Wednesday, May 21, 2008

M.I.A.

Literally! I have been so active...I have been missing IN action. My mood seems to have lifted to the point that on Sunday I would say it was the first day in 6.5 years that I felt "Well" most of the day...not too high, not to low, no anxiety, cheerful, bubbly and vivacious even around strangers, confident in my self image; basically my well self.

I say almost well because the last few days have been like that too, but at about 4pm everyday I am so burnt out I feel sick and have to sleep for 2-2.5 hours. Then after about 1/2 an hour awake I feel a bit refreshed again, but evenings I feel really low key and fatigued.

I have had such an interesting week. I went to a mental health conference on Thursday that was one of the most interesting conference I have ever been to. There were three key speakers:

  • Dr. Steve Onken (a social worker from Hawaii)
  • Dr. Maggie Bennington-Davis is a psychiatrist and medical director of Cascadia Behavioral Healthcare, Portland, Oregon (USA)
  • Amy Long (both a person with a mental illness and a psychiatric nurse)

I won't try to encapsulate their ideas, but I would like to share a few key things I am going to change, either in my beliefs, or my actions as a result of the conference. I made them into "I will" statements. Here I go:

(based on Steve's talk):

1. As I become the ancestor, I will be remembered for my voice, not my silence. This is based on an old Hawaiian saying ("As we become the ancestors, we will be remembered for our voice, not our silence). As of this moment I am "outing" myself as a person with a mental illness. I will not be afraid. My voice is powerful and I am going to use it.

2. I will speak up an challenge any "microagressions" I see in the Mental Health Care community. Microaggressions were described as subtle and not so subtle ways, through words, or social structures and concepts, that mental health staff distance themselves from the shared humanity of people with mental illnesses. An example would be "staff only" signs on washrooms (like we don't want clean washrooms too).

(based on Maggie's talk):

Her talk about how the brain changes in response to trauma and later "re-traumatization" was fascinating. I will try to capture the essence of her talk...please remember I may get some of the details wrong as I am no neuroscientist oir psychiatrist, but this is what I think I "heard":

She spoke of three areas of the brain that "manage" experiences. The amygdala, which is like a primitive responder to sensory information. It chooses, without benefit of rational thought, whether to Fight, Flight, or Freeze (FFF). Most regular daily sensory encounters go through the amygdala and then into the hippocampus, which acts as a filing system, and then your prefrontal cortex gets the information and decides what to do with the information.

When we encounter a traumatic experience, or traumatic sensory input, we skip the hippocampus/prefrontal cortex experience and go directly into FFF mode("Hypervigilance, Action, not thought, Cognitive diminishment, increased aggression, loss of impulse control, speechless terror") Bloom 2001.

The next time we encounter something similar, or the same traumatic sensory input, we become "re-traumatized". Over time it might happen than seemingly subtle "re-traumatization, can cause huge FFF responses( "traumatic Re-enactment, Chronic aggression, Dissociation, Chronic hyperarousal which interferes with cognitive clarity {and} loss of (or failure to develop)affect modulation" Bloom 2001.

Part of the problem seems to be that the more we are re-traumatized, the more our hippocampus and prefrontal lobes diminish in size, so not only are we on myper alert mode because our amygdala is working overtime, we are slowly losing the capacity to add reason to our reaction in these situations.

She was not talking about PTSD, but of other kinds of trauma. My personal trauma that I kept thinking of as she talked was about the way my Dad could be when I was growing up, and sometimes even now. He was extremely dismissive of anything I ever did. I wanted so badly for him to like me and to be proud of me, but he always pushed me away. He also had the capacity to become enraged out of the blue. He became extraordinarily intimidating and scary to a little girl (he was a policeman and he KNEW exactly how to scare the crap out of people to make them do what he wanted), he also sometimes became violent towards me in these rages.

To this day, any experience I have with anyone in a position of power or authority is coloured by my childhood experience. It takes very little to make me cry or cower, or feel abandoned or dismissed or rejected.

This is what I was conceptualizing as "re-traumatizations: A man coming towards me quickly and me fleeing in terror, A boss saying something negative about me and me being flooded with memories and tears, just like my Dad is standing over me berating me, A person stabbing their finger in the air and I am back as a little girl with my dad stabbing my chest with his finger, pushing me backwards, scaring the hell out of me.

Maggie suggested when these re-traumatizations occur that we try to use "cognitive wedges" to eventually retrain the brain's capacity to be "re-traumatized". Eventually if we are able to do this enough, the hipocammpus and prefrontal areas of the brain will begin to grow again. Those areas will become more in control of what used to be FFF reactions to external "re-trauma"

3. I will practice using cognitive wedges whenever I encounter a situation that feels like it is a re-traumatizing situation. A cognitive wedge requires that when the re-traumatization sequence begins we IMMEDIATELY start doing some task, any task, that requires you to use the cognitive areas of your brain. Examples she gave me was go into the washroom and try brushing your teeth with your wrong hand, or try reading some difficult passage, or write with your wrong hand...anything that takes the brain away from the amygdala reaction and to a prefrontal reaction.

4. I will be careful that as an instructor I do not do anything that may re- traumatize someone. In order to not re-traumatize myself if/when I make a mistake I will forgive myself and ensure the the mistake leads to a change for the next time a similar situation happens.

(Based on Amy Longs Talk):

5. I will remember that if I am alive, I am coping. I never got this before. I remember Dr. Shock replied " I am glad to see you are coping!) to one of my posts I wrote when I was really feeling close to the edge. I didn't understand what he meant. I do now. Thanks.

6. I will never ever use the word "recovery". I will instead say I am "developing my resiliency". Whenever I here the word "recovery to do with mental health I feel like I am failing, because I never seem to recover. If I do feel better I always seem to crash shortly thereafter. I feel like I am not doing what everyone else does when I fail to recover. I think developing my resiliency, so I am able to fight the depression better each time it shows its grotesque self to me is a better description of how I am working towards feeling better over time. I may never recover from this battle, but I can always add more solid layers of resiliency to my suit of armour

Anyways...it was all very stimulating and interesting. I learned a great deal at this conference. The really cool thing was that after each speaker they had a panel of three people (different people for each panel member) responding to the speakers speech. Each panel included a mental health care professional, a person with a mental illness, and a family member of a person with a mental illness. I learned as much from them as I did from the speakers. Whoever organized the event did a great job.

...aqua

4 comments:

Dr. Shock said...

Cognitive wedge, interesting. Would like to know more about it. I can understand using the frontal cortex, maybe training it in those circumstances will recreate neuronal pathways. Will have a search.
Curious about your cognitive wedges and experiences with them.
Regards Dr Shock

Polar Bear said...

Sounds like a really excellent conference, and you've sure learnt a lot! Thanks for sharing parts of it here.

Annie said...

Aqua, What a fascinating post. The things you learned were interesting and your views of the experience were also helpful. I am going to read the post again. I know I will learn more by another read! Thanks for sharing your experience with us. Annie

Aqua said...

Thanks for the comments. Dr. Shock, from what I remember the training did recreate, or create more and new neural pathways. I have already tried the cognitive wedges a few times and it did help me get out of the pattern of thinking, but was very hard to keep focusing on the "wedge" and not the re-traumatization...I assume it will take many, many times of doing this before it becomes easier and more helpful.