What Does Kurt Gödel’s Incompleteness Theorem Have to Do With Mental Health?


In 1931, Kurt Gödel, a brilliant mathematician, gained quite a bit of fame with his “Incompleteness Theorem.” What Gödel stated was the following (in non-technical terms thanks to a Wikipedia article):

Any effectively generated theory capable of expressing elementary arithmetic cannot be both consistent and complete. In particular, for any consistent, effectively generated formal theory that proves certain basic arithmetic truths, there is an arithmetical statement that is true,[1] but not provable in the theory (Kleene 1967, p. 250).

Reading this, although directly applicable to mathematics, hit home as an analogy for mental health care and the quest for successful treatment of our conditions as patients.

The equation in our case, at its simplest expression is expressed as such:

whereas P = patient, D = Doctor, C = condition, and T = treatment. But we know all too well that it is not this simple, don’t we? No treatments for mental health are fully consistent nor are they anywhere near complete.

There are too many factors involved to arrive at a simple treatment for the more complex mental health problems. Too many unknowns or additional variables. These variables come in the form of emotional/situational issues with the patient, education/knowledge of the presenting symptoms by the doctor, the symptoms presented by the patient, and the available known data regarding the various symptom sets related to the potential condition diagnoses which is again, limited by the presenting patient and comprehension of said presentation by the attending physician. Therefore, with this equation, we have an infinite amount of possibilities which is essentially what Gödel’s theorem states – that there is an infinite amount of true possible answers but none of them are absolutely provable.

If we take this theory, this Gödel theorem of Incompleteness, we significantly address the reasoning behind the continuing stigma of treatment for mental health in the world today. For instance, let’s address cancer. Most cancers respond to radiation and various forms of chemotherapy, right? Granted, we still lose people to cancer but there is an accepted manner of treatment and no one seems to question that course. It is assumed if one is diagnosed with cancer, he or she will receive some form of radiation or chemotherapy to combat the disease within.

If one is struggling mentally, we hear everything from “suck it up” to “take the natural approach” to “go exercise more” to “take a pill” to “every kind of therapy under the sun” to “eat more chocolate” to “happy light” to “color therapy” to “hospitalization” to…. you get my point. I could keep going for quite some time. There is a sea of possibilities to treat the many various forms of mental health issues which have plagued mankind since the dawn of time.

Even the ancient Greek scholars studied these disorders of the mind and out of these studies, they developed equations which helped them further gain insight into the functioning of the brain we have today. Now, they may have referred to mental imbalance as “black bile” but they were aware that when the mind and body were not connected and in balance, there was something very awry in the state of man. For the Greeks, mental well-being was very closely associated with the health of the body which is why good health was important. As a group of voracious scholars, to be off balance was to fail to be the essence of what their very society represented.

Back to the equation at hand, however. While scholars today struggle to continue to understand the inner workings of the human mind and thereby the issues which cause mental disharmony, we are left with this Incomplete Theorem of care to combat the imbalance inside us.

Gödel’s Theorem in the application of mental health may seem hopeless in the face of stigma because it does not narrow down the understanding of the range of issues so many of us face but there is a silver lining. With the infinite possibilities available for care and those possibilities increasing in effectiveness every day, we are able to fine-tune the available treatments for each patient, thereby increasing the potential for a successful outcome, even if it is just one case at a time.

I am reminded at this time of the story of the hare and the turtle. The hare zooms off past the great oak tree at the top of the hill the beginning of the race while the turtle meanders along the dusty road because well, that’s what turtles do. The hare, winded halfway through the race, stopped to nestle himself among some clover for a quick rest, only to discover the turtle crossed the finish line while he slept. As those around us continue to sleep through the reality that is the challenge of mental health issues, unaware of the battle we fight every second of the day, it is up to those of us who are awake and trudging forward to bring them to the finish line and show them that we are capable of getting there too.

An infinite but unprovable amount of solutions is not a bad thing for us – in fact, it is a rainbow of hope shining across an otherwise dark and stormy sky. Don’t let it go.

Finding Life at the End of the Comfort Zone


On our refrigerator, there is a simple black square magnet with white words in English sprawled across it. This magnet blends in with our refrigerator, making the words even more noticeable as it rests at the top of the freezer door, right in the center. What are these words?

They say this:

“Life begins at the end of your comfort zone.” ~Neale Donald Walsch~

J purchased it for me on a dreary Sunday last winter during a visit to a local art museum. Of all the colorful things in the gift shop, the simplest thing, devoid of any true colour, caught my eye.

Why?

Because the words spoke to me. They challenged me to push myself further than I was comfortable. For the first time in weeks, I felt hope. When we bought the magnet, it was not too long after Sandy roared through our area, leaving me more traumatized than I wanted to admit.

Over the past year, I have pushed myself past my comfort zone. I auditioned in NYC for Listen to Your Mother (and am auditioning again this year, only for Northern New Jersey), I joined an in-person mom’s group, and I am back to pushing myself again after a setback with former neighbors which left me afraid to set foot outside by myself, even after we moved.

Within the past month, I started going back to the gym, I’ve ventured to various places by myself, and I plan to start walking around the neighborhood once it’s not covered under a ton of snow and the temperature won’t turn me into an instant popsicle. Oh, and I am learning how to drive in the snow. Slowly. Don’t laugh, most of my driving years were spent in the deep south where it does not snow often. Yes, I am a Jersey girl and perfectly capable of tolerating the cold but that doesn’t mean I know how to drive in the snow. It’s not that difficult to do, I’m realizing.

I owe this diving out of myself to the courage in asking for help.

I made a phone call back in December to our nurse practitioner to follow up with her about the situation with the neighbors. I saw her back in August due to extreme anxiety because of the situation – anxiety which left me afraid to open the blinds, turn on lights, or do anything beyond sit on the couch and watch TV for nearly 5 days straight. My sleep even suffered and my appetite vanished. I refused to leave the condo, in fact, unless J was with me. I needed help. In August, she prescribed something for anxiety. It worked and got me through the remainder of our time there as well as through our move.

But my prescription ran out.

We were happier at our new place. It was quiet, no screaming children at 11pm, no neighbors calling us names, no trapped in a dark condo. Instead, there was peace, quiet, and a lot of sunshine as all the blinds were opened and the light poured in from every possibly window. I still found myself triggered by certain situations and sounds despite the new tranquil environment. Shell-shocked from the former residence.

Then J was suddenly let go from his job and we faced losing our brand new place. With some careful maneuvering and help from family and a few wonderful friends, as well as some well-timed freelance work,  we managed to hang on. He found a job, and has been working steadily. I am still trying to  get freelance work going but haven’t lost hope.

While he was unemployed, I was the rock. I did not panic, I held fast and trusted that he would get a job. Once he did, I unraveled – fast. I was wildly unprepared for the roller coaster exit.

J sat me down one night and quietly shared his observances – that he was worried about me, I wasn’t myself. He suggested I call our NP. I struggled with the suggestion. I made it so far without medication. So far. Through a divorce, through the struggle of job-hunting and never hearing anything back, then through Sandy. All of this by myself. I was not sure I wanted to take a pill to get by again. I couldn’t. Could I?

Finally, after realizing every possible option but taking medication had been explored yet I  was still struggling, I made that call in December. We talked about SAD (Seasonal Affective Disorder), situational issues, and what medications had worked for me before. I talked quickly, fighting the urge to just hang up. She was wonderful and very non-threatening, telling me that she would call in the script and I could pick it up if I chose to but did not need to feel beholden to it.

I picked it up the next day.

It has been almost 6 weeks and I have picked up a refill.

The medication is helping quite a bit. I am focusing, I am laughing, and I feel more like me.

Going back on a medication felt like defeat. It felt as if I was calling it in, giving up. But I know that I tried everything I possibly could before making that call. Making that call? WAY outside my comfort zone. It is the most uncomfortable thing possible to call your doctor to tell him/her that you are not emotionally stable. Yet, if it were a broken bone, I would have rushed to the ER. Stigma is a pervasive bastard – I hate it.

Every morning now, I swallow hope, in the form of a small white pill.

One day, perhaps I will get to a point where I will simply hold hope in my heart and mind, not in my stomach or blood stream.

But for now, that is where my hope lies, intermingling with my stomach acid and my blood cells flowing through my veins.

I’m okay with that because I know it is without a doubt, what I need to be the best me I can be right now.

Guest Post: Erika Pearson Krull – Ripples of Postpartum Depression


I met Erika online through Katherine Stone over at Postpartum Progress. We were asked to participate in a Mother’s Day Rally together. From there, we kind of clicked as we both have had a similar experience with one of our children and occasionally lean on each other for support in that department. And then there’s our passionate love of college football. I’m humbled to have Erika writing here today about Postpartum Depression. She addresses the after-effects of PPD with power and eloquence. I hope you enjoy her piece and have a wonderful weekend!

 

Health problems sometimes have lingering effects long after treatments are given. For example, I know personally that once you get bronchitis you have a much better chance of having asthmatic symptoms every time you get an upper respiratory illness or the humidity changes a lot. I never had a problem with this until my daughter shared her bronchitis with me a few years ago. I haven’t gotten bronchitis again, but I can’t get too far away from its affect on my life ever since.

The same seems to be true of postpartum depression for me. Between 2000 and 2003, I had postpartum depression and premenstrual dysphoric disorder (like PMS with depression symptoms) following two of my three pregnancies. I eventually got treatment before my third pregnancy, but I still feel the lingering effects of those two problems at times.

During my periods of depression, I had the typical symptoms – crying, low self-worth, negative self talk, withdrawal, etc. Now I find that my anger can burst forth more easily than it used to. When I might have turned inward during my depression, I now turn outward. That’s not an entirely bad thing because my emotions aren’t bottled up. But it can go too far more quickly than I want to admit. I get mad at the dog, my kids, my husband, myself, and so on.

The bigger problem is that this gets noticeably worse during my premenstrual time. Still. After nearly ten years. And I’m using a birth control pill that has helped control the symptoms. I haven’t been honestly depressed in almost a decade and I yet I can’t escape its long term effect entirely.

My point is that in order to get your best quality of life after dealing with depression, you need to really understand how it can affect you after you’ve handled the major symptoms. The stigma surrounding mental illness can be disheartening and confusing. Get it treated, but maybe don’t talk about it so much after that. Or better yet, just get it fixed and don’t pull anyone into an awkward conversation about it. You don’t want to look too selfish or get too much sympathy. Or be seen as incompetent or untrustworthy. And geez, it’s been years, why aren’t you over that?

Here’s the reality – the sooner you treat it the better. And it’s never too late to get treatment because late is still better than never. I firmly believe I would have fewer problems with my long-term effects if I had gotten treatment within a few months instead of waiting nearly three years. The depression would have had less time to make a deep impression on my mind and body. But still, treatment made a critical difference in my life. I don’t truly know how I’d be living if I had to try digging out on my own.

Here’s the good news! These lingering effects don’t necessarily have to make you miserable all the time. I don’t have many conversations about these issues now. I do speak to my doctor at times when my symptoms needed better management, and I find it very helpful to write articles like this or do some public speaking about postpartum depression. I’m also able to handle those tough emotional moments in the moment and recognize what I need to do from there. I don’t allow myself to make my depression history an excuse, but I do recognize the roots of my emotional issues.

Many many women get through postpartum depression and recover well. But it’s realistic for some recovered women to feel ongoing ripples at times. It doesn’t mean you didn’t do a good job of getting through it or that you are broken as a person. That’s just depression for you. It’s a serious condition and requires treatment like many other health problems.

You probably wouldn’t beat yourself up because you had to use a nebulizer years after getting a bad case of bronchitis. You need to give yourself the same break after dealing with postpartum depression. Find what works for you to handle those emotional moments, the negative self-talk, the excess anger, the regrets, or whatever makes you feel stuck again. Develop good self-care habits like regular meals, frequent exercise, lots of social support, and other emotional outlets. When something comes up, you’ll be well-equipped to handle it.

Take care of your mind and body, learn how to recognize your needs, and keep moving forward each day. By the way, it’s mid-October and that means cold season. I’ll be going all out to keep germs away from my lungs, and to be kind to myself when they sneak in anyway.

Erika Krull is a freelance writer and part-time therapist in central Nebraska. She has been married to her college sweetheart for 17 years, stays busy raising three energetic girls and a bouncy puppy, and is still learns so much every day. She writes for the Family Mental Health on psychcentral.com and does local public speaking events about postpartum depression upon request.

Therapy Choices for the Postpartum Woman


Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as $10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Just Talkin’ Tuesday 08.11.09: Breastfeeding & PPD


Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

Original Photo "the breastfeeding lady 2" by Raphael Goetter @ flickr

When I gave birth to my second daughter I saw my dreams of a normal postpartum smashed upon the rocks just 30 minutes after delivery. A delivery after 42 hours of labor, 36 weeks of pregnancy spent un-medicated but largely depressed and unaware of any potential issue facing us. We fully expected (as any parent) a healthy child, normal delivery. A large part of my smashed dreams tied into the hard reality that I would absolutely not be able to nurse her because she was born with a cleft palate so wide and large that it would be physically impossible for us to do so.

Later that day I was faced with a crucial decision. What kind of formula would I prefer for my daughter? I cried. She wasn’t SUPPOSED to get formula! That evening found me hooked up to a hospital grade pump praying for anything to happen. I barely squeezed out a drop. But I persisted and pumped for her faithfully until she was seven months old. I even researched everything I could in order to try to get her to nurse – books, cleft organizations, the La Leche League, the local Lactation consultants and even going to a training to become a trained Certified Lactation Counselor (which I completed one month AFTER we stopped nursing!) I left no stone unturned! Charlotte and I used SNS, nursing shields, and sheer determination. She eventually nursed for almost five minutes! Those five minutes were so amazing words cannot even begin to describe. In fact, it was tears falling from my face which interrupted the glorious event.(You can read more about our journey here: Breastfeeding Charlotte)

But at seven months, I faced a decision. My desire to continue to give breastmilk to my daughter or my mental health which had deteriorated so much it was adversely affecting my relationship with my husband and other daughter. With a heavy heart, I drove to Wal-mart to purchase formula. I cried the whole way home. Eventually I made peace with the decision. “Hanging up the Horns” or HUTH as it’s called in the world of exclusive pumpers, was a difficult decision. But one I was glad to make as it allowed me to bond with my entire family. I had come to resent Charlotte for all the extra work she required. But now, all I had to do was pour, heat, and I was done. I made strides towards better mental health and so did the rest of the family.

For me, the decision centered around the stress providing breastmilk created. I was also on medication which can be another tremendous issue for new moms. Many mothers don’t want anything crossing over to their infant through their breastmilk. Dr. Thomas Hale, author of Medications & Mother’s Milk, is a wonderful authority on the topic as are the researchers at Motherisk in Canada. When nursing while on any medication, it is important for the infant’s pediatrician to be aware of the medication and dosage amount so baby can be monitored for any adverse reaction. The decision to take medication is a personal one and should be made carefully with the help of professionals. Ask questions. Make sure the prescribing physician KNOWS you are nursing. And do not let them force you into quitting nursing if it is the one thing in which you find comfort. If you are currently struggling with this decision, please read this wonderful essay by Karen Kleiman: Is Breast Really Best?

So let’s get to Just Talkin’ Tuesday already!

Did your Postpartum Mood & Anxiety Disorder affect your nursing decision? Did you decide to formula feed to help improve your mental health? Do you regret your decision? Made peace with it? Did stopping help? Did your desire to nurse increase your desire to seek natural treatment? Speak up! Share!

(Absolutely no bashing for deciding to formula feed will be tolerated here. We respect the decision of all mothers to choose the course of treatment/feeding they feel is right for their families. Any posts discrediting or attacking a mother for her decision to formula feed will not be approved.)