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.
Showing posts with label medication. Show all posts
Showing posts with label medication. Show all posts
Thursday, May 28, 2009
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,
O.
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,
O.
Wednesday, September 3, 2008
Some things I wish I knew years ago...
Dear People who Suffer from Side-Effects Like Nausea, Dry-Mouth, Tiredness, and so on,
When I was first diagnosed over 10 years ago, nobody really told me much. Mind you, I think I was pretty young, and so I'm going to optimistically believe that they just didn't want to burden me with more than I was already dealing with.
I was put on medication pretty much within days of my diagnosis, and while it was clearly explained that there would be side-effects, there was never much followup about what that would mean, and where I could go to find help for my side-effects.
One of the first side-effects I noticed was hunger... I always had a low grade rumble in my belly that felt better when there was food in it. I think this side-effect exacerbates the weight gain problems that happen in a lot of people who take atypical antipsychotics.
My solution for this rumbling was to eat... all the time... but to eat food that had super high amounts of protein - and just to snack perpetually while avoiding large meals. (Since I was feeling consistently fullish from my perpetual snacking.) Luckily, my solution worked, since I managed to combat the rumbles, and I didn't gain significant amounts of weight.
Another negative effect of my medication was sleepiness. I was so tired all the time. My solution was twofold: For many years I arranged my schedule to start my dater later than everyone else so that I could sleep a little longer and to take an afternoon or morning off from school or work during the middle of the week so that I could catch up on sleep. This worked for me as a student and as a part-time worker, but has some pretty obvious limitations in the 9 to 5 working world.
The side-effect that bothered me the most was dry mouth. Because of dry mouth I have had problems with dental decay and with canker sores.
Little did I know up until about a week ago that there are actually products that you can use to help ease dry mouth and its associated problems. Why on earth did no one tell me this?
I remember telling my family doctor and my psychiatrist about dry mouth problems. And I know that more than one dentist pointed out that I may have dry mouth due to some of the things they saw. So why did not one of these health care specialists think to inform me about the things that were available to help this.
As a poor university student I often had to gather my pennies together so that I could get dental work to repair the damage caused by "insufficient oral lubrication." Now as an adult without dental coverage, I find myself still having to pay for dental problems that began long ago.
I really wish that someone would have asked me long ago about my side-effects. I wish they would have been specific in their questions. And mostly, when I complained, or when they noticed something was wrong, I really wish they would have taken it upon themselves to inform me of the things I could do to help make my life easier and more comfortable.
There is a lot of self care that is required when you have a problem of mental health. And sometimes it's just almost too much to bear to deal with the disease itself (and the discrimination issues it often carries). Why have I had to deal with the additional time-consuming burden of experimenting with schedules/organization/products when this information is out there, but just not readily available to me?
Is it time for a What to Do When You're Expecting (A Bout With Mental Health Problems) handbook for psychosis and/or other conditions?
Seriously. Shit. So much of my time and money wasted on problems that could have been solved before they even started!
Tucking her pennies away for another cavity,
O.
When I was first diagnosed over 10 years ago, nobody really told me much. Mind you, I think I was pretty young, and so I'm going to optimistically believe that they just didn't want to burden me with more than I was already dealing with.
I was put on medication pretty much within days of my diagnosis, and while it was clearly explained that there would be side-effects, there was never much followup about what that would mean, and where I could go to find help for my side-effects.
One of the first side-effects I noticed was hunger... I always had a low grade rumble in my belly that felt better when there was food in it. I think this side-effect exacerbates the weight gain problems that happen in a lot of people who take atypical antipsychotics.
My solution for this rumbling was to eat... all the time... but to eat food that had super high amounts of protein - and just to snack perpetually while avoiding large meals. (Since I was feeling consistently fullish from my perpetual snacking.) Luckily, my solution worked, since I managed to combat the rumbles, and I didn't gain significant amounts of weight.
Another negative effect of my medication was sleepiness. I was so tired all the time. My solution was twofold: For many years I arranged my schedule to start my dater later than everyone else so that I could sleep a little longer and to take an afternoon or morning off from school or work during the middle of the week so that I could catch up on sleep. This worked for me as a student and as a part-time worker, but has some pretty obvious limitations in the 9 to 5 working world.
The side-effect that bothered me the most was dry mouth. Because of dry mouth I have had problems with dental decay and with canker sores.
Little did I know up until about a week ago that there are actually products that you can use to help ease dry mouth and its associated problems. Why on earth did no one tell me this?
I remember telling my family doctor and my psychiatrist about dry mouth problems. And I know that more than one dentist pointed out that I may have dry mouth due to some of the things they saw. So why did not one of these health care specialists think to inform me about the things that were available to help this.
As a poor university student I often had to gather my pennies together so that I could get dental work to repair the damage caused by "insufficient oral lubrication." Now as an adult without dental coverage, I find myself still having to pay for dental problems that began long ago.
I really wish that someone would have asked me long ago about my side-effects. I wish they would have been specific in their questions. And mostly, when I complained, or when they noticed something was wrong, I really wish they would have taken it upon themselves to inform me of the things I could do to help make my life easier and more comfortable.
There is a lot of self care that is required when you have a problem of mental health. And sometimes it's just almost too much to bear to deal with the disease itself (and the discrimination issues it often carries). Why have I had to deal with the additional time-consuming burden of experimenting with schedules/organization/products when this information is out there, but just not readily available to me?
Is it time for a What to Do When You're Expecting (A Bout With Mental Health Problems) handbook for psychosis and/or other conditions?
Seriously. Shit. So much of my time and money wasted on problems that could have been solved before they even started!
Tucking her pennies away for another cavity,
O.
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