Mental Health: Interacting Brains

It always takes me so long to get my feelings all sorted out. I wanted to comment on Sophie’s “ramblings” post. I do not necessarily agree that culturally we are defined based on “self, the individual rather than relationships to other people”. The reason I say this is that so much of our behavior is socially constructed and such a great percentage of those social constructs are created to control/survive social situations. I feel as though people are less likely to create stories in which“I” is the protagonist. From the outside people are also judged based on their relationships, whether those relationships involve their boyfriend, husband, family, friends or lack of, all are social constructs. Maybe I am missing the point but I feel as though people are most often times not the protagonist in their stories. I believe that at least in the present day people have begun to place such a large importance on their relationships with others that they may be loosing the relationship with themselves.

For example, in Greece it is extremely important (if you are a woman) what the women in your neighborhood think of you. When I was younger my grandmother would always yell at me not to climb trees, to wear dresses and not to raise my voice. After any complaint she would always mumble what is the neighborhood going to think… I believe that she was no longer the protagonist of her stories, but simply a character in everyone else’s.  I believe this could have been damaging to her relationship with herself. This is one of many examples that I feel show that we are victims of over-socialization to the point that we can no longer understand or rationalize with ourselves.

Perhaps this is why so many people today require a psychologist as part of their entourage, because it has become increasingly difficult to understand the relationship they have with themselves, if they base their lives on the relationships that they have with others.

I think that this is imperative when considering “mental health”, because the concept of “mental health” is not really a social one, but instead a very individual concept. However, as society develops and as social norms change people are becoming more and more the characters in others stories and not developing stories in which they are the main character. People are identified and defined with respect to their relationships with others.

Now I feel like I am rambling and I am not even sure whether or not there is any validity to what I am saying, but I would like to explore what others think, “does culture [really] define people based upon ‘self’, the individual rather than relationships with other people?” Does it really make a difference?

Someone once suggested to me that a potential therapist is a person who is interested in and talented at mucking around in others tacit knowledge or unconscious. This person would make observations about their patient’s unconscious’ activities, a task the patient is incapable of performing themselves.  Then, the therapist should use these understandings to facilitate storytelling activity in their patient. 

The therapist would also have to communicate with the person’s consciousness or I-function.  The choice and execution of interacting with a patient or their brain on both levels is interesting.  Strikes me as a bit of a juggling act for the therapist.  Yet juggling, once achieved, is an unconscious activity.  So did I just incorporate the therapist’s unconscious in the interaction?  This description superficially fits with our discussion of the interpersonal loop in class.

During the weekend I read three different articles about sleepwalking and all these articles reported a Finnish study of 1997. The study suggests that sleepwalking is more frequent in children than in adults (6.9% female children and 5.7% male children are sleepwalker while only 3.1% adult women and 3.9% adult men are sleepwalkers). The only explanation that was given is that this phenomenon generally occurs during slow wave sleep SWS and children and young adults spend 80% of the night in SWS. Therefore, the phenomenon decreases as a person ages. But, could sleepwalking in children be also related to the fact that their  I function or perhaps other areas of the brain are not completely developed?

Atlantic quotient for the week, but I am quoting it anyway, as I've found an article that felt just as apropos to our discussion, if not more so.

In "First Person Plural" Paul Bloom argues, much like we have done in class, that, in each of us, there exists a multiplicty of selves responding to different stimuli (and, of course, occasionally clashing -- causing problems like addiction, overeating, etc.). And, like Katie above, he also brings up the point that the way we see other people and the way we see our"selves" is very different. In fact, he argues, we see other people's choices as somehow being inherent to their nature, whereas our own are dependent in cirsumstance. Where exactly does the self lie? And does rationality dominate? And would it be better if it did? And, of course, in the end, what are we gunning for?

I think part of the problems lies in our definition of what exactly the self/(selves) is/(are) -- and in terms of what its needs and wants are. In a way, I think the thing about our social relationships in the world is that we look to them to confirm the stories our I-function is telling us about ourselves (or about the cohesion between selves that is being created). If friends' narratives about us don't correlate with our own narrative -- we are more likely to change friends than narratives. 

In many ways, this conscious usage of the world makes sense to me -- the part of us that creates narratives engages in the world in a way that confirms those narratives. That is why people find even innocuous lying/story-telling kind of annoying, and why confronting other people's "psychoses" make people so uncomfortable. While I agree with Sophie that our conflicting selves can help us -- do help us, in the end, because no one self alone has all of "our" best interests at heart -- the I-function revels in this internal conflict less. And I agree with Katie -- our relationships with others are really useful to us in that they define ourselves, and their relationships to others (or to us) are useful to us only in how that, too, helps us define ourself. 

We are all narcissists (to a literal degree, if not a diagnostic one).

Stories in the Service of Making a Better Doctor This interesting article appeared in the NY Times 10/23/08

Given our discussion last week, I think the article is pertinent. It talks about the inclusion of "narrative medicine training" for medical residents as part of their training. One of the physicians who advocates for this sort of program said, "As we improve the technology of medicine, we also need to remember the patient's story."  Perhaps, reshaping medical education to include the entirety of the patient, not just her pathology, but her story, too, will also affect the perception of the "story" and make it an expected component of medical treatment and mental health evaluations and treatment. I'm not a proponent of the use of the medical model as the best or the only treatment for mental health, but I think the more individual stories can be heard, in a variety of contexts, the more "health" becomes a possiblity for a broader range of people. 

I thought the discussion of the meaning of dreams/why we dream was really interesting and I hope we discuss this more.  If dreams are a way of handling our anxiety it seems that this is just another type of story we tell ourselves. 

After our discussion on Monday I was reading “Love’s Executioner” by Irvin Yalom, which is the book I am reading for my book review and was really fascinated by his views on anxiety.  He says that anxiety arises when we try to cope with the four “givens” of existence which are the inevitability of death for each of us and those we love; the freedom to make our lives as we will; our ultimate aloneness; and the absence of any obvious meaning or sense to life.  

I haven’t finished the book yet and I don’t know if I agree with his theory about basic anxiety completely, but right now I think it makes a lot of sense.  It is really sad to think that much of our worldview and even in our sleep we spend so much time trying to control our overwhelming fear of just being alive.  

I like the idea that internal conflict can be a “good” thing if it can be used as a catalyst for change. I like it in that it is empowering and a way of thinking that does not place blame or judge people for feeling ill at ease, depressed, anxious, etc. It sort of reminded me of the images we looked at last week created by David Feingold. He wrote of this image /exchange/feingold08/hiddendisabilities, “Which is more problematic: When your hidden disabilities are hidden from those around you or when they're hidden from yourself?” I think this is a really interesting way to look at this issue and a question that has no answer, since both sound undesirable. I recall, at the beginning of the course, discussing “intervention” and when it might be (if at all) appropriate to interject oneself into someone else’s world in order to “help” them. Perhaps, we, collectively, need to work on evaluating other peoples’ signals better… How able are we to, whether through the story-teller function or processing through tacit knowledge, able to “sense” or give meaning to other peoples’ behavior in terms of body language and that which is not explicitly stated? Is intuition something with which one can become more in touch? This, too, harkens back to what Adi said in class about being sensitive to when other people just want someone to listen to their story and not attempt to shape it or evaluate it in any way.

Something I find interesting, too, is that our culture tends to define people based upon “self,” the individual, rather than relationships to other people. It seems that for people who may define themselves, or create stories in which “I” is, perhaps, not the primary worldly relationship, but rather “other” is (or community), this creates internal conflict. How do continually evolving relationships with others affect our relationship to ourselves? How might people who have a different sense of their relationship to the world, in a sense, be further alienated from themselves and others as a result? How can we make room for meaning to be created and accepted more widely?

In one of his descriptions of his work, David Feingold also poses the question, “what would the world be like without quirky people?” Is there a way to maximize individual potential without overtures akin to homogenization?

Is the story teller looking to tell stories that create consistent meanings over time? It would seem to make sense and if that is the case, how do we "step outsid of ourselves" and know, if it can be "known" that there are alternative stories? 

I wanted to bring up this idea of the "100th monkey phenomenon" again... Has anyone heard of it?  I mentioned it in a post a few weeks ago, but I think it's more relevant to the discussion at hand.  The idea is that two populations of monkeys are separated by a geographic structure like a lake where they can have no direct contact for communication or observation.  When a critical number (hence the name...) of monkeys learn a skill on one side of the lake (e.g. how to open a banana more effectively), the knowledge seems to jump to the other side of the the lake and those monkeys somehow know how to open the bananas in the more effective way.  

Like I said before, I'm pretty sure this is not a hard and fast scientific theory.  I actually read about it in a book that was encouraging increased awareness of the damage of nuclear stockpiling.  The idea seemed to be "If we can just get enough people to be aware of the dangers of nuclear weapons, it will eventually make the jump to the collective consciousness."

Anyway... my point now is that if there is something somewhat like this, it might be a good example for communication between the tacit knowledge of two different people.  We seemed to be a little fuzzy when we were coming up with examples for that gray arrow.  Anyone have any thoughts?  Too much of a stretch?  

Another thing on my mind is the compartmentalization of the bipartite brain.  I feel like I need more clarity as to what processes are a result of firing in the I-Function and what processes are a result of firing in the the Tacit Knowledge. Right now, I feel like the boundaries are pretty loose.  An example would be memory.  I would have intuitively put that into the Tacit Knowledge, but in class we talked about it as part of the I-Function.  Is there a working definition of the two compartments that we could use to more concretely assess upcoming mental health/illness?  

Finally, I know that people are beginning to find anatomical correlations.  For example, the I-Function is in the neo cortex, the tacit knowledge may be located in lower brain areas, and language is in Broca and Wernike's.  Can anatomical discoveries shine any light on the structure/sectioning of our model?  

I'm looking forward to exploring these specifics and more with our bipartite story in the upcoming weeks... 

Observations to date are also consistent with the mind not being in the brain but needing a properly disposed material brain to express its powers.

The  brain and mind do seem to have both conscious and unconscious functions and many stories or internal experiences are derived from the unconsciously supplied material. Aristotle is famous for saying that there is nothing in the intellect(consciousness) that is not first in the senses (unconsciousness). But, that does not mean that the intellect and its powers are material it just means that in order to express those powers, properly disposed matter is required.

I think that the story contained in Grobstein’s summary above is going to be helpful in treating many mental health problems but Idon’t know if it is the “least wrong” one yet.

I agree that it is the job of the mental health professional to help the patient to examine their “story so far” that explains the relevant perceptions of reality that the patient has. And then take that examination and determine if a better or more Realistic story might work better for them.  To ignore conflicts between my perception of reality and the effects that my actions, (that were based on myperceptions) have on me would no doubt cause mental illness. So, to acknowledge the conflicts and seek to resolve them can help.

This business of creating meaning still confuses me. Does it mean we are trying to figure out a better way of convincing ourselves we should bother to keep living at all? Since we are skeptical of any religious notion of why we live do we need to create a meaning of life in order to keep going? Is that what is being suggested?

Mind-When All Else Fails, Blame the Patient... 

This article elucidates some interesting ways in which mental health practitioners conceive of "mental illness." Namely, how the therapist's own "story" about the patient can be limited in some ways. And, as such, the therapist may feel that a patient's "failure" to respond to a particular treatment is the fault of the patient and not a shortcoming of the therapy, or a story told by the therapist that might be too narrowly focused. Additionally, this article touches on the idea that often with depression, in particular, there is a tendency to view the feelings of the depressed person as the cause of depression rather than as an effect. Perhaps, as a society, we often blame people with "mental illness" rather than attempt to understand their story and how certain behaviors stem from stories we tell ourselves, without knowing, perhaps, that other equally "reasonable" stories would do just fine as alternatives... It seems, too, a serious shortcoming in medicine as a whole, often, that blame must lie with the patient when the end goal of "recovery" is not achieved linearly. The patient was "non-compliant" or "treatment-resistant" as the case may be... This seems, to me, to be a set of stories, a line of thinking, which has no benefit for the patient (and may in fact be detrimental).

I just read an interesting article in the Atlantic about children who, from birth, feel that they were born the wrong gender. A lot of this article talks about parents who, rather than try and "treat" this is a disorder, allow their children to live out their lives as they choose. One mother says, answering another who laments that doctors had told her the problem was curable, "Yeah, it is fixable ... We call it the disorder we cured with a skirt.”

In the cases discussed there is still medical intervention necessary (and mental health intervention as well), but rather than treating these children in order to help them conform to society, they are treated in order to feel better in their own bodies. Even in the article not everyone agrees with some of the interventions (particularly medical) made for young children, but it is interesting to think about a perceived "mental health issue" treated in such a pro-individual way. 

In order to understand what about seeing her son's name on the bathroom stall in the girl's room has caused her to be so preoccupied, we thought it would be useful to understand why she feels the way that she does. Implicit in her writing about her experience, was a sense of conflict about her own reaction and, perhaps, asking questions to help her navigate the terrain between her unconscious and her "story-teller" will enable her to capture the genesis of her fears. If the story she created does not, in fact, prove to be a useful one for her, perhaps through talking about it, she will be able to fashion a story that is more useful. We also thought it might be important to talk to her son and see how he feels about the situation and, too, have the mother and son talk together about it.

Martin, Adi, Sophie

This is a case of both internal conflict within the patient and interpersonal conflict between the patient and his father. We would suggest a course of action which addresses the rage and feelings towards his father and also the effects that his symptoms (i.e. the voices in his head) have created in both his life and his relationships (namely with his father) through talk therapy. Simultaneously, we would investigate options for medication and treatment to reduce or eliminate the voices if appropriate. (One might assume it appropriate because rage emerged at finding out his father also had the experience of voices, and this particular response might have been because the voices caused the patient undue stress or anguish?)

Mary Stokes, Antonia Kerle and Laura Jones

Contributers: Paige, Riki, Laura

In this situation we would try to get as much information about her routine and experience and try to find a way to calm the girl’s storyteller.  One way we could do this is to try and talk her through her experience of believing someone is sitting on her chest, and trying to help her experience what is happening in a less frightening way.  We recommend having her keep a sleep journal so she can recall if she was stressed before this happens, and trying to recognize a pattern of behavior so she can come to a new understanding of her experience and create a new story.