Using the brain to treat the brain

I still remember the first time I saw the movie "Carrie"  For years, I have been skeptical about a human's ability to direct her/his brain power to accomplish telekinesis.  However, recently more and more articles have been appearing about the brain's ability to do something similar as research delves into finding ways for those severely wounded to use their artificial limbs more productively.

What if a person could turn that brain power into a healing energy source for themselves?  What if, indeed, a person could be taught to use their brain power to treat their eating disorder behaviors or better yet what lies behind that behavior?

Imagine if  a servicewoman or man, who returns from combat with PTSD, could use this technology to eventually retrain their brain to heal.

I don't think this is so far-fetched since for at least five years I've been reading reports and studies that illustrate how a person can train themselves to go to thought B rather than thought A in order to interrupt a harmful behavior.  I began to pay more attention to this idea while taking NAMI's free 12-week Family to Family Course back in 2007 when I learned about work done in addiction studies that was being applied to brain disorders.

So now comes news of companies in San Jose - NeuroSky - and San Francisco - Emotiv Systems, Inc. - which offer headsets and software designed to "empower" users to do things like control a computer with their thoughts or play a game called "Mind Labyrinth" "....which grants players access to 52 different levels of an ancient temple as their relaxation grows deeper."

You can find more information in an article that appears in today's (Tuesday, May 29, 2012) Wall Street Journal in Section B, pp. 1-5.

This news is very exciting.  There are, according to the article, "1,700 developers working with NeuroSky's technology, .... making mindcontrolled computer games for the company's $129 MindWave Mobile headset."  Others believe that these games will further the efforts to improve mental health.

This will take time, of course, and one needs to be wary of a silver bullet approach.  But what a possibility!!!!

Random thoughts about eating disorders and their treatment

Carrie Arnold's recent post The Eating Disorder World's Dirty Little Secret in which she states, "We have absolutely no idea how to treat an eating disorder" got me thinking about eating disorders.  Random questions came to mind as I sat here at my computer.

I thought I'd simply post them here and add to them when and if  (if I can remember!) an additional thought comes to mind while out hiking. Any other comments are always welcome.  This is a living document (since I've already changed it after posting it a few minutes ago!)  I'm not looking for answers so much as following a train of thought to see where it goes.

And, having asked the questions below, and thinking about Carrie's post, one must also consider the person one is treating.  So, it would seem that treating an eating disorder is very complicated.

And, having just read an excellent summary of things to consider/perspectives when treating an individual in the book Borderline Personality Disorder: New Reasons for Hope by Francis Mark Mondimore, MD, and Patrick Kelly, MD (Johns Hopkins University Press, 2011) reviewed here,  I thought these were relevant to the "equation" (from page 40, Table 3.1 The perspectives of psychiatry) as well:

The disease perspective considers:   what the patient has.
The dimensional perspective considers:  who the patient is.
The behavioral perspective considers:  what the patient does
The life story perspective considers:  what the patient encounters.

 There appear to be many varieties of an eating disorder.

Does each one have a different "cause"?

Is an eating disorder the outward appearance or symptom of an inner state of mind?

Does one treat an eating disorder or does one treat the inner state of mind?


Did the change in the inner state of mind occur before the symptoms appeared?

What causes the change in the inner state of mind?

Is the new state of mind a result of physiological changes in the brain? What causes the physiological changes?

Are the physiological changes simply a result of genetically programmed events that occur in some people at a certain stage of physical development?

At what stage? At what age? Or, are there other factors (environmental, hormonal, chemical or a combination of all three of these) that exacerbate the development of these physiological changes?

What molecules are involved? Likely suspects along the way – oxytocin, estrogen, insulin, neurotransmitters e.g. SSRI’s, L-tryptophan, dopamine, GABA,  norepinephrine, ….. and others listed here. 

Where does the manufacture of these take place in the body?

What external food, etc. sources are needed to manufacture these?

Do fMRI's show a difference in the relevant areas of the brain between those who have an eating disorder and those who don't?

Are the differences (if any) due to the ED behaviors (starvation/chemical imbalances) or are the differences present from birth?

As a preventive measure, might one request an fMRI of the brain of offspring of a person who had/has an eating disorder before the ED might develop?

Given what Dr. Insel stated at the FEAST Conference in 2011, might ED's begin as early as 2 or 3 years old as now can be detected for those who go on to develop diabetes?

Is there a link between diabetes and ED's?

Book impression: Borderline Personality Disorder - New Reasons for Hope

As readers here know, in 2007 our family finally was provided with information that explained years of illness, sadness, and failed treatment.  Two psychiatrists at two different institutions diagnosed Borderline Personality Disorder (BPD) and gradually, since that diagnosis, so much has fallen into place.
  

Like many parents, I began to read and digest as much as I could about BPD and you'll find several books on this topic in the list of books I've provided here on my blog.  I've also written several posts on the topic.   Early on I came up against the same themes as many parents have when the myths about causes of autism and schizophrenia and now eating disorders were discussed.  As time has gone on, the term "biologically based" has been added to the framework.  Environment, I believe, is an important factor, too, if for no other reason than to support the concept of family education to assist the person with a diagnosis of BPD to get on the road to recovery.  I've written quite a bit about this concept as it relates to eating disorders and BPD on my blog, particularly under the topic of communication.

Randi Kreger's book, The Essential Family Guide to Borderline Personality Disorder:  New Tools and Techniques to Stop Walking on Eggshells (Hazeldon Press, 2008) was the first book to help me understand the ramifications of this diagnosis as well as what positive things I could do as a parent to help.

About a month ago, I came across a reference to a book published just last year (2011) by the Johns Hopkins University Press as part of the Johns Hopkins Press Health Book Series.  It's available in paperback, which is a wonderful decision on their part because the book is affordable for parents keen on learning more.  For that matter, it's also a valuable book for the person diagnosed with BPD, as an entire chapter is directed towards that person - "If You've Been Diagnosed" (pp. 215-228).

The book is Borderline Personality Disorder - New Reasons for Hope by Francis Mark Mondimore, M.D. and Patrick Kelly, M.D.

This extensive and grounded work incorporates the latest research about and treatment of this diagnosis (dx). The book is directed not only to the therapist but also to the person diagnosed with BPD as well as to those who are family members, friends and even employers and co-workers. 

The book is divided into four sections: Understanding the Problem including clinical discussion as well as "personality"; Causes - encompassing an enormous array of information from genetics to environment; Treatment, particularly with emphasis on the difficulties when a person has co-morbidities and the sometimes ineffectiveness of medication (some believe that medications are inappropriately administered and in fact, some like the benzodiazepines compound the problems inherent in addiction) under these circumstances while looking harder at the necessary therapeutic relationships and need for truly understanding this disorder; and finally How to Cope, How to Help - written for the person with the dx and for parents, partners, friends and co-workers. 

The chapter for the person with the dx is especially frank but also supportive with solutions, an approach that I liked very much, particularly the attitude that the person needs to engage, take responsibility, accept and commit.  The section titled, "Looking for Happiness in All the Wrong Places" offers (p. 226) "...a psychiatrist or psychotherapist cannot reveal to you the meaning of life, or tellyou why your life is worth living.....Treatment for borderline personality disorder can help you learn how to cope with setbacks and disappointments better, negotiate relationships more successfully, rein in impulsiveness, make peace with a traumatic past and put it behind you, and many other important skills and lessons.....But your happiness is your responsibility, just as it is for everyone else."

The authors emphasize that the tide is turning about the dx for the dx is now being called "the good prognosis diagnosis."  They promote the idea that the nomenclature is incorrect. Not only that, but they believe the nomenclature fosters the person with the dx to think something is inherently _wrong_ with them since the word "personality" conveys such a strong definition of self.

The authors include a section titled, "International and Cross-Cultural Considerations" that trounces what some have proposed as a dx only found in the United States.  Clearly there is more at work than just environment. 

The book, to me as a layperson, is very dense in the initial sections (meaning one needs to "chew" on what one is reading)  but well-written and includes a terrific definition with examples of "splitting", something I had a hard time understanding from previous books that I've read. 

The epilogue as well as the text emphasizes, given the complexity of this diagnosis -- meaning the many aspects of emotions and behaviors, that a team of professionals skilled in differing areas must be assembled to treat the person.  It's unlikely that one professional can because, as I've been told by several people now, one who treats this illness must receive ongoing support and counseling themselves to avoid being drawn into the whirlwind created. 

The authors "distill" the disorder by writing (p. 251),

"Borderline personality disorder develops when a child born with extremes of temperament and a biologically rooted difficulty managing emotions encounters a mismatched childhood environment. This mismatch may be quite subtle or quite pathological but is experienced by the child as inconsistent and unpredictable, leading her to develop a damaged sense of self and the expectation that others will continue to be inconsistent, unpredictable, and ultimately unreliable and abandoning. This in turn causes profound emptiness and hopelessness to dominate her emotional life. To cope with her emotional extremes, and her desperate and painful unhappiness, she develops self-destructive coping behaviors like addictions, eating disorders, and self-mutilation. Frequently, these individuals also suffer from biologically based mental illnesses that exacerbate all their other problems and prevent behavioral and psychological treatments from helping them.
....Borderline personality disorder results from an interaction of genetic and other biological factors, inborn temperament, and childhood experiences and is usually complicated by the development of abnormal behaviors and psychiatric illnesses. All these factors require therapeutic attention, often by different professionals using different approaches."
 

As I wrote above, I am encouraged by this new approach to this illness and enlightened by how important it is to bring therapists up to date on the treatment of this disorder (sounds familiar, I am sure, to those promoting a change in the way eating disorders are treated).  Valuable techniques are included for therapists.

I also was pleased to just come across (May 2013) this book review by the esteemed researcher in the field of BPD, Joel Paris, M.D., Professor of Psychiatry at McGill University in Montreal.  The review appears in Psychiatric Times, Volume 29 #4.

Finally, thanks to the Epilogue, I learned that this month (May) was established by the United States House of Representatives - unanimously - in 2008 as "Borderline Personality Disorder Awareness Month."  How fitting that I discovered and read this book this month.  How important it is to promote what the authors have assembled for our increased ability, as parents, to advocate for our loved one(s).

Marjie Ruth: Finding the Route to Recovery

I've deliberately stepped away from this blog for awhile to rest.  I was exhausted by the work involved not only in advocating for and supporting my beloved daughter, but also by the tension of worrying that her body and/or her will would finally give out before her team could put together a plan that set absolute boundaries this time over or under or around which she would not be able to go.  The goal was to provide her with a safe place so she could begin the work not only of re-gaining but also putting herself back together again.  She is there now.  In life there are no guarantees.  We do hope, though, that this path will give her another chance.

Here's Marjie Ruth's latest contribution....... She puts into words what I have struggled with for such a long time.

At bottom is the best soil to sow and grow something new again.

In that sense, hitting bottom, while extremely painful, is also the sowing ground.

~Anonymous

Dear Family & Friends of the Eating Disordered;

Perhaps one of the most difficult aspects of dealing with a loved one and their disorder/addiction/mental illness, is not simply in figuring out where to get help for them. While that can truly be a daunting task at times, especially as such treatment can often come with a hefty price tag, but once found we're faced with what in some cases seems to be the nearly impossible challenge of getting them to be willing to receive the help we're offering. How do you get someone in the grips of a disorder like anorexia or bulimia or alcoholism or drug abuse to buy into the idea of going to a treatment program or working with a therapist whose goal is to wrest the crutch out of their life--the crutch that they are so very sure is not only holding them up, but also holding them together to be able to function at all? We see their behavior as, at times, bordering on insanity. Yet we then ask that "insane" person to please listen to our rational and logical explanation of why they need to submit, and we even ask them to respond in a reasonable manner. Sorry to say, but that can be asking a lot of the "inmate"--that person so locked into the irrational world of an eating disorder or some other crippling addiction.

So, what are we to do? Some would counsel us to just walk away, to throw them out, to turn our back and let them sink or swim. "Just" you say? Why don't you ask me to "just" cut off my right arm? The advisor(s) in these instances may be well intended in that they relate more to us, the family & friends, than they do the disordered person. Their motivation is to help us survive the hell that the disease can inflict on those who are closest to its victim, and to not see us destroyed by the disease also. Unfortunately, such good intentions do little to help us and instead may only make us feel more alone in our certainty that others truly cannot comprehend the depths of our pain and a love that will not give up hope until life itself is gone.

But we are not alone. Others have gone through this same pain, and countless more, I am sorry to say, will have to tread a road they have no clue about...yet. So, how have others dealt with this same horror? What have they learned that can possibly come to our aid? All 12 step programs are founded on the same guiding principles which were developed through experience with addictions and are a compilation of work by various folks as articulated by William Wilson back in 1934, who is now referred to as Bill W. Interventions are staged with the assistance of trained and experienced therapists. Treatment programs have been established all over the country. Hundreds and hundreds of books have been written. Support groups surface. Survivors share. But the struggle goes on seemingly anew for each person, each family, each circle of friends dealing with a disorder.

What all of these programs and resources do have in common are a few very basic tenets that, I feel, are the touchstone that we can repeatedly refer to:

1. Recovery only truly happens when the person is ready to do it. The important work that family & friends can do is to learn how not to be an enabler, a co-dependent, a participant in the dysfunction.
2. No one can "do" or make recovery happen for another. We can make treatment and possibly recovery a possibility, but then we must step back and get out of their disease.
3. A person can get so far into a disorder/addiction that they get to a point where they cannot find their way out without (preferably professional) intervention. When an anorexic becomes malnourished, her brain simply does not function well enough to allow for any clarity of thought. An alcoholic or drug addict needs medical supervision to safely survive withdrawal from the substance abuse. The cycles of abuse can leverage such a tight grip, both physically and mentally, that interrupting the pattern in order to even start any kind of turn around may need medical intervention initially.
4. Setting strict boundaries with no backing down may be the only way to initiate necessary treatment. This is a frightening and painful experience not only for the person with the disorder, but also for those who care and must struggle to set the boundaries and then fight their own battle with their emotions in order to find the strength to keep them in place. Learning how to and where to set boundaries is our path, as family & friends, to healthier relationships and also models healthy functioning for our loved one.
5. There are no guarantees that recovery will happen, or that even if it does that it will stick (can you say "relapse"?). But it's a pretty darn good bet that enabling a disorder will insure that it continues to thrive, even while its host is slowly dying.
6. Recovery can and does happen. While are greatest fear is that it may not happen or hold for our loved one, we need to calm ourselves with the knowledge and hope that many, many folks have come back from the brink to live healthy fulfilling lives.
7. Recognizing, understanding and accepting these truths is possibly the best way we can continue to stay grounded in order to continue to cope with their disease while not contributing to it. We need to care for ourselves while being reminded that we did not cause it, we can not cure it, and we most certainly can not control it.

Thank you for reading. Please feel free to respond with any questions or thoughts, should you feel so motivated. Also feel free to share this email with anyone who might be interested. All I ask is that you include my name & info.

Marjie Ruth

727-244-9011 (c)

MarjieRuth1@gmail.com

sruth1@tampabay.rr.com