Walking in Lock Step - The Parent Trap

I'm reading Bitter Pills: Inside the Hazardous World of Legal Drugs by Stephen Fried.  Fried turned to this subject because his wife, Diane, was prescribed and took one pill of a new [at that time] quinolone called Floxin.  I repeat, one pill.  Quinolones can get past the blood brain barrier, and it did.  Diane's response included the development of bipolar disorder.  Her brain was biologically primed through genetics.  Others who took this drug experienced terrible side effects, as well.  Those who were affected created the expression that they had been "floxed."

Fried went on to investigate just how the FDA worked (and still does) to screen drugs coming to market.  He also delves into the workings of the drug industry and its relationship with the medical professionals who prescribe the drugs as well as the process by which the drug makers do an end run to potential patients and therefore users (something that has continued at much higher levels these days, especially with medications for brain disorders) using, for example, advertisements in newspapers and magazines.

I bring this up because Stephen walked the walk (lived the walk) that so many of us do who care for loved ones with an eating disorder.  I know this following passage will sound familiar and perhaps it will help loved ones understand the process in which they've become entwined.  More importantly, I think this passage illustrates why it's critically important for a family to work with a therapist not only to learn how to deal with the illness but also to learn how to get out of the way of their loved one's efforts to get and stay on the path to recovery as fully functioning as possible.

From page 106:

"I realized it was very easy for me to shift into "emergency mode," but terribly difficult to shift out.  How did you treat a chronic illness if not by declaring a permanent emergency?  I didn't know.  In my family [many of his family members were struggling with illnesses or death of a family member at this time] we just left the siren running and adjusted to the noise.  We're basically loud people: we never really liked the quiet much anyway....

"It seemed that Diane and I were experiencing what my friend Barry Jacobs - a clinical psychologist specializing in medical family therapy with people dealing with traumatic or chronic illnesses - has called the 'locked embrace.'  He describes it as 'a rigid pattern of interaction in which the patient is stuck in an underfunctioning role as other family members overfunction in an effort to protect [her].  It allows the family as a whole to avoid difficult feelings such as anger or overwhelming sadness, but can prevent the patient from recovering to the maximum extent possible.'  I understood that Barry was describing a sort of loving dysfunction, born more of fear than hope, that should be treated with psychotherapy...."

This is a shocking, not easy to read book that is well written and chock full of information.  I am hoping to find a more recent book that will continue this conversation.  The book includes a  chapter titled "Psychopharm" because of the brain disorder his wife developed and what he learned about this aspect of pharmacology while working with folks from NAMI, for example.

As I said in my last post, I am finding myself inadvertently drawn into literature I never dreamed I'd be reading six years ago.  I've always been interested in the medical field and now more so in the workings of the brain and medications.   Fascinating.

Addictions

No, I'm not going to write about ED, although I believe that once those behaviors identified as eating disorders, whatever they are, become entrenched, the person is addicted to them.  Which is why an eating disorder truly is, for a host of reasons, a medical emergency needing immediate attention and treatment.

Instead, I continue to be intrigued by the path I am taking in my reading.  Having read the Immortal Life of Henrietta Lacks by Rebecca Skloot and then a book I posted about here earlier, The Emperor of All Maladies, by Siddhartha Mukhurjee,  I've just become acquainted with the writing of  Dr. Abraham Verghese, who is the author of the acclaimed book, Cutting for Stone.  Dr. Verghese took time out from his life as a professor of medicine to study and then be graduated from the Iowa Writers' Workshop.  We readers are all very lucky, I think.  Having finished Cutting for Stone this week, I looked him up and learned that he has written two other books -- My Own Country and The Tennis Partner.  So I ordered the books and they arrived today.

Not one to allow a book to pass unexamined even if I'm still reading another one, I picked up The Tennis Partner and read the prologue.  And, there it was again:  another viewpoint from another person in medicine who believes that alcoholism and drug addictions truly are diseases that are biologically based disorders of the forebrain.  In addition, the medical doctor speaking to David Smith, an intern addicted to cocaine and the subject of the book, notes on page 5 of the prologue that, "....you have a disease, like diabetes.  And just like a diabetic taking insulin and monitoring blood sugars, every day for the rest of your life, you will need to monitor and treat your disease."  Add eating disorders to this list.

[And here's an article from the New York Times on the subject of addictions, looking at what goes on in the brain.  This article is particularly important, I think, because the author also notes the prevalence of these behaviors in connection with other brain disorders.]

If only this philosophy would make it into federal and state laws and on into the regulations governing insurance companies so that all brain disorders would be treated equitably, without regard to cost and with knowledge of the time it will take to help the person develop new behaviors and the means to avoid old behaviors.  For many, it'll take several attempts before the demon is brought under control and then, as noted, the person will indeed "....need to monitor and treat your disease"...."every day for the rest of your life."

Now back to the book I'm currently reading, which is Bitter Pills - Inside the Hazardous World of Legal Drugs by Stephen Fried.

"Addictive Personality? You Might be a Leader"

I love titles like this one which enticed me to read a New York Times opinion piece this past Sunday morning (July 24, 2011, "Sunday Review", p. 4) at breakfast.  Written by David J. Linden, a professor of neuroscience at Johns Hopkins University School of Medicine as well as author of a book with the startling title, The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning and Gambling Feel So Good.

[I have now (7/28) received the book and the chapter "Feed Me" is one of the best easily understood descriptions of why we get hungry or the reverse that I have read.  As usual, I flipped through the book and looked at the index when I opened the package.] 

One of the sentences highlighted in the New York Times article is, "Traits that make us crave pleasure also contribute to creativity and risk-taking."

Traits and States was a topic at the National Eating Disorder Association's meeting last Fall.   I wrote a piece reflecting on this topic.   Traits are those pieces of us that can be maligned and at the same time raved about, depending on the behavior that comes along with them.  While working at the University of Arizona, I participated in a fascinating job evaluation in which I was asked to look at my traits and qualities and write about the positives and negatives and how these affected my performance.  I learned so much about myself.  I also learned to be grateful for traits that I used to believe were detrimental.  I came to value my behavior better, too.  The affirmations course I took about this time underscored my ability to get ahead.

David Linden takes this positive outlook when he notes that ...."the psychological profile of a compelling leader - think of tech pioneers like Jeff Bezos, Larry Ellison, and Steven P. Jobs - is also that of the compulsive risk-taker, someone with a high degree of novelty-seeking behavior.  In short , what we seek in leaders is often the same kind of personality type that is found in addicts, whether they are dependent on gambling, alcohol, sex or drugs."

Wow!  novel approach here.  Then he delves into the functions of the brain related to pleasure and reward.  Timely, for sure.

He also looks at the medial forebrain pleasure circuit and the role of dopamine in the seeking of rewards.  What could be classified, after all, as a reward?  Well, for starters food.  If one is hungry, one eats.  One gets pleasure from taste and the responses of the body to food.  As a runner-turned-hiker, I can tell you that water is right up there when I'm out in the desert and getting low in the fluids I'm carrying.  He also touches on the point that Dr. Ryan in her lecture noted (in an earlier post here) that one can get pleasure even thinking about things like gambling. 

Dr. Linden, however, proposes that those who have an addictive personality crave things and at the same time actually like them less.  Sounds counter-intuitive.  He also provides a clear (current) explanation about why some become addicts and others do not.  Genes "....account", he says, "for 40 to 60 percent of the variation in the risk for addiction" and that there is "...no one 'addiction gene'."  Their dopamine response is attenuated.  In other words they need higher and then higher levels of stimulation to obtain the same level of pleasure that others gain in moderation. 

Linden goes on to list a few famous addicts; it'd be interesting to learn how many others there are with an "addictive personality" who channel their risk-taking solely into "legal" pursuits.  Must be quite a few, actually.  He counsels search committees to "...look for someone with an attenuated dopamine function:  someone who is never satisfied with the status quo, someone who wants the feeling of success more than others - but likes it less."

Having read this piece, I will read his book.  Surely there are some who get quite a good "high" out of this kind of achievement and who have learned to moderate their behavior so they can continue feeling good about what they are doing..... Or who love the high, continue to go after it, and like what they are doing? ....  or not?

Nicotine and the Brain

Provocative title!  I've known for years thanks to anecdotal comments that nicotine is helpful not only to those who want to avoid weight gain and so worry about quitting smoking but also to some with brain disorders such as schizophrenia.  There seems to be a moderating effect for the latter folks.  There's been quite a bit of research about this, too.  Those with binge eating disorder may be served by this research, as well.

There's a blurb in today's Wall Street Journal (Tuesday, July 26, 2011) on page D2 in the "Health and Wellness" section (actually, there are four articles that captivated me - seriously - today).

Here's the blurb:

"Nicotine-based drugs may be useful in controlling obesity and other metabolic disorders, and also help people stop smoking, according to a study in Science.  Smokers often cite depressed appetite and weight control as reasons for not quitting, but the anorexic effects of nicotine aren't well understood.  Researchers at Yale University found that low doses of nicotine or cytisine, a drug that binds to nicotine receptors, reduced body fat in mice by 15% to 20% and food intake by up to 50% but had no effect on water consumption.

"Research showed the nicotine drugs acted on a brain pathway involved in the regulation of appetite called the hypothalamic melanocortin system.  The drugs activated receptors located on pro-opiomelanocortin or POMC cells, a subset of neurons in the hypothalamus.

"When mice with the POMC pathway were given nicotine or cytisine, they lost weight whereas mice without the pathway were unchanged.  The study found that POMC receptors aren't the same as those that trigger tobacco cravings.  Drugs that target the POMC pathway could limit the weight gain that follows smoking cessation, researchers noted. 

"Caveat: Nicotine's effects on the POMC pathway have only been demonstrated in mice."

There's more to this research too, apparently, regarding reward.  I am reminded of this link and continue to believe that eventually everything will lead back to this intriguingly complicated area of the brain  - especially the Medial Forebrain Bundle - as well as the areas of the brain through which pathways pass.