Quick Tip – Not everyone likes you, and that’s OK.

We often run around trying to make sure that everyone likes us. There is a point to doing some of that, but not as much as many people end up doing.

There are a few concepts that are useful to us here that can lead to this error. Each of these has a good point and when taken out of balance leads to bad habits.

1 – we shouldn’t be mean to people, and if we are, we will lose people who have given up putting up with us. This idea pushes us to want to change to be nicer and more wanted. 

However, when taken too far, we fall prone to people who want to take advantage of us.

To check this, changing yourself a bit to fit in is fine, changing a lot is generally bad.

2 – squeaky wheels get oiled, but all wheels need some maintenance oil. When a friend is upset, we quickly want to find out why and help do something about this. When it is because of something you did, or just a random happenstance, AND when a small to moderate thing you can do can help this, then this is a good thing to do. 

However, abusive people use fake squeaking to get more than their fair share of oil, which means we give far too much attention to trying to save these abusive people as friends, instead of putting our efforts into maintaining good friends.

To check this, remember that friends are supposed to be easy to work with and having your life. If you are spending large amounts of energy into trying to keep someone, that can be an indication that something has gone wrong. It might be worth considering letting them go.

3 – we often grow up in small families and start going to a small primary school. This helps us learn how to adapt to managing with people, because we have no real choice about who we are associating with. Learning how to adapt to people and manage incompatible people is a good skill to have.

However, there is a reasonable likelihood that none of these people are the kind of people that are good for you. There are many kinds of people and you need to find the kind that are kind to you. That may be your family and childhood friends/associates, but it also may not be. It is easy to fall into the trap of trying to hold on to people who are bad for us because we had little choice when we were young.

To check this, remember that friends should be low effort to maintain (not zero effort). Look at the people whom you are spending lots of personal energy into maintaining and wonder if you actually like them and if they are actually good for your self esteem… or not. 

Conclusion: Remember, this planet has over 7,500,000,000 people on it. You have a choice. Hang out with and spend energy on the people who do like you, instead of the people who don’t.

Sisyphus spent a great deal of time and energy trying to push that boulder up the hill
[ Friedrich John nach Matthäus Loder Sisyphus ubs G 0825 II ]

Care Fatigue – When you run out of cope

When we are in a crisis, our bodies go into overdrive to be able to put superhuman effort into survival, whether that is running, fighting, or fixing. Our brains go into overdrive along with the rest of our bodies, improving our intellect, empathy, perception and or reflexes. Sometimes our reaction is the opposite – we hide and shut down.

When the crisis is over, we come down from the hyper state and can show reactions such as fatigue, irritability, shaking and avoidance. When a crisis doesn’t abate, we stay in that heightened state. Long term crisis is bad for humans. While short term stress is good to shake things up and prompt us to get out of a slump or groove, long term stress creates unhealthy patterns, makes us more prone to illness. Our mental state can become aggressive, anxious and or depressed.

If we are not alone in the crisis, we can become care fatigued. Care fatigue is where your empathy for the suffering of others becomes overwhelming. Consequences of this are frequently being far more emotional about everything, or becoming numb to everything. We can either want to act and fix everything, or we feel powerless and just want to shut everything out and yell “la la la” until everything has gone away.

If the crisis is big and pervasive, it won’t just go away. We must act. However we can’t always act. We need to care for ourselves and take breaks, have some down time, recover our strength and then go back and push for solutions again. It is fine to turn the screens off for a few days to get some distance, before going back into the quagmire again. It is fine to let someone be wrong because this is not the fight you have the strength for. It is fine to lose your shit at someone who is being offensive occasionally, because you are too tired to be calm in the face of their irrationality. Take a breath, take a break, and then try again.

Anxiety increases when we perceive a problem that is outside of our control. As an example, I am currently witnessing reports of the East side of Australia burning and the North West side flooding. I live in the South West of Australia and can do nothing direct about these things. I am currently witnessing our countries leaders continue to deny 40 years of research on an international scale that says the problems we are experiencing are being directly contributed to by climate change. These and many more things can make me feel very powerless. And indeed, there is little to nothing I can do to directly affect these things. They are so far away and so far beyond my power to affect.

So it is important to look at what I can do. I need to make far away more local. I can and have changed the way I live to ameliorate my own impact on the climate. I can try to educate those around me to ensure that people are woke to the old science of climate change. I can support our local firies and speak to my local politicians to ensure that their future plans are green. I can attend protests and be linked in to XR (extinction rebellion) and other groups that are focused on trying to stop the destructive policies. When I can, I donate to good causes. I paid for a years worth of The Guardian online paper simply because their reporting is accurate and I want to encourage that.

When I take these actions, I feel like I am achieving something at a level that I can affect. Believe me, if I could, I would wade into Parliament and sack the lot of them. But I can’t. So it is important to look at what I can do and go and do it. In the doing, I feel better, and I can see the changes that I have made. I can then encourage others to do the same and if that works, the world will be different.

While one person cannot push back against the world of people, a world of people can push back against the threat to humanity. I can’t make every person act. But I can make me act. And if I can encourage you to join me, then that makes two of us. Now you go prompt someone to stand and act – soon it will be all of us.

Hand squishing a stress ball shaped like a brain
Stress can sometimes feel like someone is squeezing your brain

BPD Part 2 – Borderline Personality Disorder – The Diagnosis in Brief

BPD (Borderline Personality Disorder) is a complex condition that is currently listed as a mental illness.

Last time (Part 1- [LINK]) we covered how it is often misdiagnosed and stigmatised, mostly because health professionals don’t understand it and don’t know what to do when presented with someone who is experiencing it. In this section (Part 2) we will take a brief look at some of the medical definitions of the experience. I will then show you the quick checklist I use as the two medical definitions are not as useful as I’d like.

There are two primary diagnostic tools that therapists use. The ICD (International Classification of Disease – World Health Organisation) and the DSM (Diagnostic and Statistical Manual of Mental Disorders – Unites States of America).

ICD

The ICD [code F60.3 EUPD] – “Emotionally Unstable Personality Disorder” covers three variants – Aggressive personality (disorder), Emotionally unstable personality disorder (mostly what people think of as BPD) and Explosive personality (disorder). The summary brief reads as

“Personality disorder characterized by a definite tendency to act impulsively and without consideration of the consequences; the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.”

DSM

The DSM [code 301.83 BPD] – “Borderline Personality Disorder” has a specific entry just for BPD.

“A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) or the following:”

1. Frantic efforts to avoid real or imagined abandonment (Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5)

2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation

3. Identity disturbance: markedly and persistently unstable self-image or sense of self

4. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) (Note: Do not include suicidal or self-mutilating behaviour coverered in Criterion 5)

5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour

6. Affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)

7. Chronic feelings of emptiness

8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)

9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Also check out the Australian BPD Foundation found at https://bpdfoundation.org.au/diagnostic-criteria.php

Reading through those diagnostic criteria seems pretty chaotic and a bit contradictory in places. It can leave you with a very poor impression of people who are diagnosed with BPD. It will also give you very little idea about what it actually looks like.

Joshua Davidson Therapy BPD Checklist

Here is the checklist that I look for. It is not a formal list, but I find it easier to get teh gist of “is BPD a factor in this experience?” than the medical lists above. If I find most of these to be present, then it is time to look closer.

* A Loss of Self – a chameleon like ability to adapt to the person they are with. If more than one person is present, then whomever is deemed the bigger personal threat or has the strongest personality will guide the way the person is. The chamoflague is all about being safe, which can include being submissive, agreeable, overly generous, obstructive or aggressive. Being alone is either a great relief, or incredibly scary, as there is no other person to define oneself with.

* Dysregulated Mood – all moods are at extremes and calm is a foreign concept. Everything is now, everything is extreme, and everything is dramatic. From seeming calm to explosive is rapid, which can also lead to very impulsive actions.

* Perception Distortion – always looking for the threat in the situation, but more in the people they interact with. Always checking for abandonment, betrayal or abuse. People’s actions are checked for malice over charity. Sometimes the reverse of this is true, which leaves the person vulnerable to abusive people as too much charity is given.

* Black and White Thinking – as hinted at in Perception Distortion, actions are filtered via charity or malice with little room in between for “just is”. Things are either black, or white, never grey, and certainly not coloured. A thing that was categorised as “white” will be switched to “black” seemingly rapidly as a certain threshold is tipped.

* Boundary Confusion – either there is a great absence of daily living rules, or a set of rules that are too rigid. A great focus on “how it should be” and low ability to adapt to “this is how it is”. When others break the rule the person has set, it can trigger confusion, anger, anxiety or generally dysfunction. There is no “Goldilocks Zone” in the rules.

* Chaos – people around them are often thrown into chaos dealing with the persons inner chaos, life and relationship chaos, self harm and or suicide attempts, emotional dysregulation and so on. If you look at how the people are acting, realise this is a reflexion of the inner chaos of the person. This is not a trait per se, this is the result of the traits.

Each of these items can be found in a few conditions. For example, a dysregulated mood could be Anxiety Disorder, or Bipolar Affective Disorder. The Boundary Confusion could be Autism Spectrum Disorder. Black and White Thinking could just be a cultural aspect of certain trades, or old concrete thinking.

It is the combination that suggests to me that we should be looking at BPD.

Next time I will go through what drives aspects of my list, which will then help understand what the medical lists are trying to drive at.

Identity

Who we are is complex. It incorporates many aspects of where we grew up, how we identify ourselves, how others identify us, actions we have taken in the past and who we would like to grow into. Identity can be fairly solid, it can shift fluidly, or migrate through a series of stages.

Once aspect that is a key component to how we see ourselves and how society sees us is biological sex. I was going to write a big thing about it, but then SciShow on Youtube did it for me.

This episode was written by Carly Britton and covers many aspects that are worth listening to.

In short, Biological sex is not binary, it is a spectrum.

BPD Part 1 – Borderline Personality Disorder – an introduction

BPD is a label given for a set of behaviours combined with a number of personality traits by medical professionals when a person presents with a level of chaotic and sometimes destructive behaviours. The diagnosis carries a significant level of stigma which may lead labelled people finding themselves even more lost and abandoned than they started with. It is unfortunate that BPD is so poorly understood by many health professionals and so poorly supported within the system. Fortunately there are health professionals that are understanding the diagnosis better.

BPD has a few different names. It can be called EUPD (Emotionally Unstable Personality Disorder), CPTSD (Complex Post Traumatic Stress Disorder – although there is a version of CPTSD that isn’t BPD) and PD-Bt (Personality Disorder, Borderline type). None of these labels are a good description of what is going on or how the diagnosed person experiences the label. We’ll get into that a bit later.

Frequently BPD is misdiagnosed as anxiety, depression, bipolar or schizoaffective disorder. People frequently fly under the radar (often at great personal expense and discomfort) until something occurs (often traumatic) or the ability to manage fails and the person comes into the awareness of health services. By the time someone with BPD is elevated to health services the person frequently has at least one or more of these secondary traits and is thus misdiagnosed with the trait as dominant instead of secondary. A good clue that these are secondary to BPD are a failure to actually bring real relief to the person when only using the recommended treatment plans for these conditions and not realising the proper diagnosis should be BPD.

BPD has a great deal of stigma attached to it. There are three primary reasons for this stigma. Firstly, in the counselling side it seems that the secondary traits (or misdiagnosed traits) seem easier to address first, but the standard treatment plan for anxiety and depression via medication and CBT are only mildly effective. This results in frustration for the clinician and a transference of failure to the client. The clinician failed, but can’t find fault in their treatment plan (as it is for the wrong condition). The second stigma comes from the effects of the personality disorder on staff as staff become confused about who they are dealing with and often struggle with infighting as the person’s inner chaos becomes manifest in the staff. If you have found your staff lost and chaotic and find that frustrating, imagine what it is like to live with this every day. Stigmatising the person with the BPD diagnosis is personally cheaper than realising the staff need more training in BPD staff splitting. The third most common reason for stigma is the dramatic violence often associated with BPD. This can take the form of destruction of the environment, destruction of the person’s social connections and or destruction of the person’s self in the form of self harm or suicide.

Project Semicolon is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative.
Attribute: By Kencf0618 – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52641091

Many hospitals and facilities are ill equipped to manage people with BPD and thus try to avoid admitting people with any of the various forms of BPD unless they really have to. Unfortunately and ironically this can feed the abandonment issues that often accompany BPD leading to greater demonstrations of destruction. I very well understand why many hospitals have gone this way and the complexities of addressing this issue. It still sucks. A way to think about it is that BPD requires a certain specialisation to manage well, and not managing well is basically managing poorly. If there was a hospital or department that specialised in BPD, the hospitals would on refer patients there, but very few such hospitals exist and often hospital is just the wrong environment irregardless of specialisation. Consider the optics part of your hospital deciding they could manage your heart condition – this seems foolish, just get transferred to the cardiac ward. However there is no BPD ward, so where should the hospital refer you? Often to private therapy, away from the hospital environment.

Well that all seems kind of scary. Wrong diagnosis, lots of stigma, too hard for hospitals to handle, destructive nature of the diagnosis… While that feeds some of the issues with BPD, this is a more extreme end of BPD that gets the attention and drives the aversion and quite frankly a different recognition and management would ease a great deal of the problems. 

Part of the stigma attached to the diagnosis feeds the misdiagnosis of the condition. As many diagnositians are of the opinion that BPD is chronic and untreatable, they are reluctant to attribute a person’s experience to a condition that has little hope. While these diagnosticians (GP’s, psychiatrists and clinical psychologists) are wrong on this perception, let us pretend for a moment they are right. It is much better to treat someone for anxiety and depression, which have known frequently effective treatment plans, than to diagnose someone with BPD which doesn’t (remember, we are pretending there isn’t here). If you are wrong about BPD diagnosis, you have failed to treat someone who could have got help. If you are right about it being anxiety and depression, you fixed it. With this faulty assumption, the lesser evil is to diagnose with anxiety and depression and get some positive results when wrong than doom the person with a terrible condition. The avoidance of the diagnosticians is understandable. But wrong.

The misdiagnosing of people with anxiety, depression, bipolar or schizoaffective disorder is instead of BPD does great harm to far too many people who could have got effective help earlier. It is important to point out that being diagnosed with any of the above conditions does not mean you have been misdiagnosed. GAD (Generalised anxiety disorder) is a very specific condition, and the subtypes of anxiety disorders are definitely specific conditions that frequently have very effective treatment plans (which should be tailored for each individual). The same is true for the other diagnoses. Being given one of these does not mean you have been misdiagnosed. It just might, especially if you are finding the recommended treatment paths ineffective.

All of that and we haven’t even said what BPD is. Stay tuned for next time to find out – because it is complicated.

Collaboration isn’t a dirty word

I would seem weird if we had a hospital visit and the doctors and the nurses didn’t communicate with each other and tried to treat you for different things. While each has specific and different duties, one will guide the other which will guide the first. That is, the doctor’s diagnosis will guide the care the nurses give you, and the nurses observations will guide the doctor’s diagnosis.

Our podiatrist and dentist almost never need to talk to each other because they are working on very different parts or our health. However our Ears Nose Throat (ENT) specialist may need to talk to our dentist, or our GP may have to if we have certain blood conditions as they do have an overlap in our health. Frequently, though, we just tell our dentist the basic gist of why we might have an ENT or what blood condition we have that may affect dentistry and never the two specialists will speak.

It seems odd to me that when it comes to mental health, people are very reluctant to talk to their specialists openly or allow them to talk to each other. Confidentiality means that if you are my client, then I can’t talk to other professionals about you without your express permission. If a doctor has referred you to see me, built into my treatment contract is permission to send them progress reports. However that doesn’t cover other professionals that may be in your treatment team.

When I worked in hospitals it was clear that there was a treatment team. The confidentiality contract was with the hospital, so if it was relevant to your health, I would go to the OT (occupational therapist) and ask for them to support you with X, or let your doctor know they should check out Y, or ask the nurses to remind you to do Z and report back to me how that went. We worked as a therapeutic team to help you get out of hospital fastest. Once a week we professionals would all meet up and discuss your case and compare notes on progress. One of us (usually me) would come and talk to you about progress and your goals. Sometimes there would be an incidental meet up with professionals to discuss a thing, or with you and a few professionals. Every couple of weeks there would be a team meeting with you to discuss what is needed and what goals need to be hit to get you home and how we would get you there. (I appreciate that not all people get this holistic experience from hospitals, but that is how my team worked).

For some reason, once you are out of hospital, that all changes. We professionals don’t tend to talk to each other. There is no longer a “case manager” ensuring that your treatment is a cohesive holistic whole. And the fault isn’t just with the professionals not talking to each other – often you, the client, will hoard information and not tell relevant professionals relevant information. This can lead to two or more professionals trying to fix the same problem in non-compatible ways, or aspects about your health being missed because no one knew it wasn’t being taken care of.

I guess we kind of expect that you, the client, will be the case manager and get us all to do our bits. But how on earth can we reasonably expect you to be an expert in case management? Don’t get me wrong – some people become that expert and do a pretty good job at it, but that is often through lots of trial and error.

Frequently in therapy, I’ll ask my clients (who have just disclosed a thing to me) “Have you informed X about this?” where X is the relevant expert in that aspect. Frequently the answer I receive back is “no”, generally in a tone of “of course not”. I will ask the client to do so, then ask if they will do so and if not, what is holding them back and do they need support (it can be scary to be the one to initiate certain conversations).

What I want is that holistic care you get with a hospital allied health team, where we all know what the goals are, have a rough plan of how we are all going to get you there and a list of which bit each professional is going to work on. We then have accountability for doing our jobs and you get the benefit of that. Naturally you are involved with the creation of that plan and the goals and have a say about who and how those things are done.

I appreciate that it is hard to get all of the professionals together in one place when you live in the community and those professionals are your GP at one medical centre, a counsellor somewhere else, maybe a support worker from that agency etc and maybe a few more besides. Sometimes it has to be a phone in, or communications via paperwork. But mostly it comes down to you – start opening up to each of your team and tell them what is going on, what the other professionals are doing and what you want and need. Also give them permission to talk to each other.

There are three major levels of community need when it comes to mental health. 

  • Entry level – two to three professionals – eg: GP and therapist (and maybe psychiatrist)
  • Middle level – four or five professionals – eg: GP, therapist, psychiatrist, support worker
  • Pre-acute level – six or more professionals – eg: GP, therapist, psychiatrist, support worker, domestic agency, community nurse, Guardian, Administrator … etc

(After pre-acute, you are in hospital, which is no longer community)

At the Entry level, all you generally need is for your professionals to send reports to each other. Ask for “Release of Information” forms (or similar) to be signed by you for them to talk to each other. Ask them to send reports and updates to all participants.

At the Middle level, beyond “Release of Information” forms, it is important for one of the professionals to start taking on more of a coordinator role. Likely that will be the therapist, but may be another.

At the Pre-acute level you have reasonable grounds to have a dedicated Case Manager, who will coordinate the goals, care and outcomes of your team. Several of your team should be able to meet up monthly or 3 monthly (depending on your needs) with a few call ins via phone/video to have an allied health team meeting. The odds are that you are being considered for or are already on NDIS, so try to factor this role into your NDIS budget.

I’ve said that this is fairly rare, that most of my clients do not have this. I suspect that this is because of a few factors. Either my clients are a bit embarrassed that they need help and don’t want to fully admit to how complex their situation is, or they don’t trust one or more of their professionals. Sometimes there just isn’t budget (time or money) to make this happen.

Embarrassment is connected to public perception. It is time to see past the attempt of the ignorant public to try to blame you for what you are going through. We don’t stigmatise eye sight, diabetes or heart conditions. Why do we stigmatise mental health? Don’t fall for their ignorance and please, talk to your therapist about why you find it hard to open up to your other professionals. If it isn’t embarrassment, it could be denial about how complex your situation is, and again, your therapist is a good person to talk to about getting over that. You are too important to let a thought error get in the way of good care.

Trust can be a major problem. If there is a professional that you don’t trust, or feel good opening up to, that can be an indication that you need to swap that person out for someone you do trust. Almost all of your team can be swapped (unless you are under community treatment orders, where you can request for a change – and sometimes you just have to work with the least bad person assigned to you). Remember that they are your employees. They have to do what you say (within their code of professional ethics), and if you don’t like or trust them, you can fire them and get another. If you are not sure about this section, talk to your therapist. If your therapist is one of the people on that list, talk to your GP about getting a new therapist. If your GP is also on that list, go to a new GP and if you like the new GP, ask for your records to be transferred.

Many hands in the team will help lift your load

It is your health, and the best way to look after it is for the relevant professionals to have a more complete picture about what is going on for you and for a coordinated plan to be made and implemented to sort out the problem that you are experiencing. It is time to take the power back and push for this to be done. Get those documents signed so they can talk to each other, push for that coordination, and push to be central and involved in the plan.

This week in what fills me with awe: Brains

Ever wondered why snowflakes are symmetrical? How does the water molecule adhering to the snow flake know where to land and which orientation to point so that it is symmetrical with the the far side? It comes down to electric charges. Water has an electric charge that is not balanced. The shape of a water molecule is kind of like a boomerang, with the hydrogen atoms at the far ends and the oxygen in the bend. The oxygen has a strong negative charge which equals and cancels out the positive charge of the two hydrogen atoms. But that equal is only at a distance. Close up one side of the boomerang is negative, the other side is positive, so long as you are coming in from the right view. This makes the water molecule susceptible to electrical and magnetic fields, kind of like how iron filings will fall into an interesting pattern when sprinkled around a magnet. The snowflake is basically a water version of that.

As each water molecule joins the snowflake, the shape of the field shifts a bit to factor in this new particle. It is a dynamic system, ever changing as bits join the snow flake. Snowflakes are mostly water, but they also capture bits of dust, pollen and other pollutants. This can radically change the way the snow flake “grows”.

After a team of sperm cells break through the outer membrane of an egg and one timely sperm gets in and fertilises the egg, the embryo begins a massive growth and divide cycle, increasing in size manyfold very rapidly. Each of these new cells are basically exact clones of the first egg/sperm hybrid cell. After a short amount of time, the egg/sperm cell division starts to create some different versions, which begin to self sort into clumps of like type cells. Slowly some basic organs and nerves begin to grow. Some differentiate into muscles and blood vessels. Some begin to differentiate into skin. Most of the skin cells form on the outside. As the parent cell divides, if it finds itself unbalanced due to being on the outside, the new cells become skin cells. Sometimes the skin cell forms accidentally on the inside. When this happens, it will try to migrate to the outside, and if it fails, it will self destruct and be recycled – that is, consumed by a nearby cell which then divides into a more useful inner body cell.

There are no brains yet.

The gonad cells appear around 4-5 weeks. Eventually these will become either testes or ovaries. At this point, it is too soon to tell. We don’t know why the gonads appear where they do, but we do know they go on a fantastic journey before settling down in their eventual place in about 59 out of 60 people. 

Around this time, the nerve cells have self organised into a network with a definitive spine and the first preliminary bulge at one end that could be considered the beginnings of a brain. This is not a brain. It is the hint of one.

By Dr. Vilas Gayakwad – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9582575 – A six-week embryonic age or eight-week gestational age intact human embryo.

Somewhere around week 6 some of the muscle cells have divided into a specialised type that beats in a rhythm. This will eventually become a heart and be part of pumping blood. At this stage those, they just pulse. There is nothing overly special about this. If a doctor were to biopsy some of your heart tissue from your chest and put it in a nutrient bath, it will also pulse, completely separately to any external signal. Add another bit of heart tissue in the nutrient bath and they will beat out of sync from each other. When they get close enough, they self organise and start to beat in sync. Nothing special here, just the nature of that kind of cell.

The embryo at this stage is about 4mm long. The nerves are continuing to network all of the areas of the embryo together. Pre-arms and pre-facial features are starting to develop and the embryo looks like a very strange alien or fish spawn thing. 

At week 7, the growing clustered nerve ganglion at the top of the spine divides into 5 major regions and starts to specialise. This is similar to some of the earlier cells specialising into cell versus muscle. They are all nerve type cells, some are now looking more like synapses but there is no intrinsic control over the body yet per se. That is, each part of the body that was busy self organising into the things that make up a human are continuing to do so without a central instructing organ like a brain. They are working more like the snow flake, but at a much greater complexity. Each cell is emitting hormones and other communicative fluids, which attract other like kind cells. Based on rules, the cells will organise in specific but somewhat random ways similar to how a flock of birds or a school of fish will move together without a specific organiser.

The brain/nerve cells are self organising similar to how heart muscle cells self organise. In petri dishes we have witnessed synaptic cells joining together in networks and starting the rudiments of communication. There isn’t enough to have a thought, or memory or a dream, but there is some kind of organisation occurring. 

This growth keeps going. At about 20 weeks we get the first indication that the proto-brain of the fetus is responding to external stimuli. It is now plugged into enough of the fetus that it receives data from outside of brain for processing and then sends a signals back out to do something about that signal. One might be mistaken into thinking that thought is occurring now. It is possible, but the odds are more likely that it has some stimuli reflex that your lower spine does when you step on something sharp. Your foot lifts off the unexpected sharp thing before the signal can reach your brain. We don’t fight for the rights of our lower spine – it’s just a reflex mechanism with some basic data analysis without actual thought. It is like saying that your knee is capable of thought when you hit it with a reflex hammer and your foot kicks. It isn’t – it’s just a reflex.

Time goes on and the baby is born. Sometimes. Often the embryo grows faultily and is expelled before 4 weeks. Many fertilised eggs self abort because they aren’t viable and many pregnancies are not detected because of this. The uterus just gets ready for the next chance and doesn’t bother to inform the owner of the uterus that an egg was fertilised and rejected.

One third of the embryos that make it past 4 weeks don’t make it past 12 weeks. Many of these pass without notice too. 

Those what make it to live birth all have a brain. No two of these brains are the same, much like no two snowflakes are the same (allegedly this saying was tested and found that under certain circumstances you can get a duplicate snowflake around 1 in 100,000 – some people contest this). Humans are not snowflakes (leaving politics out of this). No two brains are the same. They generally look similar to a simple look, but the neurons and synapses do not conform to any rigid model. There are some organisational rules and principles that form specialised regions in similar locations, but the details are different.

For example, the bit of my brain that determines where my left index finger is going to be when I want to press the “a” key on my keyboard is located in a couple of hundred neurons in a part of the motor cortex of my brain. The odds are very high that you have a motor cortex in the same approximate region of your brain, and that the area that controls my left hand is about the same in yours. My left index finger control will be sort of similar to yours but importantly different. The cluster of neurons that allows my finger to strike the “a” key will be tellingly different to yours. And yet I can hit it quite well and the odds are high that you can do the same.

From a little before birth I have been training my brain to do a whole host of human things just as you have yours. But the details of how each of our brains do this is very different in specific, even if it is kind of similar in general. Somehow through all of this we are able to communicate, make art, create computers and send people into space. We are able to learn and teach each other skills.

If I were to take the bit of my brain that does a skill that I have and you don’t, and put it into your brain, it would mean nothing to your brain. It would not give you that skill. If I use that part of my brain to show you how to do the skill, you will form a new part of your brain, often coopting under used parts of your brain that are doing other things, to form a new pattern that is now your new skill, as per how I showed you. It won’t look like mine. It will probably be stored in a similar part of your brain to mine, or it may be in a very different part.

As we become adolescents, our brains switch from dependent child to independent adult over roughly a ten year period. This involves a massive reorganisation of the brain, vastly increasing the complexity as new wrinkles form, new connections are made and new skills are acquired. The hormones in our body trigger massive changes to our muscles, sex organs, height, hair and other bodily systems. 

While certain developmental stages can be predicted, the specific path is unique for all of us. Kind of like if I want to get some chips from the store, I’ll grab my keys, get in the car, drive to the store, find the chips, pay for the chips, drive home and then eat the chips. Assuming you don’t have chips in your reach you’ll go through a similar approximate process. However if you do it exactly the way I do, you’ll probably crash into furniture before you even get to your car, and should you drive exactly the way I did to get to the store, it will be bad. Instead, you’ll adapt the approximate system to your needs and your situation. Generally it will look the same, but specifically it will be different.

This gets interesting when we start looking at how brains work. We know that serotonin is an important neurotransmitter for certain tasks. When you have too much or too little it can look like anxiety and or depression. How much is too much or too little is determined by the individual symptoms of the person. I may be functioning fine, but if you have my levels you might be chronically depressed. We don’t have a set amount you are supposed to have – we have a range of “probably good” (not that we tend to bother measuring the amount, we just treat the symptoms). If the amount is a little out for you, then you’ll show a bit of behaviour that reflects that outness. If you are a lot out, you’ll exhibit strong symptoms. If you are very far out, you’ll have other problems.

This also makes it tricky when we are trying to define rules. Some people pick up implicit rules easily. Most pick them up easily enough. Some struggle a bit and some struggle a great deal. This is because all of our brains are different. There is no faulty neuron causing this, and probably no specific neurotransmitter. The odds are it is a shaping of the brain from birth (that’s what the science is currently telling us), which has the most likely origin in the DNA that the combination from the beginning formed – the sperm/egg cell. If your parents found it easy to pick up implicit (not clearly stated) rules, then you probably will too. If your parents struggled, you probably will too.

Basically, brains are awesome. I love that we all have different brains. I also find it kind of surprising how well we humans interrelate and interact considering these differences.

I also find it interesting when some people don’t accept that humans are a grouping of very different brains, or when people think there is something fundamentally wrong with their brain.

Different isn’t wrong as no two brains are the same.

Updated contact details

Hi folks, we’ve updated the contact details to make it easier to find us. Check out our Contacts Page.

Bassendean Total Health Care

Address: 15 Old Perth Road, Bassendean, WA, 6054

Phone: 08 9279 1805

Fax: 08 9279 3943

Email: jdtherapy (at) jomida.com

Also how to make a referral to Joshua Davidson Therapy

ADHD Part 4 – Helping yourself or another – Stigma

Part 1 – Defining ADHD [Link]

Part 2 – Experiencing ADHD [Link]

Part 3 – Managing [Link]

Stigma vs Symptom

It is important to separate the psychosocial consequences of societal stigma from the actual experience of having ADHD. Stigma is a result of how society or individuals see you, judges you and thus treats you. It is natural to experience some secondary problems as a result of this social bias that would disappear if society did not view ADHD in the negative.

In this post we will be looking at Stigma.

Anxiety

Often people with ADHD are told that their method of solving problems, of being them, or interacting with others is wrong. It only takes a few times of being told off before anyone will become a bit nervous about taking action for fear of the inevitable telling off, rejection or looks of disgust. This fear and hesitance of being judged or mistreated is often mistaken for anxiety and this can be the first diagnosis you are given, rather than the practitioner looking deeper at why you are anxious. It is important to note that if people around you had accepted you to start with, or began to accept you now, that the anxiety would fade.

Self Help

There is a fair chance you are focused too much on what other people are going to think about you and seeking their approval and acceptance. Rules of thumb on this are : is your action going to hurt you or another, if so, rethink. That’s about it. Also note, some people will accuse you of hurting them in order to control you, and some people will inform you of the hurt you are actually creating. Separating these two groups is really important. Regular counselling is good at helping you create an internal rule set you can apply to navigate this.

It is okay to make mistakes. So long as no one (including you!) is hurt, then you can learn from this. If you keep making the same mistake, then that is another problem.

It is common to develop a need to be perfect in order to try to satisfy another person because of someone we thought we needed in the past who had impossible standards. Recognise who this person or these people were and realise this is driving your impossible standard now. Practice making mistakes and being okay with it.

Helping Another

There are many valid ways to do things and just because the person you are helping picks one that isn’t on your list doesn’t make it wrong. However that doesn’t mean that people are going to just accept that either. It can be hard for someone with ADHD to perceive how their actions are going to affect others, or why perhaps their choice is invalid for complex reasons. It is important to have built some trust and in a non-judgemental or person-critical way inform the ADHD person that there may be a problem with their choice or actions, to offer suggestions of what to look out for and suggestions on how to avoid that. The person you are helping may accept your variant, go ahead and make mistakes, or go ahead and have everything work out fine.

If the person wants to know more before acting, then by all means go in depth on looking at the assumptions and methods you have used to get to your solution and what rang alarm bells for you on theirs.

Depression

After a while of being told we are doing things wrong and receiving disgust, we may instead (or also) feel welcomed and without a place to belong. This can lead to depression, where nothing has any meaning anymore. Another path to this secondary diagnosis (which may also be your first diagnosis as this is easier to recognise than some forms of ADHD) is fatigue from anxiety, or fatigue from caring about people who don’t understand ADHD. The last most likely variant of depression is related to anxiety – in fear of misunderstanding you have learned not to act, and this non-activity looks like depression, but is actually anxiety as described above.

Disgust is a powerful force. It is an important social emotion we detect in others so we know we are conforming adequately to the group to avoid being rejected. Feeling rejected can leave us feeling worthless and without purpose. We are both biologically wired to want to fit in, and raised to believe that our family and early friends should accept us for who and what we are. Without that acceptance we can feel incredibly worthless, unlovable and without a place to feel is home.

Self Help

Not all people are wired to accept others. Many neurotypical people traditionally struggle to accept variation in humans – take a look at the stigmas created by race, religion, left handedness and height. Start to recognise that some people are not going to accept you simply because they can’t and stop trying to win recognition or understanding from them.

Instead start to look for those who can and will. When you meet them, try not to be an asshole and test the boundaries of their acceptance. That leads to a self fulfilling prophecy of doom – eventually all people break. Once you have worked out a set of internal rules for reasonable social behaviour, find those who accept that and stick to it.

Also note that society is getting better. Again look to race, religion etc. In Australia racism is illegal, gay marriage is now the law, left handedness is now accepted as normal human variation and so on. It isn’t perfect, but it is progress. In a similar way, ADHD is becoming more normalised in society’s eyes.

Other Help

Accept the person you are supporting for who they are, but make it clear what behaviours are detrimental to you and which behaviours you believe are detrimental to them. While love and acceptance may not have boundaries, self care does and it is important to have reasonable limits. Recognise what it is about the person you are helping that prompts them to feel isolated and unwanted and see if you can either directly accept that, or put in some agreed upon safety management plans to minimise the risk of those aspects. Accept your person for who they are.

Low Self Worth

While anxiety and depression are part of this, those have been dealt with specifically above. What is left is the illusion of low intelligence, and the risk of abuse from others.

The school system is not set up for people with ADHD, and as such it doesn’t do well to either educate or test people with ADHD. While schools are now getting much better at spotting ADHD, those who don’t have a kinesthetic component (physical movement) are often missed, especially in those who appear female. Recent research is indicating that the genes most likely linked to ADHD don’t discriminate on sex chromosomes, and better research is indicating that XY chromosomed people are often missed in being detected for ADHD.

Consider being tested on what colour ruby is. If you had been taught about crystals, or were from a high socioeconomic neighbourhood, you would probably answer “red”. If not, then Ruby is a person you know, and you would answer accordingly. The test is poor because it relies on testing what you were taught, then holding you accountable for being taught poorly. Recognising this error in testing is the reason this question was taken out of the IQ test for youth in the USA. Our school system is often not teaching people with ADHD well or at all and then blaming the student on this.

Self Help

Your intelligence is not tied to your IQ score or your school marks. It is far more complex than that. IQ scores only test how well you score on IQ tests, which can sometimes have interesting results, but don’t necessarily indicate your actual intelligence. It is time to start letting go of the ways other people measure neurotypical people and start realising those tests don’t apply to you.

The real question isn’t how smart you are, but what kind of person are you? Separate yourself from other people’s judgements and start seeing yourself for what you are doing. Are you proud of yourself? If so, good. If not, adjust yourself until you are.

Trying to be accepted by others can make you vulnerable to being abused by those who wish to take advantage of you. Not all people are nice, and not all people are nasty. Most people who have grown up with ADHD have been messed around enough by others that your red flag (trouble) and green flag (safe) detectors are a bit messed up. Go and get some counselling to help learn what good red and green flags are when you judge others. Once you have identified those who have lots of red flags, start making changes to protect yourself from the ones you can’t get rid of, and get rid of the ones that you can.

Other Help

When raising someone with an ADHD diagnosis, it is really important to look at the environmental messages your person is receiving and balance that with clear signs of affection, love and acceptance. Ensure you teach them about detecting red and green flags in people and then how to extricate themselves from bad relationships. By all means seek some counselling yourself or do some research yourself to learn good methods.

If the person you are helping is an adult, then support them to the realisation that their upbringing may not have given them good data. Avoid just outright contradicting their mistaken beliefs as that is more likely to prompt them to dig in their heels to protect the image they have of themselves. Instead work through the logic of where their beliefs came from and help them question the validity of that themselves. Help your person to see new ways of measuring and testing themselves without the stigma bias of the past.

ADHD Part 3 – Managing

ADHD (Attention Deficit Hyperactivity Disorder) is a complex condition that affects how you focus, behave, feel and interact with people. Realising that you have the condition allows you to begin making intelligent adjustments to your variant.

Part 1 – Defining ADHD [Link]

Part 2 – Experiencing ADHD [Link]

Managing ADHD

There are two primary methods to manage ADHD, and it recommended to use both where relevant and possible.

Therapy

CBT and DBT are the better methods to manage ADHD from a therapy and egocentric perspective. That is, with some suitable help, the person who meets the criteria for ADHD can learn to manage the symptoms that earn the label.

CBT

CBT (or Cognitive Behavioural Therapy) is a method for identifying specific problems and countering them with specific solutions. This looks at identifying the problematic behaviour and or thought process and developing a specific skill to address this which changes the behaviour or thought process. The advantage of this method is that it address unique presentations and develops unique solutions to meet the variance of the client. That is, it doesn’t give you a one solutions fits all, but it may take advantage of known useful tools.

DBT

DBT (Dialectical Behaviour Therapy) was initially developed to treat BPD (Borderline Personality Disorder) in a specific course like way. The course happens to also be very useful for learning to regulate mood dysregulation (a common experience for people diagnosed with ADHD) and social interpersonal skills (another common experience). While specific parts of the DBT modules can be used in isolation
(DBT informed therapy/therapist), most people gain the most use by doing the entire course in a group (may not be compatible for all people).

Advantage and Disadvantage of Therapy

Therapy is useful for addressing expected or identifiable skill deficits, giving power of control back to the individual who is often experiencing a chaotic life due to a lack of, or poor use of, life and self management skills. The problem often comes in with a basic aspect of the disorder itself – difficulties concentrating, difficulties sticking to a task and frequently learning disabilities. It is hard to learn any skill with this interference.

Medication

Medication is often used to help manage a major component of ADHD – task prioritisation. Given the hyperactive nature of ADHD, it seems odd to prescribe a stimulant. The brain is a wonderful and complex organism. While the specific parts that affect all people with ADHD are likely to be different, some common differences are found in the insula and the anterior cingulate cortex. The insula is often attributed to mood regulation and the anterior cingulate cortex is often attributed to attention. Both of these are frequently found to be smaller in people diagnosed with ADHD (more research required). It has been found that certain stimulants boost the abilities of these parts of the brain, compensating for their underperformance. That is, the underperformance of these two parts of the brain means the patient is likely to find their mood and attention span poorly self controlled; stimulating these parts increases the patient’s ability to self regulate, decreasing the most problematic symptoms.

(Reduced insular volume in attention deficit hyperactivity disorder [Link] and Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli [Link])

If all brain scans had shown an equal problem with all people fitting the diagnostic criteria, this would be known as a neurological condition and the question would only be “how much of this one medication to prescribe?” Each brain scanned is a bit different, and not all people that fit the diagnostic criteria that were scanned have the same regions undersized. This means that medication is not going to work for all people who fit the diagnostic criteria, nor will the one type of stimulant match all peoples needs.

As such, a range of different medications have been found to be differently effective depending on the specifics of the individual person.

A very common co-occurrence of ADHD is drug addiction. Stimulants such as caffeine (coffee/tea/energy drinks), amphetamines (dexies, speed, meth amphetamines, ice) and nicotine are often used to help increase focus, while sedatives such as alcohol and diazepine are used to calm down from being hyper, and psychoactive drugs such as THC and LSD are often used to create an alternative state of mind that is easier to manage. Each of these are often used in conjunction to just self manage an undiagnosed condition.

Someone with undiagnosed adult ADHD who has a co-occuring Substance Use Disorder (SUD) will frequently struggle to be given a prescription for ADHD medication as it is either easy to dismiss the person as drug seeking (which ignores how easy it is to get illicit drugs compared to prescription), or difficult to manage due to the patient often continuing to take illicit substances. In Australia, psychiatrists are the health professionals who must diagnose and prescribe ADHD and ADHD medication. It is not uncommon for the patient to have to “go clean” prior to receiving necessary medication to manage their symptoms, which is incredibly hard; or to get frequent drug tests to ensure compliance with medication in the absence of illicit drugs.

(Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders [Link])

Advantage and Disadvantage of Medication

Medication doesn’t work for all people diagnosed with ADHD, and when it does, it doesn’t always work equally. Going through various medication trials can seem daunting and frustrating as your body adjusts and adapts to the medication. Some people find medication as a gateway to illicit substances, however most people with undiagnosed ADHD have already attempted to moderate their experience via illicit substances, so this is a bit of a chicken and the egg fable – for those who are compliant with their prescription, this doesn’t seem to be an issue. Using medication to feel better and function better can have an existential query of “Who am I really? The person on medication, or the person off it?” or stigma questions such as “why does society only treat me alright when I am on the medication, but then blame me for taking medication to be ok?”

An advantage of medication is that when it works, even partially, it makes a profound different to your experience. It can be the launching pad for effective therapy, it can quiet the more destructive impulsiveness and it can allow you to focus enough to earn a degree, get a job and have good relationships with people.

BOTH Medication and Therapy

The best results often come when a person uses both approaches – medication and therapy. A person experiencing ADHD is likely to struggled to be able to focus and retain the information and drive to take in the therapy that upskills ADHD management without medication, while someone who takes medication now has that capacity to upskill, but doesn’t have a good mentor and guide to learn what skills are actually useful.

A good combination of both medication and therapy addresses these issues and gets the best results.