Tower-of-Babel Syndrome

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From time to time, I hear complaints that someone’s brain illness got better with medications and/or ECT, but just came back when they stopped. This almost always happens when a patient never transitioned to maintenance ECT and/or medication therapy.

I dub this, the Tower-of-Babel Syndrome.  We all suffer from it at some point in life, trying to be like God.  Or maybe a lesser god?  During this Tower-of-Babel Syndrome, after we have paid the price, after we have complied with the many hard tasks, after we have built ourselves up into something glorious, we are cured from illness. Right? Once we stop perceiving it, illness that is, we are closer to God, more like Him/Her, perhaps more perfect, when we feel better and do not need medical care. Little gusts of wind are all it takes to fill our wings and off we go, living life free from disease laden earth.

But this is a mistaken expression of freedom.

The number one reason for relapse is…? You remember.  Treatment noncompliance. Is relapse most often due to life stressors? There are so many. No. All those reasons for why we think we feel what we feel and do what we do, all those forces acting on us from the outside in, they are not the reasons we relapse most often.

There is something like a super-bug growing amongst us who engage in treatment on and off. We do it four or five months out of seven. We skip here and there and do not “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent with medical treatment, demonstrate our freedom. We are free when we engage in medical treatment or when we do not. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by treatment noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Let us work together to take away barriers to consistent treatment.  You may laugh when you hear about the Tower of Babel.  You can laugh.  A bonus.

The Tower-of-Babel Syndrome is familiar to those of us who stop any variety of medical treatments on our own, excluding our treatment team members, (such as our physician, Wink! Wink!) in our decision to end treatment.

By stopping medical treatment, many of us have this sense of eliminating the reason we started in the first place.  Take treatment.  Disease continues.  Stop treatment.  We are superior.

When my son was about one year old, he learned that if he turned his head away from you, it was as good as denying your existence.  Turn.  You are gone.  Turn back.  You reappear.  Turn.  And just like that, you have been eliminated.  Even now, remembering it delights me.

Not so cute however, is disease relapse.  Maintenance ECT and/or medication therapy has a protective effect on the brain, prophylactic against further insult. It does not increase the distance between Me and God.  It does not increase a mislabeled dependency on treatment.  Maintenance therapy is part of our life journey.  It is part of our ability to be present with ourselves.  It is friendly.

Questions:  What keeps you in treatment?  Do you feel more diseased when taking maintenance therapy?  How do you manage that?  Please tell us your story.

Self-Care Tip:  Stay in maintenance therapy.

Magical-Self Sabotaging Our Biological

take treatment

“I just can’t be on medication when I go back to work!”

I had seen Rowne four times in clinic already and he still had not started his medication treatment trial.  He had seen multiple other medical physicians for other medical problems that needed addressing.  He had made appointments.  He had made phone calls.

“I’ve done so much, doctor!  I don’t want you to think I don’t want to get better!”

Rowne could have painted his house, changed the brakes on his car, had his foot bunions removed, but none of that was directly treating brain illness.  Rowne was mistaking activity for treatment.

Too often, those of us like Rowne, will gather courage to engage in the initial stages of treatment but not execute through.  Going to see a psychiatrist is its own effort.  Taking treatment recommendations and executing is another unto itself.

This is not unique to psychiatry of course.   Not even to the medical field.  Each of you in your own professions, perhaps in an auto body shop, or retail, or as a fifth grade teacher, those who seek our expertise find that the asking is, in their perception, as good as the doing.

None of us are out to create automatons though.  It is the intelligence, the self-interest on both sides, the freedom of the individual and Love that bring much of the value to treatment.  The humanity and magic combined with biology, element, and carbon matter trumps all.

Silly us though, when we allow our magical selves to exclude biology.

Self-Care tip:  Take treatment and execute.

Questions:  How do you bring yourself to take treatment and execute?  Or, what keeps you from doing it?  Please tell us your story.

Mistaken Expressions of Freedom and Medication Compliance

Sabrina

Sabrina (Photo credit: joaoloureiro)

Sabrina is here with her sadness, anxiety and inattention in full swing. She is able to say that she knows she’ll get better. However, her body and expressions tell me she is bewildered. She doesn’t know. She wonders who she really is and how this can be. She is vulnerable. A little girl looking into such a great unknown, though wrapped up in a forty-something year-old body.

One and a half weeks ago, Sabrina ran out of her medication. She knew she was coming in to see me so she didn’t bother with it. She waited. One and a half weeks.

The number one reason for relapse is…? You remember. Medication noncompliance. Is it life stressors? There are so many. No. All those reasons for why we feel what we feel and do what we do, all those forces acting on us from the outside in, they aren’t the reasons we relapse most often.

There is something like a super-bug growing amongst us who take our meds on and off. We take them four or five days a week, not seven. We skip here and there and don’t “over-react” if we do. “They don’t control me, after-all.” We apperceive the situation. We think we, by not being consistent on medication, demonstrate our freedom. We are free when we take medication or when we don’t. We are free because we are human.

The super-bug in brain illness is a progression of disease process heightened and sharpened by medication noncompliance. A growing resistance to treatment and an acceleration of our falls, how long it takes for us to drop into a relapse and how hard and far we fall.

Sabrina and I are working together to take away barriers to consistent treatment.

What are your barriers? Do you mistake how to demonstrate your freedom? Or what is it? Please tell us your story.

Self-Care Tip: Take medication consistently. Be a friend to yourself.

The Elephant is in The Room To Help Us

English: The eye of an asian elephant at Eleph...

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How do I get him to see it?

How do we get our friends, our husbands, our wives and kids and patients to see the elephant in the room?  My patients ask me this and I ask this of myself.

I want to feel better.  I just want to get to the bottom of this!  

Will someone please just treat what is wrong and I can move on?!

There is this implication that someone is plotting against progress to derail us from appropriate therapies, treatments, walnuts and soy milk.  Why they would want to do that, no one agrees on.

When Cincy said something to this effect in clinic, a huge shade in the shape of an elephant in the room, caught my eye and it was distracting.  I smiled at the wraith and conspired with it on how it could best gain acclaim.  I tried to explain what I was seeing to Cincy, but how does one describe an apparition?  I’ve never heard anyone do it better than Edgar Allan Poe and so I know it can be done.  I’m learning.  I needed to learn from Cincy.

Teach me Cincy.  Help me learn how to speak of these things better.

I felt like I should know that already.  But we physicians don’t graduate with a certificate in introducing elephants.

Trying to do the teaching-thang in clinic or out of clinic, if we want to get anywhere, we can’t do much if we aren’t both seeing the elephant.  Talking about solutions, about treatments, motives or anything that doesn’t redirect each of us back to that specter in some way is skipping critical development.  Counterintuitive, the immediate task at hand becomes more and more simple when there are ghosts about.

He doesn’t want me to take medication because he is afraid of what his mother will say.

Start talking about Me and not about him.  How does Me factor in to deciding on medications?

Smoking is my last vice and I’m not here to talk about it.  I’m here to talk about why I’m tense all the time.

Tension happens when our blood vessels constrict.  Tension increases when our heart rate….

Well, goodness.  You don’t want this from me now on this post.  I’m just trying to talk about that darn elephant.

When things feel complicated, when conspiracies seem to be around, when we hear ourselves naming others to explain our condition, when we avoid talking about something and when we lose Me -> reduce.  Still missing it?  Get even more basic.  Soon we’ll see the shade.  The elephant is there to help us, not shame us.  He’s there to bring us back to Me where everything starts and ends.

Question:  How has the elephant in the room improved or worsened your self-care?  Please tell us your story.

How To Stop A Relapse Before It Starts

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Baby I have been here before
I know this room, I’ve walked this floor
I used to live alone before I knew you.
I’ve seen your flag on the marble arch
Love is not a victory march
It’s a cold and it’s a broken Hallelujah…

– Leonard Cohen

Relapsing in brain illness is the pits.  The prodrome, as it starts creeping into our awareness, is worse than knowing we are about to walk into a spider web with the spider and his dinner still in it.  It’s so horrible that even before the prodrome hits, imagining a relapse can trigger foreboding and anticipatory anxiety.

What will I do if I…?  

Dear God no…

Recently we did a brief series on ECT and discussed how ECT can improve brain health, signal neurogenesis and trigger healing.  This brought many of us to wonder about what causes brain damage.  It became apparent that many of us had forgotten that brain illness, in fact, damages the brain.  We still have a hard time, despite all our progressive activism and awareness, believing to the core that the brain is human, that emotions and behaviors come from the brain and that a diseased brain is what generates disease symptoms as seen in emotions and behaviors.  We still have a hard time believing that the brain responds to medication, much like the liver does.

What?!  Depression causes brain damage?

What?  

Now compound that with the spider’s cousin, Medication-For-Life, and you’ll see us doing a funny walk-hop-dance in the dark to avoid what we wish we weren’t getting into.

The wonderful bit about all this is that staying on medications, even for life, is the best way to dodge the worst of it.  Sure, even with medications, as prescribed, compliant and all that fluffy five-star behavior, we still relapse.  “Depression should be considered as a continuous rather than an episodic process,” as stated so well by French biomedical expert, Vidailhet P.   But, (this is really good news,) when we relapse, we do not drop as fast, we do not fall as low and we do not hit as hard when medication compliant.  Staying on medication is prophylactic against those miseries.  Staying on medication is protective against progressive brain disease and it’s deteriorating effects.  Staying on medication is friendly.

…Hallelujah, Hallelujah
Hallelujah, Hallelujah

Leonard Cohen

Question:  What have you noticed that staying on your medication has done for you?  How do you manage to stay on it even when you don’t want to?  

When you’ve come off of it and relapsed, how was it different from when you relapsed while still maintaining your medication therapies?  Please tell us your story.

Self-Care Tip – Stay on your medication.

Other Fears of Medication For Brain Illness

Yesterday we talked about fears of addiction to medication therapy.  There are other fears that influence our choice to use or not use medication therapy for brain illness.

In clinic, we hear about people’s preference not to take medication, as if it were like ordering mushrooms or no mushrooms on pizza.

I am not someone who likes to take pills.

veggie pizza

Image by mccun934 via Flickr

Again, I think most of us agree entirely.  Who of us set out in life thinking, “I hope my life depends upon medication therapy?  I just want to have a reason to medicate.”

So tell me about this.  Questions:

  1. Are nonprescription substances safer for us?
    1. If so, why?
    2. If not, why?
  2. What are other risks you fear of taking medication for brain illness as compared the risk of brain illness remaining and likely progressing untreated?

Fears can provoke us to grow stigma and biases.  However they can also be used a tool for getting friendly with ourselves.  We can use our fears.  We can use them to gain clarity to know better why we are making our choices – stigma? Or friendship to Me?

Nothing is all right or all wrong.  But we should know our motives if we can because of it’s potential usefulness.  It is a friendly thing to do.

Self-Care Tip #285 – Know your fears so you know why you are making your choices.

Fears of Addiction To Medications for Brain Illness

I don’t want to get addicted!

We agree.  Who does set out to get addicted?  Is that really a starting motive for anyone?  “Ok.  I’m going to take this pill crossing my fingers that I get addicted.”  Even those of us who have suffered from addictions of illicit substances such as cocaine didn’t get into it hoping it would hook us real good.

pills galore

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So here are some questions for you:

  1. Do you have this concern about psychotropic (i.e. for the brain) medication?
  2. How do you see prescription medications for brain illness in comparison to illicit drugs?
  • Are they related?
  • And if so, how?
  1. Is there a difference in addictive qualities between one medication for the brain and another?
    • Is there a difference in addictive qualities between a medication for the brain and a medication for the rest of the body?
  2. Does the amount of time we stay on medication affect our risk of addiction?
    • I.e., more time, more addiction?
  3. What are other fears re: the risk of addiction with psychotropic medication that you have or think others may have?

Fears can be anxiety provoking filling us with dread and avoidance, including fears of medication addiction.  However, they can also promote a more deliberate course.  We can use our fears to get friendly with ourselves.  We can use our fears.  Fears can be a the energy we needed to do the work, to gain clarity about what we need to consider fair warning and what should be thrown out.

Self-Care Tip #284 – Use your fears as a tool to clarify what precautions are worth keeping and cleanse your stigmas otherwise.