illness. Show all posts

Oh, My Aching Neurons!

Having a hard year?

Fiscal Cliff, Sandy Hook, Sequester, you can take your Swiss Army knife on the plane with you, no you can't, North Korea, ricin -- not to mention your own life...

And then there was Boston.

If you are exhausted, you don't need to blame your meds.  Your mind has been stretched to the limit.

How's your brain doing?

Minding My Mitochondria

I don't know if this is related, but it sure seems timely.  One of my posts has gone viral - well, within the context of Prozac Monologues viral.  I have been working up to over 100 hits a day.  Nice progress -- thank you to all who have helped spread the word.  Suddenly one day this week, my hits jumped to 530.  Almost all of them were one post, a review of Terry Wahl's book, Minding My Mitochondria.

This post was already one of my most read, a cross-over hit with people who have multiple sclerosis.  Last month it got mentioned in an MS chat group, which drove a spike in hits out of Poland.  [The blogger.com software enables bloggers to track aggregate statistics.  I can't tell who is reading, but I can tell how many, what country, and to a limited extent, how readers found my blog.  This week's traffic seems to come from Facebook.]

Wahls' book is about brain cell health, and how what we eat sustains or starves our brain cells -- in particular, mitochondria, the little power plants inside our nuclei that turn what we eat into energy.

Hence, the relevance to your current state of exhaustion.

We Are On Our Own


Last week I was part of a group that was confronted with a psychiatric crisis in a visitor.  This group had never been called upon in this way.  But among our ranks we had enough experience of psychiatric crisis that:


1) We were determined we would help a stranger; and
2) We knew how to do it.

Part of the story was that inevitable series of telephone calls to offices in 24 hour institutions that were closed.  When flesh and blood was finally located, the response was rude, ineffective and dismissive.

When I debriefed with my therapist, she expected my frustration at calls for help that did not yield help.  That is one of my therapy themes -- a cognitive schema, as a former cognitive therapist called it.  I surprised my new therapist and surprised myself with my response.  No, I didn't expect help.  We are on our own.

Fabulous People With Schizophrenia

People With Schizophrenia Who Recover

My guess is you don't know people with schizophrenia who have jobs, own their homes, are married and join clubs and congregations.  My guess is, even if you work in the field or volunteer in homeless shelters, you do not count among your friends, your real friends, the ones you invite to your house for dinner, anybody with schizophrenia.

My guess is you do not know that such a thing is possible.

Lionel Aldridge decided to change that.  Lionel Aldridge played defense for the Green Bay Packers and won two Super Bowl rings.  (Go Cheeseheads!)  He lost them when schizophrenia took his life out of control.  Literally, his ring fell off his hand; he couldn't find it in the gutter.

But he came back.  He got treatment.  He vowed that if he got better, he would not remain silent, so that other people with schizophrenia would know they are not alone, so they would know they could recover, and so you would know that, too.  His story is in this link.

Inductive Research

Hope for a Cure? Or Not?

But we have to keep hoping for a cure, don't we?

I spent six months preparing a power point presentation on stages of recovery and fifty minutes delivering it.  My co-presenters and I described the misery of the Chemistry Experiment, and the hope offered by other interventions that harness the brain's capacity to heal itself.  Medicine is a piece of the answer, but just not inadequate to carry the whole load of healing.

But DNA operates even deeper in an organization than in an individual.  NAMI was born out of the medical model, when parents who had been wrongly accused of causing their children's illness pushed back and insisted on their innocence.  Mental illness is not caused by distant fathers and overprotective mothers.  Mental illness is a physical illness.

Yes it is.  Whether it arises from chemistry, wiring or structure, it is an illness in the brain, a physical organ, inside a body.

Well, it was a short jump from that insight to the search for a cure, a medical cure.  Because that is what medicine does, it cures physical illness, right?

So there was that question, the NAMI parent's quest for a cure, in response to all our elegant talk about Recovery, the NAMI peer's quest for a life worth living.  Forget Recovery. Don't we have to keep hoping for a cure?

Is Recovery Possible? - Kayla Harrison Continued

A few weeks ago I published a video interview with Kayla Harrison, USA's first gold medalist in judo.  The story was dated before her win, and showed her determination: if not London, then Rio...  (The source is the Boston Globe.  Kayla didn't make NBC's radar screen until after she won.)

Lots of shots in the gym.  A young lady you wouldn't want to mess with.

Except, her former judo coach did, starting when she was twelve years old and for three years.

Today, her former coach is in jail, and she has her gold.

Well, of course we love this story.  It follows the USA's favorite narrative arc: misery, struggle, justice, triumph.  We will listen to this story, read this book, watch this movie every night of the week.

Some of us will ponder it a little longer than others.  I expect Kayla is one.

Get Over It, Already

Those Who Have Eyes, Let Them See

Yes, I said I was on sabbatical.  But I do have to write.  Like, I do have to breathe.  My facebook page this morning, somebody posted an Ernest Hemingway quote, There is nothing to writing.  All you do is sit down at a typewriter and bleed.  I have learned there is more than one way to bleed.  Teresa of Avila's stigmata, by the way, were interior.  Mine (writing) seems better than other alternatives.

So yes, I am on sabbatical.  That means I don't have to post.  I might anyway.  Oh well.

NAMI National Convention 2012

It started with Shepherd.  He stood straight tall.  Life has taken a lot out of him, including a lot of teeth.  But he stood straight tall.  I remember him as a black man, with piercing light blue eyes.  I know that's possible, a black man with blue eyes.  Maybe it isn't true in this case.  My brain really isn't that dependable anymore.  But the piercing part is the most important.  I am so glad I wasn't afraid to look in his eyes.

Hypomania Goes To A Blog Party


The American Psychological Association is throwing a blog party.  Today!!  Why didn't anybody tell me about it until today?!  Maybe because they have heard about me and parties?

I didn't know about me and parties.  I didn't figure it out until I discovered I have bipolar II.  -- Not bipolar I.  Everybody knows about that kind of crazy.  Bipolar II is -- well, you never know what you're going to get.  Sometimes what you get makes you the life of the party.  Sometimes in a good way.  Sometimes it makes you crazy productive and successful at work.  That is why it years and years to get a bipolar II diagnosis.  Nobody goes to the doctor because they feel great, are having fun, and are the apple of the boss's eye.

Sometimes the family member knows about the evil twin.  But chances are, the doctor doesn't ask the family member.


I Told Them I Was Sick - DSM Revisited

Have you heard about the man whose tombstone read, "I told them I was sick"?

A New Diagnosis Or Two

So, the docs earned their big fee and the Pension Fund got its money's worth out of this three-day psychiatric evaluation.  I have a couple new diagnoses.

That is really not so remarkable.  If you attend a Peer to Peer course, NAMI's signature ten-week self-help program for loonies, you know this.  One week, the participants go round the circle and tell their diagnoses, or rather, their history of diagnoses.  Most trace a whole tour through the DSM, the Diagnostic and Statistical Manual.

Where Diagnoses Come From

Support the Troops - Stop Shopping

So I am back from getting my head examined, that three day intensive evaluation.  I had my doubts about this enterprise.  At my most anxious, my therapist reminded me I would get air miles.  That would be something, at least.  To my surprise, I also received some surprises.  And the experience was worth a couple of blogposts.  This one will be about PTSD, or make reference to it.  Next week we will play with the DSM.

I start at the Hilton.  Well, before that, my pension plan, which is how I ended up at the Hilton, not to mention how I ended up getting a three day psychiatric evaluation at the Gabbard Center, which does not usually happen for loonies in my tax bracket. 

Decent Benefits For People With Mental Illness? 

The Episcopal Church Pension Fund was established by one of the biggest robber barons of the 19th century, J.P. Morgan, doing penance for his sins.  Like how Charles and David Koch aren't.  Since then, clergy have put the equivalent of a whopping 15% of our salaries into the fund.

Unlike United Airlines or General Motors, this retirement fund is not run by people who have the option of stealing it by threatening to close up shop unless the pensioners just hand over their hard-earned savings to increase the compensation of the CEOs.  The shop being the Episcopal Church.  Plus for some reason, in defiance of the way managed mutual funds work in the real world, the Pension Fund beats its performance indexes year after year after decade after decade.  Maybe this has something to do with karma.  Maybe the angels.  Choose your metaphysical system.  Whichever, for me, this is good.

As a consequence, my disability pension comes from one of the last defined benefit plans in America.  And it regularly has to come up with ways to spend its excess revenues, like by providing good benefits for its disabled beneficiaries, even those whose disability is of the loony variety.

And since the people who manage that much money are used to staying in places like the Houston Hilton, then that is where they put up their loony beneficiaries when we are getting our heads examined.

Which is how I came to spend four days there, two blocks north of the Galleria. 

Galleria As A Tourist Attraction 

Malls called Galleria don't have stores with names like Old Navy.  They have stores with names like Giorgio Armani, Christian Dior, Chanel, Louis Vuitton, Saks, Baccarat, Tiffany's, Cartier, De Beers.  A whole store called De Beers, for God's sake.

Galleria is where the restaurants are, where we went when we were tired of sitting next to tables at the Hilton where we had to overhear earnest mentors training earnest mentees for their presentations to their big clients.  The oil companies were meeting at the Hilton.  Down the street, Bechtel was meeting at the Westin.  Bechtel is the construction company to the Saudi monarchy.  So it may be the timing was not a coincidence.

We walked to the Galleria.  The neighborhood isn't really designed for walking.  Houston is more of an internal combustion engine kind of place.  So as we picked our way through parking lots, we overheard a father and young son comparing their Beemer to the Beemer they parked next to.  We dodged  Maseratis and Mercedes while crossing streets.  Well, you get the idea.  There was a closer restaurant.  But the doorman appeared to be wearing Kevlar under his vest.  Well, you get the idea.

One of my docs, making small talk as we entered her office, asked if I was getting to look around Houston in the off hours when I wasn't getting my head examined.  I said, No I am too tired.  Except, we went to the Galleria.  She responded, Well, THAT's something! 

It was something alright. 

Galleria As A Mental Health Hazard 

One evening on our way toward sushi, a young man held out soap samples.  I said, No thanks, I don't do scents.  Then he grabbed my hand.  Okay, he asked permission.  I see your nails are clean.  You don't paint your nails?  No I don't.  Let me show you something.  So he explained about ridges and natural oils while he did his flirty little small talk and buffed one of my nails.  Now don't scream when you see the results.  Indeed, the nail was beautifully shined, and made the notion of painting nails seem cheap.  I agreed it was beautiful and said I was not going to buy the buffer anyway.  Why not?

Because I don't buy things. 

That took some explaining, both to him and to myself, since I had never said those words before.  He decided I had made a life style choice.  Well, okay.  That would be one way to look at it.

But it was more like a commitment than a choice, made then and there.  I would no longer buy things.

Don't get me wrong.  I am as fem as they come -- short of destroying my feet in those instruments of torture that women willingly put on their feet nowadays.  Evidently, all that work we did in the 1970s to get women to love ourselves was a waste.  In other cultures, women are forced to deform their feet.  Having stopped in the 70s, now we do it again.  In the US, we call that freedom.

Where was I?  Oh yes -- I found those beaded dresses in the Gucci windows quite lovely.  And I have some beaded things in the back of my closet from pre-loony days.  Maybe not pre-loony, maybe just not-yet-identified hypomanic days, who knows.

But tripping past them, dodging the Lexus SUVs, all of that, I felt this growing sense of doom about the American way of life.

What The American Way Of Life Costs 

I couldn't shake the images of three young men.  One is a friend of my son's, who came home from Iraq with a TBI and PTSD.  Another is a relative with a couple tours of duty in Afghanistan and a troubled marriage.  The third is a young man I counseled, who signed up, hoping to come home a hero in a box. 

Support the troops, people say.  Support the ones who are protecting our freedom.  Freedom to shop at Galleria.

There I was, surrounded by the way of life they were protecting at the cost of their brains and their families and their lives.

It is too high a cost.

It is too high a cost.

These thoughts, coming in the midst of getting my head examined, make me think we need to get America's head examined.

Money, Military and Mental Health

This isn't a political blog.  I do advocacy about mental health issues.  I am not here to plug political opinion.



This is not an opinion.  This is a photograph.


 




This is another photograph.




And here is another.





 
And now we return to the shoes.

As I look at one picture, then another, as I listen to those young men, and then to the people in that restaurant next to me, I do have an opinion.  Here it is.

These shoes cost too much.

They cost too much.

Actually, I don't think this is about mental health, after all.  It is a sickness of the soul. 

What Is The American Way Of Life? 

I did meet some very nice people at the Houston Hilton.  One man was from Ethiopia.  He drove the shuttle, and we got to know each other in twenty-minute conversations each day on the way to the Gabbard Center.  He came to this country because he wanted opportunity.  And he found it.  He drives a shuttle bus.  His eldest is a policeman.  His daughter is about to graduate from college, and his youngest about to enter.  He doesn't need a Maserati to have the American way of life.

The other shuttle driver came to the US during the war in El Salvador.  We talked about Archbishop Romero, and the strength we still get from his witness.  If I remember right, somebody gave Archbishop Romero a pair of shoes for his consecration.  People gave him lots of things, but his friend asked him what he wanted, and he said shoes.  This former refugee, now shuttle driver, also found the American way of life.  Emphasis on life.  He doesn't need a Lexus. 

Freedom And Addiction 

People say our young men and women are sacrificing their minds and their bodies to protect our freedom.

We need to protect our freedom ourselves.  We are not free.  We are addicted.  Addiction is a disease of the soul.  And it is progressive.  The more you feed it, the worse it gets.

Our freedom begins when we acknowledge our addiction for what it is. 

Step One -- We admitted we were powerless over our addiction - that our lives had become unmanageable.

I don't want those shoes.  But I do want that beaded dress.  And having resisted it, having told that young man I don't buy things, the very next day I still almost bought an Eileen Fisher sweater at Nordstrom's across the street.  Because it was on sale.

Just in time I remembered those three young men.  That sweater cost too much. 

My Bit For The War Effort 

PTSD, Post-Traumatic-Stress-Disorder is bankrupting the defense budget.  Researchers are trying to figure out how to prevent it.  Does it take a neuro-scientist to figure out that you prevent Post Traumatic Stress Disorder by preventing the trauma?

I have decided to support the troops the way the troops do, by caring about what happens to their buddies and acting to prevent harm from coming to them.  I will not wrap a flag around my shoulders nor post one on my facebook page for Veterans' Day.  I will hold before me the faces of those three young men, and wrap myself in my love for them.

I will work the Steps, always remembering that I am just as addicted to things as any of you.

With God as my higher power, the next time I buy something, it will be a bicycle.  So I can leave my Civic in the garage.


photo of J.P. Morgan by Edward N. Jackson and in the public domain
photo of Bacarrat Chrystal Sculpture used under the terms of the GNU Free Documentation License 
photo of Maserati, Gran Turismo by Rudolf Stricker and usedunder the terms of the GNU Free Documentation License
photo of Louis Vuitton shoes used under the Creative Commons Attribution-Share Alike 2.5 Generic license
photos of medical evacuation and coffins in public domain 

Differently Abled - More, Please

It's like he is in a world of his own. The first grade teacher, old school, same worksheets for the last thirty years, did not mean it as a complement.

The mom was confused. She asked her son's Montessori preschool teachers for their take on it. They, too were confused. Then the light dawned. The way they put it was, He has immense powers of concentration. They thought he was marvelous.

The problem was, he was still absorbed by the story he was writing, when the first grade teacher had moved on from writing to math. The world he was in was not her world.

His second grade teacher recommended him for the Talented and Gifted program.

His fifth grade teacher thought he had ADHD.

People who are different get diagnosed. The Diagnostic and Statistical Manual (DSM) is all about describing the various ways we don't fit. But if you can pass for normal, you don't have a disability. If they can pick you out in that One of These Things is Not Like the Others game, then you do.

Minding My Mitochondria -- A Review

Dr. Terry Wahls practices internal medicine and treats psychiatric patients at the VA in Iowa City Iowa.  In the year 2000, she was diagnosed with relapsing-remitting Multiple Schlerosis.

MS is an autoimmune inflammatory disease that damages the myelin (think, skin) of neurons, causing breaks in communication between the brain cells, neurotransmitter imbalances and cell death, with resulting physical and cognitive disabilities, including blindness, dizziness and pain.  In its earlier relapsing-remitting stage, MS is treated with chemo and immune system suppressants.  Dr. Wahls pursued the best and most aggressive treatment available.

Nevertheless, in 2003 her MS had developed into the secondary progressive variety.  At that stage, the treatment strategy is to slow the inexorable loss of function.  She used canes to walk.  Soon she was in a wheelchair almost all the time.

Wahls is a doctor.  She researched her condition.  But there are no treatments to reverse the loss of function, not even any clinical trials available for her to join.

So she went back to school, staying up at night after the rest of the family was in bed.  She studied the basic science of her condition and similar ones, Parkinson's, Alzheimer's Huntington's.

Then she designed her own treatment based on the basic science about why brain cells die.  She experimented on herself, developed a diet regime, tested potential food sensitivities.  She maintained.

This is Dr. Wahls in June, 2007.

She started working with a physical therapist to use neuro-muscular electrical stimulation, continued the diet modifications.  And then she got out of her wheelchair.

Over the course of that year, Wahls went from moving around on a scooter to walking with canes to riding a bicycle eighteen miles without assistance.

This is Dr. Wahls in October, 2008.

Today, Dr. Wahls is the one woman recovery movement for MS.  She is doing what people with secondary progressive MS don't do.  She is recovering.

I don't have MS.  I have another brain disease that began as remitting-recurring.  I tried what treatments were available.  My disease progressed to a chronic disabling condition.  Boy, do I wish I had gone to medical school.  It would be a lot easier to understand the research, figure out the basic science and develop a treatment plan that might make a difference for me.

Is it any wonder I find Dr. Wahls' story riveting?

I am glad I am not a one woman recovery movement for bipolar.  There are lots of us who are not satisfied with the limited life that our meds give us.  There are lots of us experimenting with our own treatment regimes, staying up nights reading the research, and learning from each other.

It turns out Dr. Wahls has learned some things that may aid our recovery, too.

Meet Your Mitochondria

All living things, including our bodies have tiny little maintenance workers inside our cells called mitochondria, which are busy supporting our cells doing the repair of the the wear-and-tear damage that naturally occurs each day.  Our DNA provides the blueprint for all the proteins and other biological components that need to be replaced on a regular basis.

If those little maintenance workers don't have all the proper nutrients, like amino acids, the correct minerals, and fatty acids, then they can't build according to the DNA blueprints.  Those nutrients are the building blocks that mitochondria in our cells need to keep our bodies healthy.  If those replacement molecules and structures get made incorrectly or not at all, our bodies begin to deteriorate.


Okay, this may come as a surprise to you.  But a long time ago these little critters (scientists call them organelles) swam inside the cells of living things.  Mitochondria live in our cells, like we live on the earth.  Except they are generally more useful to us than we are to the earth.

Minding My Mitochondria tells the story of how Terry Wahls overcame secondary progressive multiple sclerosis (MS) and got out of [her] wheelchair.  It is the story of what these little mitochondria critters do and what they need to do it well. 

The Essential Point

Mitochondria are the power plants inside our cells.  They take glucose molecules and convert them into adenosine tri-phosphate (ATP) -- think energy.

Many other diseases like asthma, chronic obstructive lung disease, hypertension, coronary artery disease, depression, obesity, bipolar disorder, and diabetes have all been shown to become worse as a result of mitochondrial stress and eventual failure.  Mitochondrial failure drives the development of diabetes, heart disease, lung disease, heartburn from stomach acidity, Alzheimer's, Parkinson's, many psychiatric disorders, and multiple schlerosis... Healthy cells are necessary to have healthy organs; healthy organs lead to healthier bodies and restored vitality.

The cells with the greatest concentration of mitochondria are in the brain, because the brain uses enormous amounts of energy -- unless you're sitting on the sofa, in which case your brain powers down.  So any of you readers who are concerned about the health of your brains, pay attention!

Our mitochondria need co-factors to facilitate the reactions that turn glucose into energy.  What are the co-factors?  The micronutrients in our food.  The Standard American Diet (SAD) is sorely missing in these micronutrients, making for sick mitochondria and resulting in a whole host of your favorite chronic diseases and mine. 

But you get these micronutrients simply by eating well.  Dr. Wahls applied the science of cell biology to an eating plan that helped her and can help others ensure adequate nutrition for these little critters on whom our lives depend.

Feeding Your Mitochondria/Healing Your Brain

So that is the basic message repeated over and over in each chapter of Minding My Mitochondria.  (For readers with cognitive deficits and/or fatigue issues, the repetition is helpful.)  You can eat your way to better health.


The early chapters teach the basic biology of brain cells, how brain cells are wired to each other, the role of myelin (insulation of neurons -- the issue of MS), how neurons communicate with each other.

Next Wahls describes how the chemical factory in our cells work, how cells get energy, and how mitochondria signal cells when to die or whether instead to become cancers.

Wahls includes a chart of the micronutrients needed for cell health, good food sources of each, and 100 recipes using some of the foods that are not part of the SAD -- Standard American Diet.

Cut To The Chase -- What To Eat

The typical message you hear is about what not to eat: salt, refined sugar, saturated fat.  Yeah, yeah, we all know that.   But it's only part of the problem.  Remember, if you are eating the SAD, you are not only overweight.  You are starving your mitochondria and yourself at the same time.

It's all about those micronutrients.  Wahls gets her lecture audiences to chant along with her: 

9 cups fruits and vegetables:

3 cups leafy greens
3 cups cruciferous vegetables
3 cups intensely colored.

That is the daily goal.

Okay, if you are the average consumer, you eat three cups of fruits and veggies per day max.  And you probably count peas.  Let me break it to you -- peas are not a vegetable for the purposes of nutrition.  Neither is the State of New York's state vegetable, corn.  Corn, for God's sake.  Peas and corn do not have the antioxidants or minerals you get from broccoli or spinach.  Nutritionally, they are starch.

But back to the goal.  Note that word, goal.  Work up to it, one cup at a time.

Here it is again:

Increase your daily fruit and vegetable intake, with the goal of 9 cups a day.

3 cups dark green leaves, such as spinach, Swiss chard, mustard greens... Count iceberg lettuce as water.  (60 grams = 1 cup)

3 cups cruciferous vegetables, such as cabbage, kale, collards, broccoli, the onion family.

3 cups intensely colored fruits and vegetables, such as beets, berries, oranges, your reds, your oranges, blues and purples.

There is more.  But that's a start.  Just do it.  Just start.  Today, eat a cup of cantalope for breakfast, a spinach salad for lunch, a cup of broccoli for supper, total of three.  Tomorrow, total of four.  Work up to two in each category.  Get to three later.  Just start.

What Else You Can Do For A Healthy Brain

Wahls' dietary recommendations include mushrooms, nutritional yeast, and nuts or seeds every day if possible, seaweed, dried kelp, and/or brewer's yeast, and more foods rich in omega-3 fatty acids: green leaves and the animals that eat them (less of grain-fed beef), wild fish, eggs from chickens that eat flax or bugs, flax oil, plus organ meats once a week.

The key balances addressed by the diet are GABA/glutamate and Omega 3/Omega 6 fatty acids.  We're looking to decrease inflammation and reel in those nasty free radicals.  You will learn lots about these balances in Minding My Mitochondria.  Big Pharma is pursuing exactly these issues in search of the next new wonder drug.  See my post from May 13, 2011, The Future is Bright -- For Whom?  I will come back to this topic, comparing Wahls and Big Pharma, at a later date.

Wahls includes in her program other self care recommendations that you have heard before, thirty minutes daily aerobic exercise to enhance serotonin and nerve growth factors, and thirty minutes brain exercises, puzzles, developing new cognitve and new physical skills to promote brain-derived neurotrophic factor production.

Supplements do not play a major role in the Wahls program.  While there is a mountain of evidence supporting her claims about the benefits of nutrients derived from food, it is not so clear that the body can use the nutrients in supplement form so well.  One exception is Vitamin D.  Vitamin D is free for the taking from sunshine.  But now that we all use sunscreen, Vitamin D deficiency is the newest health crisis in America.  Go figure.

Neuro-Muscular Electrical Stimulation

Parts of Minding My Mitochondria apply specifically to people with MS.  Wahls' most dramatic recovery happened when she started using electrical stimulation.  NMES is not a proven treatment for MS.  Remember, there are no proven treatments for secondary progressive MS.  However, it is recommended to treat symptoms that people who have MS have.  Wahls reviews the research behind it that led her to try her own experiment.  Now she is recruiting subjects for her efforts to replicate her results in others, by combining NMES with the diet. 

Synergy

So get real.  If NMES reverses damage to nerve cells, why bother with the heretofore fruitless exercise of trying to get grownups to eat their veggies?  It's easier to keep a drunk on the wagon than to change the food culture of the ever more obese Mc-Nited States of America.  Besides, you can bill for NMES.

One word.  Synergy.  Give the woman some credit.  She tried it.  When Wahls skips the electrical stimulation, she declines in function.  When she travels and can't eat the way she recommends, her symptoms return.  The different pieces of this program work together.

Which makes sense when you look at it from the perspective of the cell.

Our brain cells connect to each other through little arms called dendrites and axons.  It is likely, given what the literature says about exercise and the brain, that my additional exercise and/or NMES caused my brain to make more neuro-trophins, or brain cell growth factors, and the brain cells then received signals to grow more dendrites and axons.  That requires energy in the form of ATP and omega-3 fatty acids to build the myelin insulation around the new connections.  It makes sense that improving how the mitochondria generate ATP molecules (energy) is synergistic with exercise.  It is like adding an extra engine to your car.  You have more energy and more stamina.

The rate by which the brain cells respond to these messengers is likely therefore to be dependent, at least in part, on the availability of ATP generated in the mitochondria.  A diet containing more B vitamins (particularly riboflavin and niacinamide) coupled with more ubiquinone, or co-enzyme Q, should make it easier for mitochondria to make ATP and get rid of toxins generated in the cells.  That decreases the oxidative stress and makes for healthier mitochondria.  If the mitochondria are healthier, the brain cells are healthier, and healthier brains are better able to respond to brain-growth factors formed in response to the higher level of physical activity.

In other words, exercise (think of electrical stimulation as extreme exercise) makes the body produce more brain cell growth factors.  The body is designed to repair itself.  But to do the repair work, it needs the right material.  The wrong material actually increases the damage.  By contrast, good nutrition means that the mitochondria can do its job to produce energy, which can be used for repairing damaged brain cells.

It's road repair season in Iowa.  So here is synergy in road repair:  We want the roads fixed fast.  But there is no point in hiring more workers, unless you supply more asphalt.  There is no point in bringing more asphalt to the site unless you have the workers to lay it down.

What Else Is In The Book

The first sixty pages tell the story and provide the science behind it.  Wahls repeats concepts that may be new to the reader and uses real life analogies.  So don't worry about the science if you are not a science type.  She makes it understandable.

Also included: menus and recipes; charts that list nutrients, their appropriate doses, good food sources, and their function in brain (including symptoms of variety of chronic conditions caused by an insufficient supply); a list of abbreviations used; daily log sheets to help you track your food consumption and other self help practices; graphics of detoxification pathways, with the nutrients and foods that support detox; the riff on conventional and functional medicine that inspired my last week's blogpost; a glossary of terms; and references for the research studies that support Wahls' ideas.

Wahls needs more research subjects who have MS.  If she can replicate her own results in others, she hopes to get funding for more work that will move forward the science about MS.  The book includes her contact information.

Some versions of the 2nd edition were published without an index.  The one sold by Amazon does have the index, which is helpful if you want to look up something like aspartame, cognitive improvement, or cranberry chutney.

The font used in Minding My Mitochondria is APHont, developed by the American Printing House for the blind, to enhance reading speed, comprehension and comfort.  This accommodation for those who have MS and its vision difficulties makes the book easier to read and comprehend for people without vision difficulties, too.

But I Don't Have MS

Mitochondria don't have MS, either.  If they are malnourished, then their host (you, me) may have or be developing MS, or heart disease, lung disease, asthma, hypertension, depression, obesity, bipolar disorder, diabetes, Alzheimer's or Parkinson's instead -- all diseases in which sick mitochondria are implicated, all diseases for which your doctor has been telling you to eat better.  The market is bullish on chronic health issues these days.

We already know this stuff, that the way we eat is making us sick.  We read about this stuff in every magazine at every grocery checkout counter, where everybody is selling this week's magic berry or bean.

What I didn't know before I heard Dr. Wahls lecture was how all these magazine articles fit together, how exercise and nutrition play off each other at the cellular level, and how I really can help my brain heal with a long term, systematic change in how I feed my brain cells.

I will continue this ambling series on getting my brain back by exploring the realities of changing habits.

Meanwhile Remember, That's:

9 cups fruits and vegetables:

3 cups leafy greens
3 cups cruciferous vegetables
3 cups intensely colored.


To your health!



photos of Dr. Wahls used by permission
photo of mitochondria by NIH and in the public domain
graphic of neuron in public domain
photo of fruits and vegetables at Pike Place by Eric Hunt and photo of tablets by Pöllö, both used under the Creative CommonsAttribution-Share Alike 3.0 Unported license
flair from facebook
photo of road construction in Afghanistan taken by an Air Force employee and in the public domain
photo of french fries by Corpse Reviver and under the terms of the GNU Free Documentation License

Treating Bipolar Disorder Part I -- Interpersonal Social Rhythms Therapy

Medication And Mental Illness

Medication for mental illness is just like medication for anything else.  It works better when you don't ask it to do all the work itself.

In the case of bipolar, once lithium and the chemical imbalance theory came along, the thinking was that medication was the only thing that worked.  Therapy by itself certainly didn't.  I wonder if therapists, worn out by their bipolar patients, were simply relieved to believe that medication was the only thing that worked.  I wonder if therapists today, worn out by their recurrent depression patients, are secretly relieved to terminate when the diagnosis changes to bipolar, because medication is the only thing that works.

Frankly, there is a lot of wishful thinking out there in pharmacotherapy land.  If only our brains were a chemical stew and the illnesses of the brain could be treated by adjusting the recipe.  If only.

But people with mental illness, especially people with bipolar, can't afford the wishful thinking behind the better living through chemistry fantasy.  Sometimes the medications do work.  But not as well nor as often as your doctor would like to think.

I have a friend who is a psychiatrist.  He challenges his colleagues who keep trying to solve this noncompliance issue, to get their patients to comply.  He reminds them, if the medication (antidepressants, in this example) worked for 40% of those who took it in the trial, and the placebo worked for 30%, that means only three out of ten people benefit from the medication itself.  So what's the big deal about seven who quit?

He says they just look at him funny.

Treating Bipolar Disorder by Ellen Frank

This same friend, God bless him, loaned me a book about a psychotherapy designed specifically for bipolar disorder titled, appropriately enough, Treating Bipolar Disorder.  The author Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic, and her colleagues invented Interpersonal Social Rhythms Therapy (IPSRT), a kind of mash-up between talk therapy and regulating circadian rhythms.  It gets my next few posts.

In A Nutshell... 

IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.

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

Mental Health Advocacy -- The Funner Version


Okay, last week was weird.  That's what you get for reading a mental health blog written by an Episcopal priest.  You never can tell when Jesus might interrupt with, No, what would I really do?






As it happens, that is where Gandhi got his program for freedom fighting, from Jesus.

First they ignore you.
Then they laugh at you.
Then they fight you.
Then you win.

There's a Lenten meditation for you.  Overlay Gandhi's road map on the birth, ministry, death and resurrection of Jesus.  Gandhi taught us to do what Jesus would do, what he really did do.

But not all of you are Christians.  Not all of you follow The Way.  Not all of you even follow my train of thought!  What does death and resurrection have to do with mental health advocacy?

Well, never mind.  The post stands on its own, as the tried and true program for addressing oppression, the institutional arrangements that support an unjust system.

This week's post turns to a different path, what we think of as stigma-busting.  But I have come to suspect that the word stigma itself conveys the stigma it is trying to bust.  It directs attention away from the stigmatizer and toward the stigmatizee.

No, what I am talking about is flat-out prejudice, the irrational thoughts and feelings of individuals.  Focus on the person who has irrational thoughts and feelings.  How can we help him/her get over these nonproductive and painful experiences?

This path parallels last week's -- we're all headed in the same direction.  But this one you can travel while wearing designer shoes.  In fact, designer shoes might just be the ticket!

Come Out, Come Out, Wherever You Are

First step, come out.

See, if all you know about African Americans are those cop shows, all you know about Islam is Osama Bin Laden, and all you know about people with mental illness is Jared Lee Loughner, then you are not going to want to live next door to a black person, let your daughter date a Muslim, or hire a person with a mental illness.

People want to stay away from people that they think are dangerous.  This is because our brains are hard-wired to help us survive.  This is a good thing.

The problem comes when people's estimation of danger is out of whack, when they think that a whole class of people is dangerous, and when those thoughts do not have a basis in reality.

People whose fears are out of proportion to real risk need our help.  They need evidence if they are going to change what they know.  You can cite statistics until you are blue in the face.  But the most persuasive evidence is personal.  They need a face.

What does Jared Lee Loughner have to do with your child's kindergarten teacher, the kindest, gentlest person you know?  Or your Uncle Charlie, funny, generous, hard-working?  Or your roommate from college, who really struggled freshman year, and still does on occasion, yet runs a successful business anyway?  Jared is one lost soul who didn't receive the help his parents tried hard to find, and whose story could have been so different -- as demonstrated by the evidence of all these other people with mental illness whom you know.

NKM2.org


Remember these guys?  They are Joey Pants Joey (Pants) Pantaliano's bid to make mental illness as cool and as sexy as erectile dysfunction.

That's right.  Joey Pants (The Sopranos) has major depressive disorder.  And he wants the rest of us loonies to come out of the closet, too.  I described his No Kidding, Me Too campaign last October.  He represents the funner version of mental health advocacy.

Joey has a bracelet with the birds on it, a cute little way to identify yourself.  Go here to buy one.  If these bracelets catch on, then when you see somebody wearing one, you say, No Kidding?  Me, Too!  When somebody else asks you what your bracelet means and you explain, their response, one chance out of five, will be No Kidding?  Me, Too!  Or, No Kidding?  My Brother, My Boss, My Priest, My ... Too!

One brief exchange at a time, people learn that people with mental illness live and work and function and add quality to life all around them.  We are no more dangerous than anybody else.  That is not only a cold hard fact, it is also the experience of people who know people who have a mental illness.  And a number of us are rather fabulous!

Got it?  For those of you who are not ready to set a trash can on fire (last week's post on oppression), you can wear a bracelet.  You can come out and be one of many people your neighbor knows who have a mental illness and sometimes exhibit symptoms and usually get the lawn mowed anyway. 

NKM2 Needs Some Bipolar Help

It's a great idea, potentially cool and sexy.  But somewhere the program got hijacked.  Each of us has our abilities and our disabilities.  And Joey needs an assist, assigning the right task to the right section of the DSM.

That is Prozac Monologues' task for the day, to get these birds back on track.

To start: Joey's medallions come in 144 combinations of colors and finishes and a twelve page catalog from which to choose even more medallions.  My guess is he handed the bracelet job to somebody with Asperger's, who can see every potential option and wants to make each one available.

You always want to have somebody with Asperger's around to find the option outside your neurotypical box.  That person might redesign your computer platform, or notice the pothole that will break your axle if you don't swerve now, or find the resource you never dreamed existed, or restate the problem so the solution is both easy and joyous.  You always want to have an Aspie around.

My Aspie friend says, Give the Aspies the money.  Tell us the rules, and we will make sure they are followed.

But this medallion thing falls into marketing.  Go to the bipolar spectrum for marketing.

The Silver Ribbon Campaign

So maybe you have noticed there is a ribbon for every cause you can think of and many that you have never heard of.  A cloud ribbon for Congenital diaphragmatic hernia?

Nobody is in charge of this ribbon thing.  In our field we already have orange for ADHD and for self-injury, checked (they call it jigsaw) for autism, yellow for suicide, white for gay-teen suicide, green for mental health and for childhood depression, purple for dementia, silver for mental illness and for brain disorders.  A marketing nightmare.

Marketing 101: Get yourself a message.  Attach a brand to it.  Stick to it.

So we need a ribbon.  One ribbon.  One color that umbrellas all the rest.  Prozac Monologues here and now declares the color -- silver.  Just because I said so, that's why.

No, not just because I said so.  My eye is on the platform.

The Oscars.  The Emmys.  The Grammys.

We need a color that is Oscarlicious, that will stand out and look fabulous on tuxedos and those designer dresses.  We need a color that designers will design around.

AIDS awareness soared when the red ribbon became the de rigour fashion accessory at the Oscars.  The entertainment industry knew that AIDS was their issue, and they got on board.

Even more so, mental illness.  If suddenly tomorrow, the entire planet went neuro-normal, comedy would die.  Just die.  Ditto any other writing, music and set design.

So, one color for the bracelets.  One color that will take over the award shows and establish our brand.

Fire That Guy!

Next, the latest NKM2 PSA features solemn music against words on a screen about how few people with mental illness commit violent crime, alternating with video of police cars and ambulances at the sight of the shooting in a Tuscon shopping center.  WTF?!?!!  I don't know who is responsible for this marketing mess.  But fire that guy!  Or rather, channel his/her energies in a different direction.

In a nutshell: Confucius said A picture is worth a thousand words.  Maybe it was Confucius.  He usually gets the credit, sometimes Napoleon Bonaparte.  Anyway, a moving picture with *flashing police lights* is worth a whole lot more words than a mere one thousand.  It does not matter the teeniest, tiniest bit that the text says we are not violent.  The picture shows something very different.

There is nothing cool and sexy about Jared Loughner.  I don't want to live next door to him, either.

Recall NKM2 To Its Mission

Most of NKM2's videos feature depressed people ruminating about stigma.  It's what depressed people do best, ruminate.  Which is why they don't belong on camera unless they are acting.  Let's get back to cool and sexy! 

Mount Rushmore And Marilyn Monroe

So let's we put those loonie birds to work in a new PSA!



One bird says to the other, I have a mental illness.  The other: No kidding -- me, too!!

Then Joey says to the camera, I have major depression.  Abraham Lincoln answers from Mount Rushmore, No kidding -- me, too!  (Monty Python can do that moving jaw bit.)  Buzz Aldrin in his space suit chimes in, No kidding -- me, too!  Next up, J.K. Rowling, Where do you think the dementors came from?

Back to Mount Rushmore.  Teddy Roosevelt says, I have bipolar, to which a flying nun Patty Duke answers, No kidding -- me, too!  Charlie Pride can sing it.

Green Bay Packer Lionel Aldridge steps up to the line and says, I have schizophrenia.  Picture of John Nash and caption, receiving his Nobel Prize in Mathematics, with voice-over, No kidding -- me, too!

Jane Pauley, I have a mental illness.  Then pile on the animations, illustrations, faces speaking to the camera, No kidding -- me, too!  Harrison Ford, Beyoncé, Patrick Kennedy, Ann Hathaway, Amy Tan.  Include an apple falling on Isaac Newton's head.

Joey's voice comes on again, on top of photo after photo of famous and not so famous people in daily life: In science, the arts, government, business, sports, people with mental illness make valuable contributions to your life every day.  Your teachers, doctors, clergy, barristas, mechanics, neighbors, coworkers, one out of every five has a mental illness.


And the closer -- surely somewhere in Marilyn Monroe's body of work, sometime that breathless voice utters those now immortal words, No kidding -- me, too!

Are we getting closer to cool and sexy now? 

Coming Out As Evidence-Based Stigma-Busting

But coming out is scary!  Bad things will happen to me if people know I have a mental illness!

I can't argue with that.  I don't know what will happen to you.  There are ways to protect yourself.  I expect that Prozac Monologues will address this topic in the future.  This post is on how to help prejudiced people become less prejudiced.  And the research supports me here.  The more experience the general public has with people who have mental illness, the less prejudice.

Notice, I said experience.  Not knowledge.  Knowledge hasn't helped.  Experience does.

Personal Experience Mitigates Prejudice

Here is a study that shows familiarity breeds respect.  208 community college students, of diverse backgrounds and ages, were asked about how familiar they were with people who have a mental illness, whether that exposure was from movies, documentaries, work with, work for, friend, family member, own life.  They answered questionnaires on their estimation of how dangerous people with mental illness are, their fears of people with mental illness and their desire for social distance (whether willing or not to work with, live near, or associate with people with mental illness).

Sure enough, the closer the contact, the less expectation of danger, less fear, less desire for social distance.  And note: when you are asked whether you work with or live next door to somebody with a mental illness, the real questions is whether you know that you work with or live next door to somebody with a mental illness.

Strategies For Reducing Prejudice

These findings are consistent with a large body of research over a long time about how people who are familiar with members of a stigmatized group have less prejudice toward that group.  The following paragraph is quoted from the report.  You can find references for each point in the original.

Social psychologists have examined several variables that are relevant to ethnic prejudice and that could be adapted for research on contact with and stigma surrounding persons who have mental illness.  One important variable that affects contact is opportunity: members of the majority must have opportunities to interact with members of minority groups if stigma is to be reduced.  Thus persons who have serious mental illnesses must have formal opportunities to contact and interact with the general public.  Other factors that augment the effects of interpersonal contact include treatment and perception of the participants as equals by members of the public, cooperative interaction, institutional support for contact, frequent contact with individuals who mildly disconfirm the stereotypes of mental illness, a high level of intimacy, and real opportunities to interact with members of minority groups.  Each of these factors suggests specific hypotheses on how contact between members of the general public and persons who have serious mental illness can be facilitated.

These citations are for ethnic prejudice.  One's ethnicity is usually more observable than one's medical status.  Gay and lesbian people have gotten the same results with the same strategies -- by bringing their membership in a stigmatized group to the awareness of their friends, family, coworkers, neighbors, fellow church members, golf buddies...

So Come Out, Come Out, Wherever You Are

All you have to do to reduce prejudice against people with mental illness is be one.  Out loud.  We need every one of you who possibly can to come out.  We need family members and coworkers and neighbors and friends to talk about you, too.  We need to start laughing at the stereotypes and at the people who hold them.  We need to be out loud proud of our recovery.

Because there is a lot at stake here.

Silence = Death

icon of Christ Pantokrator in public domain
photo of Mahatma Gandhi in public domain
photo of Dorothy's ruby red slippers by Alkivar, used under the GNU Free Documentation License.
photo of kindergarten teacher in public domain
photo of Oscar Su Sfondo Rosso by Idea go
photo of Harrison Ford as Indiana Jones by John Griffiths and used under the Creative Commons Attribution/Share-Alike License
photo of Mount Rushmore by Kimon Berlin and used under the Creative Commons Attribution/Share-Alike License
photo of Charlie Pride in public domain
portrait of Amy Tan by David Sifry and used under the Creative Commons Attribution/Share-Alike License
screen shot of Marilyn Monroe in public domain

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