Neuroscience of Meaningful Work

Fourteen years ago, I was offered a new job, Missioner for Ministry Development.  What's that?  Sometimes I said, I consult with organizations undergoing paradigm shift.  Other times I said, I do what Paul did.  Depended on the audience.

The details don't matter.  What does matter is that I got up every single morning rejoicing at what I felt privileged to do that day.  I considered it the job I was born to do.

Well, yes and no.  It combined my burning passion for advocacy, my deep appreciation of small congregations, and my abiding love for the highways and byways of Iowa, Beautiful Land, as the native inhabitants called it.

On the other hand, it gave me intense fourteen hour work days, conflict with long time friends, people across the state who piled their hopes, dreams and desperations on my back and the resistance of those who value certain aspects of an institution that others can no longer afford.  When we mixed all that with second generation antidepressants -- Keep trying, the doctors and my therapist said -- my bipolar II went into hyperdrive.  I was both madly productive and plain old mad.  It was beautiful.  It was ugly.  It didn't last.

Ellen Frank says that people with bipolar need to deal with grief for the lost healthy self.  It's one of the interpersonal issues that sabotage our adherence to the regimen required to maintain recovery.

Stages of Recovery - AKA Hope

It gets better.  It really does.

People who get tired of the Chemistry Experiment go off their meds.  Why?  Because the meds don't work.  Or they make us sick.  And the doctor doesn't hear us, because the doctor has one tool in his/her toolbox.  [Hint: It's not an ear.]  And he/she thinks that the solution to our problem is compliance, because there isn't time for listening and problem solving.

When you walk into a hammer store, they will try to sell you a hammer.  Fair enough.  If you are trying to rebuild the life that your illness took from you, chances are you will need a hammer.  Chances are you will need some other tools, as well.

The doctor doesn't have those other tools.  But they are out there.  And so is the map.

You are angry that the meds promised what they could not deliver.  Get over it.  Pull out the map.  Or the toolbox.  Mixed metaphor.  Whatever.  Get over it.  Get to work on your recovery.

The Recovery Map

Recovery - From What?

Recovery is the individual lived experience of moving through and then beyond the limitations imposed by the disorder, by the world around us, and even by the treatment itself.

Huh?

Okay, the deal is, unless you know where you are going, it's tough to get there.

Recovery Defined as Escape from the Symptom Silo

The docs know where they want to go.  They want to get rid of your symptoms.  Your illness is defined by a list of symptoms, found in the DSM and measured by survey instruments, and when you score in the normal range, then you have recovered.

Which is sort of like saying that if you don't have chest pain or shortness of breath, then you have recovered from heart disease.  Cardiologists don't think that way.  They want to know the condition of your heart, not just your symptoms.

Recovery Redefined

 The Medical Model Failed

We got sick.  Well, we were already sick.  We sat in the doctor's office, while the doctor quizzed us about our behavior, sorting out where we belonged in the DSM's symptom silo.

Next the doctor enrolled us in The Chemistry Experiment, prescribed the chemicals that were supposed to reduce those behaviors.  Not fix our brains, mind you.  Nobody has been testing whether these chemicals fix our brains, just whether they change our behaviors.

Recovery - The Medical Model Continued

Last week I began scavenging my upcoming Mental Illness Awareness Week presentation Recovery: Rewiring the Brain for a series of blog posts.  I left you in the middle of the Medical Model.  The graphic is on the left.  The narrative left off as the person with the broken brain was reading the patient information sheet, gulped at that list of side effects, remembered the doctor said she should weigh her costs and benefits, and then discovered that, according to the patient information sheet, the doctor had already done the weighing for her, and all she had to so was swallow the damn pill.

The Chemistry Experiment

The way it actually happened was this.  The sixth antidepressant my doctor wanted to try, she said, I get really good results with this medication.

So I wanted to know, remembering the results I got from her last brilliant idea, or rather, from the samples she had just received from the last sales rep, What kind of results will I get?

Recovery - The Medical Model

My Latest Obsession Begins

It was a talk intended for a general audience.  Well, what was assumed to be a general audience.  Not many doctors attend the monthly meeting of NAMI Johnson County.  But some people in the room know a lot more about the brain, what goes wrong, why, what can be done and what really works than the average viewer of those Zoloft ads on TV.  We have to.  We have come to understand that our lives depend on it.

So when the new director of the psychiatry department explained it all, some of us caught the nuances, and squirmed in our seats.

What Is Recovery?

Seventeen Keys to Recovery

Margalea Warner is one of my partners, along with Carol Porch, for a Mental Illness Awareness Week presentation in October, Recovery: Rewiring the Brain.  Margalea is active in the Mennonite Church in Iowa City.  They have been supportive on her journey in recovery.  She says there were some years when she was hospitalized so often she bankrupted their flower fund!

This week I am reposting her recent contribution to ADNET, Anabaptist Disabilities Network.  Margalea's story is one of those lights I hold up when things get dark.  I hope it shines for you, as well.

Keys to Wellness and Friendship -- by Margalea Warner

On August 12, 2012, a group of my friends gathered at the home of my friend Becky for a celebration of two major life milestones.  My friend Sherry had achieved twenty-two years of being clean and sober.  I had reached the milestone of seventeen years outside the locked psych ward.

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

Kayla Harrison Survives Her Way to Gold

She's calling me out of sabbatical.  Damn!  She's calling for a series.  I'll have more next week.

Note added on 01/02/13 -- Links to other posts in this series are below:

Is Recovery Possible? - Kayla Harrison Continued August 25, 2012 -- The judo champ's story introduces the concept of recovery.
Seventeen Keys to Recovery August 30, 2012 -- Guest blogger Margalea Warner describes her journey in recovery in schizophrenia.
Recovery - The Medical Model September 7, 2012 -- Introduces the doctor's agenda, covers the first half of the story.
Recovery - The Medical Model Continued September 14, 2012 -- It was a great idea.  If only it worked.
Recovery Redefined September 21, 2012 -- People with a mental illness have our own definition of recovery.
Recovery - From What? October 1, 2012 -- You have to know where you are going if you want to get there.
Stages of Recovery - AKA Hope October 5, 2012 -- We recover in stages, and need different tools for each stage.
Neuroscience of Meaningful Work October 10, 2012 -- Oh goodie!  Here come the dendrites!
Hope for a Cure? Or Not? October 18, 2012 -- We finish the series with questions left unanswered, like, What is a cure worth?

Purple Heart for PTSD

I am pleased to have scooped NAMI and Fox News on this one by two years.

Some people say we have dumbed down PTSD, and that we dishonor the suffering of soldiers when we give the diagnosis of PTSD to people who have the same symptoms and same brain dysfunction of PTSD, but whose traumas were of a lesser severity.  In other medical departments, a broken leg is a broken leg, whether the person fell three feet or thirty.

Back in May, 2010 I proposed that the way to honor soldiers whose PTSD is the result of war injury is the way we honor any soldier wounded in war -- the Purple Heart.

Better yet, let's honor their sacrifice by preventing their trauma in the first place.  No more!

Meanwhile, check out Guitars for Vets.

NAMI Camino - BDNF Meets 5K

Exercise and learning new things -- two of the most powerful tools in the Recovery Toolbox.  They came together in my NAMI Camino, April 28, 2012.

NAMI Walk/NAMI Camino gave you the set up.  NAMI Johnson County held its annual walk/fund-raiser last week, when I was in Costa Rica.  It would be my fourth and last time participating.  But I would be in Costa Rica!  Inspired by the San Diego Walk in 2010, when a battalion in Iraq ran while San Diego walked, I decided to do Johnson County's Walk long distance -- though I would not be running in full battle armor and in the heat of the day.  My extra effort was confined to carrying a laptop to record the event.

With the following results:

So what follows is a series of installments, stopping at each kilometer marker.  This series shows you what you can do with Photo Booth, Youtube, not much skill, and a willingness to experiment.  Everything is reversed, left and right, which won't confuse you unless you are trying to read t-shirts or street signs.

NAMI Walk/NAMI Camino

I started a new project today, researching the route for my NAMI Camino.

I Walk For The Mind Of America

April 28 will be my fourth Walk to raise funds for NAMI (National Alliance on Mental Illness).  I have been most gratified by the support from friends who help me give back to this organization that has made such a difference in my life, and hundreds of thousands of others.

History Of NAMI

Since its founding in 1979, by a bunch of uppity Wisconsin women who said There is no such thing as a schizophrenic family; we did NOT cause our children to have this devastating BIOLOGICAL disease, NAMI has been a beacon of light, education, advocacy, and support first to families and then to persons living with mental illness.

My History With NAMI

In my case, Peer to Peer, a 10 week class helped me to understand, come to accept, and learn skills to live with my illness, whatever they think it is this week.

The Stages of Change and Weight Loss

Continuing the thread from last week, the average person in the US dies sooner than the average person in forty-nine other nations of the world.  Our higher death rates are linked to our astounding rates of overweight and obesity.  People with severe mental illness die even earlier, 15-25 years earlier.  We have the same life span as the people of Sudan.  The same things kill us as kill everybody else, heart disease, stroke, diabetes, cancer.  They just kill us sooner, because even more of us are overweight and obese.

Side bar: I have growing difficulty using the term mental illness, because I think the term leads to an artificial bifurcation of mental and physical illness.  The weight issue is a case in point.  Most psychiatrists accept the biological model of mental illness, that our diseases are brain diseases.  Nevertheless, most consider the physical aspects as outside their purview.  As a consequence, the part of our disease that is going to kill us does not get treatment.

Weight issues are a case in point.  Psychiatrists hand us prescriptions for medications that cause ballooning weight gain and off the chart cholesterol levels along with the pro forma reminder that we won't gain weight if we don't eat more than we expend in energy.  So all we have to do is eat less and exercise more.

This kind of help doesn't help anybody, regardless of mental status.  Here, as in any other aspect of our recovery, we are on our own.

Weight Loss Programs - Hah!

The temptation is to buy the promises of the commercials that flood the airwaves each New Year.  Here is the deal.  These promises are less verifiable than the ethically-compromised promises of your medications.  But what studies that have been done indicate a relapse rate of at least 50% weight regained within a year or two.

Bottom line, diets don't work.  You have to change your life.  And to change your life, you have to change your brain.

Luckily, you can change your brain.  You just have to understand how.  You have to take the time that it takes.  But you can change your brain.

++++++++++++++++

From Thursday, June 30, 2011 and edited a bit: 

Habit and the Stages of Change

I have been writing for several weeks now [June, 2010] about this mass of electrical activity inside our brains, dendrites and nerve endings, meeting at synapses, passing their spark from one neuron to the next, creating -- what?  A wink, a whisper, a sensation, the next big brainstorm.

Most of these connections could be called, in the widest sense, habits.  By habits, I mean that pathways get used over and over, form patterns, become familiar, channel us to certain outcomes.  Most bypass the frontal cortex, requiring no thought.  Like breathing, smelling, salivating at the cinnamon.
 

Most of the remainder are still automatic.  But with effort, they can be brought to consciousness where the frontal cortex could interfere, and a decision made.  Like blinking.  Or picking up the cookie somebody brought to the meeting.

What if you don't want to pick up the cookie?  Okay, you really do want to pick up the cookie.  What if you want to not pick up the cookie anyway? 

How Do You Change A Habit?

You're gonna take more than one step.

Last week, I put some numbers out there, the Wahls diet.  Nine cups a day of vegetables and fruits.  I broke it down for you: 3 cups leafy greens, 3 cups cruciferous veggies, 3 cups intensely colored.

This food plan helped Dr. Terry Wahls reverse her secondary progressive MS and get up out of her wheelchair.  It could help you reduce your symptoms of heart disease, lung disease, asthma, hypertension, depression, obesity, bipolar disorder, diabetes, Alzheimer's or Parkinson's.

If you have, or are tending toward any of these chronic diseases, you have already heard your doctor/mother/spouse tell you that you need to improve your diet.  Dr. Wahl's book, Minding My Mitochondria tells you just how much and why. 

Nine cups a day of vegetables and fruits:

3 cups leafy greens
3 cups cruciferous veggies
3 cups intensely colored

Stages Of Change 

So there is your canyon.  Here are the steps, more than one.  Several, in fact.  The steps are known as the Stages of Change.

The Stages of Change model appears all over the place lately.  This article from the journal American Family Physician uses the Stages to help physicians help their patients, something more effective than Just do it.  A Youtube search yields results for addiction recovery counselors, life coach trainers, weight loss clinics.

Different sites number the stages differently.  Some say Precontemplation is Stage 0.  Some give Relapse its own number.  Some add Transcendence, whatever that is -- said the priest who gets cynical when quasi-religious language gets used for the purposes of self-improvement.  Whatever we are supposed to transcend, evidently it is not our desire to improve ourselves. -- But I digress.

I like this site, which is the source of the graphic above, even if the author does use that word Transcendence that made me twitchy there for a minute before I got back on track.  It works through the stages from the perspective of the person who is making the change, not the person who wants somebody else to change. 

Crossing Canyons/Building Bridges In My Brain 

Dr. Wahls calls it a diet.  I don't diet.  Who wants to DIE-t?   Each chocolate chip cookie left on the plate represents a little death.  A diet is a temporary interruption.  When it ends, you go back to your life.  But there is nothing temporary about the nutritional needs of my mitochondria, without whom there would be no life.

I'm into changing my brain.  In that mass of electrical wiring, some potentially healthy pathways are blocked by the detritus of dead dendrites.  Other destructive pathways are carved into canyons of well-worn automatic responses. 

Changing my brain will take time.  It is taking decades.  It will take at least another blogpost. 

And The Word Became Flesh 

Question: What do the Stages of Change have to do with Prozac Monologues? 

Answer: Words.  The Stages of Change use language to shape the brain.

Language is one kind of pathway from neuron to neuron.  It connects electrical impulses from the autonomic systems, the olfactory nerve, the amygdala, through the hippocampus (memory and emotion) and the anterior cingulate cortex (pattern seeking) and into the frontal cortex (conscious thought).

Language is how all this electrical activity gets turned into meaning.  It is where the brain and the mind become one. 

The Stages of Change include a process of changing our patterned thinking about food.  And thinking is how we move from one stage to the next. 

Dr. Wahls writes about synergy, how exercise and diet work together to heal her myelin and reduce the symptoms of her MS.  I'm thinking the same process works for changing habits, particularly food habits.  Each new behavior reinforces the preceding thought that moved you to the new stage.  That repeated behavior patterns the thought that will move you to the next stage. 

Meanwhile, what you are eating while you are trying to make any change matters.  Your mitochondria need the right materials to build the dendrites that form the new pathways.  Like lunch for the road crew.

So don't try to skip stages.  And don't skip broccoli.

One of these days I will write my own food autobiography, my trip through these stages.

+++++++++++++++++++++

Back to New Year's, 2012 

Pre-Contemplation 

The good news is, you have already moved past Stage One, Pre-Contemplation.  I presume you have moved past Stage One.  Pre-Contemplation is when you don't really think you have a problem. And why would you still be reading this post if it wasn't your problem?  So you have already made progress! 

Contemplation 

But don't try to jump that canyon.  Don't go from I have a problem to New Year's Resolution: no more cookies.  It is January 3rd, and that resolution is probably already in the toilet.  We are not talking about the New Year here.  We are talking about your life.

One step at a time.  Make a list.  Make it as long as you can.  Why do you want to change?  What difference would this change make in your life?  Go deep here.  Screw those little graphics with the magically shrinking ladies that show up in your Facebook sidebar.  What is at stake for you?  This is no longer a game.

Read that list every day.  That will help the re-patterning process.

That is enough for this week.  You have homework to do.  I have my life to get back to.

Happy New Year!  Happy Long Life!

No New Year's Resolutions - Change Your Life December 29, 2011 -- Overweight is a major health issue, the largest contributing factor to early death for people who have mental illness.

My Food Autobiography and the Stages of Change March 8, 2012 -- Pre-contemplation and contemplation.

Changing Food Habits -- Contemplation and Preparation March 15, 2012 -- Reviews The End of Overeating by David Kessler and introduces the brain science of the sugar/salt/fat trifecta.

Dopamine -- Can't Live Without It March 23, 2012 -- The brain science behind habit formation and an experiment to try.

Preparation/Action -- Reprogramming Your Brain for Healthy Eating April 26, 2012 -- How to change a habit.

Relapse/Maintenance -- Stages of Change May 24, 2012 -- Review and finishing up the series.

photo of salmon in Ketchikan Creek by Wknight94 and used under the terms of the GNU Free Documentation License 
photo of Women Working at a Bell Telephone Switchboard from the National Archives and Records Administration and in the public domain

photos of Hatherton Canal in Staffordshire by Roger Kidd, Coal Creek Falls by Walter Siegmund, Glen Canyon by Sascha BrückJeff Kubina used under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Stages of Change graphic was created by Todd Atkins, who placed it in the public domain

No New Year's Resolutions - Change Your Life

Weight Loss For Sale

It's all done with computers.  Automatically, 12:01 AM !2/25/2011, the Target ads disappear from television screens and Facebook sidebars, the Jennie Craig ads go up.  Next morning, the Lifestyle section of the newspaper switches from appetizer and eggnog recipes to yogurt and exercise programs.  After months of selling excess, now it is time to sell restraint.

How did it work for you last year?  It worked really well for the media.  How did it work for you?

You can't buy change.  And sure as one set of ads replaces another at 12:01 AM, you cannot lose weight by buying a weight loss program.  You yourself, not just your body but even your brain has to change.

Meanwhile, Excess Weight is Killing Us In The US 

How many times have you heard that the US has the best health care in the world?  I won't dwell on that nonsense.  But clearly we do not have the best health.  Out of 221 nations, the US ranks #50 in life span.  That puts us at the 77%, a low C at St. John's Parochial School where I went, maybe a B in public school, grading on the curve.  So to speak.  Meanwhile, compare Jordan at #29, South Korea at #41 and Bosnia/Herzegovina at #45.

Those numbers come from the CIA's World Factbook, where they say Life expectancy at birth is also a measure of overall quality of life in a country and summarizes the mortality at all ages. It can also be thought of as indicating the potential return on investment in human capital.  In other words, a low C, B if grading on the curve, is the quality of life you get healthwise if you were born in the US, the country with the best health care in the world.  Who came up with that claim, anyway?

In a different but related index, the World Health Organization charts BMI, Body/Mass Index, a measure of weight in relation to height.  The US ranks #54 out of the 60 nations for which it has data, for percentage of people with normal weight, neither too heavy nor too thin.  That puts us at the 10th percentile, an F-, whether grading on the curve or no curve.  Only 36% of US citizens have a healthy weight. 

And the cost?  Cardiovascular disorders (high cholesterol, high blood pressure, heart attacks, stroke), metabolic disorders (diabetes) cancer (breast, cervical, uterine, prostate, colon, kidney...), arthritis, sleep apnea... That is the short list of health complications and loss of life associated with excess weight.  I will let you come up with your own list for what you have less of on account of what you have more of...

Excess Weight Is Slaughtering Those With Mental Illness

Meanwhile, back in Prozac Monologues Land, people with severe mental illness beat out the rest of the population in the race to break the scale.  Clinical studies have reported rates of obesity in patients with schizophrenia or bipolar disorder of up to 60%.  That compares to 34% in the US population, a number that already staggers the imagination as it is.

The reasons for the difference are many:

• The most common medications for these disorders, lithium and antipsychotics, especially the new ones are notorious for weight gain.  It is surmised that the weight gain comes from disrupting both metabolism and the neurotransmitters that regulate appetite.

• But medication-naive patients also have a higher risk for overweight and obesity.  The negative symptoms of schizophrenia and the depression-part of bipolar (lack of interest, inability to feel pleasure) lead to more sedentary lifestyles and more weight gain. 

• From the Damned-If-You-Do-And-Damned-If-You-Don't Department, the medications for schizophrenia and bipolar mostly reduce the positive symptoms (delusions in the case of schizophrenia, high energy in bipolar - the symptoms that scare your families and your care providers who write the prescriptions).  They tend to increase the negative symptoms (thereby relieving the anxieties of your families and your care providers who write the prescriptions), providing that synergistic effect that nails you to the sofa.

• There may be pre-existing genetic connections between what is considered two different conditions, overweight and mental illness.  The DSM defines mental illnesses on the basis of certain symptoms.  It does not describe what is actually going on inside the body to produce the symptoms.  Metabolism, energy levels and regulation of appetite are all controlled by parts of the brain, often with genetic predispositions.  While these are included in the symptom lists for mental illness, they are not the defining symptoms targeted by treatment.

Add it all up, what do you get?

People with severe mental illness die 15-25 years before the US national average.  Rwanda beats us.  We have the life span of people born in Sudan.

What do we die of?  No, suicide is not a significant factor in this equation.  We die of cardiovascular disorders, metabolic disorders and cancer.  Just like everybody else who weighs what we weigh.

What Are Our Doctors Doing To Save Our Lives?

Our doctors are doing their best to prevent symptoms of our mental disorders, the scary symptoms, hallucinations, delusions, too much energy combined with poor judgment that get us into trouble with the law.

They are not doing anything about what is going to kill us.

Well, okay, they are psychiatrists; they treat psychiatric disorders.  They are not general practitioners nor weight-loss specialists.

So here are two more reasons embedded in the US health care system that contribute to our lethal obesity.

• Notwithstanding that excess weight is a symptom of our disease and also a side effect of treatment, our psychiatrists consider our weight issues to be none of their business.  Never mind how significant this unaddressed health issue is when it comes to whether we are even willing to take the meds they prescribe.

• People who have mental illness are less likely to have health insurance.  We are less likely ever to see any doctor other than the one at the community mental health center who is treating our mental illness.  Not to mention access to weight loss programs.  Not to mention money for fresh foods or exercise programs.

The upshot: what are our doctors doing to save our lives?  Precious little.

Okay, having said that, some doctors are doing more.  My doctor listened when I told her my family medical history, that everybody in my family dies of heart disease, that my younger brothers had heart attacks at age 55 and age 29.  When I said I would not take Seroquel unless I was psychotic, she paid attention.  She tried to find meds that are weight neutral that I could tolerate.

But from the things I have written lately about my current psychiatrist, my readers who have real life experience with psychiatrists know that she represents a minority in the profession.

We Have To Lose Weight Anyway

What most patients get from most doctors is the pro forma reminder that we won't gain weight if we don't eat more than we expend in energy.  So all we have to do is eat less and exercise more.

There.  Their responsibility has been discharged.

Here, as in almost every area of our recovery, we are on our own.  Recovery is up to us.

We have to lose weight anyway.  We have to.  It's our hearts, our blood vessels, our pancreases, our knees and hips, our brains, our lives, 15-25 years worth of our lives that are at stake.

 

We will be swimming upstream, up against the forces of whatever is going on in our genes, our dopamine channels, our pineal glands, our medications, our lack of health care, our poverty.  So?  Salmon swim upstream all the time.

Salmon are programmed to swim upstream.  We have to program ourselves.

A New Year's resolution will not change the program.  Did it last year?

So here comes a series on reprogramming our brains.  It is a series, because we have to take it step at a time.

Word of encouragement: If you made it to the bottom of this post, you are probably already past the first step.

Who knows, maybe this series will carry us past the New Year's/Jennie Craig/NutraSystem et al season and up to the Super Bowl/Bud/Doritos season!

Note added, 01/02/13 -- The following are links to the rest of this series:

The Stages of Change and Weight Loss January 3, 2012 -- How do you change a habit?

My Food Autobiography and the Stages of Change March 8, 2012 -- Pre-contemplation and contemplation.

Changing Food Habits -- Contemplation and Preparation March 15, 2012 -- Reviews The End of Overeating by David Kessler and introduces the brain science of the sugar/salt/fat trifecta.

Dopamine -- Can't Live Without It March 23, 2012 -- The brain science behind habit formation and an experiment to try.

Preparation/Action -- Reprogramming Your Brain for Healthy Eating April 26, 2012 -- How to change a habit.

Relapse/Maintenance -- Stages of Change May 24, 2012 -- Review and finishing up the series.

clipart and photo of school paper from Microsoft

photo "Angry Father" by Akapl616.  Permission is granted to copy under the terms of the GNU Free Documentation License

photo of salmon in Ketchikan Creek by Wknight94 and used under the terms of the GNU Free Documentation License

Survival - Three Things Learned From Danny MacAskill

1.  To keep your audience, edit out most of the falls.

2.  To help your audience, keep some of the falls.

3.  Find the Iron Rule and do not break it.  In MacAskill's case -- the front wheel is for steering; you want to land on the back wheel.  In my case -- the frontal cortex is for steering; I will inevitably land on the amygdala.

A repeat from:

Thursday August 26, 2010

Tribute To Survival

This is dedicated to those who are surviving the Chemistry Experiment, and to those who hang in there with us.

Bring your courage and your hope, whatever you can manage.

And your helmet.




Thanks to Danny MacAskill and Band of Horses.

Bar Tales of Costa Rica

I need a break from upset.  Maybe my readers do, too.

Once when I was in Costa Rica, working on another unpublished book, Deep Calling -- that's my depressing book about being depressed, as opposed to Prozac Monologues, my funny book about depressed -- I needed a break from being depressed.  I took my breaks at the bar at the Pato Loco in Playas del Coco, Costa Rica.

My sister, the Voodoo Princess and proprietor of the Pato Loco also needed a break from my being depressed.  So she was delighted to learn that the Pato Loco inspired and regularly supplied material for my third book that is not published, Bar Tales of Costa Rica.  Bar Tales is not about depression.

This week we all take a break together, with the first of the Bar Tales of Costa Rica.

Shut Up, Lenny!

How are you today, Rosie?

Oh, I could use some de-stressing.  You can’t tell by looking at this big black beautiful woman in shorts, sleeveless and flip flops, but she’s running a several employee travel agency back in the States while she sits in front of her laptop in the dining room of the Pato Loco.

Rosie set up the wireless for the hotel, when she was living here while her condo in Hermosa was under construction.  That took so long, she became a member of the family, another sister.  Mama had a colorful past, we say when somebody raises an eyebrow at the introduction.  As a matter of fact, she did. 

De-stressing you need?  Let me see what I can do.  Here’s a story for you.  You know our neighbor, Lenny, the Hot Dog man?”

Yeah, I’ve been trying to buy one of those hot dogs.  Every time I go downtown, he’s never open.

No, he‘s out of business for the time being.  I guess the Pizza Hut truck had a prior lease on that lot where he had his hot dog stand.  They moved back in, what with high season coming.  So he doesn’t have a place to put his cart. 

It was a great spot, right there across from Zouk Santana and the Lizard Lounge.  Lenny said he was selling 70 hot dogs an hour between 2 and 3 AM, when the bars closed.  He said one night, he ran out of chili.  They kept buying the dogs.  He was selling them faster than he could cook them.  They bought them raw.  Four bucks a pop, chili or no, 300% profit. 

It is a triumph, that hot dog stand.

Costa Rican Developers

I don’t really care about Lenny’s success.  He’s a newbie from Texas.  And he isn’t a hot dog salesman anyway, at least, not in his head.  He says he’s a developer.  Everybody claims to be a developer.  Except me.  I claim to be a writer.  I guess it comes down to the same thing, a lot of dreams, not so much cash.  Except I really do write.  I don’t publish, but I write.  Developers seem to talk mostly, over beers at the Pato Loco, since the Bohio has been torn down for being too close to the beach, now that the tides have shifted.

The tide comes in, the tide goes out.  The beach is never the same.  They’re putting in a marina where the Bohio and a lot of other nicer bars and restaurants used to be.  I don’t cheer for developers.

What Lenny really does, or talks about doing, while the luxury condo deal is still in development, is sell vacation packages.  Ninety-five bucks buys you four vacation packages in Maui, Orlando, Las Vegas or Puerto Something.  Ninety-five bucks and a couple hours of your time while people try to sell you a time-share in Maui, Orlando, Las Vegas or Puerto Something.

The hot dog stand is the hook.  You’re cooking the dog to order, piling on the chili, the onions, peppers, cheese, and all the time talking about vacation packages, four per year, ninety-five bucks.  Except when the bars let out and you’re selling the dogs seventy per hour at 2 AM.  Not so much time to talk then.  Just, You want ketchup?  Mustard?  Mayo?

We didn’t meet over hot dogs, but on my front porch, Lenny and me, when I returned to Costa Rica this winter and said hello to my new neighbor.  He was telling me about the hot dogs when, out of the blue, You want to make a couple thousand a week?

Couple thousand what, colones?  (That’s four bucks.)

I’ll pay you twenty bucks for every vacation package you sell.

No, thank you, Lenny.  I do not want to sell vacation packages.  I do not want to make a couple thousand dollars a week.  I don’t make that much money in the States, and I didn’t move to Costa Rica to make that much money here.  I moved so I could live on what I make in the States, so I could write.  I am not a salesman.  I am a writer.

As far as I can tell, it’s a pyramid scheme.  Lenny sells this job to apparently (and in this case mistakenly so) aimless people who want to stay in Costa Rica on dreams of a couple thousand a week.  The job is to sell brochures that will lure drunks, who actually intended to buy a hot dog after they were evicted from the bars, to go to some other vacation spot, where somebody else will try to sell them time-shares, so they can come back to where some other hot dog vender, or maybe Lenny himself next year in a different location, will try to sell them some condo that he has developed, thereby justifying his self-identity as a developer.

But to pull this off, he needs the person willing to serve the hot dogs in the hopes of selling the brochures.  Since I do not want to make a couple thousand dollars a week, I do not qualify for this job.  Ironically, with a different pitch, I might be willing to help him out with his dogs.

That’s what I think Lenny really does, sell hot dogs.

Costa Rican Hot Dog Stand

And it is a triumph, not for Lenny the developer, but for our other next door neighbor, David, who bought the hot dog stand online from Canada, had it delivered to his home in Atlanta, and then shipped it through Miami to Costa Rica.

David isn’t a hot dog salesman.  He’s a pool man.  He’s also a very nice guy who made some sudden and poor financial decisions last fall.  It was a bad time in his life.  He decided that Dennis, the maintenance man at our condo, could use some extra bucks.  So David decided to set Dennis up in business as a hot dog salesman.

Except Dennis isn’t a hot dog salesman, either.  He’s a construction guy, who can do a million different things with his hands, all of them very well, but is not into handling hot dogs.  Dennis is Costa Rican and proud, and Costa Ricans are not into hot dogs, neither buying nor selling, which is why it’s hard to find a good hot dog in this country.

But both of them, David and Dennis are very nice guys, and their friendship survived this awkward spell, when the hot dog stand was taking up space outside the bodega (storage shed) next to the pool for several months, until Lenny moved to town and discovered it there while he wasn’t developing anything but his story.

I will say this for Lenny, he makes a very good chili.  And he did manage to find a vender, a German who lives in San Jose, who sells him a decent quality dog.  Not Chicago quality.  There’s no snap, none at all.  But it’s got a bit of smoke, and for Costa Rica, it’s pretty darn good.  And lots of the ex-pats (the North American ex-pats) get frustrated, looking for the hot dog stand, which often is not in operation for one reason or another.

I will also say this for Lenny – he operates on Costa Rican time.  Which is to say, he gets it open when he gets it open.  If he says 5 o’clock, don’t bother showing up until 7.  The frustrated ex-pats don’t get his business plan.  He is not into food service.  He is into money.  And he can make a whole lot of it, more than enough to live in Playas del Coco, between 2 and 3 in the morning, seventy dogs an hour, $3 profit on each one, even when he is selling them so fast he doesn’t have time to cook them.  He does not have to open when he promises or sell hot dogs during the lunch hour.

But right now he’s not selling hot dogs at all, since the Pizza Hut truck came back to town with the same business plan as far as volume and drunks go and, more importantly, the lease on his location.

We think maybe he went on a bender.  We didn’t see him for three days, but his car’s been there.  And with his muffler, we know when he moves it.  He starts it up, backs the car the hundred feet to the gate, turns off the engine, gets out and opens the gate.  I guess he only has one key chain.  Then he starts the car, pulls through the gate, turns the car off again, gets out, closes the gate, gets back into the car, starts it the third time, and leaves.  Our house is right by the gate.  So we know when he goes anywhere, since he doesn’t even walk the hundred feet to the gate.  Lenny doesn’t walk.

The Voodoo Princess, owner of the Pato Loco, interrupted, You could buy him another key chain.  She likes Lenny, and he eats at the Pato Loco a lot, since you can eat only so many hot dogs, if you want to keep selling them.

I’m telling a story here, little sister.  Work with me.  The Voodoo Princess is my little sister.  We have a diverse family.  Mama had a colorful past.

Costa Rican Neighbors

Anyway, this morning we heard from him again.  It was about 9 o’clock when he shouted, Shut up!  A couple minutes later, we heard it again, Shut up!  It took about three or four times, Shut up! before I figured this out.  Luis, the neighbor on the other side of the wall, has a mynah bird that says, “Buenas!”  The bird says it all day long, “Buenas.”

It used to bother me, David interjects from the bar where he is nursing a club soda, But I have become one with the mynah.

Yeah, now it’s just part of the sound track of Costa Rica.  But this morning it was:

Buenas – Shut up!

Buenas – Shut up!

Rosie is laughing now.  It’s good to hear Rosie laugh.  He knew he was talking to a bird?

Well, I don’t know.  Because then it became – 

Buenas – Shut the f*** up!

Buenas – Shut the f*** up!

Rosie is doubling over, He said, f***?

No, actually, he filled in the vowel and the final consonants.  Things were definitely escalating.  I wondered if he was going to go next door and throttle a mynah bird.  And then I hear it.  Our whole condo association hears it –

David knew what was coming.  He verified it, Yes, we did.

Buenas – Shut the f*** up!  Comprende?  Shut up!

She’s screaming now.  Comprende?

Comprende.  One more time, I was just about to go over there, if he said it one more time.  – Lenny, it’s a bird!  I know it’s irritating, ‘Buenas.’  [I flattened those vowels as flat as a tortilla.]  But me, I’m listening to ‘Buenas’ – ‘Shut the f*** up!’  I don’t think I’ll have much success with the bird.  So I’m going to try with the drunk.  Lenny, shut the f*** up!

So, how did that work out?

Well, I never got the chance.  Maybe the bird did comprende.  Because they both got quiet.  So, how are you feeling now, Rosie?

Thanks, I needed that.  I’m feeling a lot better.

Pato Loco logo used by permission

photo of family table at Pato Loco by Mary Cox and used by permission

photo of chili dog by LG2, in public domain

drawing of condo by tomwild, in public domain
photo of bird of paradise and front porch by author

photo of mynah bird by Dhabyany, used under the Creative CommonsAttribution-Share Alike 3.0 Unported license

NAMI Convention and the Persistence of DNA

The second of my NAMI Convention posts is about opening my heart to the other side.

History Of NAMI

Even if its origins were to be forgotten, a system does not escape the DNA of its founding.

But it is not forgotten.  NAMI began in 1979 when a mother in Wisconsin published a notice of a meeting at her house for the parents of children with difficulties.  She discovered she was not alone.  Her living room filled to overflowing by parents, desperately concerned for their children with schizophrenia.  Together they pushed back against the medical establishment that said it was their fault.  Together, they pressured for the research that revolutionized basic scientific paradigms of mental illness.  No, schizophrenia is not caused by schizophregenic families.  It is a disease of the brain.

Then real treatment began.  Better understanding about the disease led to better medications.  People were able to leave those lost locked wards.  Yes, some live in the streets today.  But some live in sheltered homes.  And some live on their own.  I know people with schizophrenia who work, who are married, who have good lives.

Okay, some have moved from locked wards in psychiatric hospitals to locked wards in jails and prisons.  More than half the residents of our jails and prisons have a serious mental illness.  But back to NAMI...

NAMI was created by and for families.  Its signature program is Family to Family, and this year's convention celebrated its 20th anniversary.  The testimonials go on for days about the difference, the support, the education and hope this program has offered a quarter of a million people so far.

Family to Family is part of the DNA and enduring legacy of NAMI.

The Miracle Of Medicine

NAMI was built on the medical model.  The medical model created the medications.  The medicines made miracles.  And that, too, is the DNA of NAMI.

Nineteen companies and organizations supported the Convention at the Logo-on-the-program level.  Nine of them were pharmaceutical companies.

A regular feature of NAMI Conventions is the Ask-A-Doctor sessions, where people line up at the microphones and get little five minute consultations on how to tweak their current medications and what else to try. There is always something else to try.

NAMI's Mission Grows

Meanwhile, people who themselves have mental illness joined NAMI.  And this part of the history I can't tell you, because we aren't celebrating it yet.

Our part of the story is different.

Families talk about the miracles of medicine.  What they want to know is how to get their loved ones to take them.  People who have these brain diseases talk about how how the medicines aren't good enough.  And we want to know about Recovery.

Recovery?

There are no biomarkers.  There are no cures.  There are no vaccines.  There is no War on Brain Disease, no national motivation, and less money for research and treatment every day.

Half of us have developed our brain disease by age 14 and 75% of us by age 25.  So we have to live with it a long time.  Granted, not as long as we might otherwise.  We die, on average, 25 years sooner than everybody else.  We have the same life span of the people of Bangladesh.  These numbers come from Dr. Thomas Insel, Director of the National Institute of Mental Health, who spoke at a special session the second night of the Convention.

We are not impressed by the Miracle of Medicine by trial and error.

So while some of us are still stuck in those Ask-A-Doctor lines, looking for a better miracle, the rest of us have gone to work on a concept called Recovery.

Recovery is the core concept of the NAMI program that didn't get mentioned at this year's convention -- Peer to Peer.  P2P is a ten week course on what to do after you have been discharged with a prescription and a follow-up appointment, what nobody told you about when they showed you the door, because frankly, they don't know about it.  Dr. Ken Duckworth, medical director of NAMI was asked about nutrition at the PTSD Ask-A-Doctor.  His response, Doctors don't learn anything about nutrition.  It's just too bad there was no Ask-A-Nutritionist session.  Because even if you have found the very best hammer in the world for your job, if you want to build a house, you will also need a screwdriver.

Recovery is about building the whole house, about living the best life possible under the circumstances.  It is about every paradigm, every treatment, every health practice and habit we can find that will improve our lot and add value to our lives, short as they may be.  It is about putting it all together and getting on with our lives. 

Recovery?

I didn't hear about Recovery at the NAMI Convention.  Well, I wasn't everywhere.  I have the dvd with powerpoints and audio, and will be exploring and reporting on what I missed.  Rumor has it that the sessions on borderline discussed therapy.  Therapy would be one of the tools in the Recovery toolbox.

There were recovery tools in evidence at the convention.  I attended a drumming circle during lunch one day, drama during lunch another day.  There was an exercise class during lunch.  Yoga was offered during dinner, a poetry slam during the party.

I expressed my regret on the evaluation form that there was so little coverage of recovery concepts, and that little bit was pushed to the corners of the schedule.  Two pages later on the evaluation form, I found a question asking me to evaluate the entertainment portions of the program, the drumming, the drama, the yoga...  Entertainment?

So, yes, people living with mental illnesses are part of NAMI and were present at the convention.  But we are still at the kiddie table.

Parents With Adult Children With Schizophrenia

So there I was, at  the end of the Stars of Light Theatre Troupe's amazing performance, when the players were introducing themselves.  It was Saturday, the last day, and I was feeling irritated by the organization of the conference and its emphasis on pharmaceuticals, even while speakers recognized they don't work that well.  (I haven't even mentioned the previous night's major speaker slot given to the guy who has a book and a treatment plan for how to get people to take their meds.  That was offered and addressed to family members entirely, while the rest of us were invited to a movie... Now in an of itself, it raised some excellent issues -- but I am talking about a pattern here, a deeply encoded pattern.)

Evidently, this irritation of mine is because I have bipolar, and when people with bipolar experience something that doesn't seem right, we get irritated and complain because we have a sense of entitlement.  Duly noted.

Somebody asked if being in the troupe helped the players deal with their symptoms.  That would be a recovery-type question, and why I would not have thought to call this presentation part of the convention's entertainment.  And one woman answered, Not only do I have bipolar and borderline and some other things, my son also has bipolar with psychotic features.  I don't know where he is right now.  Without this group, I don't know how I could manage.

So I was flipping madly through my program looking for an empty space where I could write down her words, because I knew I needed to remember them.  I saw, and with this woman's words in my head the eyes of my heart were opened so that I saw, that half of Thursday morning's sessions had been given over to estate planning.

Estate planning.  At a mental health conference.

My wife and I are doing retirement planning right now, a little concerned about how we will manage to make that money last as long as we do.  We are not doing estate planning.  Because we don't need to.  Our son does not have schizophrenia.

Then a woman stood up in the audience and expressed her support of the first.  She said, I am not worried about my son this weekend.  Because I do know where he is.  He is in the hospital.

I thought about my son.  I know where he is.  He is living with his most excellent wife, getting a PhD at a major university and doing the thing he loves best, teaching.  That's a Phi Beta Kappa cord around his neck in this picture, taken the day he graduated from college.

Broken Hearts

And these words, which I command thee this day, shall be upon thy heart. -- Deuteronomy 6:6.  The student asked the rabbi, Why on?  Why not in?  His answer, That way, when your heart breaks, it will fall in.

NAMI is about broken hearts.  The DNA of NAMI is mother love.  Does a mother forget her baby, or a woman the child within her womb?  Being a mother, I know there will be no forgetting, no changing what NAMI is about.

It will take time and tears, no small irritation, some shouting, experiments, mistakes and careful negotiation for people with mental illness to take our place at the grown-up table.  Somehow in that process, we will have to take care of our mothers.  Because they do not forget us.

It's just that, some of us do not have such parents.  And even the others grow up.

graphic of clozapine's chemical formula by Harbin and in the public domain

photo of Thomas Insel, Director of NIMH, in public domain

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

ceramic of children playing by Hannie Mein and used under the Creative CommonsAttribution-Share Alike 3.0 Unported license
photo of graduation day by Jenny O'Day