Thomas Insel - Toward a New Understanding of Mental Illness

Cutting this guy's budget is like telling Orville and Wilbur Wright to take the month off.

Jill Bolte Taylor's Stroke of Insight

Dr. Bolte Taylor's story is told in greater detail, both her stroke and her recovery in her book.  You can link to it in the column to the left under Fabulous Books.

Calling All Guest Bloggers

That little box of words is empty. Day after day, replacements do not arrive.  It is time for Prozac Monologues to go on sabbatical. I'm thinking -- two months might do it.

But I hate it!  I can't do it!  Help!

Calling all bloggers -- this space is vacant and available.

So here's the deal.  I am open to publishing your poem, blog piece, article, ruminations, if:

• It is on topic (reflections and/or research on the mind, the brain, mental illness and/or society);
• It is educational and/or entertaining;
• It is not hateful nor wildly inaccurate;
• It strikes my fancy.

Tales of woe probably won't strike my fancy, unless submitted by a mental health care professional.  You get a pass on the woe for variety's sake.

Prose that breaks the rules of grammar will not strike my fancy, unless it breaks them for style's sake, and not out of ignorance.

Previously published material is fine, as long you have clear copyright.  I am delighted to promote fellow bloggers' blogs. You know who you are.

I am also receiving suggestions for TED talks and Loony Tunes from youtube, with which I will fill this vacant space in the absence of other material.

Send suggestions and material to wmgoodfe@yahoo.com.

So do not fear -- I will do my best to provide a weekly fix.  Just, no words of my own for a while.

Cheers!

photo of umbrella by Molku, in public domain

photo of frowning teacher from microsoft.com

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.

While Wahls' own story is about MS and her remarkable recovery, the information and the food plan applies to any chronic health issue that involves nerve cells which you may have or wish to avoid.

Short version:

If one thing after another, unremitting, and seeming to come at us faster and faster has you feeling like this  è

...then you did your neurons no favor by eating this  è


Okay, I admit, I ate one of these this week, too.  It was delicious. But it did not help.


What our poor pitiful neurons really need is this:

No, this is not your mother talking.  This is brain science.  Mitochondria, GABA/Glutamate, dendrites, adenosine tri-phosphate -- I had to look that one up.

But if you can follow me when I talk brain science, you can follow Dr. Wahls.  She writes for people who have the cognitive deficits caused by MS, and I wrote my review when I had the cognitive deficits caused by anxiety, bipolar, and the meds designed to treat them.

So because my brain has been hitting a wall lately, and because the fates seem to have called it forth - by way of blogger stats - these ambling paragraphs are followed by a repost of said review.  -- The original post has a testimonial from Dr. Wahls in the comments.

To your neurons!


from Friday, June 24, 2011 --

Minding My Mitochondria

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!

book jackets from Amazon.com
photo of man on park bench by Graur Codrin, used under Creative Commons license
photo of donuts by Lucian Venutian, used under Creative Commons license
photo of fruits and vegetables at Pike Place Market by Eric Hunt, used under GNU license
flair from facebook
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 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

Why the Poor Give More

The article that inspired this post is titled Why the Rich Don't Give to Charity.  But I figure, language has power, and why reinforce behavior that I would rather see changed?

Before you go off in a huff, let me tip my hand -- I acknowledge and will discuss both the exceptions and free will.

The short answer to any of these questions, why the poor give more, why the rich don't give, and why some rich do is -- mirror neurons.  Three weeks ago I reported on these in Mirror Neurons - They Change Everything, along with a youtube featuring V.S. Ramachandran.  Here is the promised expansion on the theme.

Statistics on Giving

Ken Stern reports in The Atlantic Magazine that the top 20% of Americans donate 1.3% of their income.  The bottom 20% donate 3.2%.  He asks, What's up with that?

Paul Piff - Higher Social Class Predicts Increased Unethical Behavior

Stern doesn't mention mirror neurons.  Instead, he references research done by Paul Piff, a doctoral candidate in social and personality psychology at UCBerkeley.  Piff measured behaviors such as whether a car cuts off another vehicle in traffic, or whether it stops for a woman pushing a baby stroller in a cross walk.  Results -- controlling for time of day, traffic conditions, gender, all that, he discovered: the more expensive the car, the more likely the driver would fail to yield as the law requires.

Candy From a Baby

Piff did seven of these experiments.  The traffic ones were in what is called a naturalistic setting.  He was counting real behaviors in the real world, while he and his colleagues were hiding in the bushes with their clipboards.  Others were laboratory experiments.  In one, the subjects were told that a jar of candies was intended for children in the next room.  But after they finished filling out a questionnaire, they could take some, if they wished.  The higher the social class, the more candies the subject took from the children.  I mean -- really.

Self-reporting assessments confirmed the theme: the higher the economic class, the more likely the subjects were willing to lie during negotiations, cheat in games and engage in various unethical behaviors to pursue their own interests.

Piff, being a social psychologist, ascribes his remarkably consistent findings to factors like social conditioning, parenting styles, the access of rich children to education in economics that encourage pursuit of self-interest and self-differentiation.

Myself, I try to avoid the personality stuff, which is generally squishy and can devolve into name-calling -- though today I will not let my flight of ideas veer me off into a discussion of the personality disorder section of the DSM.  If you want to read lots more about how and why the rich are different from the poor, try Social Class, Solipsism and Contextualism by Krauss and Piff.

Hemingway's answer was the simplest.  When Fitzgerald said, The rich are different from the rest of us, Hemingway responded, Yes, they have more money.  Just show me the money.

In support of Hemingway's thesis, Piff's follow-up work revealed that when he showed a sympathy-evoking film on childhood poverty to the richer classes, their greed scores declined and they became more willing to play well with others.

So what's up with that?  It's those mirror neurons at work.  And you wondered when I would get back to them.

Mirror Neurons and Money

What happens on the neurobiological level is this:  As Ramachandran explains, 20% of the neurons in our frontal cortex are for imitation.  When we see somebody doing or feeling something, our mirror neurons fire, imitating that action or emotion.  When we recognize the emotion, that is empathy.

So the deal with this growing money gap in the United States is, we are more and more segregated.  Rich people who live in rich neighborhoods, drive their BMWs to their offices in tony parts of town, send their children to pricy private schools and recreate at their private clubs need never come into contact with poor people, or even the middle class, such of us as still exist.  Those of us riding in the cattle class on airplanes are not even allowed to use their restrooms.

Result -- their mirror neurons are never stimulated.  They never fire.  No empathy.  No sharing.

Of course there are exceptions.  Rich people do give to charity.  Mirror neurons explain that, too, and how to strengthen the will to do it, how to cultivate empathy, compassion, generosity, cooperation even in those who were raised to think all those things are bad words.

To be continued...

image of Scrooge McDuck used under fair use doctrine

clipart from Microsoft.com

book jacket of The Great Gatsby from Amazon.com

photo of first class seat on Singapore Airlines by Dan Nevill, used under Creative Commons license

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.

It is what it is.

The debates rage on, but the ship has already sailed.  We fought two wars in the last decade, and put the bill on a credit card.  Now the bill has come due, it will not be paid by the people who became not just wealthy in that decade, but obscenely wealthy.  Instead, it will be paid by the old, the mentally ill, and ironically, by veterans who came home disabled in those very wars.  Congress will not ask their corporate sponsors to contribute a dime.

It is what it is.

Violence and Mental Health Funding

Somebody with schizophrenia shoots up an Arizona shopping market parking lot and a month later, Arizona slashes its mental health budget.

An elementary school shooting again raises concerns about our tattered mental health system and our reckless arming of America.  After all the marches, petitions, phone calls, pleading, we will do nothing that effectively stems the violence.  People with a serious mental illness account for 5% of the homicides in the US.  Yet we will take the hit for the whole enchilada.  There will be a lot of rhetoric about improving mental health services.  But bottom line, the most we can expect out of Sandy Hook will be a better data base of nut cases.

We are on our own.  It is what it is.

Well, like I said, last week a group of unpaid nonprofessionals did get the job done.

What Would Jesus Do? -- Something That Works

Where I am going to put my energy is in equipping as many people as I can to do what this nation does not have the will to do, to care for the least among us, to help veterans and elderly and children and those who are ill.  You know -- all that stuff Jesus and the Prophets said.  And screw those who would rather post patriotic sentiments on Facebook than pay the price.

The challenge is to know how.  It's one thing to want to help.  It's another actually to do it.  When it comes to psychiatric illness, we have done little to educate the public on how to do it.

In the absence of knowledge, many are scared.  So they withdraw.

But when we do know how, we can do very simple things that make a major difference.

So below, I repost a list from a previous post on mental illness first aid.  The list first came to me as a laminated wallet-sized card.  When my group of friends later used it to debrief our efforts to provide help, we concluded that these were indeed the behaviors that helped.


MENTAL ILLNESS FIRST AID

Proceed to interact as you:
 
1 - Be calm and give firm, clear instructions
2 - Assess the situation for safety
3 - Maintain adequate space between you and the person
4 - Respond to apparent feelings
5 - Respond to delusions and hallucinations by talking about
       the person's feelings rather than what is said
6 - Be helpful, encouraging and supportive

Avoid:
 
1 - Reinforcing behavior related to the person's illness
2 - Staring at the person (this may be interpreted as a threat)
3 - Confusing the person
4 - Giving multiple choices (this may increase confusion)
5 - Whispering, yelling, ridiculing, deceiving or touching
       (this may cause fear and lead to violence).

Someone with a psychiatric 
illness might...                      So you need to...

Have trouble with reality...................... Be simple, truthful
Be fearful.......................................... Stay calm
Be insecure........................................ Be accepting
Have trouble concentrating................... Be brief, repeat
Be over stimulated.............................. Limit input
Easily become agitated........................ Recognize agitation
Have poor judgment............................ Not expect rational discussion
Be preoccupied................................... Get attention first
Be withdrawn....... ............................. Initiate relevant conversation
Have changing emotions....................... Disregard
Have changing plans............................ Keep to one plan
Have little empathy for you.................. Recognize as a symptom
Believe delusions................................ Ignore, don't argue
Have low self-esteem and motivation..... Stay positive


When I first came upon this list, I read it, asking myself whether it was sufficient advice for dealing with me when I am in psychiatric crisis.  I concluded that one item was missing, and I added it for our discussion.

Someone with a psychiatric
illness might.............                  feel shame.

So you need to.............              show respect.

Resources for Mental Illness First Aid

If you want to do what Jesus and the Prophets said, or if you have your own reasons, click here to learn more.

We are on our own.  So we better be in this together.

image of Good Samaritan from Christian clip art in public domain

photo of homeless vet by Matthew Woitunski, used under Creative Commons license

Red Cross graphic in public domain

In the Beginning -- Four Years Out

Four years ago I had lost my voice.  Literally.

How does a psych patient get help without a voice?  Too many times shamed into silence, when I quit my therapist I went to a Chinese Practitioner who did energy work, so I wouldn't have to speak.  When I had no choice but to find a new psychiatrist, I had to whisper.

How does a preacher preach without a voice?  Too long in the dark night, I had nothing to say.  When the pension fund required I not work at all for a year as a condition of disability, it was a relief.

How does a writer write when the words disappear?  Again I had no choice but to return to the Chemistry Experiment, this time with Lamictal. -- They tell you all about this exceedingly rare rash.  Sure it could kill you.  But you just stop taking the med, the rash goes away.  Meanwhile, they forget to mention the very common side effect -- your words disappear.  I didn't complete a sentence for months, forgetting in the middle what I intended to say.  Four books languished on my laptop.

Prozac Monologues

But I am a psych patient.  I am a preacher.  I am a writer.  I need my voice.  Enter http://prozacmonologues.blogspot.com/.

You don't know how long it takes to write a sentence.  I publish almost every week, but you may not notice how often I punt.  In one of the internet's ironies, the 6th most frequently viewed post - out of 211 - is one such punt, The Termites Ate My Blogpost.  In one of the internet's inanities, having provided a link, I probably have increased traffic to that punt.

No matter.  You keep reading.  I keep squeezing these posts out, and you keep reading.  Occasionally, you even tell me that you do!  I am glad to know that you are learning, reflecting and thinking along with me, laughing, getting mad, being intrigued - what a world, what a brain, what a wonder.

It has been four years today.  211 published posts, 66,756 page views, 280 comments (at the moment I hit "publish" on this post).  Not enough ad revenue for anyone to cut me a check yet.  Oh well.  One post at a time, one comment to keep me going -- okay, a blog plus lumosity.com, detox from the Chemistry Experiment, Dr. Wahl's diet, and every other recovery trick in the book, I am getting my brain back, including my words, my precious words.

In the beginning, after all, was the Word...

I begin to believe the original Prozac Monologues, the book may yet rise from the ashes.  In four years, it has gained a companion.  It will be Prozac Monologues - With Heckler!

Now for old times sake, here is where it began, April 5, 2009 --

In the Beginning

In the beginning I went to my doctor for a med check. I had been on Prozac for three months. I was anxious and agitated, irritable, couldn't concentrate and couldn't sleep. I thought I needed a higher dose.

I was wrong. 

As I walked in the door, I had a thought. It was more intrusive than a fantasy, and less welcome. Never mind for now what it was, but it involved a nail file... I didn't tell my doctor about this thought. I just got my higher dose.

That is when things started to get really bizarre. 

The Birth Of Prozac Monologues 

A short while later, while coming off Prozac, I tried to imagine how I could tell people about what it was like to have to come off Prozac. The only medium that seemed appropriate was the stand-up comedy routine.

And that was the birth of Prozac Monologues, with its first chapter, Bizarre.

Someday, Prozac Monologues will be available to the purchasing public. For now, come here to find out about depression and its treatment, drugs and research, the brain and its wonders.

Welcome -- Willa

In the Beginning reformatted 11/26/10 

Four years later, to my readers, to my friends -- Thank you.

photo of shadow by Cornova, used under Creative Commons license
flair from Facebook.com
photo of Prozac modified from original by Tom Varco, used under Creative Commons license