Brain and Mental Health: Meditation, Parity

Mental Health and the Brain: A Discussion Fall, 2008 a course at Bryn Mawr College and associated public conversation

Our eleventh session and resulting on-line forum discussion moved beyond mental health syndromes to some broader contexts - adolescence and attachment theory, viewed again through the lens of asking whether thinking in terms of the brain can help defragment thinking and practice in the arena of mental health generally. This week we move on to exploring some additional broader contexts from the same perspective.

Readings for this week

Parity

• Denial of PTSD in the Marine Corps
• One soldier's suicide
• Untreated chronic illness blamed for high mortality
• Mental health parity: a debate
• Mental health parity enacted after years of hard work

Relevant materials elsewhere

• H.M., an unforgettable amnesiac, dies at 82 

Where we've been

It seems to me that it is impossible to come up with one universal definition, and that maybe the definition of mental health changes with each person. Maybe instead of defining mental health we need to be educating doctors to spend more time communicating with their patients and let the patient define the issue, not the doctor. While obviously this would create many problems within our health system as it is now, it seems to me the best solution for respecting each person's unique mental health experience. Maybe if we focus on changing the system we will be more able to define mental health as our perspective on it changes ... Paige Safyer

I also believe that it is impossible to come up with a universal definition of mental health. People differ from one another in their intelligence, desires, feelings and behaviors, in their views of themselves and the others, and in their views of the world and the future. We cannot just categorize the differences among people without considering how the different parts of each person come together to make that person who she/he is ... vpizzini

Health, either bodily or mental, is best described as an activity and not a static state of being in a particular disposition or orientation. I think our discussion thus far has led us to that fact, unambiguously. But, the path we have taken to get there has diverged into the “teakettle people” and the “no teakettle people”. That difference does color the meaning of our definition as health as an activity ... MartinBayer

We can NEVER think of people outside some frame of reference, some normative reality. To strive to do so may be to free ourselves from one kind of tea kettle reality, but at the same time it is merely adopting another one ... To be able to realize that what one previously believed was limited and normative, and to adopt a new view of the world – which itself will be limited of course – seems an excellent goal to strive for ... kmanning

being a good mental health practictioner means just that: thinking about each person in his or her own way, and treating each as such. It is also about increasing a person's own ability to make choices ... ysilverman

Maybe we should operate on the premise that everyone needs “help.” If there were consensus that everyone has the potential to be a “better” version of oneself than some of the stigma associated with experiencing distressing mental states and seeking help would dissipate. If mental health is not static, but a process of a ever-refining one’s story, so as to maximize one’s potential then the necessity of reducing a person to her behavior, her symptoms, her “limitations” would cease to be relevant and each of us would be less inhibited in the process of honing our skill sets, coming up with a “tool kit” of sorts that is tailored to our individual genes, our individual experiences ... Sophie F

A human life can be considered an artwork or a series of artworks. The artist is the human living a particular life, creating a unique work of piece. This piece is based on the person’s own experiences, feelings, and talents. Others can contribute to this piece by acting as muses and teachers knowledgeable about different techniques. These are the roles that I would have doctors, physical and psychological play. The goal is simply for the artist to continue contributing artwork to the community ... jrlewis

I really like some of the new platforms upon which people have been suggesting that we move forward. Taking more consideration for the individuality of each person, encouraging growth no matter where the patient is starting, and facilitating the ability to live up to potential ... However, I have one little bone to pick with these models. ... As healthcare providers we are defining, arbitrarily, where it is we want our patients to go ... What if, instead of adopting change and growth as the cornerstone of our new model of mental health, we adopted acceptance? .... instead of encouraging patients to push forward towards some arbitrarily defined goal or potential, we encourage them and help them to accept and find peace in their current condition ... change is an inherent characteristic of our brains. It's going to happen no matter what a patient or physician does. I wonder what would happen if patient and provider stepped back and allowed the change to happen on its own instead of trying to shape it into desired pathways ... ryan g

My definition of mental health – is a growing moment-to-moment awareness of the three loops (self-world, conscious-unconscious & intrapersonal) coupled with an ability to effectively integrate insight gained from the three loops into over-arching narratives – without sacrificing he constant access to new insight brought by moment-to-moment awareness.I also believe that compassion (love) for oneself and others is both a natural outgrowth of this type of awareness as well as a useful tool for achieving it ... adiflesher

asking someone to listen to their storyteller may be easier said than done and constructing a mental health system based on this notion overlooks the complex way that people understand themselves. So yes, from a perspective of a mental health professional it would be ideal to judge each case from a unique perspective with the interests of the patient as the number 1 priority. What happens though, when the interests of the patient are conflicting and unsure? When even they do not understand what it is they want ... akerle

it is this desire for control, and the ability to control, that really defines true mental health ... kgins

I agree that this definition (that health is individual etc) is probably the least wrong definition that we have come up with this semester, but I'm not sure if it helps our broken mental health system at all. If everyone is individual, how do you help them cost effectively? How do you know how to help them at all? How do you even know WHEN they need help? ... how can we change the current system to be able to work in this new paradigm? ... Ljones

I do think that there is that ultimate reality that we are all trying to explain. However, I don't think that that ultimate reality has an inherent set of meaning to it. I would say, it just exists and all meaning that is assigned to it is done by us ... I fully acknowledge that this is not a very useful set of thoughts for addressing issues such as healthcare policy and mental health parity. Also, as a future physician, I don't think it would be very good for business to go around telling my patients I don't actually believe there is any such thing as health. Because of this, I will definitely engage in learning and applying sets of meanings. Indeed, I plan on spending the next several years learning the version the AAMC wants me to learn ... ryan g

I think we need to put more money/effort/legislation into getting these ideas to be part of every child’s education. If everyone in the world could take this course, I think we could greatly decrease the need for therapists ... kmanning

Does it all then go back to the necessity of a cultural change, which changes how we view mental healthcare, so that it can become a dynamic continuum, part of an ongoing conversation, which incorporates "reciprocity" and which doesn't necessarily have a defined beginning and end, but one where better stories are constructed toward more productive and satisfying ends? ... mstokes

Meditation: Take off points

Definition of Vipassan meditation technique

"To see clearly; insight meditation; the simple and direct practice of moment-to-moment mindfulness. Through careful and sustained observation, we experience for ourselves the ever-changing flow of the mind/body process. This awareness leads us to accept more fully the pleasure and pain, fear and joy, sadness and happiness that life inevitably brings. As insight deepens, we develop greater equanimity and peace in the face of change, and wisdom and compassion increasingly become the guiding principles of our lives."

The power of the relaxation response

"Benson, of Harvard Medical School and the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, discovered the relaxation response's power to reduce stress in the 1960s. But his subsequent research found that the approach is really no different from what people have done for centuries through prayer, chanting and repetitive motion.
Today, scientists have shown that such practices lower heart rates, blood pressure and oxygen consumption, and they alleviate the symptoms associated with a vast array of conditions, including hypertension, arthritis, insomnia, depression, infertility, cancer, anxiety, even aging."

Relaxation response can influence expression of stress-related genes

"Jeffery Dusek, PhD, co-lead author of the study notes, 'Changes in the activation of these same genes have previously been seen in conditions such as post-traumatic stress disorder; but the relaxation-response-associated changes were the opposite of stress-associated changes and were much more pronounced in the long-term practitioners.'"

Finding happiness: cajole our brain to lean to the left

"Indeed, Dr. Davidson has discovered what he believes is a quick way to index a person's typical mood range, by reading the baseline levels of activity in these right and left prefrontal areas. That ratio predicts daily moods with surprising accuracy. The more the ratio tilts to the right, the more unhappy or distressed a person tends to be, while the more activity to the left, the more happy and enthusiastic….
….Before the mindfulness training, the workers were on average tipped toward the right in the ratio for the emotional set point. At the same time, they complained of feeling highly stressed. After the training, however, on average their emotions ratio shifted leftward, toward the positive zone. Simultaneously, their moods improved; they reported feeling engaged again in their work, more energized and less anxious."

B.F. Skinner meets Buddha in DBT

"The actual skills taught in DBT groups are ancient and familiar. For example, mindfulness skills, which are versions of Eastern spiritual training, include observing, describing, participating in the here and now, taking a non-judgmental stance, focusing on one thing in the moment, and being effective. Clients learn the differences between three primary states of mind: "emotion mind," the "hot" state when emotions are in control; "reasonable mind," the cool, logical part of the mind that plans things; and "wise mind," which integrates the emotional and intellectual states and goes beyond them to include intuitive knowing. Ever validating, Dr. Linehan emphasizes that everybody has wise mind—it is that part of each person that can experience truth and know something in a centered way."