WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.




Satipatthana

trapped

The recent marriage between neuroscience and meditative traditions may hold the key to the future of human civilization. Few other modern trends hold any potential to derail humanity from its track of destruction. Many of Daniel Siegel’s writings demonstrate how a combination of internal (meditative) and external (scientific) explorations of the mind can relieve age-old sufferings of humankind. Rick Hanson’s book, Buddha’s Brain, distills this fertile and vast field into a roadmap for personal breakthrough to peace.

Living north of San Francisco, I am fortunate to be able to attend a weekly meditation event led by Dr. Hanson. Recently he guided a discussion about the fruits of practicing a venerable Buddhist meditation called Satipatthana. In the course of such work, one sequentially pays attention to body, to feelings, to mind, and to the obstacles and vehicles one encounters on the path toward awakening. Rick inquired about our personal takes on the benefits of this system of meditation. My thoughts cohered too slowly for me to participate in the discussion, but after returning home I wrote down what I believe Satipatthana is teaching me. I soon recognized a close connection between this meditation practice and what I’ve been saying on this site about the value of sorrow.

Back when I still suffered from chronic depression, my mind seemed like a monolithic psychic prison. With effort I could adopt a few moments of positive thinking, but all-too-quickly my internal world spiraled back into its baseline state of despair and negativity. It was as if my emotional habitat had been formed of poured concrete; it looked like a solid and monotonous block of cold gray stone. Changing my inner experience seemed about as likely as a prisoner breaking through the walls of a penitentiary with his fists.

Partly as a result of Satipatthana, I now understand that my mind is actually a fragmentary collection of mental activities that can be reshaped with the right kind of effort. The gray monolith turns out to be no more rigid and massive than the Styrofoam used to make stage props. By using this meditation practice to explore my body, feelings, and thoughts, I have learned that my mind is composed of many different parts. There is a module that directly monitors sensations; another evaluates what has been perceived; a slightly separate unit grasps or rejects the judged experiences. Further along the line, there is a component that suffers when desired experiences dissipate or undesired ones persist. Finally, there is an expansive region that remains detached and simply observes. While enjoying the steady peace of meditation, I can shift my focus and attend in turn to these distinct elements.

This helps me recognize the difference between the bodily and mental sensations that accompany sorrow, and the suffering that results. In the ordinary course of mental life the experience of grief and loss seems inseparable from the anguish that arises. In actual fact, there is a sequence: first comes identification of loss, then comes the sensation of grief (often felt as a hollow ache in the viscera), and finally comes the mental anguish.

Loss is inevitable. Grief is a natural and largely unavoidable reaction to major loss. But we can influence the depth of anguish and despair to which we descend. Before I started this work, the experience of grief almost always led to depression and a loss of all enjoyment of being alive. Meditation helps me embrace ongoing sadness while appreciating that life is a beautiful gift.

There is a difference between the sorrowful ache of mourning and the choking darkness of despair. The second does not necessarily follow the first. One can experience and even savor pangs of grief and remain grateful for every moment of human life.

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Satipatthana was published on May 13th, 2010, with these tags: , , . To date, this entry has received 3 comments.






Maturation of the Mind

Gandhi

There is a state of mind, known to religious men, but to no others, in which the … time of tension in our soul is over, and that of happy relaxation, of calm, deep breathing, of an eternal present, with no discordant future to be anxious about, has arrived.

William James, The Varieties of Religious Experience, 1902

James describes exactly the condition that I’ve been enjoying since the middle of January. However, he must be mistaken when he concludes that this state of mind is available only to religious men, because I am by no means religious. Setting that important discrepancy aside, the psychologist’s numerous case studies prove that a profoundly wise and peaceful state of human existence awaits us; our task is to find ways to achieve and retain this higher mode.

James’s classic compilation and analysis of spiritual growth experiences exerted a major influence on Bill Wilson, the founder of Alcoholics Anonymous. It helped Wilson and his compatriots as they created a system to facilitate spiritual transformation in alcoholics. Here is Wilson’s description of his own awakening (from the ‘Big Book’ of AA, 1939):

All about me and through me there was a wonderful feeling of Presence… A great peace stole over me and I thought, ‘No matter how wrong things seem to be, they are right’.

This transformative experience helped Wilson, a hitherto hopeless drunk, remain sober for the rest of his life. There was a time when I doubted that such a change was possible; I may even have questioned Wilson’s sincerity. But in the year 2000, after returning to AA following a long absence, I went through a series of experiences very similar to his. Here is a description of one of them, taken from a previous essay on this site:

I stood at a locus from which I viewed creation arising from subatomic scales to fill the entire span of the modern universe, in a near-instantaneous ‘vision.’ As I saw these things, I inhaled the atmosphere of all-encompassing love and ‘rightness’ that animates everything. I heard a chorus of celestial voices, and felt myself basking in a divine affection that erased all doubt that God existed, that life had meaning, and that I mattered.

Although that episode and others like it had an enormous impact on me ten years ago, I did not know how to maintain elevated states of understanding; as a result I sank back into a stubborn and miserable depression that crushed me for at least six years. Fortunately, as long term visitors here have read, transcendent awareness returned in January. As before, it was my work within the AA framework that made my heart receptive to transformation. Here is the result, once again quoting from an earlier piece (Note that this time around the experience did not feel referenced to ‘God’ or any other overtly religious concepts.):

I perceived the evanescence and formlessness of the human mind, the interplay between humans and nature, and how everything intertwines in the awesome depths of creation. The way the human spirit dwells amidst vast spreads of time, space, and scale became clear to me in ways that surpass words…The scope of this new perspective crushes into triviality many of my prior concerns.

Recently I’ve mentioned Quantum Change: When Epiphanies and Sudden Insights Transform Ordinary Lives, by William Miller and Janet C’de Baca. Like William James, these authors document many awakening experiences. Although James presented some transformations that came on gradually and others that were sudden, Miller and C’de Baca focus on ones that happened abruptly, as acute life-altering events. They cite many spiritual and secular leaders who have described swift openings of consciousness. The Buddha, Mahatma Gandhi, Mohammed, George Fox (the founder of Quakerism), Malcolm X, Florence Nightingale, Joan of Arc, Leo Tolstoy, C.S. Lewis, and saints Paul, Augustine, and Theresa of Avila all underwent rapid and profound transformations of consciousness. The list could go on and on.

Citing work of James E. Loder, Miller and C’de Baca tell us that such experiences unfold in a characteristic sequence. “Something disrupts the way in which the person has been perceiving reality and making sense out of life…’an insight, intuition, or vision appears’…frequently accompanied by a great emotional release and a deep sense of relief. Then, with time, the person integrates and interprets the experience…and new patterns of thought and action emerge.”

It is likely that these psychic events are generated by novel patterns of neurologic activity. In fact, patients with temporal lobe seizures recount rather similar feelings. In Phantoms in the Brain by V.S. Ramachandran and Sandra Blakeslee, the authors paraphrase such patients:

I finally understand what it’s all about. This is the moment I’ve been waiting for all my life. Suddenly it all makes sense…I have insight into the true nature of the cosmos.

These patients have demonstrable anomalies in their brain waves, so in at least these cases the new consciousness can be traced to altered neural activity. Often such people retain their elevated understanding of cosmic significance even between acute episodes. The authors speculate that new neural channels are opened that “permanently alter—and sometimes enrich—the patient’s inner emotional life.” These patients have seizure disorders, but there is every reason to suspect that even the brains of people without electrical abnormalities can be decisively transformed by powerful spiritual episodes.

In the five weeks since the onset of my altered consciousness, I have indeed observed major alterations in my ‘inner emotional life’. As I’ve mentioned in recent posts, the change has by no means left me in an unwavering state of bliss; the heightened and peaceful awareness comes and goes. Sometimes despair threatens to reassert control. On the other hand, I am learning that by taking some simple and concrete steps I can bring myself back into alignment and sidetrack my old neurotic patterns.

My message today is straightforward: humans have the capacity for elevated states of consciousness that reduce psychic distress. These psychological modes open the mind to broader ways of seeing life, reveal order and refuge in the cosmos, and often increase one’s desire to behave altruistically. Because they remove people from the narrow, egocentric and damaging patterns that society encourages from birth, these improved frames of mind may represent a natural maturation of the human mind. They can occur as religious epiphanies, but they can also develop as completely secular insights. Subsequent posts will explore the ways a person can make such transcendence more likely and more robust.

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Maturation of the Mind was published on February 21st, 2010, with these tags: , , , . To date, this entry has received no comments.






Tend Your Mind’s Garden

My plan and promise is to write out my spiritual insights, gained after a decade of struggle. They came to me in a rush over the span of a week or so. Unfortunately, it seems I can’t control the order in which the concepts get written. Starting with one idea, I wrote another. What follows may not be the best way to begin, but I don’t want to leave people waiting. And besides, everything has to start somewhere.
The short answer to my spiritual salvation is clarity. By looking at what it really means to be a human being, and pondering it at length, I have found self-love and motivation to live a more fulfilled life. This post is one statement of the case for looking closely in the mirror. Much remains.

GardenWe choose our world. Plato suggested humans select a life prior to birth, then live it in a state of amnesia. Perhaps that’s true, but that’s not the point of this essay. For the moment, consider the inner experience. When you think about it, doesn’t what happens inside our brains have a bigger influence on our contentment than what happens outside? And aren’t the two more separate than we appreciate in day-to-day life? Even though the environment constantly touches our senses, and so shapes our minds, it is not hard to make a distinction between the inner world and the outer one. And it is the inside that makes us happy, or drives us insane.

Somewhere ‘out there’ sits the cosmos. It consists of things we call ‘matter’ and ‘energy’. External to our minds, substances and forces move, fluctuate, and interact. We have good scientific descriptions of how this works, but we don’t experience it directly. All we have access to are the patterns of nerve signals that enter our brains by way of nerves. These nerve signals come from complex sense organs such as eyes and ears. They also arrive from scattered sensory cells (in our skin, organs, and tendons) that provide our sensations of touch, bodily condition, and movement.

It takes effort, but try for a moment to fully acknowledge these facts about the separation between the mind and the physical world. Scientists and philosophers debate about the nature of the ‘self’ that makes use of incoming data. But even without understanding the ‘self’, it is helpful to grasp that our minds depend on sense organs for contact with the universe. Sensory systems are the windows through which we view our lives.

These concepts can be used to improve mental comfort. As a personal example, the teeth in my upper jaw sometimes throb, probably because of jaw clenching. But for some reason, my lower teeth feel fine. So here’s where I get to choose my world: in my mind, I can either attend to the upper molars, or the lower ones. It used to seem like the aching was outside my control; it shouldered its way into my consciousness. Not that the pain was awful, life disrupting agony. The discomfort meant little more than annoyance. But whether I wanted to suffer with it or not seemed irrelevant.

A few days ago, I remembered something taught in chronic pain classes. Rather than paying attention to the upper teeth, I shifted my focus to the lower ones. Very quickly the toothache abated. Discomfort persisted, but without me centering on it, its intensity died. I’m not talking about pushing sensation away, only about shifting attention.

I hope this example makes clear how readily we can alter experience by attending to different sensory input, such as lower jaw versus upper. Or we could look at the flowers on the roadside rather than the litter. What’s more, we can use selective attention in other ways: we can turn toward pleasant memories, and create helpful thoughts. Recently, in the midst of one of my depressions, I listened to a friend’s advice to remember happy times when feeling sad. Naturally, it seemed like the facile suggestion of someone never tormented with true despair. But he did have a point. Just as we can choose which tooth to listen to, we can select which memories to replay in our heads. Similarly, we can decide whether to dwell on our fears, or imagine our dreams for the future.

Sound familiar? These days, most people treated for mood disorders learn about Cognitive Behavioral Therapy (CBT). It’s been proven to help people who suffer from anxiety and depression. It teaches how to steer the mind away from troubling waters. The goal isn’t to live in denial or avoid problem-solving. But why dwell on situations we cannot change, or worry about stuff that we can’t prevent, and that hasn’t happened.?

Many religions promote mental discipline. Buddhism literally makes a science of it. But spirituality is not required to gain the benefit of self-guidance. There are many books that teach CBT, and the idea of ‘positive thinking’ has been written about for at least a hundred years. My goal in this note is to give the perspective that humans exist in biological structures of unthinkable complexity, and that consciousness (whatever it really is) can direct inner experience. Gentle tuning of attention and thought can aid our perpetual search for peace. Rather than succumbing to the dreaded ‘bipolar’ label, or suffering hopelessly with the onus of ‘depression’, we can begin to take charge of our interior worlds.

Obviously, these techniques by themselves will not resolve severe mood crises. Much can be written about how to gain the self-love necessary to embrace strategies that promote contentment. But recognizing the distinction between inner world and outer reality is a useful step on the path toward ease of mind.

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Tend Your Mind’s Garden was published on January 18th, 2010, with these tags: , , . To date, this entry has received 2 comments.






‘Karma Chameleon’

Yemen Chameleon

The idea to write about chameleons in my last post came via a mailing from the California Academy of Sciences. Only I did not mention chameleons, and wrote about the institution’s new building instead. Thinking about why I got sidetracked, I realize the structure has peeved me ever since I visited it after completion. In the process of learning to be a docent, I attended a series of some twelve lectures about the new structure, and it sounded like the coolest thing ever. But when I entered it, the place just seemed sterile to me. The exact opposite of what I expect from a museum about life and nature. Why the place struck me that way remains a a bit of a mystery. Inside, they built an enclosed rainforest. Yes, an actual jungle with trees climbing dozens of feet, vines, waterways, and all manner of creatures. Granted, the animals all live in display cases (except the butterflies, which flutter freely), but the glass boxes present the organisms well. They look as natural as possible under the circumstances. The effort to do something unique and mind-blowing succeeded. And that without even taking the vast aquariums into account.

Maybe I complain about its success. The museum does such a fantastic job of bringing a tropical jungle environment to San Francisco, that it reminds me of the words from the 1970 Joanie Mitchell song, “Took all the trees, put ‘em in a tree museum”. She wrote the lyrics about a botanical garden in Hawaii, but the Academy takes the concept a step further. Oddly, the sense of that song fulfilled as a prophecy bothers me as much of anything. Has it come to that? A jungle in a bubble?

So I ended up writing about glass enclosures, and comparing them to the way our culture encourages people to rope in feelings, sensitivity and intuition. Our emotions are ‘supposed’ to remain confined, and not let out into the rational world of purchase and finance. We are to wall them off, the way the museum separates dirt, leaves, and bugs from the people walking concrete ramps in designer sneakers. A doomed and misguided stricture, it wipes all the messy ‘nature’ from the human psyche, leaving us with the machine like computations and reasoning of the brain’s neocortex (the evolutionarily ‘newest’ area of the nervous system, much enlarged in humans). When one compares the neocortex to the ‘older’ parts of the brain, sometimes called the ‘reptile brain’, a clear cut difference in regularity and modularity jumps out at you. On a functional level, the neocortex consists of repeating units of nearly identical cellular arrangement, which the brain adapts to different types of information processing in different regions. The ‘lizard brain’ on the other hand, looks chaotic, disorganized, and confusing. More organic and less like a biological iMac. The neocortex, don’t get me wrong, must be the most miraculous structure in the universe. Its capacity for figuring things out, speaking and symbolizing, creating art and song, and all the other human accomplishments must make God proud, if there is a ‘creating’ God (frankly, I kind of doubt that, but I remain open-minded and respect others who have faith that an omniscient consciousness built the universe).

Still, we share the more ‘organic’ appearing and deeper brain structures with a larger proportion of the animal kingdom. Like chameleons. (Did you think I’d forgotten about them?) What I read in that Academy publication said that chameleons don’t change their color so much in order to blend into their surroundings, as they do as an expression of ‘emotion’. It gladdened me to see affective responses freely ascribed to an organism as foreign as a lizard. When people muse about whether other animals have feelings (a discussion that happens more than I like) it immediately occurs to me that they have never loved a pet. Anyone who has bonded with a dog or cat does not need to conduct experiments to try to figure out if the animals emote. Those who love pets know that our non-human companions never stop expressing inner states that look very much like what we would call (for example) happiness, frustration, desire, or love. But I’ll have to admit, seeing the label ‘emotion’ attached to the interior world of a lizard surprised me. Not that I disagree. Even spiders seem to experience fear, for instance (ever tried to catch one and seen how it runs away in a ‘panic’?). Still, I usually think of chameleons as rather prosaic creatures.

Apparently such thoughts border on homo sapien bigotry. I humbly apologize to all reptiles for assuming they lack strong feelings. A male chameleon, in the throes of romance, will display crimson and green in vivid patterns, while puffing up like a decorated soldier on review. The female, if impressed, responds with a toned down version of the same coloration. If bored and uninterested, she turns brown. Would that human females were so easy to read.

Emotions are ancient. We share them with many (perhaps most) creatures on earth. They comprise one of our most touching bonds with the animal kingdom; unlike rational thought, which sets us apart. Emotions transform animals from machine-like entities with robotic needs for food and sex, into souls. Rather than acting like stimulus-response algorithms (if low on fuel, move toward food; if tanked up, search for a mate), they become seductive and flirtatious, ravenous or comfortably sated. Maybe just semantics, you might respond. How do we ‘know’ that a lizard flirts? Aren’t I just anthropomorphizing, to suggest such a thing? Yes. I am doing exactly that. If it looks like seduction, why not assume the lizard ‘feels’ amorous. Why should we jump to the arrogant conclusion that the chameleon has nothing going on inside. Just because we make machines that are incapable of emotion (though people try to make robots that emulate feelings; with eyebrows that move, for instance), have we justification for assuming that evolution works the same way? Does it really make ‘rational’ sense to postulate that emotions as we experience them popped into being along with the neocortex? Isn’t a more parsimonious explanation that they have been here all along? That the only human addition to the realm of feelings is the ability to speak, write, paint, and sing about them?

In that view, which I believe makes the most sense (even though it cannot be validated scientifically), emotions have an primeval heritage that we would do well to honor. Passions animate. They bring us the luxuriant and consuming experiences in life that intellect cannot comprehend. They are the language of the soul, and may even be the closest biological correlate to the ‘spirit’ world. They make animals precious. If other creatures have feelings, then they demand better treatment than they often receive. And so do we.

If feelings come to us from the earliest forms of crawling life, then they define the animal kingdom in a fundamental way. (Some would even say plants have feelings. I am not ready to go that far, but who really knows?) As I said in the last post, emotion should not be treated like an unnecessary and accidental nuisance. A world of ‘Spocks’ would be an uninteresting planet (would you want to be a Vulcan?). Feelings have a noble lineage, bond us to the natural world, and bring texture to life. Reason just figures things out.

When younger, I thought of myself as a chameleon. I used the term in a sense that the Academy tells me was inaccurate. Chameleons do not go around matching the environment. So calling people who try to blend in with every crowd by that name spreads a false myth about the lizard. In any event, my camouflage skills worked poorly. Yes, I changed from group to group, but even so I seldom ‘fit in’. I made a poor chameleon, in that sense.

With my new understanding of the animal, however, I deserve the chameleon gold medal. My emotions spread through my whole being, and completely change the face I put toward others. When depressed, I am distant, pessimistic, and terse. When happy, I become intimate, excited, and voluble. Two completely different animals.

758px-Dance_of_Love

We are all chameleons in that sense. We all change our aspect according to our inner world’s weather. Some hide their condition better than others, and alter their hue less obviously. Perhaps their inner winds blow less intensely, their passion heats without searing, and the sleet of sadness stings only a little. Or maybe they just enclose the storms better than those with more demonstrative behavior. Either way, we also know people can have such histrionic responses that the main body of humanity shies away, calls them ‘ill’, and wants them to ingest synthetic chemicals. I’m one of those ‘overly emotional’, and ‘too sensitive’ human animals. Society tells people like me to settle down.

Je refuse! I plan to wear my heart on my sleeve with gusto. Not that I want to create havoc in my life, harm others, or ‘lose it’ at inopportune times. But when the ‘spirit moves me’, I shall dance. I will boogie with all the myriad beasts on this earth, and be proud of my strong emotions. My feelings will bind me in spirit with all my furry, feathery, and scaly companions on the dance floor. Including the ‘cold-blooded’, but kaleidoscopic and ardent chameleon.

(I modified the wording of this post on 12 September 2009, c. 04:10 PDT.)
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‘Karma Chameleon’ was published on September 12th, 2009, with these tags: , , , . To date, this entry has received 3 comments.






Insomnia, and other underrated forms of madness

brainasleepanatomy

One manifestation of my brain’s atypicality can be seen by tracking my sleep patterns. Over about a six day cycle, I regularly drift from spending about nine hours asleep to getting only three hours a night. It averages out to six hours per twenty-four, which is not bad, but it’s hard to maintain a sense of predictability and regularity with this pattern. Also, sometimes around 8:30 pm I feel worn out to the point that I can’t stop myself from going to bed early, but then I wake up after midnight, like I have now, and remain awake for four or five hours. After that I’ll go back to bed and (hopefully) sleep for another hour or two. Over the years I’ve tried many things to smooth out this roller-coaster, but to no avail. I don’t want to take sleeping medications 50% of the time, which is what I would need to avoid the three-hours-of-sleep nights. And if I try to stay awake when I’m tempted to tuck in early, I find my mood sinks so low that nothing gets done except sitting and brooding. Or watching TV and dozing off. Reading and writing just don’t happen when I feel that way.

I try to take advantage of the nights I don’t sleep. I write or study or meditate. If I’m at our Yosemite place, I may sit in the hot tub and marvel at the stars (so many stars up there in those primordially dark skies). Now that I take fewer psychiatric medications, I see that I need even less sleep. As humans age, some data suggests they tend to sleep fewer hours (there is better evidence that the proportion of time in REM sleep decreases). Since I started out not requiring much more than six hours, it’s beginning to look like I’ll end up needing only five.

What is sleep doing for us, anyway? In what I’ve read, and it’s not extensive, the answer is clear: no one knows.

One popular idea is that it helps consolidate memories. Experiments with sleep deprivation after certain types of learning tasks back this up. In particular Rapid Eye Movement (REM) sleep seems connected with acquiring new skills. When people sleep after learning complex tasks, brain imaging sometimes shows that the same regions are active during REM sleep as were active when the task was being practiced. This seems to suggest that REM is replaying the learned activity, presumably in order to fix it in the mind.

On the other hand, although facility at learning tasks (technically called ‘procedural memory’) associates with sleep, the ease of learning information (‘declarative memory’) does not. And even if REM helps some forms of memory formation, that does not explain the need for all the other stages of sleep (and there are several).

Although I like to understand the brain, I am happy that there remain so many mysteries. My suspicion is that this will be the case for a long time, possibly forever. The organ has such unimaginable complexity that figuring out what it does is truly daunting. Despite all that we’ve learned, we really don’t understand more than some superficial information like which areas demand more blood during which activities, or the types of neurotransmitters that mediate different brain functions. The fine details of how computation (a.k.a. thought) occurs remain quite obscure. Some basic facts have been established. For instance that information processing is modular. This means that incoming visual data get broken down into components such as depth, color, movement, and orientation in space. Each of these are handled by separate (though often adjacent) clumps of nerve tissue, and later recombined. But computational studies remain coarse in the level of activity they investigate: typically the combined signals of hundreds of simultaneously active cells.

In fairness to the brain science community, I am oversimplifying. Enormous amounts of research have been done. So much has been learned that I really have only vague estimates about how much is known. But I have a pretty good idea about what is not understood: i.e., most of what the brain does.

It is easy to get impressed with the volume of factual information about the brain that scientists have collected in the past one hundred years. But it is even easier (and more important) to get a sense of awe from the realization that despite all the millions of pages written about the brain, we really don’t know something as basic as why sleep evolved.

Psychiatrists, and those who consult with them, would do well to keep this in mind as they try to address complex personal issues (like excessive worrying, chronic sadness, or uneven sleep) by adding one or a few chemicals to the blood stream. These solutes reach every cell in the brain, and affect many, many more neurons than the ones ‘targeted’. And even in the cells the medications are meant to affect, the actions are varied and all too often transient. The brain is quite adept at restoring its native state (see my post on receptor downregulation).

Sometimes it is better to accept an atypical pattern, like wacky sleep cycles, than to wrestle the brain into normative behavior with drugs. Besides, there can be advantages. Like writing a post in the middle of the night, so tomorrow I can concentrate on the other work of blogging: reading what others write. Or maybe I’ll have time for more fun with Mandy and the dogs. Or a longer workout. If I gave in now and took a sleeping pill, I would spend a nice restful night in bed. But I would wake up tomorrow after too many hours asleep, and still feel groggy. And if I kept taking the pill night after night, pretty soon my sleep would be dependent on the drug. If I stopped it, I would face several nights of near-total insomnia before I got back to what my brain wants: a six day rotation between nine hours and three hours of sleep.

I don’t know what this says about my brain’s health. It would be easy to call the three-hour nights ‘hypomanic’. In fact, I used to live in fear of them, thinking that hypomania meant possible manic loss-of-control and/or inevitable subsequent depression. Now I find that is not true. Provided I always allow myself to sleep when I can, and make sure that even if I can’t sleep I get some time in bed resting and calming my thoughts, I do pretty well. I don’t find myself making horrible decisions, or getting pounded by despairing feelings of worthlessness and futility. Admittedly, in my life I have seldom had true manic episodes (maybe only one time, but it lasted 2 years and destroyed my life). So I don’t worry too much about completely ‘losing it’, and (for instance) gambling away my life savings. But I know some who do have more trouble with severe mania, who find they can manage it with less or no medication, provided they are diligent and committed to keeping things healthy. It helps to have a devoted and observant spouse.

Society exerts pressure on people to conform. That becomes obvious in grade school, and it never changes. The main body of humanity tugs hard on the fringes, trying to pull them into the huddled center. Deviance, or even disagreement, tend to be poorly tolerated. So those of us with brains that function ‘differently’ from the ones comfortably in the center of the bell curve have to contend with criticism, rejection, and pressure to take drugs. All are either indirect or direct efforts to get us to conform.

There are mental states that pose hazards. Particularly to the individual who suffers them (i.e., suicide), and more rarely to others (e.g., the family left bankrupt by a manic run to a casino, or the spouse broken-hearted by a string of impulsive and dangerous sexual liaisons). The tiny threat of physical violence against strangers (the ‘psycho’ murdering students with an assault weapon), gets a great deal of attention. But if we define wanton violence as pathological (which I’m not saying is a bad idea), then many heads of state should be diagnosed as ill. If we go a step further, and say all those with a propensity for needlessly harming others require pharmacologic therapy, then we really should have force fed George W. Bush with Seroquel.

I’m not saying that no one should get psychiatric medications. That is not my position. But it is all-too-clear they are overused, that they cause physical and mental anguish, and that they are not particularly effective (unless you count drugging someone into a slurred stupor a success). The pharmaceutical companies have had free reign to promote their product, and we need to rise up and apply counter-promotion to balance the scales.

insomnia

In a larger sense, it is vital that we stand against the shove of society, and reclaim our right to be different. The tension between those who demand absolute obedience to the dominant culture’s standards, and those who advocate diversity and creativity, is never ending. The first step is to recognize that this is the problem we face. We need to demand to be allowed to be different, and then accept help when we want it. Otherwise we get the current situation, where we are told we are sick, and have to refuse drugs at every turn.

I’ll be up for a while longer. I’ll edit this post, write a letter or two, and explore some of my fellow travelers’s blogs. I’ll appreciate this night of little sleep as a time for making up the lost ground that resulted from weeks of rocky moods while withdrawing from Cymbalta. I’ll be glad I’m different. I’ll claim my privilege to consider myself ‘better’ than the boring norm.

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Insomnia, and other underrated forms of madness was published on September 3rd, 2009, with these tags: , , , , , , , . To date, this entry has received 9 comments.






‘Through a glass, darkly’

rose tinted glasses on a dog

Sometime back I promised a post about how one’s attitude changes with drugs. When I quit Cymbalta almost a month ago, I quickly lost my confidence, started to feel tired and discouraged, and decided life did not have much value. I fear that without my strong connection, devotion, and commitment to Mandy I would have succumbed at last to the suicidal tendencies that have dogged me since my first major depression at age twenty. Yet not long before things had looked pretty rosy to me.

At present I am coping with some medication-induced injuries that will never leave me, even though I’ve quit the drugs that caused the damage. I find the destruction visited upon my body demoralizing and infuriating. But before stopping the Cymbalta, it seemed like my grip on the situation had improved, and I had hope that with a little time and meditation my distress would abate and I would settle into a more-or-less calm acceptance. Not long after my final dose of that drug (I continue to take several others), the problem started looming large again. I felt, once more, like my life had been destroyed. Given that my passion for breathing (and all the other essential components of human life) has always been lukewarm, suicide started to look like a logical and acceptable solution. How much grief, defeat, and loss can one person take?

As I’ve implied, my agreement with myself and Mandy is that I will stay around for our relationship. So although I had a well-worked out plan for my demise, I never set a time frame, and just sat out the foul emotional weather. In just the past day or so, I have started to feel more like I can continue to live without merely gritting my teeth and waiting for natural death. Life has begun to look worthwhile again. Mandy and I have more frequent affectionate moments, I smile more often, and I feel like my energy has returned. Today we happen to be enveloped in smoke, due to a supposed ‘controlled burn’ that escaped its lines and is now raging in Yosemite. Every few hours the wind shifts to carry a thick cloud of particulate haze into our region. If we did not have so much air pollution, I’d be outside catching up on all the chores I neglected as I fought my way through this withdrawal. It feels good to recover the desire to be productive. I hypothesize that my brain is building more serotonin and norepinephrine receptors to compensatefor the reduced levels of those transmitters that followed stopping Cymbalta. (See this discussion about what is probably going on.)

My optimism would be greater if this had not already happened once. About two weeks after cessation there came a previous time of relief from the whirlwind, but it only lasted five or six days. So I will not be surprised if the curtain descends again. But right now I am feeling better, and I won’t spoil it by predicting another setback. This is how I ended my post back at the time of the last break from despair: “What I’ve written so far is the introduction to my real topic: the relationship between the chemicals that traverse my brain and the ‘person’ that the organ produces.”

For a number of reason I never got back on-subject. Today I am going to try to tackle, in a small way, the relation between chemical changes in our brains and the people we think we are.

In my opinion, it comes down to something like different vantage points. I wrote during the last storm break about how my little house in the hills would be invisible to a passenger in one of the airliners that regularly stretch contrails above me. I live my drama down here in the trees, yet those in the aluminum tubes soaring overhead have no clue about my problems and discouragement. They just don’t see my world of concerns. When I am medicated, it is like I am flying in the stratosphere. I observe my anxieties glide beneath me, but they look tiny and far away. Sometimes they get obscured by the pretty scenery, and I can almost forget they exist. But when I stop the drugs, I land flat on my belly on the August-baked earth, and gasp for full breaths in the smoky air. The pharmaceutical agents become the proverbial ‘rose-colored glasses’, that make a dim world look bright.

If they worked as well as I describe, I’d have to ask why one should fight the way I do to end my dependence on the medications. But if you look through pink-tinted lenses long enough, you no longer see the pink. Your mind adjusts and everything starts looking the way it did before. So then you are no longer jetting through the upper atmosphere close to the speed of sound, and instead end up bouncing along at ground level in a dilapidated truck. What’s more, even though the chemicals no longer help as much, the side effects continue. That is why I stopped Cymbalta. It helped my mood a bit, but the benefit diminished until it no longer seemed worth the heavy cost in adverse reactions (primarily anorgasmia). So I stopped taking my daily green pills, and have been fighting to regain my footing ever since.

If my entire opinion about whether to live or die hinges on a chemical called duloxetine marinating my brain, the question becomes, who am I? The suicidal man who feels life has dealt so many injuries it no longer warrants engagement? That is to say, am I ‘really’ this troubled person who emerges upon cessation of the drugs? Or am I instead the (kind of) bubbly soul that can discover benefits even in raw wounds and festering infections? Am I ‘in fact’ the wry middle-aged guy who emerges when the drugs (occasionally) work perfectly well?

Or am I both? Or neither?

At least I now recognize that my feelings change. It used to be hard for me to see that my attitudes shift. If the world felt awful, I believed in an unshakeable way that my feelings at that moment accurately summed up the nature of life as it had always been. On the flip side, if things looked cheery, I had a hard time remembering how it felt to be depressed. After years of gyrating feelings and world-views, I now recognize that tectonic shifts have repeatedly rocked my inner environment. My ability to predict eventual good feelings even when I am mired in deep depression has improved. I have recollection when I feel rotten that life once seemed fun, and vice versa.

As that sort of memory consolidates, I start to appreciate that my feelings are transient little things that have no direct relationship to outside reality. They are my internal filters, and not firmly connected to either the external scenery or my actual ‘self’. The same person (me) and the same life (mine) can look ashen through one set of spectacles, and sunny-yellow through another. I am the person behind the glasses, or even further back: behind the eyes. Possibly the real me looks through yet another screen: the brain. Some believe that our true selves have no material biology, but exist as ethereal spirits. I don’t go quite that far, but there is no question that somewhere separate from all the opinions, all the filters, all the moods and feelings, sits a person who is protected from the storms, and watches with a wise and tolerant eye as all the hurricanes and earthquakes and volcanoes thunder over the landscape. I’ve mentioned Acceptance and Commitment Therapy (ACT) before, and I am touching here on ACT’s core assumption.

I am not the earth’s tremors, or the volcano’s blast. I am not the wind or the sun or the rain. I am the ‘self’ that observes all the changes, all the weather, all the thoughts and feelings. But this is so easy to forget. It is as if, while watching a movie, I confused the events on the screen for things in real life. If I think that somehow my identity is that of a scared and lonely man, hemorrhaging and forlorn, I am overlooking the fact that at other times, with different chemicals in my blood, I feel like ‘someone’ entirely different.

It could be that I am nothing more than a memory stream. A dynamic album of photographs that keeps adding page after page after page. My identity cannot be pinned down to any particular image, not even the most recent ones. Instead, to get any sense at all of ‘me’ as a stable and defined entity, you have to look at the entire book as a unit.

By changing my drug regimen I am not creating a different person. I am just turning the page, putting in new pictures taken through different lenses. What I think and feel today is just an addition to my identity, not the summation of it.

Does this make any sense at all to others? I know these ideas are not mine alone, and no doubt writers more eloquent than I have stated something like the same point of view with greater clarity and logical support. But this is what I meant to bring up two weeks ago, during my previous respite from the Cymbalta-withdrawal nightmare that has been my ‘reality’ since August first. I am aware of some texts I need to read that touch on similar streams of thought. When I get more information, a wider perspective, and time to digest, I will return to this subject of self and how it relates to the turbulent currents of mood, opinion, biochemistry, and experience.

mothdrawing
For now, I am glad of the break from the pain. It feels good to expand again, and fill my wings with blood the way a newly metamorphosed moth pumps itself up before taking flight into the moonlit sky. For now, at least, I can nourish myself again, and savor the nectar of daily life.

(Click here to link to a nice video showing a moth feeding on nectar.)

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‘Through a glass, darkly’ was published on August 28th, 2009, with these tags: , , , , . To date, this entry has received 2 comments.






Mind, Moods, and an Organic God

dnasculpture

My last post wore me out, emotionally and physically, so I’ve needed a break. But here I sit again, ready to write. The prior essay centered on structural changes in synapses, and how those relate to difficulties with changes in either behavior or medications. Loss of serotonin receptors with SSRI antidepressant use (e.g. Prozac), leads to a dependence on the medication. When SSRIs are withdrawn, the brain no longer has the receptor capacity to work with the lowered serotonin level which follows. So we get depressed. I have experienced this repeatedly in my efforts to lower my antidepressant load.

The brain gets used to certain inputs. Many pleasurable activities, and drugs of abuse, increase dopamine. Like serotonin, dopamine is a neurotransmitter used by a minute fraction of the brain’s neurons. When the nucleus accumbens, or ‘pleasure center’, gets flushed with this chemical, one feels deep satisfaction, sensual gratification, or even euphoria. Later, when dopamine levels drop, one may develop a desperate craving to get another burst of it. Hence: addiction. Possibly behaviors that lead to unpleasant moods, like isolating or ruminating on worries and problems, provide short term release of neurotransmitters that our brains ‘like’, even though the end result is depression. This portrayal simplifies the situation, like describing an epic film with one paragraph. But my point is just that on some level much of how we feel, and what we think or do, comes from shifting movements in the symphony of chemical interactions in the brain.

So what does this all say about human nature? Are we ‘nothing’ but conglomerations of proteins, neurotransmitters, and other biological molecules? In the last post I also mentioned Jeffrey Schwartz, MD, and his hypothesis that in addition to neurons and associated brain cells, our minds consist of something non-material, which he calls ‘mental force’. This entity could just as well be called our ‘soul’, since he believes it determines our decisions under the principle of free will.

I don’t accept this proposal. Not because I think free will is an illusion, or because I don’t believe in souls. I have conviction that both exist and are the vital organs of human life. My opinion, however, is that both human ‘spirit’ and ‘will’ arise from the matrix of matter itself. The intricate and finely woven fabric of our brains makes freely determined decisions, and houses our divine spark. Humans look for miracles, yet all the time we seek them we are living in their midst. Not only that, but each one of us is divine in every sense of the word. We don’t need to postulate some ethereal force that exists detached from the trillions of cells, each a tiny universe of activity, which have grown in unison and become the mysteries we call bodies. God does not need to speak outside of matter, because our atoms and molecules already sing God’s song.

pieta

To those who have faith in a different sort of deity: Maybe we aren’t of such opposing opinions. If you can accept that whatever God is, we don’t really understand it, then there is no disagreement. In that case, every sculpture humans carve of God or spirit must be incomplete. So who is to say whether we are looking at completely different icons, or just viewing the same monument from different vantages? If, on the other hand, your belief system is more fundamentalist and inflexible, and you cannot accept that other views might also carry a little truth, then you are probably not even reading this. But if you are, I hope you will just ignore my attempt at spirituality. Go ahead and consider me morally misguided, but still listen to the basic message: We have more power to improve our minds and lives than an industry based on selling psychoactive chemicals wants us to believe.

Even with the above proviso, I suspect that my spiritual ideas do not particularly interest those who visit this blog. So I’ll stop here with the philosophy. I only want to convince readers that by taking medications, or changing our behaviors, we are tinkering with the intimate particles of our being. However, the two approaches, drugs and action, differ as coal differs from diamonds. They may be the same thing on some basic level, but they diverge in beauty and endurance. Ingesting a chemical to improve one’s experience is akin to to reshaping an ice sculpture with a blow torch. The tool carries too much power, and acts too crudely to result in anything fine. “If you can’t feel better, drugs at least make you feel different.” At the price of (possibly) lifelong dependence on psychiatric chemicals, one (typically) gains a few months of relief from pain. Then, all too often, the pain returns. Only now depression comes encumbered with an addiction (what else to call it?) to drugs that no longer work. Stopping medications takes one from depression into the pounding heart of hell.

ice_torch

Much better to work on meditating, improving spiritual sensitivity, exercising, and adjusting thought habits. Maybe drugs can help for a little while. If so, doctors should remain ever-vigilant for the first opportunity to start withdrawing them. Let us use finesse to chip and carve the ice that encases our moods. Take our time and work hard, and we can sculpt our depression into tragic but nonetheless beautiful memories.

I guess this is a repeat of my last message. Hopefully, since it is (a little) shorter, it will be more widely read. I further yearn for it to help someone. This kind of thinking comes too late for me. I am already addicted to psychiatric medications, and must struggle my way free. This writing project would fulfill both my spirit and my will if a recently diagnosed reader found it useful, and if it bolstered a non-medicated regimen of mood care. If you are that reader, I pray that the uncountable molecules of your brain begin to dance in harmony. I have faith that you will choreograph a lasting peace.

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Mind, Moods, and an Organic God was published on August 1st, 2009, with these tags: , , , , . To date, this entry has received 1 comment.