Daily Archives: July 22, 2018

Anhedonia and Alienation

I have a hard time feeling pleasure. That’s anhedonia – the inability to feel pleasure. I have a wonderful life and I’m really satisfied in many ways. But I find that I really don’t ever get truly excited about much of anything anymore. I can remember times in my earlier life – before I had The Episode that wrecked my life at 44 and I was diagnosed with Bipolar Disorder – when I was joyful and full of energy and had a great time living my exciting life. I may not have been the life of the party like so many BP folks are, but I sure did love to party and I had fun doing it. Now I rarely get pleasure from even the simple things of life – a smile sent my way, a cool piece of art, or a song I once loved. These can still humble me but they don’t give me the same level of enjoyment they once did. It’s hard to muster up the energy to be pleased anymore. I fake it a lot.

I know this is a common issue for people with bipolar, yet it’s still very discouraging. Even tho I know my diagnoses and how they play out, sometimes it just sucks bad. I don’t mean to whine. But this is so overwhelming to me that I just have to write about it. I really try to walk with beauty over the Rainbow Bridge, as the Navajo (Dine) people sing so movingly about. I try to follow the advice of Gandhi and live the change I want to see in the world. But now I don’t really care much if I succeed or not. Before The Episode I was very socially engaged – managing a food co-op, founding a non-profit educational center where I met hundreds of people, producing concerts where I affected even more, and working at a lively collective cafe where we made our own ice cream, which I got to make. Yum!! Lots of good people came thru that place and I met my first real boyfriend there from behind the ice cream counter. Good times.

Which is why this is so fucking hard on me now. I was used to a different way of life than I lead these days. Now I live far away from the bustling world of gay society I was such a part of for so many years. It’s more peaceful here, and I have a wonderful home and a loving partner to share it with. But it lacks a certain energy and queer sensibility I was used to and I’m starting to miss it a lot. Last night we went out to the Gay section of town for the first time in years. We saw a hot Drag Show. Wow, those girls (and boys!) can really dance and sing (Lip synching really, but who cares…). It was so Very Queer – it was amazing. I lived right there for over 20 years, at different times, and it was my life. But I haven’t been in that area of town for a long time now. It made me feel so nostalgic I wanted to cry. In fact when I got home I stayed up till 1:30 writing in my journal. I had to stop often to cry. I haven’t cried that hard in years. It all hit me – how far I’d come from those days of merriment and engagement. How I didn’t feel the joy of it all anymore.

I’m a very social person, but I’m an introvert too, so it’s always been hard on me to socialize with other people. But I was so damn hypomanic so much of the time back then that I overcame my insecurities and went out and did cool things. Now I’m too scared to interact with anyone, and I just garden at home. Don’t get me wrong – I Love it and it nurtures me greatly. But there aren’t any People there. It’s all just plants, and tho I used to relish that alone time I got with them, now it feels more like a trap. I’ve tried to join gardening circles, but I have little luck because I get too insecure and scared and stop myself before I even get going. Another common thing we folks with bipolar do. I want to but I just don’t Feel like it. Even tho I’m a very sexual person (even at 67 – never give up!) there are so many times I just don’t give a damn about it, tho not always. 🙂  Not my usual self at all. I just don’t feel sexual and I hate it so much. I hate not being able to always laugh at my partner’s silly jokes. I hate not being able to engage with the neighbors when we go out for a walk. And I hate feeling like nothing will ever make me feel again, ever.

Yeah I’m blowing it all out of proportion, but that’s what it feels like to me, and if there’s anything we Bipolar folks do a lot it’s to live thru our feelings, much to our dismay at times. Emotions are tricky to live with and when you have bipolar they trick you even more. They may always be real, for you, but they aren’t always reflective of consensus reality, if you get the difference. When you live thru your feelings instead of your intellect you often mistake your feelings for the reality others experience. It’s not! It can really fuck you up bad. You mistake simple social cues and you interpret things thru your own lens too much and it’s not always what may be really happening. You may feel awful when there’s no need to. You aren’t being talked about behind your back and you aren’t being thought of as “lesser than”, the way you feel about yourself. People may actually like you, despite your horrible sense of self and lack of ability to take in any compliments that may come your way. It’s kinda stupid and kinda sad when you think about it, but it’s all too real to me.

You can see how anhedonia and alienation can intersect here and how they’ve so harshly impacted my life and the lives of so many others. If you can’t feel anything you feel disconnected and alienated. Duh. It makes sense but it’s an awfully hard thing to live with. For me they seem to go hand in hand, but it may not be that way for everyone. I don’t really know. But I do know that many people with bipolar feel both of these things, whether in tandem or not. We just don’t feel good about ourselves so how can we feel good about life? It’s not easy. We feel that we’re not good enough to even deserve a life full of joy. And that hurts us terribly in many ways. It makes us unwilling to engage in things that may hurt us more. We shut down. You can only handle so much pain at any one time. Why ask for more? That seems crazy, but it may be the only way to get over it. There are potentials for joy on the other side of it if you can just hold on.

Maybe it’s just my age – I’m almost 70. But I see so many older people still loving their lives that I don’t think that’s all of it. I feel young at heart really and I look and act like it. I’m not a couch potato or a slob. I take good care of myself and try to do the right thing always, even tho I doubt myself and don’t really know if it’s right all the time. I second guess myself with people so much it drives me crazy. I’m sure none of them like me or want to hear anything I might have to say. I feel alienated from them. But if I could still feel their energy it would be so different.

I do still remember, tho it’s been so long, what it feels like to really enjoy life. And I do enjoy it sometimes, I’ll admit. I’m not totally shut down – not yet. I still feel love and give it in return. And I know it’s real and not in my imagination. So I have some hope that things can change. I always try to end these posts with something positive and this is the best I can do. I’m attempting to believe that if I keep trying to feel, that eventually I’ll get there, at least sometimes. I just can’t give up. I have to stay present in my life to integrate this and to find peace and serenity, which may be far better than happiness anyway. So I’m still hanging on, but it’s by the skin of my teeth, and my teeth are getting so sore…. 🙂

I hope you’re feeling something good today…

Steve

Autism and Mental Illness

 

One of the big debates in the neurodivergent world is how autism and mental illness should be classified. Are they unrelated to each other? Do they – or should they – come under the same heading? Is autism a mental illness or not?

Cara Nissman of Autism After 16 hits the nail on the head when she says, “Part of the reason it is so hard to separate out mental illnesses from autism is that autism is still not fully understood and looks different in each person.”

David Rettew, M.D., writing in Psychology Today, expands on this idea:

This debate has surfaced many times before and in many venues.  It is a difficult one to resolve because there really is no scientific basis on which to separate a psychiatric disorder from a neurological or developmental one.

Certainly there are some things that feel different when considering autism, especially in its more severe forms, relative to things like depression or anxiety.

But what is it that feels different? The DSM-V, the comprehensive reference manual for psychiatrists, lists Autism Spectrum Disorder among its diagnoses. But that does not automatically mean that autism is a mental illness. After all, at one time homosexuality was listed in the DSM as one.

According to the NIMH, “Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.” That implies that autism is a matter of neurodivergence – that the autistic brain is “wired” differently from those of neurotypical people.

But isn’t that true of various mental illnesses as well? My bipolar brain is wired differently too and I consider myself neurodivergent. Schizophrenia is clearly related to brain wiring. And all of these conditions can be affected, it is currently thought, by genetic and/or environmental components – including both mental illnesses and ASD.

The website itsnotmental.blogspot.com begs to differ. That site, in promoting the idea that autism is not a mental illness, argues that:

the term “mental illness” is not a diagnosis. It is jargon – a term society uses to refer to some, usually severe and persistent biologically-based, disorders of the brain such as schizophrenia or bipolar disorder which are in the psychiatric manual of symptoms and labels for sets of symptoms arising from some malfunction of the brain, regardless of cause.

So far so good. But It’s Not Mental contradicts itself by espousing the idea that true mental illnesses are based on psychological and emotional components. That’s a point of view I cannot wholly accept, given what we know of biochemistry, neurotransmitters, the brain, and disorders such as bipolar.

Besides, might there not be psychological and emotional factors associated with autism spectrum disorders? Even if the causes (still largely unknown) are developmental or neurodivergent in nature, the effects of ASD can certainly include psychological and emotional problems. Fear, anxiety, and depression can all occur in children or adults who feel they are “different” or are seen as such.

There is also the problem of co-morbidity, or both conditions occurring within the same individual. Nissman sees it as “a growing challenge in the autism community”:

A number of people with autism also have some form of mental illness and the illness can go inadvertently untreated if believed to be just another characteristic of autism.

Indeed, studies within the past 15 years have shown about 70 percent of people with autism spectrum disorders may meet criteria for what are known as comorbid mental health disorders described in psychiatry’s diagnostic manual.

What’s the answer? Right now, it’s a big “We don’t know.” If we’re talking brain wiring and neurodivergence, autism and mental illness have a number of commonalities. If we’re talking about developmental disorders, they’re probably not related to each other.

But we certainly shouldn’t ignore the possibility of the two occurring together. While psychological therapy and medication may not be the first line of treatment for ASD, it seems clear that at least some persons with autism might benefit from them as an addition.

And that, to me, is the bottom line – not how we define the conditions, but how we care for the people who have them.

 

References

http://autismafter16.com/article/09-24-2012/when-autism-and-mental-health-issues-collide

https://www.psychologytoday.com/us/blog/abcs-child-psychiatry/201510/is-autism-mental-illness

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

http://itsnotmental.blogspot.com/2007/12/autism-is-not-mental-illness.html

Visual hallucination.

 

A strange night, warm and humid. I slept badly, as always. The difference with last night (in the early hours) is that I had a visual hallucination.

It was a figure, in the darkest part of the room, a yard from my head. The figure was an exaggerated one; marching on the spot, monochrome, side-on to me.

(“All colours will agree in the dark.” – Francis Bacon)

It didn’t appear human. Without lifting my head from the pillow I reached out my hand to touch it, a couple of times. Nothing solid, and no reaction. As unusual as this was, I wasn’t afraid and was too sleepy to react further. I turned over, facing the opposite direction, and fell asleep again. Next time I woke in the night there was no figure there.

 

The Ghost of a Flea c.1819-20 by William Blake 1757-1827

William Blake, ‘The Ghost of a Flea’.

 

Processed Meats Associated with Manic Episodes

https://www.technologynetworks.com/neuroscience/news/processed-meats-associated-with-manic-episodes-306398

An analysis of more than 1,000 people with and without psychiatric disorders has shown that nitrates—chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks—may contribute to mania, an abnormal mood state. Mania is characterized by hyperactivity, euphoria and insomnia.

The findings of the Johns Hopkins Medicine study, which was not designed to determine cause and effect, were published July 18 in Molecular Psychiatry. Specifically, it found that people hospitalized for an episode of mania had more than three times the odds of having ever eaten nitrate-cured meats than people without a history of a serious psychiatric disorder.

Experiments in rats by the same researchers showed mania-like hyperactivity after just a few weeks on diets with added nitrates.

While a number of genetic and other risk factors have been linked to the manic episodes that characterize bipolar disorder and may occur in other psychiatric conditions, those factors have been unable to explain the cause of these mental illnesses, and researchers are increasingly looking for environmental factors, such as diet, that may play a role.

The researchers say that their new study adds to evidence that certain diets and potentially the amounts and types of bacteria in the gut may contribute to mania and other disorders that affect the brain.

“Future work on this association could lead to dietary interventions to help reduce the risk of manic episodes in those who have bipolar disorder or who are otherwise vulnerable to mania,” says lead author Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine.

Mania, a state of elevated mood, arousal and energy that lasts weeks to months, is generally seen in people with bipolar disorder, but can also occur in those with schizoaffective disorder. Manic states can lead to dangerous risk-taking behavior and can include delusional thinking, and most of those affected experience multiple hospitalizations in the course of their psychiatric illness.

Bipolar disorder affects an estimated 1 to 3 percent of the population of the United States and costs an estimated $25 billion a year in direct health care costs, according to a study in the Journal of Affective Disorders.

Yolken, trained as an infectious disease expert, was originally interested in whether exposure to infections such as viruses transmitted through food might be linked to any psychiatric conditions. Between 2007 and 2017, as part of an ongoing study, he and colleagues collected demographic, health and dietary data on 1,101 individuals aged 18 through 65 with and without psychiatric disorders. Approximately 55 percent of the participants were female and 55 percent were Caucasian, with 36 percent identifying as African-American.

Those with psychiatric disorders were recruited from patients receiving care at the Sheppard Pratt Health System in Baltimore. Individuals with no history of psychiatric disorders were recruited from posted announcements at local health care facilities and universities in the region.

A study of their records between 2007 and 2017 showed that, unexpectedly, among people who had been hospitalized for mania, a history of eating cured meat before hospitalization were approximately 3.5 times higher than the group of people without a psychiatric disorder. Cured meats were not associated with a diagnosis of schizoaffective disorder, bipolar disorder in people not hospitalized for mania or in major depressive disorder. No other foods about which participants were queried had a significant association with any of the disorders, or with mania.

“We looked at a number of different dietary exposures and cured meat really stood out,” says Yolken. “It wasn’t just that people with mania have an abnormal diet.”

Nitrates have long been used as preservatives in cured meat products and have been previously linked to some cancers and neurodegenerative diseases, so Yolken suspected they may also explain the link to mood states such as mania.

The dietary survey did not ask about frequency or time frame of cured meat consumption, so the researchers couldn’t draw conclusions about exactly how much cured meat boosts one’s risk of mania, but Yolken hopes future studies will address this.

To get at the roots of the association, Yolken collaborated with researchers studying the impact of nitrates on rats.

Kellie Tamashiro, Ph.D., associate professor of psychiatry and behavioral sciences, and M.D./Ph.D. student Seva Khambadkone, both of Johns Hopkins, and others divided a group of otherwise healthy rats into two groups: one received normal rat chow, and the other received both normal chow and a piece of store-bought, nitrate-prepared beef jerky every other day. Within two weeks, the rats receiving the jerky showed irregular sleeping patterns and hyperactivity.

Next, the team worked with a Baltimore-based beef jerky company to create a special nitrate-free dried beef. They repeated the experiment, this time giving some rats the store-bought, nitrate-prepared jerky and others the nitrate-free formulation. The animals that ate the nitrate-free meat behaved similarly to a control group, while the animals that consumed the nitrates once again showed sleep disturbances and hyperactivity similar to that seen in patients with mania—increased activity during normal sleep times and in new environments.

The results were then replicated with a specially formulated rat chow that had either nitrate added directly to the chow, or no nitrate.

Importantly, the amount of nitrate being consumed on a daily basis by the rats¾when scaled up to the size of a human—was equivalent to the amount a person might eat for a daily snack, such as one beef jerky stick or hot dog.

“We tried to make sure the amount of nitrate used in the experiment was in the range of what people might reasonably be eating,” says Yolken.

When the group analyzed the gut bacteria of the different groups of rats, they found that animals with nitrate in their diet had different patterns of bacteria living in their intestines than the other rats. Moreover, the animals had differences in several molecular pathways in the brain that have been previously implicated in bipolar disorder.

While the team also cautions that it’s too early to take any clinical messages from the results, and occasional cured meat consumption is unlikely to spur a manic episode in most of the population, Yolken says the findings add to evidence of the multiple factors that contribute to mania and bipolar disorder.

“It’s clear that mania is a complex neuropsychiatric state, and that both genetic vulnerabilities and environmental factors are likely involved in the emergence and severity of bipolar disorder and associated manic episodes,” says Khambadkone. “Our results suggest that nitrated cured meat could be one environmental player in mediating mania.”

Yolken’s group recently published results of a separate study showing that when people with bipolar disorder are given probiotics—which can change the composition of gut bacteria—after a manic episode, they are less likely to be rehospitalized in the following six months. “There’s growing evidence that germs in the intestines can influence the brain,” says Yolken. “And this work on nitrates opens the door for future studies on how that may be happening.”

This article has been republished from materials provided by Johns Hopkins Medicine. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference
Nitrated meat products are associated with mania in humans and altered behavior and brain gene expression in rats. Seva G. Khambadkone, Zachary A. Cordner, Faith Dickerson, Emily G. Severance, Emese Prandovszky, Mikhail Pletnikov, Jianchun Xiao, Ye Li, Gretha J. Boersma, C. Conover Talbot Jr., Wayne W. Campbell, Christian S. Wright, C. Evan Siple, Timothy H. Moran, Kellie L. Tamashiro & Robert H. Yolken. Molecular Psychiatry (2018), https://doi.org/10.1038/s41380-018-0105-6.

It’s All About The Birthday Girl

I will spare the usual rant except to say…I’m going under here battling depression, anxiety, and how deeply in debt the move and all has made me. This isn’t about me. This is about her. A sneak peak at the page to show that this time it’s different, not my babbling. I was too scatter brained to start a new page, so only $10 for Spook has been raised thus far. We are grateful for every act of kindness, every click of the share button.

Click either pic to go to the actual page to donate or share. Thanks.