Your Brain on Art Part 1 - Bad Homoeostasis

Show Notes

Summary

Alex gets mental and physical in the bumper first episode on his series that seeks to illuminate the biological and psychological causes of mental illness and the reasons why art can help treat and prevent it. In this episode he discusses the causes of the epidemic of mental illness we see in society at the moment, offers some insight onto the mechanisms leading to this, and discusses how various treatments help us.

Transcript

We’re used to getting what we want in the modern Western world. And I don’t mean by that the Ferrari, and the hot spouse. I mean, when we want a big greasy burger with all the toppings, we go out the house and we get one and I’ll take a thick shake and a large fries with that thank you very much. When we want to get smashed, we’ll just go buy some beers, or go to the pub and get smashed. If we want a week long trail of debauchery on the south coast of Spain, just go do it, no problem.

When you want to see what your friends are doing, grab your phone, go take a look. You’ll probably find them on a week long trail of debauchery in the south of Spain. In fact, doing so was probably the very thing that led you to decide to want to go on a week long trail of debauchery in the south of Spain in the first place. You do this because you can, because fun and tasty and cool things are available and they’re relatively cheap, although perhaps not as cheap as they used to be. But for those of us with a bit of disposable income there’s nothing really stopping you. Your world’s full of people doing what they feel like and having all, or at least many of, the things they want. Some people have more than you and some people have less.

This perceived social imbalance causes us to be constantly alert to our status in the world. What we have and what we don’t, things we do and things we don’t do, how people view us, for better and for worse. It comes at as almost uninterupted stream via little glowing rectangles that we keep in our pockets or bags. This tends to leave us with a feeling that we’re missing something, or lacking something, all the time. Therefore you go eat a big burger, you go get smashed out of your skull in a pub, you go on holiday to the south of Spain…where you spend all the time looking at your phone only to find your that best friend’s on holiday in the Seychelles or climbing Mount Everest or something equally enviable or impressive. So there you are, experiencing the very thing you craved, yet feeling at deficit as stare at your lukewarm, murky-looking pina colada in a crowded Spanish bar full of other Brits with sunburn, swearing and singing crappy football chants too loudly. And so this cycle of stimulation and deflation, the boom and bust of getting and having but still wanting more, continues. The desire and envy screw keeps ratcheting and no end ever seems in sight. So you just focus on the nest shiny thing. You keep consuming in the hopes that one day you’ll have your fill, and can relax by your private pool in your private villa somewhere away from all the riff raff sharing picture perfect photos of yourself and making everyone else envious.

In the west in particular, this has become the societal norm. A feature, maybe even requisite, of unrestrained capitalism. This has led to some pretty malign results from a societal perspective with ever rising rates of anxiety, depression and other mental illnesses which have become an epidemic of discontent, despair and self-loathing. No one’s quite sure what to do about it.

I try to do my bit to alleviate the symptoms of this societal dysfunction, and I guess the causes too. That’s why this podcast exists. It’s why I tend to be painfully open about my struggles with mental illness - it’s good to talk, and it’s good to share. It’s also good to create. And I hope this podcast encourages people to create, and helps them do so. As per the core thesis of this podcast, I believe the act of creation is one of the most effective means of treatment and prevention of mental illness.

And one of the main reasons I think this is precisely because it helps relieve some of the pressure of this perma-hostile environment. The process at work that lead us to these unhealthy cycles are the same ones that can actually reprieve us from them. We can blame big business, technology, social media, celebrities, and capitalism for all of this, but the root of it is in your head, driven by complex machinery designed to keep us alive in a complex, peril-filled world. If you understand a little about that machinery, it might help you understand why these destructive cycles exist. It also gives us a clue about how to tackle them.

So as much as I’ve yapped on about the therapeutic value of the creative process on here, I’ve said very little about why I believe this to be the case. Therefore I’m going to delve a little into psychology, neuroscience, physiology and try to explain how this all fits together, why we get mentally ill and how creativity helps remedy and prevent this. I’ll put this in the context of other approaches to managing mental health, and I’ll try not to get too in the weeds. Because weeds there are. Lots of them.

Now, big disclaimer. I’m not a psychology, psychiatric or medical professional. I have informally studied these areas quite a bit in my quest to understand my own brain, but I’m far from an expert. Everything I say here should be taken with a level of caution, and should in no way be taken to constitute advice. That said, I’m going to try and be as accurate as possible. If any of this resonates, then please go do your own research, and/or consult a medical professional before taking any action. If you are the latter and you spot anything inaccurate or misleading in here, then feel free to drop me a line and let me know and I will endeavour to set things straight.

Right, enough of disclaimers, on with the show.

When we think about human mind, we think of it a computer, perhaps with a ghost in the machine called the soul, but we’re going to sidestep that debate for the moment. This computer takes in information about the world around us via our senses, decides how to react to whatever new information is coming in, and sends signals to the rest of our body to take some action. So when you round the corner on your way to the shop to pick up some milk and see a tiger malevolently staring you down, your brain tells your body to flee back from whence you came hoping frantically that someone more tasty-looking passes it’s eyeline before it give chase to you. A very logical course of action given the circumstances.

On the other hand, especially when it comes to interactions with other humans, and to an extent, the animal kingdom, the experience of the brain’s functions appear fundamentally emotional and not like a computer at all. So when the rounding the same corner the next day you see Condescending Karen Almighty Gatekeeper of Taste and Decorum has spotted you and is traversing the road for today’s barrage of passive aggression, you feel suddenly panicked, especially since you left the house in your sofa clothes. Part of your brain is telling you to run away, just like when you spotted the tiger. Which isn’t so logical.

These two characterisations of the brain seem at odds - one one hand, mechanical and logical, on the other hand emotional and sometimes irrational. But these two aspects of the brain aren’t separate at all, they all part of the same set of processes, they’re just different aspects of the same machine. Think of it like, say, a camera, which, these days anyway, both takes photos and displays them. You can either think of them as separate functions or just part of the requisite functionality of the device.

They are not distinct. We are not a computer sitting atop a doing machine, like a human driving a car. The thinking machine we call the brain is simply the main component of a complex thinking-feeling-doing machine called the nervous system.

So when Condescending Karen traverses the road and you feel that general sense of unease and mild panic, a complex stream of processes are work that’s driven by a machine that sees it’s primary process as keeping you alive and well and free of conversations with self-important school mums. The nervous system is usually very good at this, but sometimes, like any machine, it goes wrong. Mostly this happens briefly, as we react to the ever changing world around us. But sometimes it goes wrong and stays wrong for long periods. When this happens, we experience what is known as mental illness, a term that encompasses a broad array of conditions. But of the purposes of this conversation assume I’m referring to the category of mental illness that mainly affects emotions, such as anxiety, depression, panic, all that fun stuff.

It’s worth getting a little bit technical for a bit, and define some terms and concepts that we’ll be referring to quite a bit for the rest of this and future episodes. Don’t worry, I’m going to try and keep things high level.

The human nervous system is a complex biological network responsible for regulating bodily functions, processing information, and allowing communication between different parts of the body. It consists of two main parts: the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which connects the central nervous system to the rest of the body.

The autonomic nervous system is a part of the peripheral nervous system that controls involuntary functions, such as heart rate and digestion. It has two main branches: the sympathetic nervous system and the parasympathetic nervous system.

The sympathetic nervous system is often called the “fight or flight” system, preparing the body to respond to threats. It boosts heart rate and redirects blood to muscles, mainly through the release of noradrenaline and adrenaline. This helps us react quickly in stressful situations such as the tiger incident. It’s the “don’t think just do” system.

On the other hand, the parasympathetic nervous system promotes relaxation and recovery, known as the “rest and digest” system. It slows the heart rate and enhances digestion.

Together, the sympathetic and parasympathetic systems maintain balance in the body. This state of balance is sometimes called homoeostasis, a word that derived from Greek and translates roughly to “the same as standing still”. This is a term I’m going to refer to quite a lot.

Paradoxically, given that many mental health issues arise from our cognition, the thoughts we think, conditions such as chronic anxiety and depression happen when the autonomic nervous system, the non-thinking bit, gets stuck in panic mode. States of affairs that we are aware of, cause malfunctions in the system we’re largely not aware of. But the ultimate cause of this mental malaise is what I call “bad homoeostasis”. Your autonomic nervous system can’t balance itself. To understand why this happens, we need to introduce what will become a very familiar term: neurochemicals, most specifically neurotransmitters and hormones.

The things that we refer to as nerves are actually called neurons. These are the wires of the nervous system, transmitting signals using electrical impulses throughout the brain and body. When a signal reaches the end of a neuron, it releases chemicals called, neurotransmitters. These neurotransmitters cross tiny gaps known as synapses to communicate with other neurons, influencing everything from our movements and senses to our moods, thoughts, and behaviours. For instance, serotonin helps regulate mood, while dopamine is linked to pleasure and reward, oxytocin is involve with social interactions and Acetylcholine aids movement.

What I’ve actually done thus far, and will continue doing is mixing up neurotransmitters - serotonin, Acetylcholine and dopamine - and hormones - oxytocin. For the purpose of this conversation, the difference doesn’t really matter, but basically, the neurotransmitters are manufactured and mainly by the nervous system, while hormones are made by the endocrine system, where stuff like insulin is made, and tend to be responsible for carrying out the commands of the nervous system. From here on, I’m going to ignore the distinction for the most part.

Since the nervous system runs on impulses transmitted by brain chemicals, those chemicals play a pivotal role in the working, or lack thereof, of the nervous system. Depending on what’s going on in your environment, different neurochemicals are created and released that trigger physical and emotional reactions. So when you’re being chased by that tiger, you’ve got lots of the neurochemicals adrenaline and noradrenaline exciting all the functions associated with prioritising fight or flight functions such as heart rate, alertness, deprioritising digestions, and triggering your bodies cooling system, and you start to sweat.

To simplify, perhaps grossly, but in service of getting my point across, the neurochemicals come in 2 main flavours:

• Those that rev us up, sometimes called stimulants, such as dopamine, adrenaline and noradrenaline
• Those that chill us out, such as serotonin and Gamma-Aminobutyric Acid aka GABA

I say this is a gross simplification, because the purpose and action of these chemicals complex and each one has various purposes in addition to their affect on mood and behaviour, for example serotonin plays a role in digestion. Their action may also affect people differently. For example for folks like me with ADHD, supplementing our levels of the stimulant dopamine, via medication or by drinking coffee, can actually make us drowsy and lethargic - the opposite to the way it affects most people. This is because dopamine is implicated in our reward seeking behaviours. ADHD brains like mine lack, or poorly regulate, dopamine therefore ADHD people are constantly seeking rewards usually via stimulating situations or activities. When you give us dopamine, this emulates getting that reward, and we can finally chill out. Having larger doses of dopamine, however, will put us in double speed mode similarly to everyone else.

All mood altering drugs do their thing by altering the amounts and actions of these chemicals in our bodies. This is includes coffee which increases dopamine, and reduces the sleep hormone adenosine, speed which increases dopamine and noradrenaline, alcohol alters dopamine and GABA levels, acid which, among other things, boosts serotonin.

In those times where you’re not being chased by a murderous feline or are “e"ed up to the eyeballs at a rave, your body’s job is to keep all these chemicals in an optimal balance - homoeostasis. But it’s not always able to do this, and sometimes this equilibrium get completely disrupted.

So imagine if Condescending Karen followed you around all day every day droning of about how smart her darling, Gucci adorned offspring are. Just once or twice a week would be just about bearable, but constantly? She’s not a threat per se, but you’re constantly on edge in case you say the wrong thing and suddenly all the other parents are giving you funny looks. Since she’s always lurking, your sympathetic nervous system rarely disengages. Even when you find moments of peace, your nervous system can’t full recover. When fight or flight is triggered, your body releases the hormone cortisol, which is sometimes called the “stress hormone”. This is the hormone responsible for putting your body in panic mode. It takes a while for cortisol to clear from your system. Therefore if you get stressed again too soon after getting a break, you never really “wind down”. Anxiety breeds anxiety, and fight or flight mode makes you hyper-aware of threats, which means you start to see them everywhere - a comment someone makes, an unusual meeting called at work, a strange pain in your belly - which in turn causes your body to release more cortisol. If you can’t get a proper break, you can get stuck in an anxiety doom loop, so even if Karen retreats permanently to her gated community, you may not be able to break the cycle. This is when chronic anxiety and depression rear their ugly heads.

This is why I sometimes call these illnesses “bad homoeostasis”. Your nervous system has lost its ability to reassert the equilibrium its usually so good at maintaining.

The Karen situation is a little contrived, although I’m sure we all know someone like that. But it’s really just a metaphor for much more common situations that also lead to these bad outcomes. You may have a patronising acquaintance, but maybe it’s sustained stress at work, illness of a loved one, new baby. It doesn’t even have to be something life changing, a noisy neighbour, a broken leg, not being able to do some activity that you love, can all cause your system to go haywire if experienced over a long period. For us autistics, just dealing with day to day activities and routine human interactions tends to set off our fight or flight response, and therefore we are considerably more prone to these types of stress related, chronic conditions.

One of the reasons that these conditions are so widespread relates to the theme that I started this episode off by talking about. Societal pressures and the anxieties these cause are nothing new, but thanks to more recent technological advances, they are much more present and more problematically, they are pretty much perpetually present. This is exactly like the Karen following you around everywhere. Every time your phone chirps, you get a little dopamine bump and you log on to see what’s happening. You find yourself on Facebook or Insta or Snapchat, and society, Karen and all her sycophantic cronies, elbow in. This, of course, is purely figurative, but that’s not how your subconscious sees it. No one, well hopefully no one, is peering back out at you, but you feel seen, observed. Since most people never turn off of leave the presence of their phone, this feeling never goes away.

We’re not designed for this. Our homes are a refuge because that’s where we shelter from the day to day dramas and etiquette of society. It’s somewhere you can wear something comfortable but ugly, forego any sort of grooming and loaf on the couch watching Adam Sandler films. Society doesn’t belong here, but there it is, leaking out at you from that little glowing rectangle. Therefore you never really relax. That respite is not a luxury, most of us simply can’t function properly without it. Having your phone constantly there is like deliberately putting grit in your bed! This is bad enough when that constant imposition is just passive, but particularly among the younger generations, this impingement goes far beyond every day dramas and into direct and unavoidable harassment, sometimes with tragic consequences. Smart phones have a so many benefits, but it’s becoming increasingly clear that those benefits are more than balanced by their down sides.

If you find yourself suffering from chronic anxiety, then that little rectangle is not likely to be much comfort, and many of the people it allows to protrude into your life will be less than sympathetic to your plight. Not everyone understands or is willing to have sympathy, especially when they’re on the other end of a wire.

Mental illness is just like any other type of illness. It has causes and treatments. However there’s an odd but pervasive stigma around mental illness that seeks to make us believe it’s all imagined and therefore the sufferer can “just pull themselves together”, “snap out off it” or “cheer up”. But mental illness is never imagined, and people can’t just pull themselves together any more than someone with dysentery can just get on with eating and give the toilet a break.

So once you got yourself some bad homoeostasis, how you return yourself to equilibrium - how do you treat mental illness? It’s outside of the scope of this podcast and my expertise to go into any great depths here. All I really want to do is talk about why the major forms of treatment work, in the broadest possible sense, because it gives us a clue as to why art is such a valuable therapeutic pursuit.

For out purposes I’m going to great down treatments into some very broad groups:

1. Medicines
2. Talking therapies
3. Physical exercise
4. Mindfulness
5. Activity based therapies

I’m deliberately not covering the more invasive or extreme medical interventions for more profound or debilitating disorders such as electro shock therapy. And I’m steering clear of “alternative” medicines that have little to no basis in scientific research. I’m not discounting these on premise, but until they have a little more evidence behind them, they can’t be considered effective treatments, whereas the rest of them do and can.

I also recognise that there are varying degrees of scepticism about some of these, especially antidepressants and mindfulness, even within the medical and scientific communities, but I’m going to stick with the mainstream scientific views here, not least because doing so backs up my core thesis. If you want to debate this stuff, feel free to do so with the next medical professional you meet.

So, onwards.

When we think about mood altering drugs, we think of often illegal substances that make the user feel good, often accompanied with less desirable side effects like dependency, physical ailments and er, death. That might be the case with cocaine, but the stuff used to treat anxiety and depression don’t really work that way, despite working along similar lines.

To understand how they work we need to go back to our “bad homoeostasis caused by sustained stress” scenario, via an analogy.

Imagine a pipe in your kitchen has sprung a major, gushing leak and is spewing water all over your kitchen floor. You’ve go no plumbing skills and no idea that the concept of stopcock even exists, let alone where to find it. You’re able to hold back the flood somewhat by putting a bucket under the offending pipe, but it fills up in a matter of seconds, you don’t even have time to call your dad to ask for advice or to call for an emergency plumber. You just need a break so that you can take some proper action without completely destroying your kitchen. Then you have an idea. You remember that if you have two or more taps running in your house at the same time, they all run down to a trickle. That’s usually annoying, especially when having shower, but it proves to be a godsend right now. You rush to the bathroom and turn on all the taps there as well as the shower. When you return to the kitchen, the leak is still ejecting water, but now at a much slower rate, and so you now only have to empty the bucket once every few minutes. Sure you’re wasting water, but at least now you have time to make some calls and fix things. Maybe that will take no time, or maybe you’ll have to keep hauling water for a couple of hours until help arrives, but you are at least able to deal with it.

When you fall into one of these spiralling, self-perpetuating doom loops, your body and brain tend to spend all their free time and energy on dealing with that, like the gushing pipe. Most treatments are less like an experienced plumber simply locating the stopcock, and more like the scenario outlined above. Yes do have the psychological machinery to get better, but it’s fully engaged in the act of trying, and failing, to prevent things getting worse.

What treatments like medication do is buy that psychological space to attempt to fix the real problem. The most common type of antidepressants are SSRI, Selective Serotonin Reuptake Inhibitors, such a prozac aka fluoxitine, and sertraline. I won’t go into the specific mechanism of how these work, but they increase the levels of inhibitory neurotransmitter serotonin in the brain, which in terms has a calming effect. You don’t feel good when you take them, in fact you barely feel anything at all, but over weeks and months, they take just enough pressure of your embattled nervous system that it can divert some resources to regaining that much needed homoeostasis. While this is happening in the background, your constant panicking and racing anxious ruminations subside, you feel generally more calm and start to see the world through more rational eyes.

If external factors are responsible for getting you into this state, for example you lost your job and have been struggling to find a new one, then this psychological headroom will make it easier to to take on that task. The source of your trouble hasn’t gone away, but you’re in much better shape to deal with it. And deal with it you should if you possibly can. Because medication can only do so much, and many people relapse when they come off these medications not because they didn’t work, or because they are doomed to suffer as humans, but because they were only ever there to tackle the symptoms. If the cause still remains, and you’ve done nothing to ameliorate it, then the illness may well return. It’s like visiting a house of cats while being allergic to cat fur. You can take antihistamines, but if you don’t leave the house, you’ll be sneezing again as soon as they wear off.

So if both illicit and prescribed substances alter your brain chemistry, then why not just go out, score some coke and get smashed? There a few reasons why this is not a good idea, as fun as it might sound, and perhaps be. We’ll sidestep the obvious legal problems, which I think obvious enough to go without saying, and stick with the inevitable side effects.

So one of the main treatments for ADHD is dexamphetamine, and the more socially liberal of you out there might have spotted that that sounds very much like the formal name for the party drug known as speed. You know, the one that Lemmy from Motorhead mainlined and that students use to get themselves through exams. And you would be right, they’re basically the same. I am prescribed dex to manage ADHD, which basically means I go to the pharmacy every month to pick up big bag of pills that have serious street value. And yes, I could in theory get off my nut on the stuff, but I don’t because it would just make things worse. Dex only has the effect that it does, to allow me to focus and to take the edge off of the constant need for stimulation, in small, controlled doses. In fact, most forms of ADHD stimulant meds are prescribed as slow release pills that yield a small amount of the drug throughout the day, ensuring that a) it can’t be abused and b) you get the requisite dose drip fed in measured. It’s still possible to take too much which generally makes me feel like crap - it’s similar to drinking too many espressos - and gives me brutal comedowns. And that’s exactly the problem with taking high doses of mood altering drugs - you get into a boom/bust cycle that tends to spiral as you need more of the drug to account for the comedowns, making the next comedown worse. And so on. Anything that increases dopamine as part of it’s effect is also potentially addictive, and we all know where that leads. There are also various other side effects that only increase with higher doses.

So even though some of these drugs can be abused, it’s always counterproductive. The same applies to stuff like alcohol and caffeine, which are arguably even harder to manage. The illegal stuff comes with a whole bunch of other perils such as not knowing what’s actually in it, having to deal with drug dealers, illegality, unpredictable supply, differences in quality and strength, high costs, higher risk of overdose or poisoning, etc. etc. Don’t do it kiddies, it ain’t worth it.

I’m getting sidetracked, but since I’m talking about mind altering drugs, I figured I better put some guard rails in.

So where does that leave us? We now see that the nervous system is, among other things, tasked wit the business of managing our emotional and physical equilibrium, and that when that equilibrium is persistently unbalanced we get bad homoeostasis which manifests as mental illness. We can take medication to help with this, but there are other methods we can use to treat it and help maintain our equilibrium. That’s what we’re going to talk about on the next episode in this series. We might even get to talking about art again!

So, biology lesson over kiddies. Please proceed in an orderly fashion to the playground. And remember: be nice to each other.

While you’re there, , since you’re going to be glaring at your little glowing triangle anyway and instead of doomscorlling, why not leave a rating and a review of this podcast on wherever you’re listening it. And if you do end up on social, tell all your friends to come have a listen.

See you soon.