Brain Implants for people with serious brain damage

A New York Times article "Brain Implants Helped 5 People Toward Recovery After Traumatic Injuries" discusses the brain stimulation for people who had serious brain damage but didn't fully recover. They stimulated the central lateral nucleus, it is a thin sheet of neurons about the size and shape of an almond shell. The human brain has two such structures, one in each hemisphere. They seem to help the brain quiet itself at night for sleep and rev up the brain in the morning. Stimulating the neurons in these regions can wake up a sleeping rat, Dr. Schiff’s research has shown. These studies raised the possibility that stimulating the central lateral nuclei might help people with traumatic brain injuries regain their focus and attention.

Dealing with psychosis

Many people hear voices that are only in their head. For example when they are about to do something stupid they hear a warning voice that might come from a parent. But for only a minority of them it becomes a problem and those voices start to dominate their life. They can become psychotic - a stage where the input from the voices becomes so important that the input from the outside world is largely ignored. In psychiatry the main treatment is anti-psychotic medicine. However, there is also an approach that stresses accepting the voices without letting them dominate. The New York Times has an article (Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices) on the subject. Some quotes:

Hearing Voices Network originated in the mid-’80s after a Dutch psychiatrist, Marius Romme, worked with a client, Patsy Hage, who was hallucinating and suicidal. Hage insisted that Romme pay attention to the content of her voices instead of dismissing what they said as meaningless. Romme went on to study hundreds of people like Hage, and in a 1989 paper in Schizophrenia Bulletin, he argued that practitioners should “accept the patient’s experience of the voices”; that “biological psychiatry” may not be “very helpful in coping with the voices because it, too, places the phenomenon beyond one’s grasp”; that practitioners should “stimulate the patient to meet other people with similar experiences”; and that patients benefited when they could “attribute some meaning to the voices.” Romme’s paper was mostly ignored, but Hearing Voices support groups cropped up, especially in Britain and across Europe. In the United States, it took much longer; some of the first were started by the alliance around 2008, four years before Mazel-Carlton began working there.

The idea is that peers can better win the trust of people who are struggling. In Hoyoke, Mass., Mazel-Carlton went to work for a fledgling peer-run organization that is now called the Wildflower Alliance, with a three-room headquarters above a desolate downtown street and a goal of transforming the way our society understands and treats extreme mental distress. Mazel-Carlton also worked as a sometime staff member at Afiya house, a temporary residence run by the alliance as an alternative to locked wards. The people who stay at Afiya are in dire need; many are not only in mental disarray but also homeless. Many are suicidal. There are no clinicians on staff, no security personnel, only people who know such desperation firsthand.

For Mazel-Carlton, one of the groups’ most essential tenets is that there must be no disabusing anyone of a personal reality. Unlike on a psych ward or in many a psychiatrist’s office, unusual beliefs are not monitored, corrected, constrained. Mazel-Carlton’s motto is, “If I’m controlling, I’m not connecting” — and connection, for her, is everything. It defines hope.

“The first time I came to this group,” the woman went on, “and said something about what happened that day with my grandma, I looked at the screen and people were nodding their heads, and I thought, holy [expletive], people get what I’m talking about. And when people talked about feeling like they’re Jesus Christ, I was like, Oh, my God, I’m not the only one? In group, I don’t feel alone, and feeling alone is like something crushing my chest.” She began to cry minimally. “Group is a place to be vulnerable,” she said. “In my everyday life, I don’t feel safe. I have to put on my armor.”

a foundational pact is that no one will be reported, not to any hotline, not to the police or any practitioner, no matter what he or she expresses an intent to do. To comprehend how thoroughly this defies dominant practice, take the policy of the country’s most-called — and heavily federally funded — suicide hotline. It advertises confidentiality but covertly scores risk and, each year, without permission, dispatches police cars and ambulances to the doors of thousands. From hotline to psych hospital, the focus is on risk management. It is on exerting control.

One woman, a mother, told Mazel-Carlton that a voice was commanding that she cut off her hand; if she didn’t, the voice would harm her child. Mazel-Carlton listened and eventually wondered aloud to the woman what the voice might be straining to communicate beneath its horrifying terms. She drew her into thinking about the voice’s underlying meaning, that it could be expressing something about the pressures and conflicts of motherhood, especially during Covid, how caring for a child sometimes feels like a commandment to give up too much of oneself.

The W.H.O. report features another innovative approach, temporary residences called Soteria Houses. In Israel, Pesach Lichtenberg has founded two of a handful of such houses now operating around the world.

Virtual reality against chronic pain

According the article "Can Virtual Reality Help Ease Chronic Pain?" chronic pain is often a function of the brain. You can see that in brain scans. Acute pain activates areas connected to the parts of the body where the pain happens but when the pain becomes chronic often see different parts of the brain activated. The kind of virtual reality discussed is in the woods or on the beach.

Happy memories against depression

 A Medium article "The power of positive memories" discusses how happy memories help against depression and how depression often is accompanied by a failure to remember happy times:

 - A 2017 study used the famous hand-in-cold-water test for stress generation. Before the test people had been asked to list a number of memories - both positive and neutral. When during the test they were asked to focus on positive memories they produced less cortisol during the test. Brain scans showed that this was accompanied by increased activity in the brain’s prefrontal cortex — areas involved in emotion regulation and “cognitive control”.

 - It brings us in CBT territory:  Over time, the activation of these negative mental pathways strengthens them; meanwhile, positive mental pathways grow weaker as they lie dormant. Based on this competitive memory theory, some researchers have explored whether positive memory training can help protect people who are at high risk for depression. A 2018 study from a group of U.K. researchers found that training people to recall happy memories led to a significant drop in depression scores. The people in the study first learned to identify their negative self-appraisals, such as thoughts of worthlessness. Next, they recalled specific occasions when they’d demonstrated worth, or when their behavior otherwise refuted their negative self-talk. Over time, reliving these positive memories seemed to reduce the brain’s tendency to fire up its negative thought pathways.

 - Positive thinking helps too: Multiple studies have found that taking time each day or week to think about the things in life for which one is grateful can improve mental health outcomes and well-being. “Whether stemming from our own internal thoughts or the daily news headlines, we are exposed to a constant drip of negativity,” says Robert Emmons, a gratitude researcher and professor of psychology at the University of California, Davis. Recalling happy memories — and creating new ones through positive experiences — can fuel feelings of gratitude and turn off the spigot of negativity, he says.

 - The old wisdom that buying experiences is more helpful than buying things comes along too.

How A New Therapy Helps People with Delusions Feel Safe Again

This time an article from Vice.com: How A New Therapy Helps People with Delusions Feel Safe Again

During a first episode of psychosis, over 70% of people have a persecutory delusion. This article discusses a therapy - "Feeling Safe" - that specifically addresses that delusion. It does that by addressing aspects that underlie that delusion: worrying, low self-confidence, sleeping troubles, and safety-seeking behaviors. The treatment helps people re-enter situations that made them previously feel unsafe, alongside targeting those other negative side effects. The therapy also provides a large amount of autonomy to the participants; it’s modular and people can choose which treatment focuses they’d like to take on first, guided by clinical psychologists. 

The study by Daniel Freeman, a professor of clinical psychology at the University of Oxford, and his colleagues was published in The Lancet Psychiatry earlier this month. It is the result of 15 years of study. The study claims a great effect compared to treatment with CBT.

Live longer: avoid stress

The original discussion was about "blue zones" a decade ago. At that time I missed it. Now there is some Medium post on the subject (We’ve Known How to Combat Dementia For Years — We’re Just Not Listening).

Some extracts:

In 2010, researchers concluded that chronic stress significantly increased women’s likelihood of developing dementia. In 2013, researchers found that chronic stress quickens the onset of Alzheimer’s disease. In 2017, a meta-analysis pointed to stress as a likely contributor to dementia. In 2017, another study successfully used measures of stress to predict dementia onset.

In 2009, Dan Buettner published his book, The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest, which covered the lifestyle of a collection of communities across the globe with especially long life expectancies. In addition to longer life, these communities have significantly reduced rates of depression, dementia, cancer, and heart disease. Buettner’s book became a bestseller and was quickly followed by a series of books on how to live like a member of the blue zones. The blue zone people became a cultural phenomenon. They were the key to living longer, and we wanted to mimic them — almost.

Two years after The Blue Zones, a group of researchers at the University of Athens published a study on the sociodemographics and lifestyles of these people. While diet, sleep, and other healthy habits contributed to their longevity, the study concluded that long life in the blue zone is a product of regular socializing, a sense of purpose, and low-stress levels as much as it is a product of physical health.

The lifestyle of the blue zone people vastly differs from the rat race culture pervasive in Western society. They live simply and emphasize community. In fact, microbiologist and health coach P.D. Mangan points out that “the factor that unites all of these [blue zone people] is either being less touched by modernity, or actively rejecting it.”

internal family systems therapy (IFS)

On Medium I found some nice post about internal family systems therapy (IFS), a kind of therapy developed by Richard C. Schwartz.

It took a long time for Schwartz to break out of family systems orthodoxy and ask his patients about their interior lives. What he noticed in their responses was a surprising echo of the conflicted interpersonal relationships he had been trained for: They tended to talk colloquially about warring “parts” of them. One part of them wanted to be skinny; another part didn’t care what people thought. One part felt shy and introverted; another part liked parties. One part sometimes seized control and ate and ate in a numb haze; a colder, more punitive part then took over and made them purge.

Schwartz found that one after another of his patients were able to identify regular voices in their heads that got into repetitive arguments with each other, often just below the level of language. At first, Schwartz was alarmed. He almost wondered if he was seeing undiagnosed dissociative identity disorder. But the symptoms didn’t quite add up. For those with DID, the switch between “alters” meant a discontinuity in consciousness and memory, but switches between “parts” were usually more subtle than that. As one early patient put it, “In the course of 10 minutes I go from being a professional who has it all together, to a scared, insecure child, to a raging bitch, to an unfeeling, single-minded eating machine.” Was it possible that parts were just a normal part of conscious experience — that everyone had parts?

Schwartz spent a while looking inside himself. Sure enough, his own inner conflicts separated out into distinct perspectives which voiced coherent points of view. In stressful situations, one or another of them would often hijack his consciousness to impose its own distorted perspective on the world, a process Schwartz came to call “blending.” It seemed that Schwartz himself, like his patients, had parts. He considered coining a technical name for them, but eventually decided “parts” worked just fine.


How to deal with those parts?

He soon learned that [] parts tended to be trapped in desperate situations they had encountered years before, using strategies to cope which had long since ceased to be adaptive. Schwartz got to know anxious achiever parts and depressed caregiver parts, super-efficient manager parts and flirtatious social butterfly parts, five-year-old parts which covered up pain with temper tantrums and 40-year-old parts which covered it up with drinking, parts which had never gotten over a small playground slight from a friend and parts which were trapped in horrifying scenes of child abuse or of war.

To this day, when a young therapist attending one of Schwartz’s workshops comes up to the mic to ask whether a suicidal part is just seeking attention or a comedic part is covering for shame, the answer Schwartz generally gives is, “You’d have to ask it,” invariably provoking a wave of nervous laughter from the room at his failure yet again to act like a guru.

Eventually, Schwartz did come up with names for the most common roles he saw parts taking on in their relationships with each other. Parts that he called protectors used a vast array of coping strategies, sometimes very extreme ones, to manage the emotional pain of deeply buried parts that Schwartz called exiles. Exiles were often very young and lived in a nightmarish limbo, interpreting even minor adult pain through the lens of the childhood memories they were trapped in. Because they were so vulnerable, exiles were hard to access. You had to go through protectors to get to them, and protectors could be tough customers. To speak to a seven-year-old exile carrying the pain of a father’s abusive criticism, for example, you might have to reckon with a blustering 40-year-old protector of a different exile who thought the seven-year-old was just as much of a pussy as his father used to call him — and that you were too, for taking his concerns seriously.

Luckily, it turned out there was an easier way of negotiating with protectors than having patients blend with them. If a patient simply closed their eyes and asked a part to “step back” a pace, they could often get enough emotional distance from it to speak for the part rather than from the part: “My defensive part is jumping up and down with rage that you would say something like that,” rather than “fuck you.” In this unblended state, the patient could ask questions of the part, listen to it, even bargain with it. If the part felt that its concerns were being taken seriously, it was often willing to step aside completely for a while, entering a visualized “waiting room” with the door closed behind it so that the patient could begin work on whatever part came up next.


When all parts step aside what is left is the Self:

If a patient got all their parts to step aside, protectors and exiles alike, something curious happened. They entered a state of mind far clearer and more joyful than any they seemed able to maintain in day-to-day life: calm, confident, curious, compassionate.

“What part is this?” Schwartz asked, amazed, the first few times it happened. He always got the same answer: “This doesn’t feel like a part. It just feels like myself.”

So Schwartz decided to call it Self: a unified mode of consciousness that seemed to lie just beneath all the sound and fury of parts, surprisingly reminiscent of the clear mental waters that Buddhists sought with mindfulness meditation.

There are other therapies that work with parts:

The Italian Freudian analyst Roberto Assagioli called them “subpersonalities” and developed a psychoanalytic school of thought known as psychosynthesis at the beginning of the 20th century that sought to integrate them into a harmonious whole. Half a century later, husband-and-wife team John and Helen Watkins developed ego-state therapy in the United States with different terminology but much the same goal.

 Patients can find IFS therapists in all 50 U.S. states through the IFS Institute’s online directory or on Psychology Today. Many have also done “parts work” on their own using psychologist Jay Earley’s popular guide Self-Therapy.