One Brain's journey

Back in the days when psychoanalysis ruled, when patients had Oedipus Complexes and Penis Envy, the major difference between treatment then and treatment now was the cure rate. There weren’t very many then and treatment could go on for decades and cost thousands of dollars. One hundred years of psychoanalysis has produced a dismal record of cures.

What has changed? It was a little book known as the Diagnostic and Statistical Manual of Mental Disorders, now in its fourth version. This DSM-IV, used by most physicians and health care workers in North America, categorizes disorders by symptomology and with it comes a rather novel idea in the world of mental health and this is the concept that if you don’t have symptoms–you don’t have the disorder. This means, for example, if you have been diagnosed with ADHD and you work in a high stimulation environment, say as a firefighter, and don’t exhibit symptoms, technically you don’t have ADHD. You can, of course, at some point have symptoms and then you once again have ADHD. But the diagnosis is not something that is going to be with you for the rest of your life nor is it your defining characteristic. The label is separate from the individual.

A few months ago I interviewed the Director of the Learning Center at one of Canada’s most prestigious independent schools and she told me she tells students with a diagnosis that they own the label and are free to use it as they will. At the time, I remember appreciating the simplicity and innate compassion in what she said.

But what am I getting at here? It is this–the DSM-IV has taken the witch doctoring out of psychiatric treatment by removing all the psycho-analytic terms from common practice, and it has made the labelling process, and the shame that can go with it, temporary and practical. The primary purpose of the DSM in the first place was not to create labels for patients but to create a common language amongst mental health practitioners.

The manual is not new.  It has been around in some form or other since 1950 but now it is employed by almost everyone in the field, at least in North America.  And in Europe, there is a similar tool known as the International Statistical Classification of Diseases and Related Health Problems.

New ideas about neuroplasticity mean that there are now effective and permanent treatments from many disorders, acquired and innate.  Finally, we have been freed from this notion that if you have a mental disorder, the best you can hope for is symptom alleviation.  Now you can be made well and whole again.  A diagnosis is no longer a label for life but the beginning of a treatment program leading to a cure.

For the most part this blog has been about the wonder and awe of neuroplasticity. It has been about discoveries in neuroscience that bring hope and joy into the lives of people who just a decade or so ago would be thought to have disorders making their lives miserable and that would likely do so for the rest of those lives. But there is a down side to it all. Neuroplasticity can work in reverse to make your life more difficult. A new study from the Life and Health Sciences Research Institute at the University of Minho in Portugal using, what else, lab rats, shows that the brain tends to reprogram itself in response to stress and that reprogramming can serve to reinforce the behaviors responsible for the stress and causing problems in the first place.

According to the study’s lead researcher Dr. Nuno Sousa in an article in Science magazine, “Behaviors become habitual faster in stressed animals than in the controls, and worse, the stressed animals can’t shift back to goal-directed behaviors when that would be a better approach.”

Take heart though, even though your brain may have rewired itself for the worse, it still has the potential to unlearn these habits and learn new more advantageous ones.

Dr. Sousa said, “The brain is a very resilient and plastic organ. Dendrites and synapses retract and reform and reversible remodeling can occur throughout life.”

Earlier this week I was with a group of people and one of them shared that she had been depressed recently and a friend had told her she was self-centered. Someone else shared they had the same experience with another friend when speaking to them about their social anxiety. A third related something similar when sharing with someone about panic attacks. I was appalled and intrigued at the same time. I have had depression and seem prone to it. I have been diagnosed with social anxiety and have, in the past, had panic disorder.

Am I self-centered?

The truth is that some decades ago when I was in my last year at university and going through a bout of real, black-dog depression the psychiatrist I was seeing fired me saying I wasn’t cooperating with him. I went home one weekend and my mother said to me, “You just can’t be always thinking of yourself.” I then telephoned the psychiatrist and begged to be taken back saying that I would try to do whatever he asked me. He agreed and within days I seemed back to normal. Were my friends right then, that depressives and anxiety sufferers are self-centered?
I think not. Just because getting out of self is effective with these disorders doesn’t mean sufferers are self-centered. Besides, the trouble with that line of reasoning is that if you believe that then everyone who has depression or anxiety or panic attacks is self-centered and what kind of world would that be?
Well it would be a world not unlike that described in Erewhon by Samuel Butler in the 19th century in which criminals are treated as being ill and confined to asylums and citizens with mental illness are put in prison. Erewhon, in its earlier chapters, appears to be a utopia but this is not the case and on close reading it is actually a satire. In other words putting the mentally ill in prison is a joke.

The world of mental disorders, in my experience is a world where only the very frontiers are now being mapped and where neuroscientists are currently revising almost everything we know about how our brains work. Besides if you believe you are self-centered when you are suffer from depression or anxiety then everyone who is depressed or anxious or has panic attacks is self-centered and this would be a world without compassion. It would be a world I wouldn’t want to live in. It would be an Erewhon and Butler called it Erewhon because if you look at it backwards, it is nowhere.

The Toronto Sun reported today that the Scarborough-North York trustee for the Toronto Catholic District School Board (TCDSB), John Del Grande, has called for an emergecy meeting to reopen the TCDSB’s decision to drop the Arrowsmith Program, for reasons of cost, just two days before the school year end last June. This latest move happened just hours after some parents of chidren who had been in the program filed a lawsuit naming the Minister of Education, Kathleen Wynne and the province’s supervision team as well as the TCDSB. The notice of application for judicial review asks for the immediate reinstatement of the Arrowsmith program and that the court review the decision to cancel it. Lawyers acting for the parents claim the supervision team headed by Norbert Hartman was acting outside of its jurisdiction when they cancelled the special education program. John Del Grande said that the move goes against the decision of the Board’s special education advisory committee which had recommended keeping the program until at least 2011. One of the parents involved in the suit said, “All we want is a fair shake for the kids.”

A month or so back I wrote that one of the first neuroplasticity programs, Arrowsmith, was about to be dropped by the Toronto Catholic District School Board fo reasons of cost. It’s a little more complicated than that. The Board had asked Arrowsmith to waive their fees over the next two years while the Board conducted a study to see specifically if the program made a difference to subjects in the classroom. There is a similar program using Cogmed Working Memory Training currently running at Sick Children’s’ Hospital in Toronto under the auspices of Rosemary Tannock. Arrowsmith refused and the Board dropped it. Well now it seems that the parents of the children who were enrolled in the program, there are about 70 of them, are taking the Board to court to get them to reverse the decision saying, according to an article in the Toronto Sun, that “the children enrolled in the program will be irreparably harmed.” Named in the suit are: Education Minister’s provincial supervisor Norbert Hartmann, associate supervisor Norm Forma and the Toronto Catholic District School Board. Michael Watson, a partner at Gowling, Lafleur, Henderson LLP, speaking on behalf of the parents said, the case, which has yet to be proven in court, isn’t about money, it’s about helping those children. ” Parents can disagree with decisions of the board … what’s really different about this case is we say this decision was made completely unlawfully and contrary to various provisions of the regulations under the Education Act and beyond the jurisdiction of the supervision team,” Mr Watson says that this team has interfered with and meddled in a very important special education program of the board under the guise of a budget matter. He went on to say that the parents fundamentally believe in the Arrowsmith Program and that it has achieved results.