Coming out of The Dark – How I Recovered My Cognitive Abilities

I have mentioned before that during my psychotic break my cognitive functions were severely restricted. My concentration was below zero, and so was my ability to make even the simplest decisions. I was unable to put a list of items together that I wanted to have in the clinic with me, and it took me ridiculously long to pick an outfit for the day. Partly, this was due to my perceiving that even tiniest decisions could change the course of events obeying to a sort of butterfly-effect mechanism. The complexity of this idea was literally mind smashing. But to an even greater extent, I just could not hold on to an idea and follow it through. A thick broth of thoughts and notions was bubbling in my mind, and there was no way for me to put them in order or assign adequate degrees of relevance to them.

Being prescribed the anti-psychotic Olanzapine (Zyprexa) did calm the storm a bit, but it did not help my cognition. I still could not put two and two together. Even trying to complete an easy Sudoku was a major challenge. In addition, the Olanzapine seemed to dull my will and thereby actually accentuated my lack of direction. During my last hospitalization, the Olanzapine was substituted with Quetiapine (Seroquel), and I also took part in a structured program of coordinated therapies and received more thorough medical supervision for the first time. The therapeutic menu included arts therapy, social interaction practice, stimulation of sensory perceptions, psycho-educative sessions (basic information about mental health and illnesses), sports and outdoor activities and one-on-one conversations with the doctors. In your spare time, patients could do pretty much what they wanted: have a walk, go downtown, visit friends or family, sit in the park, organize table tennis or volleyball matches with other patients, etc. I soon became “famous” for devouring almost any sort of written text. With swarms of anxiety-ridden thoughts still frantically revolving around my mind, it was almost impossible to take anything in, but I knew I had to do it somehow in order to find even a little bit of peace and focus. I tried books at first, but I noticed I was not ready to follow the development of complex discourses, so I switched to reading articles in magazines. I read article after article, even if the topic of some was really outside my areas of interest, until I had read the whole magazine. Whenever I was done with one issue, I would go buy the next or lend new ones out from fellow patients. Gradually, I was able to digest longer articles, and eventually I returned to books, reading anywhere between one and three in a week’s time. Reading did not rid me of my anxiety and my racing thoughts, but it forced my mind to engage in the present moment and function, at least to a certain extent, in spite of the chaos.

I wasn’t the only one who instinctively turned to cognitive stimulation. Just as you would find me reading anything anytime and anywhere, a group of ladies used to crochet together. They tried to convince me of joining them, but I preferred to stick to reading. Although they were using a different activity, their need for focus also stemmed from an impulse to overcome anxiety and recover some degree of functionality, even if on a small scale.

As of today, my concentration and capacity for learning are healthy, possibly even improved in comparison to before my psychotic break, given that I have found myself embarking on explorations of my possibilities I hadn’t been able to open myself up to in earlier years. Maybe this is a sign of better cognition, but it may also be that after escaping a terrifying episode of zombie-like existence I have become more intrepid and willing to seize life. This is really not for me to determine, and I also feel my cognitive development has not yet come to completion. Many new – and positive – things and people have come into my life, prompting me to unlearn past thinking and emotional patterns to learn new, more constructive ones.

Although all of the aforesaid is based on my subjective perception, I would like to back it up with a few lines on recent trends in neuroscience. The regenerative powers of the human brain are being studied intensely, and the traditional idea of mental illness and brain damage as being irreversible conditions seems to become gradually dismantled in the process. In this context, it turns out to be untrue humans lose their ability to learn as they grow older, or that senile dementia is an unavoidable consequence of aging. What seems to be the case, instead, is that the brain can be exercised and strengthened through persistent stimulation just like a muscle can, throughout all stages of life. Cognitive training helps the brain stay fit and even regain lost functions. The term coined to denominate this property is “neuroplasticity”. I lack the scientific knowledge to competently explain neuroplasticity in depth, but I would like to recommend a book on it I believe everyone should have read, no matter from which background they come. The title of the book is The Brain That Changes Itself, written by Norman Doidge. It describes cognitive processes and neuroplasticity in terms understandable for the layman, illustrating its point through the narration of actual cases where a radical regeneration and reconfiguration of the brain appears to have taken place in an affected individual thanks to cognitive stimulation. The Brain That Changes Itself inspires without being inspirational in the sense of trying to lift anyone’s spirit by rhetoric means or philosophic meditations. The hope and encouragement inherent in this text derive from the portrayal of real people and real occurrences. Not in all cases described in the book all neurological functions are regained, but the overall improvement observed in the treated individuals’ quality of life is undeniable.

Personally, I acquired and read The Brain That Changes Itself before my psychotic break, and I am glad I did. More than one psychiatrist and more than one website with supposed information on mental illness transmitted the idea that mental pathologies equal a life sentence in some existential limbos – that the affected face perpetual residence in a state of forced stillness, not really participating in life, yet not biologically dead. Now, in retrospect, I can see how wrong they were. Here I am, living a happy and active life. But back then I had no idea if there was any hope for me or not. I certainly wanted there to be a way out, yet indications that there would actually be one were scarce. The Brain That Changes Itself, I believe, has the potential to be a source of valuable information and invaluable hope for someone in crisis.

Looking back at the insanely lucky and very unlikely concatenation of helpful people and circumstances that lead me back into life, I have to believe some benevolent power has laid its protective hand on my shoulder to lead me out of the darkness. Subconsciously, I also must have vehemently refused to give up, even though my conscious mind was paralyzed with terror. Now I recognize that every chunk of driftwood floating by can carry you the missing extra mile. The Brain That Changes Itself could be such a piece of driftwood for you or for someone you know. I really hope you read it, even if you and all your loved ones are doing fine right now. One day, they may need strength to overcome a crisis, or maybe you just wish to explore your potential and tread on a new path. This book is an eye-opener as to what your mind is capable of doing (and no, I don’t receive any commission for recommending it).

Websites

Norman Doidge’s official website, where you can get informed on his book The Brain That Changes Itself. http://www.normandoidge.com/normandoidge.com/MAIN.html

Here are links to the stores selling it: http://www.normandoidge.com/normandoidge.com/LOCATING_THE_BOOK.html

 

Audiovisuals

An impressive and inspiring testimony by Barbara Arrowsmith-Young, a psychologist who overcame a severe congenital learning disability through cognitive stimulation techniques: http://youtu.be/o0td5aw1KXA

 

Some words on: Inspiration and Creativity

Mental illness is a dark, lonely and scary state. It brings with it a blackout of basic survival skills and thereby exposes the individual to the whim of circumstances and people surrounding them. Uncaring and abusive treatment facilities, health care professionals and relatives can turn such an existence into hell on earth. But even if you are in the best of hands, your recovery depends on one indispensable ingredient: you. It is understood that you may not be able to take care of yourself. Still, you can attempt to stimulate your mind and emotions.

In fact, many clinics offer arts therapy, music therapy, sports activities, animal therapy, walks, and other stimulating experiences. Those are not meant to simply kill time and break the monotony of another day in a dull hospital setting, although these are certainly important aspects. In the first place, they are aimed at “defrosting” you. Mental illness is, so to speak, a general paralysis of the spirit. Thoughts and feelings, which help a healthy person to evaluate situations, take action and define their direction in life, fail to develop that traction in someone going through a mental crisis. Instead, they form something like a ball of yarn, if you will, with no visible loose end to pull at. In more rational terms, the confusion and erratic choices associated with mental illness derive from the impossibility of prioritizing thoughts and feelings functionally. The result is a disabling, smothering information overload. Therapies providing sensory stimuli intend to focus the patient’s mind and reactivate its capacity for healthy judgment, in the hopes of making the individual find the end of the metaphorical thread again.

Particularly artistic therapies challenge the patient to reawaken their power of judgment and decision. Creativity relies on the processing of given resources – materials, techniques and motifs – and their elaboration into a product that represents the uniqueness of its author’s interpretation. In a nutshell, creativity is the application of preexisting, generic ideas to a specific situation, in order to produce a new circumstance or object, the creative person’s individual experiences and capacities of judgment being the catalyst for this process. In plain English: when we are baking an apple cake, recipe in hand, and notice all our apples have gone bad, we will evoke the generic idea of “fruit” and look around our kitchen to see if we have something that could work in a similar way to apples. If we are lucky, we’ll find pears or plums, and use those. That is creativity. As the culinary example shows, creativity occurs not just within the fine arts. It is the motor of our survival and evolution both as a species and as individual beings. All our life decisions are necessarily creative, because we constantly attempt to adapt our circumstances to our individual needs and wishes. No matter how unadventurous and conventional a person is, they will always need to take decisions and create situations nobody else has ever taken before in the exact same way, simply because nobody else IS them.

Interestingly, numerous theories on the causes of mental illness sustain it can be triggered by dysfunctional or abusive relationships – may they occur in childhood or in adult life. If we try to define “dysfunction” or “abuse”, we will likely conclude that the destructive manipulation of the individual’s capacity to make healthy choices is an important part of these concepts. In other words, dysfunctional and abusive relationships affect or stunt the victim’s creativity, thus injuring their survival skills.

Herein lies the relevance of therapeutic approaches that involve the stimulation of creativity. Painting or making mosaics is more than a nice pastime producing pretty results. It stimulates vital cognitive functions and can contribute significantly to a patient’s return to a functioning and satisfying life.

Another aspect of creative therapy that should not be underestimated is the fostering of self-confidence. Not just mental illness, but also the stigma associated to being in psychiatric treatment can shatter your self-image. I have come across more than one person who suffered a painful transition from successful professional to hospitalized nutcase. Among them was a woman who used to be a psychotherapist and, after collapsing and having been diagnosed with schizoaffective disorder, will likely spend many years in supervised living facilities or in and out of mental hospitals. What I wish to say is that people who were socially “normal” can end up with the label “crazy” stuck on their foreheads. The stigma of it alone, even when it is the result of a misdiagnosis, is powerful enough to down individuals who so far had been high-flyers. While creative therapy will not magically reestablish anyone in their previous position, after a catastrophic collapse it can be one of the few things left showing you that you are actually able to accomplish something. Every ounce of hope counts. Accumulate many of them.

Now, at the top of the present article I stated the importance of the individual’s wish to get better. Mostly, what counts is for you to just give something new a try. Some people may argue they are not the artsy type, but as I have argued above, that is also not was creative therapies are mainly about. Creativity is an indispensable life skill because it empowers you to take your life in your own hands and make the best out of past experiences. Creative therapies also help individuals lessen the weight of trauma on a deeper level than spoken or written words ever could. Fear and pain can be nameless, but it may be possible to encrypt them in color, shape, sound or movement. Also, the socially established connotations of verbal language often provoke feelings of shame and defeat, especially when it comes to describing a victimizing situation. Not so the arts. They allow even humiliating experiences to be expressed in a shrouded and abstract manner, therefore being emotionally less taxing than a verbal account. Words are powerful on a conscious level, but in order to release pressure accumulated in the subconscious, the arts can be more efficient. Any activity that helps you exercise your creativity will ultimately strengthen your self-confidence and enhance your coping skills.

Creativity is also a source of joy and social interaction, which are also pillars of mental health. Just to add another anecdote, from my last stay in a psychiatric hospital, I remember a gentleman who, if I am not mistaken, worked as a transport entrepreneur and was treated for depression. He looked anything but an artist. Yet, through arts therapy, he discovered his passion and talent for oil painting. In an amazingly short period of time, he became skillful enough to produce a series of remarkable, very expressive floral still lives, which the clinic decided to display in its corridors. Both staff and fellow patients openly admired his work and encouraged him to stick to his new found love. Frankly, I have no information on whether he ultimately recovered from his depression. The last thing I know, before I myself was discharged from the clinic, was that he had become an outpatient and gone back to living at home. I would not go as far as saying that his mental health improved due to arts therapy, but I am convinced that his motivating experience within the clinical setting must have given him a good push forward in everyday life as well.

Personally, I believe the all-encompassing benefits of creative activities are the reason why so many people engage in crafty pastimes. On the most immediate level, creating something beautiful or practical is an uplifting experience. It makes you feel productive and gives you aesthetic pleasure. But also, making something which has not existed before tells you that you are able to shape your surrounding circumstances. You may have only crocheted a doily or lined a shoe box, but spiritually it is a symbol for your power to contribute to reality and bring the things you desire into your life. It means you are capable of making choices which lead to a good result on a small scale, which in turn should encourage you to believe that, on a higher plane, you will succeed in the making of bigger decisions as well.

Arts therapy, as the term suggests, includes an element of systematic psychological support in addition to the application of creative skills. But even if you, or someone you know who is in need of help, have no access to arts therapy, taking up a creative hobby is always an option for you. Depending on the materials and the equipment some arts require, they can be more or less costly. Therefore, consider your budget before you get started. Also, if you don’t feel like committing to one specific activity right now, browse the internet for DIY blogs. They are literally everywhere, and many of them offer tutorials on smaller, varied arts and crafts projects. You can even look for tutorials on how to redecorate your home in an easy and low-cost way, or how to pep up your wardrobe with self-made accessories, if you wish for a practical rather than a purely aesthetic approach. Creativity has no limits, so take your time and enjoy the many ideas buzzing around on the www. Feel free to share your thoughts on creativity and mental health below in the comments section.

Websites:

The Art Therapy blog offers descriptions of various types of creative therapies, articles on related topics and information on educational options for people who are interested in becoming therapists. First and foremost, this blog is informative and inspiring. It is not a support website for those in crisis or otherwise in need of help. Still, remember that knowledge is always empowering. So, no matter on which side of the table you sit, it is a useful website to visit. The Art Therapy blog also runs a Facebook page. http://www.arttherapyblog.com/

Some Words on: Nightmares and Restless Sleep on Psychiatric Medication

As for all states of distress, APA also has a fancy name for nightmares: nightmare disorder or dream anxiety disorder. It is known that everybody has nightmares from time to time. They are believed to be caused by our mind trying to process conflicts, fears and stressful life events. In other words: nightmares are a healthy and necessary phenomenon that helps us deal with our issues and move on. Yet, when unsettling dreams become so frequent and so intense that they disrupt our sleep patterns and affect our mental and emotional balance during the day, they no longer help us to cope, but they add to our problems. Not only do nightmares leave an ugly aftertaste and cloud our mood. Deprivation of restful sleep can exacerbate already existent psychoses. Sleep, and in particular restful sleep, are a vital component of mental health.

Although it is meant to improve symptoms of mental illness, psychoactive medication commonly causes sleep disturbances, including nightmare disorder. In general, psychotropic drugs will affect your sleep cycles in one or the other way, for whatever acts upon your mental functions during your waking hours, logically also does so when you are asleep. Both my antidepressant (Sertraline) and my anti-psychotic (Quetiapine) list nightmares as a frequent side-effect, along with other sleep abnormalities, such as insomnia or excessive sleepiness. So far, I have gotten away with only the nightmares.

Ever since I got on psychoactive medication, I have had hardly one night without unsettling dreams, and this is not an exaggeration. The topics are nauseatingly repetitive. Being far from home at a place I perceive as threatening and fearing not to be able to leave, is a classic. Typically, in my dream I am anxious to leave that place before the onset of winter with its cold and darkness. A variation of this scenario is my having to travel to a threatening place. Luckily, my dream-Self has learned by now to just say “I am not going. I have a right to be where I feel safe and happy.”. Often, these dreams are coupled with scenes of confrontations between me and relatives whom I am also in conflict with in real life. Typically, they would attempt to tear down my self-confidence or force me into life choices I feel strongly opposed to. Before I moved in with my partner four months ago, I also used to dream I was living in a house that was crumbling. Cracks would appear in the walls, or big chunks of plaster would fall off them. In those dreams, it was understood that the structure could collapse and crush me any minute. I believe I can see clearly which fears all these nightmares spring from. My interpretation is that, after having seen my existence and my personal autonomy disintegrate during my psychotic break, my psyche is still fearful of it to possibly happen again. Over the last years, I have returned to a good life. In fact, I would say my life is now happier than it has ever been before. To me, it seems only logical that my not-so-subconscious is afraid of losing it all again.

Plane crashes are another frequent dream. I am actually afraid of flying, so the source of this scenario is also quite obvious. The origin of other nightmares is less evident. An interesting one is the vision of a cataclysmic volcanic eruption or simply a nearby active volcano that scares the crap out of me, but apparently out of nobody else. In my dreams, I regularly find myself in groups of enthusiastic people who absolutely want to climb up to the crater, while I am desperately trying to convince them not to. In reality, I do live in the proximity of three volcanoes, but I have never witnessed an eruption. I realize such an event is a possibility, but it is not something that occupies my conscious mind. So far in my life, I have scaled five volcanoes and slept at the foot of another three without being overly concerned about it.

A few posts ago, I had already mentioned that I am beginning to have less intense nightmares than has been usual for me over the last four years. And finally, last week, I got a break from my nightly horror-marathon. I actually dreamt something pleasant! I will abstain from going into details, but the sweet afterglow of that dream stayed with me throughout the day. It has been a while since this last happened to me. I am quite delighted! Placing the dream in the context of my current life situation, I have to assume a huge part of the improvement is certainly due to my moving into a new, lovely home with my partner and us both making healthy changes to our lifestyle. And although I have only just started to wean off my medications, I also hope the reduction of my medication dose to have something to do with the improved quality of my sleep. Could it be that my brain was too numbed down to process topics of conflict and therefore brought them up again and again through my dreams, similar to a broken record that can’t get past a certain content, but replays it in an endless loop? Could the dose reduction have begun to reactivate those parts of my psyche, allowing me to finally deal with and eventually overcome the unresolved issues? I cannot know for sure, but it is a hypothesis that I find logical.

Whether or not you consider weaning off your medications, you can – and should – attempt to improve the quality of your sleep. Actually, some speak of “sleep hygiene”. Taking measures of sleep hygiene is recommendable for everyone, even “healthy” individuals. The equation is simple: the more restful your sleep is, the better you feel all over – mentally and emotionally – and the better your cognitive functions are. If you are tormented by insomnia or by nightmares to a point that you perceive sleep as an unpleasant duty, try the following:

  • Establish regular sleeping habits. Try going to bed and getting up approximately at the same time every day, and allow yourself at least seven hours of rest. Even if your sleep gets interrupted during the night or you can’t fall asleep in the first place – stick to those seven hours and get out of bed at the established time. Eventually, your organism will recognize this resting period as its opportunity for distension and revitalization.
  • Create an optimal sleep environment in your bedroom. Make sure your mattress is comfortable and your pillows allow you to rest your head without straining your neck and upper back. Switch off all the lights and, if possible, do not keep any electronic devices in your bedroom. Use curtains or blinds which block street lights and the morning sun effectively. Try out if you prefer complete silence or soft noises like the gurgling of a small fountain or the regular ticking of a clock. Make sure temperatures in your bedroom are moderate. Neither excessive heat nor cold will help you sleep.
  • Avoid caffeinated beverages, stimulant medication or other energizing substances during the late afternoon and evening. Funnily, although alcohol can make you feel drowsy in the beginning, it is a major sleep disruptor because it messes with your sleep cycles. Same as for stimulating substances, take care not to have booze right before going to sleep. Personally, I know some people who actually have a cup of coffee or even espresso right before going to bed. They insist it helps them sleep. If you are one of that kind, fair enough, but probabilities are that you react to caffeine like most other mortals do – by staying wide awake. To be on the safe side, stay away from coffee and maybe have a glass of hot milk or soothing herbal infusion before going to sleep.
  • Just before going to bed, give yourself 30 minutes of time out. Spend them on a relaxing activity: meditation, reading, cuddling with your pet, chatting with your partner, watering your plants or just putting things in place around the house. Give yourself an opportunity for winding down and cleansing your mind and emotions at the end of every day. Studying for an exam or watching an action movie and then hitting the hay immediately is not a good idea. Just like a train can’t come to a dead halt, you need to gently let your mind come to rest.
  • Eat at least two hours before going to sleep. Going to bed with a full stomach is almost certain to make you toss and turn. If your schedule doesn’t allow for this, prepare a light snack rather than a full meal in the evening.
  • Exercise! Any type of workout, especially if performed several times a week, will not only help you burn off calories, but it will also improve your mood significantly. It is not necessary to do anything extreme or spectacular. Yoga and long walks are perfectly fin. Of course, if you wish to go for something more intense, feel free! Regular exercise will help you find a more restful sleep and balance your mood. Just remember that, if you exercise intensely in the evening, you need to come off your adrenaline rush before going to bed, so don’t hop right from the treadmill into bed. Maybe do a short yoga routine, have a nice warm shower or engage in some activity you find soothing.
  • Follow a healthy diet. Prefer whole, fresh foods to highly processed ones. Processed foods are typically rich in all the wrong things: sugar, fat, sodium, artificial sweeteners, preservatives, colorants. At the same time, they are almost devoid of vital nutrients and contain very little dietary fiber, which you need to cleanse your intestines. Thinking you can make up for your dietary deficiencies by taking supplements is a wrong assumption. Cover as many nutritional necessities as you can through your food intake. My partner and I, for example, are going low carb and mainly eating vegetables, lean meats, soy and dairy products. We have also developed the habit of drinking vegetable smoothies every morning. They taste great, and depending on which veggies and fruits you combine you can obtain different flavors, colors and nutritional benefits. We use kale as a main ingredient, and from there we just improvise according to what we have at home: spinach, strawberries, beets, celery, raspberries, carrots, apples, lettuce, and so on. Be creative, it’s your call to design your own liquid salad!

As you can see, there is a lot you can do for your sleep quality, even if you choose to stay on psychiatric medication for now. Try any or all of the above measures before asking your prescribing doctor for tranquilizers or sleeping pills. Adding medication to your treatment plan may seem like a quick fix. Yet, it only delays your getting to the root of your problems, compromises your liver and will make it even more difficult for you to ever wean off your medications. When you’re lost in the jungle, don’t add more trees. Consider taking further medication as the very last resort, or as an emergency solution to treat acute insomnia or psychosis temporarily.

Last, but not least, make sure you have the support of those living under the same roof with you. You can make your room as dark and as quiet as you like, but if your roommate insists on having noisy reunions or listening to loud music during the evenings, you will have a hard time finding sleep. Whoever you share your space with – family members, your partner, friends or fellow patients – explain to them why and how you wish to improve your sleeping habits. You might even be able to make them join in! Everybody needs restful sleep, and certainly everyone enjoys it. Personally, I find it extremely helpful that my partner and I are on the same page in terms of looking after our health. We share the same diet, do yoga together and follow the same sleeping schedule. Doing all of these things together is also a beautiful occasion for bonding. We research and discuss new food recipes, try out different yoga routines and have a small chat before going to sleep. Incorporating healthy habits into our lifestyle has been a wonderful contribution to a harmonious relationship and a happy home.

I would love for you share your own experiences with nightmares or other sleep disturbances, and with measures you have taken to overcome them. Feel free to comment. I will read through everything you send me and publish it here on my blog. Looking forward to hearing from you!