Saturday, January 28, 2012

Grief? Depression? Both?

The New York Times reports this week on a proposed change to the definition of depression for the Diagnostic and Statistical Manual (DSM) V.  Asking, When does a broken heart become a diagnosis? it raises the specter that normal grief at the death of a loved one could be classified as a psychiatric disorder.

An estimated 8 to 10 million people lose a loved one every year, and something like a third to a half of them suffer depressive symptoms for up to month afterward, said Dr. Jerome Wakefield, author of The Loss of Sadness.  This would pathologize them for behavior previously thought to be normal.

Okay, before we get our knickers in a twist -- oops, too late.  Knickers in a twist is the current US national pastime.  Nevertheless, there is a larger context here.  Several, in fact.

DSM Context I - Follow The Money

Thursday, January 19, 2012

In Memoriam - Mary Kirigin

This is one of my favorite photos of my mother, standing next to my sister Mary.  That smiling mouth agape, as if to say, Can you believe what I get to do now!


I am writing on Monday, in the few minutes before I head over to the Pato Loco for the memorial service, to be followed later by a funeral in Utah.  Not sure about my publication schedule for the next few weeks, and taking personal privilege with the topic.  It's your blog, my doc once said.  So it is.

Mama was a survivor, in the real world, not reality TV world sense of the word.  She was also a public person, and I learned from her how to set a public face, mostly a competent face.  Privately it was more often harried, the face I see in the mirror, more every day.

The thing therapists think you are supposed to say to survivors is Wow!  You are so strong!  Me, I don't care for that line.

Thursday, January 12, 2012

God, Tebow and the Problem of Suffering

You know, they could be right.  Maybe God is responsible for Tim Tebow's astounding success.

First, the one take away from this article:  It's not magic-thinking.  It is pattern-seeking, hard-wired into our brains, one of the things our brains are built to do.

I Am A Professional -- Do Not Try This At Home

A whole world of football fans are suddenly theologians, explaining the ways of God.  And how silly for me to caution non-professionals from this endeavor.  Everybody with a frontal cortex is a theologian.  Our brains are built to ask Why?  Everybody with an anterior cingulate cortex looks for patterns that make sense of the events of the world.  That is what the anterior cingulate cortex does.

How is this for a pattern -- A new quarterback about whose talents many have doubts delivers a win.  Somebody sticks a microphone in his face.  He gives glory to God.  Next week, he wins again.  Again he gives glory to God.  Again he wins.  Again he gives glory to God...

And what is with that 316 yards thing?

If this were a baseball player on a streak, it would be the same socks he wears each game.  It's the God-thing that makes people twitchy.  More than that.  If it were basketball, he'd be crossing himself at the free-throw line, and nobody would miss a beat.  But it's the politics of the God-thing that have raised the stakes.

Suddenly people who should know better are doing bad theology.  And people who do know better let their chains get jerked.  I don't except myself here.  Twice a day I write something snarky on Facebook, and have to delete before I post.  (It's a thing I have about public discourse on Facebook.  I try to save my snarkiness for my blog.)

At Prozac Monologues my readers can expect more than snarkiness.  I have to bend the topic a bit.  So here we go.

God Improves Athletic Performance

Really, I'm serious.

Well, in a particular way.  Anybody else have a hometown team whose weekly police report is longer than its injury report?  And the results -- Hawkeyes went where this year?  The Earwax Bowl?

These days a little clean living gives an incredible advantage in the world of collegiate and professional sports.

Now this is not about Tim Tebow.  I don't know anything about his private life.  I do know a lot of athletes flame out on dissolute living, leaving behind only fumes of what had been promising careers.

I also know that some people find their way back.

The Twelve Steps

  • We admitted we were powerless over [our addiction] - that our lives had become unmanageable.
  • We came to believe that a Power greater than ourselves could restore us to sanity.
  • We made a decision to turn our will and our lives over to the care of God as we understood God.

There are more steps.  These are a start, the part that matters to a mental health blog.

However and why ever they do it, and how seriously they need to work on it, a lot of athletes and a lot of the rest of us could improve our lives by acknowledging a Higher Power.  It's a bottom line sanity issue.  People who think they are the center of the universe have their own DSM code.  It's 301.81.  But they aren't in therapy.  Those closest to them are.

No, you don't have to be a Christian, religious, not even spiritual but not religious to work the Steps.  I heard somebody used gravity for his Higher Power.  Like I said -- I am not the center of the universe is a bottom line sanity issue.

Tim Tebow's Higher Power

Again, I know nothing about the man's private life, and less than nothing about his heart.  But to the extent that his publicly professed Christianity conforms to orthodox Christianity, and by that I mean not making it up as we go along, I do believe the claim that his athletic prowess comes from God, the Creator of Heaven and Earth who delights in creation and said of it, It is good.  We have something in common here, Tim Tebow and me.  We each believe that God delights in us.  Well, I am willing to be a little less specific about the details.


If nothing else, think of this also as a comparative claim.  If he thought it was all about him, he would be at greater risk to flame out, and thereby not be able to complete as many passes as he does manage to complete.

Of course, there has to be somebody to catch those passes.  Writing now as a one-time Bronco fan, I wish I heard him say more about his receivers and his left guard.  He might make a better spokesperson for the Lord if it didn't seem like his personal miracle.

Alert: Rocky Shoals Of God-Talk Ahead

So far, I have been in the realm of orthodox theology, not making it up as I go along.

Everybody is a theologian.  The advantage of professional status is that you recognize the potential shipwreck before you get there.


Oops.  Too late.

A status update from a Facebook friend Sunday night: This is what happens when God is in charge!

Pastor Wayne Hanson, Summit Church, Castle Rock Colorado said, It's not luck.  Luck isn't winning 6 games in a row.  It's favor, God's favor... God has blessed his hard work.

So... how about 19 games in a row?  Was that luck?  What happens if the Broncos make it through this weekend and next, and Tim Tebow comes up against Aaron Rodgers, who also happens to be a stand-up kinda guy?  Not to mention one hell of a quarterback.  Will that be about God's favor?

The Problem of Suffering

I think what really drives people nuts, including a lot of Christians of the orthodox/not making it up as we go along variety, is this:

While God was blessing Tim Tebow's hard work on Sunday afternoon, 720 children around the world died of hunger.  270 people committed suicide.  Two of them, by the way, were veterans of the United States Armed Forces.

That was before overtime.  Good thing overtime was short, huh?

So on Monday morning, nearly 1000 mothers were asking, If God could help Tim complete that pass, couldn't he have paid some attention to my child?  Billions still listen for their answer.

This is not a question to be answered blithely.  We have to put football, even America to the side.

See, we have been here before, trying to find the pattern.  That is what our brains do, search for patterns, notice anomalies, then respond to new information.

There is one pattern we really, really want to find, that good is rewarded and evil is punished.  For the LORD knows the way of the righteous, but the way of the wicked is doomed.

That's from Psalms.  And to some extent, we do find evidence to confirm the claim.  Usually people who treat their spouses right have happy marriages.  Or at least happier than their marriages would be if they were out running around at night, coming home drunk and violent.

This pattern gives us a way to arrange our own behavior to get outcomes we desire, which is a good thing, and the evolutionary purpose of the development of this capacity.

This is from Psalms, too: I have been young and now I am old, but never have I seen the righteous forsaken, or their children begging for bread.

720 mothers whose children died of hunger while the Broncos pulled out that squeaker against the Steelers would beg to differ.  All you have to do is turn the channel to CNN to find that pattern disrupted.

The Bible Knows Better

Well, if you actually read the whole Book, and read it several times, over different times in your life, so you have a wider experience that helps you catch things you missed the first time round, you discover that the Bible says some other things about the ways of the righteous and the ways of the wicked.  Read Jeremiah.  Read Job.  Read the rest of the Book of Psalms.  Go do relief work in Haiti or Sudan and read them again.

The Bible records how a whole community of faith over centuries has struggled with this issue.  Sometimes the Psalm begins, O LORD, my God, my Savior, by day and night I cry to you.  And at the end, it still says, Darkness is my only companion.

The Psalms of Lament speak the truth of people who do love the LORD, who are faithful.  From Jeremiah thrown down a well to Paul shipwrecked on Malta to Mother Teresa struggling her whole life with severe depression a couple millennia later, faith does not turn out to be bankable.  My God, my God, why have you forsaken me?  Maybe the Psalms can give voice to your own experience.

Creativity and the Absurd

The ancient Israelites were sure of the pattern, that they held God's favor.  They lived in the Promised Land, after all.  Then something else happened, off pattern.  A new super power came on the scene, destroyed their temple and threw them into exile.  By the waters of Babylon we sat down and wept, when we remembered you, O Zion... How can we sing the Lord's song upon an alien soil?

When faced with the unpredicted, the absurd, the anterior cingulate cortex shifts into high gear.  Its job is to modulate emotional response, to manage the panic.  It does so by reasserting sense.

Sense can be found in two ways.

The first is to revert to the familiar.  When the brain is overwhelmed by stress, it becomes more efficient.  It shuts down brain-derived neurotrophic factor, stops learning and concentrates on what it already knows, or what it is habituated to trust.  It was the forces of evil (gays, the First Amendment...)  We are being tested, we have to believe harder...  People confronted by the absurd sometimes cling to habit, reject the unfamiliar (immigrants, head scarves).  After 9/11 there was a spike in sales of mashed potatoes and mac and cheese.  That is the anterior cingulate cortex at work, modulating emotional response.

The second way is to ramp up the pattern seeking by noticing connections that had been overlooked.

The second way is the way of creativity.  For the Israelites, the Babylonian Exile resulted in an explosion of creativity, poetry, philosophy, history, new forms of worship, the legal code, and the development of a religion that was larger than their prior notions of land=success=God's favor.  They came up with a religion that could handle exile, handle loss.  It could travel and face the future.

Their brains found new patterns.  They recognized a kinship and developed compassion, even obligation toward others who were immigrants or poor or who had lost.

America At A Spiritual Crossroads

I was approached once to be a supply preacher at a Unitarian Universalist Church during an interim.  I realized I had no idea how to do that, how to preach, if not the Gospel.  So perhaps it is inevitable that I fail my nonChristian readers at this point.

But I will do my best.

The 20th century witnessed horrors when people responded to their suffering by pulling away, by blaming others and cutting off connections, dividing nations into smaller and smaller subgroups to despise.  The brain that does that eventually goes senile.

A lot of us have lost a lot since the start of the 21st century.  And the rules have been rewritten, so we can expect more of the same.  This would be a good time to seek deeper than the theological optimism that cheered us when there was still a frontier and we could always walk away from our failures.  This is not the time to place our hopes for spiritual vindication on the thin reed of an untried and immature quarterback and Christian.  Give the kid a break.  And, by the way, give the people who are rooting for him a break, as well.  They are having a hard time, too.

The good news is that there are other patterns to be found.

The brain that remains open to new experiences, that searches for common ground, grows, creates, delights, has fun!  Ditto the nation.  Ditto the world.

Imagine that.  We are hard-wired for compassion.  And for fun.

Go Cheeseheads!

photo of Tin Tebow from tempecarnivore.blogspot.com/2011/12/hate-time-tebow-here-are-10-sports.html
Hawkeye and AA logos in public domain
Creation of Adam by Michelangelo,  1510 in public domain
The Shipwreck by Claude Joseph Vernet, 1772, in public domain
photo of Haiti earthquake victim by Lohan  Abassi, used under the Creative Commons Attribution License  
photo of UA 175 striking World Trade Center in public domain

Tuesday, January 3, 2012

The Stages of Change and Weight Loss



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

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

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

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

Weight Loss Programs - Hah!

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

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

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

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

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

Habit and the Stages of Change



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

Most of these connections could be called, in the widest sense, habits.  By habits, I mean that pathways get used over and over, form patterns, become familiar, channel us to certain outcomes.  Most bypass the frontal cortex, requiring no thought.  Like breathing, smelling, salivating at the cinnamon.
 
Most of the remainder are still automatic.  But with effort, they can be brought to consciousness where the frontal cortex could interfere, and a decision made.  Like blinking.  Or picking up the cookie somebody brought to the meeting.

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

How Do You Change A Habit?



You're gonna take more than one step.

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

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

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

Nine cups a day of vegetables and fruits:

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

Stages Of Change 

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




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

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

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

Crossing Canyons/Building Bridges In My Brain 

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

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

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

And The Word Became Flesh 

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

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


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


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

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

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

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

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

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

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

Back to New Year's, 2012 

Pre-Contemplation 

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

Contemplation 

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

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

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

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

Happy New Year!  Happy Long Life!


No New Year's Resolutions - Change Your Life December 29, 2011 -- Overweight is a major health issue, the largest contributing factor to early death for people who have mental illness.
My Food Autobiography and the Stages of Change March 8, 2012 -- Pre-contemplation and contemplation.
Changing Food Habits -- Contemplation and Preparation March 15, 2012 -- Reviews The End of Overeating by David Kessler and introduces the brain science of the sugar/salt/fat trifecta.
Dopamine -- Can't Live Without It March 23, 2012 -- The brain science behind habit formation and an experiment to try.
Relapse/Maintenance -- Stages of Change May 24, 2012 -- Review and finishing up the series.



photo of salmon in Ketchikan Creek by Wknight94 and used under the terms of the GNU Free Documentation License 
photo of Women Working at a Bell Telephone Switchboard from the National Archives and Records Administration and in the public domain
photos of Hatherton Canal in Staffordshire by Roger Kidd, Coal Creek Falls by Walter Siegmund, Glen Canyon by Sascha BrückJeff Kubina used under the Creative Commons Attribution-Share Alike 3.0 Unported license.
Stages of Change graphic was created by Todd Atkins, who placed it in the public domain