Tuesday, July 22, 2014

Disability and Mindfulness - A necessary combination - Part I

I've written an essay about how Headspace helped me finally bringing meditation and mindfulness to my daily life. While I probably have much more to share on that particular journey, I'd like to draw the attention to where my interest in meditation began. If you go back a few texts in the blog, you'll realize that I've been through a deep interior change which the most fundamental aspect was identity building.

In this first part of the text I'll concentrate on the traditional treatment options used for relieving mental distress associated to physical disability, particularly cerebral palsy. In part II, I'll talk about much higher effectiveness and duration meditation and mindfulness can have in dealing with the same problems under CP context and what are the most common challenges that need to be tackled in order for these resources to be successfully incorporated to one's lifestyle.

So, to make a long story short, (and I apologize to those that have already read about that, but repetition is very important when proposing a very different point of view from mainstream), rehabilitation process I've been through because of the cerebral palsy experienced when I was born back in 1981 has made it impossible for me to accept disability as a part of my personal integral identity (for more details read Criticism and self criticism).  And since the exact same rehabilitation method and logic has been used with hundreds of thousands of people around the globe (since cerebral palsy affects up to 4 children from every 1000 born alive), the same identity issue potential dimension is quite huge since population has increased from 4,5 to 7,2 billion in these 33 years, and about 500MM people have died in the same period. Thus resulting in approximately roughly 3,2 billions births.

The hard fact is this identity problem, which is primarily caused by a social phenomenon rather than a medical one, is very likely to cause a lot of emotional distress. No surprise depression and anxiety are considered common co-morbidities to cerebral palsy (UCP article and references here). But my claim is that the usual reading of the situation is absurd. Not because the conditions don't frequently occur together. They definitely do.

What I argue about is actually the interpretation of these symptoms as a sign of bad mental health. How on Earth could depression and anxiety be considered a sign of poor mental health under these terrible life circumstances? I feel the truth is exactly the opposite. Being in a very disadvantageous social situation, that constantly threat your present and future total well-being because of a physical condition, while having full cognitive capacity to understand what is really going on in your surroundings, should be considered a sign of being very reasonable and sane. But again in these respects, society casts the problem back on the disabled person and his/her family. Apart from disability stigma, the person will then also have to carry the mental health related one.

However, this wrong conclusion usually leads to poor measures to fight the emotional distress, even when making people feel better the real final intent. Most drugs for treating depression and anxiety are central nervous system stimulants. And in the presence of a CNS lesion, it's very common that these drugs side-effects will be very much augmented (in a way that's very unpredictable). Which means that if it's already difficult and time consuming for a psychiatrist to find the best medicine to help treating someone who is able-bodied (because underlying depression mechanism isn't really currently known and treatment is a great deal of trial and error), successfully treating someone with CP is even much harder.

And the problems don't stop there. Not only the effectiveness of these drugs is lower for these patients but so is their tolerance for these drugs standard doses. On the other hand, the environmental stressors (frequency and intensity of life situations feeding the underlying condition) are much stronger. Since brain lesion physical condition cannot be significantly improved after a certain young age (when the person with CP stops growing), depression and anxiety tend to also become chronic.

Then, besides the messed up drugs situation, one also has to face the inadequacy of psychological common clinical practice. Basically the so called deep psychology relies entirely on a "normal" psychological development model and path to explain the deviations and the full spectrum of mental illness. The tragic detail here is that disabled people usually suffer from many sorts of social exclusion, which effectively prevent these people from following the standard development path. Thus, traditional psychotherapy has the potential to be a threat to mental wellbeing, since this state is only conceived when the individual manages to self-provide all the relevant social development situations needed for him/her to become a healthy adult (especially affective and sexual ones).  

Good news here is that this therapeutic model was very much possible and even plausible in the end of 19th century, in which none of the modern image diagnostic tools were available. And even today, the lack of distinctive image diagnostic methods specifically targeted at mental illnesses such as anxiety and depression still leaves a lot of room for very primitive treatment regimes, including drug trial and error therapies and even worse, these old psychotherapy techniques that are not the subject to any form of objective performance management systems.  

I really want to study all that in depth, so I can make a scientific difference in the way people with CP and other CNS lesions are usually treated for anxiety and depression. But for now I want to focus on what can really bring lasting relief and well-being and why I think that's the case based on everything I said above.  Stay tuned for that in part II.

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