Amygdala - its all your fault!!

I’ve been struggling with writers block for the last two weeks.  I know exactly what I want to write but every night I am dissatisfied with my results and refuse to post the tripe I’ve written. Its either boring or rambling or unfocussed or some combination thereof. I am very irritated lately. But tonight I think I can do it. I’m going to post something goddman it. This foolishness has gone on long enough.  I hope this blog turns out well.  Don't lose faith in me. 

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I think I’ve finally figured out why I’ve been having so many nightmares, and what it all boils down to.  It all comes down to my Amygdala.  Let me explain, because it took a fair bit of digging around for me to figure it out, but I am somewhat satisfied with the conclusions I’ve drawn.  I should start from the beginning which would be my most recent nightmares.

I’ve had 2 more terrifying nightmares since my last blog that I will share with you. 

In the first one, I dreamt a man (a dark unrecognizable formidable figure) was trying (very hard) to drown me.  We were in the ocean and he had his hands closed around my throat and he held me firmly underwater beneath him.  I struggled but he was incredibly strong and it soon became clear that fighting him was futile.   The only chance I had was to fake death. I stopped struggling, went limp and fought the burning in my lungs with all my might. It worked. He released his grip from my throat and I began to float away from him.  I drifted through the ocean with my life. I remember enjoying the drifting feeling very much. I drifted for the rest of that dream. 

In the second dream I was camping somewhere out in nature, I’m not sure where exactly but a jungle type of environment comes to mind. It was nighttime and I was asleep between 2 other people in a tent when the attack happened.  This time it was not a man, but a tiger.  The animal tore through the tent and very specifically attacked the 2 people sleeping on either side of me, but did not harm me in any way.  I watched frozen in horror as the tiger tore the flesh from their stomachs in long strips, exposing their bright red innards. A disemboweling, twice. There was no doubt the tiger wanted them both dead but me alive. I don’t know why.  I wish there was more of a conclusion to that dream.  I don't even know who the 2 murdered people were to me. Its all so confusing. 

While these nightmares were still incredibly vivid, filled with murderous rage and negative emotions, I’ve not been incapacitated by them the following day (like I had been previously with the dream about Kristen).  So thats a bright note in the darkness. 

I’m fed up with trying to make sense of these dreams using those online dream dictionaries.  All I can get is the logic behind a certain symbol but the specific actions and behaviors ongoing are too complex to explain.  For your amusement - a tiger is apparently a symbol of female power and sexuality.  I can understand why I might dream about a tiger, I’m a very intense and sexual woman. But no dream dictionary is able to explain why the tiger killed my tent mates by disemboweling them before my own eyes. That’s messed up.  Fuck the dream dictionaries.  I’m way beyond those.   I've accepted that. 

Answers often come when you’re not looking for them at all.  And this is what happened to me when I was settling down for the evening one night last week. I often watch PBS or A&E when I’m trying to wind down before bed. Their shows are a bit like reading a book - interesting but not edge of your seat thrilling. I used to download whole seasons of certain TV series, but I could never just watch one episode at night. I’ll have to watch the whole damn season that night, forfeiting sleep completely.  I’m like Gizmo from the Gremlins, don’t feed me after midnight or things can get out of hand... I’m digressing, please excuse me.

That night I’m settling in to watch NOVA on PBS, and its all about dreams!  
(http://www.youtube.com/watch?v=kqQrbF2RFQc&feature=related FYI you can watch this NOVA Dream episode on youtube over 6 clips)
I’m not sure I believe in coincidences, I think most things are meant to happen, call it fate if you want.  Whatever. But this is just want I needed.  A credible and scientific approach to dreaming.  The show discussed many different aspects of dreams (did you know that our pet cats and dogs dream too? - very cool stuff) but the most important thing I took away from the show was which parts of the brain were responsible for dreaming: the hippocampus and amygdala.  In a nutshell, the hippocampus is responsible for retrieving events that we experienced while awake and incorporates them into our dreams.  The amygdala is responsible for dealing with our emotions, both awake and asleep.  Our brain places significant emphasis on the emotional aspect of our dreams. 

When the narrator said the word ‘amygdala’ I felt like he had just sucker punched me in the guts, knocking the wind right out of me. I literally dropped my tube of lip-balm I was applying to my lips and my jaw nearly fell to the floor after it. I’m not joking. (I still need to find that lip-balm under the futon now that I think of it.).  The realization that the amygdala is responsible for emotional dreaming was my missing link.  Most normal people have probably never heard of this abstract part of the brain, but I’ve learned about it because people diagnosed with bipolar disorder have a messed up amygdala. It may actually hold the key to the disease. So naturally I was all ears when I heard it controlled dreams too. 

I’m going to try to keep the terminology simple here but there are a few things I need to explain in order to link the amygdala with bipolar disorder, emotions and nightmares, so stay with me. 

Early brain researchers had a couple nicknames for the amygdala and I think its fitting to share them with you - the brains seat of emotion, as well as, the brains seat of fear. Needless to explain much further, its the part of the brain that controls our emotional responses and our reaction to fear.  An excellent example of how important this really is, is exemplified in the Fight or Flight Response.  When humans experience a dangerous stressor its your amygdala that decides if you stay and fight or if you run away.  Inside your amygdala the neurotransmitters that deal with stress (e.g. norepinephrine, ephedrine - sound familiar??) are released and used in your body. Basically, it gets your adrenaline pumping. 

This little almond shaped part of our brain (FYI amygdale is greek for almond) does a lot of work it seems - it’s responsible for dealing with emotion, fear, stress, dreams and so forth.  So its logical to assume that if the amygdala is damaged in someway so too would be that persons reaction to emotion, fear, stress, dreams.   

Well this is most likely what happens in people with bipolar disorder. Doctors have actually scanned the brains of those with BD and observed amygdalas that are for some reason misshapen, enlarged and/or overactive. Not the nice little almonds they should be.  There is no explanation for this. Even if its cause or effect.

You may or may not remember in one of my blogs back in June I touched on the 5 neurotransmitters that play a significant role in bipolar disorder (dopamine, serotonin, GABA, ephedrine and norepinephrine).  What I didn’t discuss back then was how they were controlled by the amygdala. It seemed like too much info at the time. But now its very important to acknowledge. 

This blog isn’t meant to be all about science, but a little bit of science is necessary here to explain all this craziness. 

Yes, my madness is explainable.  There is a real physical and chemical problem in my brain that causes me to think and behave this way.  

ooohhhhhh.....if I knew then what I know now many things would be different......

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To sum up the important points: 

• the amygdala is the part of the brain that is responsible for nightmares, as well as our reactions both emotional and stressful.  
• people diagnosed with bipolar disorder have an abnormal amygdala
• people diagnosed with bipolar disorder have abnormal responses to stress and difficulty coping with emotions; they also commonly have vivid nightmares
• Here’s the frustrating catch. Brain researchers haven’t yet proven that an abnormal amygdala actually causes bipolar disorder. All they can say for sure is that these symptoms are probably rooted in the amygdala b/c thats the kind of stuff the amygdala is responsible for. But they haven’t isolated the direct casual link. Its really difficult to experiment on the human brain.  Ethics and all.  A few brain image scans isn’t enough, its still circumstantial evidence (which we all know is not enough to convict). Of course there’s animal testing but can a rat or chimp even have bipolar disorder? How would you know when a rat is manic? A rat's not going on a shopping spree or claim to be God.  Could he? lol. Perhaps my mood disorder truly separates mankind from the rest of the animals. A cruel twist for humanity!!

I’m thinking of donating my brain to science when I die so pathologists can have a good look at my brain and my amygdala. I’ll have to find a spot somewhere on the organ donor card for that specific detail.  

Hey, donating your brain is all the rage these days.  All the hockey players who ever suffered a concussion are doing it. 

Puts a whole new spin on the saying ‘Let me pick your brain’.  

Damn, that just made me think of that dinner scene from Silence of the Lambs. 

Moving on....

   

It actually makes soooooooo much sense to me now. This seat of fear and emotion in the brain, which is also responsible for dreams/nightmares just happens to be misshapen and overactive in people with bipolar disorder. If we’re having a mood swing, and our neurotransmitters are out of whack, how does the amygdala deal with sorting out these disordered emotions?  Well messed up/scary/fearful/emotional nightmares seem like a possible way the brain might be trying to sort out these emotions and thoughts.  My nightmares might not be logical because my neurotransmitters are out of whack.  I’ve been trying to find meaning in nonsense. I need to stop acting like a 5yr old who can’t handle the scary movie they snuck into.  Time to toughen up kid.  

Even though I know that I’ll probably have these intense nightmares for the rest of my life, and there will still be times I’ll wake up gripped in terror, I don’t feel so bad about it anymore.  One of the worst things about dealing with bipolar disorder was not understanding it.  Honestly, when I was finally diagnosed I was relieved because I finally had an answer for what was going on with me.  Of course I wasn’t happy to be mentally ill, but at long last I knew what I was fighting, and thats half the battle.  This is the same feeling I have put towards these nightmares.  Understanding their cause (at least in some part) actually takes away some of their power over me.  

This reminds me of a scene from one of my favorite childhood movies - Labyrinth. When Jennifer Connolly faces David Bowie (the Goblin King) and defeats him with the words “you have no power over me”. Very fitting. 

Too bad its not quite so simple as that. 

This has been a big deal for me.  I’ve never told anyone about my monsters, these terrible nightmares until now - never family, friends or doctors. They were always internalized. The first time I ever described one was the bipolar sandman blog I wrote last month. I’m not sure why I hid them away.  Maybe I was afraid of how they would be interpreted by others - I wasn’t abused as a child or witness to a gruesome act but maybe someone would be convinced I was repressing something. I did not want to deal with that. Maybe I was afraid of a doctor telling me I needed a change in lifestyle - nightmares about sexuality, men, death caused by escorting? I’m not quitting my job over a few nightmares. Maybe the best reason is simply because I just wanted to forget about them.  

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There is one more aspect of the bipolar sandman that I feel I should discuss. Then I’m done. Finito. It may actually be useful to other people dealing with BD and actually concludes this blog with a worthy end note. Here goes.  Researchers at the Psychiatry Dept. of the University of Alberta found that those diagnosed specifically with BD can use their dreams (both frequency and content of) as a predictor for mood swings (see Beauchemin & Hays, 1995, for more details).  

The researchers found that: 

- Their BD subjects dreamed least often when depressed.  

- Had dreams that were routine/mundane/uneventful when in a neutral mood state. 

- Experienced dreams that were bizarre, improbable and often featured death or bodily injury when shifting to manic states.  

How interesting. 

I took a long winding road getting here. But the view is magnificant and well worth the effort.  Now that I have a better understanding of how the bipolar sandman is created from within my abnormal amygdala I’m not so scared of him anymore.  Maybe I can also add him as a tool in my mental health first aid kit. I now have a flare - an advance alarm possibly.  To quote Metallica one more time - its all within my hands. 

Pondering stress, cortisol and drunken sailor syndrome

I read a really interesting report linking cortisol (the chemical controlling stress in our body) and bipolar disorder (BD):  

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8267925&fulltextType=RA&fileId=S0033291711000523

In a nutshell, the article found that people who were diagnosed with BD had higher sensitivity to stress and tended to produce significantly more cortisol than people without BD.  This makes sense to me as my triggers have always been caused by intense stress. My first episode occurred when my parents divorced.  Next when I moved away for grad school and had social integration issues. And again when I eventually dropped out of grad school.  The death of my step-father, and most recently, the huge fight I had with my biological father.  I think its important to note that all 5 of these episode inducing stressors were emotional, not physical or environmental, in origin. 

If my brain has a natural genetic tendency to produce too much cortisol, then my ability to deal with stress will likely be negatively impacted, resulting in the severe mood swings I experience.  That makes sense. 

To help reduce stress in my life I have adopted a healthy lifestyle.  I exercise daily, participate in recreational sports twice a week, eat healthy foods and try to avoid personal conflicts as much as possible.  Besides certain aspects of my escort work (which I really do enjoy most of the time, e.g. orgasms are good for relieving stress), I live a really healthy lifestyle which should help me deal with stress.  Since I have difficulty taking long term medications its important for me to make a proactive and sustained effort in this area. 

There are some things about stress and its affect on me that I am still confused about though. I am a bit of an adrenaline junkie, and considering my genetic predisposition regarding cortisol and stress, I wonder if my thrill seeking habits are detrimental to my mental health.  For instance, I love competitive team sports, scuba diving with sharks, ice-climbing in winter, hiking up volcanos, so on and so forth.  Surely these activities must significantly increase my cortisol levels. 

Come to think of it, I realize that I react differently to the 2 types of stress (physical vs emotional). Physical stress I manage quite well.  For example, I discovered just how far I could push my body physically under both physical and environmental stress when I did my divemaster training. I am able to objectify, compartmentalize and break down into tasks what I need to do to handle/neutralize the physical stressor. I surprised myself with just how calm, cool and collected I am when surrounded by sharks, or when I’m searching for the valve on my air tank while holding my breath at 10m depth without the visual aid of my face mask.  I trained well, think positive and complete tasks.  I think I am good at problem solving because it is something that can be learned.  I can apply logical thinking to these kind of stressors. I have a scientific mind evident in the fact that I have a Bachelor of Science degree with Honours.  My mind craves and excels in scientific exploration, which I apply to getting through thrill seeking adventures.  I’m just like Indiana Jones or Lara Croft.  Seriously, I’ve worked on projects in Europe, Africa and SE Asia before becoming an escort. 

Emotional stress on the other hand, I simply can not handle. Let me try to explain... Normally people have a coping mechanism to manage an emotional stressor, which in turn causes the neurotransmitters in their healthy brains to re-adjust to normal levels. The bipolar brain lacks the mechanism to control the neuro-transmitted chemical hormones in the brain evoked by certain stressors. It begins to overload, short-circuit (e.g. swing into an episode) and given time could even induce a network crash (e.g. hospitalization).  

Gives a certain insight into the use of ECT (shock therapy) for mental illness doesn’t it?? I’ve never had ECT just in case you were wondering. Its not a primary treatment for BD anymore, it tends to be employed only for severe cases when all drug therapy options have been exhausted. 

Reflecting on my past personal relationships, where intense emotional stress has occurred (e.g. death of a love one, family conflict, rejection, deceit and betrayal), I typically have nasty downward spirals. Just like in the cartoons where a snowball rolls downhill growing bigger and faster the longer it goes until it crashes. 

I try to solve all stress using logic but as most men will telI you, emotions are hard to understand because they often make no sense at all - they are illogical. I’m like a cross between a Vulcan and a Klingon.  I expect my male readers will give me a little sympathy in this regard!  Maybe I should seek advice from men in this regard. How do men handle their girlfriends during PMS? What coping strategies do men employ when they are emotionally attacked? I mean besides punching them in the face. As tempting as that is it will probably just add to my list of problems. 

For the longest time I blamed these emotional meltdowns and their resulting mood swings, on being a woman and a scorpio. It was the only thing that made sense. But now I realize that its probably due to this suspected cortisol imbalance, among other neurally transmitted hormones, which cause bipolar disorder.    

Now that I think about it, I tend to react to emotional stressors like someone who is completely loaded drunk.  You know that drunken over-reactive, loud, hyper-sensitive, assumptive, crying uncontrollably type of reaction people have when arguing drunk? That’s what it reminds me of. Mess with my emotions bad enough and I turn into the proverbial drunken sailor: 

Oh what do you do with a drunken sailor, 

what do you do with a drunken sailor, 

what do you do with a drunken sailor, 

early in the morning?  

You can’t reason with someone that is drunk or high. Its futile, forget it. You just have to wait until they sober up. That’s kinda what its like dealing with someone having a bipolar episode. Manics reason like a meth head, and depressives use drunken logic. The shitty thing is that bipolars need alot of time and help to sober up.  Take an aspirin and call me in the morning? Not quite, try taking lithium and call me in a month, and keep doing it for the rest of your life.  

Whoa. Stop. See what I’m doing here? I’m trying to apply logic to explain this situation. I’ve gone off on what’s an interesting, amusing and, hopefully, sensible tangent that I’m passionate and sometimes emotional about.  Its OK though b/c it might help to explain some common bipolar behaviour that normal people don't understand.

I’m going to re-focus this blog now before it spirals out of control.   See, I can recognize it. 

There are a couple things that have been going through my mind since reading that article linking cortisol and bipolar disorder.  

  

1. I wonder if there is a specific cortisol inhibiting drug that I could take when I have to deal with emotional stress?  I bet that could potentially stabilize my mood swings. Exactly which hormones do popular mood stabilizing drugs like lithium or valproate affect? 
2. Why is it only emotional stress (not physical stress) that trigger my episodes? From what I’ve read there is no difference between the body’s response to physical stress as compared to emotional stress. Apparently it produces the same hormones in response to stress regardless of its nature.  E.g. there are no specific emotional stress hormones or physical stress hormones, essentially cortisol is the multitasking stress hormone.  

I hope the authors of this aforementioned article continue to explore this topic of research. There is so much yet to learn about bipolar disorder.   In particular, the effects of emotional stress on the brain and how to manage it. 

It could help the world be a little less crazy.