brain research – Inspiring Change LLC

When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD. (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia” (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

Healing Traumatic Memory

If only life was one long, beautiful, inspirational journey. But it’s not. Some of us know that life can include experiences of such fear, helplessness and pain that we wonder how we survived. Over time, and with support, most of us get back to what we would call our normal. Yet others of us discover no matter what, we just can’t.

We call these experiences psychological trauma, the kind of experiences that steal our mental equilibrium. Many traumas have their origin in childhood; our bodies and minds are dependent, small, developing and vulnerable. The younger we are when they occur, the more impact they may have on the way we learn to relate, think, feel and trust the world around us.

Traumatic memories happen within the brain when we survive a life-threatening event and experience overwhelming shock, loss, fear, horror and helplessness. The words we have for what we experienced are just not enough to explain it to others. Motor vehicle accidents, physical, sexual and emotional abuse, parental neglect and addiction, domestic violence, plane crashes, witnessing homicide, military combat, escaping house fires: these are among the experiences that can overwhelm our emotions and capacity to bear what we have seen and known. The memory of the experience is stored in a kind of jumble in the brain, never blending into what we would call our normal sense of self, our everyday explicit memory.

Neurologists, psychologists and other researchers have made wonderful strides in the last 30 years in understanding how trauma effects the brain. And as the science of trauma becomes clearer, so has the clinical work of seeking effective treatments: treatments for the post-trauma effects that are expressed in our bodies in the form of chronic pain, sudden panic attacks, visual and auditory flashbacks, depression, anxiety, relationship and work problems, addictions and patterns of emotional dissociation.

First generation psychological care for traumatic memory was talk therapy; some relief was attained by patients helped to fully describe their experience in a private, compassionate therapeutic environment. Second generation care added strong prescription medications to calm the nervous system, limit emotional affectivity or target psychotic symptoms. What the most recent research has shown is that both methods are insufficient; talking uses the cognitive portions of the brain without adequately engaging the emotional and survival systems, systems that were in charge during a trauma, and dulling trauma memories or disengaging them temporarily with psychotropic drugs won’t heal the damaged and chronically misfiring memory patterns.

What does work is helping the sufferer to carefully, artfully, and in a controlled and focused way to re-experience the memories, feel the experience again in the body while expressing the energy, body movements, sounds, sights and postures that were suppressed at the moments of helplessness, dissociation and physical restriction. To think the thoughts that seem too terrible to think, and to help the mind link up the original memory to the fuller, day to day explicit or narrative memory that we live and work in every day.

This is what the work of Francine Shapiro’s EMDR (Eye Movement Desensitization and Reprocessing), Peter Levine’s Somatic Experiencing (SE), Albert Pesso’s Psychomotor Therapy and Pat Ogden’s Sensorimotor Approach all seek in their similar models: to have the sufferer become integrated with their physical bodies, those same bodies that have experienced the trauma, to feel, tolerate, express, observe and rewrite their story in the present sense of the self.

All this is to say: there has never been a time in human history where more can be done to help the trauma sufferer than now. If you are besieged by physical and mental echoes of a terrible event in your past, please seek out care from a psychotherapist trained in the newer trauma resolution techniques. Many of us have found peace where there was no peace, and wish the same health and healing for you.

Racism and Trauma

For decades, family therapists and other mental health professionals and researchers have believed that trauma in one generation can be expressed in the genetic code and passed as psychological suffering and vulnerability in following generations. This fact has been demonstrated in animal studies for years, but few human trials have followed.

A research team at Mt. Sinai Hospital in New York City, studying the DNA and mental health of survivors of World War II Nazi atrocities and their children, have newly demonstrated genetic changes in the children of these survivors. The Guardian article of August 21, 2015 describes the changes in a specific gene sequence associated with the regulation of stress hormones. What therapists have seen in their practices has begun to be proven in the laboratory: when emotional and mental trauma happens to us in our early life, it can change our genes, and those changes can be passed down to our children.

It helps to explain the increased mental health issues in children of Holocaust survivors, victims of political terror, accidental trauma, severe poverty, famine and the progeny of African slaves in the United States. This “epigenetic inheritance” can linger for generations and effect the culture, as it has done in the Jewish communities around the world after 1945.

The continuing hurt, vulnerability, anger and rage expressed in Native American tribes and African American communities in the United States against the majority white population can be understood as both cry for justice in the present, and a echo of generational trauma that was endured for nearly 300 years on our nation’s shores.

We have a responsibility as a nation to be struggling to heal the racial injustice and majority privilege that still stains our daily interactions. And therapists need to recognize the layers of trauma that their clients of color may bring to their offices, seeking healing for individual pain that may have been generations in the making.

UPDATE: Here is the link to the mouse study with traumatic epigenetic changes in following generations : Nature Neuroscience, Volume 17, Number 1, January 2014:
https://tinyurl.com/y7zblcwe

Men Have Emotions, Too

“Men seem to have a mental file drawer where they can store unpleasant experience. Open it up, drop it in, slam it shut. Done.” One of my friends was talking about her own experience in her marriage, and wondered if I agreed.

Well, it’s complicated. I do think that in western culture, men are expected to be problem solvers: movers, shakers, thinkers. This is what it takes to succeed in a market economy, where competition for work and other resources parallels the competition for food, shelter and safety of our earliest human ancestors. This ability to compartmentalize their lives? I see it as a psychological defense. Men are taught early in life that boys don’t cry, that when in pain they should shake it off, and that they need to be prepared to bring themselves, if not their families, and their communities to the front lines of life’s battles every day. And if their life battle isn’t a literal one, it certainly is core male metaphor.

That old saw, biology is destiny, is rather real. Men don’t bear children; women do. And women’s bodies and brains have for tens of thousands of years shaped women’s experiences of themselves as child bearer, child protector and nurturer. Women’s brains (recent fMRI imaging bears this out) have been primed to first see the world through relationship and emotional perspective. Men have brains that have developed to give a stronger preference to problem solving.

No wonder we can have trouble talking to and with each other. Women complain that their men don’t listen to them; that they simply hear every conversation with their partner as a plea for information, solution or fix. Men complain that they don’t know what their women partners want from them, if it isn’t what they are naturally good at.

I see this difference in my work as a therapist, but I see it as much through a cultural and family lens as I do a biological or neurological one. Yes, human beings have had gendered roles around children and family life as long as we have recorded history. Yes, we inherit strong personality traits from our parents, who themselves have inherited similar traits from their families. Yes, our culture has deep, anxiously held gender meanings for men (witness the current chaos that transgendered or gender-queer youth have when trying to play high school sport of their gender preference, not their biology) and you will begin to understand how hard it is for men to be really comfortable with their emotional lives.

But men, like women, are people. And we human beings all have these biological responses to the world called emotions that give us information and neurological action split seconds BEFORE our brains kick in to gear with thinking. Men are just taught to rush through them to get to their preferred way of being, thinking. Women are encouraged by biology and culture to notice emotion and better integrate it into their thought.

How can we get through this gendered issue to a better, more satisfying way of being with each other? I teach my clients to reach for their emotional reactions first. I ask men to think about looking for their female partner’s emotional experience, to respond to that, before they begin to problem solve. “Empathy first,” I intone, time and time again. And for women, I teach them tolerance for their partner’s (perceived) emotional dismissal, and patience as they must ask time and time again for their husband to listen and understand them first before they tell them what they ought to do.

We are in this together, men and women. We are all emotional beings, whose preferences with those experiences seem to differ fundamentally. But we are also creative, plastic, changeable beings, too. We can learn to better dance together. Couples who have adjusted to one another in this fundamental way can find a continuous, subtle joy in talking with and sharing life with each other.

On the brink of a PTSD breakthrough

Today I was talking with two different clients about the research done at the VA in Minneapolis in veterans experiencing PTSD – finding in brain scans that traumatic memory seems to “reside” in the right hemisphere of the brain, right above the ear. So happy to have located a story on this research, and want to pin it here 🙂 On the brink of a PTSD breakthrough
Thanks to Dr. Apostolos Georgopoulos for his continuing research!