Waking the Dead

May 27, 2007

UPenn’s Center for Resuscitation Science

Interesting web site. It’s about how we define the moment of death. They are turning Emergency Medicine on its head.

If you have advance directives, a living will or a DNR order, it’s because you don’t want to wind up a vegetable after a medical emergency or because you have an incurable, fatal condition. Advanced directives are NOT intended to force the ER doctors to let you die when medical treatment can easily fix you right up. With the exception, of course, of folks whose religion forbids medical treatment.

When I was a whitewater rafting guide I had to be certified in Advanced First Aid and Life Support. This program took four weekends to complete. It was hard for me to put in that kind of sustained effort, now that I think about it, but it really helped my confidence on the job. The point of the course was to enable the guides to stabilize someone injured on the river until we could get real medical help. And it wasn’t a far stretch to consider CPR in case a guest had a heart attack on the river.

Read the UPenn web site. Look at the powerpoint presentations. Read the doctors’ curriculum vitae.

Again: it’s about how we define the moment of death.

So.

Google “cellular reperfusion injury” and read a few of the articles that come up.

Your cells don’t die right away when you die. When oxygen-deprived they go into a kind of stasis and even after several hours a doctor can still extract undamaged, living cells. They haven’t stopped, they’ve just slowed down. You don’t fade out in that first magic 5 minutes. You fall into a deep coma, then actual cell death takes hours – or longer.

This is completely different than what the public and most of the medical profession believes at this time. The current belief is that no pulse equals death. Which really sucks for a few folks who have temporary a artificial heart that whirrrrrs instead of beating. But I digress.

So if you want to define death in terms of brain activity as monitored on an Electroencephalogram (EEG), well, the EEG can only measure down to about 0.5 Hz. This is a limitation of our technology. As you fall asleep brainwaves slow from 30Hz maximum down to around 4Hz. If you go into a deep coma, they slow down even more. No brainwave equals death, then. Except that our technology has serious limitations. Well, it turns out that brain cells go into stasis too.

Now here’s where it gets weird.

Think about what they do in the ER. It’s all about reperfusion, getting oxygen back into the brain as quickly as possible. Jump-start the heart, pump oxygen into the lungs, get a cold patient warm. Well, it turns out that if you pump too much oxygen into a cell that’s in stasis, it self-destructs. That magic 5 minutes isn’t the time that it takes the cells to die. The magic 5 minutes is the time it takes for some of the cells to go into stasis, that is, enough that the self-destruction, or apoptosis, causes wide-spread damage to the body on reperfusion. The heart seems to be the most susceptable organ.

The gist of the web page I linked to is that if someone is brought into the ER suffering from cardiac arrest, they have a better chance at survival if the ER doctors immediately cool them down and add some chemicals to prevent apoptosis before beginning slow reperfusion. The Resuscitation Medicine department at the U of P is working on establishing a new set of protocols.

Where it gets scary is here:

If they bring you in after the magic 5 minutes, present ER protocols can’t save you. Not without massive, permanent damage to the heart and to the brain. They declare you, and that’s it. The body is sent to a funeral home and cremated or injected with preservatives, sometimes long before the several-hour deadline (so to speak) is up.

No wonder the Irish hold wakes. The British, after discovering that an unsettling number of people had been buried alive – used to attach bell cords to the wrists of folks they buried. Saved by the bell.

IRL your family can decide to keep your brain-dead corpse alive despite anything you said in life. Witness what poor Terri Schaivo’s parents did to keep her mindless body alive long after her spirit was gone.

I’ll be watching the Rescusitation Medicine story with great interest.

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Borderlines

April 23, 2007

Before you think I’m defending the borderline, let me state uncategorically that I avoid them like the plague in real life.

Here’s a good article that explains why borderline personality disorder is often misdiagnosed as bipolar disorder.
http://www.nimh.nih.gov/publicat/bpd.cfm

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.

I’d like to put forth the observation that psychology in the US is mainly concerned with predicting and manipulating the behavior of large numbers of people. There is little or no acknowledgement of an internal landscape, because you can’t measure emotions – you can only measure how they are expressed. The psychologists aren’t healers, they are agents of social control.

So. “Personality Disorder” means that a certain type of personality has been pathologized because their behaviors are uncomfortable to others. The behaviors relate to the coping style – but the real problem is that the person has a damaged ego. They have to rely on others to give them clues as to who they are!

The borderlines experience an overwhelming fear of abandonment. All of the crazy behavior is to prevent you from leaving. Unfortunately, the set point is so low that most of what you do looks like abandonment. Abandonment in this context doesn’t mean left alone to rebuild their life – which majorly sucks but isn’t the End of the World. Abandonment means that who they are has been taken away from them. They have little “I” so they have to be part of a “we.”

You can teach a borderline to withhold their emotions with Dialectic Behavioral Therapy (among others), but I’m not entirely convinced that any therapy changes the real problem. It has very little to do with wanting to change, and everything to do with the fact that the fear of abandonment is so deep that – well, damn, you practically have to tear down the whole house to fix the foundation. You see?

Here is the website for Dr. Marsha Linehan, Ph.D., ABPP, who developed DBT.
http://www.behavioraltech.com/index.cfm



Consensus Reality

February 13, 2007

Referring back to Shamanism and Talking to Dog.

We have the ability to perceive *everything* until our society teaches us to block out of our minds what’s happening on the other side of the door. Privacy is how it starts. Later it becomes political. This is the definition of sanity, sharing a world-view.

My cat always has a complete aural picture of the world outside the house because her hearing is much better than mine. Her visual concept of the world is limited to what she can see by running from window to window – a very disconnected picture of the world, don’t you think? Now substitute the word “psychic” for “aural” and “sensory” for “visual.” There is nothing mystical about it. You know what you are taught to know and you de-reify what you aren’t taught.

I have no problem with concepts that lie outside the limitations of our technology. Not until some shady character tries to take my money. New Age practices, in general, are when a bunch of slightly better educated people try to sell the rest of us something that doesn’t really step outside consensus reality. Magic, after all, is nothing but a technology that you don’t understand.

I’m also an Electrical Engineer and I graduated with a minor in mathematics. I had 4 years of science and 5 years of math in high school alone. And I’ve forgotten more philosophy than most people ever read in the first place. I can tell bullsh*t from a new way of looking at reality. I’m a reiki master, by the way.

The first thing you learn in logic is that you can’t prove non-existence. Psychic ability requires breaking your mind so that you can see the things you were taught to make non-existent.

Society has a vested interest in controlling the hidden information, and quickly punishes those who step outside what is considered sane. Therapists, then, are the gatekeepers of consensus reality.

The moral? Don’t complain about your psychic abilities to your therapist unless you want to get rid of these abilities.

About schizophrenia – schizophrenia does not equal psychic ability, though a broken brain is more likely to take a big step away from consensus reality. Schizophrenia, they say, results from an inability to categorize the world in the same way the rest of us do. Imagine if your grocery store sorted things by the size of the package instead of putting sugar in the spice aisle and dryer sheets in the laundry section. Now imagine that when you complain to the manager, he sends the cops and psychiatrists over to your house to rearrange the furniture.


TFTD – on appearing normal

May 7, 2006

In appearing normal to others, one becomes a habit-ridden plaything of social pressures and expectations.


TFTD – "meaning"

April 22, 2006
To insist that the world has one meaning rather than another is politics.

TFTD – On "being"

April 18, 2006

Being can be likened to a projective test.


Having a Wonderful Life

April 16, 2006

Recently someone challenged me to

Try looking at other things moods do that are related to thought, but aren’t thought. How they change things like memory, attention, and perception.

Like whether you are motivated to work on having a life in spite of the bipolar disorder? Whether you take a small failure and read it to mean that you can *never* succeed?

I think the answer is this:

We have moods. *Everyone* has moods, ours just swing out farther. Accept it and get on with your life.

I’ve been having some problems the last couple of days, not sleeping and feeling the “raccoon eyes” again. In the middle of that I made the bad decision to stay at work late since I was having luck with a problem there. Symptoms – racing thoughts, “body armor” meaning all-over tension. A building up of toxins. I was too hyper to use my biofeedback program, couldn’t even do the first task. Bah.

Last night I took an antipsychotic. Today I’m stumbling around and every few minutes I have to lie down wherever I’m at until the dizziness passes. How the *fuck* do you people who take that crap every day manage? HA! I bet you think that’s a symptom of bipolar disorder, not a med side effect!

I have things to do. So I point myself in the right direction, gathering supplies a bit at a time. My next task – after a very strong cup of coffee, which is brewing now, will be to varnish the picnic table. It’ll take longer than it would otherwise but it will get done. Yesterday I did some body work on my ’88 Toyota pickup so that it will pass inspection.

This is where the less motivated bipolars jump up and tell me I’m not disabled. I could have gone on SSDI in late 1999 or early 2000. It would have been easy to stay on high doses of meds and get money for nothing. It just wouldn’t be me. I took the summer off and spent a big chunk of my savings going back to school to get my engineering degree instead. And learned reiki to give myself another tool for managing the illness.

The point? Yeah, hard to stay on topic when you’re stoned out of your gourd on psych meds. The point is that you have the moods. Yippee. There have always been bipolars and many of them accomplished great things in spite of it – or more likely *because of it*.

If you are a failure, it’s not because of the disorder itself. It is because of the choices you’ve made in your life. You can’t change the mood swings, but you *can* change everything else. Change is scary, even for non-bipolars, so don’t blame that on the disorder either. You deserve success – however you define “success” – so make the changes.

So quit focusing all of your energy on having bipolar disorder and start focusing it on having a life.

Or don’t. Your choice.

Coffee’s ready. Excuse me, I have to get some things done today. It would be easier if my head didn’t feel like a bag of rocks.

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