In the bleak mid-winter frosty wind made moan,
Earth stood hard as iron, water like a stone;
Snow had fallen, snow on snow, snow on snow,
In the bleak mid-winter long ago.

Our God, Heaven cannot hold Him nor earth sustain;
Heaven and earth shall flee away when He comes to reign:
In the bleak mid-winter a stable-place sufficed
The Lord God Almighty Jesus Christ.

Angels and archangels may have gathered there,
Cherubim and seraphim thronged the air,
But His mother only in her maiden bliss
Worshipped the Beloved with a kiss.

What can I give Him, poor as I am?
If I were a shepherd, I would bring a lamb,
If I were a Wise Man, I would do my part, –
Yet what I can I give Him, give my heart.

poem by Christina Rossetti. 1872

painting by Ivan Shishkin, 1890 

Prozac Monologues at the Movies

Oh, boy!  Butter up the popcorn, slip in a dvd, relax.  This is one very safe and friendly way to spend time with people during the holiday season, and my final installment of this year's Prozac Monologues holiday survival series.  I want my doc and everybody else to notice the implication, that I will survive to do another series next year.

Well chosen movies can fill time, avoid awkward conversation, provide common ground and keep you in the present, always a good thing for the mentally interesting.  Here are my selection criteria for holiday diversion movie viewing:

Movies For Fun

Tips for Surviving the Holidays: the Prozac Monologues Version

Ah, the holidays!  Time when far flung family members travel home and grow close around the Christmas tree.  Time to renew friendships in a round of parties and frivolity.  Time to go crazy?

There are stresses this time of year.  Routines are disrupted. People stay in crowded quarters. Those who have reason to avoid each other are thrown together. Negotiations between exes require professional mediation. Alcohol is consumed in greater quantities. Expectations for love and good cheer are bound for disappointment. Loonies and normies alike need to tend to their mental health.

So Prozac Monologues continues your handy holiday guide, with an assist from NAMI's Peer to Peer class and the University of Iowa Adult Behavioral Health department, covering the basics, planning ahead, mindfulness and quick getaways. 

The Basics:

Keep to your routine as much as possible. If you can't eat like you do at home, get at least one nutritious meal every day. If your family of origin was a little whacked, and your root chakra could use some assist, concentrate on protein (meat, fish, tofu, beans), root vegetables (carrots, beets, onions) and red stuff (beets, strawberries, cranberries, cherries -- jello does not count.) Don't go to parties without some protein already on board. At the buffet table, carrots. Skip the dip, limit your lipids. You will sleep better for it.

Remember Lloyd Bridges in Airplane? The holidays are not a good time to stop sipping, smoking, snorting, sniffing... You get the idea. On the other hand, ultimately substance abuse is more a hazard than a help in negotiating tricky family dynamics. So keep it under control.

Sleep -- not so easy if you get the couch in the family room. Borrow somebody's bed for a nap. If you anticipate a problem, I'm all for an occasional pharmaceutical assist, as an alternative to the straight jacket, which is where you may be headed if you don't get good sleep. This is true for everybody, essential for people with bipolar.

Safety -- no, you do not have to hang around anybody who is abusive. If that is an issue, have your escape plan ready, your keys and your credit card in your pocket, your alternative crash pad arranged.

Oh, and water -- with all your meds, you are probably supposed to push water, as it is. Even more so in the dry winter air. Even more so when dehydration can be mistaken for hunger, leading to more cookie consumption, requiring more water. Especially even more so with greater alcohol consumption. Be kind to your liver. Drink water. 

Planning Ahead:

Many a family feud could be short circuited with some conversation ahead of the storm. Which chores does the host want or expect help with? Which chores does the guest want to volunteer to do? In any relationship, 50/50 does not work. You have to give at least 60%.

Is there any tradition, activity, food, game that will blow your anterior cingulate cortex if it doesn't happen? Take some responsibility for it. Laugh about it, and let people know. And if it doesn't happen, well, that will give you material for your next therapy appointment. And you already know what your therapist will say, don't you.

How many events are planned? Which ones can you skip? Is there room for negotiation? What would you like to do in a group? When will you want to go off by yourself? When will the one who abused you as a child be around? Where will you be instead? 

What are your needs? What are others' needs? Talk to each other. Listen to each other. Remember, there is no Hallmark Family Christmas, except in Hallmark commercials. These are ads, people. They are not your family, and they are not mine, and they are not anybody else's, either. Give yourself and your family a break. Your relatives, your tree, your cookies and cocoa are infinitely more entertaining, anyway. 

Mindfulness:  

I am here, this is now. That's my chant, accompanied by some deep breathing, calling me out of the unhappy past and the uncertain future. Look up, listen up, and notice. You don't have to participate. Just notice. Concentrate on the senses, smells, touch, hearing, sight, taste.

When things get especially bleak for me, I go outside, regardless of weather, and try to replace the running voices in my head with a minute description of what I see around me. There is a little girl. She has pink leggings on. Her hair is in ponytails on either side of her  head. The woman is pushing the stroller. The tree is a pin oak and still has its leaves. The passing car is a Volvo. We used to have a Volvo. It always... -- no, that's the past. This Volvo is dark green... You get the idea.

When you can't get outside, like during Christmas dinner, become an anthropologist. Like Margaret Mead. Who are these people? What do they think? How do they treat each other? What are their eating habits? What happens after three beers? You are not responsible for any of it. You do not have to stop what you don't like. You don't even have to like or not like. You are simply an observer.

Mindfulness is a practice. Practice is what people do when they want to get better at something. Remember, if you can't pull off mindfulness every time you need it, that's okay. You just need more practice. 

Quick getaways: 

There is one more thing you need, some handy lines to get you out of the inevitable spot. Let's see how many of these you can anticipate.

There you are, being Margaret Mead, mindfulnessing away. And Uncle You Know Who turns to you and says... What will it be this year? Immigrants? Climate change? What he thinks about all this therapy you're doing? He knows your triggers like the back of his hand, because he trips them every year. Well, write this one down on the back of your hand, That's very interesting. I'll have to think about that. That one can get you out of all kinds of arguments. Sometimes it even gets my therapist off my back.

Or there you are, seated next to the cousin you haven't seen since she tried to drown you in the pool when you were kids. Remember, you are here, this is now. Try, Seen any good movies lately? It matters not a whit if that line is a dud, because it sets up your next line, What do you do with your time nowadays?

Then there is the open-ended How about them Hawks? Or Vikings, or whatever. Do a little research ahead of time, so you know a team near the person you are addressing. For the sport challenged, here is a starting point: it's football season. And if that line is a dud, follow with... are you with me yet?  What do you do with your time nowadays?

When you must escape the person or the room, there's: 

• Excuse me, my drink needs more ice
• I'm going out for a smoke/some air/to make snow angels
• and, Do you know where the bathroom is?

And when you have had your limit: I really must go. Thank you so much for the party. Merry Christmas. With a normal host, I mean really normal, not undiagnosed normal, you don't need to explain anything.

If the host is in the undiagnosed category, try: 

• My puppy/probation officer/Nurse Ratchet is waiting up for me.
• Or: I'm sorry, suddenly I'm feeling flu-ish. You can play the flu for all it's worth this year. 
• Or even, Oops, my meds are wearing off. Gotta go!

• If somebody else in the room should be on meds, a simple I'm outa here will suffice.

Make yourself a crib sheet, and these few lines will help you navigate a wide range of social situations. Do you have anything else you want to recommend to fellow readers? Make a comment!

There is one more strategy, diversion. I will cover diversion, in the form of recommended movies for the holiday season next week.  Put your recommendations (and reasons) in the comments this week.  I am happy for all the help I can get!

Families -- you gotta love 'em. And you can always laugh. It really works better if you do. Happy Holidays!

clipart from Microsoft online

photo credit Edward Lynch

popcorn credt Francesco Marino

Unintended Consequences.

A few posts ago, John McManamy and I began a conversation about brain surgery to treat mental illness.  You can follow that thread at his blog.  The link will take you to November.  The comments under Me, Captain Ahab and the Anterior Cingulate Cortex are that conversation.  

It seems that brain surgery for mental illness is the topic of the season.  Yesterday the New York Times published the story of Henry Molaison, who had surgery in 1953 to remove part of the medial temporal lobe, including most of his hippocampus.  1953 was four years after António Egas Moniz received the Nobel Prize for his lobotomy procedure, targeting the frontal lobes, and fourteen years after Moniz retired, when he was paralyzed by a former patient who shot him in the back.

The intented result of the surgery in 1953 was to relieve Mr. Molaison's seizures, which he had since childhood and were getting worse, so much so that at the age of 26, he consented to this experimental surgery.  And the surgery was in fact successful.  It relieved his seizures.

Now everybody who has ever quit a medication because of side effects, or had ECT, or did a good deed that went horribly wrong knows about unintended consequences. It soon became apparent that Mr. Molaison's short term memory was gone.  If you have seen the movie Fifty First Dates, it wasn't gone like Drew Barrymore's, who forgot every night what happened that day.  It was gone like the man in the hospital, who introduced himself to people he was having a conversation with, over and over and over.

In the letter to the Romans, chapter 8, Paul says that God makes something good come out of anything.  He doesn't say that the new good measures up to the previous bad.  But it's something.  In this case, one person's tragedy was science's incredible research opportunity.  From all the experiments subsequently conducted on Mr. Molaison, scientists learned a lot about how memories are constructed.  They learned first that the particular part of his brain that was removed is critical for the formation of memories.  Protect your brain!  They learned that there are different kinds of memory.  Mr. Molaison could no longer acquire new information, like where he put his keys.  But he still had his motor or implicit memory; he could still ride a bike.

Mr. Molaison donated his brain to science.  I am curious about the legal implications of consent for a person who has no short term memory.  How long would it take for the docs to describe their desire for the donation and for him to absorb the information and make a decision, one which presumably he would not remember the next day?  Is it informed consent if the next day, (not to mention 52 years later, before he lost his life to pulmonary complications), he would not remember his consent to be able to withdraw it?  Would the law school readers and human research subject reviewers weigh in here?  Let me add that with his memory intact but his seizures undiminished, Mr. Molaison might not have survived to the age of 82.

Anyway, continuing the one enormously good, though unintended consequence, right this very minute they are busy shaving off pieces of his frozen brain in coronal slices, and photographing each slice, to give the most detailed pictures in existence of the structures of the brain.  These slices are measured in microns.  They will get 2500 of them out of this most famous brain.

My spouse, who works for Nancy Andreasson, the researcher in schizophrenia, (Broken Brain) says that the brain images they have from MRI's measure a millimeter.  They get 196 slices (that's what they call them, but they are pictures, really) out of the coronal view.  The side view is pictured here.  Imagine slicing it like a loaf of bread.  Your face is the left end of the loaf.  When you put the slice flat on a plate, you are looking at the coronal view.

And actually, as I write, they began a break at 8:40 AM, California time, while they change the blade.  They have already passed the damaged part of Mr. Molaison's brain, and expect to finish sometime this evening.  These images will be studied for years, maybe decades.

Obviously, nobody is doing the procedure used on Mr. Molaison anymore.  I believe that they do experiment with a pacemaker-like device that gives a periodic electrical charge to the brains of people with epilepsy.  A similar technique is one of the experimental procedures used on the anterior cingulate cortexes of people with OCD, obsessive compulsive disorder, and people with depression.  The advantage of the pacemaker device, called deep brain stimulation (DBS) is that presumably it is reversible and can be removed if the unintended consequences are not so good.  The other psychosurgeries that involve actual cutting or burning are not reversible.

These experiments are conducted only on the people who are most desperate for relief.  Sometimes they get relief.  Often they get something else, as well.  When weighing the pros and cons, I suppose that one of the pros is , however it turns out, they will advance what we know about the brain.

Photo from MIT 

Permission is granted to copy image under the terms 

of the GNU Free Documentation License

News Flash -- Unintended Consequences

If it's still Friday and if you pay attention to science or technology or the brain, or if you think that live feeds are cool, then zip on over to the lab at UC San Diego RIGHT NOW where scientists are peeling 2500 slices off of a man who was brain damaged 57 years ago, during an experimental surgery to relieve his seizures.  Ever after, his short term memory was good for 15 minutes at a time.  He donated his brain to science, and this is what they are doing with it, to study memory.

I have to get cookie dough made, and will fill out this story later.  But they might finish the live feed today.  So watch it now, and read the story later.

Holiday Shopping for Your Favorite Normal

A friend once described what it was like to have cancer.  Like having a paper bag over your head, you can't see anything outside the bag.  It's all about you and your cancer.

Mental illness can be like that.  Try it for yourself.  Put a bag over your head.  Make sure it's not plastic!  Our issues can be all consuming, our fears, our doubts, our grief, our hysteria, our voices...  We lose track of the world outside our paper bag.

But outside that bag are friends, family, allies.  There are more of them, and they are truer to us than we can imagine when inside that paper bag.  The bag, our absorption in our own concerns, makes certain life skills difficult.

Like holiday shopping.

To do a good job at holiday shopping, you have to pay attention to something, or someone outside your own inner world.  So before I give suggestions to loonies about what normals like for Hanukkah, Christmas, Kwanzaa, here are first steps.

The first step to successful holiday shopping is to turn your attention away from yourself.  Remove that bag from your head.

The second step is to focus on the person for whom you want to shop.

The third step is to pay attention.  Engage your eyes and your ears.  Watch and listen for clues.  If you want to please this person, you need to find out what would please this person.  Write it down, if you have memory problems.  I assume that you have memory problems.

I have a hard time paying attention to the world outside myself.  I pay so much attention to my world inside that I trip over cracks in the sidewalk, bump into furniture, nick myself with a knife (but not on purpose!)  I bruise myself and don't even notice until my wife sees it and asks me what happened.  I have no idea.

When I decided to write this post, I realized I would have to follow my own advice.  I had to pay attention.  Actually, given the time constraint, I took the direct approach.  I asked Helen, "What would be a good gift to give a family member of somebody with a mental illness?"

She said, "A cure."

Such is the love available to me every day outside my bag.  Five years after Prozac, I can cry again, and I almost did.  I wrote "a cure" on my list.  Then we went on.

Of course, I got a list of things that Helen would like.  That is the point.  The people who love you are just as unique as you are, you little snowflake.  We got a catalog from Target today filled with gift suggestions.  Some of them may work for the person who loves you.  Some of them won't.  You can't trust the catalog for good guidance.  That is why I gave you the technique for figuring it out.  Talk to them about what's in the catalog.

Having observed your loved ones, so that you know their interests, having paid attention so that you might even have heard, "Gee, I wish I had...," or seen them pick up something at a store, then you are ready to go out shopping.

No, those of us with PTSD or OCD or whose meds wear us out or who feel like whale shit at the bottom of the ocean do not want to go out shopping.  The internet is our best friend, at least for the length of time it takes us to do our shopping.  Internet shopping does require a credit card, so those with bipolar might need supervision.

Simply google the source of your desired gift, Williams Sonoma for all things cooking, Eddie Bauer, Old Navy, Victoria's Secret, etc. for clothing, Cabela's or Scheel's for all things sporty, Amana for meat, See's or Godiva for chocolate.  See's makes the gold foil chocolate coins for Hanukkah's dreidel game.  Chocolate is also a fabulous Christmas gift, or for any occasion whatsoever.  [Does anyone know a tie-in to Islam?]  And it stimulates the production of dopamine.  So you might want to order some for yourself, while you are at it. Oh, and Amazon for just about anything.

If all the choices are just too much, get a gift certificate.

If your meds or your disease has destroyed your credit, so this is a cash deal, and if you can bear the public appearance, you can now buy at the grocery store gift certificates for all kinds of other stores, restaurants and websites.  Purchase your chocolate and do all the rest of your shopping in one stop.

If you are having a good day, head out to the mall for baskets of bath salts and candles, next year's calendar, movie coupons, cheesy popcorn, that toy workbench that I recommended your normals buy for you, and a truly amazing assortment of gadgets that you never knew anybody needed and that nobody will use by December 27, but it is the thought that counts. That "thought that counts" thing only works for your mother, by the way, and not really for her, either. Play with the worthless gadgets in the store.  Then give them a pass.

Weekdays, mid morning are safest for the mall.  I wouldn't dream of going there unless pharmaceutically protected.  Bring a friend who can drive after you collapse.

But if the cost of meds or the consequences of your disease (you know who you are) has destroyed your credit, you might like a more personal (read:cheaper) approach.  Write a poem or a story.  Draw a picture.  Make a collage.  Frame a photo.  Knit a scarf.  Bake some cookies.  Remember that thing about chocolate and dopamine.  Fudge!

I don't believe in those homemade coupon books filled with promises you can't keep, like how you will do your own laundry or cook dinner once a week, walk the dog, smile once in a while.  Don't promise.  Just do something that your normal has been begging you to do: make that doctor's appointment, attend that group, remove the leftover pizza from your bedroom, wash your hair...

Write a letter of appreciation.  That one works especially well with your mom.

clip art from Microsoft.com

Thanksgiving and the Anterior Cingulate Cortex

Did anybody decompensate at your Thanksgiving Day feast, when there were no pearl onions in cream sauce, notwithstanding the fact that nobody has ever eaten a single pearl onion in cream sauce, since Great grandma Libby died forty-five years ago?

Was it you?

I think I figured it out. Unfortunately, this flash of brilliance came to me yesterday morning, in my hypomanic surge that prepared me for my speed pie-making. Not in time for you to prevent the scene by preparing said onions.

Somebody's anterior cingulate cortex blew a fuse.

Of course, I don't know for sure. It is one more hypothesis that I would like to test in that Million Dollar fMRI machine that I am not getting for Christmas. But here is the hypothesis:

The bad economy, the fear-mongering health care debate, the single-payer stillbirth, the war in Afghanistan, global warning -- your anterior cingulate cortex (ACC) is doing all that it can to calm your amygdala. That is one of its jobs, partnered with the prefrontal cortex, to exercise executive function over your amygdala, which is convinced that you are about to die and is sending out messages to your adrenal gland, telling it non-stop to keep pumping out those glucocorticoids that are destroying your hippocampus, not to mention your heart. The amygdala must be brought under control! So your ACC has plenty of work to do already, and needs for you to help out by deep breathing. And yoga. And crystals.

But it also has another job, which is to detect abnormalities in patterns. You know those games where you are supposed to find five details that differ in two nearly identical pictures? That's a job for the ACC. But what with global warming and all that other stuff (and we still don't have any snow in Iowa the day after Thanksgiving, so my amygdala keeps telling my ACC, "I do so need to worry"), when somebody's ACC detected a variation in the Thanksgiving feast day table, i.e., the missing pearl onions, that was just one thing too many. And it blew a fuse, releasing the amygdala from its cage. And this time, the amygdala did not send out the message to freeze. It came out fighting.

So now you know. Or would know, if somebody who does own an fMRI machine would construct the experiment. Any takers?