Seth’s blog

• kaleidoscope game
• The Transfer Book. Helpful for college students thinking of transferring.
• Some medical schools have trouble disclosing their disclosure policies! In the case of an NPR show The Infinite Mind, which I liked, the founder, Frederick Goodwin, whom I took seriously, “received over a million [undisclosed] dollars from pharmaceutical companies to give promotional talks.” Details. This is especially horrifying because Goodwin co-authored the “bible” of bipolar disorder research. His influence is great. His co-author was Kay Jamison, who writes a lot about the subject for popular audiences. To me, she’s now tainted by association.
• Robert Woodward, the great chemist. A terrific biographical essay.

A 25-year-old Toronto accountant blogs:

A few weeks ago my parents came downtown to take me out for dinner. Apart from leftovers, my dinosaur garbage can and a few pieces of mail, they also brought my Ikea lamp.  Now my apartment is very small.  It’s a bachelor with about 600 square feet.  It faces south and gets a fair amount of light during the day, which is fine during the weekends.  But during the week when I’m at home – in the morning and at night – it can get pretty dark.

Now enter my Ikea lamp.  The first morning after receiving it I turned it on along with all my other lights, while getting ready for work.  I noticed a few things that day.  One, I wasn’t angry during my commute via the subway.  If you’re not from Toronto you won’t get this.  But if you are and you ride the rocket each morning, then you’ll understand the general expression of, “angry defeatism” on most commuters’ faces.  My lack of hate was personally noticeable.  I also noticed that I didn’t need my usual green tea when I got into work.  Even crazier I was alert when I got in, the type of mental alertness that often doesn’t show up until roughly 11 am.

I really thought about this for a while.  I couldn’t figure it out until I remembered this post by Seth Roberts.  It’s very short.  I thought about it for a few days and made a little experiment.  I went from turning on all my lights every morning to a few, to none.  My “awakeness” varied positively with the quantity and duration of morning light.  Along with morning light, I’ve also found that having the TV on and taking Vitamin D amplifies this effect.

It’s not a small impact.  It’s had a huge effect on my day-to-day.

I left a comment asking what the Ikea lamp was. One interesting thing about this was the exposure time. Judging from a comment (see below), it was about an hour. That’s the minimum I try to get early every morning (from sitting outside).
After I bought the absolute necessities for my Beijing apartment (bed, water heater, washing machine, etc.), my first optional purchase was a chair for the balcony. So I can sit on the enclosed balcony in the morning.

In a widely-emailed article about depression, Judith Warner, a former columnist at the New York Times, writes:

This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.

When Atul Gawande fails to mention prevention in a discussion of how to improve American health care . . . well, he’s a surgeon. Of course he has gatekeeper syndrome. What’s Judith Warner’s excuse? Judging from this article, the notion that depression might be prevented has not occurred to her.

Fourteen years ago I woke up one morning and felt really really good: cheerful, eager, and yet somehow serene. I was stunned: There was no obvious cause. I hadn’t slept particularly well. Nothing wonderful had happened the day before. But there was one thing . . . the previous day I’d watched a tape of Jay Leno right after waking up. I’d thought it might improve my sleep. Now — a day later — my mood was better. Could there be a connection? Two very rare events: A (TV early in the morning) and B (very good mood upon awakening). Did A cause B? Such causality would be far different than anything we’re familiar with. Yet it made some sense: From teaching introductory psychology, I knew that depression and insomnia are related. If you have one you are more likely to have the other. I had done something to improve my sleep; had it improved my mood? The already-known depression-insomnia linkage made the new  idea, the cause-effect relation, far more plausible. Subsequent experiments led me to a whole new theory of mood and depression.

CureTogether has found another example of the familiar depression-insomnia correlation.  Persons with depression are twice as likely to have insomnia as persons without depression. CureTogether gathered this data much more cheaply than previous studies. Unlike previous researchers, they were under no pressure to publish. (Professional researchers must publish regularly to keep their grants and their job.) Unlike previous researchers, they were under no pressure to follow a party line.

On the face of it depression makes you less active. Yet insomnia is a case of being too active. So the depression-insomnia link is far from obvious. Lots of other facts connect depression and circadian rhythms; they all suggest that the intellectual basis of anti-depressants, all that stuff about serotonin and neuro-transmitters and re-uptake, is wrong. If depression is due to messed-up circadian rhythms, taking a drug at random times of day is unlikely to fix the underlying problem.

A friend with bipolar disorder writes:

When I wrote in your blog that I use your discovery daily, it means that every day I look in a mirror for an hour, starting at approximately 6:30 a.m. I have the mirror about 20 inches from my face because I have read that a mirror image is half the size of the object reflected. [Life-size faces appear to work best. Using a mirror means the face you see is perfectly life-size, allowing for distance. TV faces can be larger or smaller than life-size.] To keep from being bored while looking at my face in the mirror, I mostly listen to tapes of C-SPAN programs. Sometimes I listen to music. Once or twice a week I may just think, or plan my day. That does get boring after about 30 minutes.

Sorry, I definitely was exaggerating when I wrote “my doctors are amazed…”. “My doctors” refers only to my psychiatrist and psychotherapist; at best, they seem “impressed” by my condition. My therapist regularly says that I’m doing “great” (variously referring to social relations, self-awareness, and general functioning) – especially considering my situation – and my psychiatrist once exclaimed that my bipolar disorder was in “complete remission”, albeit when we were composing an online personal ad. I do think both of them are at least mildly surprised that I seem to be doing alright on half the standard therapeutic dose of Depakote, and a low dose of Prozac.

There was an actual experience that weakly supports my claim about practitioners having no interest in utilizing your idea. I once asked my therapist to suspend his disbelief, and just imagine that your treatment does work as a strong antidepressant. Then would he mention the treatment to his other patients, or give a talk at a conference, or write up a report, or tell his colleagues? In all cases, he said “no”. Although he agreed that ideas for clinical trials have to come from somewhere, evidently that somewhere was not part of his concern.

I stress that my therapist is compassionate and reasonably intelligent, and he has helped me deal with many important practical problems.  And of course in your blog even you have admitted that your idea, on the face of it, sounds way too crazy. It’s to my therapist’s credit that he claims to believe your treatment works to some degree–adding positively, “whatever works for you”. Unfortunately, that addition implies that your treatment is somehow working “psychologically” for me (e.g., as a kind of meditation) rather than working “biologically” in a way that, presumably, would work for most people.

If my doctors were following my particular case as closely as they pretend to, then they ought to be amazed. Instead, my sense is that they see me through the lens of their diagnosis. Without actually dismissing the sheer statistical improbability of my having been off of drugs and without a hospitalization for four years, they do seem to forget that fact when we discuss drug therapy. When I mention those four years, they sometimes play the skeptic, offering up alternative possibilities: it was a fluke, or I was in remission anyway, or something else. I don’t try anymore to persuade anyone, not even family, about the treatment – it’s not worth the effort.

I suppose the bigger picture is that there is little credibility to the testimony of a bipolar person who has experienced psychosis. (Perhaps my case is not helped by dramatic pronouncements of mine such as, “History will judge you. People will wonder, ‘why didn’t they listen to him?’”) Too, I’m not paying my doctors enough to get lengthy consultations. If I were paying enough, and if I made the case with details to my psychiatrist, she might be persuaded that there is a big effect. She has a high opinion of you; in fact, she’s the person who told me of the report in The SF Chronicle (5/30/06) about the SLD diet. And, she gives some credence to Dr. Stoll’s results with omega-3 for treating bipolar. Nevertheless, for what it’s worth, I would stand by my original opinion about her not changing her practice.