Monday, September 15, 2008

Trying to understand is not the same as understanding...

Dear People Who Want to KNOW,

I read this (excerpt below) in the Toronto Star this morning. This quote is derived from an article about a dad who longs to understand his daughter's experience.

For caring, exorbitant caring – about the meaning of a passing glance from a stranger, the look in a news broadcaster's eye on television, the fixed fired thoughts in one's head – is the psychotic's curse. ("Skinless" is a therapist's term for those who cannot tolerate stimulation.) "To depart from reason with the firm conviction that one is following it," reads a definition of madness from an 18th-century encyclopedia.

And, indeed, inordinate conviction is the chief warning sign of our delusions. For the patient to burn low, to be half asleep, to take no notice, is the medical goal – for the patient to live in a kind of emotional cordon sanitaire. Psychosis is the opposite of indifference. Indifference, therefore, would seem to be its logical cure.

The full article can be found here.

First, I think it is extremely important to say that I respect this father's committment to his daughter and her experience. I respect the raw emotions that his family went through. I respect that the father is trying to enter into his daughter's experience by himself participating in her treatments. And interestingly, I respect that he went so far as to try her medication... although, I know that in practice this is not recommended, nor is it necessarily safe.

My issue with the article is the simplification of the experience. The father seems to endorse ideology of an antipsychiatry and antimedication approach by suggesting that the fundamental purpose of medication is to create "indifference" in the person.

I would like to offer this father a different perspective, having myself crawled out of the long, dark tunnel that is known as psychosis: medication (at its worst) can produce indifference (lack of motivation, apathy, exhaustion, etc.), especially if the dose is too strong, and even more especially if the medication is a poor fit for the person. At its best medication produces the effect of organization.

Consider the neurological "causes" of psychosis: Dopamine is cascading through neurons at an unmitigated and uncontrolled rate. This neurotransmitter is partially responsible for the rate and strength of our transissions, and so the repercussions of this barrage are confusing for a person experiencing it. (Being high on pot feels a lot like the early stages of a psychotic break, by the way... the loose associations, the multiple layers of meaning in any given context, the sense of mental fog, etc. Interestingly, the "high" effect from pot is caused by dopamine cascading though your neurons.)

The problem is not that a person with psychosis "cares" too much about the events around them (suggesting that a person with psychosis is oversensitive), the problem is actually that a person with psychosis cannot control their attenuation of sensory stimulus around them.

The "average" person is able to control the stimuli around them by focusing their attention on the stimulus that requires attention in any given context. Generally this is a passive and almost unconscious process. In the "average" brain, a stimulus from the environment penetrates the neurons which then mobilize to organize the meaning within the context. For example, when walking on the street in a crowd, one generally understands that when they hear a siren, they need to stop to look around and see how they need to respond. And so despite the sounds in the crowd, despite the bustling of moving cars and people, despite the visual stimuli of light, and shapes of buildings and people and trees; the sound of the siren takes precendence above all other stimulus, and so one would most likely focus on that one stimulus and therefore act as necessary depending on the circumstances.

From my experience, the passive process of stimulus absorbtion, interpretation, and organiation is detrimentally impeded in a person with psychosis. A person with psychosis is unable to filter through and focus on a particular theme or element of the stimulus that exists in the sounds of the crowd, the siren, the glare of the sunlight, the red of the emergency vehicle. And not only are they neurologically "forced" to attenuate to all of any incoming stimuli at once, their ability to make sense of the stimuli is also altered.

For me, it wasn't that I cared in particular about what I was taking in around me; it was that I could not control what to take in and what not to take in. I could not organize my attention for the life of me, and so all at once, everything became significant, even the things that were completely irrelevant to the context.

During a psychotic break, a brain that is unfamiliarly overridden with stimuli (caused by an influx of dopamine) also recieves a second punch: Not only does dopamine open the floodgates to hyperstimulation, but this chemical also primes the brain to make connections in an effort to "organize" those stimuli. And so in our human brains that are innately compelled to create order and to explain chaos, we now begin to make bizarre associations and start to manifest delusions in a very literal attempt to organize the influx of information.

Let's make no mistake, it's not so much that people with psychosis are more attuned, morally weak, sensitive, or lazy, or stupid, or any of the pervasive negative myths that tend to circulate: A person living with a psychotic brain is a person who is living with an overworked brain. A brain that won't stop revving its engine, so to speak.

From what I understand about biology, all organisms need rest. And rest often involves having a "quiet" brain. It was my brain's inability to passively organize the intake of stimulus that made up the greater part (and the most exhausting part) of my psychotic experience. My brain needed help to quiet itself so that it could better work through the process of organization. Part of helping my brain to be quiet was taking medication, but another significant part was ensuring that my environment allowed my brain some quiet time.

Futhermore, there was a lot of "training" involved... but that's complicated, and perhaps the subject of another post.

Organizing for clarity,

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