Musings on (my) Mental Health

Looking at what I’ve written here, I’m dumbfounded that I’m actually going to publicly post something so revealing of myself.

Why?

I don’t know, maybe because this has been on my mind, and yesterday I finally figured something out. Maybe because keeping silent only increases the stigma, and something here might help someone else. Maybe because I am who I am and I do what I do.

So, here goes…

amygdala_770

(illustration of amygdala by Bona Kim)

So… there’s a little almond-shaped area in the brain, located in the anterior temporal lobe just below the pre-frontal cortex and in front of the hippocampus, called the amygdala. This area is responsible for making instant assessments on levels of threat in the environment and raising or lowering our state of arousal accordingly. For me – and for anyone with an anxiety or stress disorder – the amygdala has become over-sensitised. Sometimes small stressors trigger an extreme response and sometimes the response doesn’t shut down properly.

It took me a while to work out that I was ill, probably because I’m on the autism spectrum and my amygdala works a little differently anyway. Neuroscience has yet to provide all the answers, but they’ve noted differences in amygdala size and numbers of neuron connections in some of us. I’m taking this to explain why I’m naturally under-reactive to most things, and over-reactive to a few. Hence my difficulty in distinguishing the boundary between “normal (for me)” and “something wrong”.

Anyway, having eventually established that something was actually wrong, here is my approach to putting it right.

A lot of this I’ve discovered recently and I’m still working through putting it into practice, so it’s early days, but I thought it worth writing down, if only to keep myself on track.

  1. Addressing the Cause

It’s worth reflecting on the reasons why people are vulnerable to developing mental illness. I recently read an interesting book on evolutionary psychiatry –  it’s called “Good Reasons for Bad Feelings” by Randolph M. Nesse.

Good Reasons

In the prologue is stated something seemingly obvious but also (I think) quite profound:

Natural selection shaped emotions such as anxiety, low mood and grief because they are useful …our suffering benefits our genes. There are also good evolutionary reasons why we have desires we cannot fulfil, impulses we cannot control, and relationships full of conflict …evolution explains the origins of our amazing capacity for love and goodness and why they carry the price of grief, guilt, and, thank goodness, caring inordinately what others think about us.

The take-out for those of us with anxiety or stress disorders – the thing to remember in the darker moments – is that our amygdala is our friend; it’s doing its best to keep us safe. If something in our environment has caused it to over-react, we should be looking first at changing our environment.

So when I set about trying to cure myself, my first move was to address all the big problems in my life, trying to reduce major stressors and overcome any barriers to my mental health. The surprise was in realising that my over-sensitive amygdala had already solved the biggest problem of all.

Nearly a year ago, in sudden overnight haste, with no prior planning or fore-thought, I left my husband. From the point of view of my long-term health and wellbeing, it was probably the best thing I ever did. But would I have left him if I’d been in my right mind at the time? Probably not. I didn’t know it but I was already ill. Bless my hypersensitive amygdala, it caused me to freak out intensely enough and for long enough to leave. It saved me.

Unfortunately, once mental illness develops, one can’t just shake it off and ‘get over it’. Just like a physical illness, it needs treatment and takes time to heal.

Probably the most common treatment method is Cognitive Behavioural Therapy (CBT), but when I first read about it I was dismissive. CBT seemed to be based on “thinking yourself happy”, and therefore of no use in addressing the real life problems underlying one’s mental state. However, after going through the process of pruning the problems from my life, after doing everything I could to set myself back on track, I was frustrated to find that I was still having acute stress reactions. Over nothing.

This is when it hit home to me that, although they call it mental illness, it’s essentially a physiological problem in the brain. This is why someone with no apparent worries can still be stuck with anxiety, or why someone with minimal stress in their life can still have a stress disorder. Even after getting our lives back on track, there’s a malfunctioning process in the brain which still needs to be fixed.

  1. Setting Up for Success

I think of this illness as being like heart disease. If you have a natural vulnerability to heart disease what’s the sensible thing to do? Even if there’s a potential treatment, you’d want to look after your heart in the meantime, so you’d do what you needed to do: eat healthily, limit stress, increase exercise.

Didn’t I say that mental illness is a physiological problem? The brain is a critical organ just like the heart, so the same principle applies.  I’m breaking down what I need to do to manage my mental health five ways:

  • Maintaining motivation. Regardless of inherent vulnerabilities, my natural state is a state of good health and I don’t have to accept less.
  • Exercise. It’s not about fitness or weight loss. It’s about easing a prolonged state of arousal by going outside and walking… and walking some more, until the nervous energy burns out. Adrenaline is not our friend.
  • Watching the diet. Two things seem to be key:

(a) Cutting the sugar. Yes, I know the brain runs on glucose, but with blood sugar, steadier is better. A sugar high is always followed by a sugar low. (Not that I’ve managed to quit the white poison yet – this is a work in progress).

(b) Brewed coffee is my nemesis. Every time I have an episode I swear I’ll quit, but then comes the downcycle and I’m as sluggish as a… slug?… and I start on the coffee again because I absolutely need it. And I can handle it fine… until I can’t. (This is another work in progress).

  • Taking medication. As long as it’s understood that there is no medication that will cure an over-sensitised amygdala. None, nada. What medication can do is ease the post-meltdown blues enough to get me to work in the morning.
  • Quitting the guilt-trips. Every mother will know exactly what I mean, but the ‘aeroplane oxygen mask’ rule holds true. We need to look after our own health to be fit to look after our kids. It feels selfish, but it really isn’t. And I try not to be embarrassed at treating myself carefully when I ‘don’t seem ill’; that just means I’m doing a good job.
  1. Uncovering the Cure

For a while, it seemed to me that my nervous system was broken and there was nothing I could do about it, but I’m reliably informed that’s not the case. We just have to de-sensitise the amygdala.

This process has been demonstrated with people with specific phobias. They undertake exposure therapy, which involves repeatedly exposing themselves to the object or situation that triggers them until they become de-sensitised. Apparently, it works every time.

The complicating factor in my case was that I could not pin down a discrete object or situation that was triggering me. With a bit of thought I could identify some connecting factors to my meltdowns, but they were internal – a configuration of emotions. I was stymied for a while by the near-infinite number of situations with potential to trigger those emotions.

Now I’ve realised identification of triggers is only the starting point. Because the amygdala is essentially activated by a fear response, I need to dig a little deeper into working out which subconscious fears underlie my emotional responses. Exposure therapy for me will be to recognise and address those underlying fears.

The-Scream-blog-featured-crop

So yes, I was surprised to discover that CBT might be useful after all. The useful part is the theory related to identifying one’s Core Beliefs, and how adherence to those beliefs can create cognitive distortions. In other words, sometime in the past, I developed a belief about myself and/or the world which led me to fear certain situations. The brain, being the highly evolved, tricky thing it is, ‘creates’ logical explanations for one’s behaviour, to give oneself the illusion of self-determination rather than recognising that our actions stem from old fear conditioning. These are the cognitive distortions.

It takes a certain amount of self-examination to work past the ‘logical’ explanations which we think underlie our behaviour, to the fear response below that, and then back to the original Core Belief which produced that fear response. But that’s what I need to do: to get right back to the Core Belief and work on changing it, because that (hopefully) will eliminate the fear response entirely, together with the need to employ cognitive distortions to maintain my illusion of self-determination.

Yes, I know it sounds a bit hippy, or New Age or whatever. I didn’t think I was into all that stuff, either. Peace, sister 🙂

hippies 2

  1. Working the Cure

If you want to understand how it works, here is an example (dealing with one of my common and more obvious triggers):

The triggering emotional configuration:

  • upset/anger over injustice, intense frustration and a sense of powerlessness.

Common element in triggering events:

  • Someone in a position of authority has made a decision which affects me and about which I was not consulted or my opinion not taken into account.

Actual events that triggered me:

  • My employer requested a doctor’s report on aforementioned health condition. I was fine with that idea for a few days, before having an epic meltdown over the thought that I would have no control over what the doctor wrote, and my employer might use it to make decisions about my employment.
  • My employer decided to cancel my corporate card (which was mostly my fault for not completing training on time). Minor meltdown at having no recourse.
  • The rental agency for my house agreed to extend my agreement another year (excellent news!) but with a 17% rent increase. No meltdown, but I got a bit keyed up about the size of the increase.

‘Logical’ explanations for my reaction (Cognitive Distortions):

  • This is unfair (fallacy of fairness)
  • This is going to cause me so much trouble (filtering/catastrophizing)

(Now it starts getting painful – press the sore point.) Underlying fears:

  • Loss of control over aspects of my life –> imposed changes, uncertainty

(Ah. Hello again, Resistance to Change. I’m not ready to attempt addressing this one – let’s move on to Core Beliefs.)

Underlying Core Belief (tease it out like a splinter):

  • I can’t express myself effectively and my opinions are not worthy of consideration; I have no power or means to influence those who are making decisions affecting me.

What actually happened:

  • On querying my employer I was reassured that the doctor’s report was just for information and I would be consulted on any decisions affecting my employment. My doctor discussed with me what to put in the report.
  • After sending an email explaining why I missed the training deadline and appealing the decision to cancel my corporate card, I was offered another opportunity to do the training.
  • I checked typical rent amounts in my suburb and the rate of inflation, and sent an analysis to the rental agency. They accepted a lower rental increase.

Conclusion:

  • My Core Belief has been demonstrated to be false. I’m perfectly capable of expressing my opinion, and that opinion has been deemed worthy of consideration on several occasions. If decisions affecting me are unfair, I’m able to mount an appeal with a reasonable chance of success.
  • I’m a lot more resourceful, capable and effective than I give myself credit for.
  • New Core Belief: There’s no need to panic, I can handle this 🙂

See, that’s how it’s done.

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