You Will Have Noticed…


…that I wrote three posts today already.

That is not accidental, nor the result of having just one good day amidst many lesser ones.

I aim to write more frequently, and from a broader perspective. In the quite long periods when my blog went silent, I learned about different perspectives on obsessive-compulsive and related disorders. I got interested in phenomenology, and in ‘the whole perspective’ (as different from the often quite reductionist approach that ‘pure’ neuroscience takes).

You can move forward with looking at the parts, but it is wise to always keep the whole in mind.

And I hope that we can engage in some lively discussions in the future.

And now I got to go home, all you good people out there.

Best, Frank.

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What does OCD express for you?


…another question:

could you describe what the symptoms of OCD mean to you, and express for you?

Of course they’re an immense and painful burden, and they cost you incredible amounts of energy.

For me, they mean(t): to create a small and very safe world for me. In this world, I am as protected as well as possible against bad influences, disruptions, general harm. When I find rest after having performed my checking rituals, I can read, listen to music, play my guitar, watch a good movie, whatever.

In brief: I can be myself.

In this respect, my rituals are by no means ‘insane’, or ‘mad’. They’re not even irrational (though the repetition is, of course, dreadful in itself). But is striving for safety, rest, and the ability to concentrate intensely on valuable activities an illness?

I shouldn’t think so. OCD is different from having distorted, ‘false’, experiences of the world (as is the case in a state of psychosis).

Finally: I don’t want to imply that OCD is ‘better’ than schizophrenia, of course.

Footnote


…I forgot: once I wrote that OCD can be seen as a neurological problem.

I must admit that this observation needs clarifying. Neurological diseases exist without any obvious external cause. And should treatment (surgery, medication) alleviate or remove the problem, then one could say: this successful ‘repair’ has taken away the ’cause’ of the illness (but the cause here means: a certain state of things that can be the end result of previous neurobiological processes, that then would be the causes prior to the ’cause’ just above.

In my earlier post of today, I hinted at environmental events that may be the true causative factors for anxiety and depression.

The chain then would look like: external factors >> getting anxious and stressed (feelings) >> elevated stress hormone in the body (a short-term protective, but long-term harmful response >> depression (associated with altered functioning in various brain regions, e.g. the hippocampus >> alterations in behaviour.

Somewhere in all of this we see lower extrasynaptic serotonin in the brain. In a number of patients these levels can be increased by administering antidepressants; but physical exercise, a well-balanced diet, good human company can also seriously improve one’s mood.

So I think it’s fair to say that low serotonin is not the ultimate cause here, there are earlier factors in the whole chain that can be well identified (and remedied). Whereas in the neurological diseases I mentioned first, the ’cause’ I meant seems to have its own, earlier causes still in the patient’s own biochemistry.

Oh, this is subtle and difficult. Writing things like this, you have to be on guard all of the time, and you can only talk provisionally, conditionally.

I would be ever so glad if anyone out there would respond, and criticism is most welcome.

A Question


…from an epistemological and phenomenological point of view:

Psychology, and psychiatry, are in turmoil. For decades these fields have been guided by the so-called biomedical paradigm. And the popularity of the neurosciences fortified the position of this working model, since all kinds of measuring and visualizing became available – which led practitioners to believe that psychiatry definitely was on its way to assume the mantle of the natural sciences.

But as they say: there’s a crack in everything. Numerous experts in the environments of mental illness raised doubts about the validity and the value in general of describing OCD, depression, ADHD, autism, and addiction (to name a few) in terms of: imbalances of chemical compounds in the brain (only); which imbalances just needed re-dressing with medication, and then improvement in one’s condition would surely ensue.

This is essential:

every psychiatric diagnosis is also a social diagnosis. For one can only speak of a ‘disorder’ if there is ‘order’, normality. And normality in human terms can only be seen as ‘that which is socially seen as normal’, ‘that what is seen as common and decent’, ‘that what most of us feel, think, say, and do. The average.

By definition: a person all alone can never be ‘mentally ill’, or ‘insane’, for there is no ‘other’, there are no ‘others’, to compare her or him with.

This leads me to the following: the critical psychiatrists in our time note that many people diagnosed as mentally ill nowadays aren’t ill because there is something different in their genes, or because they show neurochemical imbalances. Sure, their levels of neurotransmitters may be different from non-depressed  people (by way of example). There may be an association between those imbalances and their feeling unwell.

Note that I use the word: association (which says: two things are being observed at roughly the same point in time). And that I don’t speak of a causal relationship (as in: a lack of freely available serotonin in the brain causes depression (or OCD, others).

What the neurobiological-psychiatric approach does is: search for the causes of illness inside the patient’s brain (nervous system, body).

Critical psychiatrists look first  and foremost to the social environment. That is a deep and rich field to inspect. Think of a child in school, being bullied and harrassed every day. That child may (almost certainly) develop shyness, anxiety, and symptoms of depression.

That child would, in some test or another, show a lack of free serotonin in the brain. That child would probably get ‘better’ after prolonged use of the modern-day antidepressants.

Do we call that: healing, recovery?

I don’t. Because the real cause of the child’s maladies isn’t being addressed at all in my example. The real cause, the bullying, is being replaced (by the bio-psychiatrist) by a second, and false cause: that lack of serotonin.

Poverty, social inequality, unequal access to education, and many more social and environmental forms of injustice are potent drivers of mental illness. As we all know, our tragic times are especially tainted by these enormous problems.

My question for today: do any of you recognize something in these remarks of mine, out of your own experience? Did you feel at some point in time: my problems, my OCD, my depression is kind of a response to things that happened to me from the outside, I’m certainly not to blame myself? Or even: my illness might be an alarm signal of my whole being, my body itself: I am merely reacting to bad things in the outside world (inappropriate, angry, evil acts by other people)?

See: depression and anxiety can have a strong signaling function. They ring an alarm bell: that what threatens my peace of mind and well-being must stop!

Well… does all of the above ring a bell with you, dear readers?

Some Thoughts


Yesterday I did a small presentation to a group of doctors, who are specializing in treating people with substance addictions.

It was a nice and satisfying event, for the range of topics covered already was wide, and since there was good interaction between the doctor who was the chief speaker, me (invited), and our audience.

And so it happened that we talked about addiction, depression, OCD, autism, ADHD, and the treatment options available. The host had included lots of facts from the history of medicine in his talk, nicely illustrated with photos, figures, drawings, front pages of very old books. Actually, some of these caused a jolly good laugh in all of us – which suggests that that we regard as ‘contemporary’, ‘modern’, ‘state of the art’, and even ‘unsurpassable’ today, may strike a comparable audience 2128 A.D. as extremely outmoded and fairly ridiculous too (if we manage to save our precious climate, that is).

This small introduction my way of announcing the continuation of this blog. I went through major life changes during all the times when I did not write much, and there were long stretches when I did not write at all too.

I hope the new and stable life conditions I am in now will allow for much more information on OCD. I must admit that, being trained as a scientist, I revised my views on many aspects of mental illness in years gone by. There were no revolutions, nor did I suddenly see the light when changing my point of view on the topics. I hope to make these things clear – and moreover I hope that my readers may find benefits in my writings.

One last point of interest: I lowered my use of the antidepressant paroxetine (an SSRI) three months ago, to a level that usually is the minimum prescription in treating depression: 20 mg/day. I did not experience symptoms of withdrawal, nor did I get a higher urge to perform OCD-related acts: the rituals of checking locks, doors, faucets, windows, the stove, and so on and so forth.

This is as puzzling as it is positive, I think.  I will ponder it, and tell you about my thoughts on this.

Genetic Aspects of OCD Will Follow Shortly


I had planned to write a new post on the genetic origins of OCD today.

But whilst scanning new research, I learned that this effort will take a bit of time. The situation anno 2017 is markedly different from that in, say, 2007.

For instance, there’s the vast field of epigenetics, it has been expanding at a rapid pace. I quote this brief explanation from Wikipedia:

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Epigenetics are stable heritable traits (or “phenotypes“) that cannot be explained by changes in DNA sequence.[1] The Greek prefix epi- (Greek: επί– over, outside of, around) in epigenetics implies features that are “on top of” or “in addition to” the traditional genetic basis for inheritance.[2] Epigenetics often refers to changes in a chromosome that affect gene activity and expression, but can also be used to describe any heritable phenotypic change that does not derive from a modification of the genome, such as prions. Such effects on cellular and physiological phenotypic traits may result from external or environmental factors, or be part of normal developmental program. The standard definition of epigenetics requires these alterations to be heritable,[3][4] either in the progeny of cells or of organisms.

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Epigenetics is the key link between our DNA proper and our environment. The old expression to describe the interaction between genes and surroundings is: G x E.

I am almost inclined to say: the mysterious x-factor in this small formula is epigenetics.

PANDAS: What was that again?


The acronym PANDAS stands for:

pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections.

That is a whole mouthful, you’ll agree.

We’re talking about a unique sub-set of psychiatric patients: there are children in whom an acute manifestation of OCD and/or tic disorders occurs. This is special, because with OCD the symptoms usually develop over time.

The disorders were initially thought to be caused by infection with Group-A beta-hemolytic Streptococcus (GABHS).

Susan Swedo and her group published an important research report on  this in 1998.

Two decades later, there have been changes in the concept of PANDAS; actually, it is now named: PANS (pediatric acute-onset neuropsychiatric syndrome). It hasn’t been accepted as a distinct disorder (or group of disorders) yet – but that doesn’t mean there haven’t been additional findings.

  • several agents other than Streptococcus may be involved in its inception
  • there is a male predominance in the patient population: 65% of it is male
  • 54% of those affected show a specific association with Streptococcus
  • gender and pubertal status have a strong effect on symptom course and chronicity of the illness
  • the rate of co-occurring medical illness is high – a general immune dysfunction is suggested by experts
  • PANS has a considerable impact on the daily life of the children
  • antibiotic treatment is advised to resolve the symptoms of infection early on
  • it may be that the resident immune cells of the brain, the microglia, aren’t functioning well in PANS

Now, we are lucky: some fine articles on these matters are available at the open source of the National Institute for Mental Health, in Bethesda, Maryland, via the Pubmed site:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783973/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174185/

…and here’s a figure (sans comment) to whet your appetite, from the first article:

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Next Time…


…I will present some new findings on PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections – impress your friends!) and on the genetic origins of OCD.

Please stay tuned.

OCD and Free Will


This is an interesting concept –

the freedom of our will has been a central topic in philosophy all through human history. When the neurosciences had their big lift-off in the 1990s, they too began to make inquiries into brain areas thought to be key in making choices.

Decision-making is something that is more difficult than it may sound at first. We must try to somehow sketch what choices we can reasonably make at all. We also need to see into the future: which action of ours will have which practical consequences?

One may think: what action is profitable for me? What promotes my health and well-being? Or: what brings money into my bank account? On the other hand: one can consider: how can I make my wife or husband happy? My children? I am the happiest whenever I see those around me happy.

Actually, there are a multitude of motives, reasons, and feelings at play.

It is typical for these, our, times that I often see the motive of personal interest and profit rear its head, as if unselfishness and the love for others weren’t ‘cool’ enough to mention in the context of decision-making.

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Over to OCD.

All those who suffer from the illness, and those who are in their vicinity, know that there is something dreadfully wrong with a patient’s freedom to choose. People with OCD are living at the wrong side of a thick wall of clear glass: they perceive all too well how ‘the others’ live, enjoy life, act spontaneously, make mistakes, forgive and forget about those mistakes, eat well and carefree, and make music and love.

That is painful to see. For someone with OCD wants nothing more than to live like the others. But she/he can’t. There are the inner commands, the duties, the demon that wants to perform the patient all the unnecessary and irrelevant, ever-repetitive checks, controls, acts of cleaning or hoarding, and so on and so forth, ad infinitum et ad nauseam.

OCD is more about surviving than about living.

The only hope that is there for the patient is the brief time window of very relative freedom that will open after the exhausting rituals.

Even within this window (e.g. if one has succeeded in attending a dinner with others, or a movie together) there is this piece of knowledge lurking in the background: the demon hasn’t been conquered; he will return.

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It is clear that the freedom of choice, the scope of one’s free will, the ‘freedom to be spontaneous and impulsive’ – in order to experience life’s true joys, is by far not as broad and rich as it should be.

Neuroscience has described a number of brain areas that are closely associated with our capacity for decision-making. At this point it is important to emphasize that ‘being associated’ is not the same as ‘causal relationship’. ‘Associated’ can best be thought of as ‘occurring together in time’; a person may be in a test situation in the lab, perform a task that is about making choices, and a brain scan can be made. Certain phenomena in the scan are observed, that are different for people with OCD, as compared to healthy subjects. We cannot say at this point in time that these differences cause, or are the result of OCD. They co-occur (which is always a good starting point for refining the methods used, in order to get on the trail of what actually might be causal, in a later stage of research).

Three areas thus identified are: the dorsal anterior cingulate cortex (dACC), the nucleus accumbens (NAcc), and the anterior limb of the internal capsule (ALIC).

I came across this scientific article, recently:

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Neuromodulation. 2016 Apr;19(3):239-48. doi: 10.1111/ner.12405. Epub 2016 Feb 21.

Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.

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The authors looked at numerous results achieved with the method of psychosurgery – that is an invasive type of surgery, tiny modifications, changes are performed in the brain itself.
(I find this unsettling: actually meddling with someone’s brain tissue? But on the other hand: there are forms of OCD that can’t be treated well enough with cognitive behaviour therapy and/or pharmalogical treatment. And these can be so degrading for one’s quality of life, that in the end they may be the lesser of two evils.
And, let’s not forget: the other form of brain treatment in depression and anxiety, deep brain stimulation (DBS) is also an option: a tiny pacemaker that can alter neuronal activity in affected areas of the brain is implanted. Pilot projects have shown good results so far – and with our ever-evolving micro-technology there really a reason for good hopes.)
Here are the (literal) conclusions of the above authors:
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MethodologyIn modern psychosurgery three target structures exist for obsessive compulsive disorder and addiction: the dorsal ACC, the nucleus accumbens, and/or the anterior limb of the internal capsula. Research in all three areas reports favorable results with acceptable side effects. Psychosurgical interventions seem to exert their effect by a common final common pathway mediated via the pregenual ACC.

Conclusion

Successful neuromodulation increases the capacity to choose from different options for the affected individual, as well as inhibiting unwanted options, therefore increasing free will and free won’t.

 

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I think they put it very simple, and very well.

What we see here is not the outcome of a small set of smart and smooth investigations. Not at all. It is the preliminary result of long years of trial and error, great effort, serendipity, courage, and foremost: the willingness and cooperation, as well as the sheer guts of patients with OCD, who dared to go hand in hand with researchers into unknown areas of our brains.

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I will look if I can find a nice picture of the areas involved, labeled as such in a photo or drawing of our brain.

A Slight Return


Hello dear, and faithful readers of this blog –

it’s a lovely day.

Seeing that my stories and essays still attract numerous people every day is quite an experience – it makes me happy.

My weblog has been dormant for a long time, in fact for so long that it seems not very useful to go back in time and feel sad about it – better to go ahead.

I will, however, post about all the things that I did and felt in this interim. In many occasions they are directly linked to OCD, so if told in their context, they may be helpful in getting a clearer view on OCD, one’s inner life, and the relationships of this private life with all of outside reality, most of all: other people.

For now, I must log off, and that has to do with the fact that I started a second site; that deals with mental problems (stress, anxeity, depression, ADHD, autism, eating disorders, and others afflictions) within ‘our’ political and economic realities.

My ‘our’ refers to people all over the world, for human communities have become homogenized globally, mainly in economic terms.

I will be back, I hope you folks will be back too!

Best from Frank in Holland.