Making Choices: How Your Brain Decides

Interesting study on decision making, particularly in light of psychiatric disorders.

Health & Family

Every day, we face thousands of decisions both major and minor — from whether to eat that decadent chocolate cupcake to when to pursue a new romantic relationship or to change careers. How does the brain decide? A new study suggests that it relies on two separate networks to do so: one that determines the overall value — the risk versus reward — of individual choices and another that guides how you ultimately behave.

“Cognitive control and value-based decision-making tasks appear to depend on different brain regions within the prefrontal cortex,” says Jan Glascher, lead author of the study and a visiting associate at the California Institute of Technology in Pasadena, referring to the seat of higher-level reasoning in the brain.

Study co-author Ralph Adolphs, a professor of psychology at Caltech, explains the distinction by way of a grocery shopping example: “Your valuation network is always providing you with information…

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A Note on Suicide and the Black Dog

May Robin Williams now rest in peace. May his family have strength, be treated with kindness and empathy, and be given privacy at this time.

Like many others I wish to add my own thoughts on this recent sad event, and the discussion it has sparked on suicide and depression. Sadly, we hear of suicide all too often – people kill themselves every day, and chances are throughout your life a number of them will be people you know.

Whenever I hear of someone committing suicide (famous or otherwise), I am reminded that the Black Dog is never far away. He sits in your shadow, always alert  for a moment when your defences are down, when he can rip your throat out. I am reminded of this, and I am scared. Scared that one day I might do the same.

No matter how much support and love you have depression, and other disorders, are very personal experiences. You literally have to fight against what’s in your mind, and other people can only help you to an extent.

Robin’s experience is also a reminder that external things or events can’t ‘fix’ you – so often we think, ‘As soon as I’ve done or received X, I’ll feel Y and everything will be better.’ But that’s not the case, life is a continuum and there will always be something else – some other challenge or thing you want. What’s more is that the Black Dog doesn’t care about your success, your relationships, or your achievements.

In some ways I understand Robin’s decision. Indeed, when I think of another 50+ years of living this same battle as I have for the last 12-14 years, I picture an almost eternal battle of attrition. One that I might not win. Many people, including Robin, have fought the battle and succeeded for many years, but eventually they lost in the end.

For the vast majority of the time I’m glad to be alive, but of course I’ve considered suicide. Who has depression and hasn’t? Mostly two things stop me from seriously contemplating this as a course of action: I have a very intense existential fear of death and I couldn’t imagine hurting my loved ones like that. But I could imagine at some point the thought of family and friends might not be enough, that you can’t keep living for the sake of others.

My thoughts are with those all souls who have died by their own hand and the people they left behind.

#613: How do I reach out to my friends who have depression?

From the wonderful Captain, excellent advice on being a friend to someone who’s ill.

Captain Awkward

Today is a weird, sad day in social medialand and also with various life stuff and brain chemistry stuff and street harassment. To be honest, I have been crying or on the verge of crying off and on for the last 20 hours with occasional breaks for sleep and a much needed breakfast and movie (a movie …that made me cry) with a friend this morning. I almost started crying in the Apple Store a little while ago when I thought I’d have to pay $80 for a new power cable, and then I really cried when it was under warranty and it was free and this big bear of a man was so nice to me and didn’t call attention to the crying and just gently handled my transaction. Crying is good, btw. It’s better than numbness, avoidance. But this question is well-timed.

Dear Captain Awkward,

This…

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Mental illness as a disability

In this post I’ve simply collated information from a few different websites about mental illness as a disability. The information either relates to Australia in general or NSW more specifically. Of course even if you have a mental illness, that does not mean that you will necessarily have a disability (especially if you are not effected long-term). I spent some time researching this because of the separation in my mind between mental illness and disability; I have trouble accepting that, both by theoretical definition and practical experience, I have a disability.

The legal definition of ‘disability’ under NSW anti-discrimination law

Disability is defined in section 4 of the Disability Discrimination Act 1992 (Cth) and in section 4 of the Anti-Discrimination Act 1977 (NSW). The definition in both Acts is very similar. This is the definition in the Anti-Discrimination Act 1977 (NSW):

disability means:

(a) total or partial loss of a person’s bodily or mental functions or of a part of a person’s body, or

(b) the presence in a person’s body of organisms causing or capable of causing disease or illness, or

(c) the malfunction, malformation or disfigurement of a part of a person’s body, or

(d) a disorder or malfunction that results in a person learning differently from a person without the disorder or malfunction, or

(e) a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgement or that results in disturbed behaviour.

This definition includes mental illnesses under (e).

These laws also say that you don’t have to have the disability at the time of the discrimination for the way you are treated to be unlawful. So, the laws says that the disability can be one that:

  • ‘presently exists’;
  • ‘previously existed but no longer exists’: for example you may have had an episode of mental illness several years ago, but have been well ever since;
  • ‘may exist in the future’: for example, an insurance company might decide that you are likely to develop a condition based on your previous medical history or the medical history of your parents;
  • ‘is imputed to a person’: for example, an employer might believe you have a mental illness because of the way you responded to a particularly stressful situation even though you don’t have that illness.

The point of discrimination law is to stop you being treated worse or being excluded from opportunities because you have a disability or someone believes you have a disability. (Taken from Mental Health Coordinating Council)

The difference between mental illness and (pyschiatric) disability

There is often confusion regarding the use of the terms “mental illness” and “psychiatric disability”. Disabilities are the consequences of an illness, that is, a person may have difficulty in being able to carry out tasks and roles as a result of having an illness. The terms “illness” and “disability” relate to the World Health Organisation’s International classification of Impairments, Disabilities and Handicaps (Geneva 1980, reprinted 1989) which established a system of classification to identify consequences of disease and illness. (WHO is in the process of reviewing and rewriting this classification system.)

With regard to mental illness 

Impairment refers to the loss or effect of the illness on psychological, physiological or anatomical systems, for instance, experiencing hallucinations, thought disorder or depression.

With regard to disability

Disability refers to the restriction, lack or loss of the ability (as a result of the illness and impairment) to perform an activity or task, for instance, the tasks of everyday living, tasks at work, study or activities in the community. Handicap refers to social and environmental factors such as discrimination and poverty which disadvantage a person with a psychiatric disability.

Psychiatric disabilities are significantly different from many other disabilities in that they can fluctuate and are a result of an intermittent and episodic process. As well, not all people who have a mental illness will develop a psychiatric disability. (Taken from here)

Development of a mental illness into a disability

Why does it happen?

  • symptoms such as disordered thoughts, hallucinations and loss of contact with reality can make it difficult for a person to concentrate, process information, solve problems, make judgements or follow instructions
  • the intermittent or constant presence of symptoms can result in the person being emotionally fragile and vulnerable to stress
  • medication does not always control symptoms
  • the person can lose confidence in their ability to make decisions, perform tasks and engage in activities
  • loss of confidence and self-worth has a compounding impact in all areas of the person’s life and can lead to loss of motivation, neglect of self and overwhelming feelings of hopelessness
  • loss of positive emotional feelings, apathy, withdrawal, loss of self-esteem and confidence have traditionally been untreatable by medication
  • interruption to education, training and developmental phases caused by the illness can impact on the person’s ability to perform tasks and achieve independence and a valued role in society

Psychiatric disability – the social disadvantages 

The social stigma and lack of understanding about mental illness and psychiatric disability means that, for many people, overcoming these hurdles can be more daunting than coping with and overcoming the illness itself. The myth that “mad” equals “bad” still has currency in some parts of society.  People with psychiatric disability can be socially disadvantaged through:

  • limited choice due to limited income
  • lowered social status
  • lack of expectation from others
  • rejection by friends and family
  • vulnerability to being victims of crime and abuse
  • insufficient opportunities to learn new skills
  • limited options for developing a valued role in the community

(information taken from here)

Despite the obvious potential consequences of having a psychiatric disability, I am fortunate that I can mostly function fairly well.