Wednesday, September 21, 2016

High-Stakes Biology and the Catch 22 of 'Mental Illness'

Years ago as a doctoral candidate for a mental health degree, I asked my then-psychiatrist what I
thought was an important question. In class, we’d been studying the biology of trauma and learning about the fight-flight-freeze response.

I had writer's block at the time and was tremendously anxious about the papers that were required for my coursework.  I noticed that every time I had a paper due, I got ‘manic’.  I became obsessed with how I was going to get it done.  I found myself hyper-focused and way way way geared up in both my mind and my body.  I was restless, jittery, constantly on the move.  I couldn’t stop thinking or worrying about it.  I had tremendous difficulty getting started at all.  But once started, it was like a switch flipped and I'd work on the paper nonstop until it was done.  Often I barely ate or slept for days.  I got irritated if anything interrupted me.

In the early stages, when the task seemed insurmountable, I was practically despondent about the prospect of finishing.  But later on, as the ideas started flowing, my thinking would get more grandiose. I’d start feeling like I was making new discoveries and saying something really important. Heck, who knew, potentially these connections might even change the world.  

Another thing I noticed was even more striking.  The moment I finished the paper - the moment it was safely off to school and handed in, the entire 'geared up' phenomenon went away.  The huge intensity and associated 'symptoms' that had been so real while the paper was in progress either evaporated into thin air or progressively continued to fade.

Something in me relaxed.  The next thing I knew, I was sleeping, then eating.  I was able to slow down, get comfortable, take a look around me and appreciate what was happening in the world.  Not long after, I’d re-read my paper and realize that it wasn’t nearly as brilliant as I thought.  Just another paper by another college student for another class. Maybe a few good insights.  But, hey, a lot of people have said it brighter and better.

To me this seemed like a perfect example of the fight-flight-freeze survival response.  You face a high-stakes situation.  Your body gears up.  You activate to meet the challenge.  You stay activated and intensely focused on the challenge at hand until the threat goes away.  Once the challenge is overcome and you feel safe again, however, the fight-flight-freeze system turns off.  The threat has passed, the system is no longer needed, so you can go back to the normal routine and take life as it comes.

My psychiatrist didn’t buy it.  He said something like:

Well, the fight-flight-freeze system is involved in PTSD, but you don’t have PTSD.  You are bipolar spectrum, so that system doesn’t apply to you.  Just take your meds.

I think he was wrong.  Here is why:


The Activation Has to Come from Somewhere


Even if bipolar is a genetic illness, it still has to express itself in some way.  The only way for that to happen is by using the existing biological systems of the human body.  In other words, to do so-called bipolar things, my body actually has to physically create the sensations and action tendencies that cause me to gear up, get moving, keep moving, talk fast, hyper-focus on some goals to the exclusion of others, interrupt people who are trying to say something, impulsively go after things I want without thinking of the consequences, etc.  These same phenomena also make it difficult to stop moving, slow down, control my attention, relax, look around me, get perspective, hear what other people are saying, eat nutritious food, get restorative sleep and, in general pay attention to the basic needs that are essential to rational thinking, good judgement and optimal brain functioning.

This is exactly what the High Stakes (sympathetic) nervous system does. If fact, in no small part, these very responses are built into it by design.

Here is how it works:

The Human Survival Response in a Nutshell



The human survival response is nature’s answer to the challenging facts of life.  This response helps us gear up mentally and physically to meet the obstacles presented.

This response short-circuits much of our normal bodily functioning.  It produces measurable physical and mental changes. It also changes how we perceive and respond to our surroundings.

The human survival response is perfectly ‘normal’ given the threat or challenge we perceive. However, in any given situation, a particular survival response may look strange to outsiders who are not aware of the threat or challenges a given person is facing.   The appearance of strangeness to outside observers (who do not see what is happening inside us) is what gets us labelled 'mentally ill.'


How It Works: The Two Basic Nervous Systems

Human beings have two basic nervous systems:

1. All-Is-Well (parasympathetic nervous system)


The ‘all-is-well’ nervous system is for everyday routines. It happens naturally when we feel safe, secure and like there are no big deals we need to attend to.  The All-Is-Well system is ideal for things like digesting food, sleeping, relaxing, hanging out, having sex, small talk, hobbies, tinkering around...

2. ‘High-stakes’ (sympathetic nervous system/ ‘survival response’/ fight-flight-freeze).  


The high-stakes nervous system is for responding when the stakes are high.  It is designed to wake us up, get us moving, prepared us for action and spur us to take it.  Essentially, this is the ‘get your butt in gear’ reaction that takes over when anything feels like a big deal.

The high-stakes system is involved in all kinds of stuff.  This includes both threats and opportunities. The critical factor is that – from your point of view - the stakes are high.

Sometimes, the high stakes are obvious.  You’re homeless, hungry, broke, sick, cold, miserable, getting beaten up, raped or robbed. At other times, the feeling of 'high stakes' is a really personal matter.  It depends on what you have lived or come to know.  Thus, one person's 'high stakes' might not even register on another's radar.

Gearing Up for Survival


The Three Basic Responses


When the stakes seem high, human beings are wired to respond in one of three ways:  fight, flight or freeze.

1. Fight. 


The 'fight' response goes after threats and opportunities.  It takes them on or brings them down.  The hope here is to act in ways that make the world safe and get us what we want.

2. Flight


The 'flight' response avoids threats and opportunities.  It gets away (runs, hides) as fast as possible.  The hope here is that someone else will fix things or the problem will take care of itself.

3. Freeze


The 'freeze' response hides in plain sight.  It shows no apparent reaction (de facto disappears), giving others nothing to notice or chase.  Sometimes, the hope is to not be noticed by others.  Other times, the hope, at least for me, is to not notice what is going on inside me or around me.  It’s all too overwhelming and I simply don’t know how to handle it.


Escaping Predators, Catching Prey


Biologically, the High Stakes response was designed to help us do 2 things:

(1) to escape predators so that we don’t become food; and

(2) to be effective predators so that we have food to eat.


You hear a lot of about the first thing one (escaping 'predators'). It’s really important in understanding anxiety and ‘depression.’ For me, anxiety is what gears me up to try to address something I think is going to go bad. (Metaphorically, I feel like prey trying to escape a predator). The High Stakes system helps me do this.

The difference for me with 'depression' is that I've usually given up hope. The situation just seems too big and overwhelming. I still feel lousy because the High Stakes response is still there telling me that All Is NOT Well. But, in effect, a part of me has decided to stop wasting my energy trying to fix it.

The second function of High-Stakes responding is less well-known. This is where I go after something I want. (Metaphorically, I become the hunter hot in pursuit of a tasty meal). The High-Stakes system helps me mobilize the resources I need to do this. The intense activation of the High-Stakes system - including it's single minded focus and the 'thrill of the chase' - for me, explains a lot of what gets diagnosed as 'bipolar', as well as a lot of aggressive behavior and so-called ‘addiction.’

What Bodies Do When the Stakes Are HIgh


As a matter of evolution, the High-Stakes system thinks we are facing a physical threat.  It rapidly deploys our energy and resources to the physical systems that can respond to this.  These include:


  1. Blood and energy gets shifted from the brain to the muscles, heart and lungs.  
  2. Digestion shut downs in order to conserve energy.
  3. Focus narrows to the source of the threat or opportunity.
  4. Attention stays riveted there until the situation resolves.


How this Explains So-Called ‘Mental Illness’


1.  Under-resourced brains


In High-Stakes situations, our brains don’t have much to work with.  Our bodily resources are being directed away from the brain to the physical response systems.

  • This explains why so many of us go mentally blank, miss things, can only focus on a few narrow things, can’t take in new information, and have trouble with remembering what happened. 
  • The lack of mental resources also explains so-called poor judgment and impulsivity.  Our focus is narrowed due to the threat, so it’s hard to see the big picture.  Also, our brains don’t have what they need for higher order thinking. 
  • The general dearth of mental resources may also explain why many of us experience altered perceptions.  Again our brains don’t have that much to work with – so it’s hard to accurately read the information that come in from outside.


2. Activated bodies


The High Stakes system explains why we feel so jittery and activated.  Under the influence of High-Stakes, our muscles, heart and lungs are getting boatloads of input.  As a result, we breath fast (hyperventilate, get short of breath) and our hearts pound.  We feel sped up and tense inside.  Even if, objectively, we are doing very little, these parts of our body are literally being pumped up and primed for action.  Seen in this context, it is hardly surprising that some of us find it difficult to hold ourselves back, to manage our 'triggers' or to keep from ourselves from reacting in really big ways (“over-reacting”) under the influence of the High-Stakes system.


3.  Systems maintenance is out of service


The purpose of the high-stakes system is to maintain high alert until the situation resolves. This ensures that we won’t let in a dangerous threat or miss an important opportunity. To accomplish this, the High-Stakes system intentionally limits the resources allowed for restorative processes like sleep and digestion. A lot of times this means we barely eat or sleep at all under the influence of High-Stakes. The situation just feels, well…, too high-stakes.

On the other hand, sometimes we can’t seem to get enough food or sleep when the stakes are high. We eat tons of food and never feel nourished. Or, we sleep all the time and never feel rested. What is going on here?

Well, remember what happens in High Stakes...? All the energy and resources that normally would be going to the brain are getting redirected to physical response systems. As a result, our brains are not getting the benefit of the rest or nourishment that we do take in. So, from our brain’s perspective, the food or sleep we are getting is never enough.

A lot of modern mental health professionals are take appetite and sleep as core indicators of 'mental illness.' I suspect a lot of us are just experiencing 'High-Stakes.' The High-Stakes system explains why we might not eat or sleep much. It also explains why we might not feel very nourished or rested even if we eat a lot or sleep a lot


4. Why it Keeps Getting Worse



High-Stakes activation explains, in part, why our 'mental illness' is considered 'progressive' and a lot of us seem to get worse and worse over time.  (Another likely reason is actual harm from conventional treatment.  This has been talked about in other blogs at Peerly Human). Getting stuck in a High-Stakes response takes a tremendous toll on human minds and bodies. We don't sleep or process nutrition effectively so our brains are unable to perform routine maintenance or make needed repairs. Our muscles are tense all the time and therefore burning needed resources (oxygen, nutrients) that should be going to our brains.

Imagine your car needing an oil change. Now imagine continuing to drive it like that for weeks, months or years. Imagine driving your car with little or no oil for a life time - as is the case with profound kind of trauma that some of us have had. You know if you've had that kind of trauma because you've never, ever really felt safe. This is your brain in the High-Stakes system.

What is more, just like your car, the general rule is this: The longer the needs go unmet or the more intensely they are neglected, the more extreme are the issues that will arise and the harder it will be to fix them.

There is nothing inherently defective about our brains of bodies. We've just faced a lot of challenges, and we haven't had what we needed in order to repair.

This potentially explains a lot of other symptoms of so-called ‘mental illness’ – including so-called 'psychosis', 'delusions', 'perceptual disturbance' and 'irrational thinking'. The fact of the matter is that, in High Stakes circumstances, human brains don’t get what they need to reliably function. They don’t get the energy or resources needed to pay attention to the ‘big picture’ environment. They don’t get what they need to effectively process information.

The longer and longer this goes on, the worse and worse it gets. This explains why a lot of us have broken down progressively under the impact of a stressful life.

It explains why many of us:


  • Feel exhausted, depleted and unmotivated
  • Have trouble with memory and keeping track of things
  • Are concerned we are missing something and not thinking well
  • Have trouble making decisions or setting priorities
  • Experience ourselves seeing/ hearing things that others don’t seem to 
  • Feel totally out of touch with the outside world (our brains can barely pay attention to the inside one)
  • Experience the world as playing tricks on us or out to get us (something sure is!)


This also explains a lot of the so-called social and employment effects of ‘mental illness.’ A lot of us don’t feel capable of going out or navigating the world in this frame of mind. Applying for work or trying to make friends when it's gotten this bad is a recipe for disaster. All too often we end up being judged or rejected as a result of the difficulties we experience under the influence of prolonged High-Stakes activation.

5.  The Incredible Diversity of High-Stakes responses


We are adaptive beings. The purpose of High-Stakes is to maximize that.  It wants us to live as long as possible and as well as possible, given our options.  As a result, even though evolution started us off with mostly physical responses, human beings actually fight, flight and freeze in countless ways. Here are just a few examples:

Fight.  


Maybe we’re not so good at fighting physically, but we’re really smart. So we fight intellectually- we argue and argue until we get the last word in.  Or we fight emotionally or verbally by getting angry, resentful or yelling.  Socially, we might envy others, compete with others, or try to 'win' friends.  Or maybe we fight spiritually by becoming spiritual 'high achievers' or prayer warriors.

Flight. 


Maybe literally running away is not an option because we’re not very fast on our feet.  No worries, we can run emotionally or with our imagination.  We can mentally change the subject or the picture in our mind.  We can also run socially, for example, by backing down or apologizing profusely.  Or maybe we run from awareness or feelings, using work, politics, tv, sex, video games, the internet, drugs or self-injury as distractions.

Freeze.  


Even with freeze, there are a variety of options.  We might actually be driving a car, but so lost in thought that we are not even aware of the road. In a school or at a party, we might keep talking, but go numb inside.


In other words, we don’t just fight-flight-freeze physically, but across many life dimensions. This wide variability of high stakes responses is a tremendous asset to our species.  It ensures that people will respond in numerous rich and creative ways.  When an entire community is facing a threat, this promotes resilience and survival overall. If we all responded the same way to danger or opportunity, a single threat (predator, disease, disaster) could wipe us out. We need the extremes that people tend to under stress to safeguard group survival.

On the other hand, when the stakes are seemingly individual, the virtue of diversity can get obscured. Since only one person is reacting, this can look rather odd to everyone else.  As we mentioned above, this has led to a lot of us getting labeled 'mentally ill' when, really, we were just experiencing High-Stakes responses.

6. Turning the High-Stakes System Off


The beautiful thing about the High-Stakes response is that there is a simple effective way to turn it off.  High stakes is turned on when things feel insecure.  (We're either feeling threatened or we're afraid we'll lose an important opportunity.)

So, the way to turn it off is to make things feel more secure.  Once the high-stakes system is satisfied that 'all-is-well', it shuts down.  There's no more need for the intense activation.  So High-Stakes lets go of the reigns.  The moment that happens, routine functioning begins to resume and healing and restoration can begin.

In other words, the key to addressing High-Stakes responses, is to figure out what is driving the system: What turned High Stakes on? What is the underlying need?

Then, find a way to make whatever it feel more safe, secure - or at least more tolerable or manageable - in the moment.

It's that simple.

The implications of this for mental well-being are astounding.  It means that if we want to maximize mental health and well-being, we don't need to start with all the complicated medical or psychological theories of human development.   Those things might be helpful or enriching at some point.  But, to get started, this is the core of it:

We need to listen to each other and start to address our real life concerns. 

As the identified concerns are addressed or mitigated, the High-Stakes system will turn itself off. This, in turn, will result in more and more resources being available for healing.  Such resources are needed to support recovery from the high mental and physical toll of prolonged High-Stakes activation.

Equally important, we need to seriously reconsider conventional treatments - like  drugs and shock - that get in the way of this process.  Interventions like drugs and shock actually reduce a lot of our capacity to stay clear-headed and figure out what is going on with us.  All too often, such medical interventions wipe out the very clues to the understanding the real sources of distress that are driving the High-Stakes system.

For many of us, drugs and shock were like having our hand on a burning stove.  When we complained about the pain and the smell of flesh, our doctors gave us pills so that we could no longer perceive the warnings or feel the damage.  Such medical approaches did nothing to address the reality of our lives:  In actually, we were living in circumstances that are dangerous to human health and well being.

7. Why “Mental Illness’ is a Vicious Cycle and a Catch-22.


Think about it. The High-Stakes response is activated when, in real life, the stakes are high. That means those of us who grow up with a lot of really difficult life circumstances will be in “High-Stakes” responses a lot of the time. Unfortunately, there is a high degree of overlap between so-called mental disorders and the effects of the High-Stakes system. Accordingly, we should predict a lot of ‘mental illness’ being diagnosed among people who have had a rough time of it.

That is in fact exactly what is happening.  As it turns out, a whopping ninety (90!) percent of us in the public mental health system are 'trauma survivors.'  We have grown up without reliable access to basic human needs.  Things like:


  • nutritious food, habitable shelter
  • safety of person and property
  • dignity, respect and fair treatment
  • meaningful participation and voice
  • support for our families to stay together and make a living
  • opportunities to develop ourselves across major life domains
  • freedom to make sense of experience in our own way

These things are not optional.  They are essentials of life that every human being needs in order to live and be well.  This is not just an individual issue.  Far too many of our families are living withouth secure access to these things either.  Yet, without such access, neither individuals nor the human family as a whole, can be well.

Moreover, once in the system, there is virtually no way out.  In behavioral health populations, “High Stakes” is the norm.  We are broke, unemployed, barely housed, victims of crime, targets of discrimination.  When we speak up about this, it is treated as a symptom of our ‘illness.’

The stakes for us are literally 'High' all the time.  This is the real biology behind what currently is getting diagnosed and treated as ‘mental illness.’  The source is not broken brains or individual genetics.  Our brains and bodies were working fine.  They did their job and informed us of thevery real, very threatening life circumstances we were facing.

There is nothing abnormal about this. To the contrary, our collective distress is a call to action. Our biology is telling the truth about the desperate circumstances of our lives.

So what will it be: Will we continue to let others define our experience? Will we continue to ignore our own truth - to submit, comply, back down (essentially, to flight and freeze) - in the face of powerful social others?

Or will we, together, claim the truth of our experience, recognize ourselves as valid, and stand up (– fight –) for the dignity, respect and social justice we deserve…?

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