Morning Faces Therapy for Bipolar Disorder

Seth Roberts4 Comments

In 1995, I discovered that seeing faces in the morning improved my mood the next day. If I saw faces Monday morning I felt better on Tuesday — but not Monday. The delay was astonishing; so was the size of the effect. The faces not only made me cheerful, they also made me eager to do things (the opposite of procrastination) and serene. This is the opposite of depression. Depressed people feel unhappy, don’t want to do anything, and are irritable. Eventually I found that the mood improvement was part of a larger effect: morning faces produced an oscillation in mood (below neutral then above neutral) that began about 6 pm on the day I saw the faces and lasted about a day. As strange as this may sound, there was plenty of supporting data — the connection between depression and insomnia, for example.

After I had observed the effect on myself hundreds of time, I urged a friend with bipolar disorder to try it. Recently he wrote me about how it has helped him.

Here is the very short story of my experience with this treatment.

I have used your treatment since 1997. As an indication of its effectiveness, from 1999 to 2003 I was completely off of medications, and now I’ve been off again since August of last year.

I was severely ill when I began the treatment. I was first hospitalized in 1985 for manic psychosis, and I was hospitalized later for suicidal thoughts and then again for psychosis. In 1997 I was 46 years old, taking Prozac, Depakote, and Moban (an anti-psychotic), and I was barely functioning.

The initial reaction, after three days of the treatment, was astonishing. It felt like a giant headache was just lifted off me. But the [new] clarity of mind enabled me to see my awful condition, and I had acute suicidal thoughts for a day or two. After that initial bounce, the improvement in mood was more subtle, but definitely correlated to how early I started looking at faces.

The early years of the treatment were often rocky. You were still working out some of the kinks in the treatment. The biggest surprise came when you found that exposure to fluorescent lights at night cancelled the effect of the faces. Another problem, also having to do with fluorescent lights, arose when I added early-morning bright-light therapy: the start-time and duration had to be adjusted by trial-and-error. At least six times I was one step away from becoming delusional, and then the treatment would pull me back within 48 hours. You were indispensable during those early years because I could call you and you would give me advice and the will to pull through.

By 2003, I had made some good progress. I had moved back to Berkeley, I was living with “normal” roommates instead of with other bipolar guys, and I had even been able to work for short periods. But along the way I had accumulated several minor pains. Back pain and stress made it difficult to get more than 4 hours of sleep. Sleeping pills did not solve the problem. I was scared that I would have to return to the mental health system; I would be a failure at the only thing I ever cared about [using the face treatment to stay out of the mental health system]. I made a pathetic attempt at suicide and wound up back in Herrick Hospital.

It was back to the crappy life—dulling medications, the psychiatrist and the psychotherapist, the support group, a volunteer job. Then, in 2006, the publicity for your diet book motivated me to try the “faces in the morning” treatment again. By that time, you had found that using a mirror was as effective as using videotapes [such as C-SPAN Booknotes recordings], which greatly simplified the process.

By 2009 I had reduced my doses of Prozac and Depakote to only 10 mg and 250 mg, respectively. (I hadn’t needed Moban since 1999.) In August of 2010, dissatisfied with my low energy level, I decided to go off medications completely again. Getting off of Prozac and Depakote gradually was tricky, because Prozac, which can induce mania, has a plasma half-life of about 10 days, while Depakote, which is anti-manic, has a half-life on the order of only 10 hours.

Today, most people would no doubt say that I’m still a loser. No matter, I’m able to enjoy life and relate to others in ways that I never could my entire life. I’m a Total Believer in the treatment. I don’t proselytize, though. People automatically reject the idea, and in any event I don’t want to be (directly) responsible if the treatment doesn’t work for someone. (Example: My nephew has clinical depression; he also has guns. If he tried this treatment, went off of medications, and then for some reason killed himself, my sister would never speak to me.)

The most difficult aspect of the treatment for me has been simply going to bed early. Even though I feel better the earlier I go to sleep, 10:45 pm is the best I can do on a regular basis.

To sum up, I believe you have discovered a powerful anti-depressant treatment that, in my case, has been effective for severe bipolar disorder. As a complete substitute for medications, however, it has entailed serious risks, and it requires substantial discipline to maintain. It is also important to note that “face therapy” is not the only alternative therapy that I use. In addition to the bright-light therapy that I mentioned above, I currently take 3 grams of omega-3 per day in the form of fish oil capsules.

There are a few more details and observations in these blog posts:

https://sethroberts.org/2007/05/06/life-size-faces/#comment-10539

https://sethroberts.org/2007/07/31/more-about-faces-and-mood/

https://sethroberts.org/2009/10/15/more-about-faces-and-mood-2/

Tomorrow I will comment on this.

The Signaling of Economists

Seth Roberts19 Comments

I like this essay by Brad DeLong about the failure of economics professors. They didn’t just fail to predict the recent economics crisis but they have failed, as far as he can tell, to learn from it. If you are naive, of course this is astonishing — but DeLong is not naive. Yet he is “astonished”. That’s interesting.

It’s hard to imagine DeLong doesn’t know what I am about to say. I imagine anybody with any academic sophistication is aware of it — especially economists. As Thorstein Veblen (an economist) pointed out in The Theory of the Leisure Class (1899), a great deal of what professors do, including economics professors, is about signaling high status. In economics, this is done by being highly mathematical. (Same in statistics. In art history, it is done by using big words. In engineering it is done by being theoretical. In many areas of science, it is done by using expensive equipment and having a large lab. In many fields it is done by being useless — e.g., preferring “pure” research over “applied” research.) This is no mystery. Economists think a lot about signaling. Michael Spence wrote an influential paper (which included Veblen’s phrase “conspicuous consumption”) and book about it, for example, for which he won a Nobel Prize. (More examples from economics.) But DeLong ignores the signaling of economists. Let me propose why economists haven’t taken the steps DeLong is astonished they haven’t taken: Because it would make them more useful and less mathematical. Thereby signaling lower status.

Why is signaling so common? It is basic biology, yes. But it is also convenient. Here is what Veblen didn’t say: It is so much easier to signal than to make progress. Among animals, it is much easier to signal you will win a fight than to actually win one. Among professors, it is easier to use big words than to write clearly. DeLong wants economists to choose progress over signaling. Shouldn’t an economist not be astonished when the lower-priced option is chosen?

The Future of China

Seth Roberts5 Comments

Recently I had dinner with two Tsinghua students I advise.

ME Do you know what “science fiction” is?

BOTH OF THEM Yes.

ME I have an idea for a science-fiction story. Five years from now, Tsinghua and Beida [Beijing University] students get together and decide to change the government. What do you think?

They were amused by this idea. However, here’s what they said:

BOTH OF THEM Where’s the science?

I explained that science fiction often takes place in the future.

 

Seth Roberts Interview About Self-Experimentation

Seth Roberts1 Comment

For an article about self-experimentation and self-tracking to appear in Men’s Fitness UK this summer, Mark Bailey sent me several questions.

In what ways have the results of your self-experimentation directly affected your daily life e.g. health / work / lifestyle changes?

  1. Acne. My dermatologist prescribed two medicines. I found that one worked , the other didn’t.
  2. Weight. Found new ways to lose weight (e.g., nose-clipping).
  3. Sleep. Found new ways to sleep more deeply, avoid early awakening (e.g., one-legged standing).
  4. Mood, energy, serenity. Found that morning faces make me more cheerful, more energetic, and more serene.
  5. Productivity. After I started to track when I was working, I discovered that a certain feedback system made me work more, goof off less.
  6. Inflammation. Self-experimentation led me to take flaxseed oil. In the right dose — which I determined via self-experimentation — it greatly reduces inflammation. As a result, my gums are pink instead of red. They no longer bleed when I floss.
  7. Balance, reflexes. Flaxseed oil improved my balance and quickened my reflexes — I catch what I would have dropped.
  8. Blood sugar. I found that walking a lot improves my blood sugar level.
  9. Mental clarity. I found that flaxseed oil and butter improve how well my brain works in several ways.

Changes 1-6 are/were obvious. The rest are more subtle.

How long have you been self-experimenting?

About 35 years.

What are the main advantages of self-experimentation e.g. yields results specifically relevant to the individual and engages them directly in the process of finding solutions?

My self-experimentation has had three benefits:

1. Find new ways to improve health. Ways that no one knew about. I mentioned most of them earlier: New ways to lose weight, sleep better, be in a better mood, and so on. I find them to be much better (safer, cheaper, more powerful) than what was already available.

2. Test health claims made by others. I’ve done this many times. My interesting self-experimentation started when, as I said earlier, I measured the efficacy of two acne medicines my dermatologist had prescribed. I found that Treatment A worked and Treatment B did not worked, which was the opposite of what I had believed. It’s been claimed that drinking vinegar causes weight loss. I tried that, it didn’t work. Many people say that exercise improves sleep. I found that aerobic exercise made me fall asleep faster but did not reduce early awakening. The most dramatic “test” of health claims made by others came when I discovered that butter improved my arithmetic speed — which meant it was likely that butter improved overall brain function. I took this to mean that butter was good for the rest of the body — in contradiction to the official line that saturated fats are bad for us.

3. Find best “dose” of a treatment. Many people have claimed that flaxseed oil is beneficial. I found they were right. I tested different amounts/day and found the dosage that produced the most benefit. The best dose (2-3 tablespoons/day) was much larger than you would guess from the size of flaxseed oil capsules and the suggested dose on bottles of flaxseed oil capsules.

What do you consider are the potential weaknesses e.g. lack of clinical precision / possible placebo effect?

Is too-high expectations a weakness? You could spend a lot of time and not learn anything useful. Which isn’t so much a weakness as a fact of life.

In my experience, useful self-tracking and self-experimentation are slow. Other people’s self-tracking projects often strike me as too ambitious — doing too much too soon. For example, they are tracking too many things. Or worrying too much about placebo effects. Because they are doing too much — carrying too much, you could say — they may get tired and stop before they have learned something useful.

From a psychological perspective, why is the use of data / numbers, as in self-tracking, so much more powerful and engaging than merely ‘setting a goal’?

For one thing, it’s more forgiving. When I set goals for myself, I often fail to meet them. That can be so unpleasant I give up. When you simply measure something, it much easier to succeed — all you have to do is make the measurement. For another thing, it’s more informative. By studying my data I can learn what controls what I’m measuring (e.g., sleep). Setting a goal doesn’t do that.

Why, in a world dominated by numbers / statistics, has it taken so long for us to use data to learn about ourselves, our lives and our bodies?

You seem to be asking why has it taken so long to apply something so useful elsewhere (“numbers/statistics”) to ourselves? I have a different starting point. I think it is science — which is more than numbers and statistics — that has been useful elsewhere. Numbers/statistics by themselves are little help. I also think health scientists (e.g., med school professors) have used numbers/statistics to learn about ourselves — with little success.

In my experience, you need four things to make useful progress on health: 1. Good tools. Computer, numerical measurement. 2. Experiments. You need to systematically change things. 3. Knowledge of what others have learned. You can’t do experiments blindly, there are too many possibilities. You have to choose wisely what to change. 4. Motivation. You have to really care about finding something useful.

Professional scientists have Numbers 1-3 (tools, experiments, knowledge). Lacking Number 4 (motivation), they haven’t gotten very far. Self-trackers have Number 1 (tools). If they have a problem, something they want to improve, they have Number 4 (motivation). Most self-trackers have Numbers 1 and 4. Without Numbers 2 and 3 (experiment and knowledge) they aren’t going to get very far. What’s so important about the self-quantification movement is they might get Numbers 2 and 3. They might learn to experiment. They might learn to study what everyone else has already learned. When that happens, I think they will make a lot of progress. They will discover useful stuff that professional scientists have missed. And the whole world will benefit.

What developments will need to occur before self-tracking can really grow in the future e.g. better analysis / devices etc?

More successful examples. More examples where self-tracking led to improvement. They will teach everyone how to do it usefully. I think these examples will show that self-tracking alone is not nearly enough, as I said. But maybe I’m wrong. We need examples to find out.


Liberation Therapy: Contradictory Evidence

Seth Roberts8 Comments

As you may know, an Italian surgeon named Paolo Zamboni has proposed that multiple sclerosis (MS) is often due to poor blood drainage from the brain. Improving drainage, he and his colleagues found, reduced MS symptoms. The surgery is called liberation therapy. From this article (thanks, SB) I learned of evidence contradicting Zamboni’s findings:

The studies were independently conducted case–control experiments designed to determine whether abnormal outflow of blood in the head and neck is actually a defining feature of MS. Two of the studies appeared to confirm Zamboni’s observations; the pooled results identified 31 cases of CCSVI out of 35 MS patients and none in 45 matched controls. Yet three other studies, from Germany, Sweden and Holland, with a pooled set of 97 MS patients and 60 matched controls, found no significant evidence of a difference in blood flow between those with MS and those without. In fact, when Doepp et al. attempted to replicate the Zamboni trial they did not find a single case of CCSVI in either the 56 MS patients or the 20 controls examined.

Wow. What intense disagreement. The failure-to-replicate studies used different ways of measuring blood flow so the disagreement is less stark than it appears from this description. But it is still remarkable.

This is highly newsworthy. I can’t think of another case where two different labs have gotten such different results. Unfortunately the article is appalling in its one-sidedness (e.g., liberation therapy is said to have “known risks, unknown benefits”).

Meat Consumption and Weight Gain: Health Journalism Done Right

Seth Roberts15 Comments

This article by Eoin O’Connell reports a study in the American Journal of Clinical Nutrition (the top nutrition journal) that found a correlation between meat consumption and weight gain: The more meat you ate, the more weight you gained over five years. Meat is fattening! reported several newspapers.

Mr. O’Connell did something unusual for a health journalist: He thought for himself. I don’t mean he applied a formulaic criticism (e.g., “correlation does not equal causation”). That’s not thinking, that’s knee-jerking. Mr. O’Connell read the paper. And he noticed an interaction: The correlation between meat consumption and weight gain depended on activity level. The study involved about 400,000 people. The researchers put each person in one of four activity levels: inactive, moderately inactive, moderately active, and active. There was a correlation between red-meat consumption and weight only for the two most active groups (moderately active and active). The original article reported that this interaction was significant:

The relation between red meat and weight gain was also stronger in physically active subjects compared with moderately inactive or inactive subjects (P values for interaction = 0.02)

The obvious implication of this interaction, as Mr. O’Connell says, is that meat caused muscle gain. Weight differences between more-meat and less-meat eaters were due to differences in muscle mass. This puts an entirely different spin on the results. The alternative explanation is quite plausible. I once had a grad student who was a vegetarian. When he was an undergrad, he told me, he and his roommate would go to the weight room and do similar sets. His roommate, who ate meat, rapidly gained muscle; he did not. Of course, meat = animal muscle.

Mr. O’Connell continued to the really interesting part of his article:

Perhaps not so surprisingly, the consideration that muscle is a form of weight gain does not appear in the newspaper articles but much more surprising is the fact that it does not appear in the original journal article either.

The AJCN article has fifty authors. Not one of them, apparently, noticed this all-important point! Nor did the reviewers for this prestigious journal. The article concludes: “Our results are therefore in favor of the public health recommendation to decrease meat consumption for health improvement.” No, they’re not, if the more meat, more muscle explanation is correct.

Most prestigious journal. Fifty authors. Huge expense. Total F-up in the sense that the final conclusion is probably wrong. (To be fair, the paper has plenty of value in other ways.) Congratulations, Mr. O’Connell, for noticing.

Sterilities of Scale and What They Say About Economics

Seth Roberts17 Comments

You have surely heard the phrase economies of scale — meaning that when you make many copies of something each instance costs less than when you make only a few copies. Large companies are said to benefit from “economies of scale” — so there is pressure to become bigger. Every introductory economics textbook says something like this.

Here’s what none of them say: The more of Item X made by one company, the more “sterile” Item X becomes, meaning the less Item X is able to spark innovation. Call this sterilities of scale. You have never heard this phrase — I invented it. (I cannot find it anywhere on the Web.) But it is just as obviously true as the notion that when you make more of something you can make each one more cheaply. If 100 widgets are made by one company, there is going to be less innovation surrounding widgets than if 100 widgets are made by 10 different companies. Sterility of Scale 1: When ten different companies make something, more people are studying and thinking about and pursuing different ways of making it than if only one company makes it. Sterility of Scale 2: The more profitable a single item becomes (due to low cost of manufacture), the more pressure not to change anything — not to kill the goose that lays golden eggs. Sterility of Scale 3: The larger the company, the more employees who care only about preservation of their fiefdom (comparing 10 companies of 10 people each to 1 company of 100 people). See how obvious it is that sterilities of scale exist?

The two concepts — economies of scale and sterilities of scale — are equally elementary. But only one is taught. Study of innovation should be 50% of economics but in fact is close to 0%.

This is why Tyler Cowen’s The Great Stagnation is so important — because it begins to point to this great gap. Jane Jacobs did so, but had little or no impact. (At a Reed Alumni Gathering I was seated next to a professor of economics. “What do you think of the work of Jane Jacobs?” I asked her. “Who’s Jane Jacobs?” she replied.) I think human decorative preferences are so diverse (chacun a son gout, no accounting for taste) for exactly this reason, to avoid sterilities of scale. Diversity of preference makes it easier for many different manufacturers to thrive, which increases innovation. For example, diversity of furniture preference makes it easier for dozens of furniture companies to survive, thus increasing innovation surrounding furniture. Clayton Christensen’s The Innovator’s Dilemma describes many examples where large companies were much less innovative than smaller companies — so much so they often went bankrupt. Which suggests sterilities of scale can be fatal.

If there were more understanding that ten small things are going to be more innovative than one big thing, I like to think that scientists would better understand the value of very small research and grant sizes would go down. An illustration of the general cluelessness is someone who wrote to Andrew Gelman complaining that a sample size was only 30.

I started thinking about this after hearing Nassim Taleb discuss economies of scale (e.g., here).

 

Nine Years of Weights, More Shangri-La Success

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Seeing Alex Chernavsky’s ten years of weights inspired David Hogg, a professor of entomology at the University of Wisconsin, to send me his weight data for the past nine years — see above. Like Alex, he found that the Shangri-La Diet worked where other methods failed.

He is 5′ 10″ and 63 years old. When his weight reached 205 pounds (in 2002) he decided to take serious action. He began by increasing how much exercise he did, to “watch what [he] ate,” and to take “diet” pills. I asked him about the diet pills. He replied:

On [the advice of a local supplement store owner] I began to take L-Carnitine, which has a variety of effects (including some evidence for weight loss?), and an ephedrine based diet supplement (I don’t recall the name of the product). I took the ephedrine until its sale was outlawed (2006?), after which I started taking a NOW Foods product called Diet Support, which lists as major ingredients iodine, chromium, forskolin (from Coleus root), L-Carnitine, extract of Garcinia cambogia, green tea extract, and extract of Uva ursi leaf.

He described “watching what [he] ate” like this:

I started having a fruit smoothy with protein powder and flaxseed oil for breakfast (rather than eggs/cereal and toast) and I cut back from a full sandwich and fruit to a half sandwich and fruit for lunch. I did not modify what I ate for dinner but did attempt to eat less, and I tried to not snack between meals. I think all of this was somewhat successful, although I was hungry a lot and suffered regular setbacks.

He described his exercise like this:

My goal was to get some form of exercise daily. In reality I probably get exercise on average 5 days a week, but this was not too different than what I was doing previously. My primary means of exercise are bicycling and racquetball/squash, but I also golf (walking, not cart) and take a range of classes at a local health club that includes Pilates, spinning, and weight lifting.

In 2002 he increased how much exercise he did.

In 2002, in other words, he began to do conventional weight-loss things (eat right, eat less, and exercise more) plus take diet pills. This lowered his weight from 205 to 180 but not further, even though continued for years. So far the Shangri-La Diet has lowered his weight about 10 pounds. He does it like this:

I started out with sucrose water, after several weeks switched to ELOO (which did not seem to work for me, perhaps because it reminded me of popcorn?), quickly switched to fructose water, which I used exclusively for 6+ months, then switched again to walnut oil (the fructose water made me feel bloated). For the past approximately 4 months I have added fructose to the walnut oil, which I started to use up the large supply of fructose I ordered, but it actually seems to work the best of anything I’ve tried to date. I drink 2 tablespoons of walnut oil containing about a quarter of a tablespoon of fructose, twice daily.

My ideas about dietary control of the set point made a lot of sense to him.

At one time I believed weight gain or loss was purely a matter of calories in vs. calories burned. Up to age 30 that model seemed to explain my weight. After 30 it was not so simple, with my weight seemingly resistant to sustained loss or (in the short term) gain, and this led me to adopt the view that my weight was governed by an equilibrium or set point. This was easy for me conceptually. My professional interest at the time was insect population dynamics, and the prevailing view was that although insect population densities fluctuate (sometimes widely) through time, for a given species the fluctuations tend to occur around an equilibrium that is enforced through density dependent processes. However, I viewed my set point weight as “fixed”, so my paradigm did not explain the upward drift in set point and weight. Your discussion of this, from an evolutionary perspective, made me rethink my idea of a fixed set point and provided the perfect explanation for the upward drift in my weight (plus the way to convince the brain to decrease one’s set point).

His data are an important advance in understanding. They cover a long period of time and allow comparison of the Shangri-La Diet to three popular weight-loss methods: “controlling what you eat”, exercise, and various supplements (“diet pills”). No conventional weight-loss experiment covers as long a period of time.