Levels of dopamine, high or low

25/03/13 01:35 [Monday]
I’ve just woken from a dream about dopamine, and specifically the different behaviours associated with different levels of dopamine in the brain, from high down to low. The basic idea is that higher levels of dopamine create more of a distinction (when translated into behaviour) between objects or concepts the nervous system differentiates. The subject feels more certain that things which appear different from each other - perhaps only slightly different - genuinely are from different categories. On the other hand things between which differences are not noticed are more readily believed to be identical, or from identical categories. Things are seen more in an all-or-nothing manner. At lower (more normal) levels of dopamine the subject feels less certain that things are either different or (on the other hand) the same. At lower levels (I suppose) there is greater acceptance that things in the real world might be being perceived mistakenly: the response to things and events is more ‘gradualist’ with less investment in the initially formed way of regarding the thing or event and an easier quicker ability to change tack. (Also with lower levels of dopamine other people’s, or ‘Society’s’, ways of interpreting objects and events play a larger role in determining the individual’s response.)
Something I have been thinking about when awake recently is that some behaviours can be associated (the same) with both high and low levels of dopamine. For one thing this makes it difficult for doctors to be sure whether symptoms of schizophrenia are being seen, or on the other hand the effects of too powerful a dosage of dopamine-blocking drugs. For example, if the subject’s mind is empty of thoughts (from low levels of dopamine) he will be silent and appear withdrawn; but also if his mind is full of thoughts he may well appear the same since he cannot put the many and probably mutually contradictory (or ‘counteracting’) ideas into words until he has processed them, and he may never have time to process them to make them definite especially if he is being bombarded with new experiences either questions and an insistence on engagement from the doctor or (worse) the fearful experience of being hospitalised especially the first time and especially if it is by compulsion.
I adhere to the view I have come to, that schizophrenia (and related conditions: for nowadays I get the impression schizophrenia is less readily given as a diagnosis but conditions like Asperger’s or Autism more readily and earlier) results from dopamine responsivity which is too high. Given only slight stimulation very high-amplitude and possibly fluctuating waves of excitement of dopaminergic systems result. The degree and duration of the continuing fluctuation will depend on the precision of the neural networks available to do the processing ‘downstream’, that is on their resolution. The effect of such unpleasant results from any stimulation is that the subject evades stimulation, that is he becomes ‘avoidant’ or withdrawn. In turn that results in an absence of fluctuations in dopaminergic systems and this also is experienced as unpleasure, in the form of loneliness and perhaps boredom. There are ways available to a person having an over-responsive dopaminergic system of obtaining stimulation which is (if things go well) not at an overwheliming level, some more traditional (like reading, or listening to the radio or watching TV) and some new-fangled (like communicating with others - and best it is with others similar - via the internet). I will mention that Emily Brontë obtained pleasurable stimulation from her sister Charlotte when the latter described to her her ventures ‘into society’: there is something more directly appealing in real-life stimulation even at one remove (more nearly real-time, I suppose) than is available from fictive stimulation as from reading a novel.

Notes on my treatment in the 1980s

18/03/13 14:22 [Monday]
I am very subject to distraction from physical events (and, when I am not on dopamine-blocking medication, from extraneous ideas arising randomly in my head). The fact that Dawn might enquire what I am writing about, and more so if she were to express disapproval (that I keep dwelling on the past), causes me to be unable to set down my thoughts unless she is asleep or otherwise absent.
Nevertheless I do feel a sort of pressure - which is the same word, and actually the same phenomenon in a more subdued version, as is used by psychiatrists when they observe the symptom ‘pressure of speech’ - to express myself in words on the subject of what dopamine-blocking drugs did to me in the past. I must again mention the psychiatrist who prescribed them for me - compelled them on me - over the two decades starting 1980, that is Anthony Dew Armond, and state that he insisted I take them - by injection in the long-acting form so that I was never out of their influence - in very high dosages without having a clue himself what the effect on me was.
I can think more clearly at present, on a modest dosage of the dopamine-blocker Risperdal, than any time since the late 1970s. When not on medication my mind becomes filled with concerns to expose what went on over the years I was treated by Anthony Dew Armond, and the flood of thinking creates confusion and distraction so that I fail to expose what I feel I must expose. Yet when I am on medication at the dosage Armond prescribed my mind becomes blank - apart from a vague but powerful feeling of resentment and a powerful desire to escape the drugs - so that I cannot collate what it is I have to say in order to explain myself.
For practical purposes I would do well to give details of the effect on me of Risperdal at the dosage I was on in 2011, my idea being to dissuade doctors in my immediate future who might be ill-advised and prescribe a higher dosage than I am on now, and this I hope to get round to doing. As I say, when I am on the higher dosage - and this was the case in 2011 after I had been discharged from hospital - I become incapable, through a general stilling of my activity level and specifically the activity of my thoughts which should coalesce into an explanation: incapable of explaining with detail what undesirable effects the medication is having on me.
However, what is pressing in my mind this afternoon is the effect on me in the past of the medication under Armond, and most particularly the effect on my chances of employment. I remember when I had run away from going to work in the employment I had had with Dudley Council over the three years since university - this was late 1981 when the people at the Council offices were urging me to return to work if I could, and Armond was asked for reports on my progress - Armond said to me, ‘Write down in a list what is for the job you have, and in another list what is against it.’ This shows the terms he was thinking in.
The answer, which I was unable to explain to him for reasons given above (and more so when he aggressively said to me, ‘Tell me about the bloody job’), was that there were no reasons in favour of my returning to work, and it wasn’t anything like a decision or choice I had to make: what it was was I was disabled from returning to the job I had had or to any comparable job by the effects of the drugs Armond was compelling on me. Those drugs stilled my thinking completely, so that I was unable to keep up any sort of conversation and could not marshal any ideas (which Armond interpreted as symptomatic of schizophrenia, saying to my parents that he was ‘worried that Colin cannot marshal his thoughts’). Those drugs caused my legs to be terribly restless all the time. My Dad used to say I had ‘shaky legs’ and that annoyed me considerably, as it gave the impression that there was some sensation in my legs - a tickling or tremor of the muscles - which I took note of as signals from outside of myself like say tightness of my shoes. Whereas the truth was my legs insistently drew my notice to themselves in a style whereby I had to either move them to and fro - taking conscious effort - or resist moving them (which took more conscious effort). This having to devote conscious attention to my legs prevented me settling to think of anything which required thought, and what I had been doing in my employment did require thought. I did try to read, as I had been a great reader and my days now were empty - hour after hour and day after day of emptiness: a mind empty of any pleasure or indeed of any stimulation positive or negative: a living death - but I did not take in any of what I read, which at the time appeared to me to be because all I took in was the fact of my legs and their unpleasant insistent occupation of my consciousness.
I found that by lying on my bed in a semi-doze - although it was a doze involving every so often unpleasantly starting into wakefulness - the reslessness of my legs subsided. So that’s what I did with my time: lay on my bed most of my daytime as well as the nighttime when I got a type of sleep. I couldn’t ease the unpleasantness in that way every day though, because Armond insisted I attend a day-centre three days a week, and when that became utterly unbearable to me and I refused to go he implemented the Section I was on (I was ‘liable to be detained’ for over two years from 1st March 1984) and took me into hospital. I think it was on that occasion he discovered I had attempted suicide because of his treatment of me - the drugs caused me depression as well as all the other terrible ‘side-effects’ - and thereafter I attended the ward once a week instead of the day-centre and was given much gentler attention.
When we have moved home I hope to find out the true sequence of events from my old diaries. It is true I was not marshalling my thoughts at the time, not organising my memories, so the sequence of the memories I have is confused.
18/03/13 15:40
Re-reading the above it strikes me I was extraordinarily unlucky to be saddled with Anthony Dew Armond as my psychiatrist. He completely misunderstood me and the effect the drugs were having on me, yet did not shrink from signing papers which were taken to give legal sanction to the compulsion of the drugs on me. (The reason I doubt they were genuine legal sanction is that I had only one Tribunal in more than two years I was on a Section in the mid-1980s.)

Twitter diary for February 2013

I have uploaded my Twitterings for February to my website at http://www.colinbrough.co.uk/February_2013.html