The brain and the body unite!

Dear Dualists and Wholistic Leaners,

Some people think that conditions affecting mental health have a clear cause. Extreme versions of Survivor movement ideology and the anti-psychiatry movement, for example, support the notion that a harmful, violent world creates "manifestations of illness" in those who are sensitive. Persons who happen to experience serious traumas like physical abuse and sexual violence and who later experience a crisis of mental health, are often held up as examples that support the notion that a "harmful world" causes mental health problems or perceived problems of mental health.

I think it's a bit misleading to suggest that "physical" traumas, like sexual assault and abuse, are responsible for "mental" illness. This refrain has been repeated over and over again in psychoanalytic literature, has been absorbed and regurgitated by the Survivor movement, and yet it is such an incomplete picture of health and the things that can have an effect on health.

My observation has been that Survivor advocates (capital "S" in the extreme political concept of Survivor) tend to cling to the concept of trauma, reshaping the word to represent its most extreme; painting trauma always as malevolent violence, somehow always intentional (as is the truth in the case of sexual violence and physical abuse) or some type of mass-scale social subversion (big pharma plots ring a bell???).

And so in the Survivor literature, persons affected by mental illness are forever painted as victims of a social construct that is inherently violent, harmful, cruel, and indifferent to what it has created. Survivors were victims of a social construct that created the illness, then victims (to become survivors of) a system that was designed to overcome (entrench???) the illness that was supposedly caused by that social construct.

Sound complicated? It is, more than it has to be, I think. And it seems downright paranoid to me, and I'm prone to paranoia!!!

If we look outside of Survivor literature, and Survivor interpretations, there are actually many types of "trauma," besides any types of physical or sexual violence that a person and their brain can be exposed to. Some of these traumas are innocuous. Some of them are occur simply as a product of living and breathing. Poor nutrition, exposure to toxins, allergic reaction, major life change (whether positive or negative), severe illness, unfavourable/harmful social/family/relationship dynamic, access to opportunity or a lack of, a traumatic event (observer), a traumatic event (participant), a traumatic event (victim), etc... all fall under the definition proper of trauma.

It bothers me when conditions that affect mental health are explained to be a consequence of one event in some distant past... as if something as serious, as profound, and as life altering as a condition affecting mental health has such a simple solution. It's almost as if that one thing hadn't happened, all of life would be different somehow.

If only it were that simple... If only society would cease being "abusive" and "traumatizing," then everyone would be okay, seems to be the logic.

From what I understand, based on my education and experience, there is no "golden shield" protecting the brain from the varied and innumerable assaults of life. In fact, the assaults of life are, for the most part, predictable, and have predictable consequences. In truth, the reality is that the multiple and varied traumas of life don't cause "mental" illness in most people. So really, there isn't anything in the type of trauma itself that causes mental illness, the reality is that the illness lies in wait, like cancer, only to rear its head opportunistically, after an unknown number of cumulative attacks of unknown and likely unforseeable type. And because our brain is innately curious, seeking explanation for all things, and even creating explanation where none can reasonably be found, our brain (and blame) falls on the event that lies closest to our "break."

Because I find this thinking so reductionist, that mental illness can be pointed to a single cause, I'm left to wonder if this is a story we try to tell ourselves for our own comfort and sense of sanity. I wonder if these stories are a place to lay blame for the inherent vulnerabilities of our brain and brain/body relationship. Based on my knowledge and experience, the mind is primed to do things, and motivates us to do things, beyond our conscious control. Lacking conscious control over our minds is not something we are comfortable with, and absurdly, many of our daily routines are performed with little to no "conscious" thought or reflection. By Western rationalist standards, this assertion, that our minds have a consciousness beyond the reach of our own awareness, is tantamount to heresy.

An interesting bit; apparently Medieval monks believed in "mind over matter" so deeply that they were driven to castration when they had unwanted, surprise erections. In fact, castration was a "treatment" for unwanted erections. Since they could not control that bit of matter, then the solution for lack of mental control, clearly, should be to mutilate oneself, no? Out of sight, out of mind? Problem solved?

We want to believe our minds are impenetrable to the effects of life, that the mind transcends our daily routine, transcends the cumulative effects of stress; and yet even the bothersomeness of day to day details can be enough to affect a person's state of mind adversely.

What happens to the body, happens to the brain, and the brain will let the body know. The "inconvenient truth" is that our body's dependence on the brain, and the thinking brain we call the mind, makes us systemically, wholistically vulnerable. When our mind changes, our behaviour changes. If our behaviour changes, people think we have changed. And we, the changed, are forced to ponder that, and submit to the consequences of that.

But let's not be like the monks, misunderstanding the underlying issue; making associations where there are none; seeking simple solutions, potentially harmful solutions, that aren't actual resolutions.

Trying to bring it together, even if it's just for me,
O.

The Care Effect

Dear Feelers,

Yes, I'm talking to you, people who feel, and I want you to ponder this post.

Throughout my education (I studied psychology at university) there was an enormous amount of discussion about something called the placebo effect. Let me explain this phenomenon:

When a person is unwell, and they go to a doctor to get medication for whatever condition it is that is affecting them, the expectation is that the medication will work to take away the symptoms of the condition, or that the meds will "cure" the condition. Sometimes, though, doctors have no cure for what ails you, and so they kind of throw a prescription at you, with both of you hoping it will work. You go home, take the pills, and lo and behold, a few days or a week or so later, you feel better. Was it the pills? If it wasn't the pills that made you better, what did?

What if your doctor gave you "sugar pills," tablets that look like medications, but are actually really just sugar, with no actual medicinal ingredients in them? What if these sugar pills DID relieve your symptoms?

When a person finds relief in their symptoms despite having taken a sugar pill, or a med that isn't intended to have an effect on their condition, that is known as the "placebo effect."

For some reason, I was taught that the placebo effect is kind of a bad thing. Let me give you an example to explain what I mean:

Depression is medical condition where pills are often prescribed to relieve symptoms. Surprisingly, if you look at the research on medications that treat depression, the studies show that the medications for depression are no more effective than a sugar pill. So basically, whether you take a sugar pill or a medication intended to treat depression, your chances of getting better are equal with both treatment options. (The caveat is that you have to think the sugar pills is a medication intended to treat depression, and your doctors can't intentionally lie to you.) And just for the sake of being a responsible writer, I want to make it clear that medications DO work to treat depression, and work BEST when they are combined with therapy as part of the treatment.

Often the placebo effect is used as a defense for people who take issue with using medications to treat conditions affecting the brain and behaviour (like depression). For people who don't want to or don't like to take medications, they generally say something like, "Well if people can get better on a sugar pill, why should a person have to take drugs? That's just big pharma trying to control us."

Another issue that the placebo effect brings up is the issue of personal control and power over the mind. Imagine taking part in a study on depression (assuming you had depression) where you were offered a pill every day. Imagine if you felt some relief of you symptoms over time, say six weeks, where you took a pill and had to measure your symptoms at the end of every week. What if at the end of six weeks, you reported that you feel pretty good, much better than when you first entered the study. Then, what if you were told that the medication you were taking was NOT a medication at all, but was a sugar pill. How would you feel? Conflicted? Duped?

People assume that we always have control over our minds; how we think, how we react, how we feel about things. I'm not sure this is true. In fact, I'm pretty convinced this is untrue, that we have control or will over all aspects of our mind.

I think the placebo effect is an interesting and subtle reminder that life has powerful undercurrents, and our brains, minds, thoughts, behaviours, respond to these undercurrents. One of the most underrated "undercurrents" is simple social interaction... talking to people, feeling like people like you, feeling like you belong among your tribe of humans.

Let's imagine that a person had depression. What are the symptoms? Lack of motivation? Feeling flat? Social isolation?

What is the effect of being in contact with people who are interested in hearing about what is happening to your body? What is the effect of being around professionals who understand the concept of "illness," that you feel unwell, unlike yourself, and that you wish you could feel like you did before? What does is the effect of being around a person who will listen to your worries and empathize with you clearly? What is the effect of simply being around people? Being cared for?

Placebo effect my ass; it's the care effect. And it's not a bad thing. We should all be able to benefit more often from the care effect.

Now should we prescribe medicinal pills in cases where a placebo is shown to be equally effective? I'm not sure what the answer is to that, but I know doctors aren't allowed to lie to their patients, and for a placebo to work, one needs to think it's a medical treatment. However, like in our example of depression, there is a treatment option that produces healthier people than taking a pill alone. So maybe we just need to rethink our concept of "care."

Popping my people pills,
O.

is olivia a bitter person who is antipsychiatry?

Dear People Who Need to Know,

My bias: I am female. I am old enough to have enjoyed the heydays of Nirvana, but too young to grasp the reverence for classic rock. I look white, but I have a visible minority heritage that isn't obvious by my appearance. I grew up knowing too well what a fridge looks like when it's empty. I have the benefits of a university education, and hold dual degrees, one relating to the realm of medicine, the other relating to the realm of metaphysics.

I have been diagnosed with what the medical profession likes to call a SMI (severe mental illness). I have lived intimately with the effects of my diagnosis for 10 years or so. My condition has affected me in profound ways in a psychological sense, in an economic sense, and in an interpersonal sense.

Pardon me if my experience ever clouds my judgment or colours my words, and I will do the same for you.

So, given my experience, I'm going to lay out *my* opinions on psychiatry, and hope that my words are not too often abused or distorted from their original context.

In a general sense, since my experiences with psychiatry have been positive, and I see a movement in psychiatry towards accountability and collaboration, I regard psychiatry as a potential benefit for those who are affected negatively by their mental health.

I know that many people have suffered abuses (in the form of stigmatization, discrimination, sub-standard levels of care, enforcement of unwanted treatments, literal abuse, etc.) at the hands of the mental healthcare community. I respect your experiences, you own those experiences.

But those experiences are not mine. And although this blog will express a significant amount of frustration with current standards in health care, I am not fundamentally anti-psychiatry.

In the same way that abortion is a contentious, weighty, (and I believe, personal) issue; mental health is an issue that carries with it a burdensome load that is equally personal, weighty, and contentious.

So, in short, if a person confided in me that they were negatively affected by their mental health, I would suggest to them that they may benefit from seeking help from the medical community. That being said, I would be very careful about the places I would direct them to, since (those who have received mental health treatment are well aware that) not all doctors are created equal. Some doctors are simply better; being more approachable, more informed, and more invested than others.

Your 'Only Human' and Fundamentally Biased Blogger Who Genuinely Respects Her Treatment Team,
O.