The Wind Never Lies - Steven Morgan's recovery story

You've probably already read it at Gianna's blog. Anyway, for those here who haven't, or who'd like to enjoy Steven's powerful writing in this no less powerful story once again, here is Steven Morgan's recovery story The Wind Never Lies - original pdf-version here at Vermont Recovery's website.

Thanks to Steven for allowing me to post his account here. And, yes, the diagnosis, Steven gives himself at the end also works for me. The only one, that ever has worked and ever will work for me.

The Wind Never Lies
by Steven Morgan stevenmorganjr(at)gmail(dot)com

When I was young I believed the world spoke to me. Lightning split across the sky to the pulse of my thoughts. Rings around the moon prophesized the apocalypse. My cat winked at me to let me know he understood. Clouds parted like curtains to welcome a shining God.

For most of my youth this deep connection to the Natural world mystified me, pulling me into forests and spinning my imagination wild. Then at age twenty-two I finally discovered its secret.

Earlier that year I had been diagnosed with major mental illness. Suddenly I had wondered – often painfully – how much of my past was led not by free will or cosmic connection, but by disease. As I searched for answers, I absorbed medical texts, self-help books, and bestselling memoirs. I grew increasingly vulnerable to biological explanations for my behavior – Your brain is broken – in part because these theories absolved me of guilt and responsibility for experiences that were shameful. For instance, I was relieved to learn that repeatedly tapping in patterns of three to save my grandmother’s life was caused by an overheating of my caudate nucleus. And I felt less maniacal knowing that six months contemplating death every hour was caused by low serotonin.

Yet the flipside – the explosive creativity, moments of divine insight, periods of super-wit and magnetism, communication with Nature – was not so easily resigned to biological determinism. How was I to make sense of this paradox, that while some mood swings are grave and disabling, others are rich with meaning and evolvement?

According to the respected literature Bipolar Disorder is a disease of the brain. This means I would have to deny scientific reason to cherry-pick which extremities are diseasified and which are not based on their subjective worth.

At the time, I needed answers, not another harrowing epoch of existential angst, so I adopted a mental illness worldview and began to label almost everything that veered up or down in my experiences as caused by pathology in my head. In effect, I re-authored my life story, tossing fragments of my history into clinical categories of mania and depression.

One day I came across text that specifically labeled “believing the wind is communicating with you” as a symptom of Bipolar Disorder. I immediately thought about my friend. She had also felt a deep connection to the world, and she was also diagnosed with Bipolar Disorder. We had shared moments of profound synchronicity in which the wind had danced inside our unmedicated conversations at exactly the right moment, too right to have been a coincidence.

With my new perspective, there was only one explanation for this experience and others of a similar nature. They were simply neurochemical errors devoid of meaning.

From then on, the world still spoke to me, but I stopped listening. When the wind would swarm me at too perfect a moment to be coincidental, I would remind myself, “The wind isn’t speaking to you. You have a mental illness that makes you believe otherwise.” I began to lose trust in my intuition and the significance of my experiences, and the way I made meaning of the world suddenly became a suspect for deceit. Such is the effect of being diagnosed with an illness that presumes to know your mind better than you ever can. You resign your voice and become a doubter.
***
My resignation to a forecast of disability was short-lived, however. I have always harbored a fierce independence that – whether consciously or unconsciously – puppeteers my actions, and eventually we sought to unwed mental illness. But first I had to make major life changes.

At the time I was fulfilling a typical Bipolar prognosis by living at my father’s house as an unemployed artist. My fresh diagnosis was an ace in the hole to excuse inaction, but I felt ashamed and irresponsible for not holding my weight as a man. In an effort to jumpstart my life, I dove into a respectable social program that trains and places promising college graduates as teachers in the poorest areas of the country.

Here was a chance to reclaim my dignity. Here was a challenge to prove I could be successful just like everyone else. Here was an opportunity to show my friends and family I was not a lost cause naïve to the real world and blanketed by idealism. I invested all my pride in the endeavor, throwing away my Bipolar label overnight and the sedating mood stabilizer that came with it.

My training consisted of grueling eighteen-hour work days for five weeks straight. At first I was vivacious, often praised by my colleagues for creativity and energy, but by the end I had completely burned out.

I headed to my assigned region of South Dakota with barely any life-force. In a lonely house along a dirt road, I was overwhelmed by sleeplessness, paranoia, disconnection, feelings of abandonment and utter exhaustion. Despite a desperate attempt to revive myself with exercise and meditation, I eventually fell apart and landed in a hospital.

Here is what I wrote several months after the experience:
When I walked into the hospital, slow as a ghost, my arms bloodied and face covered in agony, I noticed the hospital workers noticing me. It felt very intrusive, and I wore a scared, nervous face in front of their inquisitions, both verbal and silent.
“Soooooooo, how long you been bipolar?” The doctor’s chirpy South Dakotan accent made the question all the more intolerable. I felt like her question was cruel, invasive, insensitive, ignorant, said with a doctor’s ease while I sat there in the gloom of my misery expected to answer in a coherent way.

“What kind of question is that?” I replied. I wasn’t confrontational. Indeed, I was scared because deep down, the question made me feel more insane than I had previously acknowledged.

Even now, I can feel the humiliation of awakening in that rocky bed: eyes weighted with tears, skin torn by teeth marks, throat lined with liquid charcoal, hand punctured by IV, thoughts clouded by haldol, heart stinging with guilt, mind terrified and confused. And I recall the doctor inches away from my face holding a pill between her thumb and index finger. “This will make you feel better,” she smirked with vague condescension, as if the boundless suffering before her was just another Bipolar gone off his meds…shame on him.

I cannot explain in words the trauma of those months. What I can tell you is that for years a mark had been appearing on the center of my chest that changed in color according to my moods. Though it had arrived in a shade of light brown, the year after South Dakota it doubled in size – like a virus spreading – and deepened into a blood red. Every morning thereafter, I saw that mark in the mirror and it reminded me of my utter failure at life, as inescapable as my breath beneath it.

I wanted the rest of the world to see my pain too. One night, after drinking and ripping car keys across my forearm, I took a razor and shaved my head – a highly symbolic act since growing out my hair had led to my first girlfriends – then grabbed a knife and hacked away at my face, chest, and arms.

Alongside a second hospital stay, it was becoming too difficult to deny I had serious problems, and equally as alluring to again accept the bottomline that mental illness explained me. Tired and defeated, I stopped trying to connect the dots and came to see my breakdown in South Dakota as the result of quitting medications, getting manic, and crashing into depression. With that association in mind I became terrified of discontinuing medications ever again. And there were plenty of people to confirm the wisdom of my fear. In fact, I soon discovered that all Bipolar advice orbits around one unshakeable core: Whatever you do, no matter how good or stable you feel, NEVER quit your meds, or else…

This way of thinking is justified by the belief that Bipolar is an incurable chemical imbalance in the brain which medications help restore. Given the overwhelming presence of this theory in the media, medical texts, and amongst professionals and peers, I presumed it was backed by hard science and became invested in taking pills for the rest of my life.

I even began openly expressing to others that I was taking ‘my meds,’ as if the choice made me a ‘good patient’ worthy of inclusion and accolades. However, my emergence into a walking advertisement for the pharmaceutical companies came at the price of repressing internal conflicts. Indeed, no matter how much support and validation people offered, no matter how many times I reminded myself mine was a medical disease ‘like diabetes’ which required medical solutions, the pills never quit instilling within me their unlisted side effects of shame, unnaturalness, isolation, and dependency. It is simply impossible to forget you are crazy when you eat from five bottles of pills every day.

Still, I could not consider quitting medications because I could not think outside my experiences. To survive then, I lowered my expectations and silenced my shame.

And with that I swept away the shards of my identity, aimlessly crawling through a new world where the limit came before the sky, and I solemnly accepted that my mind would forever be prisoner to the punishment of my brain.
***

After a brief relationship resurrected feelings of abandonment, the mark over my chest was aching and my soul was sinking. In response, I sought some project to once again restore my worth. Eventually my efforts transpired into creating a film about Bipolar Disorder. I sold many of my possessions to purchase film equipment, all the while rationalizing a need to push myself into highs and lows to make the movie more realistic.

After months of mad creativity, I recall an evening where I could not form sentences from beginning to end. A couple of days later I wrote a suicide note and tucked it into my mattress, then checked into a hospital.

My previous hospitalization had been relatively helpful, but this stay was pure damage. Having my shoelaces taken away now felt degrading, pointing to stick-figured faces – Happy, Sad, Angry – while setting a daily goal now felt infantilizing, smoking in a cage with other demoralized people now felt depressing, being locked indoors after voluntarily checking-in now felt infuriating, being told not to carry on conversations with the opposite sex now felt discriminating, and being observed every fifteen minutes during my sleepless evenings now felt invasive.

Yet my integrity was buried beneath a need to be liked, so I behaved as a good patient, never connecting my humiliation to external circumstances.

After a week I lied to the psychiatrist about my suicidal status, and upon release I made a vow: I will never return to a psychiatric hospital, no matter what sacrifices are necessary to stay afloat.

To pass each day I drank just enough beers to sedate my thoughts. To pass each night I popped sleeping pills at dusk. Though I remained desiccated by suicidal thoughts for months, I knew from experience that eventually the pain would dissolve.

There was also a reason to be hopeful. While researching the aforementioned film, I had met a woman who raised money for me to attend the state’s Certified Peer Specialist Project, which trains people with psychiatric labels to work in the mental health system from a peer perspective. Though I knew nothing about this line of work, I was encouraged by the prospect of employment.

At the two-week training, I kept my recent hospitalization a secret, and was skilled enough at hiding disillusionment to push through classes for the first week. Then, over the weekend break I hiked eleven miles to a desolate beach. As I stood in front of the ocean, I was desperate to feel the force of Nature as I had in years past, but she was now vacuous and dead.

When I returned to the training I broke down sobbing to the lead facilitator. She listened to my confusion and loss, then revealed some of her own struggles, particularly as a writer. Referring to a creative project she was working on, she said, “If I don’t finish this, I will have failed at life.” At any other time, in any other context, her words would have slipped by, but instead they flipped a switch.

Suddenly I realized I too could fail at life, which meant I too could succeed, which meant that life was not just a careless unfolding but purposeful, and if she could emerge from immense struggles to inhabit meaning, perhaps I could too.

This brief sense of optimism carried me through the second week of training, and upon returning home I began the slow work of moving away from lost causes and toward some kind of intentional, integrated life.
______________________________

Jim was a 60-year old bear of a man, fluff but stern with eyes that frequently watered from inspiration. He sat on a meditation cushion on the floor to look upwards at me as a gesture of humility. There was a seriousness for truth in the air which I immensely valued. He never reduced any of my experiences to mental illness nor used any diagnostic vocabulary, but I still subscribed to those contexts for making meaning.

At our first therapy session, I poured out my Bipolar story while he listened patiently, still as a rock. In the final minutes he responded: “Now, I would like to tell you about myself.” Then he happened upon exactly the right words, in exactly the right no-bullshit tone, with exactly the right conviction: “Steven, I too am a wild man.” And he meant it.

From then on, I knew I would be leaving practicalities at the door. Our work was to map dense forests of archetypes, dreams, gods, love, manhood, and madness. He introduced me to the work of Carl Jung, whose concepts were a lantern in the darkest realms of psyche.
During our fourth meeting together, I haphazardly recalled a dream. I had always dreamed vividly, often shaken in the morning by their complexity of imagery and intensity of message. Though I had derived some truth from them in the past, I had never been able to decode their ultimate function.

The dream I spoke of contained a buffalo, who appeared near the end and told me, “Do not be afraid.” I remember feeling the dream was inconsequential, but Jim treated it with sacredness, remarking, “Steven, there is nothing meaningless about Wakan Tanka.” Wakan Tanka is the name given to the Buffalo/Great Spirit by the Lakota Sioux, whose land I had lived on while in South Dakota. Though I had failed to make the obvious connection, Jim helped me realize that the buffalo’s appearance in my dream meant something. I was being communicated with.

The more I gave attention to my dreams, the more they responded, and soon I was navigating symbols too multifaceted to be trivialized in words. The immediate effect of this experience was profoundly healing. For one, the messages directly opened up locks to expansion and elevation, but more significantly they became an umbilical cord back to God.

While diagnosis had disconnected me from others and my own experiences, my dreams mended this separation by reconnecting me to humanity, the divine, Nature, and also to the inseparableness of the three. Their mythological nature made me feel important again, as if I were decoding a great secret that was inaccessible to – or at least denied by – most people.

There was admittedly a dangerous element of ego-satisfaction (“I’m special!”) built into this process that would need addressing later on, but at the time the pride was absolutely necessary for restoring my sense of value to the world.

Of course, nine months of therapy was not all “Ah ha!” moments. There was grieving over relationships and suffering from opening the floodgates of repression and clearing the spiderwebs to my past. But Jim became a father in these scenarios, validating my secrets and loving me for the volatile creative spirit that so infused my passions yet isolated me from others. He even told me once he loved me, and he meant it, a moment of naked humanity that single-handedly patched a tear in my heart.

All of my work with psyche culminated in a peak experience. I had been reading Eastern spiritual texts for years, but despite a brief flirtation with meditation in South Dakota had yet to actualize it. One night I decided to try again, and as I sat in the moonlight in front of a white wall, a surge of energy transmuted me, presenting a ritualistic dance of truths and visions that shook my consciousness to its core. For the two months that followed, I lived behind a colorful trance through which I could see auras and vivid patterns everywhere. At first, meditation fostered this psychedelic experience, but as the intensity faded it became a vessel for me to a clearer and more direct world.

During this time of evolvement, I used my training as a peer specialist to work at a progressive recovery center for adults with diagnoses. Inspired by the beautiful people who came there, I began to grasp the concept of recovery in mental health. To me, recovery meant that I could live a meaningful life with illness. My self-conception shifted from believing disease fueled my emotions to believing disease fueled some of my emotions, and I graduated my story from I am Bipolar to I have Bipolar. Still, I was locked into psychiatric seermongering that my brain would forever be hostile in its natural state.

Then one day everything changed.
***
After moving to Vermont for a new job, I began attending meetings and trainings with individuals who were leaders in the consumer/survivor/ex-patient movement. At one of these week-long trainings, one of the facilitators was a bright and humane man whose empathic charisma immediately earned my respect. Midway through the week, he revealed he had been diagnosed with schizophrenia and was not taking medications. Now, until that moment, despite all my research and conversations, I had never met nor heard of anyone diagnosed with major mental illness who was successfully living without medications.

I was perplexed. I probed for his secret, and he smiled warmly, replying, “I believe that if this is something you want to do, you will find a way.” The integrity in withholding his path empowered me to find my own without his influence. Yet his presence was enough – a living example that life without medications was possible – to inflame my will. The second before I was staying on my chemical regime for life. Now I was interested in quitting.

I approached withdrawing with caution. There was enough distance between my present experiences and past meltdowns to forget the force of cyclonic emotions. I was terrified that my brain would revert to its diseasified operations once relieved of its medicinal police. I cut most of my doses slowly to test the outcome, while maintaining a commitment to a healthy lifestyle as fundamental to staying centered.

The whole process took six months, after which I noticed two shifts: my mind sharpened and my heart opened. Both of these factors were double-edged swords. On the one hand I could think more clearly and feel a wider spectrum of aliveness. On the other hand my restored intellect would once again lead me to face the graveness in our world, and my increased sensitivities would once again produce dense emotions in response.

But the real challenge came to my identity. At first I was too occupied with watching for signs of mental slippage to indulge in existential contemplation. But after a few months, as I realized I was clearer and even relatively grounded, the question inevitably arose: What happened to the chemical imbalance in my brain?

To find answers I started researching heavily. Instead of relying – as I had in the past – on government agencies, major organizations, professionals, and bestselling books for explanations of mental illness, I went straight to the source: to the scientific journals that provide empirical evidence to support or refute psychiatric theories.
***
The first and most striking fact I unearthed was that a chemical imbalance had never been observed in a human brain. Surely, I thought, this must be a mistake, as everything I read elsewhere concluded that an imbalance of neurotransmitters was the cause of mental illness. Such a ubiquitous claim would have to be backed by solid science, right? I then discovered there was no way to measure live neurotransmitter levels in the human brain, so there was no “healthy level” of neurotransmitters by which to even make comparisons. Furthermore, I learned that if chemical imbalances did exist, they could be caused by a person’s experiences. Therefore, if I did have an imbalance, I would have no way of determining whether it had biologically erupted to cause my psychological, spiritual, and emotional crises, or whether it was a biological reflection of them.

Soon enough, I realized that even though the chemical imbalance theory was a gross oversimplification of how the brain and mind operate, it was coasting through the masses on a wave of propaganda designed and funded by pharmaceutical giants, who directly benefitted from its treatment implications.

As my presumptions fell apart, I investigated more into the concept of psychiatric recovery. I found that nearly all long-term studies indicate that the majority of people diagnosed with major mental illness significantly recover over time. That was news. Furthermore, I learned that medications are ineffective and even harmful to a large minority of people with major diagnoses, and that some alternative treatment models which use little or no medications have produced better results than treatment-as-usual. That was news, too.

But if mental illness is a brain problem, and if people who experience mental illness can recover significantly, what happens to their brain problem? Is it fixed? Was mine fixed?

At this juncture I stumbled onto neuroplasticity. In science, neuroplasticity refers to the brain’s natural ability to change, adapt, and heal across the lifespan. I learned that the brain was highly malleable, changing its structure and chemistry in response to both internal and external stimuli – from thinking positively to experiencing trauma. Most importantly, I learned that utilizing the brain’s natural potential to heal, people were recovering from massive strokes, head traumas, overcoming learning disabilities, rewiring obsessive-compulsive behavior, erasing the pain of phantom limbs, restoring memory acuity, enhancing cognitive processing during old age, learning to see without eyesight, strengthening muscles just by thinking about them, using meditation to create lower-stress neurological states, and on and on.

If people could train their brains to overcome these problems, why not major mental illness?

The research base for neuroplasticity and psychiatric recovery was small, but there was enough evidence to strongly suggest that many of the biological abnormalities correlated with psychiatric symptoms were reversible or could be compensated for by other areas of the brain.

And so I quite naturally asked, had my brain physically changed? Had my lifestyle changes reversed my mental illness on a physiological level?

Certainly this was the case with obsessions and compulsions. Whereas I once ‘got stuck’ performing irrational rituals all the time to relieve anxiety, years of challenging my thoughts had equipped me to disengage from habitual mindstreams. With the power to observe and respond in different ways, I completely eliminated most obsessions and compulsions. Studies into Obsessive-Compulsive Disorder have visually documented that such efforts actually rewire the brain.

But Bipolar Disorder was different. It was always presented as chronic, persistent, and lifelong. Was I just in remission like the literature said, an unmedicated brain temporarily strong but ready to surrender at the first invasion of stress?

I was not satisfied with that hopeless hypothesis. It seemed a slick way to firewall psychiatric creed – “No one beats Bipolar Disorder” – against anyone who is well without medications. So I changed the question from Am I still Bipolar? to Who decides what is Bipolar and what is not?

I was amazed that by merely asking a different question, I encountered a hidden world of alternative perspectives. I dove into criticism of psychiatry – most notably into its history – and grew outraged at what I found. I came to realize that mental illness was a culturally-defined construct, prone to bias and judgment. Indeed, I learned that the Diagnostic and Statistics Manual used by professionals to diagnose people had no medical objectivity whatsoever, and was instead a collection of opinions about behavior that changed with social trends.

There was no doubt that people with major diagnoses underwent profound psychological, emotional, and spiritual suffering. Yet the evidence that such suffering was caused by a biological disease was flimsy, no more convincing than the evidence that such suffering was caused by a complex psychological reaction to overwhelming life circumstances. But biological psychiatry had won the rights to define mental illness, in no small measure because it met the ideological needs and financial ambitions of pharmaceutical companies, who in turn funded many of its institutions, scientists, and research grants. The endless other vessels to understanding behavior – sociology, psychology, anthropology, mythology, spirituality, or just plain ol’ individual interpretation – had been overpowered.

As I learned and integrated this information into my worldview, the glue that stuck mental illness to me loosened. I started to wake up to a different reality, one in which I used terms like experiences instead of symptoms, trauma instead of disease, problems instead of illness, and neuroplasticity instead of chemical imbalance. I engaged in a process of re-authoring my life story once again, casting off the disease paradigm and shifting my self-conception from I have Bipolar to I am fully human. At the same time I experienced an incident of painful discrimination that reminded me of my status in society.

I had applied for an expensive scholarship to attend a breathwork retreat with progressive psychiatrist Stanlislov Grof and Buddhist psychologist Jim Kornfield. My scholarship was approved, after which I was sent a standard medical questionnaire. At the top it indicated the workshop was not appropriate for people with certain conditions, including those “with mental illness.” However, I assumed the workshop’s pioneering facilitators would factor in my current health, which I documented in detail as evidence that I was “appropriate.” After a lengthy discourse with Dr. Grof’s assistant in which I further pleaded my case, Dr. Grof personally rejected my scholarship on the grounds I was a risk.

I was totally devastated. My enormous efforts to arise from the restraints of diagnosis were simply not enough to convince others I was not disabled. No matter how I conceived of myself, my psychiatric history would forever follow me. Though I found my ensuing rage challenging to navigate without medications, I was equally thankful that I could feel such intensity again. In the past, I would employ coping skills to eliminate strong feelings, but this time I used them as a catalyst for action and advocacy.

Over the next year, I translated the research I had gathered into written resources and presentations. I worked with other mental health workers to create more recovery-based environments, while bringing my new perspective into support groups as a facilitator and educator. I also began sharing my story publically, and each time I uncovered more and more of my authentic voice.

And something strange happened: that mark over my chest that had gauged my pain for eight years, that had been confirmed by a dermatologist as a stress indicator and not an allergic reaction, that had physically mirrored my mind as it shattered and my heart as it choked, that mark of suffering disappeared.
______________________________


It has been nearly two years since I quit medications, nearly four years since I last entered a hospital seeking help, and nearly one year since I first began writing this story. Nothing has been steady, and I have stumbled along a rocky path that is at times overwhelming, at times insightful. Such is life, and I am grateful for it.

Each day, my story grows and changes in unpredictable ways, but one thing has become clear in my understanding: I am not nor have I ever been mentally ill.

Yes, at certain times I fit all the criteria for Bipolar II in the Diagnostic and Statistics Manual, but the conclusions of a small group of academics who create taxonomies of human behavior hardly constitute my truth, thus I grant them no authority. Instead, I perceive my experiences as a complex manifestation of intrinsic character, society and culture, relationships, physical health, biological processes, past experiences, collective energies, and forces beyond my understanding, and each varies in degree depending on the situation.

But none of my experiences are ill.

Indeed, I cannot believe that I have something inside me called Bipolar Disorder, for my thoughts and emotions which could be labeled as such are not separate from my selfhood and therefore I will not postulate them as disordered. That would be denying and perhaps hating myself. All of it – the ups, the downs, the middle ground - is me. I cannot apply the same logic of having a disease like diabetes toward the myriad of feelings and experiences that I essentially am. Otherwise, I would have to split my mental content and emotions – both of which often escape my conscious control – into healthy and unhealthy compartments according to arbitrary judgments from doctors whom I have never met, and to be honest, that’s absurd, dismissive of existential purpose, and detrimental to the integrity of my complex existence. It also breeds more inner conflict.

I believe that in most instances, though not all, the reduction of experiences to biological causality sucks dry the poetry of life and denies that extremes can in fact be the final, necessary, and dangerously unpredictable step before new maturation.

So where does this leave me? Things come up, things go away, and when they do, there I am. The wind blows, but it never lies. When despair arrives, I am despair. When fired up arrives, I am fired up. If I choose to sink back into a witnessing state cultivated by meditative practice, I am witnessing. States of existence – dangerous to judge and painful to deny, rolling on and on and on, each one pushes toward the next by some force which I do not comprehend. It is the Great Mystery, and I feel utterly okay not having figured it out.

This is not to deny the impact of extrinsic events upon well-being. Like nearly everyone who receives a major psychiatric label, traumatic experiences have influenced me and continue to contribute to my suffering. As a society, we all need to wake up to the obvious connection between trauma and psychiatric disorders. But just as I am no longer willing to resign my belief that the wind is communicative to a neurochemical error, I am equally unwilling to resign my emotional states solely to the past. In all truth, there is no way to neatly sum up why I entered a psychiatric hospital in 2004. It all happened on the tail end of 24 years – that’s 756,864,000 seconds – of being alive. And who could possibly understand such an expanse?

What is important to me now is to take full responsibility for what I do, to know that there are storylines that glimpse truth, and to learn and experiment with living in ways that are intuitively authentic. And since intuition and authenticity grows, there is no endpoint, no enlightenment, no final solution to or ultimate recovery from suffering.

And thank God, for what a liberation it is to know that – just like you – I am plainly human: irreducible to theoretical constructs, unfathomable in my fullness, aching and celebrating with pain and love, moving in all directions at once, complex and stacked, an imperfect being and a sliver of God’s perfection.

Alas, it’s a diagnosis that works for me.

The other side of "bipolar disorder"

Wednesday, July 16th 2008, The New York Times ran an interactive feature article on "bipolar disorder", "Patient Voices - Bipolar Disorder", that includes nine audio clips with people who are labelled "bipolar", one of them being Steven Morgan. Steven brings in the refreshing perspective of someone who doesn't identify himself as "mentally ill", as a "disorder", as well as he points out the often denied facts, that recovery, even from " severe mental illness", is very well possible, and that drugs aren't always necessarily required in order to deal with extreme states of mind. He manages to get out the essential truth that there are more than one ways to look at and deal with "mental illness" in under two minutes. Great job, Steven!

There also is a comment section to the article, where Steven in his uniquely serene way deals with one of the attacks, people like him (and me) unfortunately all too often have to deal with (comment # 73, respectively Steven's reply, comment # 75). I wish, I had Steven's serenity.

The other side of mental health science

And here it is, now also on this blog: the article "The other side of mental health science" by Steven Morgan, that I mentioned in a previous post, and that puts a number of common misunderstandings about "mental illness" right. For everyone who, for whatever reason, hasn't been to Gianna's blog yet to read it there.


The other side of mental health science

BY STEVEN MORGAN stevenmorganjr(at)gmail(dot)com

Scientific studies about mental health are widely considered to be the ultimate source for objective information about psychiatric disorders. However, most people do not or cannot access these studies themselves. They instead rely on information from doctors, organizations, peers, the media, and so on. Unfortunately, this second-hand information is often oversimplified (i.e. “Mental illness is a chemical imbalance in the brain”), spoken with too much certainty (i.e. “Schizophrenia is a chronic brain disease that is lifelong and incurable”), or skewed and manipulated to justify an opinion (i.e. “People with Bipolar Disorder must take medication to live well”). As a result, popular myths now overshadow much of the data available from science.

The following list is a collection of facts from peer-reviewed scientific journals and several research-based books. Each source is hyperlinked in References, meaning the reader can literally click on the name of the study to access it from the Internet. Given the heated atmosphere of opinions about psychiatric disorders, the hyperlinks were included to make this document user-friendly so that readers can research the facts themselves.

FACTS ABOUT PSYCHIATRIC DISORDERS

I. A chemical imbalance for mental illness has never been found in anyone’s brain.1 There is no way to measure the level of neurotransmitters in synapses between brain cells, so there is no measurement of a healthy chemical balance that would allow for comparisons of “too many chemicals” or “too few chemicals” to be made.2,3 That is why our brains are not scanned for chemical imbalances when we are diagnosed. Even if chemical imbalances are one day found, it does not mean that they cause psychiatric disorders. Indeed, since the brain changes in response to both internal stimuli (thoughts, imagination, feelings, etc.) and external stimuli (sunlight, trauma, playing the piano, etc.),4,5 a chemical imbalance could just as likely be a biological reflection of environmental, emotional, psychological, and spiritual stress as a primary cause of it. Finally, the idea that specific genes cause mental illness is inaccurate, leading one prominent genetic researcher to state in the American Journal of Psychiatry: “The impact of individual genes on risk for psychiatric illness is small, often nonspecific, and embedded in complex causal pathways… Although we may wish it to be true, we do not have and are not likely to ever discover `genes for’ psychiatric illness.”6

II. Long-term studies from around the world demonstrate that the majority of people diagnosed with major mental illness – including schizophrenia – significantly improve or completely recover over time.7,8,9,10,11,12

III. Adverse childhood events can lead to mental health problems in adulthood – including psychosis, bipolar affective symptoms, depression, borderline traits, and so on – and the vast majority of people diagnosed with major psychiatric disorders have histories of trauma, neglect, or abuse.13,14,15,16,17,18,19,20,21,22,23 Thus, in many cases, the cause of psychiatric symptoms is childhood trauma. In this context, saying “mental illness is just like diabetes” or “mental illness is a physical brain disease that is no one’s fault” is inaccurate. Consider this parallel: if I am stabbed by a knife, is my bleeding caused by weak skin, or is it caused by the knife, the stabber, and the surrounding circumstances? Linking the cause of psychiatric symptoms to the appropriate source – i.e. a traumatizing environment instead of one’s brain or genes – is crucial in determining an effective treatment path to recovery and in actually changing larger social, cultural, and familial problems that contribute to mental breakdown.24

IV. A large subset of people diagnosed with schizophrenia fare better with little or no medication usage.25,26,27 Several alternative treatment models that use little or no medications for people experiencing psychosis have outcomes equal to or better than treatment-as-usual.28,29 Also, antipsychotics are far less curative than generally acknowledged: in the most recent and largest ever study of antipsychotic efficacy for people diagnosed with schizophrenia, 74% of participants (1061 of 1432 people) quit taking their initially-assigned antipsychotic within 18 months, mainly due to ineffectiveness or intolerable side effects.30 Of these unsatisfied participants, about half (509 people) dropped out of the study altogether, while the other half entered a second phase in which they tried a different antipsychotic. During the second phase, 44% of participants assigned to clozapine (20 of 45 people) and 75% of participants assigned to another antipsychotic (282 of 378 people) again discontinued it within 18 months.31,32

V. The brain can heal, and the biological abnormalities linked to psychiatric symptoms are often reversible or can be compensated for by other areas of the brain.33,34,35,36,37,38,39,40 In other words, psychiatric recovery can happen on a biological level, both with and without medication usage.

VI. According to repeated studies by the World Health Organization, people diagnosed with schizophrenia living in developing countries have significantly better outcomes than those living in developed countries.41 The WHO suggests the better outcome “…was unrelated to drug treatment since many in the developing world did not receive continuous treatment. Psychosocial factors, such as better family support, community tolerance, extended networks and more favorable job opportunities, have been postulated as the reasons for this observation.”42

VII. Antidepressant medications are no more effective than a sugar pill for people with mild to moderate depression, and only slightly more effective than a sugar pill for people with severe depression.43

VIII. Efforts to increase a person’s awareness of their diagnosed mental illness – known as “illness insight” – may lead to self-stigmatization that decreases self-esteem and hope.44,45,46,47 Research shows that the “mental illness is like any other physical disorder” message behind many anti-stigma campaigns actually increases the public’s fear, prejudice, and desire for distance from people who are diagnosed.48

IX. Psychiatric diagnoses are not based on medical testing, but instead on self-report and professional interpretation according to culturally-defined notions of disease. They are therefore arbitrary and often unreliable, especially over time, being prone to racism, sexism, classism, and Eurocentric bias. Many people receive different diagnoses from different doctors, which muddles treatment options and can lead to unnecessary or mismatched medication usage.49

REFERENCES

For links that direct you to these sources see Steven’s hyperlinked version of this paper for further study:
1 Lacasse JR, Leo J. The Media and the Chemical Imbalance Theory of Depression. Society 45(1):35-45, Feb 2008.

2 Lacasse JR, Leo J. Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Medicine 2(12), e392 doi:10.1371/journal.pmed.0020392, Nov 2005.

3 Breggin PR, Cohen D. Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs. Philadelphia, PA: Da Capo Lifelong Books, 2007.

4 Doidge, N. The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York, NY: Viking Adult, 2007.

5 Begley, S. Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves. Ballantine Books, 2007.

6 Kendler KS. “A gene for…”: The nature of gene action in psychiatric disorders. Am J Psychiatry 162:1243-1252, 2005.

7 Davidson L, Harding C, Spaniol L, (Eds.). Recovery from severe mental illness: Research evidence and implications for practice. Boston, MA: Center for Psychiatric Rehabilitation͵ Boston University, 2005.

8 Harding CM, Brooks GW, Ashikaga T, et al. The Vermont longitudinal study of persons with severe mental illness I: methodology study, sample and overall status 32 years later. Am J Psychiatry 144:718-726, 1987b.

9 DeSisto MJ, Harding CM, Ashikaga T, et al. The Maine and Vermont three-decade studies of serious mental illness, I: matched comparison of cross-sectional outcome. Br J Psychiatry 167:331-338, 1995a.

10 Huber G, Gross G, Schuttler R. A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatr Scand 52:49-57, 1975.

11 Ogawa K, Miya M, Watarai A, et al. A long-term follow-up study of schizophrenia in Japan–with special reference to the course of social adjustment. Br J Psychiatry 151:758-765, 1987.

12 Ciompi, L. Psyche and Schizophrenia. Cambridge, MA: Harvard U. Press, 1988.

13 Read J, van Os J, Morrison AP, Ross CA. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand 112(5):330-50, Nov 2005.

14 Rosenberg SD, Lu W, Mueser KT, Jankowski MK, Cournos F. Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services 58(2):245-53, Feb 2007.

15 Hammersley P, Dias A, Todd G, Bowen-Jones K, Reilly B, Bentall RP. Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. Br J Psychiatry 182:543-7, Jun 2003.

16 Garno JL, Goldberg JF, Ramirez PM, Ritzler BA. Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry 186:121-5, Feb 2005.

17 Morgan C, Fisher H. Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma–a critical review. Schizophrenia Bulletin 33(1):3-10, Jan 2007. Epub Nov 14 2006.

18 Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R, van Os J. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand 109(1):38-45, Jan 2004.

19 Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 82(2):217-25, Oct 2004.

20 Herman JL, Perry JC, van der Kolk BA. Childhood trauma in borderline personality disorder. Am J Psychiatry 146(4):490-5, Apr 1989.

21 Harkness KL, Monroe SM. Childhood adversity and the endogenous versus nonendogenous distinction in women with major depression. Am J Psychiatry 159(3):387-93, Mar 2002.

22 Vythilingam M, Heim C, Newport J, Miller AH, Anderson E, Bronen R, Brummer M, Staib L, Vermetten E, Charney DS, Nemeroff CB, Bremner JD. Childhood trauma associated with smaller hippocampal volume in women with major depression. Am J Psychiatry 159(12):2072-80, Dec 2002.

23 Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry 160(8):1453-60, Aug 2003.

24 Read J, Ross CA. Psychological trauma and psychosis: another reason why people diagnosed schizophrenic must be offered psychological therapies. J Am Acad Psychoanal Dyn Psychiatry 31(1):247-68, Spring 2003.

25 Harrow M, Jobe T. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. Journal of Nervous and Mental Disease 195(5):406-414, 2007.

26 Whitaker R. The case against antipsychotic drugs: a 50-year record of doing more harm than good. Med Hypotheses 62(1):5-13, 2004.

27 Bola JR, Mosher LR. At issue: predicting drug-free treatment response in acute psychosis from the Soteria project. Schizophr Bulletin 28(4):559-75, 2002.

28 Calton T, Ferriter M, Huband N, Spandler H. A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia. Schizophr Bulletin 34(1):181-92, Jan 2008. Epub Jun 14 2007.

29 Mosher LR, Hendrix V, Fort DC. Soteria: Through Madness to Deliverance. Xlibris Corporation, 2004.

30 Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK; CATIE Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353(12):1209-23, Sep 2005. Epub Sep 19 2005.

31 McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK; CATIE Investigators. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 163(4):600-10, Apr 2006.

32 Stroup TS, Lieberman JA, McEvoy JP, Swartz MS, Davis SM, Rosenheck RA, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK; CATIE Investigators. Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Am J Psychiatry 163(4):611-22, Apr 2006.

33 Morgan, S. Rethinking the Potential of the Brain in Major Psychiatric Disorders. Retrieved July 6, 2008, from http://www.mindfreedom.org/kb/diagnostics/rethinking-the-brain

34 Bernier PJ, Bedard A, Vinet J, Levesque M, Parent A. Newly generated neurons in the amygdala and adjoining cortex of adult primates. Proc Natl Acad Sci USA 99(17):11464-9, Epub 2002 Aug

35 Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: changes in grey matter induced by training. Nature 427(6972):311-312, Jan 2004.

36 Merzenich, M. Brain plasticity-based “cognitive training” elevates BDNF. Message posted to http://merzenich.positscience.com/?p=35, Apr 2007.

37 Bremner JD, Elzinga B, Schmahl C, Vermetten E. Structural and functional plasticity of the human brain in posttraumatic stress disorder. Prog Brain Res 167:171-86, 2008.

38 Gould E, Graziano MSA, Gross C, Reeves AJ. Neurogenesis in the Neocortex of Adult Primates. Science 286:548–552, 1999.

39 Bieling P, Goldapple K, Garson C, Kennedy S, Lau M, Mayberg H, Segal Z. Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy. Arch Gen Psychiatry 61:34-41, Jan 2004.

40 Schwartz, JM, Begley, S. The Mind and the Brain: Neuroplasticity and the Power of Mental Force. New York, NY: Harper Perennial, 2003.

41 Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, and Bertelsen A. Schizophrenia: Manifestations, Incidence and Course in Different Cultures. A World Health Organization Ten-Country Study. Psychological Medicine Monograph Supplement 20. Cambridge: Cambridge University Press, 1992.

42 World Health Organization. Schizophrenia: Youth’s Greatest Disabler. Retrieved July 6, 2008, from http://searo.who.int/en/Section1174/Section1199/Section1567/Section1827_8055.htm

43 Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine 5(2):e45, Feb 2008.

44 Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bulletin 33(1):192-9, Jan 2007. Epub Aug 7 2006.

45 Watson AC, Corrigan P, Larson JE, Sells M. Self-stigma in people with mental illness. Schizophr Bulletin 33(6):1312-8, Nov 2007. Epub Jan 25 2007.

46 Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP. A Modified Labeling Theory Approach to Mental Disorders: An Empirical Assessment. American Sociological Review 54(3): 400-423, Jun 1989.

47 Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services 52(12):1621-6, Dec 2001.

48 Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatr Scand 114(5):303-18, Nov 2006.

49 For a research-based and in-depth overview of the problems with subjective diagnosing, see Chapters 3 & 4 of:
Bentall, RP. Madness Explained: Psychosis and Human Nature. London, England: Allen Lane, 2003.

Which came first, the chicken or the egg?

Mainstream psychiatry usually claims that people with diagnoses of major psychiatric disorders such as "bipolar" or "schizophrenia" are born with a "dysfunctional" brain, that it just needed a trigger for the "illness" to show. While the "illness" always had been there, although it needed some time to find expression. Likewise, it is claimed, that these "diseases" are chronic, that the changes in brain chemistry are permanent.

Personally, and diametrically opposed to psychiatry's view of the matter, I've always been convinced that the "abnormalities" scans and EEGs of psychotic individuals show, perfectly match the state of mind these individuals are in. That they do nothing but reflect on a material level what these individuals experience both intellectually and emotionally, actually being the brain's reaction/adjustment to what is going on in an individual's mind. A view, that is supported by findings about both talk-therapy and other approaches (such as meditation), that change an individual's scheme of things, being able to change brain functioning as well.

The following article by Steven Morgan, a member of Vermont Recovery supports my view furthermore. Thanks to Steven for his kind permission to post this excellent article on my blog! Unfortunately, Blogger doesn't fully support my Mac, so I wasn't able to keep the original formatting. I hope, both Blogger, Mac and I will be forgiven! Here's the article:


Rethinking the Potential of the Brain in Major Psychiatric Disorders

By Steven Morgan (steven(at)vermontrecovery(dot)com)

I. Questionable Theories
The human brain is likely the most complex structure in the Universe. Even though it produces our understanding of the world, we are still in our infancy of understanding it. Even so, technological advances in the past few decades have produced images that allow researchers to observe different parts of the brain reacting to stimuli in real time, and also to measure variations in brain structures to compare populations. Alongside these developments, the field of psychiatry has increasingly sought after and put forth biological explanations for psychiatric disorders. With the influence of billions of advertising dollars from pharmaceutical companies,¹ these theories have been simplified and sold to laypeople in the form of “mental illness is caused by a chemical imbalance in the brain.”²

For someone who is newly diagnosed with a major psychiatric disorder, such an explanation can provide relief. It offers a reason for extreme behavior that s/he may find shameful or bewildering, and it assures family members that they are not at fault. Blaming the brain also discredits the self-denigrating notion that one’s inability to cope with psychological problems is connected to weakness of character.

Yet there are serious repercussions for endorsing these theories. People who believe that chemical imbalances underlie psychiatric disorders are likely to believe that medication must be used as a corrective measure, often for life. They are also likely to overlook the causative influence of socio-cultural factors and histories of trauma and abuse. Even when theorists do acknowledge that environmental stressors play a role in the development of psychiatric disorders, they often refer to them as “triggers” of the underlying biological problem. In other words, the problem still originates from and remains within the diagnosed person. Finally, according to a recent study,³ associating psychiatric disorders with faulty brain chemistry actually increases public stigma: “Biogenetic causal beliefs and diagnostic labeling by the public are positively related to prejudice, fear and desire for distance.”

Underlying the debate of whether brain-based theories are helpful or harmful are far more important questions to ask: Are these theories even true? Are psychiatric disorders caused by brain diseases and chemical imbalances? And if they are, can the brain change, heal, and grow out of them?

Answers to these questions deeply influence whether workers – especially psychiatrists and medically-oriented professionals – believe that people with diagnoses can make complete recoveries, and they equally influence the hopes and aspirations of people who are diagnosed. However, as a layperson, it can be extremely difficult to investigate such material. Most people are not educated in the neurosciences, nor do they have the will or resources to explore the vast research literature that informs psychiatric practice. Furthermore, since science is equated with truth in Western society, and since doctors are equated with science, many people are conditioned to entrust psychiatrists with providing accurate and tested information. Thus, questioning medical wisdom is somewhat deviant, and attempts at challenging psychiatric theories may be quieted by self-belittlement – “What do I know?” – or rejection from social groups who endorse the dominant paradigm – “Doctor knows best.”

Yet as the consumer/survivor/ex-patient movement increasingly demands that mental health workers perceive clients as harboring untapped potential, so must workers and clients make efforts to re-examine their assumptions about the brain.

II. A New Science, A New Brain

Traditionally, the adult brain was considered relatively hard-wired and fixed, a prognosis that lowered expectations about the possibility of curing the alleged brain problems that underlie psychiatric disorders. Thus, in the medical world, schizophrenia and bipolar disorder have been conceptualized as life-long, incurable brain pathologies that a person can learn to manage, but never completely resolve. However, these hypotheses have always been problematic, for longitudinal studies have demonstrated again and again that a significant amount of people diagnosed with schizophrenia completely emerge from psychiatric symptoms and no longer use medications.⁴ These individuals pose this challenge to neurobiology: if their previous symptoms were in fact due to a broken brain, are their brains now fixed?

The simple answer is yes, and a new area of science is explaining how and why. (It should be noted that scientists could obtain a wealth of information from comparing PET and fMRI scans of people who have completely recovered with people who are still experiencing similar psychiatric symptoms, but that more research is needed). This area of science is called neuroplasticity, and its findings are rapidly reversing old myths about the potentiality of the brain.

Neuroplasticity basically refers to the brain’s natural ability across the lifespan to form new connections and change its structure in response to experience. This means the brain can change itself physically and functionally at any age to compensate for injury and disease and to adapt to new situations or changes in the environment. Whereas the brain was once conceptualized as a machine, it could now be thought of as more like clay, both malleable and vulnerable towards positive and negative influences. Of course, there are limits to how much the brain can change, reorganize, and heal, but these limits are not as imposing as might be assumed. Indeed, harnessing the power of neuroplasticity, people are fully recovering from massive strokes and other head traumas, overcoming learning disabilities to leap ahead in reading levels in a matter of months, rewiring obsessive-compulsive behavior out of their brains, erasing the pain of phantom limbs, restoring memory acuity and cognitive processing during old age, learning to see without eyesight, strengthening muscles just by thinking about them, meditating to create lasting neurological states that are conducive to compassion and happiness, and on and on.⁵ ⁶

The message here is that the brain changes. This means that it is highly likely that whatever biological correlates underlie major psychiatric symptoms can change, too. For instance, trauma and chronic stress change your brain but the areas that are affected can be changed back or compensated for. More specifically, the amygdala involved in processing emotion and anxiety and shown to be affected by trauma can form new connections including to the prefrontal lobes which helps in controlling impulses and exercising restraint.⁷ Gray matter which has been shown to be less voluminous in people diagnosed with schizophrenia can thicken.⁸ Serum BDNF (Brain-derived neurotrophin factor) which has been shown to be lower in people diagnosed with schizophrenia bipolar disorder and depression can be raised.⁹ The hippocampus which is shown to have shrunk for people diagnosed with depression and PTSD can grow back¹⁰ and even produce new cells for the rest of the brain to make use of.¹¹ Certainly neurotransmission – the release of serotonin, dopamine, norepinephrine etc. to allow communication between brain cells – is variable and can be altered by natural means ranging from sunlight to thinking positively. Even psychotherapy can significantly change the brain.¹²

One of the tenets of neuroplasticity is that in order for the brain to form new connections and change, it must be stimulated through activity. Whether this activity is external – such as playing a piano, or internal – such as imagining your fingers playing a piano sequence, an important factor in driving lasting brain changes is that you pay close attention to what you are doing. In fact, playing a piano and just thinking about playing a piano affect the brain in virtually the same way, as long as you are engaged. The importance of this point cannot be understated: if thoughts and imagination physically change your brain, you can therefore use your mind – especially through focused attention – to positively rewire it.¹³

Not suprisingly, this theme of mind over matter runs in recovery stories. Indeed, while people who recover often mention practical activities that helped them – such as eating well (which can even turn genes on and off¹⁴) and exercising (which produces new brain cells and has an anti-depressant effect¹⁵) – they also refer to the healing power of intangible experiences: spirituality, hope, human connection, having meaning and purpose in life, optimism, an undying will, and awareness. And it is likely that through the power of neuroplasticity, both the practical activities and the intangible experiences changed their brains.

To further illustrate this point, consider the experience of self-awareness, which seems to be particularly important for people who recover. Self-awareness refers to the awareness of one’s thoughts, behaviors, and actions, and how all of these are intricately connected with one’s environment. Though it is an incredibly empowering asset that most human beings – diagnosed or not – struggle to achieve, people who experience emotional and psychological turmoil may be at a unique advantage to master it, for their survival may depend on their ability to separate from and analyze the content of their minds. In any case, self-awareness requires deep attention. And deep attention to the present moment carves new pathways in the brain.¹⁶ Therefore, a person who engages in self-awareness techniques – be it meditation or another form of non-critical observation, is creating new brain states that overtime can replace or compensate for troubling brain states entirely.

III. Changing Attitudes

Taken together, the implications and discoveries of neuroplasticity challenge the traditional framework for understanding the role of the brain in psychiatric disorders. We can no longer perceive the brain as acting on its own predetermined accord in a vacuum to create experiences. Instead, we should conceive of the brain as fundamentally inseparable from experience, so that whatever happens to someone both externally and internally has the potential to significantly alter their brain. This means that people who recover can be thought of as having likely changed their brain chemistry and functioning, thus allowing for the possibility that the faulty biology allegedly behind major psychiatric disorders is reversible. In this regard, mental health workers should seriously consider eliminating talk about schizophrenia and bipolar disorder as incurable and life-long.

In fact, there are so many problems with making the simple statement, “Mental illness is caused by a chemical imbalance in the brain,” that it should perhaps be discontinued altogether. Evidence that different structures and functions of the brain are pathological in psychiatric disorders is still highly contentious; it is also well beyond the scope of this paper. However, given the far-reaching influence of pharmaceutical companies who have a financial interest in promoting biological theories – after all, their medications are primarily justified by the claim that they “fix” biological problems – it is likely that reductionist statements of the brain will continue to prevail. Therefore, we should amend these statements. Here is an example of what a worker could tell a client: “Your brain changes in response to the experiences you have. Even though psychiatric disorders show up on the biological level as differences in the brain’s functioning, your brain is not set in stone. In fact, you can change it, though it will take time and effort. There is much reason to be hopeful.”

Recovery and hope go hand-in-hand, yet there is nothing more hopeless than believing your brain will forever malfunction without medication. There is also hardly a more misinformed declaration about the brain in light of recent science, and especially when considering the multitudes of people who have completely recovered.

If mental health workers can derive from neuroplasticity that complete recovery is a possibility given the right elements, then they will perhaps hold themselves more accountable for the outcomes of their services, as opposed to justifying poor outcomes by dismissing or subtly ignoring some people as chronic and hopeless. In this way, rethinking the potential of the brain in major psychiatric disorders improves the efficacy of mental health services, revives the energy and optimism of workers, and ultimately restores hope to the millions of diagnosed individuals who currently see no way out.

References

¹ Gagnon MA, Lexchin J. The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States. PLoS Med 5(1): e1 doi:10.1371/journal.pmed.0050001, 2008

² Leo J, Lacasse JR. The Media and the Chemical Imbalance Theory of Depression. Society 45(1):35-45, Feb 2008.

³ Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the `mental illness is an illness like any other’ approach. Acta Psychiatr Scand 114(5):303-18, Nov 2006.

⁴ Davidson L. Harding C Spaniol L (Eds.). Recovery from severe mental illness: Research evidence and implications for practice. Boston, MA: Center for Psychiatric Rehabilitation Boston University, 2005.

⁵ Doidge, Norman. The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. Viking Adult, 2007.

⁶ Begley, Sharon. Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves. Ballantine Books, 2007.

⁷ Bernier PJ, Bedard A, Vinet J, Levesque M, Parent A. Newly generated neurons in the amygdala and adjoining cortex of adult primates. Proc Natl Acad Sci USA 99(17):11464-9, Epub 2002 Aug 12.

⁸ Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: changes in grey matter induced by training. Nature 427(6972):311-312, Jan 2004.

⁹ Merzenich, M. Brain plasticity-based “cognitive training” elevates BDNF. Message posted to http://merzenich.positscience.com/2007/04/05/brain-plasticity-based-cognitive-training-elevates-bdnf/, Apr 2007.

¹⁰ Bremner JD, Elzinga B, Schmahl C, Vermetten E. Structural and functional plasticity of the human brain in posttraumatic stress disorder. Prog Brain Res 167:171-86, 2008.

¹¹ Gould E, Graziano MSA, Gross C, Reeves AJ. Neurogenesis in the Neocortex of Adult Primates. Science 286:548–552, 1999.

¹² Bieling P, Goldapple K, Garson C, Kennedy S, Lau M, Mayberg H, Segal Z. Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy. Arch Gen Psychiatry 61:34-41, Jan 2004.

¹³ Schwartz, Jeffrey M, Begley, Sharon. The Mind and the Brain: Neuroplasticity and the Power of Mental Force. New York, NY: Harper Perennial, 2003.

¹⁴ Challem J. Feed Your Genes Right. Hoboken, NJ: John Wiley, 2005.

¹⁵ Bjørnebekk A, Mathé AA, and Brené S. The antidepressant effect of running is associated with increased hippocampal cell proliferation. International Journal of Neuropsychopharmacology 8:357–368, 2005.

¹⁶ Siegel, DJ. Mindfulness training and neural integration: differentiation of distinct streams of awareness and the cultivation of well-being. Social Cognitive and Affective Neuroscience 2(4):259-263, 2007.