Managing Relationship Conflict

This is no easy subject. So much depends on the specifics of the situation and of the relationship. And perhaps different people deal with conflicts best in their own different ways.

But I think a few generalizations can be made:

1) Once anger has risen beyond a certain point -- and this point may vary, for different individuals, or for different situations -- there is no benefit to continued conversation. Anger is often a state of "outward flow", a state of action; an angry person may not be able or willing to listen or receive an "inward flow" of information or feedback. There needs to be a break, to cool down, after which if there are issues to discuss, both people will be able to hear each other better. Most issues of conflict are more fruitfully discussed when both parties are in a calm state.

2) If you are feeling unsafe, bullied, or subject to physical aggression, it is necessary to find a safe place as soon as possible. This may mean leaving physically. Or it may mean leaving the relationship. From the safe place, it will be necessary to carefully assess what to do next. It can be hard to think or plan clearly when you are in a dangerous position. You may need to seek external help, for shelter or safety.

2) Practicing empathy. While the capacity to empathize is to some degree an inborn, heritable trait, it is also a skill that can be practiced and improved. The simplest exercise is, in an argument, to simply state how you believe the other person is feeling, and why. We all have a powerful resistance to actually do this, even though most of us acknowledge that it's a good idea.

3) Apologizing. But only if you truly believe that you have been out of line.

4) Accepting apology. Which doesn't necessarily mean accepting a repetition of the status quo.

5) Be wary of the same old conflictual pattern happening over and over again.

6) If there is some positive territory, allowing some time and space for that. This could be shared interests, pleasures, activities, or mutual friends.

7) There are workbooks and other reading material which deal with relationships, managing or resolving conflict in marriages, etc. If this is a theme in your life, I strongly encourage you to acquaint yourself with this literature, and to work through a workbook or two (best if both you and your partner do it, of course). As with all self-help literature, you may find some of it preachy, trite, biased by the individual views of the author, etc. but I do think it is important to acquaint yourself with what is out there, some of it can be very helpful or at least an introduction to ideas that can help.

8) An external mediator, such as a therapist, can be helpful. It can often be important to find a mediator who does not have a specific individual alliance with either person in the conflict (i.e. the mediator should be neutral). And it can be important to find a mediator who is experienced working with relationship conflict. I believe it is important to consider that a mediator may help a relationship improve, but may also help an unhealthy or unsustainable relationship end more peacefully.

9) Maybe I should have "ranked" this item higher than (9) since it is very important: if there are untreated psychiatric symptoms in either individual member of a conflicted pair, then it can be very helpful to address and treat those symptoms. High levels of irritability can be treated with various types of psychotherapy, lifestyle change, and/or medication--with a reduction in an individual's irritability, that person may be able to negotiate conflict more peacefully and productively. In some depressive or anxious states, feedback which sounds critical in any way can lead to feelings which are so badly hurt that the conversation cannot continue. This emotional lability or hypersensitivity can also be treated through psychotherapy, lifestyle change, and/or medications.

Scaled-up Structure of a Neuron

I'm always interested in analogies & thought experiments. One of them last year was to consider the following:

What would a brain cell (neuron) look like on a vastly expanded scale, where the body of the cell (cross-sectionally) would occupy an area about the size of a small urban residential lot (let's say about 10 x 40 metres, or 35 x 120 feet)?

Interestingly, it took a fair bit of effort to get an accurate picture of this (and even now, I'm sure I could get into a lot more detail). Advanced textbooks of neuroscience may be good at describing a lot of fine details, but they tend not to give the reader a good visual picture of what the brain -- or a neuron -- in action -- really looks like. In order to do this research, it involved digging at length into the neuroscience literature (full references are available to the interested reader).

Here are some of my findings:

A typical neuron cell body is about 20 microns in diameter (about 1/50 of a millimeter). If the cell body were made into a giant which occupied a whole city residential lot, we would be scaling upward by a factor of about 1.85 million.

At this scale, a single atom would be about 0.2 mm wide (well within visual resolution). At this scale, your head would be about 340 km in diameter. This is about the size of a U.S. state such as Ohio, Pennsylvania, or Louisiana; or almost as large as the Canadian provinces of New Brunswick and Nova Scotia combined.

Dendrites are arm-like extensions of a neuron's cell body. Dendrites can be up to 600 microns long, and on our scaled-up neuron, this makes the longest dendrites about 1 km long. Each neuron can have about 20 dendrites. Each dendrite in our model would be about 5 meters wide. In our model, dendrites are similar to the width of streets or alleys coming away from the yard (remember this is really in 3 dimensions), and each street or alley would extend to some outer reach of your local neighbourhood. Inside each dendrite are many mitochondria (the "power plants" of the cell), each of which about 4 x 1 meters in size (each about the size of a hippo).

There are fibers holding the whole cell together (and serving other functions), called neurofilaments and microtubules. They are typically about 10 mm in diameter in our model (like a medium-sized rope), and are spaced about 100 mm apart (so the inside of a neuron could get quite tangled up were it not for the fact that these "ropes" guide everything along smoothly, acting as miniature pulleys and motors).

A synapse is an area where two neurons communicate chemically. There are thousands of synapses on each neuron. In our model, each synapse area would be about 1 meter wide. The distance across the synapse (between neurons) in our model is about 180 mm (6 inches). Nerve cells release vesicles into the synapse containing neurotransmitters such as serotonin and norepinephrine. In our model each vesicle would be about the size of a small grapefruit. Each time the neuron is fully activated, about 300 of these grapefruit-sized vesicles would be released. Smaller activations of the neuron would cause only 5-10 vesicles to be released. After release, the vesicles are "recycled" within about a minute.

If there is a drug such as an antidepressant affecting the neuron, its size on our model would be something like a grain of sand. Concentrations of antidepressants in the brain are something like 1 in 6 million. This corresponds to one, or just a few, molecules of antidepressant -- each one the size of a 1 mm grain of sand -- in every cubic foot in our model. This shows us visually that just a tiny amount of something in the brain can have a powerful effect.

In the actual brain, neurons are "packed" with a density of about 100 000 per cubic millimeter. In our model this corresponds to neurons packed roughly equivalent to how the city lots are "packed" in a residential neighbourhood (but in 3 dimensions).

The brain's surface area, scaled up for our model, would occupy an area about the size of Washington state, or of southern British Columbia, all of which occupied by "houses" or "yards" corresponding to individual neurons (but in the real brain, there are 3 dimensions, of course). The "houses" would be locally connected through dendritic connections in areas corresponding to residential "neighbourhoods". And there would be many axonal connections linking these neighbourhoods to the far reaches of the brain's territory.

The total population of neurons in the brain is about 100 billion, which is 15 times the population of humans on the earth.

Financial Metaphor

Managing your emotional life can be compared to managing finances.

"Investments" need to be made. Investments of emotion, attachment, time, energy. And money too.

It is much easier to "invest" when you have a bunch extra to work with. Wealthy people have an easier time putting money aside into new profitable ventures.

When you are using all your resources just to survive, it can be insulting and frustrating to be asked to "invest".

Sometimes, especially in depressive states, people are operating in a state of continuing, advancing debt. Emotional debt. Energy debt. Time debt. Relationship debt.

In addictive states, there is a neurophysiological debt that has to be "paid off" in order to get out of the addiction -- the price is in the form of acute and chronic withdrawal symptoms.

There are books out there about how to invest or manage money wisely.

I don't tend to like these books, in part because I think our culture has a very unhealthy preoccupation with financial wealth. Those who manage the economies of nations also perhaps consider financial wealth or growth a higher priority than a more basic good, such as "well being".

But I think that economists, marketers, and business managers can have excellent ideas, and I have to remind myself to keep an open mind.

How IS it possible to "invest" when you don't have very much?

Most financial advisors would say to automatically squirrel away a little bit every month, and stick it in an RRSP or something like that.

The key is -- consistency, regularity, and automaticity. A little bit each month--or every day--wisely invested, can add up.

In depression, such investments might take the form of "automatically" spending a little bit of energy or time exercising every day (even a minute or two). Or working on relationship-building. Or looking into a new activity. Or meditating.

If there is a state of "indebtedness" then making a plan to pay off the debt in an organized way, and to make a budget, etc. is necessary. But sometimes, external "debt relief" is needed. This may require reliance on external help for a time.

Another thing most financial advisors would say is that one should "diversify". Investing in only one thing makes you vulnerable to having a huge loss if the market changes suddenly. Investing in several different areas protects you, and insulates you, from environmental change. This could apply to relationships, activities, and therapeutic resources. Of course, if you "diversify" too much, it leaves your energies so diluted that it can be hard to appreciate or grow from your involvement in any one thing.

A final note I would make in this analogy is to observe that most financial advisors are actually salespeople, and not true unbiased advocates. While they may be sharing good advice with you, they will also profit from you investing with them. This automatically biases their advice. Perhaps not everyone is interested in building a big RRSP fund to pay for their retirement years; perhaps not everyone cares if they miss out on "market growth opportunities". It may be more important for many individuals to put more of their resources into the here and now.

So I encourage you to be well-informed about your "investments". Receive advice, but also research your choices independently, then decide.

Sometimes the best time for "investment" is when you are already feeling better, when there is an abundance of emotional resources again. Remember then, to put aside a little bit each day, this may protect you during a future drought or famine. Things like CBT, exercise, etc. sometimes work better when you are already feeling better, and you are using them preventatively. Even medications may sometimes work better as preventative agents than as acute treatments.

Consciousness

I should caution the reader that this particular post is less directly related to psychiatry--it's more of what I would call a "philosophical musing". So you may want to skip over this post if you're not in the mood for it. But it's something I've thought about for a long time, and I find themes pertaining to it coming up frequently in my daily work.

Consciousness is miraculous.

It may be (actually this is exactly my view), that from a scientific point of view, consciousness is the product of chemical and electrical signals in the brain, influenced by both internal and external stimuli, forming an integrated network with numerous complex feedback loops. Regardless of the causes of consciousness, it remains miraculous that any physical process could give rise to a subjective experience of awareness.

The issue of free will is related. Even if we claim that free will is an illusion, that all choices are determined by the existing structure of the brain in combination with environmental events, and furthermore that brain structure and environmental events are themselves determined by historical precedents (perhaps with a degree of true randomness at the core of physical phenomena rendering all of these processes imperfectly predictable), the awareness of having -- or seeming to have -- free will is also miraculous.

Clearly there are "degrees" of consciousness. Human awareness can vary--or be changed pharmacologically--from full alertness, or hyper-alertness, to many degrees of sedation, to unconsciousness. Apparently absolute unconscious states may only be relatively so, since some degree of stimulus may produce a response even in people who are sleeping deeply, anesthetized, or comatose. As we agree that there are degrees of consciousness, how sure can we be that there is an "absolute zero" where there is no consciousness at all?

If awareness or consciousness is the product of the brain, and the brain's function is a property of a network of chemical and electrical connections, then it may follow that any system in which there are chemical or electrical connections carries a form of consciousness. It seems grandiose -- on the part of humanity -- to claim that the human brain is the only structure capable of conscious awareness or the perception of will.

Most people would have no difficulty asserting that higher animals are conscious, though most (I included) would say that the consciousness of animals is "lesser" than that of humans. At the most obvious level, we can say that the intellectual and language feedback which enriches our conscious experience is much reduced in animals, such that very little cultural development over different generations is possible in non-humans. Another "thought experiment" type of question would be, who is MORE conscious, a fully alert dog, or a heavily sedated human? I guess many would say that there are "types" of consciousness, and that the "human" type is qualitatively different than "non-human" types, irrespective of the degree of alertness or sedation, etc.

Fewer people would claim that simpler animals are conscious.

Very few people would agree that plants are conscious.

Almost nobody would agree that rocks are conscious.

I claim that all of the above may be "conscious" in a way. I do not mean to sound mystical at all here, just extending the logic that if chemical or electrical connections in a network give rise to consciousness, then perhaps any systems of chemical or electrical connections that form feedback networks are also conscious. Therefore, all of the universe could be considered "conscious". A rock could be considered "conscious" since it is intimately linked -- chemically and electromagnetically -- to its environment, and both disintegrates and incorporates environmental elements continuously during its lifetime (obvious changes in chemistry and magnetism perhaps taking place over thousands or millions of years--an example of how some forms of "consciousness" may involve different time-scales than what we are used to).

A corollary of the above could be that since consciousness is a product of networks of chemical interaction, then all conscious beings are "interconnected", perhaps part of a higher-order consciousness. A simple example of this would be to look at politics. Often times we refer to nations as though they are people. We talk about "what Russia is thinking", or about "U.S. arrogance", etc. While this is figurative language, there is a level of literal truth, I suppose, to consider that a nation itself represents a higher form of consciousness, or could at the very least appear to be a higher form of consciousness to an external observer (i.e. someone who did not realize they were communicating with a nation instead of with a person).

I am not saying that this therefore makes it rational to start singing songs to the rocks to soothe them, or to embrace some kind of animistic belief system where we deify or personify plants, mountains, planets, gemstones, etc.

But I hope this line of thinking may cause us to extend respect and caring to all things. Fellow humans. Fellow animals. Fellow living things. Even inanimate objects. The earth. The air. The soil. Your home. Your room. Your belongings. Other people's belongings. Objects that have been thrown away. And, going inwards, to all the different parts of our body (many of which, ironically, are as inert or "dead" as stones, but still require care -- for example our teeth, hair, epidermis, or nails). Going inwards further, on an even more abstract level, your feelings, your thoughts, and your life history, all deserve respect and caring.

The act of respecting and caring for ourselves is part of healthy living. I think this respect and care can be extended to all aspects of the environment around us.

And, on a slightly mystical note I suppose, I wonder if there is something about respect and care that is always mutual--so I wonder if the universe can, on some level, always perceive, understand, and reciprocate such care. This is sort of a "karma-like" idea.

Stepping back from a mystical note, though, I think there is solid psychological evidence to support the idea that caring and respecting as a way of life is part of staying healthy and happy.

Types of Alcoholism

The term "alcoholic" has been used frequently in contemporary culture. Often the label itself may carry a certain "shock value", which, I suppose, could lead to a recently-labelled "alcoholic" contemplating more seriously a reduction in alcohol use. I always worry about labels, though, because I don't like the idea of being or sounding judgmental or critical (there is enough judgment and criticism in the world today, and in psychiatric illness a lot of extra judgment and criticism comes from one's own mind). Yet I do believe in the value of attempting to fearlessly speak the truth about things, even if they are truths that we don't necessarily want to hear.

Each person who has a drinking problem may have unique factors that have contributed.

Some researchers have categorized "alcoholism" into two types. Type I alcoholics may use alcohol as an attempt to treat anxiety, and are less likely to associate alcohol with thrill-seeking or fighting. Type II alcoholics may use alcohol spontaneously for thrill-seeking, and are more likely to have had alcohol-related problems with fighting, etc.

In my opinion, there is some support for subtyping alcoholism this way, but of course I think there is a much wider range of contributing or causative factors. I can think of some people who started out with a "type II" pattern as a teenager, but ended up in a "type I" pattern later on. Others may have a sort of mixture of "type I" and "type II" characteristics. For both subtypes there is probably a robust hereditary predisposition, some of the predisposing factors being direct (i.e. a predisposition to use alcohol excessively when available or a predisposition to react to alcohol in a certain way), and some of the predisposing factors being indirect (i.e. anxiety for type I, high thrill-seeking for type II).

Type I is more common, and is probably easier to treat, I think because there are underlying issues and needs that can be met in other healthier ways (e.g. treating anxiety, building healthier relationships, engaging in psychotherapy). Type II can be more challenging to treat, particularly because those with this type may be less likely to want treatment or change.

Here's another useful link with info about alcohol and addictions, from the Centre for Addiction and Mental Health:
http://www.camh.net