Day 963

Wysa

A young couple, committed to making a difference used their love and  intellect to create Touchkin, Artificial Intelligence for proactive care, integrating behavioural health into medical practice.

Tom Insel, a psychiatrist from National Institute of Mental Health (NIMH), the world’s largest mental-health research institution, spoke frankly about how MH services and research were failing to help the mentally ill. He openly dismissed the DSM (Diagnostic and Statistical Manual of Mental Disorders). At any given moment, roughly one in seven of the world’s 7.5 billion people is struggling with mental illness. “We’re not going to reach all those people by hiring more psychiatrists,” says Insel. But we might reach them with smartphones.

In one of his talks, Insel was sharing the intricacies of the delicate workings of the brain.   Someone interrupted him and said, “You don’t get it. The house is on fire, and you are discussing the chemistry of the paint”

Jo Aggarwal, one of the developers of Touchkin says:

“This line from the article resonated deeply with me. It’s a familiar sentiment – one many of us in development have had in conferences on employment, education, conflict. They are all at some level connected to the base fire that engulfs our world today – that of mental health. Until this fire is brought under control, we don’t have a hope for any of the rest of it.

His dramatic move lends credibility behind the idea that phones may be the answer. Identifying issues using smartphone behavior is powerful, though it can feel creepy. But detection is not enough. In our trials at Touchkin, phone sensors were able to predict depression in people with diabetes to a 90% accuracy, and went a long way in getting the physicians convinced to integrate mental health into their regimen. But only 1 in 30 people diagnosed went on to take treatment for the depression.

It said to us – “The house is on fire, the fire brigade is missing, and here we are saying how accurate our fire alarms are”

Wysa the emotionally intelligent penguin willed itself into existence somewhere along the way. It was a side feature created between ‘formal’ projects to improve accuracy. Taken by how people reacted to the prototype, we all kept working on making it better… in three months it crossed a threshold. It started changing lives. Last month, 3 people wrote in to say it saved their life, it is what is keeping them from suicide. Over 50,000 people talked to it anonymously, and thousands of them wrote in to us to say how much it meant to them.

Unlike the Stanford psychologists creating Woebot- we have no hypotheses around Wysa. It is evolving entirely based on what works for its users. It has evidence-based techniques, but everytime we add more tools or advice or tips we get users telling us to just let them talk to Wysa, and not to underestimate how much of a difference that makes.

“The fire in the house, is in our brains. The fuel is the language of the conversations we have inside our head. “

We started out, like Insel, trying to detect the fires… Wysa is leading us to try and put a fire extinguisher in everyone’s pocket. Any pretence of our own hypothesis went out of the window when the first person wrote in to say it saved their life. Now we are following it to see where it goes.

Like us, like Tim, there are many unwitting recruits to this fight.

Rick Little started fighting it as soon as he graduated college. So many of my friends… Sangeeta Mahajan who lost her son to suicide and has dedicated her life to preventing it for others. Anjana Ajay who is changing others lives after healing her own Stage 4 cancer by focusing on healing her mind. Bhavana Issar who is doing amazing work at Caregiver Saathi.Pooja Goyal who is creating resilience in pre-school children and their parents, bravely facing all the storms that come her way. Archana Aggarwal Sarda has made emotional support a way to get intl level diabetes outcomes in rural children, long before she realised that she was doing it.

None of them are psychologists. They each have options of more comfortable, lucrative ways to spend their time. They are all powerless to not do this. “The house is on fire. Once you see it, and you realise that you can stop it spreading, it is hard to do anything else.”

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Day 953

Discrimination at all levels

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All anaesthetic drugs work in mysterious ways. They mainly work on the brain. One of them is Ketamine. I have used it many times as an anaesthetic and to treat resistant pain. It’s relatively safe even in hands with limited experience. It’s used in all age groups. It’s known to cause ‘Dissociative’ anaesthesia and pain relief. It works through blocking NMDA (Glutamate N-methyl D-aspartate) receptors. Unfortunately, it is known to cause tolerance and dependence. It is also used recreationally.

Recent studies have shown that Ketamine has a significant beneficial effect on patients with treatment-resistant Major Depressive Disorder(MDD). The improvement is often seen within 4 hours of administration. This is the subject of many recent research papers but much more needs to be done.

It is estimated that about 3% of the UK population, nearly 2 million people suffer from depression. A small proportion of them, about 158,000 have depression that resists treatment. Currently, only 101 people are able to access ketamine in Oxford. About 40% showed sustained improvement after taking it.

It is potentially life-changing treatment for those suicidally depressed. Michael Bloomfield from UCL says “Unfortunately, medical research spending for mental illnesses is extremely low compared to other medical conditions. Clearly this needs to change if we are to improve treatments in the future.”

 

 

 

Day 949

Iatrogenic

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Antipsychiatry – I knew the sentiment but I didn’t know the word.
Dr Bonnie Burstow has helped hundreds of “highly suicidal patients,” as a psychotherapist. She’s come to believe that conventional psychiatric treatment isn’t in their best interests.

For half a century, scholars have been looking closely at Psychiatry as a coercive instrument of oppression. Dr Burstow is a prominent figure in the field of antipsychiatry, which she describes as “a movement of both psychiatric survivors and professionals saying that we need to abolish psychiatry”. She’s the author of “Psychiatry and the Business of Madness” and “The Myth of Mental Illness”.

“Longitudinal studies have shown that people who go off their drugs after a few years do better in the long run than people who stay on them. But guess who does the best of all? The people who were never on them in the first place. So, then the answer is, no one should be on them in the first place. These are not medical substances. They do not address a single chemical imbalance. They, in fact, cause imbalances and not surprisingly they cause all sorts of problems for people who can then never get off them because they now have a disordered brain that is caused by the medical profession. You know I spend a lot of time building up that and showing how it happened. But once you take in that position, it is a very convincing argument for abolition.

Since the 19th century, psychiatry has been defrauding vulnerable people. There was dunking people in cold water. There was rotating people in chairs. There was also opium. There was bleeding. Remember we had bleeding for a long time. There was also genital mutilation, just don’t forget they thought madness was being caused by masturbation.”

The University of Toronto has recently started a scholarship in Antipsychiatry. It is a historical breakthrough and hopefully a precursor to a better society. It signals to the world that this field of inquiry has come of age.

 

Day 940

The dark thing that sleeps in me

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Thomas Joiner, author of “Lonely at the Top: The high cost of Men’s success” is an avid suicide researcher. He lost his father to suicide.

His career choice is dismissed by some as : “You’re just trying to fix your own psychological problems, just like all mental health professionals.” Having psychological problems is not insulting. They are common, often treatable and nothing to be ashamed of.

Surely, heart and cancer researchers are not perceived in the same light. This is another reflection of the stigma that surrounds suicide.

Stigma is fear combined with disgust, contempt and lack of compassion – all of which flow from ignorance. We need to understand that suicide is not easy, painless, cowardly, selfish, vengeful or rash. It is not caused just by medicines, anorexia, smoking or plastic surgery. It is partly genetic and influenced by mental disorders which in themselves are agonising. That it is preventable (eg. through means restriction like bridge barriers) and treatable (talk about suicide is not cheap and should warrant specialist referral).

Once we get all that in our heads, we need to let it lead our hearts.

“I am terrified of this dark thing that sleeps in me,
All day I feel its feathery turnings,
Its malignity.”
– by Sylvia Plath

Source: ‘Myths about Suicide’ by Thomas Joiner.

Day 937

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Just a rant

Another Thursday. Another musician. Another suicide.

This Facebook post brought up the same old questions. I am not the only one asking them. They are a big problem for many families, individuals and communities. But sadly, the easiest thing to do for a medic at a consultation is to write a prescription rather than invest time and resources in the individual.

“Just reading about Chris Cornell and how according to his wife he took too much of his prescribed medication, out of it, because he was on his medication. Whether it was a suicide or “accidental death” I am outraged at the system. I didn’t really know Chris Cornell’s music until recently, but I lost my dear friend, another talented musician, to a similar situation recently. And before that I lost my mom, who became psychotic when given anti-depressants and took the whole bottle a few days after she had started taking them. I am so frustrated by a medical establishment that refuses to treat the whole disease and the whole person, and so tired of people I love dying from the very medication that is supposed to prevent it. If you work in (mental) health, please consider the risk when prescribing medications. Years ago, I myself was prescribed ativan and other medications and became addicted and had to take myself off everything completely without the support of a doctor because they thought I needed medication, while in reality the medication was making me suicidal.

Medication without therapy from my perspective is no different than drinking or smoking or taking drugs. I see the system changing as the trauma-informed approach enters the mainstream but in Nova Scotia, so many mental health problems that need deep spiritual healing are treated with drugs. Drugs that sometimes exacerbate the problem, or create a whole new problem, without leaving the person spiritually and emotionally sober enough to make sound decisions that could save lives.

I look forward to the day when the mental hospitals and outpatient aftercare support radical healing on a whole-person level-the kind of work that the International Association for Human Values and Body Talkers are doing-treating the whole person and providing them with actual physical stress and trauma relief tools.

Just a rant. I’m done. Love to all. Please no more state/big pharma-sponsored suicides…”

Eleven years ago, purely by chance, I learnt a breathing-based meditation technique called ‘Sudarshan Kriya’. It has kept me strong through deeply traumatic life-events. Our breath is a subtle but powerful bridge to knowing the ‘self’. It has precious secrets hidden in it. It energises and detoxifies. It keeps us alive. If we are willing to learn, it teaches us the art of living.

 

Day 926

AYA-5

Finally something wholistic. Is it?

Ayahuasca is a foul tasting, nauseating brown Amazonian psychoactive brew.

The name comes from the Quechua language where aya means soul, ancestors or dead persons and wasca (huasca) means vine or rope. One interpretation of the name is “vine of the soul” and another is “rope of death”. Of late more arguments are being made in favour of the former than the latter.

This Shamanic concoction has been the core of many religious, magical, curative, initiation, and other tribal rituals for millennia in the indigenous and mestizo populations of South America. They respect the brew as a sacrament and value it as a powerful medicine for physical and mental problems, social issues and spiritual crises. It is traditional medicine and cultural psychiatry.

During the last two decades Ayahuasca has become increasingly known to both scientists and laymen. Its popularity is spreading all over the Western world. People seeking improved insight, personal growth; emotional healing and contact with a sacred nature, deities, spirits and natural energies have given rise to the phenomenon of ‘drug tourism’.

In the correct therapeutic/ritualistic setting, with proper preparation of the user and subsequent integration of the experience, Ayahuasca has proven effective in the treatment of substance dependence and depression. The therapeutic effects of Ayahuasca are best understood from a bio-psycho-socio-spiritual model.

The first Randomised Clinical trial, led by Draulio Barros de Araujo at the Federal University of Rio Grande do Norte in Natal, Brazil has been published.  2 similar groups of 14 and 15 patients with resistant depression were randomised to receiving either placebo or the active drug. They filled out standard questionnaires the day before receiving their dose and 2 and 7 days later.
64% of patients who took Ayahuasca felt the severity of their depression fall to half. This was true for only a quarter of those who took placebo. The inference drawn is that Ayahuasca is better than placebo at least for the short term. More studies are required to see if the effects are sustained over longer periods.

Roughly 350 million people experience depression globally. Between one-third and half of  them do not respond well to medications. In addition to psychedelics such as Ketamine and Psilocybin, Ayahuasca is being investigated further as potential treatment for resistant major depression.

Ref:
Articles:
1. Therapeutic Potentials of Ayahuasca https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773875/
2. Rapid Antidepressant effects of Ayahuasca: http://biorxiv.org/content/early/2017/01/27/103531

Presentation by Draulio Barros de Araujo: https://vimeo.com/143399447

Day 925

Vulnerability. Not weakness.

Stories are data with a soul. Researcher and storyteller Brene’ Brown has taken the time to take a deep hard look at shame and vulnerability.

She believes that ‘connection’ is neurobiologically why we are here.

Shame is fear of disconnection or not feeling like you are worthy of connection. For example, not good enough, not pretty enough, not strong enough, not rich enough and so on. All experiences of excruciating vulnerability.

After 6 years of researching ‘Shame’ she took a closer at a sub-group of individuals with ‘Worthiness’, people with a strong sense of love and belonging who believe they are worthy of love and belonging. She called them  ‘Wholehearted’. This group had a few remarkable  traits:

  1. Courage – to be imperfect
  2. Compassion – ability to be kind to themselves and others
  3. Connection – ability to give up the idea of perfection

They fully embraced their vulnerability. They believed that vulnerability makes them beautiful. They were willing to reach out their hand first, to invest in a relationship that may or may not work out. It was not comfortable but they did it anyway.
Vulnerability is also the birthplace of tenderness, belonging, love and joy.

What makes us vulnerable?
The simplest things like asking for help, waiting for the doc to call back, initiating sex, loosing a job, asking someone out on a date and many more.

Why do we struggle with vulnerability?
The uncertainty is too uncomfortable. So we numb it.

At present, we are most highly addicted, medicated and obese populace ever.
We can’t selectively numb feelings.
When we numb vulnerability we also numb joy and connection.

The ways in which we deal with our discomfort with vulnerability are:

  1. We make everything uncertain, certain, eg- religion.
  2. We Blame- a way to discharge pain and discomfort.
  3. We Perfect – most dangerously our children.
  4. We pretend – like what we are doing doesn’t have an effect on people.

We need to let ourselves be seen.
To love with our whole hearts even if we are unsure.
To practice Gratitude despite the uncertainty because our vulnerability means we are alive.
Lean into joy and believe – I am enough.
That enables us to be kinder and gentler to the people around us and to ourselves.

Ref:

Book :
Daring Greatly by Dr Brene Browm
TED talk by Dr Brene Brown on Power of Vulnerability: