mood swings can destroy gray matter in bipolar disorder

July 21, 2007

The more mood swings, the more deterioration.  They only looked at people with 1 to 6 swings over four years.  The news story doesn’t say whether they looked at frequency of mood episodes versus total number of days, so we don’t know whether someone with long, infrequent episodes would have the same damage as short, frequent ones (something of concern to people who rapid cycle). (I unfortunately don’t have access to this article.)

They did not find a decline in intelligence, although the article talks about declines that weren’t significant.  That just means the scientists want to say they found a decline, so they’re putting it forth even though the rules of science designed to keep that kind of thing under control say it isn’t sufficiently certain for people to count it as a finding.  (We have this kind of rule for a variety of good reasons, but mostly to keep people from overstating their findings.)

The lead author of the study says medication didn’t appear to be making the deterioration worse. He doesn’t say that helps, although both he and the writer of the news article hope that it does (as do I, and I hope someone follows up and tells us whether that’s the case).

What you can actually conclude from the news article is that people with infrequent episodes in bipolar disorder show gray matter loss in proportion to the number of episodes they have, and that we don’t have any evidence showing that this is harmful. My money is on yes, we will find it’s harmful, and maybe we’ll find that medication averts it (instead of, for example, finding that it’s related to the tendency to have more frequent episodes, rather than to the actual episodes).  But we don’t know that right now.  The news article (and possibly the lead researcher) are constructing a logical story around how things work, and telling that; and it makes sense.  But real life is often less intuitive than our stories.

On a related topic, I hope to post about kindling tomorrow.

disordered brains are not normal brains minus adequate practice

July 12, 2007

Study Shows People Can Suppress Bad Thoughts

People can get better at suppressing negative memories over time, and the prefrontal cortex (a part of the brain known to be involved in executive control, i.e. planning, carrying out plans, and inhibiting impulses) is involved. They would like this to point toward directions for therapy in post-traumatic stress disorder.

The article is somewhat misleading (although I’m fairly certain the research is much better):

Research by neuroscientists shows that, with practice, people can suppress emotionally disturbing memories. Investigators say the finding could lead to therapies for individuals suffering from post-traumatic stress disorder.

It’s not hard to read into this the notion that what works for normal people will work for disordered people if they just work at it. I.e., people with post-traumatic stress disorder just need to work at suppressing them harder; people with bipolar disorder just need to cope with their emotions better; people with AD/HD just need to concentrate harder; people with depression just need to take a shower and get out of the house for a bit, etc. But the problem isn’t that people with disorders are failing to employ normal coping techniques – it’s that those normal coping techniques do not fix the disorder, because the dysregulation you see in a functioning system – brief unpleasant memories from seeing a photograph – is not the same kind of dysregulation as in a disordered system, such as vivid, disabling reliving of memories of a situation that occurred personally to you in which you thought you would die.

The article isn’t saying that people with PTSD will be fixed by practicing suppression harder, but it’s not doing a good job of explaining the relationship between research on normal self-regulation and treatments for disorders. Humans have have very intuitive, unquestioned frameworks for thinking about other (normal) people, and in the absence of being told that those frameworks don’t apply (and having that pounded into our heads repeatedly until it overrides the intuitions), we frequently jump to the conclusion that everyone is a normal person so of course what works for everyone else will work for the person at hand, and if it doesn’t, then they’re probably just not doing it right. (And should be blamed, etc.)