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Mental Illness: Faulty Brain Circuits April 13, 2010

Posted by Crazy Mermaid in mental illness, Psychiatrists, Therapy.
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Faulty Circuits, an article in Scientific American magazine’s April 2010 issue, summarizes the leaps in neuroscience technology that reveals that psychological disorders have underlying malfunctioning physical brain connections, much like faulty circuiting in electrical wiring. This new evidence-based thinking is a paradigm shift in the way mental illness is thought of not just in the scientific and medical communities, but as this thinking infiltrates the mainstream, it will result in a shift in our perception of how people with mental illness are perceived.

The author, Thomas R. Insel, a psychiatrist and neuroscientist, is director of National Institute of Mental Health, the federal agency that supports the study of mental illness. In describing new findings in the neurocircuitry of mood disorders, Insel tries to bridge divisions between biology and psychology by highlighting the inter-relatedness between neural activity and behavior.

For the first time, we can see in real time problems in brain circuitry by the use of the newest imaging technologies, called neuroimaging.   While the details of each disorder’s “circuit diagram” are still emerging, the new views are already producing seismic shifts in the way we think about mental illness. We’re getting insight into their underlying causes, and that means quicker and more accurate diagnosis as well as better and more effective treatment.

With the new neuroimaging techniques, brain circuits are diagrammed out like electrical circuits, allowing scientists to see exact locations and nature of specific problems.   Some of the problems are coordination problems, where areas that are usually synchronized are out of synch. Other problems involve activity levels in, or communication between, brain areas.  Areas that should be talking with each other aren’t.

One of the more interesting points the author makes is that the behavioral and cognitive symptoms that we perceive as a mental illness may be late manifestations of dysfunction in a circuit. He points out that it wasn’t that long ago that heart disease was diagnosed only when a person had a heart attack, just like clinical depression is diagnosed today only when a person exhibits clinically depressed symptoms.  But in reality, it’s quite likely that in clinical depression as in heart disease and a whole host of other illnesses, observable symptoms only emerge after other compensatory mechanisms no longer suffice.

With this new view of mental illness, we will no longer have to wait until those other compensatory mechanisms fail in order to diagnose mental illness. A Schizophrenia diagnosis won’t have to wait for a psychotic episode.  Not having to wait for the psychotic episode to show up will take some of the fear out of a diagnosis of schizophrenia, since with an accurate diagnosis will come a more targeted therapy that will mitigate some of the more extreme symptoms.

To take clinical depression as an example, we have come a long way in its diagnosis and treatment, and yet we have a long way to go. Back in the early 1960’s for example, there were no predictors of risk, the diagnosis was done by interview, interventions were limited to institutionalization, electroconvulsive therapy and insulin coma, and the outcomes were a very high risk of relapse and a high rate of suicide.

In 2010, we have come a little further. Predictors of risk now include a family history and/or history of trauma. Diagnosis is still done by interview. Interventions are antidepressants and cognitive behavioral therapy, and outcomes are a 50 percent response after 12 weeks. Mortality and relapse are still very high.

The goal for 2020 is ambitious and yet I hope doable.  As a predictor of risk, we will use gene and protein analysis as well as brain imaging.  Interventions will include preventatives such as a vaccine and/or cognitive therapy as well as treatment options tailored to individual need including improved medications, cognitive therapy and brain stimulation. The goal for outcomes is to have the patient respond to treatment within 24 hours, and to reduce relapse risk and mortality risk to low.

The author notes that although mental disorders are currently classified by their symptoms, which overlap in many conditions and aren’t linked to any particular biological evidence, he suggests that reclassifying disorders based on brain function would be very beneficial because it could yield a system of diagnosis based on biological signs such as chemical or structural changes to the brain specific to the condition. He argues that using this new classification system could allow disorders to be diagnosed earlier and with more precision, based on their biological markers.

Changing the way diagnoses are made from interview-based to biological-marker based will change public perception of mental illness in a major way.  A scientific approach to the diagnosis and treatment of mental disorders, he notes, could help eliminate the stigma associated with mental illness.

Source:  Magazine Article: Faulty Circuits, Scientific American, April 2010, pgs 44 through 51

Mental Illness Medication and Slower Thinking February 18, 2010

Posted by Crazy Mermaid in Disability Claim, mental illness, Recovery, Therapy.
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Yesterday, I had a “Flowers for Algernon” moment.  Or rather an hour and a half.  Let me explain.

Distilled into the Readers Digest Condensed Version, Flowers for Algernon, the 1958 story by Daniel Keyes, is about a man with an IQ of 68 who is given an operation to increase his IQ to genius level. He maintains that genius IQ for a relatively short period of time and then reverts back to his former self.

In my case, although I never had my IQ tested, I performed work that was intellectually challenging.  I managed many projects over my 25 year career, and they all required the ability to simultaneously process large quantities of information.  My last job, project managing the construction of a $55 million ice hockey rink, was no different. Building a  project of that magnitude requires some heavy duty brain power.

Thinking quickly, making snap decisions, and processing vast quantities of information in the blink of an eye, skills that I developed from a very early age, were all second nature to me. My intelligence allowed me to walk into any meeting or presentation and do the “Vulcan Mind Meld” with any presenter, routinely asking the presenter a barrage of questions allowing me to acquire an accurate understanding of exactly what the presenter knew and, more importantly, what he didn’t know. That knowledge allowed me to make the kind of decisions I needed to make in order to perform my job as efficiently as possible. That ability made me very good at my job.

I regarded my talent as normal, and was routinely disappointed in people when they couldn’t perform according to my standards. I had difficulty relating to many people, since I believed that they simply weren’t putting their God-given abilities to work.  It never occurred to me that they might not have the ability to process the same quantities of information as rapidly as I could.

When I was hospitalized in May 2008, the medication that I was given began the process of bringing me back to reality. But the side effect of that medication was what I call the “Flowers for Algernon” effect.  The speed that I process information severely slowed down.  Immediately. One minute I thought quickly, the next I thought slowly. That fast. I now think about ½ to 1/3 as fast as I used to.  Unable to hold four thoughts at a time, I have had to re-learn how to think.  More importantly, I have had to re-think exactly who I am, since my identity  is tightly tied to the speed with which I think.

Generally speaking, I have come to accept the new terms of my existence.  The further away I get from my past, the easier it is to forget how fast I used to think and how much information I could absorb.  Very few incidents in my relatively cocooned existence occur that renew my sense of frustration and shame at losing part of my brainpower. Yesterday was one of those days that reminded me of what I have lost.

In consulting an attorney about a personal matter, I was obliged to have an hour and a half consultation in the attorney’s office. As the attorney talked, I found it surprisingly difficult to keep up with the conversation. My brain just couldn’t process the concepts the attorney spoke about. I took notes, but they were too nonsensical to help me retain any information. Despite the fact that I had ample opportunity to ask the attorney any questions I wanted to at any point, I felt, at the end of the visit, as if I hadn’t even been present for the majority of the consultation. This happened, I should add, through no fault of the attorney’s. I’m the one who can’t comprehend relatively simple concepts. That’s virtually unheard of in my universe. Until now.

The woman who ran the meetings and made the snap decisions is gone.  In her place is a much more humble, much slower-thinking person who vaguely remembers what it used to be like to have some heavy-duty brainpower. Flowers for Algernon.

My (Fake) Funeral November 11, 2009

Posted by Crazy Mermaid in mental illness, NAMI, Recovery, Therapy.
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My upcoming 50th birthday has been weighing on my mind, but not for the usual reasons. I have no qualms about turning “old”- whatever that means.  But as the day approaches, I’m dreading it more and more. To celebrate it would be a lie.

Because the person that I used to be suddenly and irrevocably died last year. It was a slow death, sort of. Or at least the process of dying stretched out for months. The mental breakdown that started in February 2008 began the process of cutting away at the very core of my being, and the medication I began taking in late May 2008 finished off what was left of me.  All of what I was is gone, survived by the shell that houses my physical being.

How, then, to celebrate the occasion of the 50th anniversary of my birth?

In my therapist’s office this morning, we arrived at a solution- of sorts. Rather than look at the situation as the anniversary of my birth, I will acknowledge the anniversary in the form of a funeral.  It will, at least for this year, represent my death 16  months ago rather than the anniversary of my birth.  The funeral will be a ceremony in which my grieving can be publicly acknowledged for what it is: the loss of life. The grief is for the birthday that I cannot have.

I returned from counseling and told my husband that in lieu of a big party,  I wanted to have a funeral for my 50th. Not the usual joke-type party where everyone dresses in black and brings old-people gifts. The real kind of funeral. The kind that recognizes the enormity of my loss. I explained that because I died last year (see my blog entry “I Am No More”) celebrating my birthday would be a lie. I told him I’d like just 4 of us, including my sister and brother-in-law and him and I, to go to a nice restaurant, all dressed in black. I said I want a funeral flower arrangement- the kind with the 3 gladiolas. (Did you ever notice that funeral arrangements usually contain those three gladiolas?) One sticking straight up and the other two at 90 degree angles? I told him I wanted one of those. And I want to write my obituary and post it on my blog.

At first, he was in shock (understandably). Then he said that from his perspective, I don’t appear to have changed much. Or at least I have recovered from my psychosis and from those horrible, horrible side effects of the medication I was taking. I no longer believe, sadly, that I am a Mermaid. I no longer have the Parkinson’s, no longer have trouble peeling a banana. I can once again read and write. Getting all of these abilities back after losing them gives the impression that, at least physically, I am back to my old self, whole again.From his perspective, I’m back to normal- more or less.

But it’s really not about how I appear physically to him. It’s about how I am emotionally. And I know that I will never be the way I was. For better or worse, the person that I used to be died. Quickly. Last year. And so for that reason, I cannot in good faith celebrate the 50th anniversary of my birth.  My therapist gave me permission to have the funeral. And after discussion with my husband, he agreed that if that’s what I want, then he’s willing to go along with it also. My sister, I must confess, doesn’t yet know anything about my wishes. But I’m sure that she will honor my request.

We will wear black at dinner. I will purchase a funeral arrangement. I will write my own obituary, to be posted on my blog. The final sentence will say: “In lieu of flowers, donations may be made in her memory to her favorite charity, NAMI”.  Just like the real obituary will say when my shell also dies.

And so we’ll have a funeral. A private funeral, but still a funeral. Because that’s what it really is.

Therapy and Weight Loss October 26, 2009

Posted by Crazy Mermaid in Therapy.
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I never would have voluntarily entered counseling in a million years.

However, my release from the mental hospital was conditioned by a contract I had to sign before the hospital would release me. The Least Restrictive Treatment (LRT) contract between the State of Washington and me required me to attend weekly therapy sessions with a Licensed Mental Health Counselor. Michelle, my caseworker at Fairfax, selected my therapist, Beth, and made arrangements for my first therapy visit to occur three hours after my release from the hospital.

Walking through the door of my new counseling office, I was very wary of the arrangement. Still psychotic, I didn’t believe that I belonged in therapy. Therapy was for screwed up people, and I clearly wasn’t one of those. I was perfectly well. But rather than return to Fairfax, I resigned myself to going through the motions of therapy.

It turns out that my therapy has had and continues to have surprising benefits. Who knew that my lifelong battle with my weight and food started at a very early age, and is the root of my personal battle of the bulge?

My battle with food is getting more interesting the more therapy I have. The therapy allows me to put my food battle in perspective, something that has eluded me for the past 50 years of my life. It never dawned on me before I started counseling that I could put a pattern to my personal battle of the bulge.

Talking with my therapist continues to be valuable.  With the increasing trust in my therapist comes knowledge. The little girl in me is starting to understand that everyone has food calorie limits that aren’t dictated by others. Regardless of whether I felt starved as a little girl, there were always caloric ceilings to adhere to or I gained weight. The laws of physics apply to everyone, including the little girl in me. As adults, we’re free to live on our own, with rules and regulations acquired independently.  But certain things never go away. No matter what the circumstances, there is a limit to the number of calories we can ingest each day before gaining weight. In my case,  1950 calories a day is what  my body needs in order to perform at the optimum level. Any less and I lose weight, and any more and I gain weight.

Recently my therapist has been guiding me through some exceptionally difficult therapy. With that difficult therapy has come an ever-expanding girth.   In the three months of exploration of certain things in my life, my stomach has expanded about 3 inches because of the enormous number of calories I have been taking in. One of my ‘go-to” comfort foods is dark chocolate. During my intense therapy sessions, I have been allowing the little girl in me to eat as much and whatever she wanted, understanding that it was part of the therapy process. Chocolate chips are my comfort food, and I need to have unlimited access to them in order to get better.  I understood on an intellectual level that my body had daily calorie limits.  But the little girl inside me has been fighting those caloric limits as if they were imposed by people rather than the laws of physics.

I’m finally reaching a landmark in my therapy, where I am beginning to internalize the fact that caloric limitations area caused by the laws of physics. They aren’t administered by others. With concept comes a new approach to food. I’m not saying I’m skinny or even that I’ve started to lose weight. I’m simply coming to terms with the laws of physics. That, after 50 years, is a major accomplishment.