The Just In Time Government

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Just in time delivery is a system that improves efficiency by only producing items that are to be sold in the short term. It wasn’t really possible until the advent of faster delivery like UPS and Fed Ex. Once all the parts of the supply chain were capable of keeping up with different levels of consumer demand, JIT became more feasible. Say you run a clothing store that sells 5 shirts per day. It’s inefficient to stock 10 shirts. It’s better to stock 5 shirts, then take delivery of 5 more shirts each day. It reduces inventory and makes sales more efficient. It works for some things, but not for others. JIT works well in situations where demand can be forecast accurately. Manufacturing and delivery ramps up during holidays and ramps down during the rest of the year. You make more chocolate around Halloween than you do around the Fourth of July. You make more barbeque tools around the Fourth of July than you do around Halloween.

JIT can’t be applied to everything, though. A mall parking lot seems like an enormous waste of space in July. There are hundreds of parking spaces that go unused day after day. The mall maintains a large parking lot because they will need that capacity during holiday periods. If you go there looking to create efficiencies in July, you might be tempted to cut the number of parking spaces. That would be short sighted, because you would be woefully under capacity in December.

Recently, there has been a trend to try to apply private sector efficiencies to government programs. Like JIT itself, it works better in some situations than it does in others. Achieving efficiencies in supply can be good when demand for services and products can be forecast. Just like the mall parking lot, looking for efficiencies in situations that don’t lend themselves to easy prediction can cause problems. A good example is regulatory agencies. When businesses are working well, there doesn’t seem to be a need to regulate or inspect them. Why use government resources to confirm that there are no problems? The difficulty is the same one that happens when you look at the mall parking lot in the summer. Even though it seems like a waste, the excess capacity becomes necessary at some point. People seeking to improve government efficiency looked at the regulatory situation in the Texas fertilizer industry and thought that reducing the inspection capacity was a prudent solution. This led to fewer inspectors and made it possible for unsafe, insecure, situations like the West Fertilizer manufacturing plant to continue until there was an accident.  The West fertilizer Plant had not been inspected by OSHA for almost 30 years.

For a business, the sudden popularity of a new shirt fashion means that demand exceeds the production and delivery chain, leading to lost revenue. Governments exist, in large part, to deal with unforeseen circumstances. That reduces the instances where Just In Time efficiencies can be applied.  Politicians see a surplus and do not see it as an opportunity to bank against a future need.  Instead, they see it as an opportunity to further trim government, to make it more “efficient”.   That doesn’t mean that we need unlimited government, but we do need to empower government to do its regulatory duty.  Government is the way that we collectively face the unknown and unforeseeable.  We need to have a government that is capable of responding to new events and circumstances.   Letting government grow too large can lead to intrusive and unnecessary regulation.  Letting government wither away by trimming it in the name of “efficiency” isn’t the answer, either.  Creating the right balance of capabilities and efficiencies is more complicated than a soundbite or slogan.  Saying that all government is bad is no better than saying that government can solve all problems.

Emotional Biases in SSRI Withdrawal

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If you flip a coin 4 times, and the first three come up heads, there is a built in human bias to assume that the next flip will be tails. Even though the coin has no memory of previous throws, the human mind still assigns a bias to the series as a whole. Similarly, withdrawal symptoms create their own momentum. The timeline of withdrawal is much longer than a short series of coin flips, but the principle can still apply.

For many people, withdrawal occurs in windows and waves. It oscillates between times when symptoms are lighter and times when they are more severe. Since the mind always seeks to find or create patterns in what it experiences, it’s natural to try to anticipate the next cycle, and predict what it will be like. This can be good and bad. In the middle of a wave, it gives the mind something to look forward to. Instead of being mired in a wave, the mind can anticipate the symptoms improving. Likewise, a window can be seen as an opportunity to consolidate gains and take stock of overall progress towards recovery.

The relief that you get from lighter symptoms can be squandered by anticipating the next wave, though. In many ways, it’s a one sided bias. There is fear of slipping into a wave during windows, but no anticipation of a new window during a wave. There is an emotional weight associated with each stage.  It’s like our perception of a coin flip instead of the actual binary nature of the flip. While you’re in a wave, that negative feeling gains a sense of permanence that it shouldn’t. Even though waves inevitably give way to windows, except in the case of a chronic conditions (withdrawal is usually episodic, not chronic), there’s no anticipation, just suffering in the moment. That fear persists into the next window, coloring our interpretation of the window. Instead of recognizing it as an improvement, it’s seen as a brief respite or interlude before the next wave.

One of the big mental tasks in making progress during withdrawal is to separate waves and windows. Instead of viewing them as two sides of the same coin, inevitable partners, they should be viewed in the larger context of recovery. The window/wave pattern is a sign that the brain is recovering. Once the symptoms begin to break up, the waves should get shorter/milder and the windows should get longer/better. Waves and windows should also be viewed in isolation from each other, like a coin flip. Feeling better is not the cause of the next wave, just as feeling bad is not the cause of the next window. Those cycles are signs of deeper restructuring taking place in the brain. There are things that you can do to mitigate waves and extend windows. Mindfulness can help.  Being aware of the cycle between waves and windows can mitigate the bad, and extend the good.  It’s important not to obsess about your emotional state, but be cognizant of the ebb and flow of emotions.  At the same time, waves and windows need to be dealt with individually.  You can’t always be looking forward to the next change. At first glance, a window seems like an easy thing to deal with.  You’re feeling better! Normal!  What’s to do?  Actually, windows are opportunities to take stock.

Windows

Windows represent your progress towards normalcy during withdrawal.  It’s very hard to compare your mid window state with “normal”, though.  We all live in a relative mental state.  It’s very hard to step outside yourself and compare the way you are now with the way you’ll be after recovery.  It is possible to perceive changes from one window to another, though.  Keeping a journal can help quantify your well being during a window.  It’s human nature to avoid dwelling on negative emotions when we’re feeling good, so it takes a bit of discipline to go back to your journal during a window.  Many people post on withdrawal sites until they start to feel better, then only come back when they experience a wave.  Just like a course of antibiotics, it’s important to keep the mindfulness momentum going during a window, even if you feel better.

Waves

Dealing with waves is a defensive thing.  Being mindful that the symptoms of a wave are not a normal part of your mental makeup is a good strategy.  In normal thought, we only consciously perceive a small portion of what happens in the depths of our minds.  Our cultural and mental makeup parses most thoughts, and they don’t become conscious thoughts.  Anger, fear, anxiety, even psychosis, are all parts of everyday thought.  We only see the small part that our conscious mind actively thinks about, though.  Psychotic, angry, and fearful thoughts are normally not part of our daily interactions, so we don’t give them much “processor time” in our active minds.  We present the side of our minds that we want to the outside world.  In a wave, the normal checks and balances are suppressed.  Instead of automatically suppressing thoughts we don’t want, the mind presents everything all at once.  It’s important to actively take over the parsing role until that automatic system has a chance to re establish itself.

So, in a strange way, waves and windows should be seen in the larger context of overall recovery and also viewed as binary things (heads or tails).  It’s not easy to take the long view of withdrawal while still dealing with each individually.  One of the symptoms of withdrawal that makes it particularly hard is the suppression of cognition.  We simply don’t think as quickly or deeply as we normally would.  It creates a vulnerability to the symptoms that makes the waves more powerful and the windows less satisfying.  Even if you fail to have much of an effect on the cycles in the beginning, that effort will pay dividends over time.  It’s hard to keep trying through multiple “failures”, but you’re building a mental reserve that will eventually have an effect on the whole process of recovery.

James S Heaney 1926-2013

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James S Heaney, 1926-2013

Main Line Times Obituary

My father passed away last week.  I loved my dad a great deal.  As I look back on his life, I think he is one of the luckiest people I’ve known.  Not lucky in the sense that he was given everything he wanted, but lucky in the sense that he took the unfinished opportunities that life gives us and made the most of them.

He grew up during the depression, but was insulated from the worst of it because his father had a good job at a food market.  He spent one year at the Wharton school before volunteering for the Army Air Corp in 1944.  He was part of the contingency force for the invasion of Japan.  He gained the rank of Corporal as a crew chief for a Consolidated B-24J Liberator bomber.  He was one of the people who was saved an uncertain fate in Japan by the Atomic bomb.

After World War 2, he went back to the Wharton School.  He loved rowing, and was part of the University of Pennsylvania rowing team.  After graduating, he continued rowing for the Vesper Boat Club.  As national champions, Vesper was chosen to represent the US in the 1952 Olympics.  He also rowed in the Pan American Games in 1955.  He stayed active with Vesper long after his active rowing days were over.  He was a stock broker for over 40 years.  He loved being a stock broker, and didn’t retire until 2006.  He entered the field during the golden age of managed investing, and retired before the industry underwent the fundamental changes of online trading.

Dad coached me in soccer when I was little.  He was a demanding, supportive coach.  He didn’t want to show favoritism towards me, but I think he truly did think that I was the best goalie on the team without parental bias.  He would have told me if he didn’t think that way, but he would still have rotated me in because I was his son.  We did pretty well under his leadership.  Our club had by far the finest soccer field in the league.  We played on a field that was used for grass tennis courts during the summer.  It was magnificent to play soccer on such a finely manicured field.  It was also the only field in the league were the players were required to replace their divets after the game.  Dad also played squash and tennis every week.  He stopped playing most sports a few years ago.  His knees bothered him and his mobility was reduced.  He still enjoyed talking about strategy and the nuances of the games, though.

In recent years, he often said that this was the happiest time of his life.  He seemed to get happier as time went on.  How many of us can truly say that?  I certainly grew happier with our relationship as time went on, and I will be sadder for the loss of it.

Waves and Windows in SSRI Withdrawal

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Tapering off of an SSRI can be very difficult.  It’s not like other ailments that have defined timelines and symptoms.  When a doctor treats a broken bone, there are long established milestones in recovery.  SSRI withdrawal is different.  Each case seems to be unique, with different length and severity of symptoms.  One of the frustrating parts of withdrawal is the way that symptoms fluctuate over time.  People call them waves and windows.  At first, withdrawal is unremitting.  There seems to be no respite from the symptoms.  After some time, which varies from person to person, symptoms begin to break up into cycles.  There are times when symptoms aren’t as bad, and other times when they are quite severe.  It’s not a universal pattern.  Some patients find that they have constant symptoms that slowly go away.  The wave/window pattern seems to be the majority, though.

Waves

Waves describe those times when symptoms are more severe.  Symptoms can be physical or emotional.  It feels like getting sick.  When you start to get a cold, you can feel little changes that presage the illness.  A sore throat or headache, then the full symptoms of the cold start in a day or two.  A wave has similar precursors.  Usually, physical symptoms are the first sign that a wave is coming.  A stiff neck, headaches, and dizziness are some of the symptoms.  A day or two later, the emotional symptoms become more pronounced.  These symptoms include obsessive or compulsive thoughts, depression, or anxiety.  It can be helpful to break waves up into different parts.  Knowing that each part of a wave is coming, and what to expect next, can make the whole process easier to handle.  The reason we’re so adept at knowing the cycle of a cold is that we’ve had them off and on all our lives.  we’re aware of the subtle changes in our bodies that tell us that we’re getting sick.  In the same way, it takes some experience before you can separate the parts of wave from each other.  It takes still more time to develop ways of dealing with each part of a wave.

Physical symptoms of a wave are hard to mitigate.  There isn’t much you can do about general joint pain, headaches, or dizziness.  You can try analgesics like aspirin or ibuprofen, but those aches are fairly resistant to those kinds of pain killers.  Dizziness is likewise difficult to deal with.  Withdrawal dizziness isn’t just something that happens when you stand up or spin around.  It’s hard to believe that you can feel dizzy when you lie down, but it happens in withdrawal.  Try to stay as still as possible until it gets better.  Try to use the physical symptoms as a sign that there are new symptoms coming that you need to deal with.

There isn’t really any way to avoid the emotional symptoms of a wave.  There is no way to “suck it up and get over it”.  Our minds create our reality in a fluid way.  The anxiety, depression, and obsessions of a wave are just as real as the screen in front of you.  The fact that our rational mind would recognize that it’s not real or overblown doesn’t mean much when you’re experiencing it.  That’s the essence of a wave.  It’s not rational or thoughtful.  Obsessive thoughts can be about almost anything from the benign to the surreal.  Self harm can suddenly seem like a rational idea.  In normal thought, the entire spectrum of emotions are right below the surface.  When you’re cut off in traffic, you have several choices.  You can ignore it, respond verbally or visually, speed up, slow down.  Even the psychotic is present in that moment.  We’ve become so accustomed to suppressing psychotic thoughts that we don’t even realize that the idea of ramming the other car didn’t rise up to our conscious minds.  In withdrawal, those thoughts that would normally be dismissed without a thought gain the same weight in our conscious minds as socially acceptable thoughts.  The only way to mitigate the emotional symptoms of a wave is to be mindful of the difference between normal thought and the unnatural power that irrational thought has in a wave.  It’s very hard to pick apart which thoughts are your normal responses and which ones are caused by the wave.  They mingle together in a chaotic way.  That’s what makes your reactions to a window just as important as your reactions to a wave.

Windows

Windows are periods of time when symptoms are not as pronounced as they were before.  At first, it feels like it’s over… you beat withdrawal, you’re free.  That’s the cruel joke of SSRI withdrawal.  Windows and waves are intertwined together.  The way withdrawal works for most people is that the windows slowly, ever so slowly, get longer, and the waves get shorter.  A window is more than a vacation from symptoms, though.  It is a huge relief to have some time off from feeling miserable.  Savor the good times in withdrawal, because that is what you have to look forward to in recovery.  More than relief, though, windows are an opportunity to prepare yourself to deal with waves in a better way.  Try to pay attention to how you feel.  Examine the way you think, the way you respond to things.  Try to recognize the way that you automatically choose responses and thoughts.  Emotionally, a window is a return to the normal way of parsing thoughts.  Instead of allowing all thoughts to rise to consciousness, you mind is automatically tuning out undesirable thoughts based on your personality.  Paying attention to the process during a window makes it easier to impose that same kind of structure during the next wave.  It’s that mindfulness that you’ll need during the next wave.  After a while, you can tell when a thought is out of character, and consciously dismiss it.

Withdrawal is a process of alternating good times and bad.  The more you’re able to mitigate the bad with mindfulness, the shorter the waves become.  Our minds often work in feedback loops.  One thought leads to another through association, creating the pattern of our minds.  Mindfulness allows us to shape the pattern to a certain extent.  The more you can recognize that a harmful thought is just part of a wave, and not a normal part of your normal mind, the faster you’ll get to the next window.  Eventually, that last window becomes reality, and the next wave never comes.  The mindfulness you’ve developed getting there will remain, though.

 

Meta symptoms of SSRI withdrawal

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SSRI withdrawal causes many symptoms, both physical and emotional.  In some cases, the emotional symptoms can combine to create larger symptoms, meta symptoms.   Renewed or new depression is one of the most common symptoms of withdrawal.  Depression is an inward emotion.  It forces the patient to examine themselves in an overly critical manner.  In that compulsive self examination, other symptoms can emerge.  It’s not the healthy self examination of mindfulness or self awareness, it is an uncontrollable focus on the negative.  The patient doesn’t see themselves in a mindful light, but through the dark lens imposed by the depression.  Even joyful memories are seen in that distorted way.

Regret and Guilt

The depression of withdrawal forces the mind to pick negative aspects out of any event and focus itself on that exclusively.  That single minded focus creates regret in the patient.  Many times, it is out of proportion to the event itself.  Regret and guilt are very similar to each other.  They feed on each other.  Withdrawal pushes the mind to see guilt in places that the patient normally wouldn’t.  Withdrawal depression narrows the focus of the mind to see only the negative in an event.

I only remember a few things from my 10th birthday.  My parents had organized a party for me and invited several friends to come over.  I had wanted toe clips for my bicycle for a long time, and was very happy that I got them for my birthday.  Being 10, I wanted to install them on my bike right away.  During withdrawal, the nature of that memory changed.  Instead of remembering the happiness of the event, I focused on the fact that my parents scolded me for installing toe clips instead of playing with my friends.

Compulsive memories

One of the symptoms of SSRI withdrawal is renewed memories.  While taking the drug, memories are largely suppressed.  Many patients report that they do not have a good sense of what happened to them while they were on the drug.  They know the larger arc of events, but many of the details are missing.  The emotional nature of memories is likewise suppressed.  During withdrawal, the emotional tie to memories is reawakened.  It doesn’t happen in a linear way, though.  Instead of recalling memories in an associative way, where one memory reminds you of another, memories flood into the conscious mind without context.  It can be profound or trivial, the only commonality is that the memory is not recalled, it is imposed on the mind.  It is a sign that the mind is reordering itself, cataloging memories and emotions into a new order.

For more than a month I couldn’t get the image of a fast food restaurant out of my mind.  I ate lunch there 2-3 times a week for a year, 4 years ago.  The restaurant didn’t have any particularly strong memories associated with it for me.  Every time I tried to go to sleep, though, the image of that Wendy’s just wouldn’t leave my mind.  There was no guilt or other emotion associated with the image, I just couldn’t see anything else when I closed my eyes.

Fear of relapse

At first, withdrawal is unrelenting and overwhelming.  The symptoms occur continuously.  As time goes by, symptoms begin to break up.  Withdrawal becomes a cyclical thing.  There are times when symptoms are severe, and times when they are light.  People call them Windows and Waves.  A window is a period where symptoms are lighter, waves are times when symptoms are more pronounced.  There is an inevitable fear that arises from feeling better.  It’s not intuitive to an outside observer, but it is a real phenomenon for the person going through it.  Withdrawal creates a mental relativism where the way you feel at the moment feels like a permanent state.  Combined with uncontrollable negative self examination, waves begin to feel “realer” than windows.  That breeds a distrust of windows.  There is always the fear that a window is just a prelude to another wave.  Windows and Waves are closely connected, they are part of the cycle of recovery in SSRI withdrawal.  There is some validity to that fear of relapse in the beginning.  Windows will revert to waves, just as waves will break up into new windows.  As time goes by, the windows become longer and the waves become shorter.  There is no point in time that the patient can point to when the severity of waves falls below the level of awareness.  It’s one of the subtleties of withdrawal that progress can only be measured once it has occurred.  You just realize one day that you haven’t experienced a wave in a long time.  The last window has just extended longer than the others, with no wave afterwards.  The fear of relapsing into a wave lingers, though.  It becomes one of the central thoughts during recovery.  Slipping into a wave feels like getting sick, just mental instead of physical.  It begins with a subtle feeling of instability.  It then progresses into more profound feelings of despair.  Waves are very difficult to deal with.  The entire context of the mind has been altered.  There is little memory of feeling better, just the emotions associated with the wave.  So, when the wave breaks up into a window, there is a legitimate fear of the next, seemingly inevitable, wave.  The inevitable thing about withdrawal is that recovery will happen, though.  Many people have experienced prolonged feelings of despair, even suicidal ideation, and recovered themselves in the end.

The best way to deal with the window/wave cycle is to recognize that it is occurring.  It’s difficult to think of waves as temporary phases in recovery.  Somehow, it’s easier to believe that the windows are the temporary phases.  Being mindful of the cycle between windows and waves helps.  Just as windows are temporary in the beginning of withdrawal, waves likewise become temporary as recovery progresses.  Think of the last time you started a new job.  At first, all the new information felt overwhelming.  It’s easy to think that you will never absorb it all.  You quickly become accustomed to the new routine, though.  Eventually, the daily tasks lose their overwhelming quality and become easier to accomplish.  Withdrawal is similar in some ways.  At first, it’s very hard to believe that it will ever end.  Eventually, you begin to reclaim yourself, and it gets easier the longer you do it.

How long do SSRI withdrawal symptoms last?

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This is one of the most common, and hardest to answer, questions about SSRI withdrawal.  Withdrawal from psychiatric medications is still officially a mystery.  According to the manufacturers, SSRI do not cause severe withdrawal.  Instead, symptoms from “discontinuation syndrome” are mild to moderate and last one to three weeks.  This is in direct contrast to some patients that experience prolonged, severe, symptoms.  The disparity between experience and official information causes a lot of confusion for patients.  When we break a bone or pull a muscle, there are long established timelines for recovery.  Individual recoveries can vary in time and intensity.  Overall, most patients follow the timeline and recover close to the time expected.

The lack of information about SSRI may be part of the reason why it is so hard to predict how long withdrawal symptoms will last.  Most studies of SSRI are limited to 8-12 weeks and do not address cessation of the drug.  Manufacturers study their drugs in this manner to gain regulatory approval for sale, not so much to study the effects of the drugs.  Studies of the effects and withdrawal would be more of an academic pursuit and wouldn’t contribute to the commercial application of the medications.  Fewer people would begin prescriptions for SSRI if they knew that there was a chance that they would become dependent on the drug and have to go through an extended withdrawal period when they decide to stop taking it.

From the symptom perspective, it’s very hard to say which patients will experience withdrawal.  Some patients do follow the accepted tapering schedule and are able to stop taking the medication with minimal symptoms, despite taking the drug for a long time.  Other patients experience extended symptoms after taking the drug for a short period.  The underlying predictors of which patients are sensitive to SSRI and which ones aren’t are not well understood.  Without enough knowledge to predict which patients will experience withdrawal, it is even harder to predict how long those symptoms will last.  It becomes a very personal, individual, struggle for each patient.  That being said, there are some ways to gauge progress and predict how long an individual will experience withdrawal.

When a patient first experiences withdrawal symptoms, they can be quite frightening.  Since the mind creates reality in real time, withdrawal can seem like it will become permanent and debilitating.  That is the reality that withdrawal creates, though, not reality as an impartial observer would see it.  We live in a relative state of mind, though, so that’s all we see.  If we could step back from withdrawal symptoms, we would realize that this is a temporary crisis and not a permanent state of mind.  Withdrawal forces the mind to act more on instinct than it normally would.  In normal thought, the intellect regulates instinctual responses, moderating them to match social situations and our own moral beliefs.  Withdrawal disconnects the intellect from its normal regulatory function.  Instead of moderating behavior, anger, fear, and anxiety are allowed to come to the conscious mind.  As an example, take a trip to a supermarket and pay attention to your reactions.  When another shopper blocks an aisle or cuts you off at an intersection, anger is a possible reaction.  Normally, that anger is easily suppressed and you let the incident go without any reaction.  Withdrawal removes that moderating behavior and allows anger to become the acceptable response.  For a person not experiencing withdrawal, it takes a great deal of introspection to even detect the anger that arises from the incident.  It’s almost automatic to suppress the anger because reacting to such a trivial interaction is socially inappropriate.

Reasserting the intellect during withdrawal is the best way to control symptoms and mitigate the power they have.  Being mindful of how you would normally react to a situation and forcing yourself to follow that course of action can help.  It’s easier said than done.  Because of the mental relativism that withdrawal causes, it can be very hard to separate yourself from the immediate symptoms you’re experiencing.  Mindfulness is the process of stepping back from a situation and evaluating the emotions that you are feeling, and then changing your behavior based on what you think rather than your immediate emotions.  Essentially, it’s replacing the automatic moderating behavior that’s suppressed in withdrawal with conscious effort.  It can slow down the flow a conversation quite a bit second guessing every thought, but it’s better than acting out in a way that you might regret later.  It’s not necessary to think your way through every interaction forever, just until the automatic moderating function reestablishes itself.

Taking a longer view of withdrawal can help as well.  It’s very hard to envision how you will feel in two months when you’re living with symptoms minute by minute.  SSRI withdrawal happens in waves and windows.  Those are the names that veterans give to the cycle of withdrawal symptoms.  Waves are periods of time when symptoms are more severe.  Windows are periods when symptoms are not as bad.  As withdrawal progresses, waves come and go.  In the long term, the waves become shorter and milder, while the windows become better and longer.  Eventually, you enter a “window” that doesn’t end.  Mindfulness allows you to see that waves are not permanent and not put too much hope in the permanency of windows.  It sounds fatalistic to acknowledge that windows do not represent a cure, but it’s more realistic.  It’s a delicate balance between hope and pragmatism.  Being aware of how you are feeling during a window is just as important as being aware of your feelings during a wave.  Just as you need to consciously moderate your feelings in a wave, you have to bank the good parts of a window to use when you enter the next wave.  It’s an intrinsic exercise that you can’t really start to practice until you have the experience of a couple cycles behind you.  In the beginning, it’s very hard to see the larger picture because all there is is the immediate symptoms.  Some faith that symptoms will get better is required.  Faith is one of the first things to be shaken in withdrawal.  Family and friends don’t understand, doctors don’t believe it’s withdrawal.  You can’t “suck it up”, either, it doesn’t work like that.  All that can shake anyone’s certainty.  The wave/window pattern is part of withdrawal, though.  Just as you will enter waves during withdrawal, they will also end at some point.

As time goes by and you become accustomed to the cycle of waves and windows, the question becomes less about how long will withdrawal last.  Mindfulness becomes a habit, something that is almost second nature.  It’s something that you can apply to your life after withdrawal.  Most people started taking an SSRI to treat an existing condition.  The decision to stop taking an SSRI usually comes after the drug has lost efficacy or the side effects outweigh the benefits.  That requires some way of dealing with the symptoms of the condition after withdrawal is over.  It’s hard to see the mindfulness that withdrawal forces on you as a benefit of that trauma, but it does give you a good way to handle an existing condition.  In the long term, the goal becomes less about getting off the drug as fast as possible, and more about getting off the drug with as much quality of life as possible.  In a way, a good way, the coping tools you develop during withdrawal will serve you for the rest of your life.  The adage that alcoholics use to describe recovery is apt for people suffering from SSRI withdrawal. “One day at a time” is the best way to approach recovery.

Memory and Cognition

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There are several theories about how we create memories and how we use those memories to interact with our worlds.  Take a restaurant as an example.  When you think of a restaurant, a fairly specific memory is used to represent restaurants in general.  Now think of a fast food restaurant.  The image changes.  One theory of cognition is that we create lists that represent different interactions.  For example, we have a script for restaurants so we know what to expect when we go to one.  We enter, wait to be seated, order, eat, pay, leave.  The script is modified to account for different types of restaurants.  in the fast food example, waiting to be seated won’t work.  So, we create a new list to account for it.  In that list, we enter, order, pay, eat, leave.  The other theory of cognition is that we store elements of previous encounters and use those to assemble an appropriate mental picture that we can apply to a specific situation.

The way we recall events and integrate them into our minds isn’t as simple as recording them.  The analogues to memory that we have created, hard drives, web sites, etc. record events in a linear way.  Human memory doesn’t record events in the same way.  Instead of remembering an event like a wedding one instant at a time, we record a representation of the event that we can later recall.  This method of remembering can alter the event in our minds in interesting ways.  Each element of an event is stored in different parts of the brain and then reassembled when we recall it.  Each time we remember a wedding, the mind assembles the different parts together to create a new representation of the event.  In essence, we’re recreating the event each time we remember it.

For the wedding example, the ceremony is broken into different elements.  The visuals sounds, smells, and tactile memories are compiled together from different areas of memory to create the memory that we then recall.  The way that the elements are stored allows the mind to free associate those parts with other memories that can then impact the recollection of the whole.  When you recall a wedding, the smell of the flowers can be influenced by other memories that include smells.  A trip to an arboretum can influence the wedding memory in subtle ways.  Discrete elements of the arboretum won’t intrude on the wedding memory, the mind would recognize those parts as being out of place in the wedding memory.  Instead, the sensations and smells of the arboretum can influence the recollection of the wedding.  When the mind assembles the wedding memory, it pulls the smells from the same area that stores the smell memories of the arboretum.  In doing so, the two memory fragments influence each other.  The memory of the arboretum would likewise be influenced by memory fragments from a wedding.

When the mind assembles a memory, it has to free associate within each part of the memory to assemble to whole.  Each sense, smell, touch, sight, sounds, and taste has its own area.  As the mind recalls each sense, other memory fragments can influence how we recall each element of the whole.  This is one of the reasons why eye witness testimony can be problematic.  When the witness tries to assemble the memory of an event, other experiences can influence how that memory is assembled.  Since the mind essentially creates the memory each time it is recalled, that recollection can drift over time.  As other experiences change the memory, a discrete memory can start to change the more we recall it.  That’s why police want to get eye witness testimony when it’s “fresh” and people say that the first impression is usually the right one.  It’s not necessarily true, but it does leave the memory less time to be affected by other experiences and memory fragments.

The list and fragment theories of memory aren’t exclusive to each other.  We could use memory fragments to create the lists dynamically.  The list theory is tempting because that is the way it feels when we go to a place like a restaurant.  We create a script that we expect to follow throughout the whole episode.  How we create the list may be more interesting than the list itself.  In many ways, every memory is the culmination of all our experiences.