Popular myths surrounding incontinence or urinary leaking

The three things that most people do when they find that they are suffering from any sort of incontinence or urinary leaking are to decrease their fluids, increase their frequency of urination and to stop exercising.

They figure that if they're leaking fluid that they must be taking in too much or that decreasing intake will somehow make it less likely to leak out. They figure that if they have been urinating every three or four hours and leaking in between, then maybe they can stave off that leaking by going more frequently. They figure that if they have been leaking on impact when exercising, then maybe they should stop exercising. All of these are rational; all of them are wrong and set up the bladder for more incontinence.

If a bladder is already compromised, it may be that there are false signals relayed to the nervous system indicating an urge to urinate when the bladder is not full. Often this is from irritation within the bladder or from dyscoordinated neuromuscular activity of the bladder with other surrounding structures. In any case, the strategies of drinking less and urinating more are strategies of dehydration. This is never healthy systemically and actually makes the bladder worse off as it atrophies over time. The bladder has a muscular layer, the detrusor, and like any muscle, needs to be worked to stay healthy. Unlike other muscles, the detrusor is only worked when filled and stretched. The detrusor is stretched by the bladder filling up to functional capacity, by drinking fluids and urinating infrequently.

There are studies that show that any exercise done regularly, even if it doesn't address the pelvic floor itself, will improve the condition of the pelvic floor over time. If there is leaking on impact, the leaking is not caused by the impact; it is caused by the neuromuscular dyscoordination. One might consider switching to a low-impact exercise or wearing pads while continuing the higher-impact exercise.

So, counter-intuitive as it may seem, the best course of action when one starts leaking or experiencing any sort of incontinence is to drink more fluids, urinate less frequently and keep exercising (or exercise more). Work that bladder!

You might want to check out the List of Bladder Irritants in my Treasure Trove (tab in navigation bar).

Barefoot running & knee/leg problems

For four years I tried to start running only to be waylaid by shin splints. I would cease training to allow them to heal and then try again, only to continue the cycle. I bought better running shoes (which made a difference but did not solve my problems), massaged and needled (acupuncture) my legs and practiced various stretches and exercises. But each time I tried to start up again, I would succomb to the shin splints. I have also experienced a disturbing lack of control over my left foot when my leg muscles seized up, usually around the second mile. I was unable to lift my left foot voluntarily. It wasn't painful and if I slowed down I could run through it, but it couldn't be healthy.

A friend told me about the research that was being conducted at Harvard University on barefoot running. Careful scrutiny and measurement from video of people running reveal that people raised in cultures where shoes are not worn never heel strike. They land on either the balls of their feet or in the midfoot and then roll through their feet. They also never complain of knee and low back pain associated with their running. Apparently the heel strike is unnatural, caused by the improper alignment of the foot to the rest of the body while in supported shoes, and it sends an enormous force through the joints.

I started toe striking last year. It took conscious effort in the beginning but I quickly adapted. I'm still in my supported running shoes, but just changing my foot strike solved my leg issues permenantly--no more shin splints and no more lazy foot. I hope to transition further toward the unsupported slippers over the next year. Transition is imperative as changing one's foot strike requires use of different muscles and one can sustain significant injury without a slow, deliberate transition.

Culinary herbs that act against systemic inflammation

Many chronic health conditions have been identified as systemic inflammatory processes affected by increased stress levels, sedentary lifestyles and poor diets. Using herbs in meal preparation is one way to hedge against, and treat, systemic inflammation.

My favorites are cinnamon, nutmeg, garlic, ginger, pepper, tumeric and cumin. You can get creative. I add cinnamon or nutmeg to my coffee and tea. I keep two pepper mills on hand--one for black peppercorns and one for a mix of black, green, pink and white peppercorns. Tumeric is a nice choice because it has a pretty color but adds little in the way of flavour unless used in huge amounts. One can add it liberally to just about anything without changing the flavour much. Cumin has a distinct flavour, and some people don't like it, so one should try it before commiting.

Tumeric, in particular, has received a lot of attention of late. Much research has been underway in studying its effects on preventing and treating arthritis, Alzheimer's and cancer, and without side effects. Here is Dr. Weil's recipe for Tumeric Tea.

Neurology & the pelvic floor

I'm always stressing the central role of the nervous system in the functioning of our bladders and pelvic floors.

Eric Franklin, PT:  "In the opening stages of training, the building up of strength is almost wholly neurogenic. An actual change in muscle substance is called a myogenic change, and this only happens after a relatively long period of training."

Janet Hulme, PT:  "Even muscles you are not aware of being able to control, like the bladder, are affected when you change muscles you can control."

Diane Lee, PT:  "Exercises for PFM are not intended to improve strength! Coordination and endurance is key!!!"

Dumoulin & Hay-Smith (2010) found in randomized trials "support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence." as compared to no treatment, sham treatment and placebo.

Neuromuscular coordination is the goal of pelvic floor or pelvi core rehabilitation.

The myth of sports drinks

A good friend of mine, Paul Ashman of Manic Salamander, brought this to my attention:

Sports drinks don't deliver. They have so little in the way of electrolytes in them and the most sporty thing about them is the neon artificial colors. Let's compare labels on the most famous sports drink, GatorAde, which has changed its moniker to G and G2, with V8 juice.

Here's what's in a 20 oz. bottle of G:  130 calories, 34g carbs (11%), sodium 270mg (11%), potassium 75mg (2%), sugar 34g and 0 protein, vit A, vit C, fiber, calcium or iron. 

A 12 oz. bottle of V8 contains: 70 calories, 15g carbs (5%), 630mg sodium (26%), 700mg potassium (20%), sugar 12 g, as well as 3g protein, 3g fiber, vit A (60% daily value), vit C (180%), calcium (6%), iron (6%).

V8 kicks ass and can actually replenish after exerting one's self in sports activities. V8 is a powerhouse of nutrition on the go.

Curious Connections: low back & knees

There are oh-so-many ways that the low back and knees are connected. One that has been catching my attention of late is that people who complain of chronic low back pain invariably have grainy, mealy, lumpy, unhealthy soft tissue on the popliteal fossa (backs of the knees). In the middle of the popliteal folds (transverse crease of popliteal fossa, to be precise) is Bladder 40 (UB40, Wei Zhong), a potent acupoint for low back pain. How did the ancient Chinese physicians make this connection? There are many theories and beliefs about how acupuncture came to be. But I wonder if perhaps some physicians, who were more focused on manual modalities and the cadaver studies done at the time, noticed this difference in the tissues and that perhaps this contributed to the discovery of the acupoint.

Tissues reflect the health of the structures with which they are related. Often these are contiguous (next-door or adjacent) structures, but sometimes these structures are related through their fascial connections (like the low back & knees). It is through these fascial connections that tissues can, in turn, influence the health of other organs and structures in the body. It goes both ways. So keeping the tissues healthy through hydration, nutrition, massage, manual therapies, skin brushing, etc is important to overall health of the internal organs.

Tissue Talk: tensegrity

Here's a fascinating and creative take on functional structure:

Tensegrity is a term popularized by Buckminster Fuller when he built the first geodesic dome. These buildings transfer loads through tension beams which are connected in triangles. The integrity of this tension system is crucial to the stability of the structure (tension integrity = tensegrity). When a force pulling in one direction is equally opposed by a force pulling in the opposite direction, stability is achieved for that direction only. For complete rigidity of a structure the various lines of force form a series of isosceles triangles. These are called tensegrity structures. Our bodies do not require this amount of rigidity, in fact our function would be limited because of it. However, the linking together of muscles through their connective tissue bonds (fascia, ligaments, and bones) can create momentary tensegrity systems that assist in the transference of force without too much compression through the joints. Exercises, which connect muscles both individually and collectively, provide tensegrity for the direction of load being imposed.

---Lee, BSR, FCMAT, Diane, An Integrated Model of "Joint" Function and Its Functional Assessment, 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.

Proprioceptive Neuro-muscular Facilitation (PNF) tests and treats patterns of movement that utilize all of a joint's movements through all three dimensions. Since most muscles' tendons and their attending structures (fascia, nerves) attach to their nearby joints, taking a joint through its functional patterns that include abduction/adduction, extension/flexion, and internal & external rotation challenges all of the structures' strength, mobility, range of motion and, most importantly, neuro-muscular coordination. The points in the movement that present as weak, ratchety or painful reveal dyscoordination of a system of structures through that particular part of the pattern of movement. This need not show up in testing single muscles in single planes of strength such as is done in kinesiology. And building strength alone will not provide results. The system as a whole must be reeducated in how to behave as a system. PNF provides systemic functional reeducation.

Tummies & Posture

The pendulum keeps swinging back and forth between two camps. There are those who say that we should pull in our tummies to keep our abdominals strong and promote core strength and there are those who advocate for not pulling in our tummies, that we should maintain our lumbar curves. Right now we are in an era of 'let it all hang out'. Actually, the two camps are not entirely mutually exclusive, yet both are wrong.

We do want to activate our transvers abdominus throughout our day, while maintaining our lumbar curve and while allowing our tummies to move with our breath. This means pulling in our tummies slightly, about an inch, while not maintaining a rigidity to that hold. The transverse abdominus is a component of the core, which provides stabilization for functional movement and contributes to balance and proprioception. We do want to strengthen our core. But more importantly, we want to engage our core in concert with functional movement. In this way we educate our bodies in neuro-muscular coordination. A strong muscle without neuro-muscular coordination is a bully to its neighbors.

Urology as a subspecialty of neurology, a case study

"It's all about neuro-muscular coordination."

If you've taken my Bladder & Pelvic Floor Health class (whether for patients or for practitioners) you've heard me say this umpteen times. It's one of the major take-aways from the class. You've also heard me joke that "Your bladder doesn't pee, your brain does."  While this is not completely accurate, it serves to underscore an important theme: Your bladder is part of a very complicated neurological system and it operates within that system, not as an adjunct.

I have a patient whose story is an excellent representation. She had an existing bladder issue from a previous trauma when she came to my Bladder & Pelvic Floor Health class. Over time, she was healing herself with the exercises that I taught. However, she recently had a fall that caused a moderate head trauma. She didn't drive for four weeks and she was off of work for seven weeks. She found that her body prioritized the new trauma; her bladder issue, with the new stressors her body was going through, worsened. The concussion left her balance and proprioception compromised. She experiences dizzy spells. These are common neurological symptoms with trauma, and especially with head trauma.

At my Pelvic Floor & Core Workout Series she has shared with us how, in doing the slow movements and really paying attention and feeling her body, it fatigues her mind and body. She's noticed that she gets emotional with the movement and with her impatience in feeling fatigued, and that the emotion and fatigue are both signals for her to take a rest. But she's seeing improvement with these slow, intentional movements that challenge the core, coordinate proprioception and improve balance. Remember, these all contribute to and mirror the condition of each other because they are all neurologically based.

It truly is all about neuro-muscular coordination.

Care of the soul

Last night I witnessed the most brazen act of bravery that I've ever encountered: A young woman stood up at church (yes, your eyes are ok here) and confessed that she doesn't like god, that she's not sure she believes anymore and that she feels lost. She lay herself bare in front of about 70 people in a truly awe-inspiring display of speaking her truth, raw and unorthodox. Just as impressive is the community that embraces this young woman as she struggles against and within their creed.

She's in the midst of tremendous, rich growth. Thomas Moore, in Care of the Soul, asserts that real growth comes from moving through the mire and muck of the dark unconscious.

From my rotting body, flowers shall grow and I am in them and that is eternity.

Soul enters life from below, through the cracks, finding an opening into life at points where smooth functioning breaks down.

He uses decomposition as an analogy for the process of delving into the unconscious--feeling and fearing while not fleeing one's self--to do the hard work of breaking things down. This process is the tilling and toil that necessarily precedes any transformation or insight that may come. Struggle, pain, fear, and frustration comprise the soil of transformation, the agar of the soul. Transformation can not happen outside it.

But this is human life: the war, the deeds, the disappointment, the anxiety. Imaginations struggles, far to nigh, all human; bearing in themselves this good, that they are still the air, the subtle food, to make us feel existence. This is the "goal" of the soul path - to feel existence; not to overcome life’s struggles and anxieties, but to know life first hand, to exist fully in context.

It is in resisting our struggles, pains, fears and frustrations that we find the places where we are most deeply wounded and where we have the potential for deep connection, within ourselves and with others. Resistance is our compass, our pointer to what matters. [Anger is, too. Resistance is our internal struggle with ourselves; anger is our internal struggle with others or outside forces.] If we flee from our resistance, we lose the opportunity for growth and insight [same with anger] and quite possibly cause ourselves more despair as we add the pain of abandoning ourselves.

It is precisely because we resist the darkness in ourselves that we miss the depths of the loveliness, beauty, brilliance, creativity, and joy that lie at our core.

Meeting resistance (much like expressing anger) is messy. It's not pretty or meditative or Buddha-like or artsy; it's ugly, depressive, stormy, unruly, and sometimes explosive.

The soul doesn't distinguish between good and bad as much as between what is nutritious and what isn't.  --"Soulmates"

One doesn't come out the other side happy, glowing and accepting of everything. One learns to discern what is acceptable and what is not, what aligns with one's self and what does not, what is healthy and what is toxic, what we accept as our identity and what is other. Only then, can we take action that supports and nourishes our soul.

While I feel deeply for this young woman who expressed her distress, I know that she is doing really good, hard work, that she will reap the benefits of her toil, that she will find her self, all the more so because of the community that supports her.

Self Care: skin brushing

Skin brushing is an important part of self care. Do it before showering as you want to do it on dry skin. Your pores will be more open for hydration after brushing. The reason for brushing "toward the heart" is that the body's major drainage for the lymph system is in the center of the chest, near the heart, so we want to brush in the direction of flow. Your skin will immediately become red as blood flow increases. This is also a sensory awakening for your brain.

Tissue Talk: neurology of chronic pain

An item I share in my Bladder & Pelvic Floor Health for Practitioners class from Haslam & Laycock's "Therapeutic Management of Incontinence and Pelvic Pain", 2nd edition:

When pain persists, even after healing has taken place [from a trauma], the nerve cell membranes undergo a change in conformation, establishing new receptor sites and the formation of new neural pathways that become embedded into the central nervous system. Once established, the chronic pain pathways are difficult to eradicate. Chronic pain no longer serves a useful purpose, but leads to physical, behavioral, and psychological changes that combine to produce the pain experience.

There are a couple very practical implications here. Firstly, chronic pain causes very real physical changes, even when the physical cause can no longer be detected. Secondly, the longer someone waits to get treatment for pain, the more established will be those physical changes and the more treatments they will require to try to reverse the pathology.

I have had patients who have become frustrated with western medical practitioners who told them that the pain "is in your head". It's an unfortunate (and rather dismissive) way to language it, but sometimes this is to what they refer. The physical cause has resolved; the pain now lives in their neurology. Chronic pain requires both physical modalities and CBT (cognitive-behavioral therapy) in order to be addressed completely. It will not be resolved by medications or surgery.

Uneven Terrain

I'm struggling with something that should be soooo easy, especially given my just having completed something similar that was (or should have been?) more challenging. This is a good reminder that strengths and weaknesses, abilities and disabilities (within ourselves), insight and blindspots are not evenly distributed throughout our beings, they're not relevant 'across the board', almost never.

I built my website on SquareSpace in a matter of a couple weeks. When I had questions, I emailed tech support or looked for answers in their database of questions. Putting together the website was no more complicated than writing the content. There are a couple peices I'm leaving for my tech helper to do, but I got it to the point of up and running, workable, 98% done.

MailChimp, however, is another story. They, offer a wide variety of tech support methods--video tutorials, searchable database of FAQ, emailing tech support (with fast turn around on replies). The process for setting up forms and campaigns guides you through, step by step, having you select what you want and plug in your info. Should be cake, right?  But I'm finding I'm constrained by the overly-rigid format. (At least I think this is the problem, at this juncture.) I can't figure out how to get out of it what I need to have in place and I'm not finding the help that I need, even with all of these tech support options. I'm right now waiting on a reply to another email I sent out to tech support.....

This mirrors other things in life. You have the skills, knowledge and experience but something is a little different this time and it trips you up. You find yourself floundering in a sea when you had just entered a pool...how did that happen? It's a good place to manage frustration because no other people are around. Practice patience with yourself.  And actually, how awesome is it that these services come with free tech support! I have no dearth of things to do, so I get to finish some other project.

"The Worst Ride Ever" or "What I Learned About Fun"

Ok, I'm goal oriented. Not a little. A lot. I look ahead and achieve. It's served me well in many respects; I'm able to get shit done. But when combined with my sense of competitive spirit, it can get over the top and perhaps needs tempering.

I rode the MS150 this weekend with some friends. We were four, all veterans with the exception of moi. This was my first ride of this length (150 miles in two days). My longest ride to date had been about 60 miles in one day, 100 miles in two days. I should probably mention that my training for this event was only my running. I hadn't been on the bicycle, really, this season. It was great to get away for the weekend, go camping, and ride the trails. I love watching for wildlife and I was fortunate enough to see a grey fox (in a hotel parking lot in Duluth, of all places!) and, on the second morning, a pair of cranes flying very low. I rode slow (as much because of the wind as my desire to behold) and I really made a point to look at the view. I didn't want to just plow through and miss the experience of the gorgeous surroundings. I'm not without an appreciation of process, to be sure.

Race days are times to celebrate what you've done, test for where you're at and push a little more out of yourself as you pull from the energy of the pack. I have a rule for myself: I never stop (ie: walk) during a race (most of my races are running races). I'll slow down when I need to, but I must keep running. I always say, "I'm not stopping unless they take me off on a stretcher." I really want to get through. ; ).  The MS150 is a ride, not a race (it's not timed), but my stipulation remains--move on to the end.

The first day of the ride was difficult. I didn't have much with which to compare it; I was tired, but not overly. On the second day I was cycling. along. very. slowly. I had left at 5am, long before the rest of my team, because I knew I was slower and they'd catch up with me. The wind was tremendous. 30mph tremendous. The temperature would reach 92* later in the afternoon. I saw busload after busload of riders SAGging--getting a van ride to the next rest area or dropping out altogether. I was alarmed. These riders had the fancy, expensive bikes, they wore the fancy uniforms, they must have trained. If they were dropping out, how would I fare??

At the second rest stop I discovered the blessings of body butter (aka: "hoo-ha ride glide", "butt chamois" were the two brands I tried) and I found that life was worth living again. Thank you, chemistry.

My friends caught up with me at the (about) half-way point at the lunch rest stop. I lamented the fallen bicyclists, but also judged them. What the hell was happening to them to make them drop out?? My friend patiently listed a number of physical ailments that can befall a cyclist. But they should be able to anticipate them, prevent them, right? And then she said it: "And maybe they just decided it wasn't fun anymore." She said it like it was a valid excuse, but I knew that the finish line was waiting at the end. I think her comment fanned a flame of panic in me because I countered with, "I'm only dropping out in a body bag." Dramatic? Yes, well....

On we went. Midway through the second-to-the-last leg of the ride, my team stopped for a prearranged rest. A conversation took place out of range of my hearing and next I knew the decision had been made to SAG. O.M.G. Fifteen miles from the end! Fif. teen. miles. They pointed out that at the rate we were managing that's another two to three hours of riding (with stops). And they weren't having fun anymore. I definitely was tired and I most certainly was not going to do this alone. It was really hard work by now and I needed the team. They were right, it wasn't fun anymore. It was do-able, but at a cost.

I don't know, I feel like this is where I am expected to wrap it all up with a quip about how I changed my thinking and became a new person, but that wouldn't be genuine. I like that feeling of accomplishment. It pushes me on. It gets me through. It's important. Alas, 135 miles in two days against 30mph winds is an accomplishment. I overheard several long-time veterans of the ride say that this was "the worst ride ever" because of the winds and heat. I guess 135 miles is enough.

My friend's comment struck me, though. Fun hasn't been so salient to me for my sports. While I'm running or cycling I consciously monitor my physical well being--how am I feeling, how am I breathing, what muscles do I feel, etc.--and I do monitor my general mood and motivation. But there's another level of emotional responsiveness available to me when I have a running partner that I don't practice when I run alone (and most of the bicycling I've done has been alone). With a partner, if I get bored, I change the conversation or make jokes to keep it interesting; there's more playfulness.

When I am alone, I can get too introspective and zen-zoned. The challenge for me is to be more playful. Then I can add the question, "Am I having fun?" to my lexicon of emotional responsiveness. I'm not sure how to implement this, really, without someone else with whom to interact, but it will prove an interesting exercise.

By the way, the decision was right. One member of our team became a little ill after we stopped and had a bumpy van ride. Barring the predisposition to carsickness, she could have been far worse off had we continued on.

Lumpy forearms

I've had several female patients present with lumpy, painful forearms after significant hormonal changes (postpartum, perimenopause). The nodules feel very similar to those that formed on my thighs after I had suffered multiple fractures to my pelvis. They showed up months after the trauma, were massaged out over a period of six months, and recur on occasion. The difference seems to be that these women have pain with use of the arms; I had pain only with pressure on the nodules. Both feel like the beginnings of scar tissue if they don't get worked out. Fortunately, both tend to be responsive to friction. 

It's not uncommon for women to have major, unexpected changes in their bodies after hormonal changes. Many women report that their health changed either for the better or for the worse after a pregnancy. Some women experience change in hair texture (straight to curly) or a change in how fast their hair or nails grow. But the lumpy, painful forearms is something I've not heard of before.

A Google search yielded no relevant results. If you have experience with this, please let me know.

Vulnerability

Oh, I had a lesson. No, it was practice, in vulnerability the other day. I had sent out my MailChimp link via my personal email to invite people to sign up for my email lists for my practice (turns out I had been spamming all of these years and didn't realize it!). Several hours later I remembered that it is recommended that one send out campaigns to one's self so you can monitor it. I sent out the email to myself and signed up for my list.

I was horrified to find that the last screen offered the option to go back to what one was doing before, or to go to the website of the email list!! As far as I was concerned, my website was off line, private, not accessible and not visible to the public!!!  I had a some stuff on my website that was rather personal, that I was considering having there, but I wasn't sure..... I felt exposed. Really, uncomfortably exposed.

After a freak-out, where I had a friend of mine test the PayPal to make sure it was functioning and I made sure that all of the pages were enabled, I did some editing. But I decided, at least so far, to include the parts that make me feel exposed. I feel in the long run these are the parts that make for good relationships, show the work that I'm doing, and show that I'm real. Yes, one can be a superhero and have fears at the same time. There's evidence that the progressive business sense has enveloped vulnerability. And, really, this is where I want to be--unsure, exploring, feeling a bit exposed, on the edge, a bit uncomfortable. It's where I trust I can connect with others better and it's where I can most be myself.

My practice truly is my best source of practice.

Score!

So, my highest scoring Scrabble word:  "Gauntlet".  82 points because it traversed two double-word score spaces and I used all of my tiles (50 points). The "n" was already on the board. Yay!

Egregious Deficit in American Culture

I have become aware that even people with whom I associate regularly are glaringly unaware of some basics of American culture--TED Talks and carrot-ginger soup. 

I urge you to check out TED--he's become my late-night companion for intellectual stimulation. In his own words he's:

TED is a small nonprofit devoted to Ideas Worth Spreading. It started out (in 1984) as a conference bringing together people from three worlds: Technology, Entertainment, Design. Since then its scope has become ever broader. Along with the annual TED Conference in Long Beach, California, and the TEDGlobal conference in Oxford UK, TED includes the award-winning TEDTalks video site, the Open Translation Program, the new TEDx community program, this year's TEDIndia Conference and the annual TED Prize.

TED has compiled the presentations from the conferences on his website.  These talks are about 20 minutes in length (some are only five) by people who are on the cutting edge of their fields and most of them are fascinating. 

As to the problem with the carrot-ginger soup, I have two solutions. First is to get it at MayDay Cafe.   However they make it seldom so you really need to go every afternoon until you happen to be there on a day they make it.  Second, you can try making it yourself (doesn't seem to come out as well, I find).  Here is a recipe. For any of the recipes you find, I suggest quadrupling the ginger--it never seems potent enough.

If Health Care were like AirLines

I've been meaning to recommend this website devoted to

Participatory Medicine

for some time now.  It's a growing movement of consumers and practitioners striving to change the face of health care by transforming the way patients interact with their health care providers.  It encourages transparency, consumer responsibility, consumer choice, informed decision-making (as opposed to informed choice), and restructuring of a broken system.  Also, check out their video,

"If Air Travel Worked Like Health Care"

.  It's funny, yet sad.  Many interesting and thought-provoking articles to peruse.  Have at it!

Caffeinated Sedation in a HyperSensational, HypoSensual Dimension

This is a post I wrote for another blog on 22 Dec 2009:

I just read "Regular & Decaf: One Friend with Schizophrenia, One Friend with Bipolar, One Ongoing Conversation, One Cup at a Time" by Andrew D. Gadtke.  It's a good review of some basic premises behind mental illness and lends a personal bent to the stories.  Andrew, the author, has schizophrenia.  His best, and only, friend, Benji, has bipolar (manic/depression). They recount their experiences with prodromal phases (early symptomology before getting diagnosed), the diagnoses, the hospitalization, changes in relationships and work.  

Two things struck me as I read.  First, it reminded me of that first-year psych student syndrome where one believes one has the disorder because symptoms are exaggerated from normal and because  there is a range of symptomatic behavior.  Andrew recounts that his mother didn't want to believe that he had schizophrenia--she could account for his behaviors within contexts.  Those contexts, however, were too far-fetched and his behaviors too pervasive.  I was reminded of the range of behavior and of that precarious line that separates normal from diagnosable.  In particular, I found sympathy with the paranoia, obsessiveness, and narcissism of mental illness in general.  Most mental illnesses have elements of these characteristics.  It depends on the pervasiveness and how they are manifested, as to the diagnosis.  Too, most "normal" people experience aspects of these elements.  So, when psych students are learning about specific disorders, it is common for them to empathize with the disorder (or think they have it) because they have experienced the symptoms.  However, they lack the persistence of symptoms, the pervasiveness of symptoms, or they lack the distress caused by the illness (to themselves or others) to qualify for a diagnosis.  This experience, however, of feeling as though one could have a certain mental illness is instructive in one's approach to treating. If students could take hold of this uncertainty as part of their approach to healing, they would do well toward servicing their patients.  Practitioners might offer a more balanced, realistic approach to care.

The other thing that impressed me in reading this book is the similarities between mental illness and trauma.  The depression (as a symptom), the fatigue/weakness, the lack of motivation, the despair, the side effects from drugs are all commonalities between mental illness and trauma--and few people, including the doctors or practitioners treating these, really understand the basic experiences of their patients.  I would have guffawed at it before I experienced it, but there is a level of exhaustion that one can only understand if one has experienced it first-hand.  It has nothing to do with laziness and everything to do with changes in physiology.  I really appreciate their (Andrew and Benji) belabouring the point. 

One place I must disagree with Andrew and Benji is in instituting segregated church programs for the DD (developmentally-disabled) as a "step in the right direction" (p. 214).  I find this problematic in many instances.  I understand that some DD people create disturbances to the general public.  I get it--I've worked with them.  There are those people who are simply not able to be in crowds.  But programs that segregate all DD people into special programs seems like a way to segregate people while feeling like you're doing them a service--a double standard one can feel all warm and fuzzy over.  'It's for their own good, after all.'  Yesterday I accompanied a Downs-syndrome couple to a segregated program at a mega-church in a wealthy suburb of Minneapolis.  I was appalled at the paternalistic setting designed mostly to serve the needs of the volunteers.  Most, if not all, of these people could have easily sat in on the regular service (which was going on at the same time) without being too much of a disturbance (if any) to the people around them.

Andrew writes, "To me, the loneliness of mental illness is immeasurable. I ache in my body for relationships with others, but virtually to no avail." (p. 175).  I know that historically mentally ill people, and really anyone deemed 'different' was ostracized. However, I can't help thinking that rather than getting 'better' or 'more advanced' in this regard, we've actually taken steps backward. This statement not only applies to mentally ill people, or the developmentally-disabled, but to anyone living alone or otherwise marginalized by mainstream society. We've created a deliberate social diabetes--loneliness within a sea of beings. (Diabetes is often described as a disease of starvation amidst plenty.)   Loneliness--it's not just for geeks anymore.

Andrew Gadtke recommends "Proof", the movie, as a decent representation of the prodromal phase of psychosis.  I'll be writing of that in the next weeks as I view it.