tag:blogger.com,1999:blog-20124997086882548472024-03-13T09:41:15.174-07:00Prozac Monologuesreflections and research on the mind, the brain, mental illness and societyWilla Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.comBlogger388125tag:blogger.com,1999:blog-2012499708688254847.post-80203354879613709472023-11-08T12:33:00.001-08:002023-11-08T12:33:28.628-08:00Thanksgiving Day is Coming: How to Avoid a Holiday Meltdown<p><span style="font-family: verdana; font-size: large;">Did
anybody decompensate at last year's Thanksgiving Day feast, when there were no
pearl onions in cream sauce, notwithstanding the fact that nobody has </span><span style="font-family: verdana; font-size: large;">ever </span><span style="font-family: verdana; font-size: large;">eaten a single pearl onion in cream sauce, since GreatGrandma Libby died forty-five years ago?</span></p>
<span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;">Was it you?</span><span style="font-family: verdana; font-size: large;"><br /></span><div>
<span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;">I
think I figured it out. Unfortunately, this flash of brilliance came to
me the morning before, during a hypomanic surge that got me ready for my
stuffing/broth/cranberry sauce/pie-making marathon. But not in time to prevent the scene by preparing
said onions.</span><span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;">Somebody's anterior cingulate cortex blew a fuse.</span><span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;">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 have requested <i>for years</i> for Christmas. Some girls want a pony. I want an fMRI machine. I don't expect it this year either.</span></div><div><span style="font-family: verdana; font-size: large;"> </span></div><div><span style="font-family: verdana; font-size: large;">But here is the hypothesis:</span><span style="font-family: verdana; font-size: large;"><br /></span>
<span style="font-family: verdana; font-size: large;"><br /></span><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">The Anterior Cingulate Cortex and the Amygdala</span></h3></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">The
rising cost of that Thanksgiving feast, the family-splitting political
debates, the impending government shutdown, the war in the Middle East,
climate change -- 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, it
exercises executive function over your amygdala. </span></div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiofWwbuRgN_U6NabGwhG06SfJIGch2rxvka9IfR0NdJYgniSAcxM30eEUp5J3_uuOcf2lHj-vqwnVrA1-r-4UY4etihcwro5Nlv6jUc4q-IM0b9hFJLeBkz1HjlX7RxldO0sXbBPM1oJmYb99eaKjfqUMlwI_R6Ws-vkPfKFm8PMbkrrd_tlKNpogGx8NN/s800/anterior_cingulate_cortex%20grey's%20anat,%20pub.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="467" data-original-width="800" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiofWwbuRgN_U6NabGwhG06SfJIGch2rxvka9IfR0NdJYgniSAcxM30eEUp5J3_uuOcf2lHj-vqwnVrA1-r-4UY4etihcwro5Nlv6jUc4q-IM0b9hFJLeBkz1HjlX7RxldO0sXbBPM1oJmYb99eaKjfqUMlwI_R6Ws-vkPfKFm8PMbkrrd_tlKNpogGx8NN/w428-h250/anterior_cingulate_cortex%20grey's%20anat,%20pub.png" width="428" /></a></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div><div class="separator" style="clear: both; text-align: right;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXUYzIHCUGXaKFKOB9y2318KPx-U7KnFb11C49ttVdwIEzLXaQcDkF1ZoA7AgmJxH5TlBrIR0h7jzaPITyxUgA8ZFUU2zf7cmVqjoQ4kMAGyqGKBmUvH1jy2S9byVitpE2UmhB-RcPsIC30jKsC0Tg_EOEjRk5a6mcFUwzwmx_TJcxnrIkoMzz-NXOR3uF/s897/hpa%20axis%20nih.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="897" data-original-width="627" height="381" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXUYzIHCUGXaKFKOB9y2318KPx-U7KnFb11C49ttVdwIEzLXaQcDkF1ZoA7AgmJxH5TlBrIR0h7jzaPITyxUgA8ZFUU2zf7cmVqjoQ4kMAGyqGKBmUvH1jy2S9byVitpE2UmhB-RcPsIC30jKsC0Tg_EOEjRk5a6mcFUwzwmx_TJcxnrIkoMzz-NXOR3uF/w267-h381/hpa%20axis%20nih.jpeg" width="267" /></a></div><span style="font-family: verdana; font-size: large;"><div><span style="font-family: verdana; font-size: large;"><br /></span></div>Your amygdala is
convinced
you are about to die and is sending out </span><span style="font-family: verdana; font-size: large;">non-stop </span><span style="font-family: verdana; font-size: large;">messages to your adrenal gland to keep pumping out those glucocorticoids. All those glucocorticoids are
destroying your hippocampus, not to mention your heart. The amygdala
must be brought under control!</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><div style="text-align: right;"><span style="font-size: large;"><br /></span></div></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">So your ACC has plenty of work to do
already, and needs for you to help it out by deep breathing. And yoga. And
crystals.</span></span></div><div>
<span style="font-size: large;"><span style="font-family: verdana;"><br /></span></span><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">The Anterior Cingulate Cortex and the Thanksgiving Table</span></h3></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">But it also has another job, which is to <a href="http://prozacmonologues.blogspot.com/2009/11/nonsense-and-anterior-cingulate-cortex.html">detect abnormalities in patterns</a>.
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 climate change and all that other stuff, or last year's version of all that stuff, when somebody's ACC detected a variation in the
Thanksgiving Day </span><span style="font-family: verdana; font-size: large;">feast</span><span style="font-family: verdana; font-size: large;"> 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
<i>freeze</i>. It came out <i>fighting</i>.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span>
</div><div><span style="font-family: verdana; font-size: large;">Couldn't we all use a little peace this year? Just for one day? Here is what you can do:</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span>
</div><div><span style="font-family: verdana; font-size: large;">If you are the
cook, poll your guests about what food item they Have. To. Have. In my
family, we serve three different types of cranberry sauce. Because we
have to have <i>each one</i>.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span>
</div><div><span style="font-family: verdana; font-size: large;">If you are not the cook, do a bit of self reflection beforehand. What do <i>you</i> have to have? Then give the cook a break, so the cook doesn't have a meltdown. Bring your own damn pearl onions.<i><br /></i></span></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-29021889530547975562023-08-30T11:05:00.001-07:002023-08-30T12:06:54.339-07:00Racism is not a Mental Illness; Racism is a Sin<p></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">Racism is not a mental illness; racism is a sin.</span></li><li><span style="font-family: verdana; font-size: large;">White nationalism is not a mental illness; white nationalism is a sin.</span></li><li><span style="font-family: verdana; font-size: large;">Violence is not a mental illness; violence is a sin.</span></li><li><span style="font-family: verdana; font-size: large;">Hatred is not a mental illness; hatred is a sin.</span></li></ul><p></p><p><span style="font-size: large;"><span style="font-family: verdana;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><span style="font-family: verdana;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgjW_LNeEKrwK9JCDCyZfO9DxvnL9quSvtqI0tzwndOaMq-PFQs-AzOVL1jyOXTgRw4-xk0_gfw-V0rzW6-94xdVYMXoYWr3eMfX2a3QY0k4p9thrZz4y3DIwe7bH_PUGu4kxYVJ_1jIok87qVnzlUjNJD8-lMIp7T3_vfqO4cZ3HrlilJbGhvqMng8UgVy" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="886" data-original-width="886" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEgjW_LNeEKrwK9JCDCyZfO9DxvnL9quSvtqI0tzwndOaMq-PFQs-AzOVL1jyOXTgRw4-xk0_gfw-V0rzW6-94xdVYMXoYWr3eMfX2a3QY0k4p9thrZz4y3DIwe7bH_PUGu4kxYVJ_1jIok87qVnzlUjNJD8-lMIp7T3_vfqO4cZ3HrlilJbGhvqMng8UgVy" width="240" /></a></span></span></div><span style="font-size: large;"><span style="font-family: verdana;">Okay, the Christian in me is coming out here when I say </span><i style="font-family: verdana;">sin</i><span style="font-family: verdana;">. And even some Christians have trouble using that word these days. Which is fine. Don't use it if you can't sort out sin from all the baggage it carries.</span></span><p></p><p><span style="font-family: verdana; font-size: large;">But for the love of God and your neighbor, don't substitute <i>mental illness</i> to explain the appalling image of the latest white guy with his racist manifesto and his swastika painted on his semiautomatic weapon shooting up the Dollar General, or the supermarket, or the bible study.</span></p><p><span style="font-family: verdana; font-size: large;">Use the word <i>wrong</i> if you can't bring yourself to say <i>sin.</i> <i>Wrong</i> doesn't seem strong enough, I understand that. But explaining these events as <i>mental illness</i> is <i>REALLY </i>wrong on two levels.</span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Ignoring the Evidence about Mental Illness</span></h3><p><span style="font-family: verdana; font-size: large;">First, mental illness does not correlate with violence.</span></p><p><span style="font-family: verdana; font-size: large;">Let me say it again for the people in the back of the room.</span></p><p><span style="font-family: verdana; font-size: large;">Mental illness does not correlate with violence.</span></p><p><span style="font-family: verdana; font-size: large;">Sure, journalists will go digging into the background of the latest shooter. And journalists will find that the shooter had some previous contact with mental health services. The American Journal of Public Health <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935671/" target="_blank">article</a> by Sherry Glied and Richard G. Frank explains this phenomenon:</span></p><p><span style="font-size: large;"><span style="background-color: white; color: #212121; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;">The journalist’s search for a mental illness explanation of aberrant acts will almost always succeed. Epidemiological research suggests that nearly half the population—whether or not involved in crime—experience some symptoms of mental illness over the course of their lifetimes. The most recent population estimate of the lifetime prevalence of major mental illnesses meeting diagnostic criteria among US adults is 46%, and 9% meet criteria for a personality disorder.</span><a aria-expanded="false" aria-haspopup="true" class="bibr popnode" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935671/#bib1" rid="bib1" role="button" style="background-color: white; box-sizing: inherit; color: #376faa; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"><span style="box-sizing: inherit; line-height: 0; position: relative; top: -0.5em; vertical-align: baseline;">1,2</span></a><span style="background-color: white; color: #212121; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"> Seeking mental health treatment is hardly less common: the literature suggests that about one fifth of the US population report seeking professional care for a mental health problem in a year and nearly one third do so over their lifetimes.</span><a aria-expanded="false" aria-haspopup="true" class="bibr popnode" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935671/#bib3" rid="bib3" role="button" style="background-color: white; box-sizing: inherit; color: #376faa; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"><span style="box-sizing: inherit; line-height: 0; position: relative; top: -0.5em; vertical-align: baseline;">3</span></a><span style="background-color: white; color: #212121; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"> </span></span></p><p><span style="font-size: large;"><span style="background-color: white; color: #212121; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;">The very high lifetime prevalence of illness and treatment seeking helps explain why virtually every story of a violent act can be linked to some clues of psychological abnormality or mental health treatment—even though the rate of violent behavior of any type among people who meet diagnostic criteria for mental illnesses is estimated to be only about twice as high as the rate among those who never experience a mental illness.</span><a aria-expanded="false" aria-haspopup="true" class="bibr popnode" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935671/#bib3" rid="bib3" role="button" style="background-color: white; box-sizing: inherit; color: #376faa; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"><span style="box-sizing: inherit; line-height: 0; position: relative; top: -0.5em; vertical-align: baseline;">3–5</span></a><span style="background-color: white; color: #212121; font-family: Cambria, "Cambria Math", stixgeneral, "Times New Roman", Times, serif;"> Mental illness is simply not a very specific predictor of violence.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">People with <i>serious</i> mental illness are only twice as likely to commit violence than the general population. Which means that they commit 4% of violent crime. 4%.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">It is wrong, it is <i>incorrect</i> to explain violence by mental illness.</span></span></p><p><span style="font-family: verdana; font-size: large;">Why does the myth persist, contrary to the evidence? Because having rejected the concept of sin, we can't figure out why these things happen, unless something is wrong with their heads. But that explanation is wrong, as in <i>incorrect</i>.</span></p><p><span style="font-family: verdana; font-size: large;">Indeed, there is something wrong in their heads. But it is not mental illness.</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">Racism is not a mental illness.</span></li><li><span style="font-family: verdana; font-size: large;">White nationalism is not a mental illness.</span></li><li><span style="font-family: verdana; font-size: large;">Violence is not a mental illness.</span></li><li><span style="font-family: verdana; font-size: large;">Hatred is not a mental illness.</span></li></ul><div><span style="font-family: verdana; font-size: large;">Which is why, when these guys are taken in for evaluation, they are released. Because they are not mentally ill.</span></div><p></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Making Mental Illness Illegal</span></h3><p><span style="font-family: verdana; font-size: large;">Blaming mental illness for violence is wrong in a second way. It is harmful, hateful, and dangerous.</span></p><p><span style="font-family: verdana; font-size: large;">Harmful, hateful, and dangerous.</span></p><p><span style="font-family: verdana; font-size: large;">Liberals repeat the myth of violence caused by mental illness to support funding for more services for the mentally ill (which never are forthcoming). Conservatives repeat the myth to push back against gun control (without allowing any restrictions, even for those they claim to be violent). Both liberals and conservatives, <i>both</i> liberals and conservatives create scapegoats of vulnerable people.</span></p><p><span style="font-family: verdana; font-size: large;">Here is what a candidate for president of the United States <a href="https://twitter.com/VivekGRamaswamy/status/1694529340220887166" target="_blank">tweeted</a>, repeating his answer to the violence question in the recent GOP debate:</span></p><p><span style="font-family: times;"><span class="css-901oao css-16my406 r-poiln3 r-bcqeeo r-qvutc0"><span style="font-size: large;">Don’t remove guns from law-abiding citizens. Remove violent, psychiatrically deranged people from their communities and be willing to involuntarily commit them. Revive mental health institutions: less reliance on pharmaceuticals, more reliance on faith-based approaches that restore purpose to people’s lives. </span></span><span style="font-size: large;">We know from the 1990s how to stop violent crime. The real question is if we have the spine to do it.</span></span></p><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">That this candidate has low polling numbers does not undo the damage he does by calling us violent and deranged. He makes such discourse seem reasonable. </span></span></p><span style="font-size: large;"><span style="font-family: verdana;">On the other end of the political spectrum, both California and New York City politicians are endorsing <a href="https://www.nytimes.com/2022/11/29/nyregion/nyc-mentally-ill-involuntary-custody.html">forced institutionalization</a> and treatment of people with serious mental illness, even for those who do not pose an immanent threat to themselves or others.<br /></span></span><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">Forced institutionalization may look like compassion. It is a violation of civil liberties. It makes mental illness illegal.</span></span></p><span style="font-family: verdana; font-size: large;">Where will these forcibly institutionalized people be housed? The latest figures for all types of psychiatric inpatient settings are from 2014, when there were <a href="https://www.nri-inc.org/our-work/nri-reports/trends-in-psychiatric-inpatient-capacity-united-states-and-each-state-1970-to-2014/">170,000 beds</a> available. However, that figure includes VA and private hospitals. State capacity, where those who are hospitalized by the state go, is <a href="https://www.treatmentadvocacycenter.org/storage/documents/backgrounders/how-many-psychiatric-beds-does-america-need.pdf">35,000 beds</a>.<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhYpqSaJQzZOY61P5RVu8cVg6L5H5zU32wpS4mKNuphaw5v1lntiGWJF1BA5rQH-jl9dmq3DNvjK0IWVxxNLLOyoQsjYgqQD3ur4efD2APTsO4kxu0PNkPmeITLEaPtK1lVot70c4WEpittTt_MTYUp64iPprs_zsSvuFFjVB2a_JjuabHcjr7H2UfBWT-k" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="96" data-original-width="96" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEhYpqSaJQzZOY61P5RVu8cVg6L5H5zU32wpS4mKNuphaw5v1lntiGWJF1BA5rQH-jl9dmq3DNvjK0IWVxxNLLOyoQsjYgqQD3ur4efD2APTsO4kxu0PNkPmeITLEaPtK1lVot70c4WEpittTt_MTYUp64iPprs_zsSvuFFjVB2a_JjuabHcjr7H2UfBWT-k" width="240" /></a></div><br />Where are the mentally ill really housed? According to a recently released federal Bureau of Justice Statistics (BJS) report, <a href="https://www.hrw.org/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled?gclid=CjwKCAjwrranBhAEEiwAzbhNtU9hc0aGOiKmdPBkQ6ecY733V2Rl2NZu2KAXxI6bESyD3wjVkNa-LBoCLqoQAvD_BwE">1.25 million</a> of them are in prison, where they do not fare well. According to this report:</span><p style="border: 0px solid; box-sizing: border-box; color: #444444; margin: 1.5rem 0px; text-align: left;"><span style="font-family: times; font-size: large;">Prisoners with mental illness find it more difficult to adhere to prison rules and to cope with the stresses of confinement, as evidenced by the new BJS statistics that 58 percent of state prisoners with mental problems have been charged with violating prison rules, compared to 43 percent without mental problems. An estimated 24 percent with a mental health problem have been charged with a physical or verbal assault on prison staff, compared to 14 percent of those without. One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without.</span></p><p style="text-align: left;"><span style="font-size: large;"><span style="color: #444444; font-family: times;">Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.</span></span></p><h3 style="text-align: left;"><span style="color: #444444; font-family: verdana; font-size: large;">The Bigger Picture - Making Homelessness Illegal</span></h3><p style="text-align: left;"><span face="nyt-imperial, georgia, "times new roman", times, serif" style="background-color: white; color: #363636;"><span style="font-family: times; font-size: large;">“The man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team: These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered,” the mayor said.</span></span></p><p style="text-align: left;"><span face="nyt-imperial, georgia, "times new roman", times, serif" style="background-color: white; color: #363636;"><span style="font-family: times; font-size: large;">...Mr. Adams has received criticism from some progressive members of his party for clearing homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor has defended his focus on public safety and has argued that many New Yorkers do not feel safe, particularly in Black and Latino neighborhoods.</span></span></p><p style="text-align: left;"><span style="background-color: white; color: #363636;"><span style="font-family: verdana; font-size: large;">Connect the dots. From homeless to mentally ill to dangerous to better off incarcerated, one way or the other.</span></span></p><h3 style="text-align: left;"><span style="background-color: white; color: #363636;"><span style="font-family: verdana; font-size: large;">The Myth Will Not Make You Safe</span></span></h3><p style="text-align: left;"><span style="background-color: white; color: #363636;"><span style="font-family: verdana; font-size: large;">My friends, you can put another 1.25 million of us loonies in jail. That young man will still be stalking the streets who lives with his white middle class parents in their suburban home with an arsenal in the basement. You will have done nothing to protect our schools, our shopping centers, and our bible studies.</span></span></p><p style="text-align: left;"><span style="background-color: white; color: #363636;"><span style="font-family: verdana; font-size: large;">So stop it.</span></span></p><p style="text-align: left;"><span style="background-color: white; color: #363636;"><span style="font-family: verdana; font-size: large;">Racism is not a mental illness; racism is a sin.</span></span></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-3385372527048474322023-07-17T11:28:00.000-07:002023-07-17T11:28:17.568-07:00Fear of People with Mental Illness Fades When We Know How to Help<h3><span style="font-family: verdana; font-size: large;">Trends in the public marketplace of ideas:</span></h3><div dir="ltr" trbidi="on"><ul><li><span style="font-family: verdana; font-size: large;">There are more houseless people around us</span></li><li><span style="font-family: verdana; font-size: large;">Many churches, congregations, and volunteers of all sorts are trying to help</span></li><li><span style="font-family: verdana; font-size: large;">Some local governments are trying to restrict these efforts</span></li><li><span style="font-family: verdana; font-size: large;">Claims are made in support of these restrictions that people with mental illness are dangerous</span></li></ul></div><div dir="ltr" trbidi="on"><span style="font-family: verdana; font-size: large;">The following post is a repeat from a few years ago. It seems time to repeat it. It does not address the mistaken notion about mental illness and violence, nor the scapegoating of people who are in need. It does address the issue of fear. I hope to provide resources for people who are exercising their constitutionally protected right to the free practice of their religion.</span></div><div dir="ltr" trbidi="on"><span style="font-family: verdana; font-size: large;"><br /></span></div><h3><span style="font-family: verdana; font-size: large;">Mental Illness First Aid</span></h3><div dir="ltr" trbidi="on"><span style="font-size: large;"><span><span style="font-family: verdana;"><br /></span></span></span></div><div dir="ltr" trbidi="on"><span style="font-size: large;"><span><span style="font-family: verdana;"><span style="font-size: small;"><a href="http://2.bp.blogspot.com/_eRQUuPVfFqU/SlPQfl6GUaI/AAAAAAAAAD8/17-FYNjl3bI/s1600-h/8faebaa076ca947f66560494e289dbb651e855fa.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5355853623043969442" src="http://2.bp.blogspot.com/_eRQUuPVfFqU/SlPQfl6GUaI/AAAAAAAAAD8/17-FYNjl3bI/s320/8faebaa076ca947f66560494e289dbb651e855fa.jpg" style="cursor: pointer; float: left; height: 110px; margin: 0pt 10px 10px 0pt; width: 110px;" /></a></span>We know how to do this. A car hits a light pole -- somebody, maybe <i>you </i>will call 911. Somebody is choking in a restaurant -- somebody else, maybe <i>I </i>will leap up to do the Heimlich Maneuver.</span><br /><br /><span style="font-family: verdana;">It doesn't have to be an emergency. If a friend has a persistent cough, or mentions a bruise that won't go away, or complains about chest pains, we urge them to see a doctor. We have learned to recognize signs of cancer, heart disease, stroke. We get involved, we even get on their case when the people we care about need help.</span><br /><br /><span style="font-family: verdana;">Most of the time we do. Sometimes we turn away. Last week I kept having the same two </span></span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_0" style="font-family: verdana;"><span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">conversations</span></span><span><span style="font-family: verdana;"> over and over. The first was about a man who dangled by a chain from the end of a crane. He reached out to catch a woman caught in the boil of a dam, to rescue her from drowning. The second was with friends who just didn't know what to do -- about a cousin who is irrational, a daughter who doesn't get out of bed, a godson who can't keep a job, each of them </span></span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_1" style="font-family: verdana;">diagnosable</span><span><span style="font-family: verdana;"> with a serious mental illness, none of them getting treatment.</span><br /><br /></span></span><h3><span style="font-size: large;"><span><span style="font-family: verdana;">What To Do When A Friend Has A Mental Illness</span></span></span></h3><span style="font-size: large;"><br /></span><a name='more'></a><div><span style="font-size: large;"><span><span style="font-family: verdana;">The <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">juxtaposition</span> of these two <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">conversations</span> struck me, the immediate, eager help in one and the bafflement in the other. My baffled friends are not callous. They are baffled. And it struck me, somebody taught me how to do the Heimlich maneuver. But nobody taught me what to do when my brother or sister goes crazy, except -- be scared.</span></span><br /><br /></span><h3><span style="font-size: large;"><span><span style="font-family: verdana;">First Aid</span></span></span></h3><span style="font-size: large;"><br /></span><a href="http://2.bp.blogspot.com/-ZI90llcnB9w/TepcS6IxEFI/AAAAAAAAAzY/KIv4ueNFORo/s1600/Red_Cross_icon.svg.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" height="200" src="http://2.bp.blogspot.com/-ZI90llcnB9w/TepcS6IxEFI/AAAAAAAAAzY/KIv4ueNFORo/s200/Red_Cross_icon.svg.png" width="200" /></span></a><span style="font-size: large;"><span><span style="font-family: verdana;">A crisis is less scary when you know what to do. Did you ever take a first aid class? I learned to put pressure on a bleeding wound in Girl Scouts. I learned CPR in Health Class. What if we had a first aid course for mental illness?</span></span><br /><br /><span><span style="font-family: verdana;">I believe that well-meaning people will do the best they can. I also believe they can do better if they <span style="font-style: italic;">know </span>better. We need the same basic information about mental illness as we have about physical illness, how to recognize signs, </span></span><span><span style="font-family: verdana;">how to negotiate the immediate crisis, and </span></span><span><span style="font-family: verdana;">how </span></span><span><span style="font-family: verdana;">to get the person to appropriate help.</span><br /><br /><span style="font-family: verdana;">I just discovered that such a thing exists, when a friend took a class in <a href="https://www.mentalhealthfirstaid.org/" target="_blank">Mental Health First Aid</a>. </span></span>Mental Health First Aid is a <span style="font-family: verdana;"><i>public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders.</i><span> </span><span><i><b>The 12 hour course</b></i></span> <i>presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments.</i> </span><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Check it out. Look on the website for a course in your area. </span></span></span><br /><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">The good news about first aid for mental illness -- there will not be blood.<br /><br /></span></span></span></span><h3><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Communication Skills</span></span></span></span></h3><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><br /></span></span></span><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Meanwhile, I am quite taken by a card that <a href="https://namijc.org/" target="_blank"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">NAMI</span> Johnson County</a> in Iowa distributes. It is 1 1/2 by 2 1/2, laminated, and gives practical guidance.</span></span></span><br /><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">The front is about <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">communicating</span> with someone in crisis who has a psychiatric illness.<br /></span></span></span></span><h3><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><br /></span></span></span></span><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Proceed to interact as you:</span></span></span></span></h3><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><span> </span></span></span></span><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><span>1 - Be calm and give firm, clear </span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">instructions</span><span><br />2 - Assess the situation for safety<br />3 - Maintain adequate space between you and the person<br />4 - Respond to apparent feelings<br />5 - Respond to delusions and </span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">hallucinations</span><span> by talking about the person's feelings rather than what is said<br />6 - Be helpful, encouraging and supportive</span><br /><br /><span style="font-weight: bold;">Avoid:</span><br /><span> </span></span></span></span><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><span>1 - Reinforcing behavior related to the person's illness<br />2 - Staring at the person (this may be interpreted as a threat)<br />3 - Confusing the person<br />4 - Giving multiple choices, this may increase confusion<br />5 - Whispering, yelling ridiculing, deceiving or touching, this may cause fear and lead to violence.</span><br /><br />The back is a list of behaviors and responses.<br /></span></span></span></span><div><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><br /></span></span></span></span><h3><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Someone with a psychiatric illness might... <br /></span></span></span></span><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"> So you need to...</span></span></span></span></h3></div><span style="font-size: large;"><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><span> </span></span></span></span><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><span>Have trouble with reality.......... Be simple, truthful<br />Be fearful.............................. Stay calm<br />Be insecure........................... Be accepting<br />Have trouble </span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">concentrating</span><span>...... Be brief, repeat<br />Be over stimulated................. Limit input<br />Easily become agitated........... Recognize agitation<br />Have poor judgment........... Not expect rational discussion<br />Be preoccupied....................... Get attention first<br />Be withdrawn......................... Initiate relevant </span><span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">conversation</span><span><br />Have changing emotions.......... Disregard<br />Have changing plans............... Keep to one plan<br />Have little empathy for you...... Recognize as a symptom<br />Believe delusions............... Ignore delusions, don't argue<br />Have low self-esteem and motivation..... Stay positive</span><br /><br /></span></span></span><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">For what it is worth, this list describes well what would be helpful to <i>me </i>when I am in a crisis, what has been helpful. </span></span></span><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">I would add one item:</span></span></span></span></div><div><span style="font-size: large;"><i><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"><br /></span></span></span></i></span></div><div><span style="font-size: large;"><i><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">Someone with a psychiatric illness might feel <b>shame</b>. So you need to demonstrate <b>respect</b>.</span></span></span></i><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;"> </span></span></span><br /><br /><span><span style="font-family: Times New Roman;"><span style="font-family: verdana;">For each of these, the essential point is to <span style="font-weight: bold;">recognize the symptom</span>. The behaviors that make people turn away from those who are mentally ill are <span style="font-weight: bold;">symptoms</span>. They are <span style="font-weight: bold;">not about you</span>. They give you important information, that <span style="font-weight: bold;">the person needs help</span>.<br /><br />If you stay focused on that, it may be easier not to turn away. You could be the person who reaches to the one who is caught in the boil. You could keep your friend from going under.</span></span></span></span><br /></div><div style="text-align: right;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><i><span style="font-size: xx-small;">flair from facebook</span></i></span></span><br /><span style="font-size: small;"><span style="font-family: Times New Roman;"><i><span style="font-size: xx-small;">red cross in the public domain</span></i></span></span></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-62922326380321868482023-05-24T11:21:00.000-07:002023-05-24T11:21:07.016-07:00Bad Mental Health Take on Autism - One More from Allen Frances<p><span style="font-family: verdana; font-size: large;">Before <b>Mental Health Awareness Month</b> draws to its nonconsequential end -- </span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Allen Frances</span></h3><p><span style="font-family: verdana; font-size: large;">New York Post has published a <a href="https://nypost.com/2023/04/24/doctor-who-broadened-autism-spectrum-sorry-for-over-diagnosis/" target="_blank">new interview</a> with Allen Frances about how bad it is to receive a diagnosis, or as he puts it, become a <i>mental patient.</i></span></p><p><span style="font-family: verdana; font-size: large;">Become a mental patient?</span></p><p><span style="font-size: large;"><span style="font-family: verdana;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><span style="font-family: verdana;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPS23IaNVU-dXrQjwSLNzh7DHEhz2o_0Adgwm6uAaBLxDck2kuKy-TTWYUKdSxQ358-hR27wgvnrrY-BNN_HCRJI-PbHPtZqKFL8J0md5F2oCdoJkZJxlayV47_NGlI4Qom1nzLcHdnjo0zXtcaFtHn--V8FUxoluuBgH879iRR01IFNUiBMLoutHmiA/s100/allen%20frances%20amazon.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="100" data-original-width="80" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPS23IaNVU-dXrQjwSLNzh7DHEhz2o_0Adgwm6uAaBLxDck2kuKy-TTWYUKdSxQ358-hR27wgvnrrY-BNN_HCRJI-PbHPtZqKFL8J0md5F2oCdoJkZJxlayV47_NGlI4Qom1nzLcHdnjo0zXtcaFtHn--V8FUxoluuBgH879iRR01IFNUiBMLoutHmiA/w165-h206/allen%20frances%20amazon.jpg" width="165" /></a></span></span></div><span style="font-family: verdana; font-size: large;">Some background: Allen Frances is a professor emeritus of psychiatry and behavioral sciences at Duke University. His fields of research were wide ranging, including p<span style="background-color: white; color: #202122;">ersonality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. [Note: not autism]. He served as</span> the chair for the DSM (Diagnostic and Statistical Manual of Mental Disorders) task force, which published the DSM IV in 1994. He later became the chief critic of the DSM 5, which is a modest revision of his work.</span><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">In a nutshell--he didn't like any of the revisions.</span><p></p><p><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir-exDp_LWi3rGbJf4wCmQmdsZTG8tzfXTLCXtwxFHsQsZTj4eb0HTsK_IiIXUe480qBM2mRvy5tSYvqLC-0QOcC7Nbw8JB6_LnADMoW3ZD6qHNSPulHcB8-WER5TxHRYpFMp1NQo5SVK7mY73PZZlzuZ34IqpjVVqhbaHhtpKOxuvqzcyY-Jk8c5Njg/s346/saving%20normal%20amazon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="346" data-original-width="233" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir-exDp_LWi3rGbJf4wCmQmdsZTG8tzfXTLCXtwxFHsQsZTj4eb0HTsK_IiIXUe480qBM2mRvy5tSYvqLC-0QOcC7Nbw8JB6_LnADMoW3ZD6qHNSPulHcB8-WER5TxHRYpFMp1NQo5SVK7mY73PZZlzuZ34IqpjVVqhbaHhtpKOxuvqzcyY-Jk8c5Njg/w146-h218/saving%20normal%20amazon.jpg" width="146" /></a></span></div><span style="font-family: verdana; font-size: large;">As part of Frances's critique of the DSM 5, he wrote <a href="https://www.prozacmonologues.com/2013/08/saving-normal-diagnosis-game.html" style="font-style: italic;" target="_blank">Saving Normal</a>, subtitled <span style="background-color: white; color: #0f1111;"><i>An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. </i>His book was published one week before the DSM-5<i>. </i>Since then he has continued the themes of the subtitle.</span></span><p></p><p><span style="background-color: white; color: #0f1111;"><span style="font-family: verdana; font-size: large;">In addition to my review of his book linked above, I have commented <a href="https://www.prozacmonologues.com/search/label/Allen%20Frances" target="_blank">a few times</a> on Frances's statements. I appreciate his concerns about Big Pharma's influence in the treatment of mental illness and inappropriate use of medication, especially in the case of <a href="https://www.prozacmonologues.com/2021/09/should-every-primary-care-patient-be.html" target="_blank">mild depression</a>. His periodic attempts to <i>save normal</i>, not so much.</span></span></p><p><span style="background-color: white; color: #0f1111;"><span style="font-family: verdana; font-size: large;">A couple quotes from his New York Post interview:</span></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><span style="background-color: white; color: #2a2a2a; letter-spacing: -0.16px;"><span style="font-family: verdana; font-size: large;">Dr. Allen Frances told The Post that he is “very sorry for helping to lower the diagnosis bar.”</span></span></p><p><span style="background-color: white; color: #2a2a2a; letter-spacing: -0.16px;"><span style="font-family: verdana; font-size: large;">Now, Frances said, he fears his work “contributed to the creation of diagnostic fads that resulted in the massive over-diagnosis of autistic disorders in children and adults.”</span></span></p></blockquote><h3 style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">Stigma Against Mental Illness</span></span></h3><p><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">One of the themes of <i>Saving Normal </i>is that diagnosis exposes people to stigma. So it would be worrisome to him that so many people are now mental patients, newly exposed to stigma.</span></span></p><p><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">I'll grant Francis this point. Prejudice against mental illness is alive and well - and particularly dangerous when it is <a href="https://www.prozacmonologues.com/2013/07/doctors-prejudice-against-mental-illness.html#more" target="_blank">expressed in the medical field</a>.</span></span></p><p><span style="font-size: large;"><span style="font-family: verdana;"><span style="color: #2a2a2a;"><span style="background-color: white; letter-spacing: -0.16px;">There is scant evidence that <i>Stamp Out Stigma</i> campaigns have moved the needle, except on the issue of depression. Judging by news reports, prejudice against people with mental illness has been growing. </span></span></span></span></p><p></p><ul style="text-align: left;"><li><span style="font-size: large;"><span style="font-family: verdana;"><span style="color: #2a2a2a;"><span style="background-color: white; letter-spacing: -0.16px;"><a href="https://www.pbs.org/newshour/health/how-some-encounters-between-police-and-people-with-mental-illness-can-turn-tragic" target="_blank">Police killings</a> of people with mental illness are routinely excused.</span></span></span></span></li></ul><ul style="text-align: left;"><li><span style="font-size: large;"><span style="font-family: verdana;"><span style="color: #2a2a2a;"><span style="background-color: white; letter-spacing: -0.16px;"><a href="https://www.forbes.com/sites/anafaguy/2023/05/14/daniel-penny-raises-15-million-for-defense-after-charges-in-nyc-subway-chokehold-death/?sh=2b7fc0e742e4" target="_blank">Recently, an ex-Marine </a></span></span><span style="background-color: white; color: #2a2a2a; letter-spacing: -0.16px;">is lauded as a hero after</span><span style="background-color: white; color: #2a2a2a; letter-spacing: -0.16px;"> putting Jordan Neely, a disturbed man on a New York subway, into a choke hold for fifteen minutes. In two days Daniel Penny raised over $1.5 million</span></span><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"> </span><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;">for his defense against a charge of second degree manslaughter.</span></span></li></ul><ul style="text-align: left;"><li><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">As <a href="https://abcnews.go.com/Health/gov-abbott-places-shooting-blame-mental-health-texas/story?id=84993527" target="_blank">politicians</a> regularly blame mass shootings on mental illness, they also routinely reduce funding to address it.</span></span></li></ul><p></p><p><span style="font-size: large;"><span style="color: #2a2a2a; font-family: verdana;"><span style="background-color: white; letter-spacing: -0.16px;"></span></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><span style="color: #2a2a2a; font-family: verdana;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhbwUdfptoK-GjncaMOyKh9R92ESnzu60J-IRL0Cm_JJwsriiyaozBWO4Ny-Lx9KHC2aeMDzj5SzLFCj6O7X6L8LJ_F99fLe7wXt69FtzHDVo6j2MPnpW-loGBeRzeIwAOglmEEDh3Z90FfBK8Ei6dNn8M0RYfNinwD91IO-VqIaBEfWGUygvlIxMk_PA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="163" data-original-width="310" height="231" src="https://blogger.googleusercontent.com/img/a/AVvXsEhbwUdfptoK-GjncaMOyKh9R92ESnzu60J-IRL0Cm_JJwsriiyaozBWO4Ny-Lx9KHC2aeMDzj5SzLFCj6O7X6L8LJ_F99fLe7wXt69FtzHDVo6j2MPnpW-loGBeRzeIwAOglmEEDh3Z90FfBK8Ei6dNn8M0RYfNinwD91IO-VqIaBEfWGUygvlIxMk_PA=w439-h231" width="439" /></a></span></span></div><span style="font-size: large;"><span style="color: #2a2a2a; font-family: verdana;"><br /></span><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;">The thing is, prejudice against difference does not stem from diagnosis. It stems simply from difference itself.</span></span><p></p><h3 style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">A Diagnosis of Autism</span></span></h3><p><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">In the case of autism, l</span></span><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">et me suggest an alternative to Francis's view.</span></span></p><p><span style="font-size: large;"><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;">From the anecdotal evidence of many people finally diagnosed in adulthood, the diagnosis brings not stigma but relief. They had </span><i style="color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;">already</i><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"> been stigmatized throughout childhood. Not by a psychiatric diagnosis, but by the schoolyard diagnosis </span><i style="color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"><b>weird</b></i><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"> and the classroom diagnosis </span><i style="color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"><b>behavior problem</b></i><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;">. They grew up being bullied and punished because they were not </span><i style="color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"><b>normal</b></i><span style="background-color: white; color: #2a2a2a; font-family: verdana; letter-spacing: -0.16px;"> - to use Dr. Francis's favorite word.</span></span></p><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">People diagnosed with autism in adulthood often already have other diagnoses, most commonly depression and anxiety. They sometimes have experienced suicidal thoughts or attempts. These are the consequences not of their undisclosed diagnosis of autism, but of the way they have been treated by others - on the basis of their difference which it does not take a psychiatrist to notice. It only takes a psychiatrist to <i>explain.</i></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">Hence their relief - finally to have an explanation.</span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">The NYP quotes the statistic that rates of autism in the US have soared 500% over the last sixteen years. This is a bait and switch statistic. The DSM 5 changed the definition of autism, combining profound autism, childhood disintegrative disorder, pervasive developmental disorder, and what was once called Asperger syndrome under one umbrella diagnosis, autism spectrum.</span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">Whether or not combining these conditions with different treatment needs under one label was a good idea is a separate discussion. But the change in <i>rates</i> was not as drastic as the statistic suggests. The numbers for three separate diagnoses have been added to the first.</span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">But it is <a href="https://www.prozacmonologues.com/2013/11/soldiers-on-psych-meds.html" target="_blank">not the first time</a> Dr. Francis has played fast and loose with statistics to claim over-diagnosis. The statistic does not support his thesis of over-diagnosis because the sample population has changed.</span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><h3 style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">Underserved Children with Autism</span></span></h3><div><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">The article misses the most significant part of the story, reported in the journal <a href="https://publications.aap.org/pediatrics/article-abstract/151/2/e2022056594/190525/Prevalence-and-Disparities-in-the-Detection-of" target="_blank"><i>Pediatrics</i></a>. There are significant disparities in rates of diagnosis between white and black children and between affluent and poor children:</span></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div style="text-align: left;"><span style="background-color: white; color: #1a1a1a;"><span style="font-family: verdana; font-size: large;">Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas.</span></span></div></blockquote><p><span style="font-family: verdana;"><span style="font-size: large;">The consequence of <i>under-</i>diagnosis is that, while rich white kids get services, poor black kids get placed in the <i>school to prison</i> pipeline.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">There are real life consequences to <i>under</i>-diagnosis. Poor black kids should not have to pay the cost for Allen Frances's hobby horse.</span></span></p><h3 style="text-align: left;"><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;">More Next Week</span></span></h3><div><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><br /></span></span></div><div><span style="color: #2a2a2a; font-family: verdana; font-size: large;"><span style="background-color: white; letter-spacing: -0.16px;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSNu12HzBM8uLnnB4TbcZMa-tMR9NqfcM2OPqW5wRftdsgsLZ2OgIvycSGur7K4NrGaG9dV_BQwQJiWG1tUr5GckF5xVbULGwie0n5GLUBAqVuF2s084JEY2qVYGcIeYad6UdGUr6mSD49qdQArZnFWciusuoa_o4kp57YKShPBU3GbDqdnA72ZmX_BQ/s110/microphone.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSNu12HzBM8uLnnB4TbcZMa-tMR9NqfcM2OPqW5wRftdsgsLZ2OgIvycSGur7K4NrGaG9dV_BQwQJiWG1tUr5GckF5xVbULGwie0n5GLUBAqVuF2s084JEY2qVYGcIeYad6UdGUr6mSD49qdQArZnFWciusuoa_o4kp57YKShPBU3GbDqdnA72ZmX_BQ/w140-h140/microphone.jpg" width="140" /></a></div>So clearly, I have thoughts. Lots of thoughts. It's time to sign off for this week and promise more to come. But you are welcome to join the conversation by commenting below!</span></span></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-62529625535239397322023-04-17T08:53:00.001-07:002023-04-17T08:53:22.668-07:00Why Am I Still Sick? Mental Illness, Faith, and the Love of God<p><span style="font-family: verdana;"><span style="font-size: large;">Rumor has it, I'm going to start preaching again. My brain functions a lot better than it used to. But it still functions slowly. So to give myself plenty of time, I have been looking ahead to the scriptures that are coming up in the lectionary.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: medium;">[In the Episcopal Church, among others, we preachers don't pick and choose our favorite bits of the Bible. We get confronted by and have to deal with what is assigned.]</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">That's how I came across Matthew 9:18-26, one of the texts for early June. Jesus is on his way to heal a young girl when a woman with <i>an issue of blood</i> reaches out surreptitiously to touch him. He feels the power go out of him and turns to confront her. Then he says:</span></span></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>Take heart, daughter; your faith has made you well.</i></span></p></blockquote><p><span style="font-family: verdana;"><span style="font-size: large;">Ah, here it comes -- the faith question of every person with a chronic or fatal illness, every person who prays and has people praying for us.</span></span></p><p style="text-align: center;"><span style="font-family: verdana;"><i><span style="font-size: large;">Don't I have faith? Don't I have <u>enough</u> faith to get my healing?</span></i></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">Many years ago in one of my darkest times, I met a young woman. She was part of a mission group who had come from Mexico to Costa Rica. On behalf of a local church, she and others would be going door to door, sharing their witness.</span></span></p><p><span style="font-family: verdana; font-size: large;">She asked me what <i>I</i> was doing in Costa Rica. So I told her that I had depression and was writing a book about it.</span></p><p><span style="font-family: verdana; font-size: large;">Without missing a beat, she answered, <i>If you give your life to Jesus, he will heal you, and you won't have depression anymore.</i></span></p><p><span style="font-family: verdana; font-size: large;">She described her life in her teens, a life of indulgence, as she put it. She was a smoker. But then she gave her life to Jesus and he turned her around. He took away her addiction to cigarettes</span></p><p><span style="font-family: verdana; font-size: large;">Oh, honey.</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">She and I had met at the church that was sponsoring the mission. The worship service had gone long</span><span style="font-family: verdana;">. I was tired. And I didn't have enough Spanish to get into it with her.</span></span></p><p><span style="font-family: verdana; font-size: large;">So I didn't tell her that </span></p><div style="text-align: left;"><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">I fell in love with Jesus when I was eight and was baptized</span></li><li><span style="font-family: verdana; font-size: large;">I took Jesus as my Lord and Savior when I was eighteen at college</span></li><li><span style="font-family: verdana; font-size: large;">I gave my life to Jesus when I entered seminary at twenty-five</span></li><li><span style="font-family: verdana; font-size: large;">I vowed to <i>. . . pattern my life in accordance with the teachings of Christ, so that I may be a wholesome example to my people</i> when I was ordained a priest at twenty-nine</span></li><li><span style="font-family: verdana; font-size: large;">I . . . well, you get the idea.</span></li></ul></div><p><span style="font-size: large;"><span style="font-family: verdana;">The thing is, I have a brain that works differently, and sometimes not very well. L</span><span style="font-family: verdana;">iving a life in Christ has not protected me from the symptoms of bipolar disorder, nor even from feeling suicidal at its worst.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">Bipolar disorder has been around for millennia. People had it before the coming of Christ. And people have had it since. Faith in Jesus really has nothing to do with it.</span></span></p><p><span style="font-size: large;"><span style="font-family: verdana;">I am glad that Jesus took away her addiction to cigarettes. I am glad that Jesus healed the woman with an issue of blood, that he freed the </span><span style="font-family: verdana;">Gerasene </span><span style="font-family: verdana;">man who had been possessed, that he raised Lazarus from the dead.</span></span></p><p><span style="font-family: verdana; font-size: large;">But he hasn't healed me. At least, he hasn't taken away my bipolar.</span></p><p><span style="font-family: verdana; font-size: large;">Why not?</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">No, don't answer that question. I don't want an explanation. </span><span style="font-family: verdana;">I especially don't want </span><span style="font-family: verdana;"><i>God</i></span><span style="font-family: verdana;"> to </span><span style="font-family: verdana;">explain</span><span style="font-family: verdana;"> to me how He -- and I use that pronoun on purpose -- how </span><i style="font-family: verdana;">He</i><span style="font-family: verdana;"> is using my suffering to some greater end. To help you, I suppose.</span></span></p><p><span style="font-family: verdana; font-size: large;">I don't want a God who manipulates people who are suffering, moves us around on some chessboard as part of His grand design.</span></p><p><span style="font-family: verdana; font-size: large;">For God's sake, don't tell me to have faith.</span></p><p><span style="font-family: verdana; font-size: large;">What a cruel notion that if you just believe hard enough you will be healed.</span></p><p><span style="font-family: verdana; font-size: large;">The first preaching I will do after an absence of a few years will be for a man who was one of the most faith-filled people I know. He died after waiting for years for a lung transplant, while people around the world prayed for him. As people have prayed for me.</span></p><p><span style="font-family: verdana; font-size: large;">Why am I still sick? I think that's the wrong question to address to God. I think that question posits the existence of the kind of God that we <i>want</i>, a God who will answer our questions and give us certainty and make us feel good.</span></p><p><span style="font-family: verdana; font-size: large;">A God that exists only in our desires and our imaginations.</span></p><p><span style="font-family: verdana; font-size: large;">Whoa! Did the preacher say that God doesn't exist? No, the preacher said that the God that <i>does</i> exist is not small enough to fit inside the box of our desires.</span></p><p><span style="font-family: verdana; font-size: large;">Who is the God who <i>does</i> exist? I am a very smart person. Nevertheless, that question is beyond my bandwidth. I have my own desires about God. But I no longer expect that God will satisfy them.</span></p><p><span style="font-family: verdana; font-size: large;">However, reading all those stories of healings year after year, over forty years of preaching on them, there is something that I have noticed. In almost every one of them, part of the healing is a return to community.</span></p><p><span style="font-family: verdana; font-size: large;">The woman who had had an issue of blood for fifteen years (endometriosis?) would have been <i>unclean</i> on that account. Nobody would have touched her. For fifteen years. Now she could take a neighbor's hand.</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">The Gerasene man who was possessed (schizophrenia?) lived in chains outside the city of </span><span style="font-family: verdana;">Gerasa</span><span style="font-family: verdana;">. When he was restored to his right mind, Jesus sent him home.</span></span></p><p><span style="font-family: verdana; font-size: large;">Lazarus -- dead and in the tomb. Jesus returned him to his sisters.</span></p><p><span style="font-family: verdana; font-size: large;">And me with my bipolar -- that is the kind of healing I <i>have</i> experienced. When I was newly disabled and not leaving my second floor condo except to go to the doctor, I joined NAMI -- National Alliance on Mental Illness. I went a Peer to Peer class, where people with mental illness teach other people with mental illness how to navigate our lives.</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">I discovered people who didn't care whether I had faith or not. They </span><span style="font-family: verdana;">didn't need for me to be healed to confirm their own faith. They expected I wouldn't be. And they loved me.</span><span style="font-family: verdana;"> They invited me in. They were my new community.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">Romans 8 -- that's what I believe. When I don't believe in God -- I <i>really</i> don't believe in the God who withholds healing based on my puny wounded capacity for faith -- I do believe this:</span></span></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>I am sure that neither death, nor life, [nor feeling suicidal], nor angels, nor principalities, [nor health insurance companies], nor height, nor depth, [nor the personal hell of side effects], nor anything else in all creation will be able to separate us from the love of God in Christ Jesus our Lord.</i></span></p></blockquote><p><span style="font-family: verdana; font-size: large;">I am not healed. But I am loved.</span></p><p><span style="font-family: verdana; font-size: large;">That's a kind of healing. And it is enough.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMzsdXbxoKYTG24Vytx5_xE8FmgyQT-aYxATVZajiXDiNq2j634LqjXvDwY1XvKwOpokDV8-t5yNHTlYbGCepVvjMUgaz9kxPACTe5Zi9YyB3MVeaKTB5UA5RoFWJcHhQnJOcud76253ZxW8QrdacUYJQG0S537fTyiu0af5WIwnvrNBSnLfOeLsocQw/s800/candles,%20Nevit%20Dilmen,%20GNU%20license.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="529" data-original-width="800" height="277" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMzsdXbxoKYTG24Vytx5_xE8FmgyQT-aYxATVZajiXDiNq2j634LqjXvDwY1XvKwOpokDV8-t5yNHTlYbGCepVvjMUgaz9kxPACTe5Zi9YyB3MVeaKTB5UA5RoFWJcHhQnJOcud76253ZxW8QrdacUYJQG0S537fTyiu0af5WIwnvrNBSnLfOeLsocQw/w418-h277/candles,%20Nevit%20Dilmen,%20GNU%20license.JPG" width="418" /></a></div><br /><div style="text-align: right;"><i style="font-family: verdana; font-size: x-small;">photo by Nevit Dilman, used under the creative commons license.</i></div><p></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-1576106522661808742023-04-10T11:31:00.003-07:002023-04-12T17:03:46.367-07:00This is an experiment<p></p><div style="text-align: center; width: 480px;"><iframe allow="fullscreen" frameborder="0" height="200" src="https://giphy.com/embed/VqZlCI0cPC5aUT9lNK/video" width="480"></iframe></div>
<br /><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Oops. I didn't realize this was published. I'm trying to figure out how to get it into a powerpoint, with the byline - this is NOT what I mean by self care. Silly. But oh well, I'll leave it up for now.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">But as long as you're here, check out the labels in the column to the right. Explore some topics of past posts.</span></p><p></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-60964489188778769662023-03-29T11:26:00.001-07:002023-03-29T11:26:20.412-07:00World Bipolar Day: What the Heck Happened to my Brain?<p><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9SG8zYSgenGYveY61YyqoKhPG-jPfBhsH6-u2weWfrDqFkcJ8OxCrD9VA7L4qZy1iWr2MXd4QfWFOlTUN1s3aTeNeF9ZLIpxQaO8s_NVu7KghCwImZoJXv3dQmMCIAqKkf4RxAbv_2Yl_SskjTqkrmxUpIKcdGkQpkC0PAjlO4Svzx2xaR6VUFKNpCQ/s110/microphone.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="110" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9SG8zYSgenGYveY61YyqoKhPG-jPfBhsH6-u2weWfrDqFkcJ8OxCrD9VA7L4qZy1iWr2MXd4QfWFOlTUN1s3aTeNeF9ZLIpxQaO8s_NVu7KghCwImZoJXv3dQmMCIAqKkf4RxAbv_2Yl_SskjTqkrmxUpIKcdGkQpkC0PAjlO4Svzx2xaR6VUFKNpCQ/s1600/microphone.jpg" width="110" /></a></span></div><span style="font-family: verdana; font-size: large;">Prozac Monologues is a book within a book. Its original form was a series of monologues written in an unrecognized hypomanic state. The rest of the story is what I learned about bipolar disorder after I learned that I have it.</span><p></p><p><span style="font-family: verdana; font-size: large;">In <i>Balancing Act -- The Science Chapter, </i>I answer the question, <i>How did I get into this mess anyway?</i> I compare it to another question, <i>Why did the roof collapse?</i> Both answers are to be found in a process that begins with something a little wonky and develops into a systemic mess.</span></p><p><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxmtMKQ1PV-fp0p_O0K1tsHPnvmj2uK_2c6F0sYWN1KCykZ59tzoUYZCjYccrP0dFF5BGHd3kva-1wD_iRp7D5z556pzzfAlhCgjdYhGgOf4E_GLJE5-yHAWQGBYYX03hqp_sRYwFcnhcC-qWGBH_P-NDt7w0vojIlf7v0-RFHMi-GFiIPH5zEWOC9g/s2592/snowmageddon.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1936" data-original-width="2592" height="325" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxmtMKQ1PV-fp0p_O0K1tsHPnvmj2uK_2c6F0sYWN1KCykZ59tzoUYZCjYccrP0dFF5BGHd3kva-1wD_iRp7D5z556pzzfAlhCgjdYhGgOf4E_GLJE5-yHAWQGBYYX03hqp_sRYwFcnhcC-qWGBH_P-NDt7w0vojIlf7v0-RFHMi-GFiIPH5zEWOC9g/w435-h325/snowmageddon.jpeg" width="435" /></a></span></div><span style="font-family: verdana; font-size: large;"><br />The following excerpt skips the charming roof collapse explanation (inspired by true events during one Central Oregon snowmaggedon in 2017). Buy the <a href="https://willagoodfellow.com/">book</a> for that story! It goes straight to the science part. Let me know in the comments what you think.</span><p></p><p><span style="font-family: times; font-size: large;"><span></span></span></p><a name='more'></a><span style="font-family: times; font-size: large;">. . . So what happened?</span><p></p><p><span style="font-family: times; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: times; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUaJpsMSedTEqWHtk8YqL8-5LFz3-pkXSDZTJFas58I5CdJS_Poou3t3Bpb4rEHB_WL_matNLw9oY_jK6pEx4LJdfqjBu2DSgmph-kIjTk_80sOlTzogQonMZyKtpebvexX0imeIC9AUGUGV88E3-JoWwXJ_rLnnxwmEzZPcYB5ffghRiNe7daG1ZTXg/s300/DNA_orbit_animated_small.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="300" data-original-width="182" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUaJpsMSedTEqWHtk8YqL8-5LFz3-pkXSDZTJFas58I5CdJS_Poou3t3Bpb4rEHB_WL_matNLw9oY_jK6pEx4LJdfqjBu2DSgmph-kIjTk_80sOlTzogQonMZyKtpebvexX0imeIC9AUGUGV88E3-JoWwXJ_rLnnxwmEzZPcYB5ffghRiNe7daG1ZTXg/s1600/DNA_orbit_animated_small.gif" width="182" /></a></span></div><span style="font-family: times; font-size: large;">In the brain's construction phase, there were some genes that added variety to the plan. One or two would have been fine. But as the anomalies added up in what would develop into a mind-bogglingly complex network of interacting processes and feedback loops, the potential for breakdown rose.</span><p></p><p><span style="font-family: times; font-size: large;">Next, the brain built pathways between parts and developed those processes and feedback loops. Trying to accommodate its problematic genes, things got wonky.</span></p><p><span style="font-family: times; font-size: large;">Throw some environmental factors on top. Your mother's childhood trauma or even her case of the flu while you were riding along in utero counts as an environmental factor. Add a few adverse childhood experiences, maybe somebody who did his/her own jumping on your fragile roof.</span></p><p><span style="font-family: times; font-size: large;">Your already wonky brain doesn't have the resiliency that other kids have to shake things off. Trace that deficit to genes and environment both. You develop some practices, both neurological and behavioral to cope. Some of these practices bring short-term benefits but morph into neuroses that will take years of therapy to undo. Others get you into trouble from the get-go. Sleep would soothe the savage beast, but your sleep cycle is one of the wonkier parts of this system, and your impulse control shows it.</span></p><p><span style="font-family: times; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: times; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkyKW9tSxn3MaeVmXGwPd5knF4RKYgzyDExJU5F_ZelE9sjYi6hTsV6KCDn5tTNodjpIRIzir7t31kA28RMHiln6VgAEit9z8f1ma1p8cr5LZfoFd4iTiaMfRQKiNYotL9RKAnyaTrwIVUEd6rSjO_7L05KB5SbKWyfzsn-DpRuD9-1bwA425q-6V93g/s273/HPA%20loop%20D%20Rosenbach.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="273" data-original-width="259" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkyKW9tSxn3MaeVmXGwPd5knF4RKYgzyDExJU5F_ZelE9sjYi6hTsV6KCDn5tTNodjpIRIzir7t31kA28RMHiln6VgAEit9z8f1ma1p8cr5LZfoFd4iTiaMfRQKiNYotL9RKAnyaTrwIVUEd6rSjO_7L05KB5SbKWyfzsn-DpRuD9-1bwA425q-6V93g/w194-h205/HPA%20loop%20D%20Rosenbach.png" width="194" /></a></span></div><span style="font-family: times; font-size: large;">So many in the bipolar tribe have what they call comorbid anxiety disorders that anxiety could be considered a key feature of some variants of the condition. The alarm system in your brain may not have a functioning "off" switch. It can dial down within a limited range, but the buzz runs continually in the background, making you hypersensitive, hyperactive, hyperreactive, which gets you into trouble, creating more trauma, which sets up a cycle that continues to do damage, especially if you start self-medicating to ease the pain.</span><p></p><p><span style="font-family: times; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: times; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjARp2NUubncCXQSeLWF5p39PKHVMyYYwyRItu_vlRFJ_1WXYNfjdMOj9Qz8L4-7_2Yx9Lk6dWIc9bT81ctNXX93hTmT736_isCrsNdK2y1ZJLErYEgt2oWJoIOFDThBolQ1UfoZPuhxUvBWspU7WlJTqUy1kLCcfDiE-aHM8FK3PGJa0hjPisRF5SsnQ/s192/blue%20ribbon.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="192" data-original-width="192" height="121" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjARp2NUubncCXQSeLWF5p39PKHVMyYYwyRItu_vlRFJ_1WXYNfjdMOj9Qz8L4-7_2Yx9Lk6dWIc9bT81ctNXX93hTmT736_isCrsNdK2y1ZJLErYEgt2oWJoIOFDThBolQ1UfoZPuhxUvBWspU7WlJTqUy1kLCcfDiE-aHM8FK3PGJa0hjPisRF5SsnQ/w121-h121/blue%20ribbon.jpeg" width="121" /></a></span></div><span style="font-family: times; font-size: large;">On the outside, all may be well. In fact, your bursts of activity, properly directed by the appropriate neuroses, may lead to great success, college scholarships, job promotions, friends and influence, lots of parties of which you are the life. Your brain processes information and reaches conclusions with lightening efficiency, and don't ever let your slowpoke psychiatrist forget it. If two feet of snow never falls on your roof, you turn into Christopher Columbus, Teddy Roosevelt, Ted Turner -- some astounding if slightly weird overachiever.</span><p></p><p><span style="font-family: times; font-size: large;">However. This is a progressive condition. Each untreated glitch creates another problematic issue, which sets up the next troublesome response, which reinforces a bad pattern, which continues to damage the underlying structure. Until something gives.</span></p><p><span style="font-family: times; font-size: large;">Since you can't replace your brain like you can your roof, enter a whole team of doctors, pharmacists, support groups, websites, and books (see the chapter <i>Keep Going</i> in this one) to help you prop it up, develop new habits to reduce the risk of collapse, and house you on those occasions when you need major repairs.</span></p><p><span style="font-family: times; font-size: large;">Brain nerds can describe it in one paragraph . . .</span></p><p><span style="font-family: verdana; font-size: large;">(which I delete here)</span></p><p><span style="font-family: times; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: times; font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjX4kmTw85XlOWNT-dhDULjfFrVkZXtmIsqA3sEZd6cHDppdcfKgCk29YwbZlc-wvx-DVxk8a2r1kqqpd9gSvbTPcY0YOXcXTY9nOLVfOqBfHbaQN0uLS0JV261SK7ADSU1wMniAAaxrwci2MpDOCcqoPDscF1APs01wmJJ9F6MPBm707fXxGThCO6SXA/s300/Manic-Depressive%20Illness%20amazon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="300" data-original-width="300" height="157" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjX4kmTw85XlOWNT-dhDULjfFrVkZXtmIsqA3sEZd6cHDppdcfKgCk29YwbZlc-wvx-DVxk8a2r1kqqpd9gSvbTPcY0YOXcXTY9nOLVfOqBfHbaQN0uLS0JV261SK7ADSU1wMniAAaxrwci2MpDOCcqoPDscF1APs01wmJJ9F6MPBm707fXxGThCO6SXA/w157-h157/Manic-Depressive%20Illness%20amazon.jpg" width="157" /></a></span></div><span style="font-family: times; font-size: large;">. . . Frederick Goodwin and Kay Jamison wrote <i>Manic-Depressive Illness,</i> the bipolar bible, where you can find a more detailed version of this description in head-spinning vocabulary, down to specific locations on DNA strands. They and others who are actually making progress figuring out this disorder say the bottom line has to do with the brain's ability to regulate its responses to a whole range of processes to maintain homeostasis, which is to say, to balance.</span><p></p><p><span style="font-family: times; font-size: large;">That's what went wonky in the developing brain, the capacity to balance.</span></p><p><span style="font-family: verdana; font-size: large;">Are you astounded at how any of us are walking around, taking care of business, raising families, and sometimes excelling in our fields of endeavor?</span></p><p><span style="font-family: verdana; font-size: large;">We work at it. We work hard at it.</span></p><p><span style="font-family: verdana; font-size: large;">There are tricks to better control the hormones. There are ways to support the cells. There are workarounds to this wiring thing...</span></p><p><span style="font-family: verdana; font-size: large;">The more we know, the better we get at it.</span></p><p><span style="font-family: verdana; font-size: large;">So this World Bipolar Day, don't spout bullshit like <i>Isn't everybody a little bit bipolar?</i> No. No, you are not. Maybe you are a bit moody. But you do not have to manage a brain disorder. Every. Single. Day.</span></p><p><span style="font-family: verdana; font-size: large;">Instead of saying something stupid, how about lending a hand? Or at least, a bunch of flowers?</span></p><p><span style="font-family: verdana; font-size: large;">I am so proud of myself, for the work I did to heal my brain enough to write that book, and for the work I do every day to maintain (more or less) my stability.</span></p><p><span style="font-family: verdana; font-size: x-large;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjFqUX7E_Sbmbff2Vpi57a1UNk9M32_4X2NeeJrBWvXrimMR1w7oxqNZPPDwi9UVuiru0tIUoxOFlMMVoRQi5fKWbXpXfZw7Nm0jL87_M9BbKOsSYOM-ifZs1Dj2KwPe4Tfn62_-SkeY_P9Cdy_L4bXMgIEpVD-FHCVpru7xuiSnfgPO5c0r3epb9GBOg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="1232" data-original-width="1600" height="160" src="https://blogger.googleusercontent.com/img/a/AVvXsEjFqUX7E_Sbmbff2Vpi57a1UNk9M32_4X2NeeJrBWvXrimMR1w7oxqNZPPDwi9UVuiru0tIUoxOFlMMVoRQi5fKWbXpXfZw7Nm0jL87_M9BbKOsSYOM-ifZs1Dj2KwPe4Tfn62_-SkeY_P9Cdy_L4bXMgIEpVD-FHCVpru7xuiSnfgPO5c0r3epb9GBOg=w209-h160" width="209" /></a></div>I am so proud to be part of the bipolar tribe, people who work against and work around our deficits to get the job done, sometimes even with brilliance and panache.<p></p><p><span style="font-family: verdana; font-size: x-large;"><br /></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">So as they say on the <i>Red Green Show,</i></span></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgekdzM9v1K7xJPn_FRwA3DGiBIEp5RV3dNAEj3DLSYi9RFKD4XCyqU-ewp7FCmoLS_TGRnaAvEcRSLhqBNXLfKopqMJPCphASa6rs6MYiF36-4Kuh35Y4FnttFLEo3TlTZtHQmot73r33eqdbWFvE59S1w3WBMfnUFAYqVBrgzqAva7K8yzypy5uSwlA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="245" data-original-width="435" height="254" src="https://blogger.googleusercontent.com/img/a/AVvXsEgekdzM9v1K7xJPn_FRwA3DGiBIEp5RV3dNAEj3DLSYi9RFKD4XCyqU-ewp7FCmoLS_TGRnaAvEcRSLhqBNXLfKopqMJPCphASa6rs6MYiF36-4Kuh35Y4FnttFLEo3TlTZtHQmot73r33eqdbWFvE59S1w3WBMfnUFAYqVBrgzqAva7K8yzypy5uSwlA=w452-h254" width="452" /></a></div><br /><p></p><div style="text-align: right;"><span style="font-size: xx-small;"><i>flair from Facebook.com</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo by author</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>DNA gif from Richard Wheeler, used under createive commons license</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>HPA axis image by D Rosenbach, used under createive commons license</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>blue ribbon from Microsoft clipart</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>book cover from Amazon.com</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>ribbon graphic from <a href="https://www.dreamstime.com/world-bipolar-awareness-day-green-low-poly-ribbon-world-bipolar-awareness-day-green-ribbon-low-poly-colorful-vector-illustration-image142703283" target="_blank">dreamstime.com</a> <a href="http://dreamstime.com">d</a>reamstime.com</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>meme from <a href="https://imgur.com/t/red%20green" target="_blank">imgur.com</a></i></span></div><div style="text-align: left;"><br /></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com1tag:blogger.com,1999:blog-2012499708688254847.post-64060027388509738402023-03-22T08:32:00.001-07:002023-03-22T08:32:19.425-07:00A Book Review: Loving Someone with Suicidal Thoughts<p></p><p style="clear: both; text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">I just don't want to live anymore</span></li><li><span style="font-family: verdana; font-size: large;">If only I could fall asleep and never wake up</span></li><li><span style="font-family: verdana; font-size: large;">One well-placed bullet would solve all my problems</span></li><li><span style="font-family: verdana; font-size: large;">You'd be better off if I were dead</span></li></ul><div><span style="font-family: verdana; font-size: large;"><br /></span></div><p></p><p style="clear: both; text-align: left;"></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBxfrYMtTRs6r0NEfy0P2dDpftRJVf1iOXpA8lwN36drGiLGcGp-YlcHAUj3u4uOp5WwmWwPmpY5c7f3o5P4ctmdzzgqUK_2DsvK5DMgJV0uaxDyRLRxuenjLFW1don5grOdxs47YtPrdIKBvy2pgzxx1CYjFZ5xttFg1gCkTSOYQuTcA5N0dIkEfz1w/s600/Depressed%20public%20domain.svg.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="440" data-original-width="600" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBxfrYMtTRs6r0NEfy0P2dDpftRJVf1iOXpA8lwN36drGiLGcGp-YlcHAUj3u4uOp5WwmWwPmpY5c7f3o5P4ctmdzzgqUK_2DsvK5DMgJV0uaxDyRLRxuenjLFW1don5grOdxs47YtPrdIKBvy2pgzxx1CYjFZ5xttFg1gCkTSOYQuTcA5N0dIkEfz1w/s320/Depressed%20public%20domain.svg.png" width="320" /></a></div><br /><span style="font-family: verdana; font-size: large;"><br /></span><p></p><p><span style="font-family: verdana; font-size: large;">Oh my gosh, words you don't want to hear from somebody you love. It is tempting, so very tempting to say something that will get your loved one to take it back.<span></span></span></p><a name='more'></a><p></p><p></p><div style="text-align: left;"><p></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">You don't really mean that</span></li><li><span style="font-family: verdana; font-size: large;">That's a terrible thing to say</span></li><li><span style="font-family: verdana; font-size: large;">You're joking, right? Don 't joke about that</span></li><li><span style="font-family: verdana; font-size: large;">Oh come on, things aren't that bad</span></li></ul><div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhK_JnQCBKR9AxaDdZoiF7noBUqGvREBZJlxIzMhougzq2xPQJS95wm8GAQ9ZOZ4c29-ps5NSr5EtVTanWPRXQXmQN675Vsfwf3PMiQ026Es9hzCf3_zCm_N2pUhZGaTYaB7Ts5R12wnARNh3v8pJL_S8zu0WDtJ0dccxcRBNfOu5ajRaHcXslDdqhjmQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="370" data-original-width="498" height="238" src="https://blogger.googleusercontent.com/img/a/AVvXsEhK_JnQCBKR9AxaDdZoiF7noBUqGvREBZJlxIzMhougzq2xPQJS95wm8GAQ9ZOZ4c29-ps5NSr5EtVTanWPRXQXmQN675Vsfwf3PMiQ026Es9hzCf3_zCm_N2pUhZGaTYaB7Ts5R12wnARNh3v8pJL_S8zu0WDtJ0dccxcRBNfOu5ajRaHcXslDdqhjmQ" width="320" /></a></div><br /><br /></div> <script async="" src="https://tenor.com/embed.js" type="text/javascript"></script><span style="font-family: verdana; font-size: large;">Well, there are reasons why people try to shut us up when we are suicidal.</span><p></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">Guilt</span></li><li><span style="font-family: verdana; font-size: large;">Fear</span></li><li><span style="font-family: verdana; font-size: large;">Hopelessness</span></li><li><span style="font-family: verdana; font-size: large;">Confusion</span></li><li><span style="font-family: verdana; font-size: large;">Burn out</span></li><li><span style="font-family: verdana; font-size: large;">You really, really don't want it to be true</span></li></ul><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Okay. That's all very real. You love us, so you don't want us to be in such pain. We love you, so we don't want to cause you the pain of knowing about our pain. I didn't want to scare my wife.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">So nobody's sayin' nothin' until we get to</span></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">We had no idea</span></li><li><span style="font-family: verdana; font-size: large;">Why didn't they ask for help?</span></li><li><span style="font-family: verdana; font-size: large;">Could we have done something different?</span></li></ul><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Maybe. Maybe. If you love someone with suicidal thoughts there is something you can do.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Dr. Stacey Freedenthal, psychotherapist, consultant, and associate professor at the University of Denver Graduate School of Social Work wrote a book to help family, friends, and partners know what to say and what to do.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i></i></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><i><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHpvWBUL2WWrfJc3aityJSveAXq4BeiE6S8eaDLbOmtcI89nOlgseDibKZi1CYe1MbShKLLAO95r9PjeXVhuSColdvZKfJn8pJmPoiTzZA3cUvDaTToHoGF2Vt7UpCKcHyMWKtC0ty-YFkND1PVwUeUg36wj-gwmJ4mobub0ekQZ_X7oV7wQyCq_bHTg/s232/Freedenthal%20loving%20someone.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="232" data-original-width="232" height="305" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHpvWBUL2WWrfJc3aityJSveAXq4BeiE6S8eaDLbOmtcI89nOlgseDibKZi1CYe1MbShKLLAO95r9PjeXVhuSColdvZKfJn8pJmPoiTzZA3cUvDaTToHoGF2Vt7UpCKcHyMWKtC0ty-YFkND1PVwUeUg36wj-gwmJ4mobub0ekQZ_X7oV7wQyCq_bHTg/w305-h305/Freedenthal%20loving%20someone.jpg" width="305" /></a></i></span></div><span style="font-family: verdana; font-size: large;"><i><a href="https://www.amazon.com/Loving-Someone-Suicidal-Thoughts-Harbinger/dp/1648480241/ref=cm_cr_arp_d_product_top?ie=UTF8" target="_blank">Loving Someone with Suicidal Thoughts</a></i> is not about fixing anybody. It provides no magic wand to make those thoughts go away. Instead it gives to loved ones a gentle, understanding, expert guide through a dark place.</span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">It acknowledges those scary personal feelings and gives guidance about how to deal with them</span></li><li><span style="font-family: verdana; font-size: large;">It teaches how to listen bravely</span></li><li><span style="font-family: verdana; font-size: large;">It supplies practical information about getting help and creating safety</span></li><li><span style="font-family: verdana; font-size: large;">It even brings hope</span></li></ul><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">I read this book slowly, took lots of breaks, as the author recommends. Suicide is hard stuff.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">I didn't realize how frightened my wife already was when I was in that dark place. I didn't realize she knew. I wish she had had this resource at the time.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Now that I am on the other side of it (yes, there <i>is</i> hope) <i>Loving Someone with Suicidal Thoughts</i> equips me to help others.</span></p><div style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Depression png in public domain</i></span></div><div style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Photo of covered ears from <a href="https://tenor.com/search/cover-ears-gifs">https://tenor.com/search/cover-ears-gifs</a></i></span></div><div style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>book cover from Amazon.com </i></span></div><div><br /></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-80028400646608881642023-03-15T11:12:00.000-07:002023-03-15T11:12:04.488-07:00Anxiety My Old Friend - Will I Let It Kill Me?<h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Anxiety and stress are not the same thing.</span></h3><p><span style="font-family: verdana; font-size: large;">Stress is a physiological experience in the face of a change in the internal or external system. It has its plusses and minuses. A little bit of stress over something you can do something about </span><span style="font-family: verdana; font-size: medium;">[I need to make that doctor's appointment]</span><span style="font-family: verdana; font-size: large;"> provides motivation to get it done and satisfaction (a nice hit of dopamine) once you do it.</span></p><div style="text-align: center;"><span style="font-size: large;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="280" src="https://giphy.com/embed/LRkv2LHyW2mCiAEXNZ" width="449"></iframe></span></div><p><a href="https://giphy.com/gifs/originals-nycoriginals2019-LRkv2LHyW2mCiAEXNZ"><span style="font-size: large;">via GIPHY</span></a></p><p><span style="font-family: verdana; font-size: large;">On the other hand, chronic stress that cannot be resolved </span><span style="font-family: verdana; font-size: medium;">[I never knew when he would explode]</span><span style="font-family: verdana; font-size: large;"> exhausts every resource the body has to maintain homeostasis/balance. And that's not good.</span></p><p><span style="font-family: verdana; font-size: large;">Anxiety describes the negative <i>thoughts and</i> <i>feelings</i> that accompany stress.</span></p><div style="text-align: center;"><span style="font-family: verdana; font-size: large;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="366" src="https://giphy.com/embed/yoJC2D22ruCQKUM1bi" width="449"></iframe></span></div><p></p><p><span style="font-family: verdana; font-size: large;"><a href="https://giphy.com/gifs/wetv-feelings-yoJC2D22ruCQKUM1bi">via GIPHY</a></span></p><p><span style="font-size: large;"><span style="font-family: verdana;">It's not the only feeling that could accompany stress. When faced with changes like a new job, a challenging ski slope, or a date with the person of your dreams, you might also feel </span><i style="font-family: verdana;">excitement.</i></span></p><div style="text-align: center;"><span style="font-size: large;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="312" src="https://giphy.com/embed/vMEjhlxsBR7Fe" width="449"></iframe></span></div><p><a href="https://giphy.com/gifs/vMEjhlxsBR7Fe"><span style="font-size: large;">via GIPHY</span></a></p><p><span style="font-size: large;"><span style="font-family: verdana;">Or maybe not. "Good" change and "bad" change are labels we apply from our own perspective. As far as the body goes, they don't really figure in. The physiological response is the same.</span></span></p><p><span><span style="font-size: large;"><span style="font-family: verdana;">Consider a winding mountain road in a snowstorm. Some people default to </span><i style="font-family: verdana;">excitement.</i></span><span style="font-family: verdana;"><span style="font-size: large;"> </span><span style="font-size: medium;">[That would be Colorado-raised me.]</span><span style="font-size: large;"> Some people default to </span></span><i style="font-family: verdana;"><span style="font-size: large;">anxiety. </span></i><span style="font-family: verdana;"><span style="font-size: medium;">[That would be my California-born wife.]</span></span><span style="font-family: verdana; font-size: x-large;"> </span><span style="font-family: verdana;"><span style="font-size: large;">T</span></span><span style="font-size: large;"><span style="font-family: verdana;">he people who can't help but default to it have an anxiety </span><i style="font-family: verdana;">disorder</i><span style="font-family: verdana;">. These are my people.</span></span></span></p><h3 style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">Anxiety Defined</span></span></h3><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">Anxiety is the intense, excessive, persistent worry, fear, or dread about everyday situations, present, future, and imagined future. It's a normal enough experience. It becomes a <i><b>disorder</b></i> when "intense" tilts over into "excessive" to the point of interfering with daily activities.</span></span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvqjzwHN9pOjC-b8f0K9R2-VLl-o9gokFQ9RAu4F_7XZOeznh-dt9XWap01mv-N17_9Uy9US5NuBOBstdwam63ZRur2LGA-MurtYTwIMu9uncdTFEIvt09JY-Rz_mEw8ukKnoMQsytWngsGKJyMw2ioAIFlY7HDJ8eZa0TlMr6wy0AyQF4dxgp0CPXrQ/s110/microphone.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="110" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvqjzwHN9pOjC-b8f0K9R2-VLl-o9gokFQ9RAu4F_7XZOeznh-dt9XWap01mv-N17_9Uy9US5NuBOBstdwam63ZRur2LGA-MurtYTwIMu9uncdTFEIvt09JY-Rz_mEw8ukKnoMQsytWngsGKJyMw2ioAIFlY7HDJ8eZa0TlMr6wy0AyQF4dxgp0CPXrQ/s1600/microphone.jpg" width="110" /></a></span></div><span style="font-family: verdana; font-size: medium;">Insert side comment here: People who have a mental illness, whether social anxiety disorder, depression, or schizophrenia, are not a different kind of people. Almost every symptom of a mental illness is a "normal" experience - shared by people who do not have a mental illness. These experiences do not need to be diagnosed or treated, until they pile up and become so intrusive that they become unmanageable, until they interfere with daily activities.</span><p></p></blockquote><p><span style="font-family: verdana; font-size: large;">The physical manifestations of anxiety include fast heart rate, heavy breathing, sweating, and fatigue. How do we get from a thought to a heart rate? The brain - that's how.</span></p><h3 style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">Anxiety in the brain</span></span></h3><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">Anxiety involves an interaction of three different parts of the brain in particular.</span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">It begins when the amygdala senses a threat. The job of the amygdala is to leap into action at the sign of a threat. The amygdala initiates a sequence that releases adrenaline and cortisol to gear the body up to address the threat. As with the body's response to other stress, these hormones cause the faster heart rate and heavy breathing. Blood flow increases to the limbs to prepare it for action, and away from the digestive system - when your life is in danger, lunch can wait.</span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">The prefrontal cortex, the "thinking" part of the brain, provides information and interpretation that mitigate or support the threat. </span><span style="font-size: medium;">[That's a garter snake, not a rattler. It's harmless.]</span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">The anterior cingulate cortex sorts through the sense of threat and the additional information to find patterns and determine whether the current situation is a big deal or not. It tells the amygdala whether to calm down or GET MORE EXCITED!</span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><h3 style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">The difference between anxiety and anxiety disorder</span></span></h3><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">When there is a threat, the amygdala goes into action. When the threat goes away, what is </span><i style="font-family: verdana;">supposed</i><span style="font-family: verdana;"> to happen is that the amygdala and all its downstream partners stand down. The body returns to its pre-threat state.</span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">When the threat is chronic or, even worse, unpredictable, then these systems do not stand down. They just keep pumping out that cortisol.</span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span></span></span></p><div class="separator" style="clear: both; font-size: x-large; text-align: center;"><span style="font-family: verdana;"><span><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiK8Yq3MXP2ADvOwaBS5K491IYf7DoOo3KQlY5xN4C9xLpnQwKNa0RmiWnLXs5eWY8qVE4irYk6iXW8zRyWvBInj1rDhCuUFn6i2JU0tJN1G0HVrJw4zSlnaxsvIQVdZKTmMF6yxsyJNUK6Sv_Ux9iBeVxVDij-4czDkgxwW2_hM7lWbxW_rGVAy6PEMg" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1080" data-original-width="1080" height="448" src="https://blogger.googleusercontent.com/img/a/AVvXsEiK8Yq3MXP2ADvOwaBS5K491IYf7DoOo3KQlY5xN4C9xLpnQwKNa0RmiWnLXs5eWY8qVE4irYk6iXW8zRyWvBInj1rDhCuUFn6i2JU0tJN1G0HVrJw4zSlnaxsvIQVdZKTmMF6yxsyJNUK6Sv_Ux9iBeVxVDij-4czDkgxwW2_hM7lWbxW_rGVAy6PEMg=w448-h448" width="448" /></a></span></span></div><p style="text-align: left;"><span style="font-family: verdana;"><span><span style="font-size: large;">In the brain, the amygdala increases in size.</span></span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span><span style="font-size: large;">Under constant assault from cortisol, the hippocampus (memory and emotion) and prefrontal cortex shrink. The hippocampus gets stuck on negative memories and emotions. </span><span style="font-size: medium;">[I call this the little time machine inside my brain. It plays the worst of my past on an unending loop.]</span></span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span><span style="font-size: large;">The connection between the amygdala and the prefrontal cortex that could moderate the fear goes down.</span></span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span><span style="font-size: large;">In other words, the brain changes. It changes in a way that reinforces the the problematic pattern, raising the risk for depression and dementia. Yuk!</span></span></span></p><p></p><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;"></span></span></p><p style="font-family: Times; font-size: medium;"><span style="font-family: verdana;"><span style="font-size: large;"><span style="font-family: verdana;"><span style="font-size: large;"><i>Everybody gets anxious</i> is not a helpful thing to say to a person with Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, or Social Anxiety Disorder. These are real things. They have tipped past the experiences of <i>everybody. </i>And a warm bath or deep breathing do not fix them.</span></span></span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;"><span style="font-family: verdana;"><span style="font-size: large;">Healing the problematic pattern may take many forms: distancing from the chronic stressors, medication, a variety of modalities in psychotherapy, even therapy dogs.</span></span></span></span></p><p style="text-align: left;"></p><span style="font-family: verdana;"><span style="font-size: large;"><span style="font-family: verdana;"><span style="font-size: large;">At ProzacMonologues.com I like to focus on what is happening inside the brain, to help me remember that my issues are not mere thoughts. They are experienced in my body. Here's <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/#:~:text=The%20sympathetic%20system%20controls%20%E2%80%9Cfight,%E2%80%9Crest%20and%20digest%E2%80%9D%20functions." target="_blank">an article</a> with much more detail about the sympathetic and parasympathetic nerve systems and how they function.</span></span></span></span><div><span style="font-family: verdana;"><span style="font-size: large;"><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></span></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiagjdDpxDOFxTNctkBrAXX9COQ9qJrflFglQ6O0HDdirH1cd4vJg6mNldskPXRC48pArDQ_11rtTydnXEV86x2LSqAtVaw2I_DPHOrOMYiDUK5D-RMuQjlxUyYHWsxNhtuAaMvY9LzD6-a93TZNvftYCROkBjv807g19JVWMPZSD_9Ff4Aprg98q6z3g" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="1024" data-original-width="769" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEiagjdDpxDOFxTNctkBrAXX9COQ9qJrflFglQ6O0HDdirH1cd4vJg6mNldskPXRC48pArDQ_11rtTydnXEV86x2LSqAtVaw2I_DPHOrOMYiDUK5D-RMuQjlxUyYHWsxNhtuAaMvY9LzD6-a93TZNvftYCROkBjv807g19JVWMPZSD_9Ff4Aprg98q6z3g" width="180" /></a></div></div><div><span style="font-family: verdana;"><span style="font-size: large;"><span style="font-family: verdana;"><span style="font-size: large;">A physical therapist friend, encouraging me to take a leave of absence to deal with my tattered brain, once told me, <i>It's just like a broken bone. It takes time to heal.</i></span></span></span></span><p></p><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">I do wish it healed as easily as that broken foot is healing. But these issues do respond to </span><a href="https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders" style="font-family: verdana;" target="_blank">treatment</a><span style="font-family: verdana;">. If your anxiety interferes with your life, you don't have to suffer alone!</span></span></p><p style="text-align: left;"><span style="font-family: verdana;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjAYfTxYTIqZGxJ6Z7r4oncFajqCnul28QosPMBkSTgqUZqwi2ExV_8JJLcx36LRgfOxunHYEKmOTey8pOddy6OE-ZXabKfCNlrpBL4M7ILyURTQQ3sJtkUZG4U9kQ6tSRePiPN0tN_x-GbjJtIWcfUSWXSYnXO-3MHUrWN6Xbyx39oDUfFDXe7YpOtng" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img alt="" data-original-height="186" data-original-width="272" height="268" src="https://blogger.googleusercontent.com/img/a/AVvXsEjAYfTxYTIqZGxJ6Z7r4oncFajqCnul28QosPMBkSTgqUZqwi2ExV_8JJLcx36LRgfOxunHYEKmOTey8pOddy6OE-ZXabKfCNlrpBL4M7ILyURTQQ3sJtkUZG4U9kQ6tSRePiPN0tN_x-GbjJtIWcfUSWXSYnXO-3MHUrWN6Xbyx39oDUfFDXe7YpOtng=w392-h268" width="392" /></span></a></div><br /><p></p><div style="text-align: left;"><div style="text-align: right;"><i style="font-family: verdana; font-size: x-small;">brain graphic from <a href="http://www.xcode.life/genes-and-health/how-anxiety-affects-brain/">www.xcode.life/genes-and-health/how-anxiety-affects-brain/</a></i></div><span style="font-family: verdana;"><div style="text-align: right;"><i style="font-size: x-small;">photo by author</i></div></span><span style="font-family: verdana;"><div style="text-align: right;"><i style="font-size: x-small;">Red Green Show meme from <a href="https://br.pinterest.com/pin/549368854549300734/" target="_blank">imgur</a> on Pinterest</i></div></span></div><p></p><p></p>
</div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-54864965159073479352023-03-08T09:45:00.000-08:002023-03-08T09:45:14.419-08:00Is Stress Good or Will My Brain Explode?<h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">What if I told you that stress is not a bad thing?</span></h3><p><span style="font-family: verdana; font-size: large;">What if I even told you that stress is good?</span></p><p><span style="font-family: verdana; font-size: large;">Okay, you have to understand what I'm talkin' about. Modern lives are so driven by stress that we're all walking around like ticking time bombs. Except for those meditators out there. (But are they even for real?)</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="280" src="https://giphy.com/embed/xkmNi280NkrcY" width="280"></iframe></span></p><p><span style="font-family: verdana; font-size: large;"><a href="https://giphy.com/gifs/realitytvgifs-reality-tv-xkmNi280NkrcY">via GIPHY</a></span></p><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">It turns out that a little bit of stress is just the ticket to feel good and accomplish a lot of good things.</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">I'm talking about <i>challenge.</i> I'm talking about <i>excitement.</i> Yes, I'm even talking about...</span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></h3><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Deadlines</span></h3><div><span style="font-family: verdana;"><span><a name='more'></a></span><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">Consider the deadline. Sure, if you are drowning in too much work and struggling to get it all done when it is expected, that's going to be a problem. More on that later.</span></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">But have you ever noticed how much easier it is to get something done when you have a deadline?</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">I never had a problem writing a sermon every week. Really! Sometimes it was hard. Often, <i>usually,</i> it felt stressful. But every single week, after the reading of the gospel and before the collection plate was passed, I had something to say.</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">And that felt good. It felt great! It gave me an enormous hit of dopamine, the hormone the brain dishes out to reward us for whatever reward-worthy activity we have just done. To be specific</span><span style="font-family: verdana;"> for the brain nerds like me</span><span style="font-family: verdana;">, that would be the substantia nigra (SN) and the ventral tegmental area (VTA) parts of the midbrain.</span></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg5NqmXahX75Y6fPpJaBBF_MuFmn82RPavzGAo1_X0aoByxlTDbWkl00kFWU5f8FPp3xQEs8qasHBQcSkWW2N8oWxuA2IhNKiYcButo5qMlanJsVcmHKbUwg50Ppfa5Kj8q7cOY9p-4RZkdj6_gxl3bwogcCZwdH5C1OL5e83o9Xug7w-VI9-BBdCAmwQ" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="665" data-original-width="856" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEg5NqmXahX75Y6fPpJaBBF_MuFmn82RPavzGAo1_X0aoByxlTDbWkl00kFWU5f8FPp3xQEs8qasHBQcSkWW2N8oWxuA2IhNKiYcButo5qMlanJsVcmHKbUwg50Ppfa5Kj8q7cOY9p-4RZkdj6_gxl3bwogcCZwdH5C1OL5e83o9Xug7w-VI9-BBdCAmwQ" width="309" /></a></div><br /></div><div class="separator" style="clear: both; text-align: left;">Blogposts, on the other hand, that's a mixed bag. Used to be, I got one written almost every single week. Check the blog archive at the bottom of the right column. The numbers in parentheses tell you how many posts were published each year.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">But <i>weekly</i> was a self-imposed deadline. When something else in my life became more pressing - finishing <a href="https://willagoodfellow.com/" target="_blank">my book</a> - I gave myself a break from that deadline. And it became harder and harder to get a post written, until the blog was nearly closed down.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">In the run up to publication, I felt more urgency, more <i>stress</i> about my online presence. And I got back to the blog.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Post-publication, the stress was gone. And I had time, lots of leisure to do whatever I chose. There was this thing called a pandemic that kept me in the house, after all. But no stress meant no productivity meant no dopamine hit.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">I miss that weekly hit that came when I hit the button that says: <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFGxOG9TOT3beFclSDWPpvjHSjf24aFoMqE5rCtqS4E05uf7_At-aO01b1JKHacWTfmi5_7sdItWSBPNIKQQFYQ_pcVl8KU9Lag8t_uHOvndMkiFj4hNtTL6IP8eqf-5ifLNCS8GJYuEztGXmETvEOgsGHNeJnsf9crvNl9aw5-a0ySEe3HU0uISgYOg/s198/Image%202-28-23%20at%2011.59%20AM.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="94" data-original-width="198" height="59" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFGxOG9TOT3beFclSDWPpvjHSjf24aFoMqE5rCtqS4E05uf7_At-aO01b1JKHacWTfmi5_7sdItWSBPNIKQQFYQ_pcVl8KU9Lag8t_uHOvndMkiFj4hNtTL6IP8eqf-5ifLNCS8GJYuEztGXmETvEOgsGHNeJnsf9crvNl9aw5-a0ySEe3HU0uISgYOg/w124-h59/Image%202-28-23%20at%2011.59%20AM.jpeg" width="124" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div>Now, it was hard to publish weekly. It was stressful. But it felt good. So what's going on here?</div></span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></h3><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">What is stress, anyway?</span></h3><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Quite simply, stress is the body's response to any demand for change. The demand for change is perceived as a threat. Because - </span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiuP1v6p9btgiLpEkjHbweuYZMYoPb9dqjG6jJ8VqVuqjIXStcvgKs1v2m2bsdS5yfW_7Frdrak3DxctZ4JRa_Ak8HiEMFi0SC_dVGzjCW4GrqgBqyjWuqVtGa5g70RtU7r3v_SfTZlaVoNlVrnDN9hescQRr0lZLU-6knf9pZAvDUDhURyDZxLOkcZmA" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="197" data-original-width="256" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEiuP1v6p9btgiLpEkjHbweuYZMYoPb9dqjG6jJ8VqVuqjIXStcvgKs1v2m2bsdS5yfW_7Frdrak3DxctZ4JRa_Ak8HiEMFi0SC_dVGzjCW4GrqgBqyjWuqVtGa5g70RtU7r3v_SfTZlaVoNlVrnDN9hescQRr0lZLU-6knf9pZAvDUDhURyDZxLOkcZmA" width="312" /></a></div><br />Change is bad, right? It activates the <a href="https://simplypsychology.org/stress-biology.html" target="_blank">hypothalamus</a> and starts a sequence that produces cortisol.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Cortisol is another one of those words, like stress and change, that get a bad rap. Cortisol increases glucose levels, increases heart rate, increases blood flow to the arms and legs. It sharpens your thinking and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432168/" target="_blank">memory consolidation</a>. It's just the thing to get you out of bed in the morning. It moves you to get your work done and your blogpost written.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Next in line in this cascade of events is the activation of the aforementioned <a href="https://www.nature.com/articles/s12276-020-00532-4" target="_blank">dopaminergic reward system</a>. That's where the shot of <i>feel good</i> comes from when I <i>finish</i> my sermon or publish my blogpost or accomplish whatever activity the stress-induced cortisol got me to do. On a more subtle level, it's also the shot of <i>feel good</i> that we get when we know we are out the door in the morning in time to get to work on time.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">What about all those articles that say stress is bad?</span></h3><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">So here's the thing. A little bit of stress is good. The hypothalamus leaps into action to help us deal with whatever is coming at us.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">But give it a break! When the hypothalamus and its downstream partners never get a chance to stand down, cortisol will bite you in the butt. All those good things that cortisol does will simply flip, dysregulating metabolism, causing weight gain, messing up blood pressure, increasing inflammation from infection-prevention levels to heart-and-brain-damage levels, and zapping memory <i>retrieval</i>.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">And that <i>feel good</i> that you get from meeting your deadline? When the deadlines pile on top of each other, when stress becomes unmanageable, then you get the opposite -- depression. </span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="480" src="https://giphy.com/embed/PJoPkDYpD4nU8Sqaju" width="480"></iframe></div><span style="font-family: verdana; font-size: large;"><div><span style="font-family: verdana; font-size: large;"><a href="https://giphy.com/gifs/Millions-tower-jenga-tumble-PJoPkDYpD4nU8Sqaju" style="font-family: Times; font-size: medium; text-align: center;">via GIPHY</a></span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div>It's all about balance. It's always about balance. That's the job of the hypothalamus. Not rigid immobility, but balance. Enough stress to make life exciting, productive, and fun. Not so much that we all fall down.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="364" src="https://giphy.com/embed/J4li4awWEbGStTIeOf" width="480"></iframe></div><p><a href="https://giphy.com/gifs/jason-clarke-J4li4awWEbGStTIeOf">via GIPHY</a></p><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Last week, <a href="https://www.prozacmonologues.com/2023/03/tips-for-successfully-managing-your.html" target="_blank">Julia Mitchell's post</a> presented a number of ideas both for preventing and relieving out of control stress. Because, yeah, that's a thing. And that's not good.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Next week I will continue with a look at anxiety. Not really the same as stress. More mental stuff. See ya then. Because now I have a deadline!</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>meme from <a href="http://networkstatic.net">networkstatic.net</a></i></span></div><div><br /></div><p></p>
Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-25764598958332728002023-03-01T09:11:00.000-08:002023-03-01T09:11:21.415-08:00Tips for Successfully Managing Your Stress and Anxiety<p><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCor3RpKILYxbsg1TKA9MvJhL-3mkaoByN23NIEEPMZlKyeDZS-iOwBeCqqErhRgszUM38fgI11i4AgLg_OlDjTqCsULJj1nbM-75lCLPtDSblPMf20OqaEQqGMgEIn9FxjQej6gCJJ4YmLxf8htN9TWfv-n3h1GC5LHrsJIBwl9cysx1zgv87UtTbXA/s332/Picture1.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="332" data-original-width="221" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCor3RpKILYxbsg1TKA9MvJhL-3mkaoByN23NIEEPMZlKyeDZS-iOwBeCqqErhRgszUM38fgI11i4AgLg_OlDjTqCsULJj1nbM-75lCLPtDSblPMf20OqaEQqGMgEIn9FxjQej6gCJJ4YmLxf8htN9TWfv-n3h1GC5LHrsJIBwl9cysx1zgv87UtTbXA/w190-h285/Picture1.jpg" width="190" /></a><span style="font-family: verdana; font-size: large;"></span></div><span style="font-family: verdana; font-size: large;">Anxiety and stress are simply parts of life for most people, especially when we try to juggle multiple responsibilities. However, if your stress and anxiety attacks have begun to impact your ability to function in everyday life, then you need to seek out ways to manage these emotions. ProzacMonologues.com explains the importance of finding strategies that help you to manage your anxiety both at the moment it occurs and long-term.</span><p><span style="font-family: times; font-size: large;">Guest blogger Julia Mitchell, lifestyle expert at <a href="http://outspiration.net">outspiration.net</a> contributes this piece about tips to manage stress and anxiety. I (Willa) have added a few links to previously posted pieces from ProzacMonologues.</span></p><p></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Develop Skills to Proactively Manage Stress</span></h3><p style="clear: both; text-align: center;"></p><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">Raising children, earning a living, maintaining family harmony and wellness, and pursuing your passions can all be stressful. While each of these things may contribute to creating the life you want, they can also undermine your overall well-being, if they cause you too much stress. The Anxiety and Depression Association of America notes that you can <a href="https://adaa.org/tips" target="_blank">equip yourself to manage stress</a> and prevent anxiety attacks by building healthy habits with sleep, exercise, food, work, play, attitude, and self-fulfillment.</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">You can also pick up a new hobby like gardening, which has been shown to help mitigate stress. Not only do you have the opportunity to get your hands dirty while watching what you've planted grow into healthy edibles, you'll be getting much-needed Vitamin D as you spend extra time outside. For expert advice and pointers, go online and visit <a href="https://homegardenhero.com/" target="_blank">Home Garden Hero</a>.</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Identify and Manage Your Triggers</span></h3><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;">It's a good idea to identify the situations that trigger your anxiety so you can take constructive steps when you encounter those things or avoid them. Triggers are external events, large or small, that prompt your body and mind to respond in a seemingly irrational way. The response is generally flight, fight, fawn, or freeze. As <i><a href="https://www.becalmwithtati.com/identify-anxiety-triggers/" target="_blank">Be Calm with Tati</a></i> explains, you have to learn your triggers in order to disrupt this cycle. Then you need to implement some deep breathing exercises so you can calm down and focus on what happened and why.</span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;"><div class="separator" style="clear: both; font-family: verdana; text-align: right;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEioiOqnMe_VHusa-wnM-0kabVACc3pNe-1ESMD0QQTcPzZCs4q9k1TuIircIRjO_d7neVD7oCyGJpcwU1omemtjfPT1YPY2gCahodTLC3e3zgYIzgXE2h2cPyv2dOG7xbSzHSi7AUR-nnLzP_lflGuqTO5YOrq3uwYgBJuKGLEb0hKkDCujtgyRScrSeA" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="173" data-original-width="200" height="157" src="https://blogger.googleusercontent.com/img/a/AVvXsEioiOqnMe_VHusa-wnM-0kabVACc3pNe-1ESMD0QQTcPzZCs4q9k1TuIircIRjO_d7neVD7oCyGJpcwU1omemtjfPT1YPY2gCahodTLC3e3zgYIzgXE2h2cPyv2dOG7xbSzHSi7AUR-nnLzP_lflGuqTO5YOrq3uwYgBJuKGLEb0hKkDCujtgyRScrSeA=w181-h157" width="181" /></a></div><span style="font-family: times;">This Prozac Monologues post, <i><a href="https://www.prozacmonologues.com/2009/12/dont-you-love-holidays.html" target="_blank">Tips for Surviving the Holidays</a></i>, was originally written for the specific event of an extended family gathering. But its suggestions for managing triggers can be applied in a variety of contexts.</span></span></div><div style="text-align: left;"><span style="font-size: large;"><span style="font-family: times;"><br /></span></span></div><div style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Create a Low-Stress Work Environment</span></h3><div style="text-align: left;"><br /></div><span><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">There are things you can do to <a href="https://www.zenbusiness.com/blog/the-stress-free-home-office/" target="_blank">make your workspace less stress-inducing</a>, particularly if you work from a home office. Reduce clutter by putting items in designated bins labeled "to do," "to read," and "to file." Make sure the lighting is adequate and easy on your eyes. Use a planning system that works for you, whether paper or electronic. Evaluate your office desk and chair for ergonomic comfort. It's well worth making the investment in a good office chair that places you at the proper height to use your computer easily.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">You can also manage work-related anxiety in other ways. If your current job is what's making you anxious, consider a new position or different career path. Just remember that before seeking new opportunities, creating an updated resume by utilizing a type of free resume maker is a good idea. You can use a free online resume template to customize with your own copy, profile photos, and color scheme.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><h3 style="font-family: verdana; text-align: left;"><span style="font-size: large;">Dealing with Anxiety in the Moment</span></h3><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">When you're in the grip of anxiety or a full-blown panic attack, it can be difficult to know how best to handle the situation, which is why it is best to develop strategies ahead of time. Do some deep, abdominal breathing. Focusing on your breath can have a calming effect. As you inhale, allow your abdomen to expand, and then try to make the exhale slightly longer and allow your abdomen to relax. The University of Texas MD Anderson Cancer Center suggests <a href="https://www.mdanderson.org/cancerwise/anxiety-hacks--7-tools-to-manage-stress-and-worry-in-the-moment.h00-159537378.html" target="_blank">using guided imagery</a> to fill your mind with thoughts, images, sounds, and smells of positive experiences.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">You can also go for a walk, do yoga or tai chi, or <a href="https://www.priorygroup.com/mental-health/anxiety-treatment/how-to-calm-anxiety" target="_blank">engage in vigorous exercise</a>, such as dancing or running. Take a moment to question any catastrophic thoughts that are running through your mind. As the saying goes, "Don't believe everything you think."</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><div class="separator" style="clear: both; font-family: verdana; text-align: right;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiEN0e_izNjmingcEnc_qGfDl9cGwJ_J-wRkoSHnL_eMUiEEvvVQuIbMQujBOScxNo-cYw--Rp66ukIoLjMY6_g0vyJ8gDnGgDHL_QhxJWt06ZcsmxrNn7EpqCP8wbpUA4VIyalf_3j1k6_4U5KzJXjUk7EzW5WrdtZpBoRFnw-tYfs8CrQfGRyXiLQCQ" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="150" data-original-width="200" height="132" src="https://blogger.googleusercontent.com/img/a/AVvXsEiEN0e_izNjmingcEnc_qGfDl9cGwJ_J-wRkoSHnL_eMUiEEvvVQuIbMQujBOScxNo-cYw--Rp66ukIoLjMY6_g0vyJ8gDnGgDHL_QhxJWt06ZcsmxrNn7EpqCP8wbpUA4VIyalf_3j1k6_4U5KzJXjUk7EzW5WrdtZpBoRFnw-tYfs8CrQfGRyXiLQCQ=w176-h132" width="176" /></a></div><span style="font-family: times; font-size: large;">Here is a Prozac Monologues post, <i><a href="https://www.prozacmonologues.com/2011/07/recovery-in-progress-my-first-nami.html" target="_blank">Recovery in Progress</a>, </i>that walks the reader through my own experience of an anxiety attack at a NAMI conventions, and the tools I (Willa) used to manage the incident.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><h3 style="font-family: verdana; text-align: left;"><span style="font-size: large;">Find Long-Term Stress Management Strategies</span></h3><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">If you're prone to anxiety attacks, then it's important to have a long-term plan for managing the stress of daily life. Establishing an ongoing practice of meditation and/or a slow deliberate movement, such as tai chi, qi gong, or yoga can be helpful. If your anxiety has resulted in sleep disturbances, irritability, difficulty focusing, or ongoing muscle tension that last for more than a month or so, <a href="https://withtherapy.com/therapist-insights/8-signs-its-time-to-see-a-therapist-about-your-anxiety/" target="_blank">it's time to seek professional help</a>.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;">Journaling and cultivating your sense of humor may also be helpful. Evaluate your responsibilities and consider whether you can realistically fulfill them; you may find that you need to delegate some tasks. Develop the habit of taking breaks from stressful activities. Make sure to <a href="https://intermountainhealthcare.org/blogs/topics/covid-19/2020/04/when-youre-stressed-go-outside/" target="_blank">spend some time outdoors</a> whether hiking, running, walking, or simply enjoying a park bench in the sunshine.</span></div><div style="font-family: verdana; text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;"><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg05ElK2Ni4PMBa--KOUrROGbHu9ritj6OVBjNpGX2tGnEFDrBaouuw7pa7KnB1QypO-SR7i84fJLH5kuYapn_PuTfUMBOFoJ2HCLPhTFjur1vxDFvCvE4qzyFTld23Lhn6qpnYt3csC4GwDM3DUZBOOXJIK4QX8ZgCkN-7rilCinMw1P0rlL1NtotcYg/s110/dragon%20w%20hat.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="128" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg05ElK2Ni4PMBa--KOUrROGbHu9ritj6OVBjNpGX2tGnEFDrBaouuw7pa7KnB1QypO-SR7i84fJLH5kuYapn_PuTfUMBOFoJ2HCLPhTFjur1vxDFvCvE4qzyFTld23Lhn6qpnYt3csC4GwDM3DUZBOOXJIK4QX8ZgCkN-7rilCinMw1P0rlL1NtotcYg/w128-h128/dragon%20w%20hat.jpg" width="128" /></a></div><span style="font-family: times;"><div style="text-align: left;">In this post, <i><a href="https://www.prozacmonologues.com/2020/04/frazzled-cafe-and-ruby-wax-i-am-fan.html#more" target="_blank">Frazzled Cafe and Ruby Wax</a>,</i> the comedian, with master's degrees in psychotherapy and mindfulness-based therapy, describes how these activities can be used to channel the brain's functioning to relieve stress.</div><div style="text-align: left;"><br /></div></span></span></div><div style="text-align: left;"><span style="font-size: large;"><span style="font-family: times;"><br /></span></span></div><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><b>Find and Implement Your Anxiety Solutions</b></span></h3><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">Anxiety can be present at any phase of life, whether you're a parent, student, worker, or retiree. It's important to develop constructive ways to manage stress so that you can live your life and meet your responsibilities. There are many methods of managing and prreventing anxiety, ranging from exercise to finding a less stressful job to journaling and to professional therapy. Figure out what works best for you and build some healthy habits that will be useful in both preventing and managing anxiety when it occurs.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;"><b><i>If you</i></b><i><b> are dealing with stress, anxiety, or other mental health disorders, join Willa Goodfellow on her journey to research and process these issues in her own world through ProzacMonologues.com.</b></i></span></div><div><span style="font-family: verdana; font-size: large;"><i><b><br /></b></i></span></div><div><span style="font-family: times; font-size: large;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ6JyVCwf6VI4qzgpN8w7ssiF9u6z_ma-6RL2TA2ap1sQe6u_bKCJZjHIZcTZvsHjkcELrcBDKaXt0wTAZ-hDPf_TAE4zcRPJpcbRwmE0EPMidzq2NVgm6yexUrI-2XZWLHQr7c1ed-BKQICnPp3qmmATLpRon9reIqI6oDJ4XFc_BXV9S5j-6kkVi_g/s110/coffee%20and%20computer.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="110" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ6JyVCwf6VI4qzgpN8w7ssiF9u6z_ma-6RL2TA2ap1sQe6u_bKCJZjHIZcTZvsHjkcELrcBDKaXt0wTAZ-hDPf_TAE4zcRPJpcbRwmE0EPMidzq2NVgm6yexUrI-2XZWLHQr7c1ed-BKQICnPp3qmmATLpRon9reIqI6oDJ4XFc_BXV9S5j-6kkVi_g/s1600/coffee%20and%20computer.jpg" width="110" /></a></div>Note: Many thanks to Julia Mitchell for this, my first foray into guest contributors. You may have noticed the different voice. Less... loony? Julia is a lifestyle writer, not quite my wheelhouse. But there is a lot of interest in mental health lately that is not about mental illness. Those two terms do get used interchangeably. Julia inspires me to continue the conversation with another post about how stress and anxiety differ and what the brain has to do with it. See ya next week.</span></div><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div style="font-family: verdana; text-align: right;"><i><span style="font-size: xx-small;">photo courtesy of <a href="https://www.pexels.com/photo/irritated-black-woman-gesturing-and-talking-emotionally-5700201/" target="_blank">Pexels</a></span></i></div><div style="font-family: verdana; text-align: right;"><i><span style="font-size: xx-small;">clipart by Microsoft online</span></i></div><div style="font-family: verdana; text-align: right;"><i><span style="font-size: xx-small;">photo of toolbox by Eric Strandberg and used under the Creative commons license</span></i></div><div style="text-align: right;"><span style="font-family: Verdana, Geneva, sans-serif; font-size: xx-small;"><span style="background-color: white;"><i>flair from Facebook</i></span></span></div></span>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-74173041080784433142022-09-28T09:08:00.000-07:002022-09-28T09:08:16.204-07:00Getting My Brain Back -- I'm Still Excited by BDNF<div class="separator" style="clear: both; text-align: left;"><i>Learning </i>has been fundamental to my mental health recovery<i>.</i> It started with this blog itself. I wanted to know <i>What the hell happened to my brain?!!!</i> So I read the research and used <a href="http://ProzacMonologues.com">ProzacMonologues.com</a><i> </i>to keep track of my notes.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">For a while I added piano to my recovery regimen. Not for music therapy, but for <a href="https://www.prozacmonologues.com/2019/08/making-music-to-build-your-brain.html" target="_blank">brain development</a>. Okay, I didn't keep at it. I can sort of play <i>Desperado. </i>But it did get me a few more miles down the road.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Lately I am learning a new language. Five minutes a day of Irish on Duolingo -- I don't expect to be fluent any time this decade. I don't need to be fluent. For those five minutes a day, I am building my brain.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Which is always a good thing.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">I did a search in my blog for BDNF. And found something I wrote in 2011, right after I wrote that review of Ellen Frank's <i>Treating Bipolar Disorder. </i>Now you, kind reader, have no idea the struggle it took back then to write these paragraphs. I am proud of it both for the accomplishment and for the content itself. I present it to you again:</div><div class="separator" style="clear: both; text-align: left;"><br /></div><h2 style="clear: both; text-align: center;">Getting My Brain Back -- In Praise of BDNF</h2><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-aNBk_pGJjhE/Te0iuOWozZI/AAAAAAAAAzg/p5pZAq82bVs/s1600/Neuron+golgi+image+robert+huber+creative+commons.jpg" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="70" src="http://1.bp.blogspot.com/-aNBk_pGJjhE/Te0iuOWozZI/AAAAAAAAAzg/p5pZAq82bVs/s320/Neuron+golgi+image+robert+huber+creative+commons.jpg" width="320" /></a></div><p><span></span></p><a name='more'></a>Here is the star of <i>Getting My Brain Back</i>, the Neuron. I've got lots of neurons. So do you. They are our friends and we need to take care of them, so they take care of us. BDNF, brain-derived neurotrophic factor will help us do that. How BDNF is giving me my brain back is our story for the day. But first...<p></p><div dir="ltr" trbidi="on"><br /><b>Preface</b><br /><br /><a href="http://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1307383181&sr=8-1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="http://3.bp.blogspot.com/-KZ6GrU72kXg/Te0VZWN0GeI/AAAAAAAAAzc/ql_QufVcOmI/s200/treating+bipolar+disorder.jpg" width="200" /></a>Did you notice? I wrote a <a href="https://www.prozacmonologues.com/2011/05/treating-bipolar-disorder-part-iv.html" target="_blank">book report</a> in April. If you are a regular reader, I guess that is obvious. Let me try again.<br /><br />I <i>read </i>a book. Not just the one by Agatha Christie. Maybe you still don't get it. Never mind. Here is the story.<br /><br /><h3><b>Introducing Neuron, The Brain Cell</b></h3><b> </b><br /><div style="clear: both;"><a href="http://1.bp.blogspot.com/-kanLZJ-SLGo/Te0ke3vgQJI/AAAAAAAAAzk/JyAfzRqSv2Q/s1600/neuron%252C+dendrite%252C+axon+Pearson+Scott+Foresman+pub+dom.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-kanLZJ-SLGo/Te0ke3vgQJI/AAAAAAAAAzk/JyAfzRqSv2Q/s320/neuron%252C+dendrite%252C+axon+Pearson+Scott+Foresman+pub+dom.png" width="238" /></a><!--more-->To the right we have a line drawing of the neuron with its major parts. Neurons are essentially communication devices. Each one receives messages from another neuron and passes them on to the next. Dendrites are like the receivers. Yes, they look like kinky hair. Today let's call them <i>ears</i>, one ear at the end of each little spine growing out of each branch Axons are senders. They carry the messages to the next neuron. Yes, the nerve endings look like feet. Today let's call them <i>mouths</i>.<br /><br />Now imagine each of these dendrites pressing its ear against the mouth of another neuron's ending, and each of these nerve endings pressing its mouth against the ear of the next neuron's dendrite. A lot of action going on here! A lot being communicated. The dendrites/ears and nerve endings/mouths connect at synapses, where a chemical exchange occurs, which passes the information from one neuron to the other. But the chemistry is a subplot, not to be detailed in this post. Maybe in a sequel, if this story goes well.</div><br /><b>We Need Lots And Lots Of Dendrites And Axons</b><br /><br />So the story begins. Baby brain is born, with a cast of a million neurons, more or less, like the one above. I like that line drawing. I'm thinking of my neurons all lined up, dendrites and nerve endings touching, grooving on each other, a regular reggae party, <i>Don't worry 'bout a thing. 'Cuz every little thing gonna be alright...</i><br /><br />Just how many of these connections are there? Notice lots of dendrites on the one cell body in this line drawing, with spines coming off branches, a dendrite at the end of each spine. Some cells have just one dendrite. In the cerebellum, the purkinje cells have about 100 branches and 60,000 spines on each branch, more or less. That's 6,000,000 dendrites/ears/potential connections per cell. Not all of baby's 1,000,000 brain cells are quite so crowded as the ones in the cerebellum. But if we do the math, that adds up to a gajillion dendrites, give or take a few, a gajillion potential connections.<br /><br /><b>Pruning Dendrites -- Sometimes Less Is More</b><br /><br />Okay, a gajillion connections is<b> </b>a lot of noise, even for a baby. Baby's brain has work to do. What tastes good when I bite it? What hurts? What doesn't hurt? What gets mad and goes away? Focus, kid! That mad reggae party in there is great, but we need some focus!<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-fPZW9fo88c0/Te5ZXPANuLI/AAAAAAAAAzo/x9yCIoTMBgs/s1600/babies+talking+p+pogo+creative+commons.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="http://4.bp.blogspot.com/-fPZW9fo88c0/Te5ZXPANuLI/AAAAAAAAAzo/x9yCIoTMBgs/s200/babies+talking+p+pogo+creative+commons.jpg" width="200" /></a></div>So right off the bat, some of these connections get used a lot, and some start disconnecting. At birth, baby will pay attention to anything. Within a year, baby pays attention to people speaking the language (or languages) spoken in the house and gets bored by people speaking something else. The rule of the house regarding dendrites is <i>Use it or lose it</i>. The connections for all the other languages of the world die off, and the connections for baby's own language get reinforced.<br /><br />This pruning of connections is how we develop habits, as the messages go down the same channels over and over, like chopping a path through the kudzu. The next time we go that way, the chopping is already done. We can get there faster, and have energy for whatever we want to do once we reach our destination.<br /><br /><h3><b>Brain-Derived Neurotrophic Factor</b></h3><br />But wait! While you were standing there with the tape recorder, coaxing baby to coordinate lips and tongue and breath and come out with -- will it be <i>mama </i>or <i>papa</i>? -- BDNF was already on the scene.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-9WqU7ya1PoI/Te5txAN1LpI/AAAAAAAAAzs/-Gwdc6IuW6s/s1600/bdnf+Jawahar+Swaminathan+and+MSD+staff+at+the+European+Bioinformatics+Institute+pub+dom.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://3.bp.blogspot.com/-9WqU7ya1PoI/Te5txAN1LpI/AAAAAAAAAzs/-Gwdc6IuW6s/s320/bdnf+Jawahar+Swaminathan+and+MSD+staff+at+the+European+Bioinformatics+Institute+pub+dom.jpg" width="320" /></a></div><br />Here is the co-star of <i>Getting My Brain Back</i> -- Brain-Derived Neurotrophic Factor. BDNF is a protein, one of the neurotransmitters. It is found in greatest concentrations in the hippocampus (memory, emotions, learning), cortex (thinking) and basal forebrain (which produces acetylcholine, another neurotransmitter used in learning). Its job is to help cells grow, survive and differentiate. It supports the dendrites, to strengthen existing connections and make new ones.<br /><br /><b>So Which Is It We Need, More Connections Or Less?</b><br /><br />Both, of course.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/--AG11PqQVKk/Te_dYxKoHbI/AAAAAAAAAzw/09JKEAdrTY0/s1600/deck+of+cards+Polybius+pub+domain.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="http://3.bp.blogspot.com/--AG11PqQVKk/Te_dYxKoHbI/AAAAAAAAAzw/09JKEAdrTY0/s200/deck+of+cards+Polybius+pub+domain.png" width="200" /></a></div>I lost all my Spanish speaking dendrites when I was a baby, and painfully replaced them in high school, with the help of the protein designed to do just that, BDNF. Then they fell into disrepair again for several years, until my spouse and I visited her high school foster family in Ciudad Obregon, Mexico. Sra. Ramirez was teaching me some card game. Only the rules seemed to change every turn. I needed to repair those Spanish-speaking channels fast! BDNF works, but not that fast. That little old lady robbed me blind.<br /><br /><h3><b>Stress Makes Things Happen</b></h3><br />So we have our stars, Neuron and BDNF. Now we need some plot. Otherwise known as <i>Stress</i>.<br /><br />Poor stigmatized and misunderstood stress. How about for now, we rename it <i>stimulation.</i> Here is what I mean.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-00kPALpFJ14/Te_maV0MtkI/AAAAAAAAAz0/S4uOxddTDDg/s1600/Bicycle+jacob+and+Marlies+creative+commons.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="http://4.bp.blogspot.com/-00kPALpFJ14/Te_maV0MtkI/AAAAAAAAAz0/S4uOxddTDDg/s200/Bicycle+jacob+and+Marlies+creative+commons.jpg" width="150" /></a></div>Shiny new bicycle. The five-year-old begs, <i>Oh, please, please, <b>please </b>take the training wheels off!</i> It took a lot of begging. It was made clear to me that once the wheels came off, they were not going back on.<br /><br />Meanwhile, in the previous five years, the dendrite/axon connections in charge of balance were developing, as I learned to walk and even skip -- no mean feat! But this was a new wrinkle on the task. One step up onto those pedals, the other foot lifts off the ground. Houston, we have lift-off. And suddenly -- <i><b>STIMULATION!!</b></i><br /><br />The inner ear is going crazy, sending out urgent messages to the basal ganglia which is supposed to remember this stuff, like skipping. And falling. Remember falling?! That sets amygdala, hypothalamus and pituitary into action. Remember panic?! Now the hippocampus gets the SOS. This is a job for BDNF!<br /><br />So inside hippocampus cells, the endoplasmic reticulum goes into BDNF production, and the dense-core vesicles start pumping the stuff out. Time for some dendrite growth and support!<br /><br /><h3><b>Nature/Nurture</b></h3><br />What happens next is an interplay between the existing brain and its wider environment.<br /><br /><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-QK5-5w6Rm8c/TfDY4UVEfGI/AAAAAAAAA0A/FENE5CHibyE/s1600/Hippocampus+Washington+Irving+pub+dom.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="http://1.bp.blogspot.com/-QK5-5w6Rm8c/TfDY4UVEfGI/AAAAAAAAA0A/FENE5CHibyE/s200/Hippocampus+Washington+Irving+pub+dom.png" width="168" /></a></div><b>Nature: </b>A normal hippocampus (here in red) looks like a sea horse or a curled up green bean, 1 1/2-2 3/4 inches long if stretched out. Depending on the genetic role of the dice and/or the stress experienced by the pregnant mother, and hence by the fetus who is along for the ride, some brains have smaller hippocampi right from birth, along with a diminished capacity to produce BDNF.<br /><br />That is not necessarily a problem. Little people can do big things, same with little hippocampi. It depends on whether the demands for BDNF are matched by the capacity of the hippocampus to produce it.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-CFRRYt6Te2Q/Te_-iK7EIZI/AAAAAAAAAz8/Ydwg5xi3PNY/s1600/Drill_sergeant_screams+Corporal+Shawn+M.+Toussaint+pub+dom.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="http://2.bp.blogspot.com/-CFRRYt6Te2Q/Te_-iK7EIZI/AAAAAAAAAz8/Ydwg5xi3PNY/s200/Drill_sergeant_screams+Corporal+Shawn+M.+Toussaint+pub+dom.jpg" width="165" /></a></div><b>Nurture: </b>There is this perception out in parentland that shouting helps children to learn. Actually, sometimes it does. When the task is simple and the learner lacks motivation, like, how to take the dishes from in front of the television set and place them in the kitchen sink, an occasionally-used loud voice can be just the trick to stimulate the neurotransmitters needed for memory consolidation. Downside -- this method loses effectiveness with frequent use.<br /><br />Riding a bicycle, however, is not a simple task. There is a lot of communication already going on inside the brain of the person who is trying with all her might not to hit the pavement. That BDNF is pumping out just as fast as it can. In this case, shouting adds more cortisol load to the hippocampus than is helpful. It overwhelms the learning process and turns it into a survival process.<br /><br />When stimulation crosses over to stress and from stress to terror, the brain has to get more efficient. Learning is a luxury. The over-stressed person falls back into what is familiar.</div><div dir="ltr" trbidi="on"><br /></div><div dir="ltr" trbidi="on">Like falling. <br /><br />Well, into every child's life, an occasional full adult meltdownage will fall. Nobody will learn to ride a bike today. But the brain is built with its own repair system. BDNF will clean up the mess, and we will go back to bike-riding another day.<br /><br /><h3><b>Overstimulation</b></h3><br />Then there are those parents who think that <i>nature </i>is bad and that hitting is part of <i>nurture</i>. Hitting is even less helpful than shouting for learning complex skills. Hitting <i>really </i>overstimulates the brain.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-8RmcPMmBRm8/TfEbxCsDOdI/AAAAAAAAA0M/-gaC4zb18Ns/s1600/car+on+fire.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-8RmcPMmBRm8/TfEbxCsDOdI/AAAAAAAAA0M/-gaC4zb18Ns/s1600/car+on+fire.jpg" /></a></div>Especially random hitting. Unpredictable and random shouting and hitting disrupt the feedback circuits in the HPA (hypothalamus/pituitary/adrenal) axis. Over time the HPA axis loses its ability to shut down when not needed. Because it has learned that it never knows when it will be needed. So it just pumps out that cortisol 24/7. The hippocampus keeps getting the message and pumping out that BDNF, until it is depleted. Learning stops. The dendrites in the hippocampus itself atrophy and die. Literally, the hippocampus shrivels.<br /><br />Then that already-from-birth-little hippocampus gets smaller still, with even less capacity to produce BDNF to repair the damage. Or learn to ride a bike.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-Oih-pAaHu4Y/TfDbiopfcvI/AAAAAAAAA0E/eLMnJrGTXQg/s1600/broken+wheel+Giusto+Cerutti+dutch+national+archive+pub+dom.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="http://4.bp.blogspot.com/-Oih-pAaHu4Y/TfDbiopfcvI/AAAAAAAAA0E/eLMnJrGTXQg/s200/broken+wheel+Giusto+Cerutti+dutch+national+archive+pub+dom.jpg" width="148" /></a></div>As far as cycles go, this one is not good.<br /><br /><b>Getting My Brain Back Anyway</b><br /><br />But. Take away the shouting<b> </b>and hitting. Take away the random and unpredictable. Give the poor pitiful hippocampus a rest. The brain comes equipped with its own repair system. Give it a couple years.<br /><br />Build some more implicit memory in the basal ganglia, more balance, more skipping. How about some roller skating? Stronger legs?<br /><br />Then one day, go to some safe and sane spot. Little bit at a time. Push off. Put a foot down. Push off. Put a foot down. Over and over. Nobody else knows how often the foot touches the ground. Nobody gets bored or angry at this repetition that stimulates a new channel of communication from inner ear to hips and knees and shoulders. Learn. This is what the brain is designed to do.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-DwADlWRb7ZE/TfDfne6_5nI/AAAAAAAAA0I/9adoSFB_qwg/s1600/bike+woman+by+pedrosimoes7+flikr.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-DwADlWRb7ZE/TfDfne6_5nI/AAAAAAAAA0I/9adoSFB_qwg/s320/bike+woman+by+pedrosimoes7+flikr.jpg" width="179" /></a></div><br />I can ride a bike.<br /><br /><b>I Wrote A Book Report</b><br /><br />In one long run-on sentence I will now slide by subsequent shouting, hitting and random adult meltdownage, resulting in hippocampal damage and over-sensitized HPA axis, followed by untreated episodes, inappropriately treated episodes, SSRI poisoning, countless chemistry experiments setting up insomnia, hypomania and hysteria, exacerbated by continual harassment and activation of HPA madness by the short-term disability carrier, terminating in brain damage and long-term disability.<br /><br />Only, of course, that is not where it terminates. The brain has its own built-in repair system, BDNF.<br /><br />Take away the shouting<b> </b> and hitting. Take away the random and unpredictable. Give that poor pitiful hippocampus a rest. Give it a couple years.<br /><br />I used to write books. In 2005 I wrote most of the book <i>Prozac Monologues</i> in one week, and finished it in two more. Well, maybe that was more a symptom than an accomplishment. But still, it was written <i>well</i>.<br /><br /><a href="http://2.bp.blogspot.com/-drj83mo_qJ0/TfE6tMg4FlI/AAAAAAAAA0Q/GFojwXwoMbw/s1600/stunned+yellow.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-drj83mo_qJ0/TfE6tMg4FlI/AAAAAAAAA0Q/GFojwXwoMbw/s1600/stunned+yellow.jpg" /></a>Last year, on the other hand, I could not <i>read </i>a book. The year before, I would pick up a magazine, like an airline magazine, read a sentence at random, read the sentence that came before it, remember you are supposed to read from the beginning, find the beginning, get halfway through the first sentence and lose interest.<br /><br />But even that little pea pod hippocampus of mine can still produce BDNF. Go to some safe and sane spot. Push off. Write a sentence. Put a foot down. Go empty (half) the dishwasher. Push off. Delete a prepositional phrase. Collapse into an hour of BeJeweled Blitz on Facebook. Write a paragraph.<br /><br />Next day, rearrange the sentences of the paragraph. Google something. Half an hour later, try to remember what I wanted to know. Delete the whole paragraph. Quit for the day.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-PVioRYd_jGo/TfE7snOhrNI/AAAAAAAAA0U/OWIR0bI3O0A/s1600/tightrope+foot.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-PVioRYd_jGo/TfE7snOhrNI/AAAAAAAAA0U/OWIR0bI3O0A/s1600/tightrope+foot.jpg" /></a></div>Over and over. Nobody else knows how the writer wobbles, how often the foot touches the ground. Nobody else gets bored or angry at this painful process that stimulates a new channel of communication from one part of the brain to the next, hippocampus, amygdala, facebook, frontal cortex, Pub Med, anterior cingulate cortex.<br /><br />This is what the brain is designed to do, grow new dendrites to replace the ones that burned up in that fire, in all those fires of all those years.<br /><br />I wrote a book report in April. I am getting my brain back.<br /><br /><b>Afterword</b><br /><br />If you have read the original<b> </b>(<i>How the Brain Works</i>), or God help me, wrote it, you may be disappointed to find major characters missing from this adaptation of the book to the blog post. Given the name of the blog itself, Eli Lilly might marvel that serotonin did not get a mention. Some other lab, ready to role out a new psych med, will protest that BDNF would be nothing without glutamate. Me, I miss cousins Val and Met, who did get written, but whose paragraphs got left on the cutting room floor. You dopamine channel fans, write your own story.<br /><br />Gimme a break. It's a blog post.<br /><br /><div style="text-align: center;"><iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/4xA9pfaGGXg" width="420"></iframe></div><div style="text-align: right;"><i><span style="font-size: xx-small;">Golgi-stained Neuron with cell body, axon, and dendrites from Robert Huber and used under the <a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a> <a class="external text" href="http://creativecommons.org/licenses/by-sa/3.0/deed.en" rel="nofollow">Attribution-Share Alike 3.0 Unported</a> license</span></i></div><div style="text-align: right;"><i><span style="font-size: xx-small;">Scott Foresman, the elementary education publisher released the line drawing of the neuron and parts into the public domain</span></i><br /><i><span style="font-size: xx-small;">photo of babies talking by P Pogo and used under the <a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a> <a class="external text" href="http://creativecommons.org/licenses/by/2.0/deed.en" rel="nofollow">Attribution 2.0 Generic</a> license </span></i><br /><i><span style="font-size: xx-small;">Jawahar Swaminathan and MSD staff at the European Bioinformatics Institute created the cartoon of BDNF and placed it in the public domain </span></i><br /><i><span style="font-size: xx-small;">photo of child on bicycle by <a href="http://www.flickr.com/photos/jacobenmarlies/">Jacob and Marlies</a> and used <a href="http://www.flickr.com/photos/jacobenmarlies/">under the </a><a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a><a class="external text" href="http://creativecommons.org/licenses/by/2.0/deed.en" rel="nofollow">Attribution 2.0 Generic</a> license</span></i><br /><i><span style="font-size: xx-small;">Wahington Irving created the image of the hippocampi based on an MRI, and placed it in the public domain </span></i><br /><i><span style="font-size: xx-small;">photo of drill sergeant screaming taken by Corporal Shawn M. Toussaint and in the public domain</span></i><br /><i><span style="font-size: xx-small;">flair from facebook</span></i><br /><i><span style="font-size: xx-small;">photo of cyclist Giusto Cerutti from the Dutch Nationaal Archief and in the public domain</span></i><br /><i><span style="font-size: xx-small;">photo of woman on bicyle by <a href="http://www.flickr.com/photos/pedrosimoes7/">pedrosimoes7</a> and used under the <a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a> <a class="external text" href="http://creativecommons.org/licenses/by/2.0/deed.en" rel="nofollow">Attribution 2.0 Generic</a> license</span></i></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-26673229683817701062022-09-20T13:08:00.000-07:002022-09-20T13:08:15.049-07:00Interpersonal Social Rhythms Therapy: Good, Bad, and Ugly (Mostly Good)<p><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiEgltFHQK7ytB9TnRfOlXl-H2UbkilBSZr2ITpsLKQ8i_4AGFEaTqOST1jB1YVsNpzFxNtXqdYHc1M_0BvNhY2hthN__AOXl6Aau9IyyX-Hu7_6sDoUuTtJWrbv_zuJDSrFGAnATKOkr7p-u8xb40bIY9q_Cd-kbgVLTIaG32tHbwfAZpXbvTaHqlIJg" style="clear: left; display: inline !important; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img alt="" data-original-height="200" data-original-width="194" height="203" src="https://blogger.googleusercontent.com/img/a/AVvXsEiEgltFHQK7ytB9TnRfOlXl-H2UbkilBSZr2ITpsLKQ8i_4AGFEaTqOST1jB1YVsNpzFxNtXqdYHc1M_0BvNhY2hthN__AOXl6Aau9IyyX-Hu7_6sDoUuTtJWrbv_zuJDSrFGAnATKOkr7p-u8xb40bIY9q_Cd-kbgVLTIaG32tHbwfAZpXbvTaHqlIJg=w197-h203" width="197" /></a>Following <a href="https://twitter.com/search?q=%23bipolar&src=typeahead_click" target="_blank">#bipolar</a> on Twitter for the last few years, I am often dismayed. So many people seem to spend so much time struggling with their medications and so little time focused on anything else that could help.</p><p>Don't get me wrong. Medication is an important tool for managing bipolar disorder. But it can't do the whole job. Education and life style changes are crucial for getting off the roller coaster of constant med adjustments to address the episode du jour.</p><p>I decided it was time to revisit my 2011 review of Ellen Frank's <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&qid=1304520413&sr=8-1" target="_blank">Treating Bipolar Disorder</a>. </i>It was a four-part review. The last three posts describe the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.</p><div dir="ltr" trbidi="on"><a href="https://www.prozacmonologues.com/2022/08/do-your-meds-work-theres-more-you-can.html" target="_blank">Part I</a> laid the educational foundation, describing the relationship between circadian rhythms (our interior physiological clocks) and mood disorders.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-ocPzNWLtmco/TbID-Cig-qI/AAAAAAAAAvw/syxyN61ZkCo/s1600/clock+rainbow.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-ocPzNWLtmco/TbID-Cig-qI/AAAAAAAAAvw/syxyN61ZkCo/s1600/clock+rainbow.jpg" /></a></div><a href="https://www.prozacmonologues.com/2022/08/how-social-zeitgeber-theory-works-for.html" target="_blank">Part II</a> outlined Frank's <i>Social Zeitgeber Theory</i> and the treatment that proceeds logically from it, a process of establishing regular daily rhythms that set our interior clocks and keep them running on time. (<i>Zeitgeber </i>means <i>timekeeper</i>.)<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-bynDfmPzohk/TbIEmmKJq-I/AAAAAAAAAv0/4tNOMsnS7Cg/s1600/stunned+yellow.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://4.bp.blogspot.com/-bynDfmPzohk/TbIEmmKJq-I/AAAAAAAAAv0/4tNOMsnS7Cg/s1600/stunned+yellow.jpg" /></a></div><a href="https://www.prozacmonologues.com/2022/09/how-does-interpersonal-therapy-help.html" target="_blank">Part III</a> explained how work on interpersonal issues helps people reduce stressors and prevent disruptions to their social rhythms.<br /><br />This last post will pull together my appreciation, my reservations and my hopes for future directions.<br /><br /><h3 style="text-align: left;"><b>Social Zeitgeber Theory</b></h3><br /><a name='more'></a>Frank builds IPSRT on the theory that people with bipolar are more vulnerable than others to disruptions in our circadian rhythms. When our interior clocks get screwed up, we do, too. Daily events, like getting up at a certain time, seeing people, going to work, set our circadian rhythms. The core of the therapy is to help keep our rhythms regular.<br /><br /><b>The best brilliant part of <i>Treating Bipolar Disorder</i> is this theory.</b><br /><br />A good theory accounts for as much of the data as possible, and then provides a way to solve problems.<br /><br />The old theory is <i>bipolar is a chemical imbalance in the brain.</i> The advantages of the old theory is that it is simple, it suggests a way to solve the problem, and it is earning the pharmaceutical companies billions and billions of dollars. The disadvantages are that decades after it was first offered, it has offered false hope and subsequent despair to millions of sufferers, focused blame on those who won't take the drugs that make them sick and/or don't work, and for a majority of people who receive the best pharmacotherapy possible, simply failed to fix the problem. It also neglects a lot of data.<br /><br />The chemical imbalance theory comes from the data of clinical experiments -- that symptoms go away when you change the chemical stew. Or at least, they go away enough to get FDA approval for marketing claims. It does explain a piece of the puzzle.<br /><br />But another set of data has to do with what was going on <i>before </i>the symptoms developed. Frank and company turn to circadian rhythms to account for how the chemical imbalance developed. And here there is a wealth of data. For example, study of circadian rhythms reveals that lack of sleep <i>causes</i> depression as often as it <i>is caused by</i> depression. This suggests a whole other way to solve problems.<br /><br /><i>Treating Bipolar Disorder</i> documents this evidence in support of the theory. Most of the book then describes the therapy that derives from the theory.</div><div dir="ltr" trbidi="on"><br /><b>People With Bipolar Who Are Doing Well</b><br /><br />The Social Zeitgeber Theory accounts for the data of those with bipolar disorder who are managing their symptoms, working, thriving over the long haul. There are almost no studies done from this angle -- what people are doing to stay well. John McManamy reports on <a href="https://www.mcmanweb.com/staying_well.html" target="_blank">two of these studies</a> at mcmanweb.com. Healthy lifestyle is the top strategy for these people, particularly maintaining good sleep. Most, 85% take medication, but do not make medication the center of their self-care. None rely entirely on medication to stay healthy.<br /><br /><h3 style="text-align: left;"><b>Medication, Medication, Medication</b></h3><br />My chief reservation about the book has to do with its assumptions about medication.<br /><br />Let me put it this way. It is a bold move to list the uses of specific medications in a hard copy printed published book. Chances are that such a book will report positively on a medication for which the manufacturer then settles <a href="https://www.lawyersandsettlements.com/lawsuit/zyprexa.html">a class action suit</a> in the same year as publication. Zyprexa/olazapine is just one example of how quickly the chapter's information became debatable and/or dated.<br /><br />Frank assumes that IPSRT is an add-on to pharmacotherapy. She notes that lithium, the miracle drug that was supposed to have solved the problem of bipolar has turned out not to have done so in near as many cases as people think. She acknowledges that there are problems with side effects and efficacy for anything that is currently in use. But just barely.<br /><br /><i>Unfortunately, it is only a minority of patients with bipolar disorder who can comfortably take the medications that seem to control the symptoms of the illness and who are <b>willing to submit to this control.</b> Especially early in the course of the illness, before it has wrought complete havoc in the patient's life, there is denial that there is anything permanently wrong and <b>a longing for the highs</b> that the medications take away.</i><br /><br /><a href="http://2.bp.blogspot.com/-mDIMKf6p2d4/Tb7KkmH_whI/AAAAAAAAAwI/e8RsyFlUMoE/s1600/rage.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://2.bp.blogspot.com/-mDIMKf6p2d4/Tb7KkmH_whI/AAAAAAAAAwI/e8RsyFlUMoE/s1600/rage.jpg" /></a>Yup. There it is. Ellen Frank, too. <i>They miss their highs.</i> I won't go there right now. It's just too tiresome. But stay tuned...<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-NTcjCk1ZrYs/Tb8HprW_7RI/AAAAAAAAAwU/26Zei7uNlUo/s1600/chemistry+better+living.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://3.bp.blogspot.com/-NTcjCk1ZrYs/Tb8HprW_7RI/AAAAAAAAAwU/26Zei7uNlUo/s1600/chemistry+better+living.jpg" /></a></div>Frank continues the clinicians' tradition of oversell. She considers whether a clinician should refuse to work with a person who has bipolar I and does not take medication. Her recommendation is that the work might proceed anyway, with the goal of revisiting the issue at every opportunity until the patient finally does take meds, and holding open the possibility that treatment may be terminated if the clinician concludes that he/she cannot accept responsibility for somebody who is not on meds.<br /><br />Okay, on a positive note, Frank pays more attention to side effects than other clinicians, repeatedly urging that the therapist and prescribing clinician work in partnership, and that medication problems be addressed.<br /><br />On a very positive note, Frank spends a lot of ink on the issue that people with bipolar I or II spend way more time depressed than manic and hypomanic. And our depressions are far and away the part of the illness that disables us.<br /><br /><b>Can We Ever Crack This Medication Nut?</b><br /><br />This<b> </b>medication debate never seems to get anywhere. Like abortion or the Palestinian issue in US politics, nuance is not allowed. You're either pro-med or anti-psychiatry. And I can feel myself drawn into the blogosphere's quicksand. So let me do the down and dirty on Frank's position and get out of here.<br /><br /><a href="http://3.bp.blogspot.com/-eIsViY8qMnk/Tb7Jbicn0xI/AAAAAAAAAwE/k_WeKRatkTg/s1600/dislike+button.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://3.bp.blogspot.com/-eIsViY8qMnk/Tb7Jbicn0xI/AAAAAAAAAwE/k_WeKRatkTg/s1600/dislike+button.jpg" /></a>Frank's assumption that everybody who has bipolar I and not on meds is a train wreck waiting to happen -- maybe that is a necessary evil to maintain her professional credibility; maybe more of the usual professional wishful thinking:</div><div dir="ltr" trbidi="on"><br /></div><div dir="ltr" trbidi="on">I call it <b>disappointing</b>.</div><div dir="ltr" trbidi="on"><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-A7UVlk0DHwA/TcBpyZKjdSI/AAAAAAAAAwg/1774sfwjuJE/s1600/dislike+button.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://4.bp.blogspot.com/-A7UVlk0DHwA/TcBpyZKjdSI/AAAAAAAAAwg/1774sfwjuJE/s1600/dislike+button.jpg" /></a></div><a href="http://4.bp.blogspot.com/-A7UVlk0DHwA/TcBpyZKjdSI/AAAAAAAAAwg/1774sfwjuJE/s1600/dislike+button.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://4.bp.blogspot.com/-A7UVlk0DHwA/TcBpyZKjdSI/AAAAAAAAAwg/1774sfwjuJE/s1600/dislike+button.jpg" /></a>Frank's repetition of the old <i>they miss their highs </i>thing: </div><div dir="ltr" trbidi="on"><br /></div><div dir="ltr" trbidi="on">I call it <b>tiresome</b>.</div><div dir="ltr" trbidi="on"><br /><br /><br /><br /><a href="http://1.bp.blogspot.com/-bKNqYZ5KvGg/TcBo-C-lisI/AAAAAAAAAwc/tXaOvQdvNP0/s1600/like+button.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-bKNqYZ5KvGg/TcBo-C-lisI/AAAAAAAAAwc/tXaOvQdvNP0/s1600/like+button.jpg" /></a><a href="http://1.bp.blogspot.com/-bKNqYZ5KvGg/TcBo-C-lisI/AAAAAAAAAwc/tXaOvQdvNP0/s1600/like+button.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a>Frank's concern to take side effects seriously and her criticism of the standard practice of medicating people with bipolar into a permanent state of mild depression, treating anything approaching a normal feel-good state as a danger sign of impending mania:</div><div dir="ltr" trbidi="on"><br /></div><div dir="ltr" trbidi="on">I call that <b>refreshing</b>.<b> </b><br /><br /><h3 style="text-align: left;"><b>Clinical Language Alert</b></h3><br />I have spent the last several years reading books and articles written not for me, but about me. It is a perilous business. <i>Prozac Monologue </i>readers occasionally are on the receiving end of <a href="https://www.prozacmonologues.com/search/label/OMGThat%27sWhatTheySaid" target="_blank">my efforts to manage the consequences</a> of this endeavor. It is getting less perilous, as I learn some skills, the first of which is simply to acknowledge the intended audience. So...<br /><br /><a href="http://3.bp.blogspot.com/-a4WRwj3os64/Tb8WPzLwEpI/AAAAAAAAAwY/u7dfLyqjbTY/s1600/Caution_GNU.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="141" src="https://3.bp.blogspot.com/-a4WRwj3os64/Tb8WPzLwEpI/AAAAAAAAAwY/u7dfLyqjbTY/s200/Caution_GNU.png" width="200" /></a><i>Treating Bipolar Disorder</i> is written <i><b>for </b></i>clinicians and <i><b>about </b></i>people with bipolar. I am not a clinician; I am a person with bipolar. Therefore, <i>Treating Bipolar Disorder</i> is not <i><b>for </b></i>me; it is <b><i>about </i></b>me.<br /><br />If you are <b><i>like </i></b>me, you need to take this into account when reading this book.<br /><br />Having said that, this book is less perilous than others.<br /><br />Yes, there are a couple bumps in the road: the <i>bipolar temperament</i>, the <i>attitude of entitlement</i> and <i>they miss their highs</i>. For the record, Frank never uses those exact words. Her exact words are above.<br /><br />On the other hand, this book is exceptional in its tone of respect and genuine partnership between clinician and patient. Absolutely exceptional. Props to Ellen Frank.<br /><br /><h3 style="text-align: left;"><b>The Future Of IPSRT</b></h3><br />Like I said, this book was written for clinicians, who are addressed directly. It was not written for people who have bipolar disorder, nor for a general audience. There is no book, no pamphlet, no article, no website, no youtube that describes IPSRT for a general audience. <i>Prozac Monologues</i> is as close as you get. Not enough for a do-it-yourself-er. But a start.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-j59aPhLRU9s/TcFhMOxGjlI/AAAAAAAAAwo/s5c_XgIAyws/s1600/magnifying+glass.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://2.bp.blogspot.com/-j59aPhLRU9s/TcFhMOxGjlI/AAAAAAAAAwo/s5c_XgIAyws/s1600/magnifying+glass.jpg" /></a></div><span id="goog_1286813509"></span><span id="goog_1286813510"></span>At this point, getting access to this therapy would be a trick. If you use one of those <i>Find a Therapist</i> websites and actually do find one in your area whose interests include bipolar, you are still likely to get the response I got, <i>The way to treat bipolar is with medication.</i><br /><br />Frank and company keep track of those they have trained. She says maybe she should develop a website. A lot of people think maybe they should develop a website. Most of them have many other things to do. I wouldn't hold my breath. I would write her directly and ask. And then come up with a do-it-yourself strategy. I have one outlined below.<br /><br />Frank has the support of NIMH's STEP-BD study giving IPSRT the magic label of <i>evidence-based.</i> So she has a therapy, a book, a training. And 5,700,000 people who could benefit from this treatment. She needs to develop the market for her training the same way pharmaceutical companies develop their markets -- go directly to us 5,700,000 people with bipolar.<br /><br />There's a whole world of people out here who get our mental health care from Facebook friends and <i>[Name Your Diagnosis and/or Treatment] for Dummies. </i>We need an <i>IPSRT for Dummies.</i> We need a workbook. Once we get started, we'll ask for help, and our care providers might get interested.<br /><br />Here is my story: The meds don't work. I have been stalled in Cognitive Therapy for some co-morbid trauma issues. I don't have the capacity to interview a bunch of therapists who might deal with my bipolar, even if I could find them. I lose my voice when I talk with therapists -- back to those trauma issues. So I went back to my CBT therapist. We are renegotiating to do more interpersonal work and I am experimenting on my own SRT/Mood Chart. <a href="https://www.prozacmonologues.com/2012/12/mood-charts-revisited.html" target="_blank">Here's a post</a> describing it. <a href="https://www.prozacmonologues.com/p/the-standard-mood-chart-tracks-moods-up.html" target="_blank">Here's the chart</a> itself. I will do the SRT part on my own. My therapist and I can talk about my <i>grief for the formerly healthy self.</i><br /><br />You have to really have it together to do therapy this way. I am not starting from a position of crisis. I have good insurance and a lot of resources. My wife tells me, if I have lost half of my cognitive functioning, that still makes me smarter than 80% of the people in the room.<br /><br />So this might work for me and maybe another 100,000 high functioners out there. 5,600,000 more to go.<br /><br />On July 14, 1990 Ellen Frank <i>knew with absolute certainty that [she] needed to dedicate the next decade of [her] life to doing better by these patients and family members. </i>It was a decade well spent. And then another. I hope she keeps going into the third.<br /><br /><h3 style="text-align: left;"><b>Last Words</b></h3><br />If you are a person living with bipolar disorder, cut the author a break for the inevitable mental health provider mentality. The medication issue is a minor, minor piece of an otherwise helpful, hopeful book.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&qid=1304520413&sr=8-1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://1.bp.blogspot.com/-Oeew0Sj_SO8/TcFnCWKhgYI/AAAAAAAAAww/2g8ig1Rp_2w/s200/treating+bipolar+disorder.jpg" width="200" /></a></div><i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&qid=1304520413&sr=8-1" target="_blank">Treating Bipolar Disorder</a></i> offers hope. Read it. Talk to your therapist about it. Get yourself a schedule that includes enough sleep at a regular time each day. Talk with your therapist about whatever keeps you from doing that.<br /><br />If you are a therapist, read this book. Give its techniques a try. There's now an eight hour online training available <a href="https://www.ipsrt.org/training" target="_blank">here</a>.<br /><br />If you are a doctor, read this book. Stop promising more from meds than meds can deliver. There is more help out there for your patients. Help us find it.<br /><br />If you are Ellen Frank, get this stuff out to those of us who can't find or afford a therapist whom you have trained. And God bless you.<br /><br /><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo of clockworks by <a href="http://commons.wikimedia.org/wiki/User:HNH" title="User:HNH">HNH</a> and used under the <a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a><a class="external text" href="http://creativecommons.org/licenses/by-sa/3.0/deed.en" rel="nofollow">Attribution-Share Alike 3.0 Unported</a> license</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>flair from facebook</i></span></div><div style="text-align: right;"><i><span style="font-size: xx-small;">caution sign by<a href="http://commons.wikimedia.org/wiki/User:RTCNCA" title="User:RTCNCA"> RTCNCA</a></span><span style="font-size: xx-small;"> and used under the <b><a class="extiw" href="http://en.wikipedia.org/wiki/en:GNU_Free_Documentation_License" title="w:en:GNU Free Documentation License">GNU Free Documentation License</a></b>,</span></i></div><div style="text-align: right;"><i><span style="font-size: xx-small;"> </span></i></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-86904437891203993842022-09-07T13:35:00.002-07:002022-09-07T13:35:39.196-07:00How Does Interpersonal Therapy Help People with Bipolar Disorder?<h2 style="text-align: left;">Ellen Frank - Treating Bipolar Disorder, Part 3</h2><p><span style="font-size: large;">Lately I have been reposting my 2011 review of <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" target="_blank">Treating Bipolar Disorder</a> </i>by Ellen Frank. It was originally recommended to me by a friend who was researching hypomania. <a href="https://www.prozacmonologues.com/2022/08/do-your-meds-work-theres-more-you-can.html" target="_blank">Part I</a> described the basis of Interpersonal Social Rhythms Therapy (IPSRT) in circadian rhythms that control the many physiological symptoms of mood disorders. <a href="https://www.prozacmonologues.com/2022/08/how-social-zeitgeber-theory-works-for.html">Part II</a> outlined the <i>Social Zeitgeber Theory</i> and described the early stages of the therapy process, history taking and stabilizing social rhythms. Today I pick up with the later stages, interpersonal therapy and maintenance.</span></p><span style="font-size: large;"><br /></span><a href="http://1.bp.blogspot.com/-W3c8SmJgfbg/TaM0pvczzlI/AAAAAAAAAuo/oBb2Zf9XWfY/s1600/birthday+candles.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" src="https://1.bp.blogspot.com/-W3c8SmJgfbg/TaM0pvczzlI/AAAAAAAAAuo/oBb2Zf9XWfY/s1600/birthday+candles.jpg" /></span></a><span style="font-size: large;">Interpersonal Social Rhythms Therapy came to Ellen Frank in an epiphany on her birthday, July 14, 1990. Personally, I like that. I especially like that it was the day that she participated in a conference for people with bipolar, and <i>listened </i>to them.<br /><br />Frank and her colleagues were already using interpersonal therapy for people with recurrent unipolar depression. Their theory was that certain life events, particularly losses could result in lost social <i>zeitgebers</i>, (timekeepers), with subsequent disruption of circadian rhythms, leading to eventual relapse into another episode of depression.<br /><br />IPSRT took up from there as an adaptation specifically for people with bipolar disorder, integrating the work on issues (as in, you've got <i>issues</i>) with greater focus on behavioral changes to achieve and maintain daily rhythms, time of rising, time of first human contact, work, main meal, etc. The purpose of IPSRT is to help people achieve stability and then to avoid relapses into either depression or mania/hypomania.</span><div><span style="font-size: large;"><b><br /></b></span><h3 style="text-align: left;"><span style="font-size: large;"><b>Why Do People Relapse?</b></span></h3><span><a name='more'></a></span><span style="font-size: large;"><br />IPSRT builds on Goodwin and Jamison's work in their classic <a href="https://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-Depression/dp/0195135792/ref=sr_1_1?ie=UTF8&qid=1302644834&sr=8-1" target="_blank">Manic-Depressive Illness</a>, which argues that instability is the fundamental dysfunction in manic depressive illness. Goodwin and Jamison identify three interrelated reasons why relapse occurs for those who have been successfully treated with medication (lithium): noncompliance with medication regime; disruptions in social rhythms; and stressful life events. IPSRT addresses all three.<b> </b><br /><br /></span><h3 style="text-align: left;"><span style="font-size: large;"><b>How Interpersonal Therapy Helps</b></span></h3><span style="font-size: large;"><br />The friend who brought Frank's work to my attention wondered if the interpersonal part of this mash-up (IP+SRT) is integral to the results, or if they do IP just because that is what they were already doing. I wondered that, too.<br /><br />Frank answers most succinctly in a 1994 article for the journal, <i>The Behavior Therapist</i>. (And I thank her for sending me a copy.) There she identifies the interpersonal work specifically with the third reason for relapse, stressful life events:<br /><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-Yq1LrNigtIY/TaNCErGI4zI/AAAAAAAAAuw/hUy_-zUd6vA/s1600/jenga+blocks+by+jason7825+gnu.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" height="150" src="https://1.bp.blogspot.com/-Yq1LrNigtIY/TaNCErGI4zI/AAAAAAAAAuw/hUy_-zUd6vA/s200/jenga+blocks+by+jason7825+gnu.jpg" width="200" /></span></a></div><span style="font-size: large;"><i>By addressing interpersonal problem areas in the patient's life, IP/SRT attempts to reduce the number and severity of interpersonally-based stressors the patient experiences. We believe that reduction of interpersonal stress was important for three reasons. First, stressful life events can have a direct effect on circadian integrity through increased autonomic arousal. Second, many life events lead to marked changes in routine which, in turn, affect circadian rhythms. Finally, the psychological meaning of such events frequently has the capacity to affect mood directly.</i><br /><br />The interpersonal issues on which they focused for treating unipolar depression included unresolved grief, social role transitions, interpersonal role disputes and interpersonal deficits. Grief for the formerly healthy self was added in their modification for for bipolar disorder.<br /><br /><b>Where To Begin</b><br /><br />The therapist and client contract together on which issue to address in therapy, usually the one that most clearly contributed to the most recent relapse. A tour through each issue can illustrate how closely integrated the theory and therapy indeed are. Some of what follows is from Frank. Some is my own take on the matter<span>.</span><br /><span></span><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-Ug-gWBUuD8o/Tad95GkkK5I/AAAAAAAAAu0/EaztDzA7Eh4/s1600/roller+coaster+WillMcC+wiki.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" height="150" src="https://3.bp.blogspot.com/-Ug-gWBUuD8o/Tad95GkkK5I/AAAAAAAAAu0/EaztDzA7Eh4/s200/roller+coaster+WillMcC+wiki.jpg" width="200" /></span></a></div><span style="font-size: large;"><span><b>Unresolved Grief -- </b>Even normal grief makes people with bipolar disorder vulnerable to a mood episode. A death in the family brings with it all kinds of stresses.</span><span> Pick your own favorite family craziness. </span><span>Plus travel, finances, interacting with unfamiliar professionals, unresolved spiritual issues... There is a reason why funeral home directors speak in that gentle voice. They know how close to the edge you are, and don't want to set you off. It's called</span><span> <i>funeral parlor mania. </i></span><span>Add to stress the disruption of schedules, temporary for some and long term for those whose daily lives were most closely linked with the deceased. In the chaos of events and emotions, self care, including medication can be neglected or forgotten. </span>Stressful life events, disruptions in social rhythms, noncompliance with medication regime -- there you have the Goodwin/Jamison relapse trifecta.<br /><br /><span>If the person with bipolar has not worked through a past grief, like, went off the deep end during the original event, he/she can return to the chaos at an anniversary or when confronted with some trigger. Reload, repeat, relapse.</span><br /><br /></span><a href="http://2.bp.blogspot.com/-aGWlGroMiOE/TaeC9rBJ_qI/AAAAAAAAAu4/vtbkoTzgaXg/s1600/stunned+yellow.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://2.bp.blogspot.com/-aGWlGroMiOE/TaeC9rBJ_qI/AAAAAAAAAu4/vtbkoTzgaXg/s1600/stunned+yellow.jpg" /></span></a><span style="font-size: large;"><span><b>Grief For The Lost Healthy Self -- </b>It's a real whack upside the head to be diagnosed with a serious mental illness that will be with you for the rest of your life. Frank says it helps to acknowledge what has been lost, like meaningful work, accomplishment, recognition -- my glorious career with its circadian rhythm wrecking lifestyle. Framing the issue in terms of grief helps people move on to acceptance of a new sense of self. Self-expectations, concepts of <i>healthy</i> and <i>ideal </i>have to be redefined to include good judgment about self care.</span><br /><br /><span>I have to take her word on this. Among the stages of grief, I have moved past <i>stunned</i>, and am stuck on <i>royally pissed</i>. I can see that more realistic expectations could reduce stress, and that <i>acceptance</i> could morph into motivation to search for and stick with the program that works, including limits on those late night sessions that solve the problems of the world. But I suspect a large part of Frank's agenda, wanting me to get to acceptance, includes acceptance of medications I don't want to take. And I go back to <i>royally pissed</i>. Notice, we have stress, schedule and meds again, all addressed in one stop shopping for resolving grief for the lost healthy self.</span></span></div><div><span style="font-size: large;"><br /></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="text-align: left;"><span style="font-size: large;"><span>Note from 2022: This post was written originally in 2011. Since then I have - moved on. My lost healthy self is like a dream. Meanwhile, I have a new self, as an author. Many authors have mood disorders. Many people with mood disorders write. It fits the ways our brains work. And it's not so tied to external expectations that we cannot consistently meet. The joy of moving words around on a computer screen until I get them to do what I want them to do surpasses the satisfactions of my former self.</span> </span></div><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;">Life is not easy. I still have to deal with symptoms. But I am at peace. Usually. Enough.</span></div></blockquote><div><span style="font-size: large;"><br /></span><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-sNhlP4cEgS8/TaePU2P4kzI/AAAAAAAAAvA/Cm_SZpCYROM/s1600/5b14d4a6e227cbdfe299dc8c7c5a4f0d5c0a973d.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://4.bp.blogspot.com/-sNhlP4cEgS8/TaePU2P4kzI/AAAAAAAAAvA/Cm_SZpCYROM/s1600/5b14d4a6e227cbdfe299dc8c7c5a4f0d5c0a973d.jpg" /></span></a></div><span style="font-size: large;"><span><b>Interpersonal Disputes -- </b><i>Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population.</i></span><br /><br /><span>Well. The <i>bipolar temperament</i> and <i>attitude of entitlement </i>will take a whole post to unravel. Later.</span><br /><br /><span>Irritability -- yes, we know that story. Irritability is not only a symptom, it is also a side effect of medication. How blessed is the patient whose doctor and/or therapist will explore the second possibility and not take it personally; for that bipolar II patient might get to a correct diagnosis sooner and suffer fewer years of antidepressant trials.</span><br /><br /><span>But one does need to save ones attitude of entitlement for the doctor's office. When we inflict our symptomology on family, friends, coworkers, bosses, we end up in interpersonal disputes. Therapy can teach reasonable expectations and alternate means of communicating distress. Again, the goal is to lower stress, preventing its increased autonomic arousal and potential for circadian disruption, loss of sleep or appetite, or even being kicked out the door. Nothing like getting fired or divorced to disrupt your rhythm and move you to your next interpersonal therapy issue:</span><br /><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-rQDs0D_Vmfs/TaeVvJG-_fI/AAAAAAAAAvE/OOsCpy2qsRo/s1600/upside+down+monkey.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://2.bp.blogspot.com/-rQDs0D_Vmfs/TaeVvJG-_fI/AAAAAAAAAvE/OOsCpy2qsRo/s1600/upside+down+monkey.jpg" /></span></a></div><span style="font-size: large;"><span><b>Role Transitions -- </b>Whether positive, negative or neutral, marriage, divorce, new parenthood, birth of child or kids leaving home, new job or retirement, new house, new town, change is difficult for people with bipolar. We just have a hard time with change, whether it hits our relationships, social rhythms or self image.</span><br /><br /><span>Which is a bite, because bipolar is all about change. The therapist's focus will be on management of symptoms, helping the client to plan transitions, possibly set limits on expectations that come with the new role or even rethink choices to decrease stress and overstimulation.</span><br /><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/--LiC6OmUiKs/TaoDDCOe-RI/AAAAAAAAAvI/eAOBv_7NHH4/s1600/empty+gas+gauge.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://1.bp.blogspot.com/--LiC6OmUiKs/TaoDDCOe-RI/AAAAAAAAAvI/eAOBv_7NHH4/s1600/empty+gas+gauge.jpg" /></span></a></div><span style="font-size: large;"><span><b>Interpersonal Deficits -- </b>Are you chronically dissatisfied, burned all your bridges or afraid that you have in previous manic episodes? Interpersonal deficits is one of those global issues, more difficult to tease out and to treat. Frank recommends that it get postponed until later in treatment, and has less to say about it. I suspect this issue includes the slush category for when therapy just gets stuck. Interventions include a more general approach to the conflict issue, addressing patterns of interpersonal conflict, building new interests and relationships to replace those that have been lost, and exploring whether broken relationships might indeed be reconciled.</span><br /><br /><span>Perpetual dissatisfaction does keep that autonomic arousal system aroused and prevents the stability/rhythms that good relationships offer. Social isolation might decrease stress. That would be why some of us do it. But again, it costs us the stability and the stress buffer that positive relationships offer.<b> </b></span><br /><br /></span><h3 style="text-align: left;"><span style="font-size: large;"><span><b>Why The Mash-Up</b></span></span></h3><span style="font-size: large;"><br /><span>So interpersonal issues cause stress. They have the potential to screw up your circadian rhythms. They mess with your mood. And they can interfere with the program.</span><br /><br /><span>The major reason for interpersonal therapy is to support the program, meds and schedule, and to intervene in whatever would mess with the program.</span><br /><br /></span><h3 style="text-align: left;"><span style="font-size: large;"><span><b>Living Healthy With A Chronic Disease</b></span></span></h3><span style="font-size: large;"><br /></span><a href="http://3.bp.blogspot.com/-ip_pC76oZ2M/TatiwZH7doI/AAAAAAAAAvQ/1FEgtDBaLFg/s1600/facebook+dislike.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://3.bp.blogspot.com/-ip_pC76oZ2M/TatiwZH7doI/AAAAAAAAAvQ/1FEgtDBaLFg/s1600/facebook+dislike.jpg" /></span></a><span style="font-size: large;"><span>I was concerned about a young friend whose </span><span>marital conflicts are reported with several Facebook updates every day. I just don't get people who conduct their fights with their spouses on Facebook. Anyway. The emotional whip-lash between <i>perfect </i>and <i>doom </i>got so extreme that one day I picked up the phone and told her I was worried for her. Actually, scared. I don't let suicidal language pass by. I reminded her of her previous diagnosis of bipolar. <i>Oh no, that was years ago. I haven't taken medication for a long time. It didn't help anyway.</i></span><br /><br />Sigh. The girl doesn't have health insurance. Where she lives, she doesn't have access to psychiatrists nor community mental health nor support groups. All she has is Facebook messages from friends who are not qualified to say what her diagnosis is. I am not qualified to say what her diagnosis is, nor how it should be treated. And my amateur armchair diagnosis goes to a different section of the DSM anyway.<br /><br />But if it's bipolar, it won't go away. That the meds stopped working has nothing to do with it. That's what meds do. They stop working. They never were able to <i>prevent</i> relapse, only postpone it.<br /><br />It is not helpful when doctors tell us that if we don't take our meds for the rest of our life, we will get sick again. They imply a promise that the meds won't keep. We probably <i>will </i>get sick again. The meds help. They do not cure. When we relapse, we quit taking them, because they didn't live up to the sales job.<br /><br /></span><a href="http://2.bp.blogspot.com/-3--lHM1W4qw/Tasl0VA2HPI/AAAAAAAAAvM/LRhFCTqokqU/s1600/dirty+dishes+mysid+pub+dom.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" height="150" src="https://2.bp.blogspot.com/-3--lHM1W4qw/Tasl0VA2HPI/AAAAAAAAAvM/LRhFCTqokqU/s200/dirty+dishes+mysid+pub+dom.jpg" width="200" /></span></a><span style="font-size: large;">If you have bipolar, you have to take care of it every day, or it will get the best of you. Every day for the rest of your life.<br /><br />Now if you do that, you can have a life. It may or may not be the life you planned on. But it can be a good life. And a hellava lot better than if you don't take care of it.<br /><br />Meds alone do not solve the problem. This is what Ellen Frank heard over and over on July 14, 1990, when she listened more than she talked at a conference for people with bipolar. And she decided to find something that would do better.<br /><br />Those who have been at this for a long time say that #1 is lifestyle. #2 is support. #3 is meds. IPSRT is about helping you learn a lifestyle that will maximize the success of treatment. And NIMH agrees. <span><a href="https://www.nimh.nih.gov/archive/news/2007/intensive-psychotherapy-more-effective-than-brief-therapy-for-treating-bipolar-depression" target="_blank">People who take meds do better if they also do IPSRT than if they do just meds alone.</a></span><br /><br /></span><h3 style="text-align: left;"><span style="font-size: large;"><span><b>Maintenance Treatment For Bipolar Disorder</b> </span></span></h3><span style="font-size: large;"><br /><span>The last part of IPSRT is sticking with it. </span><br /><br /><span>Once you've got a workable program, have a better handle on what would interfere with the program and know how to adapt to changing circumstances, appointments become less frequent, every two weeks, once a month, once a quarter, whenever something major comes up.</span><br /><br /></span><a href="http://1.bp.blogspot.com/-8eJa0TL8-QQ/TaxXEaedLhI/AAAAAAAAAvY/mY1u6LCoX54/s1600/magnifying+glass+get+a+clue.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://1.bp.blogspot.com/-8eJa0TL8-QQ/TaxXEaedLhI/AAAAAAAAAvY/mY1u6LCoX54/s1600/magnifying+glass+get+a+clue.jpg" /></span></a><span style="font-size: large;"><span>Things do come up. Not all of them are events. The fundamental dysfunction in manic depressive illness is instability. You go up, you come down. You do your best to create and maintain what stability you can. Then you monitor your moods, your energy level, your sleep, the volume of your voice, the rapidity of your thoughts, the number of projects you take on, looking for evidence that things are slipping.</span><br /><br /><span>The IPSRT therapist and client learn to recognize the warning signs of an impending episode, and then to respond. Interventions might include ratcheting up or down the level of stimulation one is experiencing. Maybe you need to get out of the house more. Maybe you need less time with your chronically hypomanic buddy. Maybe the book you are reading at night is too stimulating, and a different author will solve your sleep issue. Or maybe you could use a few nights of "rescue" medication for sleep to nip that incipient hypomania in the bud. Maybe your regular meds need adjusting.</span><br /><br /></span><div class="separator" style="clear: both; text-align: center;"></div><a href="http://4.bp.blogspot.com/-AE9DMQaV88E/TaxjjGVETYI/AAAAAAAAAvg/ub_TOsrgNrg/s1600/teeter+totter+peanuts.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" src="https://4.bp.blogspot.com/-AE9DMQaV88E/TaxjjGVETYI/AAAAAAAAAvg/ub_TOsrgNrg/s1600/teeter+totter+peanuts.jpg" /></span></a><span style="font-size: large;"><span><span>The earlier the intervention, the more successful. It's all about the right balance, knowing how far you can move off center and how to get back.</span><b><span> </span></b><br /><br /><b><span>Hope</span></b><span><b> For Living With Bipolar Disorder</b></span><br /><br /><span>If your meds don't work well enough or if they don't work at all, there are more tools in the tool box. I love this book.</span><br /><br /><span>Next week, I finish up with a little nitpicking and my overall recommendations regarding <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" target="_blank">Treating Bipolar Disorder</a></i>, by Ellen Frank.</span><br /></span><span><br /></span></span><br /><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo of book cover from amazon.com</i></span><br /><span style="font-size: xx-small;"><i>flair from facebook</i></span><br /><span style="font-size: xx-small;"><i>photo of jenga blocks by Jason7825, used under the <b><a class="extiw" href="http://en.wikipedia.org/wiki/en:GNU_Free_Documentation_License" title="w:en:GNU Free Documentation License">GNU Free Documentation License</a></b></i></span><br /><span style="font-size: xx-small;"><i>photo of roller coaster by WillMcC,<b> </b></i></span><span style="font-size: xx-small;"><i>used under the <b><a class="extiw" href="http://en.wikipedia.org/wiki/en:GNU_Free_Documentation_License" title="w:en:GNU Free Documentation License">GNU Free Documentation License</a></b></i></span><br /><i><span style="font-size: xx-small;">photo of dirty dishes by <a class="extiw" href="http://en.wikipedia.org/wiki/User:Mysid" title="w:User:Mysid">Mysid</a> and in the public domain</span></i></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-490795645116303902022-08-31T09:00:00.001-07:002022-08-31T09:00:39.409-07:00How the Social Zeitgeber Theory Works, for Good or Ill - IPSRT<p></p><p>This -- this system is the gift I wish I could give to the people I meet on Twitter who struggle with their bipolar, who are in endless rounds of medication adjustments and medication failures and medication despair. Medication isn't the only thing you can do. I'm not saying quit your meds. I'm saying, add social rhythms therapy. Originally posted in 2011:</p><h3 style="text-align: left;">Ellen Frank - Treating Bipolar Disorder, Part 2</h3><p></p><p><a href="http://1.bp.blogspot.com/-yELzmcV-Iu4/TZue8IuNoQI/AAAAAAAAAuU/3DlxmISbcJc/s1600/rage.jpg" style="clear: left; display: inline; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" src="https://1.bp.blogspot.com/-yELzmcV-Iu4/TZue8IuNoQI/AAAAAAAAAuU/3DlxmISbcJc/s1600/rage.jpg" /></a>So you have bipolar. You know you have bipolar. You are way past the denial stage. You are into the pulling out your hair, screaming with frustration stage. Or maybe moved on to despair stage. Because:</p><p><br /></p><p></p><ol style="text-align: left;"><li>The medication sucks.</li><li>You keep getting sick again anyway.</li></ol><p></p><div>But contrary to what everybody has been telling you, medication is <i>not </i>the only thing that works. It may be essential to your recovery and continued functioning. But you can do better if you do more. From my <a href="https://www.prozacmonologues.com/2022/08/do-your-meds-work-theres-more-you-can.html" target="_blank">last post</a>:<br /><br />IPSRT [Interpersonal Social Rhythms Therapy] is one of three psychotherapies tested by the National Institute on Mental Health in its recent major study of best practices for treatment of bipolar disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder, STEP-BD discovered that <a href="https://www.nimh.nih.gov/archive/news/2007/intensive-psychotherapy-more-effective-than-brief-therapy-for-treating-bipolar-depression" target="_blank"><i>Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy</i>.</a><br /><br />Do I have your attention? Today we continue with Ellen Frank's <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" target="_blank">Treating Bipolar Disorder</a>, </i>in which she describes this therapy of her invention.<br /><br /><h3 style="text-align: left;"><b>What Happens In IPSRT</b></h3><a name='more'></a><br />After diagnosis with bipolar I or II (primarily designed for bipolar I), IPSRT proceeds roughly in four stages:<br /><ul><li>history-taking with education about bipolar and orientation to the treatment</li><li>evaluating and then stabilizing social rhythms</li><li>addressing interpersonal problem areas appropriate to the individual</li><li>monitoring progress and termination</li></ul><h3 style="text-align: left;"><b><br /></b></h3><h3 style="text-align: left;"><b>An Integrative Theoretical Model: Social <i>Zeitgeber </i>Theory</b></h3><div><br /></div>Therapy generally begins with history-taking, going over the client's life story with focus on factors related to the therapist's theoretical orientation. The intake interview for IPSRT is guided by its own theory of how people with bipolar get off kilter.<br /><br /><b>Off Kilter. Like:</b><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-eeUr3cWEaQE/TZzhgiQTzLI/AAAAAAAAAuY/SA1SmsMr1yM/s1600/Train_wreck_at_Montparnasse_1895+pub+dom.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://1.bp.blogspot.com/-eeUr3cWEaQE/TZzhgiQTzLI/AAAAAAAAAuY/SA1SmsMr1yM/s320/Train_wreck_at_Montparnasse_1895+pub+dom.jpg" width="266" /></a></div><br /><br />Here is the flow chart for Social <i>Zeitgeber </i>Theory, with my comments in italics:<br /><br /><div style="text-align: center;"><i>Well, first you start with your life. Then, more life happens.</i><b></b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><b>Life Events Affecting Interpersonal Relationships</b></div><div style="text-align: center;"><b>and Social Roles</b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>Like, you get laid off from work.</i></div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" /></a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b>Change in Social Prompts (Social <i>Zeitgebers</i>)</b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>So you don't have anywhere to go in the morning.</i></div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" /></a></div><div style="text-align: center;"></div><div style="text-align: center;"><b>Change in Stability of Social Rhythms</b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>So, whatever. You party wherever, sleep whenever.</i></div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" /></a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>In these early stages, you may have a variety of mitigating factors, reducing the disruptive impact of whatever life event just started this slide. Frank lists social supports, coping, gender and temperament as potential protection.</i><b> </b><i>Maybe you have a dog who will insist on her 6 AM run, no matter what you have in mind.</i></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i> Good dog.</i><b><br /></b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b>Change in Stability of Biological Rhythms</b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>Lacking a dog to keep your social life sane and your out of bed hour regular, the hormones governing sleep don't know when to come online.</i></div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" /></a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b>Change in Somatic Symptoms</b></div><div style="text-align: center;"><b><br /></b></div><div style="text-align: center;"><i>Uh-oh. Here comes the insomnia again.</i></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>Again,<b> </b></i><i>Frank lists mitigating factors. You may have a genetic background that makes you more or less vulnerable to these disruptions. Or you may have previous treatment experience, so that you recognize when you are in trouble and change your ways before you go off the rails. If something doesn't turn this train around, then...</i></div><div><b><br /></b></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-OEjeIZPJtjI/TZuKp1hTfpI/AAAAAAAAAuQ/xbGpBLlMwU0/s1600/arrow+pointing+down.jpg" /></a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><b>Mania or Depression = Pathological Entrainment of Biological Rhythms</b></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><i>In other words, mania and depression happen when your lack of normal </i><i><b>becomes </b>your normal.</i></div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-eeUr3cWEaQE/TZzhgiQTzLI/AAAAAAAAAuY/SA1SmsMr1yM/s1600/Train_wreck_at_Montparnasse_1895+pub+dom.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://1.bp.blogspot.com/-eeUr3cWEaQE/TZzhgiQTzLI/AAAAAAAAAuY/SA1SmsMr1yM/s320/Train_wreck_at_Montparnasse_1895+pub+dom.jpg" width="266" /></a></div><div style="text-align: center;"><br /></div>Been here before, have we?<b></b><br /><br /><h3 style="text-align: left;"><b>IPSRT Theory Integrates Social, Psychological and Biological Explanations Of Mood Episodes</b></h3><div><br /></div>Notice, life events, emotional and behavioral responses to these events, and subsequent physical symptoms are all included in the development of a mood episode -- the whole person, not just the final so-called <i>chemical imbalance</i>. The target of medication is the bottom of the line. But any of these prior stages is also an appropriate point of intervention and prevention.<br /><br />This is really good news for people whose medication isn't up to doing the whole job.<br /><br /><b>History Taking</b><br /><br />Lots of case studies make the book readable and illustrate points along the way. Frank tells the stories of individuals who functioned well until a disruption in social patterns triggered a depression or a mania.<br /><br />An IPSRT therapist helps the client create a time line tracking the current and past episodes of depression, mania and hypomania with attention to what <i>preceded the onset</i>, or started the descent into the train wreck outlined above, particularly disruptions in social rhythms. This history-taking begins the educational process and makes the case for the behavioral changes the therapist will recommend.<br /><br />As I read, episodes from my own life came to mind. I used to be a legislator in a national church convention that happens every three years -- extremely stimulating events. I was <i>on </i>14-16 hours a day, 11-12 days in a row. I would be living in strange surroundings, eating restaurant food at irregular hours, on a work schedule invented by the devil. I always "rose" to the occasion, was energetic, productive, persuasive, effective, charming... hypomanic. Some of my readers can give an <i>Amen </i>to that statement. What they didn't know was that I went home from two weeks of brilliance to begin another several months of depression. The classic bipolar II cycle before it progressed to rapid cycling.<br /><br />This life review did indeed make the case for me. There is no IPSRT therapist in my area. So I moved on to stage two on my own.<br /><br /><b>Evaluating And Stabilizing Social Rhythms</b><br /><br />The challenge begins here. Having come to suspect that irregular habits contribute to mood disturbances, now we establish just how irregular the client's habits are.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-v1wg13F1jSI/TZzm_WMqCJI/AAAAAAAAAuc/0wAk7073CZM/s1600/Alice+drowning.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://1.bp.blogspot.com/-v1wg13F1jSI/TZzm_WMqCJI/AAAAAAAAAuc/0wAk7073CZM/s1600/Alice+drowning.jpg" /></a></div>Frank and colleagues developed a chart, the <i>Social Rhythm Metric</i> to track the times that seventeen different events occur each day, getting up, first contact with another person, time to work or school, meals, and so on. Seventeen. What time does each happen today. Every day. For three weeks. To start. If I know my friends with bipolar, we would bail right here.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-APll_tvavI4/TZznx8lY_5I/AAAAAAAAAug/OOvhmc_DlPM/s1600/math+formula.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://2.bp.blogspot.com/-APll_tvavI4/TZznx8lY_5I/AAAAAAAAAug/OOvhmc_DlPM/s1600/math+formula.jpg" /></a></div>Then there is a formula to determine the average time of occurrence for each activity, the deviation each day, and the total of all the deviations. It's more complicated than that. But I decided to pass on the flow chart. The client doesn't have to do the math; the therapist does. I imagine this is where the potential therapist bails.<br /><br />Never mind. They figured out which five activities give you the most bang for your buck. The book recommends the five item version for clients who are not well enough to do track all seventeen. I hope sometime since the book was published, Frank has changed her interpretation of the resistance to the longer instrument. Maybe it's not the clients who are too sick to do it. Maybe it's just an unwieldy instrument.<br /><br />So I started to track five items. The shorter instrument also asks how stimulating the activity was on a 0-4 scale. By the third day, I was in tears and had managed to record no more than two activities each day. Toward the end of the book, Frank acknowledges that people who have been sick a long time may have cognitive deficits and be able to handle only one or two items.<br /><br />That's me, cognitive deficits.<br /><br /><b>Choose A Place To Start</b><br /><br />Nevertheless, I moved on to a decision -- get up at more or less the same time every morning.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-e7iD7SG6sw0/TZ3ch394CqI/AAAAAAAAAuk/D9D3-KPtURU/s1600/clock+rainbow.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://4.bp.blogspot.com/-e7iD7SG6sw0/TZ3ch394CqI/AAAAAAAAAuk/D9D3-KPtURU/s1600/clock+rainbow.jpg" /></a></div>Of course, getting out of bed anchors other social rhythms, what time I greet my wife, what time I eat breakfast. At the other end, I have to structure my evening so that I sleep better and long enough to wake up at the appointed hour.<br /><br />There are other self care activities/rhythms anchored by getting out of bed. If I am out of bed before I drink my first cup of coffee, I do my stretches, I say my prayers -- habits that went by the wayside when my out of bed time was disrupted a couple years ago. <br /><br />There is significant meaning attached to doing these self care activities that are anchored by getting out of bed -- which affects my mood.<br /><br />Pretty soon I've got some positive movement in social, psychological and biological realms, my whole person. My normal baseline, from which I veer violently up and down, is mild depression. Lately, that seems to have lifted ever so slightly. We'll see.<br /><br />See, I didn't need to track five items.<br /><br /><i><b>That's Fine For You But My Life Isn't That Regular...</b></i><br /><br />I never said that IPSRT is easy. But it might help.<br /><br />In fact, it seems pretty difficult to me. And Frank acknowledges that. <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" target="_blank">Treating Bipolar Disorder</a></i> is written for clinicians. Her advice to clinicians is to expect resistance, to normalize resistance, and to review, whenever needed, the multiple motivations for the difficult changes that are required.<br /><ul><li>What did the time line indicate? Is there a connection between loss of social rhythms and onset of episodes? (If not, then this is not the therapy for you.) But if there is...</li><li style="text-align: left;">What has this illness cost you already? What will it cost you in the future if you cannot manage your symptoms better?</li><li>What <i>issues </i>(therapy-type issues) prevent you from making these changes?</li></ul><br />We continue with issues, the IP part of IPSRT, next.<br /><br /><div style="text-align: right;"><span style="font-size: xx-small;"><i>flair from facebook</i></span></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo of Train wreck at Montparnasse Station, 1895 in public domain</i></span></div></div><p></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-75852154224388222842022-08-24T05:27:00.000-07:002022-08-24T05:27:16.602-07:00Do Your Meds Work? There's More You Can Do to Treat Bipolar<h3 style="text-align: left;">Ellen Frank: Treating Bipolar Disorder - A Review</h3><p>Ellen Frank changed my life. When I was diagnosed on the bipolar spectrum, and hadn't found a medication regime that I could tolerate, her Interpersonal and Social Rhythms Therapy gave me a way to get a handle on my wildly fluctuating condition.</p><p>She and I corresponded in 2011, as I was writing a four-part review of her book and her therapy. I published with her assurance that I got it right.</p><p>I was over the moon when she agreed to endorse <i><a href="https://willagoodfellow.com/" target="_blank">Prozac Monologues: A Voice from the Edge</a>. </i>She wrote:</p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="background-color: white; border: 0px; box-sizing: border-box; color: #232222; font-family: Roboto; font-size: 18px; margin: 0px 0px 1em; outline: 0px; padding: 0px; text-align: left; vertical-align: baseline;">Brilliantly written, engaging from the first page, <i style="box-sizing: border-box;">Prozac Monologues</i> is a bit like a great evening at a first-rate comedy club…except that it is deadly serious. Goodfellow’s painful and all too common journey to finding the right treatment for her bipolar disorder points her to the ultimate realization that doing well with this illness requires the right medication, the right psychotherapy, and the specific lifestyle modifications that support wellness.</p><p style="background-color: white; border: 0px; box-sizing: border-box; color: #232222; font-family: Roboto; font-size: 18px; margin: 0px 0px 1em; outline: 0px; padding: 0px; text-align: left; vertical-align: baseline;">Ellen Frank, Ph.D.Distinguished Professor Emeritus of Psychiatry,<span style="background-color: transparent;"> </span></p></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="background-color: white; border: 0px; box-sizing: border-box; color: #232222; font-family: Roboto; font-size: 18px; margin: 0px 0px 1em; outline: 0px; padding: 0px; text-align: left; vertical-align: baseline;">University of Pittsburg School of Medicine</p></blockquote><p>Pretty cool, huh! She even wrote privately to her listserv to recommend it.</p><p>So many people I read on Twitter struggle to manage their bipolar disorder. I figure it's time to bring this four part series out again. So here is Part 1 - from April 4, 2011.</p><h3 style="text-align: left;"><b>Medication And Mental Illness</b></h3><br />Medication for mental illness is just like medication for anything else. It works better when you don't ask it to do all the work itself.<br /><br /><a href="http://1.bp.blogspot.com/-9XYQtm1Ih8o/TZNiJXPwpoI/AAAAAAAAAts/3CjYHHNCr1I/s1600/weightlifter+Bundesarchiv+german+federation+archive.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://1.bp.blogspot.com/-9XYQtm1Ih8o/TZNiJXPwpoI/AAAAAAAAAts/3CjYHHNCr1I/s200/weightlifter+Bundesarchiv+german+federation+archive.jpg" width="200" /></a>In the case of bipolar, once lithium and the chemical imbalance theory came along, the thinking was that medication was the only thing that worked. Therapy by itself certainly didn't. I wonder if therapists, worn out by their bipolar patients, were simply relieved to believe that medication was the only thing that worked. I wonder if therapists today, worn out by their recurrent depression patients, are secretly relieved to terminate when the diagnosis changes to bipolar, because <i>medication is the only thing that works</i>.<br /><br />Frankly, there is a lot of wishful thinking out there in pharmacotherapy land. If only our brains were a chemical stew and the illnesses of the brain could be treated by adjusting the recipe. If only.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-r7c7viZAL-8/TZSnM0NvTtI/AAAAAAAAAtw/Gm6hp1bdHUI/s1600/chemistry+better+living.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://4.bp.blogspot.com/-r7c7viZAL-8/TZSnM0NvTtI/AAAAAAAAAtw/Gm6hp1bdHUI/s1600/chemistry+better+living.jpg" /></a></div>But people with mental illness, especially people with bipolar, can't afford the wishful thinking behind the <i>better living through chemistry</i> fantasy. Sometimes the medications do work. But not as well nor as often as your doctor would like to think.<br /><br />I have a friend who is a psychiatrist. He challenges his colleagues who keep trying to solve this <a href="http://prozacmonologues.blogspot.com/2010/09/omgthatswhattheysaid-noncompliance.html">noncompliance</a> issue, to get their patients to <i>comply</i>. He reminds them, if the medication (antidepressants, in this example) worked for 40% of those who took it in the trial, and the placebo worked for 30%, that means only one out of ten people benefit from the medication itself. So what's the big deal about nine who quit?<br /><br />He says they just look at him funny.<br /><br /><h3 style="text-align: left;"><b><i>Treating Bipolar Disorder</i> by Ellen Frank</b></h3><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://4.bp.blogspot.com/-lbNGYNJkWbU/TZJdvHHSLWI/AAAAAAAAAto/OXjT9GQu2RE/s200/treating+bipolar+disorder.jpg" width="200" /></a></div>This same friend, God bless him, loaned me a book about a psychotherapy designed specifically for bipolar disorder titled, appropriately enough, <i><a href="https://www.amazon.com/Treating-Bipolar-Disorder-Individualized-Evidence-Based/dp/159385465X/ref=sr_1_1?ie=UTF8&s=books&qid=1301437803&sr=8-1" target="_blank">Treating Bipolar Disorder</a></i>. The author Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic, and her colleagues invented Interpersonal Social Rhythms Therapy (IPSRT), a kind of mash-up between talk therapy and regulating circadian rhythms. It gets my next few posts.<br /><br /><h3 style="text-align: left;"><b>In A Nutshell...</b><i> </i></h3><br /><i>IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.</i><br /><a name='more'></a><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-VrTvXN2QhQk/TZdo9sY9e6I/AAAAAAAAAuA/n7f1OhM0G8o/s1600/clock+rainbow.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://1.bp.blogspot.com/-VrTvXN2QhQk/TZdo9sY9e6I/AAAAAAAAAuA/n7f1OhM0G8o/s1600/clock+rainbow.jpg" /></a></div>In other words, the therapy focuses first on getting your daily activities on a regular schedule. That will support your body's internal schedule and reduce the manias, hypomanias and depressions of bipolar. Then the therapy turns to the classic issues of talk therapy, particularly those that interfere with a regular schedule, like grief and conflict. The long term goal is to anticipate and manage whatever would throw your routine off track, so that new episodes are not triggered, or are identified and interrupted quickly.<br /><br />IPSRT was designed for bipolar I, but can also be used for bipolar II. For the latter, the therapist is not so concerned to get you to take your meds. Which is good, because while there are always people for whom an ineffective med is effective, mostly the meds for bipolar II depend on the placebo effect. Now that the placebo effect has worn off for me, I am delighted to learn the following:<br /><br /><h3 style="text-align: left;"><b>Medication Is <i>Not </i>The Only Thing That Works -- STEP-BD</b></h3><br />IPSRT is one of three psychotherapies tested by the National Institute on Mental Health in its recent major study of best practices for treatment of bipolar disorder. The <a href="https://www.nimh.nih.gov/archive/news/2007/intensive-psychotherapy-more-effective-than-brief-therapy-for-treating-bipolar-depression" target="_blank">Systematic Treatment Enhancement Program for Bipolar Disorder</a>, STEP-BD discovered that <i>Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy</i>.<br /><br />The other psychotherapies studied were family focused therapy and cognitive behavioral therapy. None showed an advantage over the others. Each was better than medication alone.<br /><br /><h3 style="text-align: left;"><b>Circadian Rhythms -- Your Interior Clock</b></h3><br />IPSRT is unique in its attention to circadian rhythms, the biochemical, physiological and behavioral processes that are driven by the twenty-four hour cycle of the day. There are lots of these rhythms. If your schedule is relatively regular, your body prompts you to wake up, feel hungry, have peaks and lows of energy and get sleepy at about the same time of day every day.<br /><br /><a href="http://4.bp.blogspot.com/-Y4G9VqoNfcE/TZX0KsYA3iI/AAAAAAAAAt8/jOOIpL1iZ3Q/s1600/clockworks+hnh+creative+commons.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://4.bp.blogspot.com/-Y4G9VqoNfcE/TZX0KsYA3iI/AAAAAAAAAt8/jOOIpL1iZ3Q/s200/clockworks+hnh+creative+commons.jpg" width="193" /></a>These are not simply habits. Your body signals each of these by releasing hormones like cortisol and neurotransmitters like melatonin on a cycle. Your body temperature rises and falls on a cycle. Your digestive juices flow on a cycle. Your kidneys even empty into your bladder on a cycle.<br /><br />These cycles are called a <i>circadian rhythms. </i>They are interrelated and are regulated by an interior clock.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-igAWoRz_Ucc/TZSyzUOv3KI/AAAAAAAAAt0/mak6l5sqZTs/s1600/alarm+clock.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://3.bp.blogspot.com/-igAWoRz_Ucc/TZSyzUOv3KI/AAAAAAAAAt0/mak6l5sqZTs/s1600/alarm+clock.jpg" /></a></div>Circadian rhythms are why people get so grumpy by the time change every year, all that <i>springing forward </i>and <i>falling backward</i>, why changing work shifts interferes with sleep, and why travel across time zones causes jet lag. Our clocks don't like to be messed with.<br /><br />Some people don't mind the time change. They fall asleep whenever anybody tells them to go to bed. The day after a transcontinental flight, they are as perky as ever. They can reset their interior clocks on demand. These people do not have bipolar disorder.<br /><br />The clocks of those who <i>do</i> have bipolar disorder are less flexible. And those who do not expect their medication to do all the work, who work on recovery, pay attention to their cycles, learn from each other -- these people know this. We respect our circadian rhythms, because when you mess with <i>our </i>clocks, they mess with us.<br /><br /><h3 style="text-align: left;"><b>Insomnia And Mood Disturbance: Chicken And Egg</b></h3><br />When I told my former psychiatrist that the antidepressant-induced insomnia was making my depression worse, she countered that insomnia is a <i>symptom</i> of depression, and would go away as the antidepressant took effect. That was the end of the discussion. But there has been considerable research on circadian disregulation and mood disorders, some of it supporting my side of this chicken and egg argument.<br /><br />Prozac Monologues has made recent forays into the possibility of <a href="http://prozacmonologues.blogspot.com/2011/02/sleep-real-antidepressant.html">treating depression by treating sleep disorders</a> directly, sleep cycles being a foundational circadian rhythm.<i> Treating Bipolar Disorder</i> reviews the basic research behind the miscellaneous studies I mentioned, endearing the book to my heart. It made me feel very smart.<br /><br />But seriously, when you are the lab rat in the chemistry experiment, trying to find the medication that works, it is first frustrating and eventually flat out scary when the doctor rejects the reported results of the experiment because it conflicts with her theory.<br /><br />So how extraordinary to find a treatment that was developed when a doctor <i>listened!</i><br /><br /><h3 style="text-align: left;"><b>The IPSRT Story</b></h3><br /><i>Treating Bipolar Disorder</i> begins with a story, how Dr. Frank invented IPSRT in one flash at the end of a fly in/fly out day at a convention for the National Depressive and Manic-Depressive Association (now called the <a href="https://www.dbsalliance.org/" target="_blank">Depression and Bipolar Support Alliance, DBSA</a>). It was for her an unusual exposure to people who actually live with bipolar. Contrary to her understanding that <i>bipolar disorder was a problem solved,</i> she heard the real stories of people living with stigma, underemployment and doctors who discouraged them from participating in activities that meant something to them. She discovered the planners of the convention had anticipated that people would have problems from overstimulation, and had prepared for it with an emergency hospitalization protocol. She found people hungry for more attention to and information about the psychosocial dimensions of the illness.<br /><br /><a href="http://4.bp.blogspot.com/-TpB711bFg28/TZT0EEcQZRI/AAAAAAAAAt4/L3IQXNWar4k/s1600/lightbulb%252C+yellow.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://4.bp.blogspot.com/-TpB711bFg28/TZT0EEcQZRI/AAAAAAAAAt4/L3IQXNWar4k/s1600/lightbulb%252C+yellow.jpg" /></a><i>As the door to the limousine closed... I knew with absolute certainty that I needed to dedicate the next decade of my life to doing better by these patients and their family members. No sooner were the words formed in my head than I knew exactly what to do: Combine IPT [interpersonal therapy] with a social rhythm regulation treatment.</i><br /><br />As Dr. Frank describes it, <i>My colleagues and I had argued in papers... that the major mood disorders (major depression and bipolar disorder) reflected, among other things, a disruption in circadian rhythms, a disturbance in the body's clock.</i><br /><br /><h3 style="text-align: left;"><i><b>Zeitgebers/</b></i><b>Timekeepers</b></h3><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-ONKaYHsC-tw/TZdpAtZFPoI/AAAAAAAAAuE/e2_BhUl_FVc/s1600/clock+mickey+mouse.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://1.bp.blogspot.com/-ONKaYHsC-tw/TZdpAtZFPoI/AAAAAAAAAuE/e2_BhUl_FVc/s1600/clock+mickey+mouse.jpg" /></a></div><i>Think about how many of the symptoms of these two disorders are functions that have a regular 24-hour rhythm: sleep (and waking), hunger, energy, ability to concentrate, even mood itself. Furthermore, we said that external social factors, like the time we need to be at work, the time the family normally has dinner, the time a favorite TV show ends, help to set the body's clock. When social factors function in this way, they become social zeitgebers.</i><br /><br /><h3 style="text-align: left;"><b><i>Zeitstorers/</i>Time Disturbers</b></h3><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-wiaiSGfmLG4/TZdpZaUj8AI/AAAAAAAAAuI/YZdhB7tbGrU/s1600/clock+melting.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://2.bp.blogspot.com/-wiaiSGfmLG4/TZdpZaUj8AI/AAAAAAAAAuI/YZdhB7tbGrU/s1600/clock+melting.jpg" /></a></div><i>We had also argued that changes or interferences in social routines, which we termed zeitstorers (or time disturbers), could disrupt the body's clock and destroy the body's naturally synchronized rhythms. We concluded that, in those who were vulnerable to mood disorders, it was the loss of social zeitgebers or the appearance of zeitstorers that led to new illness episodes (depression or mania).</i><br /><br /><h3 style="text-align: left;"><b>IPSRT Is Born</b></h3><br /><i>During that flash in the limo, </i><i>I knew that it would be relatively easy to borrow some of the scheduling and monitoring techniques of cognitive therapy and refashion them for the purpose of helping patients to establish and maintain regular social rhythms. I also realized that such efforts would fit very naturally with at least three of the four interpersonal problem areas that form the foundation of the interpersonal work in IPT for unipolar depression...</i><br /><br />Next week: what happens in IPSRT.<div><br /><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo of weightlifter in public domain from the Bundesarchiv</i></span></div><div style="text-align: right;"><i><span style="font-size: xx-small;">flair from facebook</span></i></div><div style="text-align: right;"><i><span style="font-size: xx-small;">book cover from Amazon.com</span></i></div><div style="text-align: right;"><span style="font-size: xx-small;"><i>photo of clockworks by <a href="http://commons.wikimedia.org/wiki/User:HNH" title="User:HNH">HNH</a> and used under the <a class="extiw" href="http://en.wikipedia.org/wiki/en:Creative_Commons" title="w:en:Creative Commons">Creative Commons</a><a class="external text" href="http://creativecommons.org/licenses/by-sa/3.0/deed.en" rel="nofollow">Attribution-Share Alike 3.0 Unported</a> license</i></span></div></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-11662686238121949482022-07-13T08:16:00.006-07:002023-02-27T10:28:28.020-08:00Questions Work Magic: How They Change the Brain<p>Quick - What does a lemon taste like?</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaacRPtva5L0N6bEsXoNk6CyuptgMqD_Aw2eaHGW-HtgMCo9FjxEs-zpdXMwYulfeU3zlzej8ktpROxXeztNIi9nB3fGvcB8rtArobw_1d60TlOTrQx0-XpmD_ns2MsIrgpr-KlH06ZzPvDPPQm00othgJw4_J4sfAH6aqMdORrwArICrrorDJxdZrIw/s1599/Lemon%20Ivar%20Leidus%20creative%20commons.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1066" data-original-width="1599" height="269" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaacRPtva5L0N6bEsXoNk6CyuptgMqD_Aw2eaHGW-HtgMCo9FjxEs-zpdXMwYulfeU3zlzej8ktpROxXeztNIi9nB3fGvcB8rtArobw_1d60TlOTrQx0-XpmD_ns2MsIrgpr-KlH06ZzPvDPPQm00othgJw4_J4sfAH6aqMdORrwArICrrorDJxdZrIw/w404-h269/Lemon%20Ivar%20Leidus%20creative%20commons.jpeg" width="404" /></a></div><p>I know what a lemon tastes like. Tell me something else instead:</p><p>What just happened inside your mouth?</p><p>David Hoffeld asks another one: <i><a href="https://www.fastcompany.com/3068341/want-to-know-what-your-brain-does-when-it-hears-a-question?fbclid=IwAR12kTDPyCjifnYqycqOg70mqzsI1L9USEJp3nE2cOxCavocxTGfC919Bis" target="_blank">Want to know what your brain does when it hears a question?</a></i></p><p>His article from the website <a href="http://FastCompany.com">FastCompany.com</a> explores the neurological consequences of hearing a question. Questions temporarily hijack the brain. Did you immediately think about lemons? First, serotonin is released, causing the brain to relax. Next you get a hit of dopamine. The question takes over your thought processes while you think about the answer. The technical term is <i>instinctive elaboration.</i></p><p>The hijacking doesn't last forever. The person who was asked the question can choose to ignore it, can argue against it, can go off on a tangent - though for people with ADHD or bipolar disorder, a question that interrupts our train of thought may cause us to derail.</p><p>But Hoffeld cites a number of research studies that document when you ask somebody whether they are going to do something, you increase the probability that they will do it - <a href="https://www.jstor.org/stable/2489199?seq=1#page_scan_tab_contents" target="_blank">buy</a> a car, <a href="https://www.researchgate.net/publication/232579629_Increasing_Voting_Behavior_by_Asking_People_If_They_Expect_to_Vote" target="_blank">vote</a> in an upcoming election, even <a href="https://pubmed.ncbi.nlm.nih.gov/18377136/" target="_blank">donate</a> blood.</p><p>Questions not only alter your perception. They can even alter your chemistry. Chances are, when you read the lemon question, you started to salivate.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkgvUZRWuYQuLauMaHy17SPxGqmizv4oVjesYZmRSQ1qMUDlJpj0gEpitTgTNHDuISE0G_MXw23Hkpdy0wKb5STDoEc63SiOFJm1E1xLB2U6Vc9BpCdgeuys2emhOdRvGHMlTECgh8UlZP2htj5PGsyRGFIsPUfgLDpTZqW6nwiJ5OZ7K9VqK6TrtoQA/s500/Hoffeld%20The%20Science%20of%20Selling.jpeg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="333" height="159" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkgvUZRWuYQuLauMaHy17SPxGqmizv4oVjesYZmRSQ1qMUDlJpj0gEpitTgTNHDuISE0G_MXw23Hkpdy0wKb5STDoEc63SiOFJm1E1xLB2U6Vc9BpCdgeuys2emhOdRvGHMlTECgh8UlZP2htj5PGsyRGFIsPUfgLDpTZqW6nwiJ5OZ7K9VqK6TrtoQA/w106-h159/Hoffeld%20The%20Science%20of%20Selling.jpeg" width="106" /></a></div><span><a name='more'></a></span>Hoffeld is a business guy. He has a book, <i><a href="https://www.amazon.com/Science-Selling-Strategies-Influence-Decisions-ebook/dp/B01CDVCBIC/ref=sr_1_1?crid=2BAAJTPNUW7CZ&keywords=the+science+of+selling+by+david+hoffeld&qid=1657662914&sprefix=the+science+of+selling%2Caps%2C486&sr=8-1" target="_blank">The Science of Selling</a>.</i> It uses neuroscience, social psychology, and behavioral economics to teach a more <i>scientific</i> approach to sales. That's his interest in instinctive elaboration, getting people to buy things or ideas.<p></p><p>Me, my interest in instinctive elaboration is more about mental health:</p><p></p><ul style="text-align: left;"><li>What are the questions I might ask that tell you I care and seek to understand?</li><li>What are the questions that shut you down?</li><li>What are the questions that help you sort through your thoughts and feelings?</li><li>What are the questions that could interrupt an anxious spiral?</li><li>Would the game of <i>Trivial Pursuits</i> help my family dance around the emotional landmines of somebody's upcoming surgery?</li></ul><p></p><p>Questions work their magic by engaging the brain. A recent <a href="https://twitter.com/MichaelFulwiler/status/1546202923528585216" target="_blank">Twitter thread</a> asks, <i>Therapists, what's your favorite question to ask clients?</i></p><p>That's my favorite part of therapy, my therapist's opening gambit. It brings me into the room and puts me to work. It takes the muddle of my brain and begins the sorting process.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHY5q7Od0YQT6osYlKVRHf6Px99Ct7WrT1UIiVtTIhgrsMLKZCUCeVogoFazb5PzQf_6bGveqbi7fpPo0SWIE5e49HaLPj3wrIs-kBfuuWAoraYCUj1cRq9Pnh58ddFJM8ilgDNicY481hQZLifRVhgqZNxQhuKyHjRtoFG6-I2k6KaaLVe6NAFLac6A/s664/therapy%20and%20yarn.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="664" data-original-width="640" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHY5q7Od0YQT6osYlKVRHf6Px99Ct7WrT1UIiVtTIhgrsMLKZCUCeVogoFazb5PzQf_6bGveqbi7fpPo0SWIE5e49HaLPj3wrIs-kBfuuWAoraYCUj1cRq9Pnh58ddFJM8ilgDNicY481hQZLifRVhgqZNxQhuKyHjRtoFG6-I2k6KaaLVe6NAFLac6A/s320/therapy%20and%20yarn.jpeg" width="308" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">I am thinking of other applications, too. What questions could help with emotional regulation? Building trust? Priority setting and problem solving?</div><p>So, what's your favorite question?</p><p style="text-align: right;"><i><span style="font-size: xx-small;">photo of lemon by Ivar Leidus, used under creative commons license</span></i></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-53449307084276284922022-07-06T12:12:00.000-07:002022-07-06T12:12:38.892-07:00Why Writing Bar Tales of Costa Rica is Good for my Mental Health<h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>Mindfulness</i></span></h3><div><span style="font-family: verdana; font-size: large;"><i><br /></i></span></div><div><span style="font-size: large;"><span style="font-family: verdana;"><a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356" target="_blank">Mayo Clinic describes mindfulness</a> as <i>a type of meditation in which you focus on being intensely aware of what you are sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress</i></span><span style="font-family: verdana;">.</span></span></div><p><span style="font-size: large;"><span style="font-family: verdana;">For some of us,</span><span style="font-family: verdana;"> these meditation exercises, "close your eyes, focus on your breath..." are difficult, frustrating, and stress </span><i style="font-family: verdana;">inducing.</i><span style="font-family: verdana;"> Particularly for people with a trauma history or ADHD, </span><i style="font-family: verdana;">mindfulness</i><span style="font-family: verdana;"> can be a land mine.</span></span></p><p><span style="font-family: verdana; font-size: large;">For others, the whole enterprise sounds like woo-woo mental health. Add some essential oils and affirmations - who needs therapy or, God forbid, medication?</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">But there's more to mindfulness than nonsense.</span></span></p><p><span style="font-size: large;"><span style="font-family: verdana;">The same Mayo Clinic article identifies several mindfulness practices. Three could be taken as basic concepts:</span></span></p><p></p><ul style="text-align: left;"><li><span style="font-size: large;"><span style="font-family: verdana;">Pay attention</span></span></li><li><span style="font-size: large;"><span style="font-family: verdana;">Live in the moment</span></span></li><li><span style="font-family: verdana; font-size: large;">Accept yourself</span></li></ul><p></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><span style="font-weight: 400;">How does that work out <i>irl - </i>in real life?</span></span></h3><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><span style="font-weight: 400;">Let me tell you about my recent five week stay in Costa Rica. First, the back story:</span></span></h3><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i><br /></i></span></h3><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>Prozac Monologues</i></span></h3><p><span style="font-size: large;"><span style="font-family: verdana;">My first book, <i>Prozac Monologues,</i> began with a hypomanic episode during an earlier trip to Costa Rica. I wrote a series of comedic monologues in an effort to <i>not</i> be mindful. The monologues danced around the memory of a recent Prozac-induced traumatic experience. It began with a bizarre thought, and moved on to </span><span style="font-family: verdana;">some other weird stuff</span><span style="font-family: verdana;">: dissociation, thought broadcasting, paranoia, and the like. </span></span></p><p><span style="font-size: large;"><span><span style="font-family: verdana;">Years later, </span></span><span style="font-family: verdana;">once I was correctly diagnosed with bipolar disorder, </span><span style="font-family: verdana;">I added edgy essays about that experience and everything I learned about bipolar disorder while trying to figure out what the hell happened to my brain. Like many memoirs, </span><i style="font-family: verdana;">Prozac Monologues</i><span style="font-family: verdana;"> is a hybrid of my story and my issue. Sheila Hamilton's podcast, <i>Beyond Well, </i>captures it. Here's the <a href="https://podcasts.google.com/feed/aHR0cDovL2ZlZWRzLmxpYnN5bi5jb20vMTY3ODg4L3Jzcw/episode/NWYxZDcyZmUtY2U2OS00NWU2LTk4MDAtM2ZiMjFmOGNjOTUy?sa=X&ved=2ahUKEwjZup7s3bLsAhWNmZ4KHR35CuIQkfYCegQIARAJ&hl=en" target="_blank">link</a>. </span><span style="font-family: verdana;">It's also a great read and now available on audio.</span></span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>Bar Tales of Costa Rica</i></span></h3><p><span style="font-family: verdana; font-size: large;">So what about <i>Bar Tales of Costa Rica?</i> My second book is exactly what the title promises: the stories I heard while sitting in bars in Costa Rica. That sounds like a very different book. Am I a genre hopper?</span></p><p><span style="font-family: verdana; font-size: large;">Yes and no.</span></p><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="285" src="https://giphy.com/embed/4GXGz9bwX1qYgq1thZ" width="285"></iframe></div><p><a href="https://giphy.com/gifs/youngertv-tv-land-tvland-4GXGz9bwX1qYgq1thZ">via GIPHY</a></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><i style="font-family: verdana; font-size: x-large; text-align: left;"><br /></i></div><div class="separator" style="clear: both; text-align: left;"><i style="font-family: verdana; text-align: left;"><span style="font-size: large;">Bar Tales </span></i><span style="font-family: verdana; font-size: large; text-align: left;">is about a milieu, a place and the people in it. It is not about mental illness. There are passing references to my own. But that's not the point. No references to research. No descriptions of recovery strategies. Stories heard in bars - it's a very different book.</span></div></div><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;"><span>Still, it is a sequel<i>.</i> It picks up where the monologues left off. In the first book, my wife Helen and I thought about moving to Costa Rica. S</span></span><span style="font-family: verdana;">everal months later, w</span><span style="font-family: verdana;">e did buy a little house in Playas del Coco. Didn't quite move there, but we spend several weeks there every year.</span></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDpPNOVjt7NaWCbTJ_jQ32VX264NH-4bSLAindflZgqWPOhXEUXn94_wiIlzk-kIdnch9ouhh1dmfeNhjgbGd_v7lojGrcuKlph741Qh4lvU6W08tL_QoGTlrUfu6gyX3tQQOTBsOY4jpSeJ-L-qqkmIE7YLi4A_aD4xnTVNSkhlfM8xqwFnb2hiz8NA/s2592/casita.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="1936" data-original-width="2592" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDpPNOVjt7NaWCbTJ_jQ32VX264NH-4bSLAindflZgqWPOhXEUXn94_wiIlzk-kIdnch9ouhh1dmfeNhjgbGd_v7lojGrcuKlph741Qh4lvU6W08tL_QoGTlrUfu6gyX3tQQOTBsOY4jpSeJ-L-qqkmIE7YLi4A_aD4xnTVNSkhlfM8xqwFnb2hiz8NA/w382-h285/casita.jpeg" width="382" /></span></a></div><span style="font-size: large;"><br /><span style="font-family: verdana;">That's where I continued to work on <i>Prozac Monologues.</i> It's also where I gathered my bar tales, most of them at my sister's hotel and restaurant, the <i>Pato Loco,</i> which means "crazy duck." Other sites included El Bohío (referenced in the first book), Pacifico Beach Club, Coco Palms, and Soda Navidad.</span></span><p><span style="font-family: verdana; font-size: large;">You could call the second book a segue to the first. I turn a corner. That would be a right turn that leads me out of my neighborhood <i>Los Canales, </i>on to the Boulevard de Iguanas, and over to a whole new cast of characters: Patricia, Bruce, Andy, Sydney, Monique and André. <i>Bar Tales </i>is about their stories.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGOsGrAQ09fvVesfqRTsEJC58ILEqqmDBg427UrgIWZurpMm3VBFST_xfHN5as2nf4l4o-KJZWDjGuLJcxM3Ia1BVhoKUkpIIu1XHGa46r-WhIHaNf3qTZeRLSTmH6LUs_Tvb9wq55-ve_mpGWON5v_anY128YKoCs61WwYEVeMQO3gzz2ycSHkOYefw/s2592/Patricia%20at%20the%20Pato%20Loco.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1936" data-original-width="2592" height="274" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGOsGrAQ09fvVesfqRTsEJC58ILEqqmDBg427UrgIWZurpMm3VBFST_xfHN5as2nf4l4o-KJZWDjGuLJcxM3Ia1BVhoKUkpIIu1XHGa46r-WhIHaNf3qTZeRLSTmH6LUs_Tvb9wq55-ve_mpGWON5v_anY128YKoCs61WwYEVeMQO3gzz2ycSHkOYefw/w367-h274/Patricia%20at%20the%20Pato%20Loco.jpeg" width="367" /></a></div><br /><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: right;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGUHxSOpSDc5b0yJ2OiReVUvXmYgcNKy957L6FmMhGB2VLOEeuG4wK411rtrKo0OuC1w0NSEoedWH5vETu9QKZ3FRDVjuAgfXC6Oekxu3C6snzml9uqAyDA5ckIKqXytXfdnrHIePP2ERlIY5WKfaDlGr-wt32hb7Rob6dlypDeq1j7dG_QA6vpBp97g/s2592/Mary%20and%20Sydney.jpeg" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2592" data-original-width="1936" height="287" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGUHxSOpSDc5b0yJ2OiReVUvXmYgcNKy957L6FmMhGB2VLOEeuG4wK411rtrKo0OuC1w0NSEoedWH5vETu9QKZ3FRDVjuAgfXC6Oekxu3C6snzml9uqAyDA5ckIKqXytXfdnrHIePP2ERlIY5WKfaDlGr-wt32hb7Rob6dlypDeq1j7dG_QA6vpBp97g/w215-h287/Mary%20and%20Sydney.jpeg" width="215" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheGAFKg3bMf_M8KyJzTy35iklVTPDNhDUqdu3LvD5tXKL3CODbQLzxjSnwicsQf8R0G-RHrIigxpCOAi0tfxgp2c6JnDeTngp9d-CZaWQkRF8J5eFlbaWnunT6riOy6t0cz8Hez-VK-7s7ngU2xLb_beT7rQQkn6OX-0US-Z-k1Ha2vw4fnoxYRk7p_A/s2592/Andre%CC%81%20Miller.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2592" data-original-width="1936" height="287" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheGAFKg3bMf_M8KyJzTy35iklVTPDNhDUqdu3LvD5tXKL3CODbQLzxjSnwicsQf8R0G-RHrIigxpCOAi0tfxgp2c6JnDeTngp9d-CZaWQkRF8J5eFlbaWnunT6riOy6t0cz8Hez-VK-7s7ngU2xLb_beT7rQQkn6OX-0US-Z-k1Ha2vw4fnoxYRk7p_A/w210-h281/Andre%CC%81%20Miller.jpeg" width="210" /></a></div><br /></div><span style="font-size: large;"><span style="font-family: verdana;">So why is this book good for my </span><span style="font-family: verdana;">mental health</span><span style="font-family: verdana;">?</span></span><div><p><span style="font-family: verdana; font-size: large;">As I am polishing these tales for publication in the spring of 2024, I spent several weeks in Coco for research. <i>Research</i>.</span></p><p><span style="font-family: verdana; font-size: large;">I wasn't sitting in bars, gathering tales - though inevitably a couple got added to the collection. This time I was gathering sensations. Physical sensations.</span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Trauma and Sensations</span></h3><p><span style="font-family: verdana; font-size: large;">Sensations - these are at the heart of my mindfulness technique.</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">The person who has experienced trauma sometimes gets stuck in the past, reliving a loop of troublesome sensations. And let me tell you - being suicidal, as I was, is traumatic.</span></li><li><span style="font-family: verdana; font-size: large;">Or, in the face of current strife and stress, that person might dissociate - disconnect from present anxiety by going numb.</span></li><li><span style="font-family: verdana; font-size: large;">Or, based on deeply rooted thought patterns about bad things that happened in the <i>past</i>, the person faces the <i>future</i> with dread, anticipating - and pre-experiencing - a repeat of negative experiences.</span></li></ul><p></p><p><span style="font-family: verdana; font-size: large;">Each of these are ways that we lose or escape the <i>here and now.</i> I think of <i>here and now</i> as my worst subject.</span></p><p><span style="font-size: large;"><span style="font-family: verdana;">The thing is - </span><i style="font-family: verdana;">here and now </i><span style="font-family: verdana;">is where joy lives.</span></span></p><p><span style="font-family: verdana; font-size: large;">Let me repeat that.</span></p><p><b><span style="font-size: large;"><span style="font-family: verdana;"><i>H</i></span><i style="font-family: verdana;">ere and now</i><i style="font-family: verdana;"> </i><span style="font-family: verdana;">is where joy lives.</span></span></b></p><p><span style="font-family: verdana; font-size: large;">So my research, gathering sensations, experiences in the present, kept me anchored in <i>here and now.</i></span></p><p><span style="font-family: verdana; font-size: large;"><i>And it filled me with joy.</i></span></p><p><span style="font-size: large;"><span style="font-family: verdana;">What color are the rooster's feathers? - bronze head and breast, black legs, </span><span style="font-family: verdana;">wings of </span><span style="font-family: verdana;">teal and red.</span></span></p><p><span style="font-family: verdana; font-size: large;">What sound do the geckos make? - <i>chk, chk, chk</i>. How about the howler monkey? muffler dragging on concrete!</span></p><p><span style="font-family: verdana; font-size: large;">What do mangoes smell like when they are sitting in the field near my house in the hot sun? - like a fortified sweet wine.</span></p><p><span style="font-family: verdana; font-size: large;">What does <i>carne en salsa</i> taste like? Beef stewed in a rich vegetable sauce with hints of smoke when Juan cooks it all day in an iron pot over a wood fire under the mango tree.</span></p><p><span style="font-family: verdana;"><span style="font-size: large;">What does it feel like to walk in the surf? Caressing waves, then grit in my sandals.</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">I walked around town with my phone in my hand, making voice memos, describing these sights, sounds, smells, tastes, and sensations. My mind fixed on the present, there was no room there for regrets about the past or anxiety about the future.</span></span></p><div><p></p><div><p></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Health Benefits of Mindfulness</span></h3></div></div></div><p><span style="font-family: verdana; font-size: large;">Mindful meditation has been demonstrated to reduce anxiety, depression, stress, pain, insomnia, and high blood pressure.</span></p><p><span style="font-family: verdana; font-size: large;">There are many ways to do mindfulness. A review of literature published in <i>Clinical Psychology Review, </i><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679190/" target="_blank">Effects of Mindfulness on Psychological Health</a>, summarizes the context of mindfulness practice in its Eastern and Western versions and its application in a variety of psychological treatments.</span></p><p><span style="font-family: verdana; font-size: large;">What I offer here is one simplified self-help practice for addressing panic and anxiety, a disciplined version of what I called my research:</span></p><p><span style="font-family: verdana; font-size: large;">Focus on your environment.</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">Name five things that you see right now</span></li><li><span style="font-family: verdana; font-size: large;">Name four sounds that you hear</span></li><li><span style="font-family: verdana; font-size: large;">Name three things that you feel</span></li><li><span style="font-family: verdana; font-size: large;">Name two things that you smell</span></li><li><span style="font-family: verdana; font-size: large;">Name one thing that you taste</span></li></ul><span style="font-family: verdana; font-size: large;">Yeah, don't get hung up on remembering whether it's three feelings or three smells. I don't remember the order of the sensations and made it up.</span><p></p><p><span style="font-family: verdana; font-size: large;">The point is to redirect the catastrophizing brain, to pull it into the here and now. Remember - <i>here and now </i>is where joy lives.</span></p><p><span style="font-family: verdana; font-size: large;">This practice isn't the cure all to my mental health issues. And I doubt it will cure yours. But it gives our poor brains, exhausted by the three alarm fires that usually occupy them, a break. It turns down the temperature and lets a different input in.</span></p><p><span style="font-family: verdana; font-size: large;">And that's a good thing.</span></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-613763390566858812022-06-07T10:03:00.000-07:002022-06-07T10:03:29.771-07:00Why Get Diagnosed with ADHD - And Introducing Jesse Anderson<p>Am I the oldest new member of the ADHD club? At age sixty-nine, why bother with a diagnosis and treatment?</p><div class="separator" style="clear: both; text-align: left;">That was the attitude of my new and now former primary care provider. She said that the prefrontal cortex develops out of ADHD in adulthood, or that people learn workarounds for its difficulties.</div><div class="separator" style="clear: both; text-align: left;"></div><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq2YEQ5hmSRjAzlB8P6HQAenIYCZsQMNor3dyMItX0_buVguS5XS2cPX47PBLt1ag3KDRMUAwIB9dgGvKD54dV25SPRiN-pF4ttJiizDRP3nbNE9bKul1v70YLZmmrH1Ki-S4g2rbFRP1JPsewco-42rvz48dYYDBZsM7MozUpSFptRMtfX9P1sSNcVA/s1138/Screen%20Shot%202022-05-30%20at%203.15.58%20PM.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1138" data-original-width="920" height="127" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq2YEQ5hmSRjAzlB8P6HQAenIYCZsQMNor3dyMItX0_buVguS5XS2cPX47PBLt1ag3KDRMUAwIB9dgGvKD54dV25SPRiN-pF4ttJiizDRP3nbNE9bKul1v70YLZmmrH1Ki-S4g2rbFRP1JPsewco-42rvz48dYYDBZsM7MozUpSFptRMtfX9P1sSNcVA/w103-h127/Screen%20Shot%202022-05-30%20at%203.15.58%20PM.png" width="103" /></a></div>She didn't ask about <i>my</i> prefrontal cortex, or whether <i>I</i> had found workarounds. She thought I should just not worry about what I can't do.<p></p><p>As I said, <i>former</i> care provider.</p><p>But back to that question - why bother?</p><p>Two reasons:</p><p><b>Treatment for ADHD works</b></p>Sure, over those many years I developed <i>some</i> workarounds, ways of coping with the challenges of my neurologically divergent (ND) brain.<p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvEwyhip9Bfx6_AHxJx7IlEVUcEi7q8IIKrIYhyixQc3L3LrnG0KlbqTZQe9SkgZlxAijfu0xAAwsaGmuZH7-JaTJ4h9fcZLPOXI6KMNiIynUZt9FaRTROSq4Wt_4zbEKAiQGaICAuAhzgKzMPz0-ou2_PS03CgABseps4LeRW_nhH912LfJutk7ldVA/s950/Maze_simple.svg.jpg%20creative%20commons.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="596" data-original-width="950" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvEwyhip9Bfx6_AHxJx7IlEVUcEi7q8IIKrIYhyixQc3L3LrnG0KlbqTZQe9SkgZlxAijfu0xAAwsaGmuZH7-JaTJ4h9fcZLPOXI6KMNiIynUZt9FaRTROSq4Wt_4zbEKAiQGaICAuAhzgKzMPz0-ou2_PS03CgABseps4LeRW_nhH912LfJutk7ldVA/w199-h125/Maze_simple.svg.jpg%20creative%20commons.png" width="199" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div>But they weren't alway sufficient. There were key times in my life when I failed to reach my goals because I couldn't get started, because I couldn't keep going, because I couldn't maintain concentration, because I couldn't remember, because I couldn't turn down the emotional interference that I experienced as a consequence of all the other symptoms. SHAME! Loads of SHAME!<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfuPL_mOOa4RAfYGtcpWzULp6vLpEd0oP2PZYtCdAEtL4iu0HQaO3QULTnFntdbyKP65gTNKN0O_7qEqUZ7t_83e1I9yxug4FWoIOIlGj6eVlKj65Bu6_gisujymkBBL6svTzkdyFoP03-eoOB8C7_Xa26J01ADqkZdE5FYddD7R9312-IRjlY7yYVCA/s640/Maze_complex.jpg%20creative%20commons.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="507" data-original-width="640" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfuPL_mOOa4RAfYGtcpWzULp6vLpEd0oP2PZYtCdAEtL4iu0HQaO3QULTnFntdbyKP65gTNKN0O_7qEqUZ7t_83e1I9yxug4FWoIOIlGj6eVlKj65Bu6_gisujymkBBL6svTzkdyFoP03-eoOB8C7_Xa26J01ADqkZdE5FYddD7R9312-IRjlY7yYVCA/s320/Maze_complex.jpg%20creative%20commons.png" width="320" /></a></div><p>My workarounds got me a certificate in congregational development. But I am not the Rev. DOCTOR Willa Goodfellow, because - I couldn't.</p><p>And yet today, I still have more I want to do, big things for which my workarounds have not been sufficient in the past and are not now.</p><p>But that pill, that tiny pill, that fraction of a pill after I cut it with my pill splitter, because for me it never takes much. . .</p><p>It was like the window opened, the sky was clear, I sat down, like I am right this very minute. . .</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsVP1D1CNVoUdR4p8AdabmRez42ZM0P4ys0pDaFWcltIPxC8Q0ZwnhFMl8lFUfEeR9YE6IeJqjTz65vTibOdKuf8QnDeTb3VxeGl3uX4FdPcFtdSfObsvcy1O7mCDjlAMh6YE2U4ac7lF9vUWwvs5MUeGZ5vNL0xNcr7EjKYz5VdxfdxdfLc26jfuPFw/s1600/window%20to%20sky,_Dingle_Peninsula,_Co._Kerry,_Ireland.jpg%20by%20Maoileann%20creative%20commons.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="257" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsVP1D1CNVoUdR4p8AdabmRez42ZM0P4ys0pDaFWcltIPxC8Q0ZwnhFMl8lFUfEeR9YE6IeJqjTz65vTibOdKuf8QnDeTb3VxeGl3uX4FdPcFtdSfObsvcy1O7mCDjlAMh6YE2U4ac7lF9vUWwvs5MUeGZ5vNL0xNcr7EjKYz5VdxfdxdfLc26jfuPFw/w457-h257/window%20to%20sky,_Dingle_Peninsula,_Co._Kerry,_Ireland.jpg%20by%20Maoileann%20creative%20commons.jpeg" width="457" /></a></div><br />And I worked.<p></p><p>That's all. I didn't speed. I didn't stay up late. I didn't go down to the schoolhouse to score some more tabs off a sixth grader.</p><p>I simply worked. My brain was clear and in gear. And I got the job done.</p><p>There are things I want to do, books I want to write and promote, podcasts on which I want to be a guest, deadlines I want to meet. And one little fraction of a pill has opened the window for me.</p><p>Treatment works.</p><p><b>Community for people with ADHD helps</b></p><p>That's the second reason to get diagnosed, community. Just like any other challenging condition, the people who have it can help each other. Breast cancer, kidney cancer, Parkinson's, depression, bipolar, alcoholism, arthritis, eating disorders - whatever you've got, hanging out with others who have it too is huge. Community offers support, reassurance, information, and resources.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEind8NwqecwhfCOgopeG7OMos1x7mzHouXeh8vak4bC3u9mynGn1PERHp0zLqvsBBEWWb8VCRyg82zmwKojl9dQyfZhPj-1k6lrumI-Flj4qmc0LNqBcExN1m7Gzo5LOpwlw2KiByQgjPhRpn82XNLtgYgpSIjKwjT1F3edf3HhSgaPt9h-S1eEizoLvQ/s160/handshake%20by%20shark,%20GNU.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="105" data-original-width="160" height="151" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEind8NwqecwhfCOgopeG7OMos1x7mzHouXeh8vak4bC3u9mynGn1PERHp0zLqvsBBEWWb8VCRyg82zmwKojl9dQyfZhPj-1k6lrumI-Flj4qmc0LNqBcExN1m7Gzo5LOpwlw2KiByQgjPhRpn82XNLtgYgpSIjKwjT1F3edf3HhSgaPt9h-S1eEizoLvQ/w230-h151/handshake%20by%20shark,%20GNU.jpg" width="230" /></a></div>Once I knew I had ADHD I no longer felt like I was keeping a shameful secret - my failure to do what everybody else on the planet could do and what I expected myself to do.<p></p><p>And then I discovered others.</p><p>Twitter is a godsend for all things diverse, including neurologically diverse. It's where you find the people like you. Because there <i>are </i>people like you.</p><p>So if you have or wonder if you have ADHD, head for the bird app. <a href="https://twitter.com/search?q=%23ADHD&src=typed_query&f=top" target="_blank">This link</a> will take you to the posts that people have tagged with #ADHD. That's a start.</p><p><b>Jesse Anderson</b></p><p>And <a href="https://twitter.com/jessejanderson" target="_blank">this link</a> will take you to Jesse Anderson on Twitter.</p><p>Jesse has a <a href="https://extrafocus.io" target="_blank">newsletter</a> filled with ideas and strategies to help people with ADHD manage our time, energy, and motivation - those workarounds that we all supposedly discover on our own by the time we are sixty-nine. We don't all have to reinvent the wheel by ourselves!</p><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFqKFyrlbOfx8C3EjYBpL353ibgB5KfEsLO82TZZzz-Q8zNZRK7ny8QNqjIY18wl6nEYfolZs9BaiSOcRKVp42klwqoMC_OcNakOxWKHNTiJMilrtc4J9qmNM-2xxF3gWYsPkwkTyPHZ5YAVLsDh-jUI0H3KDwT2UPs_iyYT1f7NS7wU7zgPtsPK6GWQ/s720/ADHD%20nerds%20logo.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="720" data-original-width="720" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFqKFyrlbOfx8C3EjYBpL353ibgB5KfEsLO82TZZzz-Q8zNZRK7ny8QNqjIY18wl6nEYfolZs9BaiSOcRKVp42klwqoMC_OcNakOxWKHNTiJMilrtc4J9qmNM-2xxF3gWYsPkwkTyPHZ5YAVLsDh-jUI0H3KDwT2UPs_iyYT1f7NS7wU7zgPtsPK6GWQ/w150-h150/ADHD%20nerds%20logo.png" width="150" /></a><b></b>Jesse has a podcast called <a href="https://www.adhdnerds.com/" target="_blank">ADHD Nerds</a> that's just getting started. Personally, I am glad that they come in at around thirty minutes. Because who has the attention span for those ninety minute podcasts? - Not somebody with ADHD! Four episodes so far. I hope he finds it interesting enough to keep it going, because I find it interesting enough to keep listening.</p><p><i>And</i> he's writing a book, <a href="https://www.refocusbook.com" target="_blank">Refocus: A Practical Guide to Adult ADHD</a>. Not out yet. When it is, I'll drop a review. But get this - he is inviting input about what should be included. So go to that website; see what's already in the table of contents; send him your own thoughts.</p><p><b></b></p><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKFOuHB2zdQfaCN3TVVDf0S3_NXI6IXtlgp8mQE0sZXd39Y5avW8PPu-UZrTyRJcGpea0tnunO24sHVys90pdUh4HqVKHWY2yyklCy3UZKaNJOBzh1lNwqdyJ5w-ffo0UezgWkNYfsGucTSbN5jL3hrcWZ2_qOMS1MzBv1x71-kBFPxDVTlJOI6SwUrw/s735/mental%20health%20meme.com.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="735" data-original-width="600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKFOuHB2zdQfaCN3TVVDf0S3_NXI6IXtlgp8mQE0sZXd39Y5avW8PPu-UZrTyRJcGpea0tnunO24sHVys90pdUh4HqVKHWY2yyklCy3UZKaNJOBzh1lNwqdyJ5w-ffo0UezgWkNYfsGucTSbN5jL3hrcWZ2_qOMS1MzBv1x71-kBFPxDVTlJOI6SwUrw/s320/mental%20health%20meme.com.jpg" width="261" /></a></div>So yeah, folks, even if I am the oldest kid in class, I am glad to have gotten here. I really like the consequences - being able to get stuff done, stuff that matters to me.<div><br /></div><div>And finding my peeps. You rock!<br /><br /><p></p><p style="text-align: right;"><span style="font-size: xx-small;"><i>photo of old lady and last meme from memes.com</i></span></p><p style="text-align: right;"><span style="font-size: xx-small;"><i>photo of window to the sky, taken in the Dingle_Peninsula,_Co._Kerry,_Ireland by Maoileann, used under creative commons license</i></span></p><p style="text-align: right;"><span style="font-size: xx-small;"><i>photo of handshake by shark, used under GNU license</i></span></p></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-41482836016489841702022-05-18T11:48:00.002-07:002022-05-28T14:45:07.079-07:00How Do You Keep Your Eye on the Ball - Maintaining Attention with ADHD<p style="text-align: left;">First step: Get started.</p><p>That was the topic of my <a href="https://www.prozacmonologues.com/2022/04/how-do-you-get-going-working-with-adhd.html" target="_blank">last blogpost</a>, dealing with the <i>activation </i>aspect of ADHD.</p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhinuH8hQBNIfWabmsuswrM6vQcA4h5loxYxzI0MKe2kXriU9OB0IZMDz9nrztrzZ2s15Q24AebK0yt952yQQ_mY5C3gGm4j_Z_JSyaMJUhBC7df2ponaRel0SMCyrhEeSEph7-GE5T5vUVlBSE5JXJ73U1eqYK9SjDt5Yyc0jqQGNfNZ_cZ9fPaD8MQ/s1024/pie%20https-::thedinnerbell.recipes:ice-cream-pie:.jpeg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="819" height="126" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhinuH8hQBNIfWabmsuswrM6vQcA4h5loxYxzI0MKe2kXriU9OB0IZMDz9nrztrzZ2s15Q24AebK0yt952yQQ_mY5C3gGm4j_Z_JSyaMJUhBC7df2ponaRel0SMCyrhEeSEph7-GE5T5vUVlBSE5JXJ73U1eqYK9SjDt5Yyc0jqQGNfNZ_cZ9fPaD8MQ/w101-h126/pie%20https-::thedinnerbell.recipes:ice-cream-pie:.jpeg" width="101" /></a></div>Following my own advice, just now I did two quick little internet tasks and crossed them off my list. Got a dopamine hit off that, like taking one bite of a piece of pie. So now I have a long task in front of me, writing my next blogpost on <i>attention</i>.<p></p><p>Oops, damn. Just took a break to eat a banana. And then I started a timer on one of my games. And now I'm remembering it's a friend's birthday and I haven't sent a card yet.</p><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="160" src="https://giphy.com/embed/NoHe3HpB1Mg8w" width="280"></iframe></div><p><a href="https://giphy.com/gifs/movie-up-NoHe3HpB1Mg8w">via GIPHY</a></p><p style="text-align: left;">NO! I <i>will</i> get back to the blogpost. Ugh. Even with a med on board, this is hard.</p><p>So. How do I keep working when my friend really deserves a birthday card and I really want to send it?</p><p>Here are my tricks:<span></span></p><a name='more'></a><p></p><p></p><ul style="text-align: left;"><li>Keep it short. Don't even try to work three hours at a time on any one project. I have a number of projects going right now. Each could benefit from an eight-hour-day effort. I never put in an eight hour day on any of them. My day is divided into blocks and I assign a different task to each block. No task gets more than two hours. And I take mini breaks in the middle of two hours. So yeah, I will check my email - waiting to hear back from my publisher. And I won't beat my ADD brain up for doing it.</li></ul><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="196.6" src="https://giphy.com/embed/JoxvmZFZ224I4kD8qN" width="280"></iframe></div><p style="text-align: center;"><a href="https://giphy.com/gifs/RosannaPansino-ro-rosanna-pansino-JoxvmZFZ224I4kD8qN">via GIPHY</a></p><p style="text-align: left;"><span style="text-align: left;">That reminds me: decades before I knew anything about my brain, one of the reasons I loved working in a parish was the variety of tasks within a day/week/year. Hurray for CHANGE!</span></p><p></p><ul style="text-align: left;"><li>Break it down. This one is related to the former. I have a whole book to edit. Nope. Gonna edit one chapter today. That's it. Next chapter tomorrow. Move on to a different task. Laundry: I pile the clean clothes on top of the dryer and fold one item each time I pass by. Who made some dumbass rule that says you have to wash, dry, fold, and even <i>put away</i> a load of laundry all in one day? You're an adult. Change that rule.</li></ul><div><br /></div><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="156.6" src="https://giphy.com/embed/l3vR4RYyp7neS0XC0" width="280"></iframe></div><p><a href="https://giphy.com/gifs/nickelodeon-baby-laundry-l3vR4RYyp7neS0XC0">via GIPHY</a></p><ul style="text-align: left;"><li>Build in movement. I write at a standing desk and shift my position frequently, wiggle my hips, stretch my arms over my head. Go fold one more piece of laundry.</li></ul><div><br /></div><div><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="232" src="https://giphy.com/embed/O7G40G72SHYLC" width="280"></iframe></div><p><a href="https://giphy.com/gifs/laundry-O7G40G72SHYLC">via GIPHY</a></p></div><ul style="text-align: left;"><li>Build in a mindless task to run in the background. In grade school, I used a coloring book. My grad school notebooks are filled with doodles. Back when I went to in-person conferences (remember those days?) I would bring my knitting for those two hour meetings. Now that all my meetings are on Zoom, I can play a game while listening (yes, I really <i>am</i> listening) and no one is the wiser.</li></ul><div><br /></div><div><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="197" src="https://giphy.com/embed/yPko2tn6I22emjxtJF" width="280"></iframe></div><p><a href="https://giphy.com/gifs/BrabantinBeelden-knitting-apron-mad-grandma-yPko2tn6I22emjxtJF">via GIPHY</a></p></div><ul style="text-align: left;"><li>Make yourself accountable. Give yourself a deadline. Your boss or your professor may handle this for you. But those deadlines are probably for the whole task. Once you have broken it into the bit you can accomplish before lunch, tell somebody else what you're doing, a coworker, a spouse, Twitter, whatever works for you.</li></ul><div><br /><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="280" src="https://giphy.com/embed/dxP9yzCvWre2XLoPfx" width="280"></iframe></div><p><a href="https://giphy.com/gifs/SWR3-time-watch-timing-dxP9yzCvWre2XLoPfx">via GIPHY</a></p></div><p></p><p>And look -- there's a whole blogpost!</p><p>But I gotta tell ya. Sure, my little kid ADHD prefrontal cortex developed, and sure, I developed some of these coping mechanisms on my own. But there is a difference between [agonizing over a blogpost for four days, eventually abandoning it in the draft pile] and [hanging in there with a few little breaks but getting it done in one morning.] And that difference seems to be <i>medication</i>.</p><p>Next up: well, I'm not sure. But I think I will continue on the ADHD thread and review a resource or two.</p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-13434147935009828262022-04-21T08:56:00.007-07:002023-05-29T10:27:23.396-07:00How Do You Get Going? Working with ADHD<p><span style="background-color: white; font-family: verdana; font-size: medium;"><a href="https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-screeners.pdf" target="_blank">Screens for ADHD</a> measure five clusters of symptoms: </span></p><p style="background-color: white;"></p><ul style="background-color: white; line-height: 1.4; margin: 0.5em 0px; padding: 0px 2.5em;"><li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: verdana; font-size: medium;">organizing and activation for work</span></li><li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: verdana; font-size: medium;">sustaining attention and concentration</span></li><li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: verdana; font-size: medium;">sustaining energy and effort</span></li><li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: verdana; font-size: medium;">managing affective interference (emotions that get in the way)</span></li><li style="margin: 0px 0px 0.25em; padding: 0px;"><span style="font-family: verdana; font-size: medium;">utilizing working memory and accessing recall.</span></li></ul><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;"><a href="https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf" target="_blank">The DSM checklist</a> assumes that ADHD is a diagnosis for children. If you didn't have it as a child, you don't have it now.</span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;"><br /></span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;">Well, okay. I am not qualified to quibble with the American Psychiatric Association about how many angels dance on the head of a pin and when they showed up for the dance. But the problem of diagnosis is this: I can't remember which of their criteria I demonstrated in my childhood. And my mother certainly never noticed any struggles that her brilliant and perfect daughter may have experienced in the early 1960s. I mean, she didn't even notice suicidal depression...</span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;"><br /></span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;">So what do I make of that DSM assumption?</span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;"><br /></span></span></div><div><span face="Verdana, Geneva, sans-serif"><span style="font-family: verdana; font-size: medium;"><a href="https://chadd.org/for-professionals/diagnosis-in-adults/" target="_blank"></a><div class="separator" style="clear: both; text-align: center;"><a href="https://chadd.org/for-professionals/diagnosis-in-adults/" target="_blank"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZQh-Yp650fKNaNOayJNkQBnlk69ntW6bFfsE5hsQS4zDQO0ox93ERVvP71X8zSTm_XYMMqNfB6Wb693LTjKcDr4F6s_OagqZV3jj-HZlvfbgjHWK8AihzAsS7j_OYCDqyl48mObkhGcv8Bxt6bKx6J59-IZBXd5cjDA_8BlPxQfwjEupS1rh7vDg99A/s285/CHADD-4.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="285" data-original-width="268" height="96" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZQh-Yp650fKNaNOayJNkQBnlk69ntW6bFfsE5hsQS4zDQO0ox93ERVvP71X8zSTm_XYMMqNfB6Wb693LTjKcDr4F6s_OagqZV3jj-HZlvfbgjHWK8AihzAsS7j_OYCDqyl48mObkhGcv8Bxt6bKx6J59-IZBXd5cjDA_8BlPxQfwjEupS1rh7vDg99A/w90-h96/CHADD-4.png" width="90" /></a></div>CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder has this to say about diagnosing adults:</span></span></div><div><span face="Verdana, Geneva, sans-serif"><span><a name='more'></a></span><span style="font-family: verdana; font-size: medium;"><br /></span></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><span 14px="" font-family:="" font-size:="" montserrat="" sans-serif="" style="font-family: verdana; font-size: medium;"><i>Although some ADHD symptoms are evident since early childhood, some individuals may not experience significant problems until later in life. Some very bright and talented individuals, for example, are able to compensate for their ADHD symptoms and do not experience significant problems until high school, college or in pursuit of their career. In other cases, parents may have provided a highly protective, structured and supportive environment, minimizing the impact of ADHD symptoms until the individual has begun to live independently as a young adult.</i></span></div></blockquote><p><span style="font-family: verdana; font-size: medium;">Okay, Mama would buy that explanation, since she would say that I am very bright and talented. And she was right.</span></p><p><span style="font-family: verdana; font-size: medium;">Now I have been diagnosed, notwithstanding that my interest in schoolwork hid my difficulties with attention and activation, and I was (usually) able to find workarounds for those difficulties. I am taking medication, which is helping immensely.</span></p><p><span style="font-family: verdana; font-size: medium;">But this is not my first rodeo. I know that medication helps. It's like a crutch. Crutches really help people who have a problem with a leg. But they still have to use that leg.</span></p><p><span style="font-family: verdana; font-size: medium;">So. How do we use that feeble leg?</span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Working around Activation Issues</span></h3><p><span style="font-family: verdana; font-size: medium;">How do people with ADHD start?</span></p><p><span style="font-family: verdana; font-size: medium;">It's a bizarre kind of issue, embarrassing actually. Here I am, all my work tools lined up, great idea in hand, some measure of enthusiasm even.</span></p><p><span style="font-family: verdana; font-size: medium;">And I Just. Cannot. Start.</span></p><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="480" src="https://giphy.com/embed/Ry9UZHHYucxOw" width="400"></iframe></div><p><a href="https://giphy.com/gifs/lynda-carter-lever-Ry9UZHHYucxOw">via GIPHY</a></p><p><span style="font-family: verdana; font-size: medium;">How do I trick my weird little brain into "go" mode?</span></p><p><span style="font-family: verdana; font-size: medium;">My go-to strategy used to come from Mark Twain's observation:</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: medium;"><i>Eat a frog for breakfast </i></span><i style="font-family: verdana; font-size: large;">and nothing worse </i><i style="font-family: verdana; font-size: large;">will happen to you the rest of the day.</i><span style="font-family: verdana; font-size: large;"> </span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Okay, I know that's bizarre. But my book has a whole chapter devoted to the meaning of <i>bizarre.</i> <i>Bizarre</i> works for me.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">The idea used to be to pick the thing on my to-do list that most resembled a frog, so that eating it for breakfast would constitute the worse thing that would happen to me that day. Everything else that followed would seem easy.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">For example: call my Costa Rican internet provider to find out why I keep getting kicked off my connection. It took two weeks to get around to this phone call, out of a six week stay.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">That's a frog.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">So one day, I did it first.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Only, I didn't do it first. It's a really effective strategy for neurotypicals, and I stand by it for neurotypicals. But it wasn't actually what I was doing.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">My frog was the <i>second </i>course of the day.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Once I analyzed my behavior, I realized I was following a different aphorism:</span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Eat dessert first</span></h3><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisOMVG_rVW4A1lT-lDy-JkEJXP-or_n-vthmlkiJNvI57i2RUbR2INhZHexAfc25ohVc9XtZpKuQjz99r3M1oz76zGwYS6pGbv7CJfGzs6jIuheI6D-rBg-T2Mf4Qz1wir9xbUoNfnXADLrZbeUkVbvEDIRl6aX-SE6-f9mq_JWEFRnPsr8T1m7y8bow/s1024/pie%20https-::thedinnerbell.recipes:ice-cream-pie:.jpeg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1024" data-original-width="819" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisOMVG_rVW4A1lT-lDy-JkEJXP-or_n-vthmlkiJNvI57i2RUbR2INhZHexAfc25ohVc9XtZpKuQjz99r3M1oz76zGwYS6pGbv7CJfGzs6jIuheI6D-rBg-T2Mf4Qz1wir9xbUoNfnXADLrZbeUkVbvEDIRl6aX-SE6-f9mq_JWEFRnPsr8T1m7y8bow/w173-h217/pie%20https-::thedinnerbell.recipes:ice-cream-pie:.jpeg" width="173" /></a></span></div><span style="font-family: verdana; font-size: medium;">Right before I made that call to the internet provider, I did something else first, a <i>little</i> task that I enjoyed and that gave me a sense of competence.</span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Just one bite. Don't get distracted. That's another ADHD hazard that I'll discuss next post.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">That gave me a shot of dopamine, the feel-good neurotransmitter. I rewarded myself <i>before</i> I made that phone call.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">In other words, make your brain your friend. Your ADHD brain. Not everybody else's brain. That first bite of pie jump starts the brain that is stuck.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">The website for <a href="https://advancedpsychiatryassociates.com/resources/blog/strategies-for-adults-living-with-adhd/">Advanced Psychiatry Associates</a>, located in California, has a raft of suggestions. One of them reminds me of my strategy for getting started:</span></p><h3 style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Get organized</span></h3><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">That may seem a bit of a stretch until you break it down. I mean, if you were organized, you wouldn't have ADHD, right? But it's not the organization that helps you get started. It's the little task of organizing <i>something</i> that does the trick.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">My version: </span><span style="font-family: verdana; font-size: large;">Make a list.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">That's all. Just make the list.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">I make a list for the week, not the day. That way I can reward myself for whatever I manage to accomplish, which gives me that dopamine hit that moves me to another item on the list. </span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">If I don't get the list done in a week, well, I make next week's list! The list itself is for me that one bite of pie. As soon as I make it, I can get started on one item on it.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Yeah, this isn't the perfect solution. Sometimes one particular item moves from one week's list to the next until it becomes a moot point. But it helps. It helps me.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"><b>What helps you?</b> Add your tricks to the comments.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">This post has addressed the first cluster of ADHD symptoms, one of my top difficulties - activation. Next post will move on to the classic symptom - it's in the name, after all - <i>attention deficits</i>.</span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>photo of pie from <a href="http://thedinnerbell.recipes/">thedinnerbell.recipes/</a></i></span></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-77872703333155858982022-03-31T08:58:00.002-07:002022-05-18T11:42:22.166-07:00There's That Squirrel Again! How Do I Know if I Have ADHD?<p>There is a reason why I haven't posted in months. My latest diagnosis -- ADHD -- <b>Attention Deficit Hyperactivity Syndrome </b>-- the adult version.</p><p>I have a fistful of posts in my draft file that were never finished before they seemed beside the point. That is not an unusual state for me. Many years ago my brilliant brain was unable to write the doctoral thesis for which I had already conducted extensive field research and had a thorough outline. Periodically I would write whole chapters in my head. But when the laptop was in front of me...</p><p style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="268" src="https://giphy.com/embed/QegDHUhbNylHVjEBmr" width="480"></iframe></p><p><a href="https://giphy.com/gifs/road-off-QegDHUhbNylHVjEBmr">via GIPHY</a></p><p>I was stuck.</p><p>We'll see how this post goes.</p><h3 style="text-align: center;">Diagnosis</h3><p>Wait a minute. Don't I have bipolar disorder? Where did this new diagnosis come from? What are the chances a person could have both?</p><p><a href="https://www.sciencedirect.com/science/article/pii/S0149763421000312" target="_blank"><span></span></a></p><a name='more'></a><a href="https://www.sciencedirect.com/science/article/pii/S0149763421000312" target="_blank">Research by Carmen Schiweck et al</a>., published in <i>Neuroscience & Biobehavioral Reviews</i> found that "up to 1 in 13 patients with ADHD has comorbid BD [bipolar disorder] and up to 1 in 6 patients with BD has comorbid ADHD.<p></p><p><i>Comorbid</i> is medical speak for -- DOUBLE THE FUN!</p><p>So how did I discover I was one of the lucky one in six?</p><p>A close family member told me that he has taken ADHD meds for years and that they really help. It turns out that family studies show that the ADHD and BD genes are usually transmitted together.</p><p>I connected the dots: </p><p></p><ul style="text-align: left;"><li>I thought about my experiences at work, especially the aspects that gave me the most difficulty: getting started and continuing once I <i>was</i> started.</li><li>I remembered that lost DMin degree.</li><li>I remembered how I did get my thesis for Reed College done. <i>I was on Adderal!</i></li></ul><p></p><p>I mentioned it to my therapist who gave me a screen. That came up </p><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="260" src="https://giphy.com/embed/6cFcUiCG5eONW" width="480"></iframe></div><p><a href="https://giphy.com/gifs/the-office-pam-6cFcUiCG5eONW">via GIPHY</a></p><p>positive.</p><p>The screen measured five clusters of symptoms: </p><p></p><ul style="text-align: left;"><li>organizing and activation for work</li><li>sustaining attention and concentration</li><li>sustaining energy and effort</li><li>managing affective interference (emotions that get in the way)</li><li>utilizing working memory and accessing recall</li></ul><p></p><p>I hit the "highly probable" threshold for all five clusters, with the highest in activation and attention. That's when I saw a specialist who did a different screen and confirmed the diagnosis.</p><p>If these clusters look suspiciously familiar to you, <a href="https://www.aafp.org/family-physician/patient-care/prevention-wellness/emotional-wellbeing/adhd-toolkit/assessment-and-diagnosis.html" target="_blank">here is a website</a> with a number of screens and resources. A positive screen doesn't necessaruly mean you have ADHD. It means you could use an evaluation by a specialist. It could be something else. Like, some of my symptoms overlap with PTSD. But not all.</p><p>So yes, I follow any squirrel that wanders across my vision or my brain.</p><div style="text-align: center;"><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="276" src="https://giphy.com/embed/NoHe3HpB1Mg8w" width="480"></iframe></div><p><a href="https://giphy.com/gifs/movie-up-NoHe3HpB1Mg8w">via GIPHY</a></p><p>How do I get work done anyway?</p><p>To be continued...</p>
<p></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-28574947591670868442021-12-24T13:51:00.001-08:002021-12-24T13:51:24.746-08:00My Holiday Wish for Us All - Trip the Light<p><span style="font-size: large;">In my darkest bleak midwinter, I find the following. And I believe again. I do believe we can get back to this. And if the video were made again, with everybody in masks, it would not detract from the joy. It really wouldn't.</span></p><p><span style="font-size: large;">PS - While you are watching, dance!</span></p><div dir="ltr" trbidi="on"><div style="text-align: center;"><iframe allowfullscreen="allowfullscreen" frameborder="0" height="236" src="http://www.youtube.com/embed/Pwe-pA6TaZk" width="420"></iframe></div><span style="font-size: large;"><br /></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">If all the days that come to pass</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">Are behind these walls</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">I'll be left at the end of things</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">In a world kept small</span></blockquote></blockquote><p> </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">Travel far from what I know</span></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">I'll be swept away</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">I need to know</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">I can be lost and not afraid</span></blockquote></blockquote><p> </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">We're gonna trip the light</span></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">We're gonna break the night</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">And we'll see with new eyes</span></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><span style="font-size: large;">When we trip the light</span></blockquote><span style="font-size: large;"><br /></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">Remember we're lost together</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">Remember we're the same</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We hold the burning rhythm in our hearts</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We hold the flame</span></blockquote><span style="font-size: large;"><br /></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We're gonna trip the light</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We're gonna break the night</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">And we'll see with new eyes</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">When we trip the light</span></blockquote><span style="font-size: large;"><br /></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">I'll find my way home</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">On the Western wind</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">To a place that was once my world</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">Back from where I've been</span></blockquote></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><span style="font-size: large;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">And in the morning light I'll remember</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">As the sun will rise</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We are all the glowing embers</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">Of a distant fire</span></blockquote><span style="font-size: large;"><br /></span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">Come on and trip the light</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">We're gonna break the night</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">And we'll see with new eyes</span></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><span style="font-size: large;">When we trip the light</span></blockquote></blockquote><br />Music: Garry Schyman<span 13.63636302947998px="13.63636302947998px" 20px="20px" ejavu="ejavu" font-family:="font-family:" font-size:="font-size:" imbus="imbus" l="l" line-height:="line-height:" ms="ms" rebuchet="rebuchet" sans-serif="sans-serif" sans="sans">©</span><br />Lyrics: Alicia Lemke and Matt Harding<span 13.63636302947998px="13.63636302947998px" 20px="20px" ejavu="ejavu" font-family:="font-family:" font-size:="font-size:" imbus="imbus" l="l" line-height:="line-height:" ms="ms" rebuchet="rebuchet" sans-serif="sans-serif" sans="sans">©</span><br /><br />Source LYBIO.netWilla Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-48407451943956167242021-12-15T14:00:00.002-08:002022-05-18T11:43:02.615-07:00Surviving Suicide - Can Our Stories Help Others?<p><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://livethroughthis.org/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="1280" data-original-width="768" height="284" src="https://blogger.googleusercontent.com/img/a/AVvXsEiSK6USdDcX2y_bXTAsOVW47VnsJZUIo6FfkaekMvR1pOHh-r8lY7kzHqUjXaxSYrGj92Nt9snNImDiKyJt2MhG025ZdlTa-HZ_dftHc9aUid7VAVD280cPPvHv14Cwob20aWfjZWOXf6iDfVi308aTe9jcn__NPYbsM6Ky0ak0oSYbR31tClOCFMP0JA=w170-h284" width="170" /></a></span></div><span style="font-family: verdana; font-size: large;">The worst part of being suicidal isn't that it can kill you. The worst part is that you likely suffer alone.</span><p></p><p><span style="font-family: verdana; font-size: large;">You don't talk about it with friends and loved ones because it hurts them. And they respond by saying hurtful things.</span></p><p><span style="font-family: verdana; font-size: large;">You don't talk about it with a professional because you fear being subjected to the trauma of forced treatment.</span></p><p><span style="font-family: verdana; font-size: large;">No, that's not right, not always right anyway. Sometimes loved ones know how to listen. Sometimes professionals know how to help.</span></p><p><span style="font-family: verdana; font-size: large;">But still. These skills seem to be rare. And it's all so scary.</span></p><p><span style="font-family: verdana; font-size: large;">Even after you're better, it's scary. Scary for you, scary for them. Especially scary if it got to the point of self-harm, a suicidal act. Upon release from the hospital, you are treated to silence. People want to "protect your privacy." They also want to protect their own peace of mind. NOBODY wants you to mention it again.</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><b><a href="https://livethroughthis.org/" target="_blank">Live Through This</a></b></span></p><p><span style="font-family: verdana; font-size: large;">So an archive of 157 stories of people who tried to die at their own hand, and yet they survived, a place where you can find people who are willing to tell their stories, how they got to that scary place and how they moved beyond it, or how they didn't (the scary lingers), that place is -- transgressive.</span></p><p><span style="font-family: verdana; font-size: large;"><span></span></span></p><a name='more'></a><span style="font-family: verdana; font-size: large;">It is especially transgressive because these stories do not follow the "<a href="https://www.prozacmonologues.com/2020/10/confessions-of-good-suicide-survivor.html#more" target="_blank">good survivor</a>" script. You know it. You read it every September in Suicide Prevention Month. It goes: <i>I felt terrible; I asked for help; I got help; I'm all better now; you can be, too; ask for help.</i></span><p></p><p><span style="font-family: verdana; font-size: large;">These stories are different. They are messy. They are in process. They are true.</span></p><p><span style="font-family: verdana; font-size: large;">And that's what makes them so helpful. They are a testament, in their very messiness, to a proposition that seems quite dubious - that you are not alone. That I am not alone. That we can find one another. And we can speak our truth.</span></p><p><span style="font-family: verdana; font-size: large;"><a href="http://LiveThroughThis.org"></a></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEg6eADDSJjuqomWVOgBc7_wF12ClV2sj9pdPkA3hK6F4X-T2Y6PIH6yw-1I5dnlAgeQOC16ZvZ8sopBPIpZGpNKn1lDhtIudqAcFqP40-ZMdeSMK0dPcPYJ774fbK89f3K0uXVOruUdN4pv1UKOL7o9fqG3Cxm5BP77vIzDMmZFuUMNjcSY27xRV7-VXA=s266" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="266" data-original-width="190" height="266" src="https://blogger.googleusercontent.com/img/a/AVvXsEg6eADDSJjuqomWVOgBc7_wF12ClV2sj9pdPkA3hK6F4X-T2Y6PIH6yw-1I5dnlAgeQOC16ZvZ8sopBPIpZGpNKn1lDhtIudqAcFqP40-ZMdeSMK0dPcPYJ774fbK89f3K0uXVOruUdN4pv1UKOL7o9fqG3Cxm5BP77vIzDMmZFuUMNjcSY27xRV7-VXA" width="190" /></a></span></div><span style="font-family: verdana; font-size: large;"><a href="http://LiveThroughThis.org">LiveThroughThis.org</a> is the project of Dese'Rae L. Stage, a photographer, mom, suicidologist, activist, and MSW student with lived experience of suicide. Its intent is to make suicide a <i>human</i> issue, more than a puzzle, a statistic, a secret.</span><p></p><p><span style="font-family: verdana; font-size: large;">Did you know that 1.4 million people in the United States attempted suicide in 2017? You don't really <i>need</i> to know that. What you need to know is that Cathy did. Raul did. Shawn did. Summer did. Fatima did. Terrence did. Maybe you did.</span></p><p><span style="font-family: verdana; font-size: large;">Live Through This celebrates the survival of each and every one. And grieves the ones who did not survive. It lets us celebrate and grieve together. Even if for now we do it in the privacy of our own browsers.</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><b>Batshit Crazy Support Group</b></span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Back in the days when I didn't have a therapist I trusted, I heard people at church praying for April. She was in the hospital again and having a hard time. A couple times a year it seemed, this prayer got repeated.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">I didn't know April. But I knew Rachel, our common friend. I asked Rachel to ask April if she would be willing to talk with me.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: left;"><span style="font-family: verdana; font-size: large;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjkxX0HuU-av-qGOLvkOYRvq0ckDVar0RIa9pR9FrIBEv5rkFXFkCGrisf4fYvu7pqMFXO8EkOOeJc3inEyZY23SKMvdm9HyGV-b2LKOblOC9MEWl-ZZME_4YI3kf3mAZYdsvOkUmWY1wnjjRdogW_KwqoaGLtiKEXsB0LLNEZ7kYXXyb02lPzeRB5ymw=s460" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="460" data-original-width="460" height="179" src="https://blogger.googleusercontent.com/img/a/AVvXsEjkxX0HuU-av-qGOLvkOYRvq0ckDVar0RIa9pR9FrIBEv5rkFXFkCGrisf4fYvu7pqMFXO8EkOOeJc3inEyZY23SKMvdm9HyGV-b2LKOblOC9MEWl-ZZME_4YI3kf3mAZYdsvOkUmWY1wnjjRdogW_KwqoaGLtiKEXsB0LLNEZ7kYXXyb02lPzeRB5ymw=w179-h179" width="179" /></a></div>And God bless her, she was. We met for coffee and I asked all my questions and confessed to all my fears. Eventually we asked two others to join us.</span></div><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">And we were no longer alone.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">The name of our support group, by the way, was inspired by Jared Poore whose line of t-shirts, totes, mugs, and more can be purchased. at <a href="https://www.cafepress.com/crazymeds">cafepress.com/crazymeds</a>.</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><b>SUPPORT A GOOD CAUSE AND GET COOL STUFF</b></span></p><span style="font-family: verdana; font-size: large;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiddZ43i2_j4aa87Gea7pp7h4QNYQrPOtGk6_XxLVawyH3G0E8c-dB-NYL1CY4URTzOlVQYZjUqJ3njcLcRU0eooqKYH2nslbnmUuDd7TVsI34fQVMe_6o_X-nyORJBi38MWJxoZgVmjbij8qD7pobtkeYE6MycZWc2FiRGDyod83kSkO6BD3C8a6WOrw=s2250" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="2250" data-original-width="1500" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEiddZ43i2_j4aa87Gea7pp7h4QNYQrPOtGk6_XxLVawyH3G0E8c-dB-NYL1CY4URTzOlVQYZjUqJ3njcLcRU0eooqKYH2nslbnmUuDd7TVsI34fQVMe_6o_X-nyORJBi38MWJxoZgVmjbij8qD7pobtkeYE6MycZWc2FiRGDyod83kSkO6BD3C8a6WOrw=s320" width="213" /></a></div>Candles, shirts, mugs, pins, bracelets, that sort of stuff - you can support the work of the Live Through This project and wear the words of encouragement that you or a friend may need to hear through the <a href="https://ltt.bigcartel.com/" target="_blank">merchandise department</a>.</span><div><span style="font-family: verdana; font-size: large;"><br /></span></div><div><span style="font-family: verdana; font-size: large;">I am eagerly awaiting the arrival of my bracelet. Good golly - it's made by a company that calls itself <i>Pura Vida, </i>the motto of Costa Rica meaning "pure life." That's the title of a chapter in <i><a href="https://www.amazon.com/Prozac-Monologues-Voice-Willa-Goodfellow-ebook/dp/B083B98CK8" target="_blank">Prozac Monologues</a></i>, the book, and the philosophy that keeps me going. Clearly has my name on it. I ordered two, one for me and one for the next raffle for subscribers to my <a href="https://willagoodfellow.com/" target="_blank">newsletter</a>.</span></div><div><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div style="text-align: center;"><span style="font-family: verdana;"><span style="font-size: large;"><b>Suicide is not a choice</b></span></span></div><div style="text-align: center;"><span style="font-family: verdana;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-family: verdana;"><span style="font-size: large;">Suicide is not a choice. It happens when pain exceeds resources for coping with pain.</span></span><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">The isolation of suicidal ideation is pain. Other people who know what you are experiencing and care for you are resources for coping with that pain.</span></span></p><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">Live Through This is suicide prevention. Thank you, Dese'Rae. Stay.</span></span></p></div>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0tag:blogger.com,1999:blog-2012499708688254847.post-44438770911583917362021-11-11T12:00:00.002-08:002022-05-18T11:43:38.940-07:00Beyond the DSM: Three Ways to Manage Other Issues of Bipolar Disorder<p><a href="https://1.bp.blogspot.com/-WiVDPG_d72M/YYsFQbyu-VI/AAAAAAAAMIQ/P87XOgHPedcgB4Pj0zUl_8oJhaMD6SOAwCLcBGAsYHQ/s436/DSM-5.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-size: large;"><img border="0" data-original-height="436" data-original-width="283" height="197" src="https://1.bp.blogspot.com/-WiVDPG_d72M/YYsFQbyu-VI/AAAAAAAAMIQ/P87XOgHPedcgB4Pj0zUl_8oJhaMD6SOAwCLcBGAsYHQ/w128-h197/DSM-5.jpg" width="128" /></span></a><span style="font-family: verdana;"><span style="font-size: large;">Medication is approved for a mental illness if it reduces symptoms, the symptoms listed in the Diagnostic and Statistical Manual (DSM).</span></span></p><p><span style="font-family: verdana;"><span style="font-size: large;">Did you know that there is more to bipolar disorder than: </span></span></p><p style="text-align: center;"><span style="font-size: large;"><span style="font-family: verdana;"><i>an episode of depression</i> </span><span style="font-family: verdana;">+ </span></span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><i>elevated or irritated mood, inflated self-esteem, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increase in goal-directed activity, psychomotor agitation, and excessive involvement in pleasurable or risky activities?</i><br /></span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">These are merely the outward and visible signs of what is happening inside the brain. These are how the doctor can tell that you have bipolar disorder.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">But even after you suppress these symptoms, you still have a variety of neurological dysfunctions that affect your thinking, your energy metabolism, and your health.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Psych meds do not address all these other issues. They are a piece of treatment, an important piece. But suppressing symptoms, while it relieves the anxieties of those around you, does not fix your life.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><span></span></span></p><a name='more'></a><span style="font-family: verdana; font-size: large;">What am I talking about, and how come you weren't told this stuff when the doctor wrote the script and your family member told you to take the damn pill already?</span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">First, what I am talking about:</span></p><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><a href="https://1.bp.blogspot.com/-O7MdUoYiCIk/YYsGVpRRsvI/AAAAAAAAMIc/N2Rx67Km4EIMzlo9ge-Eq0c_JsZSOeOdwCLcBGAsYHQ/s110/teeter%2Btotter%2Bewarning.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="110" data-original-width="110" height="110" src="https://1.bp.blogspot.com/-O7MdUoYiCIk/YYsGVpRRsvI/AAAAAAAAMIc/N2Rx67Km4EIMzlo9ge-Eq0c_JsZSOeOdwCLcBGAsYHQ/s0/teeter%2Btotter%2Bewarning.jpg" width="110" /></a></span></div><span style="font-size: large;">In a person with bipolar disorder, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to rebalance. And I don't mean just mood. It's not just up and down.</span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">The list of these mis-timings and misalignments includes:</span></p><p style="text-align: left;"></p><ul style="text-align: left;"><li><span style="font-family: verdana; font-size: large;">Dysregulation of hormones, neurotransmitters, and immune system</span></li><li><span style="font-family: verdana; font-size: large;">Irregularities in communication within and between brain cells</span></li><li><span style="font-family: verdana; font-size: large;">Disrupted wiring among the networks that connect the thinking, feeling, evaluating, and reacting parts of the brain.</span></li></ul><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">A number of these issues persist beyond the individual episodes of depression and mania/hypomania that the medication is intended to reduce.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Here are three examples, and how to reduce the damage they do.</span></p><h4 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Dysregulation of hormones, neurotransmitters, and immune system</span></h4><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Let's look at cortisol, the get up and go hormone.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><a href="https://1.bp.blogspot.com/-yCopnSGws2E/YYsHBnmst-I/AAAAAAAAMIs/Vfvw7OI0BbgkjUzn0VnLMnIJdpduRkvMQCLcBGAsYHQ/s640/corticosteroid-binding%2Bglobulin%2Bin%2Bcomplex%2Bwith%2Bcortisol%2BProtein%2BData%2BBank%2Bpub%2Bdom.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://1.bp.blogspot.com/-yCopnSGws2E/YYsHBnmst-I/AAAAAAAAMIs/Vfvw7OI0BbgkjUzn0VnLMnIJdpduRkvMQCLcBGAsYHQ/s320/corticosteroid-binding%2Bglobulin%2Bin%2Bcomplex%2Bwith%2Bcortisol%2BProtein%2BData%2BBank%2Bpub%2Bdom.png" width="320" /></a></span></div><span style="font-family: verdana; font-size: large;"><br />Cortisol fluctuates throughout the day. You can trace the fluctuations in a curve. In a healthy brain, a high level of cortisol gets you out of bed and out the door in the morning. Throughout the day, you get an extra boost in response to stress, when you need more energy to deal with whatever the issue is. In the evening, the level dials down so you can go to sleep.</span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><a href="https://pubmed.ncbi.nlm.nih.gov/20732746/" target="_blank">In the bipolar brain, the curve is flattened</a>. It has similar highs and lows, but not high enough in the morning, making for a sluggish start to the day, followed by too high at night, making for sleep difficulties.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">These flattened cortisol curves persist even in remission.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Is there a pill to change this pattern? Your mood stabilizer or antipsychotic may make you sleepy at night. But what about the morning?</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Here's an idea - live with it. Plan on it. Build the cortisol curve you have into your schedule. I get up at least an hour before my spouse does. She doesn't expect me to participate in meaningful conversation until I have been up for two hours.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">At the other end of the day, I start signaling to my brain that it is time to dial down two hours before bedtime. Routine soothes the savage beast. No super-stimulating television, no news, no Facebook right before lights out. I treat my limbic system, the source of all that cortisol, gently.</span></p><h4 style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;">Irregularities in communication within and between brain cells</span></span></h4><p style="text-align: left;"><span style="font-family: verdana;"><span style="font-size: large;">Mitochondria are the little critters inside our cells in charge of energy production.</span></span></p><p style="text-align: left;"><span style="font-size: large;"><span style="font-family: verdana;"></span></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><a href="https://1.bp.blogspot.com/-i4n6NTWAPUw/YYsLJTdEBvI/AAAAAAAAMI0/EWUjLyYKI9cZC_ocJrP7nWS2TsnBtrm8QCLcBGAsYHQ/s224/Mitochondria%2Bnih%2Bpub%2Bdom.gif" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="210" data-original-width="224" height="280" src="https://1.bp.blogspot.com/-i4n6NTWAPUw/YYsLJTdEBvI/AAAAAAAAMI0/EWUjLyYKI9cZC_ocJrP7nWS2TsnBtrm8QCLcBGAsYHQ/w299-h280/Mitochondria%2Bnih%2Bpub%2Bdom.gif" width="299" /></a></span></div><span style="font-size: large;"><br /><span style="background-color: white; font-family: verdana;">T</span><span style="background-color: white; color: #212121; font-family: verdana;">hese little critters are <a href="https://pubmed.ncbi.nlm.nih.gov/14993118/" target="_blank">not as efficient in bipolar brains</a> as in non-bipolar brains. This is a problem particularly in the hippocampus, the part of the brain in charge of memory and mood regulation. Inefficient energy production in the hippocampus means that this part of the brain shrinks and cannot do its job as well as you would like.</span></span><p></p><p style="text-align: left;"><span style="background-color: white; color: #212121; font-family: verdana;"><span style="font-size: large;">How do mitochondria produce energy anyway? They use the fuel that we provide by what we eat. So what kind of fuel makes for happy, healthy, productive mitochondria? Can you guess?</span></span></p><p style="text-align: left;"><span style="background-color: white; color: #212121; font-family: verdana;"><span style="font-size: large;">Is it this?</span></span></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-pTiF2mbxZ3I/YYsQ0hhC_7I/AAAAAAAAMJM/vzyqd0VtiF0XvcAv3K6P1wJmpMBH3JQKQCLcBGAsYHQ/s800/Donuts%2Blucianvenutian%2Bcreative%2Bcommons.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="584" data-original-width="800" height="290" src="https://1.bp.blogspot.com/-pTiF2mbxZ3I/YYsQ0hhC_7I/AAAAAAAAMJM/vzyqd0VtiF0XvcAv3K6P1wJmpMBH3JQKQCLcBGAsYHQ/w397-h290/Donuts%2Blucianvenutian%2Bcreative%2Bcommons.jpg" width="397" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana; font-size: large;"><br /></span></div><span style="font-family: verdana; font-size: large;">Or is it this?</span><br /><span style="background-color: white; color: #212121; font-family: verdana; font-size: x-large;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-3SegKXr7e0c/YYsQdDOErjI/AAAAAAAAMJA/S00DS9HtMrApGP4kXAeD-f2HBdyT-iRCwCLcBGAsYHQ/s800/Fruits_and_Vegetables_at_Pike_Place_Market%2Beric%2Bhunt%2Bgnu.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="800" height="304" src="https://1.bp.blogspot.com/-3SegKXr7e0c/YYsQdDOErjI/AAAAAAAAMJA/S00DS9HtMrApGP4kXAeD-f2HBdyT-iRCwCLcBGAsYHQ/w405-h304/Fruits_and_Vegetables_at_Pike_Place_Market%2Beric%2Bhunt%2Bgnu.jpg" width="405" /></a></div><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Hmm, I'm going to let you figure out that one yourself.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">I'll just add that the wrong fuel produces waste products that poison the mitochondria, like burning "dirty coal."</span></p><h4 style="text-align: left;"><span style="font-family: verdana; font-size: large;">Disrupted wiring among the networks that connect the thinking, feeling, evaluating, and reacting parts of the brain</span></h4><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">One part of the brain really does need to hear from other parts of the brain on a regular basis to function well. For people with bipolar, there is <a href="https://www.nature.com/articles/4001585" target="_blank">static on the line</a> between the prefrontal cortex (the thinking brain) and the limbic system (the reacting brain). The result can be a hasty judgment, an emotional upheaval, and an impulsive reaction when thought can't catch up in time to modulate a response.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Practice the pause.</span></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"> </span><iframe allowfullscreen="" class="giphy-embed" frameborder="0" height="480" src="https://giphy.com/embed/Wsjyhfgat7LaUGKiSt" width="480"></iframe></p><p><a href="https://giphy.com/gifs/primark-relax-breathe-breathing-Wsjyhfgat7LaUGKiSt">via GIPHY</a></p><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">And it does take practice, to pause after the stimulus to give the message from your intelligent self time to reach your self-protective self before you act.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Victor Frankl put it this way:</span></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-wngxIoBszQg/YY1kYX0a62I/AAAAAAAAMJc/vMK74EOUYN0_PDARldU6qxVYSZ6zev10ACLcBGAsYHQ/s467/frankle%2Bquote%2Bbrainyquote.com.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="245" data-original-width="467" height="229" src="https://1.bp.blogspot.com/-wngxIoBszQg/YY1kYX0a62I/AAAAAAAAMJc/vMK74EOUYN0_PDARldU6qxVYSZ6zev10ACLcBGAsYHQ/w437-h229/frankle%2Bquote%2Bbrainyquote.com.jpg" width="437" /></a></div><br /><span style="font-family: verdana; font-size: large;">When I was writing my book and working with a developmental editor, every time she gave me feedback, <i>every damn single time, </i>my first reaction was <i>She doesn't understand. Why am I paying this person who just doesn't get it?</i></span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">I learned to say <i>I'll think about that. </i>Then I would breathe. Then I would remember that I was paying her to give me feedback. No, she wasn't being mean; she was using her own expertise. Then I would think about how to use her feedback. I seldom took her suggestion exactly. But I did figure out how to address her concern in a way that was true to my vision. And I made the book better.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Thanks, Brooke. Thanks, breath.</span></p><h4 style="text-align: left;"><span style="font-family: verdana; font-size: large;">How come your doctor didn't tell you this stuff?</span></h4><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Ah, well. Just like the gap between your prefrontal cortex and your limbic system, there is a gap between what the research has been saying about bipolar disorder for decades and what is actually taught in medical school. Your doc didn't tell you, because nobody told your doc.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">The focus on treatment of mental illness is still on addressing the crisis and reducing symptoms, not healing the brain.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Well, the symptoms are indeed problematic, sometimes life-wrecking. But once you get those under control, if you think things still aren't working for you the way you would like, you are not crazy. And the solution is not to tinker with your meds.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">The solution lies in all the life-style measures that address all the other, out of sight dysfunctions of the brain. Regular schedule, healthy eating habits, exercise, self-awareness.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Oh, and education to learn what your doctor didn't tell you.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">It's not easy. But when you start putting this stuff into place, it gets easier.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">Remember, I'm rooting for you.</span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Graphic of corticosteroid-binding globulin in complex with cortisol from the Protein Data Bank, in public domain</i></span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Picture of mitochondrion by NIH, in public domain</i></span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Photo of donuts by lucianvenutian, used under Creative Commons license</i></span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>Photo of fruits and vegetable at Pike Place Market by Eric Hunt licensed under GNU</i></span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: xx-small;"><i>brainyquote.com</i></span></p><p style="text-align: right;"><span style="font-family: verdana; font-size: large;"><br /></span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;"><br /></span></p><p><span style="font-size: large;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p>Willa Goodfellowhttp://www.blogger.com/profile/05816752444634576606noreply@blogger.com0