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.
Weighing the Costs and Benefits Part I -- What Counts?
If I am a lab rat, I will be a free-range lab rat.
There. I feel better already.
To recap from last week:
You Have to Weigh The Costs and Benefits
That is what the doctor says.
Last week I promised I would develop a way to do that. So this week we play math games. For the next few weeks, actually.
Now, don't freak out. I am not going to ask you to do math. I am going to make up some rules. You are along for the ride. Though do feel free to suggest better rules. Plus, I promise lots of pictures. And a musical interlude.
I am a rat. I live in a laboratory, where I participate in the Chemistry Experiment. Along with other scientists, I am trying to find the chemicals that will make a dent in my mood disorder. Not theirs. Mine. Which is how I got the rat end of this job. But because I am a free-range rat, I get to decide which experiments I am willing to try.
I now insist that I contribute more to this enterprise than my body.
Manifesto of a Lab Rat -- Weighing the Costs and Benefits Part I
Here is the deal. I was lucky enough, and you were lucky enough to be born after the discovery of penicillin (1928). Well, I don't know when you were born. But evidently penicillin was discovered before it became a life or death issue for either of us, or I wouldn't be writing and/or you wouldn't be reading Prozac Monologues. This is good.
In another age, my ruptured appendix might have been treated with leeches. That would not have been good.
As far as my more immediate health challenge goes, we are barely out of the leech stage. Okay, that's a bummer, the timing of my life, that is. But like I said, ruptured appendix, penicillin. It could have been worse.
Research Into Mental Illness -- Rats
In the treatment of mental illness, they have figured out that leeches don't work. They think chemicals might. They just haven't figured out which ones. They are working on it. They have lab rats, rattus norvegicus to be specific, who do the heavy lifting in this Chemistry Experiment. Some people question the ethics of what gets done to these poor rattus norvegicuses who participate with not a single informed consent form in sight. But that not only is another post, it is another blog.
Nonsense and the Anterior Cingulate Cortex -- Redux
If you are traveling too fast when you hit the pothole, you break your suspension.
So I am taking a break while we try to balance the GAMA and glutamate in my synapses. Here is a slightly modified rerun of an oldie but a goodie. I think it addresses the current phenomena of the Tea Party, the growing rigidity of those whom it threatens, and the retreat of the rest into reality tv. If I didn't make so many connections like that, my brain wouldn't hurt so much. Then again, Prozac Monologues wouldn't exist.
Nonsense and the Anterior Cingulate Cortex -- November 7, 2009
John McNamany put the thought into my head, the New York Times tickled my fancy and a blog new to me gave me the art work.
Finally, it's Anterior Cingulate Cortex Week! This lovely portion of the brain is found in the limbic system, located just above the center, about where Iowa would be and extending into western Pennsylvania, if you flip the image so that it faces right, as I did here. Like a true Midwesterner, the ACC modulates emotional response. A hard-working manager, the ACC handles motivation to solve problems and anticipation of tasks and rewards. It also monitors for conflict, things that don't make sense. The brain is unhappy when it cannot detect a pattern. Confronted with anomaly, the ACC goes to work.
The Absurd Stimulates Pattern Finding Behavior
"Researchers have long known that people cling to personal biases when confronted with death... In a series of new papers, Dr. Travis Proulx of University of California Santa Barbara and Steven J. Heine, a professor of psychology at the University of British Columbia, argue that these findings are variations on the same process: maintaining meaning, or coherence. The brain evolved to predict, and it does so by identifying patterns.
To test whether confronting the absurd leads to pattern-searching behavior, they had twenty college students read Kafka, The Country Doctor, a story that is urgent, vivid and nonsensical. Does anybody who is not in college ever read Kafka? Anyway, after reading the story, they were given a task, to study strings of letters that did not form words. They were then shown a longer list, and asked to find the strings they had seen before. The letters did have patterns, very subtle patterns. And the students who had read Kafka did better at this task than another twenty who had not been exposed to the absurd, 30% better. With a Kafka-stimulated ACC, they were primed to find the patterns.
I wonder if that explains the college student's propensity to read Kafka in the first place. Not to mention all those posters by Salvador Dali on dorm room walls. The college student is at a crossroads, and has to puzzle through the animal tracks of his/her life, to discern the pattern, the call, the next direction. These representations of the absurd stimulate the part of the brain needed at this developmental moment, just as caffeine stimulates the system before the exam.
I graduated from college at loose ends, with the Episcopal Church still discerning the patterns that would allow for the ordination of women. That was a few years off, and I wasn't ready to commit to a vocation that might not be received. But I didn't read Kafka. Instead, I decided to read everything that Kurt Vonnegut had written up to that point, a modern day Kafka. Kafka-lite, if you will. Today, as I fill out disability applications, I am again at a crossroads, and again instinctively, am drawn to Vonnegut, whose body of work has grown since 1975. Evidently I am stimulating my ACC and boosting my pattern/meaning/coherence finding abilities, priming myself to discern my next direction.
Patterns and the fMRI
Oh boy, I found another fMRI experiment! There is a study in the Journal of Pain (what a title!) that discovered, when people were prompted by pain-related words to remember painful autobiographical episodes, the fMRI machines showed that it was -- you guessed it?! -- the anterior cingulate cortex that lit up.
Dialectical Thinking -- On Not Blowing Out Your ACC
This person loved me; this same person abused me -- two memories in conflict, absurd. Put them together, they cause pain. They call it dialectical thinking when you hold two seemingly contradictory ideas in the same head at the same time. But dialectical thinking is a highly developed skill. Before anybody ever suggested to me that I could employ it to reduce my pain, I spent (and still do spend) enormous amounts of energy trying to make sense of events that were absurd.
Some of us had Kafka-esque childhoods. I wonder, does the ACC become quiet if we engage in dialectical thinking? I wonder, does it blow a fuse if we don't?
If you are searching for Christmas gift ideas for the Prozac Monologues blogger, an fMRI machine would certainly be well received.
photo of traffic sign by Richard Drdul, Creative Commons
Attribution-Share Alike 2.0 Generic license.
image of brain from NIMH
Obama inauguration photo taken by
Petty Officer 1st Class Chad J. McNeeley, USN
and in the public domain
and in the public domain
Mood Disorders -- Tolerable, Bad and Downright Ugly, Part I
But here is the short answer. Normal mood cycles within a normal range, sad/okay/glad. Major depression has bigger distances, between normal and really sad. Bipolar has the biggest distances. Bipolar I ranges from really sad to really really up, with more time spend down than up. Bipolar II moves the base line down from bipolar I. It goes up, though not so far, and way, way down, lower than the others.
There are other aspects to mood disorders, affecting thought, desire, motivation, energy, sleep, digestion, appetite and even physical pain. But this astonishingly short answer says way more than your common perception that depression means you are sad; bipolar means you are crazy.
Since I regularly write about these and the other mood disorders in Prozac Monologues, it may be helpful to give the longer answer here. So today begins another three-part series. I do seem to like these three-part series. Things stretch out when I want to make Prozac Monologues both clear and entertaining -- though I suspect that it's mostly people with diagnoses who get the entertaining part.
OMG!!!That'sWhatTheySaid -- Failed Method/Successful Attempt
First, let me introduce HealthCentral.com. From their website:
Health Central's mission is to empower millions of people to improve and take control of their health and well-being.
- Our 35+ sites provide clinical resources and real-life support to those with life-changing conditions.
- Our wellness resources and tools help people to live healthier, more fulfilled lives.
- We are honored to serve over 12 million visitors each month.
Health Central addresses lots of different health issues, including mental health. Often their information is excellent. This time they missed the boat with this OMG Award-winning title to one of their featured articles. They don't get points for originality. They have repeated a much too popular -- what shall I call it?
Let me put it this way:
A twenty-seven year old woman is diagnosed with breast cancer. Young women with breast cancer generally have a poor prognosis. So she receives the most aggressive treatment available, including procedures that damage her body in ways that can be mended and other ways that cannot. She undergoes intense pharmacological treatment using harsh chemicals that leave her sick, debilitated and at risk for other health complications. Willing to try anything, she joins a support group, does mindfulness and visualization and changes her diet.
These measures eventually do work. Her cancer goes into remission. Her health is monitored carefully for a long time. Just when she and her family begin to breathe again, she relapses. Again, she opts for aggressive treatment, tries new drugs prescribed in off-label use, and again is left too weak to care for her children or leave the house.
This time, everybody's best efforts do not work. She dies.
Does her doctor call that a success? Does the preacher say she fought a long hard battle and finally succeeded?
Let me put it another way.
A middle-aged man has heart disease. He gets regular medical attention, takes all his meds, monitors everything he is supposed to monitor, changes his lifestyle, even his job to reduce stress.
Nevertheless, he has a heart attack, in fact, several heart attacks. Each time he is rushed to the hospital, where emergency personnel work their butts off to save him. He is transferred to ICU, then to a regular bed, then to rehab. His family posts frequent status reports on facebook, and his church prays for him every week.
Does anybody say he failed? That he wasn't serious about these heart attacks of his? When he returns to church or the golf course, do they turn their faces, afraid they might say the wrong thing and provoke another attack? One that might be successful?
Mental illness is physical illness. It has a mortality rate, just like cancer and heart disease. We struggle desperately for years and undergo every treatment we can find and tolerate, trying to survive our illnesses. Death by mental illness is not a success. It is a tragedy. Survival is not a failure. When somebody has to be rushed to the hospital and manages to fight his or her way back to life, it is a hard won victory celebrated in heaven. It ought to be celebrated on earth. This person deserves a party. With balloons. And a cake.
Now let me pause to discuss the content of the article with this outrageous title, because the article does give important information.
The article reports research into the prognosis of suicidal individuals according to the method of self-harm they originally use. The numbers are astounding.
Those whose initial act of self-harm takes the form of hanging, suffocation or strangulation have the poorest prognosis. Of those who survive, 85% of them die at their own hand within a year. They do not get it out of their system. They die. Within the year. 85% of them.
Those who jump, or use a firearm or drowning are at a moderately lower risk of subsequent death (69-78%, as reported in the original research.) Those who use poisoning, overdose or cutting have the lowest risk of completed suicide with in year (25-36%.)
These figures hold true when controlling for diagnosis and for sociological factors.
That said, the single greatest risk factor for death by suicide is a previously survived episode. Nobody gets it out of their system.
These findings have implications for aftercare. Just as the most aggressive treatment is warranted for younger women with breast cancer and out of shape persons with heart disease, those whose original method of self-harm is hanging, strangulation or suffocation need the most intensive follow-up, monitoring and treatment.
Again that said, one potentially harmful consequence of this report is that those who use less lethal means, such as cutting or poison, may be dismissed as not serious, as engaging in attention-seeking behavior.
Yes, cutting and overdose are attention-seeking behaviors. They are the serious attempts of seriously ill people to get serious attention for their serious condition.
Cutting and overdose have serious health consequences. They are the methods used most often by Latina and African-American girls, who have less access to health care and mental health care anyway. The consequences of not receiving the attention that these girls plead for are first, brain and liver damage, and then further deterioration of their lives, including dropping out of school, substance abuse, being continued victims of violence at their own hand or that of family and acquaintances, continued poor health choices and early death on account of all of the above.
If you turn your face from anybody who commits a potentially fatal act of self-harm by any means, you become the Scribe who turned his face from the man who was mugged, beaten and left for dead on the road to Jericho, because you count your agenda more important than that person's life.
As I said, this would be an unintended consequence of this article, and one that the author seek to avoid: However, "although use of more lethal methods of self-harm is an important index of suicide risk, it should not obscure the fact that self-harm in general is a key indicator of an increased risk of suicide," Hawton wrote.
Back to the OMG! Award. I am on a Mission from God. It is my mission, in whatever years I have remaining of my own life, permanently to eradicate the use of the word successful in the same sentence as the word suicide, and to eliminate the scandalous naming of survival as failure.
So I plead for your help. I plead, when you hear a grieving friend or family member say that their loved one who died of mental illness was successful in the attempt, I plead that you tell that person, kindly and gently, Suicide is not a choice; it happens when pain exceeds resources for coping with pain. I am so sorry for your loss, and so sorry that your loved one has lost the battle.
I plead that you, whenever you hear health care professionals refer to a failed attempt, that you feel and that you express your shock and horror at the words. I plead that you confront them, and urge then to examine the hostility toward their patients and clients that lie beneath their words.
I don't usually inform people that they are winners of the OMG!!That'sWhatTheySaid Award. Following what I have urged you to do, I will inform Health Central of their award. Right now.
Mood Charts -- Why Bother?
The chart I use is here, the same destination linked to Mood Charting on the left side of the blog, under RESOURCES ON MENTAL ILLNESS. The second page puts my remarks in context. The first page was written for doctors. This post will make all that verbage user friendly.
So let me tell you about my experience and why I am still at it.
The essential point is to understand your illness better, so you can manage it better. These are things I have learned from my chart:
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