Tag Archives: violence

“What Is the Function of the Brain?” by Laura K. Kerr

29 Jan
reblogged from Trauma’s Labyrinth
If you haven’t checked out Trauma’s Labyrinth yet, DO IT.  Its curator, Laura Kerr is a psychologist specializing in trauma and her blog is a must-read for anyone in the process of recovery. Her writing is academic but accessible, a great balance of scientific evidence and artistic/literary sensibility. Go read it, please.

Based on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present.

Identifying the origins of mental illness likely depends on both interpretations. There is an undeniable organic component to mental illness, just as psychological and social conditions are inexorably linked to mental well-being. But like the Democrats and Republicans, these two approaches are often pitted against one another, often leading to that old, tiresome nature versus nurture debate.

Unfortunately, in a world of limited resources, including limited time, the implicit guiding question — Where should we place our focus? — naturally divides our attention. Is it helpful to explore genes and neurobiology in our efforts to reach best outcomes? Or is it better to explore the social conditions that contribute to mental disorders? Unfortunately, much like U.S. politics, the treatment of mental illness often is derailed when such questions become fodder for polarizing arguments that serves allegiances and professional agendas more than persons in the throes of mental suffering.

Instead of worrying if nature is more influential than nurture, perhaps it would be more helpful to identify what counts as optimal functioning for the brain. Perhaps we could then focus on the value of combining information, thus leading to better outcomes rather than increased competition (and often, market share). I think the significance of function often gets overlooked because we aren’t adept at looking at any issues from multiple levels. Although the term biopsychosocial was coined to address the issue of scale and focus in the treatment of mental illness, it often feels piecemeal in approach.

How might we identify the causes of mental illnesses in ways that address their biological, psychological, and social aspects without parodying the impact of any of them?  Furthermore, what stands in the way of answering such a seemingly straightforward and important question?

More than any other arena of healthcare, the mental health field is paralyzed by politics, disciplinary boundaries, and financial stakes competing to define the disorders it treats and studies. I have wondered what it would be like for all of us who either work in the field or receive treatment for a mental disorder (a Venn diagram of these two groups would show a big overlap) to restart our quest for mental health and well-being with the very simple question:

What is the function of the brain?

With this question, I think we might begin treating the brain like any other organ of the body, and not according to its current exalted status. Appropriate treatment would “simply” mean returning the brain to its optimally functioning state. I believe this question could also encapsulate the complex relationship between biology, self, and society that complicates understanding the nature of mental illness as well as identifying best treatments.

Typically, something is perceived as a disease or trauma when it interferes with an organ’s proper functioning. By knowing the function of an organ of the body, it follows that healing that organ involves returning it to its homeostatic, functional state. Thus, what counts as disease or trauma are those things that interfere with normal functioning. For example, we know the function of the heart is to repeatedly and continually pump blood through the blood vessels, and anything that interferes with this process would be identified as disease or trauma. Similarly, the functions of the stomach include storing food during a meal and breaking down food particles into molecules small enough to be absorbed by the small intestine.  Whatever interferes with these functions is treated as disease or trauma.

We can identify the functions of every major organ of the body — the lungs, the skin, the intestines, the skeleton, the immune system — and with this knowledge, both diagnose and treat the causes of disease or the effects of trauma. Whereas there may be many paths to the cure, there is nevertheless a shared understanding of how the organ is meant to function. This simple approach seems to evade the mental health sciences, and I wonder if this is because there is a lack of agreement about the function of the brain.

We know the brain is part of the central nervous system, which functions like a command center for the rest of the body as well as gathering sensory information from the environment. The neurochemical model of mental illness relies heaviest on this understanding of brain functioning, particularly given its focus on neurotransmitters. Having a well-functioning central nervous system certainly seems central to mental well-being, yet it is also likely only one contributor to mental illness, and cannot adequately account for the psychological and social impairment also associated with mental illnesses. Although this model of mental disorders is not necessarily wrong, it nevertheless is too limited in scope to grapple with the myriad phenomena we associate with mental disorders.

An alternative model of the brain has emerged with research into the neurobiology of trauma as well as research into the different regions of the brain. With this model, the brain is understood more in terms of the functions of its components and adaptation to environmental conditions, especially the environments created through our relationships with significant people in our lives. This is an important change in scope from the biochemical model of mental illness that seems to rest on the “command, control, communicate” metaphor that has dominated information systems thinking since World War II.

In contrast, the neurobiology of trauma model examines how specific areas of the brain — often depicted as three primary regions: the cortex, limbic system, and brain stem — take part in the process of gathering information from the body and the environment, synthesizing this information, and then acting in accordance with often implicit needs or desires. In particular, two dominant action tendencies are thought to organize how the brain functions, which also correlate with two dominant environmental conditions:

  • conditions of attachment and normal daily activities, and
  • conditions requiring defense (i.e., fight, flight, freeze, submit, cling).

From the perspective of the neurobiology of trauma, sociality, and the capacity to engage with others in meaningful and pleasurable ways, is inversely related to the amount of traumatic stress a person experiences. Too little of the conditions that contribute to sociality, along with too many of the conditions that activate defense responses (including low levels of chronic stress), lead to poor mental functioning. And yet both functions — surviving in states of peace and in states of defense — are necessary functions of a healthy brain. (Thus an added benefit of the neurobiology of trauma model is that it replaces notions of pathology with notions of adaptation.)

The neurobiology of trauma model of the brain can also incorporate the functions of the central nervous system associated with the biochemical model of mental disorders, especially when the primary function associated with the brain is this concept of sociality. When the brain is seen as primarily a “social” organ, it seems to have two main functions:

  1. to communicate with the rest of the body in the creation of a coördinated response to stimuli (creating an ‘internal’ society of sorts); and
  2. to communicate with the world in the creation of a self among others selves.

When the primary function of the brain is seen as sociality — both within our own psyches & bodies and with other people — mental illness could then be simplified to include

  • interference with the capacity for internal communication that contributes to authentic self-care;
  • interference with the ability to be a self among others, and thus feeling relaxed and safe in the presence of others; and
  • interference with the capacity to maintain meaningful and supportive relationships.

Just as there are many ways for the heart, stomach, or any organ to be diseased or traumatized, there are many ways for the brain to lose functionality. Impairment does sometimes result from genetic predispositions, although typically in combination with physiological stressors such as exposure to toxins, exposure to bacteria and/or viruses, poor diet, high levels of stress, and injuries that alter the physiology of the organ or impairs its normal development. Also included in these physiological environmental stressors are traumas such as adverse childhood experiences, assault, combat, and other situations where people hurt people, thus not only overly activating defense responses, but also altering the capacity to function as social beings.

Both nature and nurture are undoubtably contributing causes to mental disorders. But perhaps we should think of them as either less or more relevant depending on which lens best helps people regain functionality — both in terms of their inner and outer sociality.

Another way of thinking about this would be in terms of integration. Feeling internally integrated lessens the sense of internal fragmentation. And integration is central to mental well-being. Feeling internally fragmented demands a lot of energy and attention, and often leads to isolation and limited integration with the larger community, hence also limiting the capacity for sociality.

Lacking the capacity for sociality seems central to the suffering associated with mental disorders, irrespective of the cause. And isn’t the reason we have any type of healthcare is to help people overcome suffering? Sometimes when overloaded with competing theories, professional agendas, and the potential for large profits, we lose sight of this otherwise straightforward goal. Yet if we can agree on the primary function of the brain, I think we can also be more astute in our choices about what counts as best treatments.

Sharing the Trauma: Convictions in the Steubenville Rape Trial

17 Mar

As I read about the convictions of the two teenage boys in the Steubenville rape trial, I’m filled with sorrow, relief, and appreciation. I am inspired by the sixteen year-old girl who after months of being pilloried in her community, on social media, and in the national news, faced her assailants in court and testified for two hours about her ordeal; I doubt they would have been convicted otherwise, and I thank her from the bottom of my heart for her bravery and for what her actions have done for other victims of sexual assault.

The Christian Science Monitor ran a great article about the reactions this case has stirred in sexual assault survivors. So many people’s trauma has been awoken by this case. I couldn’t bring myself to completely read many of the articles about it, and broke down crying more than once as I learned about not only the cruel brutality exhibited by these boys, but of the complicity of her classmates who saw a young girl’s victimization as sport and the adults who held her responsible  because she had the audacity to drink alcohol and “boys will be boys.” An individual’s cruelty is one thing, but the social acceptance and support of it, the willingness of adults and the media to excuse the perpetrators and blame the victim, are more than I can bear, in part because it hits so close to home; when I was fourteen, my father told me that I shouldn’t hold someone accountable for what he did because he was from another culture where such behavior was accepted.

I hope this serves as a wake-up call that we are not so different from India, that we obviously have a lot of work to do to educate our children, peers, and ourselves about the ramifications of sexual assault and what constitutes consent. I pray that that sixteen year-old girl achieves a measure of peace after this nightmare. I pray that her assailants come to appreciate what they did and use their experience to educate others. And I pray for the strength of all of us who understand too well what she’s gone through. Take care of yourselves: don’t isolate when your trauma resurfaces. Reach out to friends and resources–a list of hotlines and organizations appears at the bottom of the article. Remember that by working through our trauma towards healing, we make it easier for others who’ve been victimized to realize that it’s not their fault, that they can reclaim their lives, and that they are not alone.

http://www.csmonitor.com/USA/Society/2013/0316/Beyond-Steubenville-rape-case-inspires-action-angst-among-victims-video

Policing the Mentally Ill, Part 2

7 Mar

On March 4th, the Portland Police killed a veteran with PTSD. It was the second fatal shooting by the police this year. His name was Santiago Cisneros. He was thirty-two years old and had served in Iraq from 2002 to 2005.  In an interview with a Seattle TV station in 2009, Santiago said, “I fought a war over there in Iraq. I didn’t know I was going to have to fight a war back here in the United States within myself” and “it took awhile to realize I was dealing with PTSD because I didn’t know what post-traumatic stress disorder was.” I don’t know what precipitated his confrontation with the police. All the Oregonian reported was that he shot at the officers first, and they returned fire. He’d been speaking to his mother on his cellphone directly before the police arrived. She was still on the line when the shooting started.

http://www.kgw.com/news/local/Armed-man-killed-by-Portland-police-was-Iraq-vet-195543251.html

The first man killed by the Portland PD this year was named Merle Hatch. His mother said he had a terrible drug habit and that neither she nor his father had seen in him in more than ten years. The police shot him a few weeks ago in the parking lot of the hospital where I attend my bipolar recovery group meetings.

http://www.oregonlive.com/portland/index.ssf/2013/02/federal_fugitive_merle_hatch_h.html

I was at the hospital roughly two hours before Merle died. I stood in that parking lot chatting with fellow members of the recovery group as we wandered out to our cars. It’s a strange and sobering juxtaposition.

In both cases, the police had no other option. Merle threatened to shoot them with what turned out to be a black phone receiver. He taunted them and told them he was going to kill them. The term for it is “suicide by cop.” Santiago started shooting when he saw the police. It’s possible that he also chose that route.

The parallels between Santiago’s mother and Jay Swift’s mother are heartbreaking. I cannot even begin to imagine the pain that woman is feeling. I don’t want to imagine how many parents can empathize with her suffering. BTW, here’s an account of the shooting Jay’s mother posted in response to the media coverage of her son’s death:

http://samanthabeaudette.com/jasonswift/

In a previous post about this subject, I called out the police for their use of excessive force and tendency to shoot first and ask questions later when they respond to a call involving a person with mental health issues. It’s a serious problem and it’s the responsibility of law enforcement to address it. But I cannot deny the fact that this wouldn’t be happening nearly as often if there were adequate resources and treatment for people who have mental illness, particularly when those people are in crisis.

For a good overview of the problem, check out this article from the Charlotte Observer:

http://www.charlotteobserver.com/2013/03/09/3904455/when-a-mental-health-emergency.html

I wish I could drum up some optimism about this, but quite frankly I can’t. Cut after cut has been made to programs that would avert these kinds of tragedies. Our economy might be in for another recession and the sequester is set to decimate these programs even more. I do know that I see the imperative now more than ever to become an advocate and an activist. We are facing a spike in fear and stigma because of last year’s mass shooting in Newtown CT and the fear-mongering groups like the NRA engage in because they want people to blame us instead of guns. Resources for treatment and management grow scarcer with each financial crisis, and given the current state of our federal government I’m not holding my breath for things to improve on that front any time soon.

But we do have advocacy groups, and the Internet grants us access to information and means to mobilize. We must educate ourselves and others. We must make our voices heard in our communities and seats of government. And we must do it now, not only for ourselves but for our family members who also suffer from mental illness and the loved ones whose lives are ruined because a person they love can’t get the help they need. We must do it for the people with mental illness and the police who die when this broken system of ours engenders yet another avoidable crisis. This is literally a life-or-death issue.

Look Forward to More Shootings: What the Sequester Means for Mental Health Services

6 Mar

The mental health advocacy group Mental Health America reports that 1.3 million children and adults are at risk of losing mental health services based on the cuts dictated by the sequester.

That means more mentally ill people will die. In all likelihood, more police officers will die. Unless our elected officials figure out how to stop squabbling and do their jobs, we will be seeing an uptick in the number of shootings this year.

Whenever there’s a school shooting, politicians blame our broken mental healthcare system. Some of them do it to throw the heat off of gun control. Others like the sound of it because they can nod and provide vaguely concerned sound bites about how disgraceful our current system is in the hopes that their constituents will think they’re doing something about it. But more than a million people, including children, may lose their mental healthcare because of the sequester, and I don’t see anyone in Washington evincing any concern.

MHA reports that the sequester also slashes over two million dollars from national youth violence prevention initiatives–the very programs most needed to counteract school shootings. None of the politicians who were grandstanding about this problem a few weeks ago seem the least bit conflicted about allowing that axe to fall.

Substance abuse treatment will also feel the pain of the sequester with an estimated 10% reduction in budget for federally-funded treatment programs and resources. Grants funding research in substance abuse treatment will also be cut. According to the Bureau of Justice Statistics’ numbers for 2007, 26% of violent crimes in the U.S. were committed by people under the influence of drugs and/or alcohol.

http://publichealthfunding.org/uploads/MHA_MH_SA_Sequester_Impacts_Detailed.pdf

Our country is like a dysfunctional family denying its role in their children’s trauma.


For a good overview of what the sequester means for mental health services, I recommend this article by The American Prospect:
http://prospect.org/article/sequester-mental-health-crisis

A Lunatic’s Response to Wayne LaPierre

8 Feb

I hate Wayne LaPierre.

It isn’t hard to do. I am a screaming, pinko liberal. I was raised by hippie activist parents who participated in the grape boycott and instilled in my four-year-old ethos their conviction that Ronald Reagan was the devil. In college, I attended numerous rallies protesting the Iraq War. I rejoiced in Sarah Palin’s tears during John McCain’s 2008 concession speech. Guess how I feel about gun control?

But that’s not why I really hate Wayne Lapierre. Yes, his black-and-white fallacies and reach-around relationship with the gun industry turn my progressive stomach. But what sets my teeth on edge, what invokes my absolute white-hot loathing of this paranoid pasty-faced ghoul, is something far more personal: his demonization of people with mental illness.

Continue reading

“Sexual Abuse and Mental Health Sequelae” by Anita H. Clayton

3 Feb

http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=682

This article blew my mind. It looks at the relationship between childhood sexual abuse and the development of mental illness, as well as the risks of revictimization. I highly recommend it.

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