Part 1 is HERE
Hank Pellissier: Have you tried mindfulness meditation? As a treatment for Bipolar disorder
Gareth John: My history has obviously meant that mindfulness meditation, along with many other meditative techniques, have been central to my life as a younger man. These days I occasionally practice mindfulness meditation but not in any formal sense. I have issues with the latest fad where mindfulness seems to be prescribed as a panacea for any and all ills.
These are generalised issues - obviously some people will derive a positive effect and some will not - but I am particularly concerned where people with a vast range of mental health issues are encouraged to practice mindfulness. I can see the advantage of mindfulness, successfully practiced, providing a space within which to better recognise triggers for their mental illness or once some stability has been reached through the use of medication and associated therapies. What I do question is the use of mindfulness in any and every case, right from the beginning of treatment which seems to be the direction it has taken since being popularised and secularised by Jon Kabat-Zinn among others.
In terms of bipolar, I’m not convinced that mindfulness can be productively used to control mood swings or indeed to help manage each on their own merit. With manic phases the idea that sitting quietly doing nothing might help is, I believe, naive at best. I suggest that attempting either to control or ‘go with the flow’ with the flight of ideas or pressure of speech and general restlessness associated with mania can result in an actual increase of these symptoms as the pressure builds during your meditation practice with the result that your symptoms will have to find a vent somewhere down the line. Even more potentially destructive is the use of mindfulness where people experience depressive symptoms, especially the more extreme varieties associated with severe mental illness. Mindfulness can be described as a sort of ‘controlled depression’ where the sense fields are shut down and one’s attention is fixed upon one’s state of mind - at least for beginning practitioners. This I do not feel to be helpful, indeed, possibly dangerous.
The only evidence I can offer for these criticisms is my own training in meditation practice, but I do believe there are dangers to the usage of mindfulness in the treatment of mental ill-health that we have yet to encounter. My other questions would be: who are the people teaching mindfulness? What are their qualifications? How much have they practiced themselves - how well do they know themselves? What would they do if the meditators under their tutelage started to experience visual or audible hallucinations as part of their practice, something extremely common if mindfulness is practiced properly?
A recent study announced in the Guardian newspaper under the headline ‘Mindfulness study to track effect of meditation on 7,000 teenagers.’ Psychologists and neuroscientists from Oxford University and University College London are planning an unprecedented trial of how mindfulness affects mental health. This is all to the well and good, but I hope the participants don’t suffer as a result. The test will be to see whether mindfulness can increase resilience to “a core vulnerability” displayed by teens: difficulty sustaining attention in the face of thoughts and impulses that can become overwhelming. But in the researchers’ own words “enthusiasm is running ahead of the evidence and that is no basis for policy decisions. None of the previous research has been definitive and there is now a pressing need for a high quality robust trial to assess effectiveness.”[1]
Non-secular Buddhists spend years training before they become teachers. I wonder how many mindfulness teachers have that much experience and is it safe for them to be taking responsibility for people’s mental and emotional health in what has become, let us face it, a very lucrative industry.
What psychotherapy treatments have you tried?
I’ve engaged in psychotherapy organised via my CMHT. The so-called ‘Welsh Measures’ introduced in Wales in 2010 guaranteed anybody under the care of a CMHT access to a named psychiatrist, an assigned Community Psychiatric Nurse (CPN) and a Care Plan drawn up with the patient to help proceed with treatment.[2] Psychotherapy can also be offered if it is felt that it would be beneficial. Due to high caseloads and time restraints sessions are restricted to six hour long weekly meetings, with the possibility of increasing this to ten if it is felt to be necessary.
I personally found psychotherapy helpful, although I think this was as much to do with the person of my psychotherapist as opposed to any particular psychotherapeutic technique. We decided Cognitive Behavioural Therapy (CBT), the most commonly utilised form of therapy in the UK at present, would not be particularly conducive to assisting me and my particular situation, so opted instead for a humanistic, integrative therapy taking its lead from whatever arose in the sessions, à la Carl Rogers and Abraham Maslow. Although there has long been a criticism of talking therapies that talking to one’s relatives or friends can be just as affective and while I think there is some truth to that, having this person to yourself for an hour who is open and non-judgmental and objective with regards your circumstances can be helpful. Once again, the caveat: this is not the case for everyone.
Some online mental health services have been approved for use by the NHS. Research shows that these can be just as effective as face-to-face therapy with a therapist for depression, anxiety and other mental health problems. You’re also likely to experience shorter waiting times to access them.[3] The kind of support offered by NHS-approved online mental health services varies. Some offer the chance to work through a self-help course with a mental health professional providing support online. Others offer live therapy with a therapist via instant messaging or a video link using webcams. Or you can join an anonymous online community where you can meet and interact with other people who have similar mental health problems to you.
I do liaise with a lot of people on Twitter with similar mental health issues, but I do think you need a certain level of self-awareness to engage with others in this way as there are plenty of people cajoling to offer advice that is not always helpful. You also get the ‘trolls’ who can do immeasurable damage by targeting vulnerable people - we’ve all seen or heard about suicides that have taken place due to online bullying and for many people with mental ill-health they’re halfway there already. On the flip-side people do look out for each other and there is a strong community built up around this mutual support.
Have you tried ‘exercise?’ Yoga?
I’m somewhat embarrassed to admit that I have not and do not perform any exercise, despite knowing the beneficial effects it can have, particularly with depression. Dr Alan Cohen, a GP in the UK with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. “Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events,” he says.[4] If you haven't exercised for a long time or are concerned about the effects of exercise on your health, you can ask your GP about exercise on a prescription programme. Many GP surgeries across the country prescribe exercise as a treatment for a range of conditions, including depression. Your GP will refer you to a local active health team for a fixed number of sessions under the supervision of a qualified trainer. You decide what type of activity will suit you with your GP and the active health team. Depending on your circumstances and what's available locally, the exercise programme may be offered free or at a reduced cost.
Indeed, today (19th Sep) the BBC reported on tai-chi being prescribed following a study in the British Journal of Sports Medicine for such illnesses as arthritis, chronic obstructive pulmonary disease (COPD) and it may have some physical benefits for people with breast cancer or heart failure, according to researchers from the University of British Colombia, Vancouver.[5] Following on from question three above, I would suggest that a moving meditation such as tai-chi would be far more beneficial for people with depressive illnesses than sitting mindfulness practices.
While we don’t have such a programme locally (I do live out in the sticks somewhat) I applaud this initiative. Studies have shown exercise to be as effective as medication with people suffering depression and certainly when used alongside them.[6] The problem for a lot of people suffering long-term depression is that getting out of bed or into the shower is like climbing a mountain in itself, so the thought of going for a brisk jog, bike ride or walk seems an impossible task. In my case it’s not helped by a social phobia that means I rarely leave the house and if I do it’s always within the safe confines of my car.
Of course, there’s nothing to stop my exercising at home - as you suggested, yoga - or pilates, tai-chi or simple stretching exercises, climbing stairs etc. Despite many promises on my part, I have yet to take advantage of any of these opportunities, so I’m afraid the answer would have to be no.
Have you tried transcranial stimulus?
No. My understanding of transcranial stimulus is that it can be used diagnostically in cases of multiple sclerosis, amyotrophic lateral sclerosis, movement disorders, motor neuron disease and injuries and other disorders affecting the facial and other cranial nerves and the spinal cord as well as treatment for a range of mental health disorders such as major depression disorder, panic attacks and the negative effects of schizophrenia as well as bipolar disorder and treatment resistant suicidal ideation.[7]
In the mental health system here in Mid Wales it would be extremely unlikely you would be put forward for such interventions due to cost and availability. I know the Cardiff University Brain Research Imaging Centre (CUBRIC) is a University facility operated and supported by the School of Psychology and is (according to their website) a world-class facility, featuring state-of-the-art brain imaging and brain stimulation technologies.[8]
My guess would be that, at best, my psychiatrist would say we have not exhausted all medication-based approaches and therefore we should continue down the present path for now. I’ll make it a point to ask him about transcranial stimulus when next we meet. You never know.
Are there any future treatments that you intend to try?
Well, to be honest I’m waiting for the promise of the Hedonistic Principle to come to fruition. Be it through genetic engineering, nanotechnology, pharmacology, or neurosurgery - or potentially a mixture of them together - if they could potentially converge to eliminate my depressive episodes then put me down for Paradise Engineering 101.[9]
The bizarre thing about my particular experience of bipolar disorder is that there is a very real sense that I don’t want to wake up tomorrow morning. However there is also no question that I do want to see what happens to humanity over the coming decades, if not centuries. And despite having been somewhat tongue-in-cheek above about the Hedonistic Imperative and the work of David Pearce, as someone who identifies as a technoprogressive who also happens to have a mental illness, I’m obviously extremely interested in Pearce’s work and aspirations.
Another obvious crossover with the idea of paradise engineering is hypomania itself as experienced by people with type II bipolar disorder. It could be called nature’s own mood-brightener - a feeling of being high, full of energy and feelings of extreme and intense happiness – with increased confidence and self-esteem.[10]
With hypomania you get all the benefits of feeling good about yourself and your environment without the lack of control associated with full blown mania. Very often people with hypomania are extremely productive and of course there have long been associations between certain forms of mental illness and creativity.[11] Granted, hypomania can also lead to impatience, irritability and anger, but I would maintain that there is food for thought there in terms of continuing to investigate the causes of hypomania (and bipolar disorder as a whole) alongside genetic engineering, pharmacology and the rest.
Although I apply the above only to myself and my experience of bipolar, as a technoprogressive it’s important to me that any future therapies and/or biotechnologies be available to all. Though I may not live to see them at work, I firmly believe that we are on the cusp of, if not eliminating suffering, at the very least easing peoples’ experience of psychological distress still further than at present.
In the more immediate future, I am interested in the use of ketamine as a possible treatment. In a small study of people with bipolar disorder whose symptoms had not responded to prior treatments, a single dose of ketamine—an anaesthetic medication—significantly reduced symptoms of depression in as little as 40 minutes. These effects lasted about a week on average.[12]
Ketamine itself is unlikely to become widely available as a treatment because it can cause serious side effects at high doses, such as hallucinations. However, scientists are working to understand how the drug works on the brain in an effort to develop treatments with fewer side effects and that act similarly to ketamine. Such medications could also be used for longer term management of symptoms. This is an interesting field of study that I am particularly interested in.
Are there any lifestyle changes that impact your bipolarism?
I lead a pretty boring life which is spent swinging between extreme happiness (usually only for short periods) and deep depression (which can last months at a time). Along with many people with mental ill-health I try to do what I can to improve my life, although I am not always successful in achieving any improvement. So I keep trying. Sometimes I take a leap and agree to write something like this, despite anxiety and nervousness about its reception. Sometimes I struggle to get out of bed. Sometimes it all becomes too much and I try to sabotage the very thing that transhumanists stand for above all else (arguably) by attempting to end my life.
However, I also have to admit that I sabotage potential recovery in other ways too. In question two I said that I would return to the subject of being prescribed diazepam. Doctors, both GPs and psychiatrists, are extremely unhappy prescribing ‘benzos’ apart from as short-term use to control anxiety and panic attacks.[13] I have been prescribed them for a much longer time.
Alongside their effects just mentioned, the reason they have been prescribed for so long is that they are meant to counter my own particular form of self-medication: drinking. I will drink a bottle of wine a night and have done so for many years. The alcohol subdues anxiety, panic and thoughts of suicide and diazepam was initially prescribed to replace that need. Sadly (or stupidly depending on how you look at it) I regularly wash down my final diazepam and anti-psychotic of the day with a glassful of Sauvignon Blanc.
When in crisis, medical practitioners have tended to leave yourself and such self-medications alone, figuring you need all the help you can get, but when you are a little more stable you can expect a lecture. I guess it’s only fair.
Notes
1. http://www.theguardian.com/lifeandstyle/2015/jul/15/mindfulness-study-meditation-7000-teenagers-impact?CMP=share_btn_gp
2. http://gov.wales/topics/health/nhswales/healthservice/mental-health-services/measure/?lang=en
3. http://www.nhs.uk/conditions/stress-anxiety-depression/pages/self-help-therapies.aspx
4. http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx
5. http://www.bbc.co.uk/news/health-34279190
6. Reynolds, Gretchen. "Prescribing Exercise to Treat Depression". The New York Times. Retrieved April 29,2013.
7. https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation
8. http://sites.cardiff.ac.uk/cubric/tms/
9. http://paradise-engineering.com/
10. http://www.mind.org.uk/information-support/types-of-mental-health-problems/hypomania-and-mania/#.Vfr__Z1Viko
11. http://www.independent.co.uk/news/science/scientists-find-that-schizophrenia-and-bipolar-disorder-are-linked-to-creativity-10305708.html
12. http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml#pub12
13. http://www.benzo.org.uk/amisc/bzgrampian.pdf
Image #3: Illustration by Jessica Johnson
