Wednesday, October 20, 2010

Getting Through - Surviving Mental Illness 6

How do we survive?

Walled Garden St Anne's Park Dublin, 3
No matter what we take on we have to be realistic about our abilities to achieve that goal.  One of the greatest boons in anyone's life is self-knowledge outside good self-esteem.  If one knows oneself well one will be as cognizant as possible of both one's strengths and weaknesses.  Some people like to avoid the truth, especially if it is unpleasant or appears to be unpleasant to them.  They prefer, rather, to live in a world of denial where all unpleasantness is literally swept under the carpet to use that most common cliché.  Real survival is about facing the truth.

Personal Survival:

I suppose the best way to write about survival is to write autobiographically here.  As I write these few lines I have just been listening to The Liveline with Joe Duffy where one distressed caller spent more than twenty minutes outlining the death by suicide of one very troubled friend whose wife she was now comforting.  This poor man had reached the bottom of the pit of darkest depression, could not find the energy or even a little sliver of hope to help him scramble out of that pit and in desperation finally hanged himself.  No human heart could remain unmoved by this woman's story and her passionate pleading for help to repatriate the poor man's body to his homeland - Slovakia, I think.  What a lonely hell that poor wretch must have dwelt in immediately before his end in hanging from a lonely tree in a lonely field in Ireland many miles from his homeland.

How does one survive a severe mental illness?  The following are activities, actions and insights that have been helpful to me

(i) Cultivate friendships.  Having good friends in whom one can trust and in whom one can confide is vitally important.  No one is an island.  We travel through this life with the help of others.

(ii) Go to the family doctor.  Talk to him or her.

(iii) Be involved in as many social activities as possible where you will meet others.  Hobbies and interests are very important whether it is stamp collecting, coin collecting, chess, drafts, cards, crochet, knitting, photography, or whatever, but make sure you meet others who have a shared interest in various clubs.

(iv) Always do some physical exercise no matter how small.  I could never run a marathon or even jog for 10km, but I certainly can walk for at least 5km any day.  Therefore, determine to go out and walk a few km after reading this.  I remember when I was very badly depressed some twelve years ago that going for a walk, even a short one, was at least somewhat energising at first and it gradually helped my mood to pick up.

(v) Remember that if the depression is severe that medication will be necessary, and that even sometimes, hospitalisation will be prescribed to allow that medication to kick in.  Antidepressants commonly take between two and three weeks to become effective.

The patience of a Snail: Santry Woods, October 2010
(vi) Various forms of psychotherapy - of which there are many kinds, from psychoanalysis and Jungian Therapy to Rogerian/Person-centred Counselling and Cognitive Behaviour Therapy - are successfully used in combination with drug therapy, after initial drug therapy or without the use of medication at all.  The approach to depression today is to use any therapies that work in tandem with medication if the latter is judged to be needed.  In my case I attended counselling for about a year after leaving hospital.  Because my depression is of the endogenous variety I am still taking the lowest effective dose of an antidepressant.

(vii) Read as widely as you can about your particular type of mental illness.  Get familiar with the literature on the subject.  Read up on the side-effects of any medication you are on.  Ask your Doctor or Consultant if you are in doubt.

(viii) Learn to meditate and to use at least one form of the many different types of relaxation exercises as one can, e.g., Tai Chi, Pilates, Yoga etc

(ix) Ask yourself if you are fully accepting of your diagnosis?  Allow the truth of your diagnosis to sink in through the meditation exercises mentioned above.  Learn to be deeply compassionate for yourself.  Learn to parent the hurt child within.  Use positive visualisations to strengthen your acceptance and healing of the inner Self.

(x) Attend self-help groups if you feel you need the support.  You may really need them in the early stages of coping after the initial diagnosis.

(xi) Try to educate your emotional intellience (EI) as well as your intellectual intelligence (IQ).  Read about and meditate on the Multiple Intelligences as outlined by Dr Howard Gardner in Frames of Mind.  Then read Emotional Intelligence by Daniel Goleman. Other scholars have mentioned that there is a Spiritual Intelligence (SI) deeper again than EI.  Today the experts argue that our "intelligence" is like an onion as it were with SI at the core, then EI and finally IQ in the outer ring.  There is some substance to this contention of layers of depth as we go deeper into the nature of human intelligence.  It's another paradigm or model we can use along with Freud's structural and topographical models.  They are many others suggested by Assaggioli and Jung etc.

(xii) If desperate ring the Samaritans.

(xiii) Finally here is a list of worthwhile websites to explore on the subject of menatl health:

Tuesday, October 19, 2010

Getting Through - Surviving Mental Illness 5

To Medicate or Not to Medicate:  That is the Question

I have always been amused at how people, even very learned people like to take up opposing positions, and some are wont to rush to the barricades all too quickly.  I have long since tired of the debate between fundamentalist or extreme believers (in God, that is, whether they be fundamentalist Protestants, Catholics or the so-called more recently-named Creationists) on the one hand and extreme atheists or evangelical atheists as I am wont to call them because of their equally self-righteous intellectual positions as their opponents.  While I have not openly written on this debate as an erstwhile theist, indeed theologian, who holds an agnostic position today, I do believe this debate is paralelled by the drugs treatment (psychopharmacological or chemical interventionist) approach versus talk-therapy-only approach.  In other words, what I am arguing here is that there is a balanced middle ground.  Life in general, from my lived everyday experience often presents us with a both/and position rather than an either/or one.  What's missing in the theist-atheist debate is a singular lack of understanding of the psychology of religion; an absence of comprehension of the motivations for belief in ordinary people; a want of an appreciation for the power of myth, of story and of the creative arts.  I shall return to that debate later in these posts when I get the time.  Now I should like to return to the question of medication in mental illness.

A Controversial Issue:

Without a doubt this debate, which I have discussed several times before in this blog, is an extremely controversial one.  However, The recent Irish Times Supplement on Health of the 12th of October 2010 presents what I would call an extremely balanced approach, a middle-ground or a both/and approach.  This is exemplary to my mind.  As a sufferer from endogenous depression of the unipolar variety who, of necessity, has to take medication and who has availed himself of many other therapies including counselling and meditation exercises, I am indeed heartened by this objective approach.  Two professors of psychiatric medicine are allowed to put forward their opposing views: on the one side Sidney Kennedy, current professor of psychiatry at Toronto University (in the medication camp) versus Ivor Browne, emeritus professor of psychiatry at UCD (who is firmly in the anti-drug/talk therapy only camp.)  I am aware that I may be presenting them in a very black and white way here, in the sense that the former may allow for some therapeutic intervention, and the latter for some little chemical or pharmacological intervention.  However, we may conclude from their views expressed in  last week's Health Supplement that while they might not be extremists, they do tend to their respective contrary positions.

Here is a brief excerpt from Professor Kennedy's article/interview :

Prof Kennedy, who was in Ireland recently addressing GPs on advances in treatments for depression, said the debilitating side effects associated with some conventional treatments often prompted sufferers to give up on them. And he said some sufferers were also giving up on antidepressants because it takes some antidepressants so long to have an effect. “They may start to work after three or four weeks, but that is no good to the person who flushes them down the toilet after two weeks because nothing is happening,” he said.

An advocate of a controversial surgery used to treat adults with severe depression who have not responded to other treatments, Prof Kennedy said there had been huge advances in treatments in the past 20-30 years.  Deep brain stimulation (DBS) involves the insertion of wires into part of the brain “to alter the circuits involved in depression” while the patient also has a pacemaker inserted beneath the skin around the collarbone.

Prof Kennedy said trials on about 40,000 depressed patients had been very encouraging, with about 50 per cent showing improvements. DBS has already been used to successfully treat other conditions such as chronic pain and Parkinson’s disease.... His visit to Ireland coincides with the launch here of Valdoxan, an antidepressant he has endorsed for the manufacturers.

Professor Sidney Kennedy
Prof Kennedy said some people were resistant to all medications and other options such as neurostimulation of the brain were a possibility. He said that, while ECT also carried a burden of side effects such as memory loss, it worked for some sufferers. He also said that the key, as far as treatment was concerned, was to seek help as early as possible and to investigate the least invasive methods of treatment first.  (See this link here: Sidney Kennedy )
One can see that Professor Kennedy advocates the importance of early intervention and the use of the least invasive methods first.  Presumably talk therapies like psychotherapy and counselling and cognitive behaviour therapy (CBT) would fit into this non-invasive treatment.   However, one could be cynical with respect to his backing of a certain drug.  One wonders what financial kick-back he is getting for this promotion of their product.

Next, here is a little taste of Professor Ivor Browne's article which proposes the opposite viewpoint, thus:
Professor Emeritus Ivor Browne
Mental illness is seen as a disease caused by either a disturbance in our biochemistry or by genetic influences – but this is a myth.  This view of mental illness arises from a reductionist scientific concept, where the disturbance of the whole person is seen as caused by something wrong with the parts. It’s derived historically from Galileo’s statement that, to make scientific progress, we must concentrate on things we can measure. But this is only half the story and it breaks down when applied to living creatures such as ourselves....Because of the mechanistic attitudes that have accompanied advances in science and technology, the western mind has fallen prey to the illusion that there is a remedy for every ill; we expect to be able to avail of these without any effort or suffering on our part.

When a person comes to a doctor or therapist with symptoms that indicate depression or anxiety, they expect the doctor to do something to relieve them.  Certainly doctors can relieve symptoms, but without the natural healing power of the body and a functioning immune system, medicine and doctors are largely helpless.  In dealing with psychiatric illness, there is no treatment you can apply to a person that will bring about real change in them. The person has to undertake the work himself and this involves pain and suffering.  Many psychiatrists seem to have missed this point entirely. They think that, by giving tranquillisers or ECT and temporarily relieving symptoms, something has been achieved, whereas in fact no real change has taken place and, sooner or later, the person will slip back to where they were.
However, Browne does enter a caveat on drug therapy, so his view is not solely and completely anti-drug as we see in this comment a little later:

The issue here is not the giving of a drug; many of the psychoactive drugs can be the only way of making initial contact with a person who is psychotic, anxious or depressed so that therapy can begin. The question is whether they are given as treatment, or as an aid to working in a relationship with the person. It is not the drug – it is the message that accompanies it that is really damaging.  (See this link here  Ivor Browne )

One can appreciate what both learned professors are saying, but once again I do believe that there is a balanced middle ground between these two advocates of opposing positions on whether to medicate or not.  Taking the Supplement in toto, the view presented is one that is well balanced and tends to no partisan view.  Once again such objectivity is what I would expect from a paper as well known and as unbiased as The Irish Times.

Sunday, October 17, 2010

Getting Through - Surviving Mental Illness 4

A Note on Schizophrenia

I have for some ten years been interested in schizophrenia as I know three adults with this disabling mental illness, one of whom I was in a close relationship with.  That any one human being could live in a world where the borderlines between reality and non-reality were so blurred as to render existence in this world very difficult to negotiate is quite literally mind-blowing to use a rather inappropriate metaphor.  I have written about schizophrenia in these pages before as hitting the label link on the right of this blog will show.

Once again, if we need any reminders at all, mental illness was a taboo subject for many years in many societies. Unfortunately taboos (and vestiges of taboos) still remain even if we are loathe to use that particular word. Let's use the words "perception" and "prejudice" instead.  That there is a "damaging perception" (Dr Muiris Houston's formulation of words - again in the wonderful Irish Times supplement on mental health) out there in Ireland at least with regards to schizophrenia in no way surprises me.  I still count the three individuals I have mentioned in my opening paragraph as friends.  That some others might not surprises me somewhat, but misinformation and skewed perceptions about schizophrenia, and most mental illnesses, still abound.

Among the positive symptoms of scizophrenia are those of delusion and hallucination.  The lovely woman with whom I had a relationship suffered from visual and auditory hallucinations.  One morning she told me that her twin brother had at that moment a knife held to his throat, and no words of mine could convince her that such was only an hallucination.  However, she did calm somewhat after some time, though I don't believe I ended up disabusing her mind of that hallucination.  Dr Houston mentions the fact that many sufferers of schizophrenia present with delusions.  None of the three people I know present with that particular symptom, at least to my knowledge.  One of the delusions he mentions is that of the young student (his first encounter with this mental illness) who deeply believed that he was Jesus Christ.  I've heard of others who believe they are Napoleon, Hitler, JFK etc  A delusion is defined as a fixed idiosyncratic belief unusual in the culture to which the person belongs.

However, we are more likely to meet the more negative symptoms, viz., reduced motivation, lack of interest in social contact, diminished emotional expression which is called a flat presentation or flat look in the literature.  This flat presentation was the most disturbing aspect for me as the person looks so drained of all emotion as to render her or him almost beyond real human contact.  I tried so hard to bring a smile to her cheeks and often in vain unfortunately.

However, it is the bad press given to the positive symptoms of schizophrenia that is the primary cause of the fear, the gross misconceptions and wrong perceptions of this illness among the general populace.  One can only agree with Dr Houston's contention that "sensationalist media reporting has fed the myth that people with schizophrenia are dangerous..."  Even the use of the term "split personality" is essentially wrong and totally inappropriate.  It is important to state clearly that violence is extremely rare among the sufferers of this very disabling mental disease.  Here below is an excerpt from Dr Houston's column outlining the nature of delusions and it will give you some insight into their sheer power over the individual and how disabling they can in fact be:

Once successfully treated, some people actually miss their delusions. Delusions of grandeur are not uncommon; in one case, a man who thought he had special powers and had been chosen to save the world felt bereft to the point that life as an ordinary person living in a homeless shelter had lost its purpose. Another patient described how the voices he was hearing were nice to him and now that they had gone he felt lonely without them.

However, many delusions are disabling. One woman wakes up every morning believing she is being called to a child protection trial and spends the day writing down the evidence she will give in court. She had an abusive childhood and so her delusions may be her way of working through her past. In another case, a woman has a fear of being attacked from behind and so will not sit with her back to any window; she won’t travel in the front seat of a car for the same reason.

Hypochondriacal delusions, especially those associated with de-personalisation and a loss of identity, can be especially disabling. And paranoid delusions usually centre on a conviction that the person is someone of great importance and, because of that, is being persecuted, despised and rejected. (Se the following link here: Houston Irish Times
However, there is hope for the sufferer because medical science is progressing all the time and new medications are constantly coming on the market and the latest antipsychotics have less disabling side effects.  The goal of these medications is obviously to dampen down the intensity of the delusions and hallucinations while at the same time promoting social interaction.  However, this appears to me to be a "big ask" for any medication.  Obviously, hallucinations and delusions must be stamped out to as great an extent as possible as they are so disabling, but there needs to be interventions by a whole team of experts like psychiatric nurses, psychiatric social workers and occupational therapists.  I'm not so sure as to how successful any intervention from talk therapy can have as schizophrenia is more at the psychotic/psychosis end of the spectrum as regards mental health.  Psychosis is an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur. Hence, it is indeed less likely to be amenable to talk therapy intervention.

Houston at the end of his insightful article mentions the fact that a lot of sufferers can live a fairly reasonable life - some managing to hold down a fulltime job, others a part-time one, still yet others who volunteer to help less fortunate others and teach them some skill.  Quite a number also manage to sustain relationships - often very hard for the schizophrenic - with the help of the supports mentioned above.  Also he refers to one young man who stated on his profile on an on-line dating site that he suffered from schizophrenia.  Bravo for him!