Friday, April 22, 2005

Strange day...

;p trying to think of a title for this post... inevitably, this has a title by the time you read it, so what's going on in my head at the moment might be a rather confusing, redundant ramble that won't really interest you anyway... so without further ado, i'll go on to describe a really strange day ;p

relatives have arrived here yesterday - seven of them, all of whom are my mum's siblings (there are 11 brothers/sisters total), are all staying at our place!!! somehow this seems to still work... only greeted them this morning, after being woken at 4am, and being grumpy, due to being unable to get back to sleep for quite a while... somehow was still able to exchange pleasantries, as is customary... ;p

set off today for train, miss intended train, and have to wait... get on train, conscious of running late to my 9am tute, but seemingly unfazed... miss tram at flagstaff and wait for ages, adding to degree of lateness... next tram comes, i see sandra on board - so good chance to catch up - incidentally, first of some bizarre bump-into-ppl things today... after sms'ing several ppl to inform of my impending lateness, i turn up only to find that not only am i the only student to turn up, but that the tutor has cancelled the tute too!!! feel much like idiot at this time, later learning that i ought to have been in the camp of the other students who either forgot, slept in, or were off with some other psych team... yeh, i could've slept in!!!

ah well... anywayz, get to rmh, in unmotivated, sulky mood, trying to cheer up self by reading blogs ;p yah... anyhow, cath turns up and tries to motivate me... she succeeds, we set off to interview a patient... on the way, bump-into-ppl thing happens and we see eunice and mark (haven't seen mark for yonks!!!) who take the opportunity to talk to us abt long cases... all those of u who are doing long cases in 5th yr, don't panic!!! - key elements are a thorough history, presented with "some structure" (you'll learn so many different structures, you'll get confused, but so long as you have some structure, u'll be fine), a focused physical examination (yes, really focus on what you expect to find given the history!!!), and topped off with an ability to ramble indefinitely if need be... ;p

anyhow, i digress... we continued on our way to ward... and meet a patient who happens to have all these roundabout connections to both myself and cath!!! we end up really connecting because of these coincidence things, and have heaps of fun really... shall discuss no further, lest i risk incriminating myself and breaking the hippocratic oath re: confidentiality... anyhow, really pray for her (our patient), she's really got a lot to live for!!!

finally have a good tute, my presentation went well (see, if i can do a long case, even tho it's psych, anyone can!!!) ;p some really helpful tips from tutor abt organisation of the psych presentation (e.g. grouping by diagnostic criteria, refined focus in mse)...

after tutes, wind up at uni, sally has to pick up this book, and the librarian asks about christian union... ;p so that's really awesome, she and sally get talking, and turns out they know some ppl in common, and are attending the same b'day party 2moro nite!!! coinkidink?!? or what?!? ;p God really has demonstrated His awesome reign and wonderful sense of humour today, i tell u!!! - so much so i had to indulge in half a pack of m&m's...

had some wonderful dinner... looking to start planning for next yr (yes, next yr already...) - but ought to sort out car troubles... hope it can be fixed in time for beaufort trip!!! mind tripping atm... need sleep... (get out of overdrive... haha... before i self-diagnose mania or schizoaffective disorder or something...)

God bless ;p

dave

Friday, April 15, 2005

On an article...

hey - jus writing down some of my musings abt this topic in response to an article i read recently... the reference, for anyone who's interested is:
Fuchs T (2004). Neurobiology and psychotherapy: an emerging dialogue. Curr Opin Psychiatry 17:479-485

firstly, i'm hardly in a position to challenge the expert opinion of an associate professor at a major european uni... so what i'm saying, to go in the face of some things implied by the article, is probably somewhat foolish!!! but i jus thought i'd say it anyway... i guess what i'm saying doesn't really argue against anything that he says, but rather jus puts a different light on the findings described in the article... - i'll quit rambling, here goes:

fuchs' article outlines some exciting, recent developments that link, by correlation, psychotherapy and neurobiology, which are two traditionally separate scientific fields... neurobiologists probably see their field as far more "scientific", but as psychotherapy is increasingly pressured to join the bandwagon of evidence-based therapies in order to survive in mainstream psychiatry, studies are being carried out looking at brain changes brought about thru psychotherapy and comparing them to brain changes brought about thru pharmacological intervention... - neuroimaging has gone a long way to making this possible... some very interesting findings have come to light - these include the similar neuroimaging findings across the two modalities of therapy, the temporal dimension of change brought about by the two modalities, and the circuits involved in mediating the long-term brain morphological effects of psychotherapy...

i'll begin with a brief overview of psychotherapy - a modality of treatment consisting of courses of sessions with a psychotherapist (psychologist or psychiatrist, usually) that finds its origins in the psychoanalytic theories of freud... the image that comes to mind is one of the patient on the couch, and the psychiatrist in a chair, a cozy room, and the patient divulging intimate details about past lives to a psychiatrist with an ulterior motive!!! of course, there is in truth much structure to psychotherapy, and more recent incarnations of psychotherapy are short courses of 10-20 separate hour-long sessions in which certain themes in the patient's history are explored using sophisticated, controlled techniques in which the psychiatrist not only seeks to understand the patient, but his or her own reaction to the patient's story also... the current vogue is cognitive-behavioural therapy (CBT), which is a form of psychotherapy in which the patient is encouraged to exercise thought-pattern and behavioural changes slowly and consistently to overcome his or her problems, often employing goal-forming and distraction techniques to achieve these changes...

CBT has been found to achieve very similar brain changes on neuroimaging to pharmacotherapy for certain conditions, such as obsessive-compulsive disorder... this is an encouraging finding, since although both had some level of evidence that they worked, the neuroimaging findings support the view that a disturbance in the architecture of the brain (distinguishable at an anatomical level) is associated with the disorder itself, and not merely a confounder... on the other hand, different changes were observed between the two types of therapy when applied to depression...

the temporal aspects alluded to earlier were ones of a more top-down progression of change associated with psychotherapy, and a more bottom-up progression associated with pharmacotherapy... the implication here is that psychotherapy recruits the active involvement of the cortex, and reorganisation thereof causes secondary changes in associated circuits in lower centres, while pharmacotherapy primarily targets the lower centres... this makes sense as well, with pharmacotherapy being more targeted at different neurotransmitter pathways, which are usually localised in lower centres, while psychotherapy's involvement of the conscious mind implies the involvement of the higher centres (cortex), which has traditionally been described as the part of the brain responsible for consciousness, and "what makes us human"...

i guess this is the point that i find contentious... the point of view put forward commonly in scientific papers such as this one tends to ignore or exclude the existence of a mind that transcends the physical world... as a dualist (as in, one believing in an extraphysical mind), i tend to look upon conscious humanity as being an entity additional to, rather than emergent from, the physical brain... now what relevance does this have to the article?!? - the existence of mind-brain correlates, as found by neuroimaging following intervention, should not be interpreted to imply that the brain is therefore responsible for the mind-state... the brain, to me, is simply reflective of the mindstate, and certainly exerts influence over the mind as much as the mind exerts influence over it... the fact that psychotherapy, as every interpersonal relationship, is going to involve connection between minds, does not mean that psychotherapy implicitly will have no effect on the brain, since the mind and brain are very closely related units...

take memory for example... ppl talk about implicit and explicit memory, and different circuits in the brain being involved in each... yet these structures have been shown to be associated with memory formation, but no area has been proved to be associated with memory storage as such... - does this mean that memory isn't stored in the brain?!? - i don't think it's a wise thing to extrapolate and say that it definitely isn't, but i think that the distinct possibility that memory may be stored in a mind additional to the brain should not be discounted... brain changes related to learning also should not automatically be attributed to storage - since there are changes in the memory formation apparatus (refinements) that may well result from the process of learning...

memory is a really interesting concept - i can look at a scene, and take it in, and remember in great detail so many aspects of the scene... we can all do this, with remarkable success, through processes that are unconscious as well as conscious ones... an interesting question, though, would be whether the rich sensory information that is able to be remodelled with recall can be stored in some compressed, compact format in the brain itself... such a complex system of memory storage would be an amazing feat of association (between all five senses, previous experiences, and completely novel constructs with each experience), and an amazing metabolic accomplishment, since remodelling is constantly necessary to live a well-adjusted life... not only does memory cover perceptual experience, but also conceptual experience, whereby the mind forms or encounters abstract constructs in order to help make sense of the world... this, in effect, is imagination... anyhow, to think that such amazing things are possible with the brain in isolation, given the physical limitations of the brain organ, is quite mind-boggling... to me, it seems to make more sense that the mind allows us to transcend these limitations...

i can come up with counter-arguments to myself tho... what of the monkeys?!? do they also have minds?!? after all, they seem to have a fairly strong sense of declaritive and procedural memory too... it's a hard topic... i really don't know... but i'm always finding this interesting, and hoping to find out more...

anywayz, have been rambling long enough... ;p shall return to reality once more... ah, the responsibilities of being a member of human society...

Thursday, April 14, 2005

Ages - no blog...

fern's msn name is kinda relevant right now... "sometimes i wonder why, why i'm even here at all, but then you assure me, i'm a little more than useless"

it's true, God cares for me, God cares for each one of us... i mean, He created us in His image... we bear His likeness, so what more need we do but look in the mirror and see that God is with us!!!

had christian union meeting today - talked abt revelation 4-5, transport to heaven in Jesus' revelation to john... and how much more did God intend for us to have!!! God is with us already - but look at the middle of the passage, and realise that john was weeping, for there was nobody worthy to open up God's scroll - i.e. set God's plan in motion... - this is kinda where we feel we're at... incomplete, meaningless, useless... we weep too... for we find we are blind to what God has yet to reveal...

but the one who is worthy to open up God's scroll is, of course, Jesus... ;p He, the lion-lamb, has come to reveal the glory of God to us here on earth... so that we may be with Him in heaven in the time to come!!! our purpose is also revealed in this passage - that is, to worship the living God with all we are, and in all we do... praise God!!!

so why is it that i still feel useless?!? i want to be all things to all ppl... i want to go beyond who i am, to be who God wants me to be... and coz i fall so far short of God's standards, i'm overwhelmed by a sense of inadequacy... i wish to be able to extend and share my sense of God's presence with the world, and with those around me... yet i'm stopped by my own inability to recognise my own problems in the first place... i jus pray, full of the knowledge that God's plan is in motion, that Jesus has unrolled the scroll for my life... i wonder what will become of it in the end... i pray God, tho it's hard to see right now, that my life will be a true light for the world...

Saturday, April 02, 2005

A void to be filled

been feeling quite strange and grumpy again... hard to say why - i mean, i am the recipient of so many blessings from God, more than i could ever deserve - so then, how is it that i should feel like there's a void in my being that's in need of filling in?!?

firstly - a word of apology to all those who have been affected by my grumpiness... i hope i can make it up to u sometime...

also, talked to mary earlier abt this, thx mary for sharing and being such a great help to me... God bless u!!! i'm going to use this blog as a bit of a problem-solving slate... hopefully it'll help yield some answers?!?

some contributing factors to my mood:

fear/insecurity - i'm sure fear probably plays some role... i have all these blessings - yet, i don't deserve them... it only seems right that i'll be punished severely and lose all these blessings in the process... perhaps i'm fearful of such an event... perhaps i'm also fearful because i simply don't have my own handle on things - i'm not in control...

repression/denial - this isn't the first time i've felt strange and grumpy like this... if i repress/deny my feeling, then this is only as good as putting a starving monster back into a glass cage without dealing with it in some way... it'll come back twice as angry next time, bursting out of that insecure cage at the worst possible time, when one's back is turned...

inadequacy - this is something that also surely causes terrible moods, coz i am a sinner, no better than anyone, yet i seem to be the luckiest person when it comes to many things... i have nothing really to offer that nobody else can provide... i've got more than my share of the meal, but can't cook to save my life!!! i'd like to be able to learn, develop into someone more like who God wants me to be... i try, but it's a straining effort against the limitations of humanity and my own willingness...

competition - hmmm, this is a strange one to put here... but i think this is a true factor!!! pride, competitiveness and need for recognition all feature under this heading... i like to think that i'm good at something... yah?!? sometimes i need affirmation... and it doesn't help if i can't prove to myself that i'm any good at something i try... it seems cruel, but certainly honest that triumphing in competition (which implies comparison and hence loss for another person) can make someone feel better... pride in oneself confers a dependence on recognition in order to maintain that and feel good... but i have nothing to be proud of, and i ought to have nothing to be proud of - truly!!!

perpetuating factors:

this is where my eyes are being opened - i think... i've always been able to identify some possible reasons why i might be feeling strange... - but these have all been based on my characterising how i've felt at the time... fear, guilt, shattered pride, self-deprecation, are some of the things that dominate my mindset when i'm grumpy... this much is clear... but jus as clear is the solution - that God alone can fill my void!!! but then, why is it that i still feel this way?!?

there's definitely a difference between the intellectual knowing of God and experiencing a personal relationship with God... there are things that are hindering this, and these things are among the perpetuating factors that mean that this mood becomes an increasingly frequent recurring theme... i have been in a personal relationship with God since accepting Christ as my Saviour about eighteen months ago now... but like many, i think i might be encountering a spiritual wall, like a spiritual lethargy, in that my heart feels less free to give of itself unto God... much of my daily walk with God, from prayer to reading to every decision i make, becomes felt more like a restriction rather than freedom and fulfilment...

probably the first out of those factors is my tendency to ignore and repress my moods... often, i feel exhausted by the efforts i make in order to please others and become the person that God wants me to be... and it can feel like an unrequited love at times!!! effort goes in - but i am ignored, set aside, my efforts minimised or laid to waste in a gesture that's clearly not meant to insult, but can feel like a sledgehammer... but all the while, i continue to try, in the process keeping a pleasant façade, an exterior that says to the world that everything's ok... then i collapse suddenly - the feelings mounted to the surface, and overflowing... in this mood, i jus can't function - everything seems like a conspiracy, and it seems like everything i've lived for has all been chasing after the wind (like in ecclesiastes)...

probably the second of these factors is another thing inherent in myself - impatience... i am trying to breed patience, truly!!! and pray for it frequently... but it's hard... expecting that things are going to fix themselves within a short time, expecting that others will understand with little need to explain... thinking that it's a simple matter of one prayer and God will answer... - perseverance is needed too... perhaps i've jus slowed down too quickly and expected too much... but God has given us a lifetime...

the third - the fact that i've now been a Christian for about eighteen months, i'm probably jus emerging from that "honeymoon" period of feeling things with a freshness and driving me on... do i need a new way of worshipping?!? or do i jus need to persevere, trusting all the time in the truth that God will bring me out of whatever he brings me to?!?

solution:

hmmm... this is where i need to be working ;p am feeling slightly happier that i've sorted thru some of this... but mary made me realise that i ought to be acknowledging the simple truth and not putting on a façade... i need to let go of the pressure that i sometimes feel to be outwardly happy all the time, and instead be simply who i am... an unworthy sinner who needs God fully... and re: the spiritual lethargy, be honest to God that i am a person with doubts, who gets grumpy and frustrated without understanding it... there's never an easy process, but hopefully, by no longer denying and repressing my moods unhealthily, the lid can be removed from the boiling pot of uncertainty, fear, insecurity and inadequacy, and hopefully i can resume my walk with God in the direction He wants me to go!!!