Why Do Men Stupefy Themselves? Leo Tolstoy on Why We Drink | Brain Pickings

Why Do Men Stupefy Themselves? Leo Tolstoy on Why We Drink | Brain Pickings



by Maria Popova

“The seeing, spiritual being, whose manifestation
we commonly call conscience, always points with one end towards right
and with the other towards wrong, and we do not notice it while we
follow the course it shows.”

“The people of the United States spend exactly as much money on booze alone as on the space program,” Isaac Asimov quipped in a witty and wise 1969 response
to a reader who had berated him on the expense of space exploration. At
no other time of the year are our cultural priorities more glaring than
during our holiday merriment, which entails very little cosmos and very
many Cosmos. Long before Asimov, another sage of the human spirit set
out to unravel the mystery of why such substances appeal to us so: In
1890, a decade after his timelessly enlightening spiritual memoir and midway through his Calendar of Wisdom magnum opus, Leo Tolstoy penned an insightful essay titled “Why Do Men Stupefy Themselves?”
as a preface to a book on “drunkenness” by a Russian physician named P.
S. Alexeyev. Eventually included in the altogether excellent posthumous
volume Recollections and Essays (public library; free ebook), Tolstoy’s inquiry peers into the deeper psychological layers and philosophical aspects of substance abuse and addiction.



Decades before the founding of Alcoholics Anonymous and nearly a
century before alcohol abuse was recognized as a disease by the World
Health Organization, Tolstoy writes:

What is the explanation of the fact that people use
things that stupefy them: vodka, wine, beer, hashish, opium, tobacco,
and other things less common: ether, morphia, fly-agaric, etc.? Why did
the practice begin? Why has it spread so rapidly, and why is it still
spreading among all sorts of people, savage and civilized? How is it
that where there is no vodka, wine or beer, we find opium, hashish,
fly-agaric, and the like, and that tobacco is used everywhere?

Why do people wish to stupefy themselves?

Ask anyone why he began drinking wine and why he now drinks it. He
will reply, “Oh, I like it, and everybody drinks,” and he may add, “it
cheers me up.” Some those who have never once taken the trouble to
consider whether they do well or ill to drink wine may add that wine is
good for the health and adds to one’s strength; that is to say, will
make a statement long since proved baseless.

Ask a smoker why he began to use tobacco and why he now smokes, and
he also will reply: “To while away the time; everybody smokes.”

Illustration for 'Alice in Wonderland' by Lisbeth Zwerger. Click image for more.

And yet Tolstoy peers beyond this blend of apathy and pluralistic ignorance, into the true root of substance abuse:

“To while away time, to cheer oneself up; everybody does
it.” But it might be excusable to twiddle one’s thumbs, to whistle, to
hum tunes, to play a fife or to do something of that sort ‘to while away
the time,” “to cheer oneself up,” or “because everybody does it”” that
is to say, it might be excusable to do something which does not involve
wasting Nature’s wealth, or spending what has cost great labour to
produce, or doing what brings evident harm to oneself and to others…
There must be some other reason.

He offers a compassionate explanation of that other cause, that deep
dissonance that rips the psyche asunder by pulling it simultaneously
toward fulfillment and self-destruction — a nonjudgmental insight
gleaned as much by “observing other people” as by observing his own
experience during a period when he “used to drink wine and smoke
tobacco”:

When observing his own life, a man may often notice in
himself two different beings: the one is blind and physical, the other
sees and is spiritual. The blind animal being eats, drinks, rests,
sleeps, propagates, and moves, like a wound-up machine. The seeing,
spiritual being that is bound up with the animal does nothing of itself,
but only appraises the activity of the animal being; coinciding with it
when approving its activity, and diverging from it when disapproving.

This observing being may be compared to the needle of a compass,
pointing with one end to the north and with the other to the south, but
screened along its whole length by something not noticeable so long as
it and the needle both point the same way; but which becomes obvious as
soon as they point different ways.

In the same manner the seeing, spiritual being, whose manifestation
we commonly call conscience, always points with one end towards right
and with the other towards wrong, and we do not notice it while we
follow the course it shows: the course from wrong to right. But one need
only do something contrary to the indication of conscience to become
aware of this spiritual being, which then shows how the animal activity
has diverged from the direction indicated by conscience. And as a
navigator conscious that he is on the wrong track cannot continue to
work the oars, engine, or sails, till he has adjusted his course to the
indications of the compass, or has obliterated his consciousness of this
divergence each man who has felt the duality of his animal activity and
his conscience can continue his activity only by adjusting that
activity to the demands of conscience, or by hiding from himself the
indications conscience gives him of the wrongness of his animal life.

Illustration for Herman Melville's 'Pierre' by Maurice Sendak. Click image for more.

Tolstoy extends this duality beyond alcohol and into the broader human dilemma:

All human life, we may say, consists solely of these two
activities: (1) bringing one’s activities into harmony with conscience,
or (2) hiding from oneself the indications of conscience in order to be
able to continue to live as before.

Some do the first, others the second. To attain the first there is
but one means: moral enlightenment — the increase of light in oneself
and attention to what it shows. To attain the second — to hide from
oneself the indications of conscience — there are two means: one
external and the other internal. The external means consists in
occupations that divert one’s attention from the indications given by
conscience; the internal method consists in darkening conscience itself.

As a man has two ways of avoiding seeing an object that is before
him: either by diverting his sight to other more striking objects, or by
obstructing the sight of his own eyes just so a man can hide from
himself the indications of conscience in two ways: either by the
external method of diverting his attention to various occupations,
cares, amusements, or games; or by the internal method of obstructing
the organ of attention itself. For people of dull, limited moral
feeling, the external diversions are often quite sufficient to enable
them not to perceive the indications conscience gives of the wrongness
of their lives. But for morally sensitive people those means are often
insufficient.

The external means do not quite divert attention from the
consciousness of discord between one’s life and the demands of
conscience. This consciousness hampers one’s life: and in order to be
able to go on living as before people have recourse to the reliable,
internal method, which is that of darkening conscience itself by
poisoning the brain with stupefying substances.

One is not living as conscience demands, yet lacks the strength to
reshape one’s life in accord with its demands. The diversions which
might distract attention from the consciousness of this discord are
insufficient, or have become stale, and so in order to be able to live
on, disregarding the indications conscience gives of the wrongness of
their life people (by poisoning it temporarily) stop the activity of the
organ through which conscience manifests itself, as a man by covering
his eyes hides from himself what he does not wish to see.

Illustration for Herman Melville's 'Pierre' by Maurice Sendak. Click image for more.

He returns to substance abuse as a symptom of this deeper pathology:

The cause of the world-wide consumption of hashish,
opium, wine, and tobacco, lies not in the taste, nor in any pleasure,
recreation, or mirth they afford, but simply in man’s need to hide from
himself the demands of conscience.

More than that, Tolstoy considers the role of “stupefaction” in
compartmentalizing good and evil in our conscience, acquitting the acts
of the latter from the demands of the former:

When a man is sober he is ashamed of what seems all right
when he is drunk. In these words we have the essential underlying cause
prompting men to resort to stupefiers. People resort to them either to
escape feeling ashamed after having done something contrary to their
consciences, or to bring themselves beforehand into a state in which
they can commit actions contrary to conscience, but to which their
animal nature prompts them.

A man when sober is ashamed to go after a prostitute, ashamed to
steal, ashamed to kill. A drunken man is ashamed of none of these
things, and therefore if a man wishes to do something his conscience
condemns he stupefies himself.

One particular remark strikes with its chilling prescience in light
of the date rape epidemic exposed in recent years, where it is not
uncommon for the perpetrator to deliberately drug the victim:

Not only do people stupefy themselves to stifle their own
consciences, but, knowing how wine acts, they intentionally stupefy
others when they wish to make them commit actions contrary to conscience
that is, they arrange to stupefy people in order to deprive them of
conscience.

Illustration for Herman Melville's 'Pierre' by Maurice Sendak. Click image for more.

But such crescendos of immorality, Tolstoy takes care to note, are
the most dramatic but not the most common cause for alarm in our
relationship with alcohol — he is equally concerned about the small,
daily, incremental stifling of the conscience by ordinary people:

Everyone knows and admits that the use of stupefying
substances is a consequence of the pangs of conscience, and that in
certain immoral ways of life stupefying substances are employed to
stifle conscience. Everyone knows and admits also that the use of
stupefiers does stifle conscience: that a drunken man is capable of
deeds of which when sober he would not think for a moment. Everyone
agrees to this, but strange to say when the use of stupefiers does not
result in such deeds as thefts, murders, violations, and so forth when
stupefiers are taken not after some terrible crimes, but by men
following professions which we do not consider

criminal, and when the substances are consumed not in large quantities
at once but continually in moderate doses then (for some reason) it is
assumed that stupefying substances have no tendency to stifle
conscience.

We assume, Tolstoy argues, that if no crimes are committed under the
influence of alcohol, there is no harm done to the conscience — ours or
that of others. But this obscures the more subtle, everyday ways in
which we flee from ourselves — from our highest selves — by getting
drunk:

But one need only think of the matter seriously and
impartially not trying to excuse oneself to understand, first, that if
the use of stupefiers in large occasional doses stifles man’s
conscience, their regular use must have a like effect (always first
intensifying and then dulling the activity of the brain) whether they
are taken in large or small doses. Secondly, that all stupefiers have
the quality of stifling conscience, and have this always both when under
their influence murders, robberies, and violations are committed, and
when under their influence words are spoken which would not have been
spoken, or things are thought and felt which but for them would not have
been thought and felt; and, thirdly, that if the use of stupefiers is
needed to pacify and stifle the consciences of thieves, robbers, and
prostitutes, it is also wanted by people engaged in occupations
condemned by their own consciences, even though these occupations may be
considered proper and honorable by other people.

In a word, it is impossible to avoid understanding that the use of
stupefiers, in large or small amounts, occasionally or regularly, in the
higher or lower circles of society, is evoked by one and the same
cause, the need to stifle the voice of conscience in order not to be
aware of the discord existing between one’s way of life and the demands
of one’s conscience.

Tolstoy goes on to examine how “stupefiers” appeal to us differently
during different stages of life, why we seek them most urgently when
confronting challenging moral questions, and what we can do to foster in
ourselves the spiritual conditions that would render such escape and
control strategies unnecessary.

Complement Recollections and Essays, which is a spectacular read in its entirety and is available as a free ebook, with Tolstoy on “emotional infectiousness,” how to find meaning in a meaningless world, his letters to Gandhi on why we hurt each other, and his reading list of essential books for every stage of life.

How I Escaped A Recent Depression (And How To Spend Free Time) | How To Beast

How I Escaped A Recent Depression (And How To Spend Free Time)

 




I’ve been in Spain for the last two weeks. I’m here visiting family.

While I’ve been here the amount of free time I’ve had has been
through the roof. I’m only working a couple hours a day for my IT job,
and I don’t have to train any personal training clients.

I’ve used a lot of this time to work on a new book I’m writing. And
I’ve used another chunk of it to spend time with family, of course.
However, the amount of free time I have is still exponentially more than
I’m used to.

Too Much Free Time Can Cripple You

The first day or two, this free time felt liberating, like I could
just bask in the sun of southern Spain, swim laps in the rooftop pool,
and enjoy life. But this quickly changed. I soon found myself face up,
on my bed, staring at the ceiling for hours straight. My mind wandered
to places that it should never wander. I began to feel crippled by
obsessive thought patterns about stupid things:

– How was I going to pass the next three weeks I’m here?

– What’s going to happen with this girl I’ve been seeing in the states the past month or so when I return?

– Should I continue working on my business, blog, and books or strike into new territory?

– Should I train my clients privately when I return or sacrifice some
income and do it at a gym that can provide health insurance and a
membership?

At the surface, these things don’t seem so bad. But the thoughts they
led to became increasingly marked by insecurity. I questioned my
self-worth, my progress, and the value of my life. I can’t rationally
explain how I got from point A (the type of thoughts listed above) to
point B (the depressive thoughts that developed), but I think you can
probably relate.

My Initial Attempt At Treatment

After experiencing this shit for a few days in a row, I realized it
was something I needed to address. Otherwise, this could get worse and
worse, and I’d end up wasting my time in beautiful Spain worrying about
pointless bullshit.

So I began to meditate whenever this pattern started to emerge – and
I’d feel immediate relief. However, I’d stay inside working on my book
or some IT work and just minutes later my mind would wander into the
abyss of negative thoughts. I’d try to pair this meditation with
affirmations and positive self talk, but this served as a temporary fix
just the same.

Then I Took Action (READ: Got The Fuck Outside And Did New Things)

I finally said FUCK IT, this surface level treatment isn’t doing
SHIT. And I decided that I would do something new, OUTSIDE of the house,
every single day. Yesterday I went pedal boating on the river with my
brother:



Today I’m going to go out shopping and talking to strangers, and then
connect with an old friend for drinks tonight. Tomorrow I’m hitting up a
water park with my brother. Sunday, to a Sevilla futbol game. And next
week I scheduled a trip to Marrakech, Morocco that will be an adventure.

It Was An Incredible Reminder Of How Fragile And Susceptible To Depression We All Are

This isn’t a situation I’d been in for a while. In the states, I’ve
been so busy between work, women, habits, and business that I haven’t
had the time to think so much. I developed an inaccurate self-image of
invincibility and unshakable confidence. I WASN’T PREPARED TO BE ALONE
WITH MY THOUGHTS FOR AN EXTENDED PERIOD OF TIME.

While the treatment for this condition is essentially the same thing
that I’d been doing at home (ie. constantly doing things), it was an
amazing reminder of just how mortal I really am.

If you’ve been feeling stuck lately, I highly recommend you check out my new online bootcamp 28 DAYS TO ALPHA. It will get you taking MASSIVE ACTION and feeling vastly more CONFIDENT in less than a month. Click HERE for more info.

Is Anxiety Really a Gift? | Brain Blogger

Is Anxiety Really a Gift? | Brain Blogger



by Sherianna Boyle, MEd, CAGS | December 7, 2014

Anxiety is most known as a “thinking”
disorder which can be evidenced through symptoms such as chronic
worrying. Science now shows that human beings have on average between
60,000 and 70,000 thoughts per day and according to author Joe Dispenza,
roughly “70% of those thoughts are negative in nature.” Negative
thoughts create negative emotions which over time neurologically create
redundant behaviors such as rushing, nervousness, preoccupation with the
future as well as the past. How is it then, that anxiety could be a
gift?

The truth is the actual symptoms itself may not be a gift, however
the experience of the symptoms are. It turns out thoughts and emotions
are made up of energy. They are simply molecules and atoms in motion.
These send off a vibrational frequency. When the frequency is low (has
little movement) this corresponds to low level emotions such as fear,
insecurity and guilt. When the frequency is high (more movement) this
corresponds to higher emotions such as courage, love and appreciation.
This information has been scientifically tested and validated by
scientists and clinicians such as Dr. David Hawkins.

This information allows us to approach, interpret and treat the symptoms of anxiety in
a new way. Rather than attempt to beat, cure, prevent or control the
symptoms the focus becomes on learning how to convert lower vibrational
emotions into higher ones. This creates quite a shift in the field of
psychology not only in the role of a therapist but also for the client.
When applied consistently techniques such as visualization, mindfulness,
and breathing have proven to transform emotions such as fear and worry
into faith. As this occurs, new interpretations and insights develop.
Similar to receiving clues in a board game symptoms become assets rather
than barriers. For example, an emotion such as shame when released from
the body has the capacity to uncover the gift of empathy.

Transforming emotions such as guilt into courage can be quite rewarding however, as stated in The Four Gifts of Anxiety
“a life with your gifts does not mean a life without challenges,
vulnerability or pain. Instead, a life with your gifts allows you to
become empowered by the very same symptoms you once believed
disempowered you.” The symptoms of anxiety when viewed in this light
become a guidepost rather than a barrier. Rather than being a signal for
what is wrong, think of a symptom such as increased heart rate as a
marking of a buried treasure (in this case a buried emotion) waiting to
be discovered.

Through skill development and awareness one can begin to surrender
the stigmas and stereotypes anxiety has formally attached to. Some of
these include subconscious beliefs that you have anxiety rather
than a reflection of your current experience (I am experiencing worry).
It is not until each and every one of us breaks the habit of becoming
our symptoms, instead choosing to pay attention to how they may in fact
be our greatest ally, as they often point out exactly which emotions are
looking to be acknowledged and cleared so we may open up the pathway to
our gifts.

References

Dispenza, Joe Ph.D. (2014) You Are the Placebo. Hay House, Inc. pp 45.

Hawkins, David R. M.D., Ph.D. (1995, 1998, 2004, 2012.) Power vs. Force. Hay House, Inc.

Magnesium and the Brain: The Original Chill Pill | Psychology Today

Magnesium and the Brain: The Original Chill Pill | Psychology Today

Published on June 12, 2011 by Emily Deans, M.D. in Evolutionary Psychiatry

41
inShare

Magnesium
is a vital nutrient that is often deficient in modern diets. Our
ancient ancestors would have had a ready supply from organ meats,
seafood, mineral water, and even swimming in the ocean, but modern soils can be depleted of minerals and magnesium is removed from water during routine municipal treatment. The current RDA for adults is between 320 and 420mg daily, and the average US intake is around 250mg daily.Does
it matter if we are a little bit deficient? Well, magnesium plays an
important role in biochemical reactions all over your body.  It is
involved in a lot of cell transport activities, in addition to helping
cells make energy aerobically or anaerobically. Your bones are a major
reservoir for magnesium, and magnesium is the counter-ion for calcium
and potassium in muscle cells, including the heart. If your magnesium is
too low, you can experience muscle cramps, arrythmias, and even sudden death. Ion regulation is everything with respect to how muscles contract and nerves send signals. In the brain, potassium and sodium balance each other. In the heart and other muscles, magnesium pulls some of the load.

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That doesn't mean that magnesium is unimportant in the brain. Au contraire! In fact, there is an intriguing article entitled Rapid recovery from major depression using magnesium treatment, published in Medical Hypothesis in 2006. Medical Hypothesis seems like a great way to get rampant (but referenced) speculation into the PubMed database. Fortunately, I don't need to publish in Medical Hypothesis, as I can engage in such speculation in my blog, readily accessible to Google. Anyway, this article was written by George and Karen Eby, who seem to run a nutrition
research facility out of an office warehouse in Austin, Texas - and it
has a lot of interesting information about our essential mineral
magnesium.

Magnesium is an old home remedy for all that ails you, including "anxiety, apathy, depression, headaches, insecurity, irritability, restlessness, talkativeness, and sulkiness." In 1968, Wacker and Parisi
reported that magnesium deficiency could cause depression, behavioral
disturbances, headaches, muscle cramps, seizures, ataxia, psychosis, and
irritability - all reversible with magnesium repletion.

Stress is the bad guy here, in addition to our woeful magnesium deficient diets. As is the case with other minerals such as zinc, stress causes us to waste our magnesium like crazy - I'll explain a bit more about why we do that in a minute.

Let's look at Eby's case studies from his paper:

A 59 y/o "hypomanic-depressive male", with a long history of treatable mild depression, developed anxiety, suicidal thoughts, and insomnia
after a year of extreme personal stress and bad diet ("fast food").
Lithium and a number of antidepressants did nothing for him. 300mg
magnesium glycinate (and later taurinate) was given with every meal. His
sleep
was immediately restored, and his anxiety and depression were greatly
reduced, though he sometimes needed to wake up in the middle of the
night to take a magnesium pill to keep his "feeling of wellness." A
500mg calcium pill would cause depression within one hour, extinguished
by the ingestion of 400mg magnesium.

A 23 year-old woman with a previous traumatic
brain injury became depressed after extreme stress with work, a diet of
fast food, "constant noise," and poor academic performance. After one
week of magnesium treatment, she became free of depression, and her
short term memory and IQ returned.

A 35 year-old woman with a history of post-partum
depression was pregnant with her fourth child. She took 200mg magnesium
glycinate with each meal. She did not develop any complications of pregnancy and did not have depression with her fourth child, who was "healthy, full weight, and quiet."

A 40 year-old "irritable, anxious, extremely talkative, moderately depressed" smoking, alchohol-drinking, cocaine
using male took 125mg magnesium taurinate at each meal and bedtime, and
found his symptoms were gone within a week, and his cravings for
tobacco, cocaine, and alcohol disappeared. His "ravenous appetite was supressed, and ... beneficial weight loss ensued."

Eby
has the same question about the history of depression that I do - why
is depression increasing? His answer is magnesium deficiency. Prior to
the development of widespread grain refining capability, whole grains
were a decent source of magnesium (though phytic acid in grains will
bind minerals such as magnesium, so the amount you eat in whole grains
will generally be more than the amount you absorb). Average American
intake in 1905 was 400mg daily, and only 1% of Americans had depression
prior to the age of 75. In 1955, white bread (nearly devoid of
magnesium) was the norm, and 6% of Americans had depression before the
age of 24. In addition, eating too much calcium interferes with the
absorption of magnesium, setting the stage for magnesium deficiency.

Beyond Eby's interesting set of case studies are a number of other studies linking the effects of this mineral to mental health
and the stress response system. When you start to untangle the effects
of magnesium in the nervous system, you touch upon nearly every single
biological mechanism for depression. The epidemiological studies (1) and some controlled trials (2)(3) seem to confirm that most of us are at least moderately deficient in magnesium. The animal models are promising (4). If you have healthy kidneys, magnesium supplementation is safe and generally well-tolerated (up to a point)(5),
and many of the formulations are quite inexpensive. Yet there is a
woeful lack of well-designed, decent-sized randomized controlled trials
for using magnesium supplementation as a treatment or even adjunctive
treatment for various psychiatric disorders.

Let's
look at the mechanisms first. Magnesium hangs out in the synapse
between two neurons along with calcium and glutamate. If you recall, calcium and glutamate are excitatory, and in excess, toxic.
They activate the NMDA receptor. Magnesium can sit on the NMDA receptor
without activating it, like a guard at the gate. Therefore, if we are
deficient in magnesium, there's no guard. Calcium and glutamate can
activate the receptor like there is no tomorrow. In the long term, this
damages the neurons, eventually leading to cell death. In the brain,
that is not an easy situation to reverse or remedy.

And then there
is the stress-diathesis model of depression, which is the generally
accepted theory that chronic stress leads to excess cortisol, which
eventually damages the hippocampus of the brain, leading to impaired
negative feedback and thus ongoing stress and depression and neurotoxicity badness. Murck tells
us that magnesium seems to act on many levels in the hormonal axis and
regulation of the stress response. Magnesium can suppress the ability of
the hippocampus to stimulate the ultimate release of stress hormone, it
can reduce the release of ACTH (the hormone that tells your adrenal
glands to get in gear and pump out that cortisol and adrenaline), and it
can reduce the responsiveness of the adrenal glands to ACTH. In
addition, magnesium can act at the blood brain barrier to prevent the
entrance of stress hormones into the brain. All these reasons are why I call magnesium "the original chill pill."

If
the above links aren't enough to pique your interest, depression is
associated with systemic inflammation and a cell-mediated immune
response. Turns out, so is magnesium deficiency.
In addition, animal models show that sufficient magnesium seems to
protect the brain from depression and anxiety after traumatic brain
injury (6), and that the antidepressants desipramine and St. John's Wort (hypericum perforatum)
seem to protect the mice from the toxic effects of magnesium deficiency
and its relationship to anxious and depressed behaviors (4).

The
overall levels of magnesium in the body are hard to measure. Most of
our body's magnesium is stored in the bones, the rest in the cells, and a
very small amount is roaming free in the blood. One would speculate
that various mechanisms would allow us to recover some needed magnesium
from the intracellular space or the bones if we had plenty on hand,
which most of us probably don't. Serum levels may be nearly useless in
telling us about our full-body magnesium availability, and studies of
levels and depression, schizophrenia, PMS, and anxiety have been all over the place (7).
There is some observational evidence that the Mg to Ca ratio may be a
better clue. Secondly, the best sources of magnesium in the normal
Western diet are whole grains (though again, phytates in grains will
interfere with absorption), beans, leafy green veggies, and nuts. These
happen to be some of the same sources as folate, and folate depletion is
linked with depression, so it may be a confounding factor in the
epidemiological studies.

Finally, magnesium is sequestered and
wasted via the urine in times of stress. I'm speculating here, but in a
hunter-gatherer immediate stress sort of situation, maybe we needed our
neurons to fire on all cylinders and our stress hormones to rock and
roll through the body in order for us to survive. Presumably we survived
or didn't, and then the stressor was removed, and our paleolithic diets
had plenty of magnesium to replace that which went missing. However, it
may not be overall magnesium deficiency causing depression and
exaggerated stress response - it may just be all that chronic stress,
and magnesium deficiency is a biomarker for chronic stress. But it
doesn't hurt to replete one's magnesium to face the modern world, and at
least the relationships should be studied thoroughly. Depression is hugely expensive and debilitating.
If we could alleviate some of that burden with enough mineral water...
we should know whether that is a reasonable proposition.

As I
mentioned before, there are only a few controlled trials of magnesium
supplementation and psychiatric disorders. A couple covered premenstrual
dysphoria, cravings, and other symptoms (8)(9). Another small study showed some improvement with magnesium supplementation in chronic fatigue syndrome (10). Two open-label studies showed some benefit in mania (11)(12). There is another paper
that postulates that magnesium deficiency could exacerbate the symptoms
of schizophrenia. However, there is nothing definitive. Which is, of
course, quite troubling. How many billions of dollars have we spent on
drug research for depression, bipolar disorder, and schizophrenia, when here is a cheap and plausibly helpful natural remedy that hasn't been properly studied?

So
everyone get out there and take some magnesium already!  Whew.  Well,
just a few more things to keep in mind before you jump in.

There
are some safety considerations with respect to magnesium
supplementation. If you have normal kidney function, you do not have
myasthenia gravis, bowel obstruction, or bradycardia, you should be able
to supplement without too many worries. In addition, magnesium
interferes with the absorption of certain pharmaceuticals, including
dixogin, nitrofurantoin, bisphosphanates, and some antimalaria drugs.
Magnesium can reduce the efficacy of chloropromazine, oral
anticoagnulants, and the quinolone and tetracycline classes of
antibiotics.

Magnesium oxide is the cheapest readily available
formulation, as well as magnesium citrate, which is more likely to cause
diarrhea in excess. (In fact, magnesium is a great remedy for
constipation). The oxide is not particularly bioavailable, but the
studies I've referenced above suggest that you can top yourself off
after about a month of daily supplementation. Those with short bowels
(typically due to surgery that removes a large section of bowel) may
want to supplement instead with magnesium oil. You can also put some Epsom salts
in your bath. In addition to diarrhea, magnesium can cause sedation,
and symptoms of magnesium toxicity (again, quite unlikely if your
kidneys are in good shape) are low blood pressure, confusion, arrythmia,
muscle weakness, and fatigue. Magnesium is taken up by the same
transporter as calcium and zinc, so they can fight with each other for
absorption. Jaminet and Jaminet
recommend total daily levels (between food and supplements) of
400-800mg. Most people can safely supplement with 200-350mg daily
without any problems (again, don't proceed without a doctor's
supervision if you have known kidney disease or if you are elderly).

People looking for good (but not all paleo) food sources can go here (also a good link for more information on the other formulations of magnesium - there are many!), here, and here.

Image credit (magnesium is used to make sparklers)

More articles like this one at Evolutionary Psychiatry

Copyright Emily Deans, M.D.

Magnesium and the Ketamine Connection | Psychology Today

Magnesium and the Ketamine Connection | Psychology Today

A natural mineral mimics the intercellular effects of the anesthetic ketamine

Published on October 26, 2014 by Emily Deans, M.D. in Evolutionary Psychiatry

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Ketamine,
an anesthetic and street drug known as “Special K” has garnered a lot
of attention for it’s ability, in some, to relieve the symptoms of very
severe depression in a matter of minutes. A recent study has demonstrated how it might work, but before you go signing up for a clinical trial (and there are currently many going on in the US),
it’s important to understand the downsides to the drug. One major
problem is that the effects wear off, usually within 10 days, leaving
you just as depressed as before. It can cause urinary incontinence,
bladder problems, addiction, and, with chronic use, it can worsen mental health problems, causing more depression, anxiety, and panic attacks.

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Ketamine seems to have a remarkable, short term ability to heal the synapses injured by chronic stress. However, anything that acts that quickly and successfully usually has a long-term cost. All powerfully addictive drugs work on our own natural receptors and neurons. Cocaine, for example, causes immediate racing euphoria by inhibiting the natural neurotransmitter dopamine
from being recycled, leaving bunches of dopamine in the synaptic cleft.
In the very short term, you feel great. In the long term, you tax the
system by driving the neurotransmitter system far out of balance in an
aggressive way.

Nicotine has a similar effect on
the alpha-7 nicotinic receptor. It activates it in a pleasing way, but
unfortunately desensitizes the receptor so much that only nicotine will
keep it firing. A nutrient found in foods such as egg yolks called
choline activates the same receptor, but without desensitizing it.  Long
term, regular ingestion of choline keeps the receptor functional and
happy, helping with certain brain
tasks. Long term, regular use of nicotine activates the receptor but
forces you to take more nicotine to keep the receptor working, leaving
you foggy-headed and less sharp if you go without cigarettes.

So
is there a less dramatic, “natural” version of ketamine, something we
can safely ingest every day, but might be a little depleted in our
modern diets? Nothing taken in physiologic amounts would reverse a
depression in half an hour like ketamine, but could another chemical we
find in food and mineral water help with resilience
to stress, synaptic repair, and make us more resistant to depression
and anxiety symptoms? Sure—that chemical is the mineral magnesium.
Magnesium, like ketamine, acts as an antagonist to the NMDA receptor,
which means it is a counter to glutamate, the major excitatory
neurotransmitter in the brain. The exact mechanisms are complex, but
both ketamine and magnesium seem to help glutamate do its job,
activating the receptor, without damaging the receptor with too much
activation, which, chronically, leads to excitotoxicity, synaptic
degradation, inflammation, and even cell death.

One
of the exciting things about ketamine is that it works in some people
with severe treatment resistant depression who have failed the
traditional therapies. Treatment-resistant individuals tend to have
lower intracellular magnesium levels than normal (1).
Ketamine and magnesium may also work synergistically, complementing
each other. Ketamine leads to an increase of intracellular magnesium,
and ketamine will reverse the normally seen magnesium decreases after
brain trauma (2). There is some evidence also that more standard antidepressant
medications, such as imipramine, work in part by reversing the
magnesium-depleting effects of chronic stress, suggesting that adding
magnesium supplementation to standard antidepressant regimens might help
the medications work better (at least in rodents) (3).

It’s
great to see an interesting compound like ketamine be taken seriously
and thoroughly studied for its action in serious, resistant depression.
Ultimately its usefulness may be limited to hospitalized patients who
can be closely monitored for the side effects, and who also may benefit
the most from the quick mechanism of action, while the longer term risks
may be outweighed by the short term benefit in such a critical, serious
situation. I would love to see a much safer compound, the mineral
magnesium, be studied as an adjunct treatment.

In the mean time,
magnesium supplementation is generally safe for most folks with normal
kidney function. Many folks eating a normal Western Diet have a low intake of the mineral (4).
Those with bowel obstructions, very slow heart rate, or dangerously low
blood pressure should not take it. Magnesium can interfere with the
absorption of certain medicines (digoxin, nitrofurantoin,
bisphosphanates, and some anti malaria drugs). Here are some excellent food sources
of magnesium (though remember that both nuts and grains have phytates,
which bind minerals, so the magnesium you absorb may not be quite as
much as the magnesium you ingest.) Magnesium is also available in many
mineral waters.



For more information about magnesium and the brain, please read my article here: Magnesium the Original Chill Pill. A nice paper from last year details the ketamine-magnesium connection if you have journal access (thanks to Drew Ramsey for pointing the paper out to me). 

Dyslimbia - A Possible New Name for BPD”

A Possible New Name for BPD”

The BPD is a medical problem, likely a form of epilepsy (brain cells
firing inappropriately and out of control). The characteristic symptoms
include inappropriate moodiness, chronic anger, emptiness, boredom,
dysphoria (anxiety, rage, depression and despair) and psychosis. The
other criteria are symptoms related to these medical problems.

ALL neurological disorders can have an effect on the personality,
such as Parkinson’s disease which isn’t called the ‘shaking personality
disorder.’ ”

What does this term “Dyslimbia” mean?

Dys’ means malfunction, and limbia meaning from the limbic system.

‘Dyslimbia’ is malfunction of the limbic system. While other
neuropsychiatric disorders involve malfunction of the limbic system, the
limbic system dysfunction is profound in the BPD. I chose Dyslimbia for
my patients to take the stigma away. The BPD needs a new name, one that
emphasizes healing not labeling.

I don’t care if it’s renamed ‘Dyslimbia’ or not, but a more honest,
humane, and hopeful name needs to be made for this illness. Patients
deserve to get medical attention for ‘Dyslimbia’ (or an equivalent
name), rather than have doctors and therapists shun them because they
are ‘borderlines.’”

Borderline Personality Disorder (BPD) – Biological Unhappiness (Dr. Leland M. Heller)

Dr. Leland M. Heller discusses the Borderline Personality Disorder (BPD) – Biological Unhappiness

By Dr Heller On October 18, 2011 · 1 Comment

“…Epilepsy was once thought to be a psychiatric problem, until the
underlying neurological abnormalities were understood.  Researchers
have uncovered medical and neurological abnormalities in borderlines. 
Many symptoms are likely due to malfunction in the brain’s limbic
system.  In my opinion, the borderline personality disorder is primarily
a medical problem.  It can now be treated."

The Borderline Experience

Imagine you are faced with a minor stress – a flat tire, a
clogged-up sink, or a trivial disagreement with your spouse, friend,
lover, child, etc.  Instead of finding an acceptable solution, your mind
seems to panic.  A sense of unease develops, possibly causing
discomfort in the stomach or chest.  Feelings of anxiety complicate the
increasing sense of uneasiness and restlessness.  This is followed by
progressively worsening anger – eventually becoming a rage so strong it
overwhelms you – even though you realize it’s excessive.  Over the next
few minutes to hours, other negative sensations creep in – including
memories of past hurts – until you are experiencing virtually every bad
emotion a human can feel.


You feel trapped and vulnerable.  Your psychological defenses are
overwhelmed by unbearable emotional pain.  You feel depressed.  You find
yourself unable to cope as your mind and body are now in a full scale
panic.  You lose proper perception of reality – jumping to erroneous
conclusions in a futile effort to make sense of what’s happening.  As
the pain continues to intensify the nervous system creates bizarre
sensations such as emptiness, numbness, and unreality.  You become
incapable of rational thinking as the panic continues to worsen.


Your mind now desperately tries to find a way out of the pain and
searches for solutions.  It recalls past activities that have made you
feel better.  Once a method is found, your mind frantically forces you
to pursue that activity to a self-destructive excess – finally resulting
in a biochemical rescue.  Brain chemicals are released that stop the
pain and let you feel ‘normal’ again.


But how can you ever feel normal again knowing that such a
horrible experience will return?  How can you feel normal again when
your self-destructive and inappropriate behaviors are witnessed by
family, friends, employers and/or co-workers?  How can you feel normal
again when those behaviors result in financial, interpersonal, physical,
or legal trouble?


For those not afflicted with the Borderline Disorder this is a
nightmare we hope never happens to us.  Borderlines experience it over
and over – especially when confronted with stress.  While individual
borderlines may feel some symptoms differently, the horrible feelings
described in the first paragraph (called ‘dysphoria’) intrude frequently
into a borderline’s life.


Borderlines will do almost anything to make dysphoria go away. 
Most impulsiveness and self-destructiveness is an effort to relieve
dysphoria.  Some borderlines, especially those suffering very severely,
will literally cut their bodies during dysphoria.  The self-mutilation
is itself painless (the cuts don’t hurt), yet it relieves the dysphoria.


Borderlines also suffer from intense, frequent and unpredictable
mood swings that can cause ‘dysphoria’ even without stress.  The mood
swings cripple a borderline’s efforts to live a happy, successful life.
Borderlines are victims of an incredibly painful illness…


Like victims of epilepsy, muscular dystrophy, and
neurofibromatosis (the ‘Elephant Man’s’ disease), victims of borderline
neither asked for, deserved or caused their affliction.  The symptoms
can be so unpleasant to those interacting with borderlines that feelings
of compassion and understanding may be difficult or impossible to
feel.  Borderlines desperately want to be loved, but their illness makes
them at times seem unlovable.  They are terrified of being abandoned,
yet are powerless to keep the illness from destroying relationships.


This is the borderline experience.

The Facts

Genetic factors are important – borderline tends to run in
families.  The risk of developing borderline is 6 times higher when a
close relative has the disorder.  In studies of identical twins,
researchers have discovered that many personality traits are genetically
determined.  There is an association between some personality
characteristics and blood type (called ‘blood group antigens’).
Borderlines commonly suffer from other disorders as well.  PMS,
depression, hypothyroidism, vitamin B 12 deficiency, other personality
disorders, anxiety, eating disorders, and substance abuse problems are
the most common.  Intelligence is not affected by the disorder, but the
ability to organize and structure time can be severely impaired.  There
is no association with Schizophrenia.


…While many borderlines suffered from abuse or neglect in
childhood, some developed the disorder from head injuries, epilepsy, or
brain infections.  Early parental loss and incest are commonly
associated with borderline.


The facts indicating a medical origin are impressive: Brain wave
studies are frequently abnormal.  Neurological physical examinations are
abnormal.  Sound interpretation is impaired.  Memory and vision are
impaired.  Glandular function may be abnormal.  Sleep is abnormal.  The
response to some medications is bizarre.  When injected intravenously,
the medication procaine normally causes drowsiness, but a borderline
will feel the ‘dysphoria’ described in the first paragraph.  If
borderline was exclusively an emotional illness, why would all these
medical neurological abnormalities be present?


Borderlines likely have abnormalities with the neurotransmitter
‘serotonin’ – an incredibly important brain chemical.  Serotonin
problems can cause anxiety, depression, mood disorders, improper pain
perception, aggressiveness, alcoholism, eating disorders and
impulsivity.  Excess serotonin can depress behavior.


Serotonin deficiencies can cause many problems, especially
suicidal behavior.  Low levels of serotonin increase the risk of
self-destructive or impulsive actions during a crisis.  The most violent
suicides (hanging, drowning, etc.)  are usually committed in patients
with low serotonin metabolite (waste product) levels in the spinal
fluid.  In those who attempted suicide unsuccessfully, 2% will likely be
dead within one year.  If the serotonin metabolite level is low, that
risk increases to 20%.

Treatment

Due to new developments in medicine, borderlines can now be
treated and often cured.  The medication fluoxetine (Prozac) usually
stops most of the mood swings in a few days.  It is, in my opinion, as
big a breakthrough for borderlines as insulin was for diabetics. 
Borderlines generally see themselves very profanely.  I frequently tell
my borderline patients ‘you’re not an *#%@*, your brain is broken.’ Once
this concept is understood, the borderline patient usually feels an
enormous sense of relief.  They need to know they have value as a human
being.  Feelings of desperation and hopelessness are often replaced by
optimism and motivation once Prozac stops the mood swings and the
patient begins to realize that a happier, more successful life is
possible.


All borderlines need psychological counseling.  It’s almost
impossible to live for years as a borderline and not need psychological
help.  While the underlying problems are probably structural within the
brain, the borderline is left with a lifetime of bad experiences and
inadequate skills for recovery.


No medication should be given without proper medical supervision.
This is particularly true for the drugs used to treat the borderline
disorder.  Some medicines make the symptoms of borderline worse,
especially amitryptilline (Elavil) and alprazolam (Xanax).  Possibly a
third of borderlines may suffer from low thyroid (hypothyroidism) –
despite a normal ‘TSH’ blood test.  They may need to take thyroid
medication.


The antidepressant fluoxetine (Prozac), a serotonin increaser,
virtually eliminates the mood swings.  Feelings of anger, emptiness and
boredom are often eliminated or reduced as well.  Most borderlines I’ve
treated consider Prozac to be a miracle.  While some need the medication
indefinitely, many have been able to stop it after a year without the
mood swings returning.  Side effects are rarely a significant problem.


Neuroleptics…have been proven effective.  They are remarkably
helpful for treating dysphoria and psychosis, and can be preventive when
the borderline is undergoing stress.  They seem to ‘put on the brakes’
when the thoughts are racing.  They should only be used as needed, like
using an antacid for heartburn.  These medications can be effective at
low doses, and must be taken with great caution.


While medications can help with some symptoms, the brain is
clearly broken.  After a stroke, the brain needs therapy to let the
healthy areas take over for the broken ones.  The same is true for
recovering borderlines.  I feel strongly that the brain must be
retrained.  Affirmations…will work, as the human brain can believe
almost anything if told it enough times…


The psychology of positive thinking is very helpful.  I strongly
recommend massive brain re-education.  Devote as much time as possible
for 3-6 months reading positive self-help books and listening to
motivational tapes – especially those by the motivational speaker Zig
Ziglar…


Sometimes symptoms of ‘temporal lobe’ involvement (similar to
epilepsy) complicate the disorder.  Common symptoms include unawareness
spells, feeling like things are unreal, and numbness of body parts. 
These symptoms are more common under stress, depression, severer
dysphoria, and incest crisis.  They can be treated with the epilepsy
medication carbamazepine (Tegretol)…


Borderlines are VICTIMS – they did not cause their illness.  They
do not want their illness.  They want to be treated and possibly cured.
They deserve that opportunity.


The National Institute of Mental Health (NIMH) has been the single
most influential source of unbiased study and information regarding the
true biology behind the borderline personality disorder.


Landmark studies, such as those produced by Drs. Cowdry and
Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and
neuroleptics, and the dangers of Xanax (alprazolam).  This article was
published in the Archives of General Psychiatry Feb 1988.  A subsequent
article showed that conclusions of low brain serotonin in the BPD were
erroneous, low levels were associated with suicide, not the BPD.


Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research.”


Permission by Leland M. Heller, M.D.

The BPD New Management Concepts

The BPD New Management Concepts

By Dr Heller On November 2, 1991 · Leave a Comment

For Primary Care Physicians

by Leland M. Heller, M.D.

November 2, 1991

SUMMARY OF TREATMENT


1. Prozac 20 mg daily (clomipramine) Anafranil and other SSRI’s may prove to be just as effective

2. Haldol 0.5 mg q 4-6h prn (thioridazine, 10 mg and thiothixene 1 mg can be equally effective)

3. check for hypothyroidism, treat if suspicious

4. check for vitamin B12 deficiency

5. psychological counseling

6. stress reduction

7. help with spiritual issues

8. develop self-esteem

9. retrain the brain with books, tapes and affirmation


INTRODUCTION

The Borderline
Personality Disorder (BPD), a psychoneurological disorder affecting tens
of millions [1,2] is now treatable with a combination of medication and
other therapies. Fortunately fluoxetine (Prozac) [3] and low dose
intermittent neuroleptics [4] can stop most of the mood swings, and many
of the irrational behaviors. Untreated, these patients suffer from very
painful, difficult lives – and a caring health care professional can
make a profound difference.

GENERAL DESCRIPTION

According to Dr. Rex
Cowdry of the NIMH the “BPD is characterized by tumultuous interpersonal
relationships, labile mood states, and behavioral dyscontrol set
against the background of a relatively stale character structure. While
the syndrome can be identified with reasonable reliability, the
fundamental nature of the disorder remains unclear…” [ 5] See Table 1
for the DSM-III-R criteria. It is a worldwide phenomenon, being
described in the U. S., England, Scotland, Switzerland, Germany, France,
Norway, and Japan. [6] It likely affects approximately 2-3% of men and
5-10% of women. [1]

Prior to effective
medical therapy, managing borderlines was a difficult struggle. Articles
in Family Physician [7] and Nursing [8] journals describe them as
demanding, manipulative, disruptive, frustrating, non-compliant, and
hostile – especially when not medicated properly.

WHAT BORDERLINES EXPERIENCE

Untreated, a borderline
lives an emotional vertigo – experiencing totally unstable moods. These
mood swings and most any stress cause a horribly progressive dysphoria.
They intensely feel almost every painful emotion at once.

Borderlines desperately
search for relief, usually by endorphin releasing behaviors that are
ultimately self-destructive – such as binge eating, binge spending,
aberrant sexual behavior, substance abuse, and reckless driving. When a
severe borderline is extremely dysphoric, cutting the skin causes no
physical pain and actually relieves the dysphoria.

Because untreated
borderlines live with constant mood swings and frequent dysphoria,
normal psychological functioning is crippled. Understanding this enables
the Family Physician to help. Borderlines need to understand their
illness, and to be treated properly.

MAJOR SYMPTOMS

Mood Swings:
Mood swings are a fundamental devastating symptom of borderline. Moods
can shift inappropriately from hour to hour, even minute to minute.
Without appropriate environmental of though-provoked justification. [9]

Dysphoria:
A combination of depression, rage, anxiety, and despair – often
complicated by shame, humiliation, embarrassment, excitement, terror,
jealousy, and self-hate. It can be triggered by mood swings, stress, and
emotional pain. Once dysphoria begins, it tens to steadily intensify –
possibly due to limbic system malfunction. [5] The sensation is so
painful that borderlines will desperately search for a way out – often
relying on drugs, alcohol, self-destructive and impulsive behaviors,
self-mutilation, and suicide. [9.10]

Psychosis:
Psychotic thinking often develops when the dysphoria becomes severe.
Because of the psychotic episodes, borderlines are said to live at the
“border” between reality and psychosis. The main psychotic symptoms are
moods, physical sensations and perceptual distortions.

The dominant psychotic
moods center around worthlessness, badness, rage, and self-destruction.
The physical sensations are remarkably similar to temporal lobe epilepsy
and include unreality, derealization (familiar things become unreal).
Deja-vu, out-of-body experiences, depersonalization (as though no longer
yourself), unawareness spells, and feeling like body parts are numb and
no longer part of oneself. [9]

Psychotic perceptual
distortions primarily include transference (incorrectly perceiving a
present day person to be like someone hurtful from the past),
inappropriate interpretation of motives, and hallucinations. Psychosis
can also be brought on by drugs, especially alcohol and marijuana. [1]

Splitting:
Small children see everything in life as being all good or all bad.
This immature psychological defense persists in borderlines, resulting
in “black and white thinking.” When life events are perceived as bad,
dysphoria usually results. When things are good, the borderline
frequently feels vulnerable, and fears the black returning – often
leading again to dysphoria.

Other symptoms:
A borderline’s life is defined by inconsistency – mood, identity,
trust, behavior, attitudes, values and thoughts. While intelligence is
not impaired, [11] organization and structure are [12] – borderlines
have trouble following through and completing tasks. Access to memory is
frequently impaired. Chronic anger, fear of abandonment (often
resulting in manipulative behavior), lack of trust, impulsivity,
feelings of emptiness and/or boredom, jumping to incorrect conclusions,
and severe PMS are commonly experienced.

Comorbidity:
Borderlines frequently suffer from other psychiatric illnesses. The
most common include depression, [1] anxiety, [13] substance abuse,
alcohol abuse, [14] other personality disorders, and eating disorder
(approximately 40% of eating disorder inpatients suffer from the
borderline). [15] There is no association with schizophrenia. [16]

ETIOLOGY

Psychological theories
alone cannot explain the BPD. Borderlines have significant biological
abnormalities – see Table 2. CNS serotonin malfunction is likely
involved. Temporal lobe dysfunction is often associated with stress. The
BPD is probably a medical predisposition combined with environment
insult.

There are many
psychological theories and concepts, with considerable disagreement
among experts in the field. Both overprotective and underprotective
parents have been “blamed” as the cause. [16] Most theories center
around traumatic childhood experiences, arrested psychological
development (especially at the separation/individuation phase), and
reliance on maladaptive coping and survival mechanisms. [23,28]

Adoption, early parental
loss, and incest are often associated with the BPD. [14] The most
severe borderline patients suffered from both sexual and physical abuse,
usually while very young [6] – chronic dysphoria and derealization are
the best predictors. [29] In one study, 81% reported major childhood
trauma, 71% physical abuse, 68% sexual abuse, and 62% witnessed serious
domestic violence. [30]

Genetics:
The BPD tends to run in families, six times more likely in first degree
relatives. There is an increased family history of alcoholism,
substance abuse, other personality disorders, and depression, but not
schizophrenia. [16]

DIAGNOSIS

Psychological tests,
such as the MMPI and NIMH Diagnostic Interview Schedule, are only
accurate between 85 and 89%. [31,32] Most knowledgeable psychologists
can easily arrange for an MMPI. The NIMH test may be more difficult to
obtain.

If I encounter a patient
who has multiple complaints, especially fatigue, headaches, stress,
depression, etc. I will often review and discuss the DSM-III-R
Borderline criteria to determine if he/she feels 5 or more symptoms are
present. If yes, I will usually initiate treatment with fluoxetine
(Prozac), evaluating the patient and diagnosis 1 week later.

TREATMENT

Medications:

Prozac (fluoxetine):
Prozac appears to increase serotonin. It is a breakthrough medication
for borderlines – eliminating most mood swings, chronic anger, chronic
emotional pain, emptiness and boredom within 3 days. A daily a.m. 20 mg.
dose is usually effective. For most side effects (nausea, jitteriness,
agitation), reduce the frequency to every 2 or 3 days. If fatigue
develops, switch to an evening dose. While for a few patients the
serotonin deficiency symptoms resolve permanently in 6-12 months, most
need to take the medication long term. In my experience, clomipramine
(Anafranil) and sertraline (Zoloft) have shown similar efficacy.

Neuroleptics:
Can be effectively used on a prn basis during stress or dysphoria, or
prophylactically for stressful situations. I prefer Haldol 0.5 – 1 mg
every 4-6 hours as needed (side effects are rarely a problem at this low
dose). Navane (thiothixene) [3] and Mellaril (thioridazine) [4] have
been proven effective. High doses, especially in hospitalized patients,
are also effective. [4]

Tegretol (carbamazepine):
Can markedly reduce episodes of behavioral dyscontrol. [5] Extremely
effective for unreality, chronic dysphoria, incest crisis, relationship
dissolution, extreme anger, dissociative symptoms, and when neuroleptics
are ineffective. Dosing and blood levels are comparable to treating
temporal lobe epilepsy.

Thyroid:
Many borderlines have symptoms of hypothyroidism, with “low normal”
thyroid blood tests. Approximately 1/3 of borderlines have an impaired
TSH response to TRH. [33,34]

Vitamin B12 deficiency: Approximately 20% of borderlines have low vitamin B12 levels, with symptoms of fatigue, leg stiffness, and dysesthesias.

Medications to Avoid:
Xanax (alprazolam) can markedly worsen behavioral dyscontrol. [5]
Elavil (amitriptyline) increases suicide threats, demanding and
assaultive behavior, and paranoid ideation. [35] MAO inhibitors have
helped borderline symptoms, but may be dangerous due to the impulsivity
and behavioral dyscontrol borderlines can experience.

Psychological Counseling:
Borderlines need a multidisciplinary approach. A good therapist is
necessary, and borderlines should be strongly encouraged to get into
counseling. For some, a psychologist/family physician team is very
effective. Referral to a psychiatrist may be necessary. Psychiatric
hospitalization is occasionally required, especially for strong suicidal
ideation.

Stress Reduction:
Borderlines need to keep their stress level down, and to use
neuroleptics when under stress. Physical exercise, relaxation
techniques, and TM (Transcendental Meditation) can be very helpful.

Spiritual Healing:
Making peace with God and one’s spiritual self is very important. The
AA (Alcoholics Anonymous) approach can help, especially with destructive
behavior patterns. Borderlines generally hate themselves. I try to get
them to understand that they have a “good” soul that has been “stuck” in
a broken biological computer.

Self-esteem: Since most borderlines experience self-hate, strong efforts must be made to build a strong and secure self-esteem.

Retraining the Brain:
Borderlines must learn to think differently. Cassette tapes, books, and
affirmations can teach them how. I strongly encourage borderlines to
purchase and listen to the “How to Stay Motivated” tape series (or at
least “Success and the Self-Image”) by Zig Ziglar. (1-800-527-0306).

Borderlines need to
listen to positive/motivational tapes frequently and persistently. Brian
Tracy’s “The Psychology of Achievement,” and others (Earl Nightingale,
Denis Waitley, Robert Schuller) from Nightingale /Conant
(1-800-323-5552) are excellent subsequent tapes.

Borderlines must be convinced to read positive/inspirational books. I recommend How to Win Friends and Influence People by Dale Carnegie, The Power of Positive Thinking by Norman Vincent Peale, Seeds of Greatness by Denis Waitley, Unlimited Power by Anthony Robbins, Your Erroneous Zones by Wayne Dyer, and books by Leo Buscalia and Norman Cousins.

Affirmations: Saying a
meaningful phrase in a repetitive, broken record like manner – are very
effective. The borderline needs to say these affirmations dozens of
times daily, and within a few weeks they will subconsciously accept new
and much needed positive concepts. I recommend phrases like “I like
myself and feel terrific,” “I am lovable,” and “I’m a success.” This
technique is very powerful.

FINAL COMMENTS

The borderline
personality disorder is common and now treatable with a combination of
medications, psychological counseling, and self-help approaches.
Untreated borderlines suffer painful, destructive lives. They are
victims of an illness they don’t want and didn’t cause. They deserve to
be helped, and the primary care physician is in the best position to
initiate treatment.

TABLE 1 – DSM – III-R CRITERIA

“A pervasive pattern of
instability of mood, interpersonal relationships, and self-image,
beginning by early adulthood and present in a variety of contexts, as
indicated by at least five of the following:

1) a pattern of unstable
and intense interpersonal relationships characterized by alternating
between extremes of overidealization and devaluation.

2) impulsiveness in at
least two areas that are potentially self-damaging, for example,
spending, sex, substance abuse, shoplifting, reckless driving, binge
eating, (do not include suicidal or self-mutilating behavior covered in
No. 5)

3) affective
instability: marked shifts from baseline mood to depression,
irritability, or anxiety, usually lasting a few hours and only rarely
more than a few days

4) inappropriate,
intense anger or lack of control of anger, for example, frequent
displays of temper, constant anger, recurrent physical fights

5) recurrent suicidal threats, gestures, or behavior, or self-mutilating behavior

6) marked and persistent
identity disturbance manifested by uncertainty about at least two of
the following: self-image, sexual orientation, long-term goals or career
choice, type of friends desired, preferred values

7) chronic feelings of emptiness or boredom

frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behavior covered in No. 5)”

Those who suffer from the Borderline Personality Disorder have at least 5 of the 8 criteria.

TABLE 2 – BIOLOGICAL ABNORMALITIES

1) Abnormal neurological
soft signs (such as awkward gait, left-right confusion, and difficulty
with pronation/supination and finger-thumb opposition). [17]

2) Abnormal REM sleep. [18,19]

3) IV procaine, normally sedating, causes dysphoria in BPD. [20]

4) Abnormal auditory P300 on EEG – sharing a dysfunction of auditory neurointegration with schizophrenia. [21]

5) EEG abnormalities in 1/3 – ½, not usually correlating with symptoms. [22,23]

6) Altered platelet alpha 2-adrenergic receptor bind sites. [24]

7) Low platelet monoamine oxidase activity. [25]

Low circadian melatonin profile. [18]

9) Abnormal lithium transport. [26]

10) Normal head CT’s. [22,27]

11) Cases of BPD have been described from CNS trauma and infection. [27]

TABLE 3 – SUMMARY OF TREATMENT

1. Prozac 20 mg daily (clomipramine) Anafranil and other SSRI’s may prove to be just as effective

2. Haldol 0.5 mg q 4-6h prn (thioridazine, 10 mg and thiothixene 1 mg can be equally effective)

3. check for hypothyroidism, treat if suspicious

4. check for vitamin B12 deficiency

5. psychological counseling

6. stress reduction

7. help with spiritual issues

8. develop self-esteem

9. retrain the brain with books, tapes and affirmations