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.

No one is safe from a sterotype...

Dear Trusted Adults, Carers of Children, Mothers, Fathers, Sisters, Brothers, and Friends,

Some less than light reading excerpted from the Globe and Mail (Click on the title to view the entire article):


Bullying in Childhood May Help Trigger Schizophrenia
By Paul Taylor

"Children who face relentless bullying from their peers are at elevated risk of developing psychotic symptoms by the time they reach early adolescence, a British study has revealed.

Previous research has shown that bullying can lead to anxiety, depression and even suicide. But the new study, by researchers at the University of Warwick, is the first to link bullying with psychotic symptoms, which include hallucinations, delusions, and bizarre and paranoid thoughts.

Essentially, the stress caused by severe and chronic victimization may be enough to push a vulnerable person over the edge, leading to full-blown schizophrenia, Dr. Wolke speculated.

He noted that stress spurs the release of cortisol, a hormone that might alter the developing brain. What's more, being treated badly can have long-lasting effects on the thought processes of an impressionable child.

Further research would be needed to confirm that bullying can be the spark for schizophrenia.

The latest findings, published in Archives of General Psychiatry, are based on an assessment of 6,437 young individuals.

About 46 per cent of the kids had been victims of bullying to some degree. The children who experienced a great deal of bullying tended to be the ones who were most likely to suffer from psychotic symptoms.

But Dr. Wolke emphasized that the odds of developing such symptoms must be kept in perspective.

"You have an increased risk, but it doesn't mean that most of the children who were bullied developed psychotic symptoms," he said in an interview."

________________________________

And now to highlight how attributions are assigned to those living with mental illness, and to behold the appearance and evolution of stereotypes, prejudice, and discrimination; from the comments section related to this article:

this is just my opinion from Toronto, Canada writes:
Could be a chicken vs egg issue. Maybe kids who are predisposed to mental illnesses tend to be picked on more because the other kids think they're 'weird'..?

Nature Lover from Canada writes: Not only that, but kids who have psycological disorders don't "get" the triggers that make them annoying, and they are poor judges of situations that could cause other kids to lash out at them. As much as we could "sanitize" schools with anti-bullying messages, the reality is that kids are just unformed adults who don't always behave in a civilized way. So if kid A is "bugging" kid B, be it verbally or physically, kid B may react chldishly to the situation, hitting back etc. I've seen this all before and the mother of kid A will jump in and accuse kid B of being a bully, when it was really kid A's behaviour that precipitated when went down.

_____________________________________

And last but not least, a comment from sum crumb summarizing the reality/absurdity of what the hell is going on with these comments:

sum crumb, from Canada wrote: Interesting presumptions about children with potential predispositions to psychosis floating around... "weird"... "childish"... "annoying"... "poor judges"... will the value attributions associated with mental illness never end? And now we're laying these myths, labels, and stereotypes on children?

Speaking of bullies, remember how we call the adults with mental illnesses lazy, unmotivated, and social leeches? Isn't that bad enough? How about we just leave the kids alone (with the assigning of labels and misplaced value attributions), and rotate around this discussion of children and mental illness VERY carefully... preferably with a ten foot pole?

These are children afterall, and we do want them to have the rosiest, as unblemished as possible, future, no?

Labels are harmful, no?

Or have the bullies just not got around to understanding these basic facts of life yet?

(Thanks to the bullies who are flying their flags even here, on a topic like this. Do you people have ANY morals or sense of ethic?)

__________________________________


So I guess the final message is: Bullies never die, and ignorance lives on forever?

I hope we do leave the kids alone. Let's let kids just grow up and be kids? Let's not let little people (children) grow up and live forever under any of our misplaced and/or ignorant banners, huh?

Crossing my fingers that we cross the bridge to a brighter side, but not holding my breath,
O.

PS. Why isn't anyone discussing parenting and intolerance to bullying? Are we really supposed to accept the "kids will be kids" mantra? Kids WILL be kids. Some kids will be nice kids. Some kids will be less nice. Other kids will be jerky kids. They will be the kids that their parents brought up... so this says something, I think. Something about parenting...

Fierce love... ferocious affection

Dear People Who Love Others,

I read an interesting thing the other day on one of my favorite web-based time wasters. Here is the quote from www.postsecret.com:

"My sister's boyfriend came to find her after she left him.
I greeted him at the door holding a shotgun.
I'm afraid of what I would have done if he hadn't walked away."

While I'm not an advocate of gun ownership in general, unless you use it to feed yourself and your family, I thought, what an interesting expression of love. What a fierce expression of love. This PostSecret resonated with me because of what you will read below.

I grew up in tandem with a girl from elementary school. Born less than a day apart, inseperable twins from separate mothers, we began a tentative friendship in grade 7, when we were entering into the strange new world of our teenage years. We spent our last years of elementary school fairly innocently, and even the first few years of highschool were unremarkable. We got into the typical troubles that other kids got into, experimenting with new relationships, dealing with temptations and the introduction of vice.

Somehow, in our last few years of highschool we diverged. She went away to school, I stayed home, and we diverged. I went away to school, she came back and stayed home, and we diverged even more. In that time, she sunk deeper and deeper into something that I can't articulate; bad choices, depression, a series of choices based on impulse... I don't know. But these things led her to a lifepath she didn't predict for herself in the optimism of her youth. She had dreams of becoming a writer; a dream that grew more and more distant as her grades sunk, and as she later found herself quagmired in the consequences of adult opportunities.

Her family watched. I watched. I felt helpless and unable to help her. I felt powerless to control her path, or steer her path, or even to offer guidance. And I didn't feel it was my place to interfere with her choices. I could not choose her friends. I could not choose how or where she spent her time. I could not choose what she put into her body. And I had no role in who she chose as partners in her relationships. It's not that I wanted, really, to control any of these things persay, but truly, I could often predict where she was headed for certain pain, and I wanted to help her avoid that because I loved her.

I have no idea what her family felt through all of this, but I can imagine. And I've heard the stories from my friend herself, of how her family had to bail her out of troublesome places from time to time. I'm sure these weren't easy choices for her family, there is a fine line between "enabling" and helping, but how can we watch the ones we love remain mired in the consequences of bad choices and circumstance?

At our most recent visit, over two years ago, her and I talked idly about life. She expressed a certain amount of regret, without ever specifying what it was she was regretful of. And I worried about her for all the things she did not say. The man she was living with was abusive. I knew the signs. Having to call in every 10 minutes, complaining of the consequences of raising his ire, and hiding the bruises under her eyes behind darkened lenses. I asked her about those, and she said that she'd provoked him. No, he's not such an asshole, I did it, I pushed him into it. He's rough around the edges, but he's really a decent guy.

A decent guy who happens to hit the woman he loves?

I knew there were no magic words that could convince her that she did not deserve any of her life as it was at that moment. All I could do was let her know that if she ever needed a break, or an escape, that she could come to my house.

I wish she would run to my house. And when he came looking for her, I wish I would be brave enough to love my friend ferociously enough to worry about losing my own sense of control.

I wish I could do more than offer an ear and a place to run to.
Regretfully,
O.

The season for giving

Dear People Who Love to Give,

I love gifts, but this year, I'm unusually poor due to a confluence of circumstances that have arisen and expectations that I just cannot fulfill at present. This is not a complaint, rather it is an unfortunate fact of life that has caused my previously (more) prosperous pocketbook to languish in pools of dust from lack of use.

In particular, I love to give gifts. As you can assume, it is fairly hard to "give" a tangible thing to another person when you don't have the means to gain access to tangible things.

And so, I've let myself off the hook as far as actual, real, material gifts go, and I plan to make the following pledges, and hand them out as gifts:

My gifts to you:
I promise to love you, the best I can.
I promise to listen to you when you have things to say.
I promise to be there for you in your hour of need.
I promise to care, and be concerned, and to worry about you should painful/unhealthy circumstances arise.
If I am able to, I promise to help you.

Simple things. I suppose if I were to summarize the list, I offer to my loved ones, to be the best friend that I can be. This gift won't be perfect, but I promise I will do my best.

Every Christmas I also like to get a gift for myself. In the past I've given myself new shoes, or a little piece of jewelry, or the luxury of a meal at a decent restaurant. This year, since my pockets continue to wheeze dust and moths, and since I can't even get gifts for my loved ones, I especially cannot afford a token for myself. And so, I will make a pledge or two to myself; and instead of gaining in material goods, hopefully I will gain in that special way that only the immaterial can allow.

The gifts to myself:
I promise myself good food, and a healthy life.
I promise myself the love of good friends, and the will to expect that from others and to seek that out.

Happy Holidays!
XOXO Olivia

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.

enough love for everyone!

RE: Comment regarding "dear people who post on postsecret.com"

Dear Olivia,

I just wanted to let you know that sometimes we try our hardest to keep our loved ones with us. Please don't think that everyone feels this way.

I know I don't.

From,
Baldylocks
April 21, 2008 3:13 AM/end

Dear Baldy,

thank you for your comments.

i do know for a fact that not everyone feels this way, since my family and friends have been fantastic throughout.

in fact, the optimist in me believes that most people do not feel this way.

it just hurts to see things like that. it really does. and i think it is irresponsible to ignore these types of sentiments.

With Gratitude,
O.

PS. I sincerely appreciate that you wrote to let me know this. It means a lot to me.

dear people who post on postsecret.com

Dear postsecret.com poster,

You said this (posted on the April 20/2008 edition of postsecret.com):

"When my schizophrenic brother finally succeeded after 15 years of suicide attempts, I was relieved."

As a person who was diagnosed with schizophrenia, and who has successfully managed the condition for over 10 years, I want you to know, that reading this statement made a part of me die a little.

Please understand that I know that I am a burden to my family, and to society in general. And please understand that I know that my actions can cause problems, stress, and pain.

I already know this. Why do you have to reinforce how shitty I am and how much people like myself make your life miserable?

You need to know that this is why we kill ourselves. We despair and we suicide because we are acutely aware that we cause problems (for ourselves, and for the people we love). We suicide because mental illness HURTS everyone it touches and that pain is often unrelenting.

You need to know that mental illness hurts its sufferers from the bottom of our toenails to the top of the hairs on our heads. I'm not talking about a literal pain; I am talking about a relentless ontological throb that we endure from our daily toils in a fast, competitive, and unforgiving world that cries for conformity (and punishes those who do not fit neatly into those compartments you have all neatly sorted out for yourselves).

Please realize that I can understand where this sentiment comes from, and that I respect your feelings, but fuck, what about me?

My sympathies for your loss,
O.