Everything discussed in this section so far has been building up to this theoretical model, the Brainbox.
Remember the initial model introduction:
- We have a “Brainbox” of a particular size: CAPACITY
- We carry our “stuff” around in it: STRESSORS
Now let’s imagine that the largest box in the world is size 10 and the smallest is size 1, therefore, everyone has a box rated at a size graded between 1 and 10.
And the same story for the stuff. The maximum stuff that anyone has to carry is 10, and the minimum is 1, so everyone can grade their stuff between 1 and 10.
Let’s look at some examples.
- An average non diabetic adult has a box of size 7 and carries around stuff of size 4, including, work, health, children, relationships, finance and so on. The stressors are difficult to carry, they weigh quite heavy on the mind, but the capacity of the box is good enough to contain it.
- Another non diabetic person has a capacity of 6 and stressors of 6. The box is just big enough to contain with the stuff, but it is hard! A week later, there is a bereavement in their family, stressors increase to 7. The box is no longer fit for purpose, it is overflowing. In this model, this is when depression occurs.
- A person with long term mental health issues might suffer from them because their capacity is very low. They might have a box of only size 2 but a life with very few stressors, only 3. However, this explains how, for some people depression can be a huge internal battle despite the exterior perception that their life is relatively good.
In essence the brainbox model is that:
- BRAINBOX DEFICIT: If the value of stressors is greater than the value of capacity, depression is the result.
- BRAINBOX EQUILIBRIUM: where capacity is equal to stressors. This is not a good state to be in. It leaves you sailing too close to the edge of depression
- BRAINBOX CREDIT: The ideal brainbox situation is to have a gap of where capacity is greater than stressors.
If in deficit or even equilibrium, a person should try to create a gap and there are two ways to do this:
- Increase the size of the box: The best way to do this is to take antidepressant medication.
- Decrease the value of the stuff: Counselling and cognitive behavior therapy can be used to change the perception of the stressors to reduce them.
Implications with T1D
T1Ds are 4 times more prone to experiencing depression because:
- T1D increases our stressors: All of the unique anxieties and disorders discussed in this series increase the value of the stuff!
- T1D reduces our capacity: The serotonin imbalance caused by T1D decreases the size of the box
It should be no surprise that so many suffer, I reiterate, it is normal and to be expected.
Consider an average adult diagnosed with T1D, walking around with a box of size 7, filled with stuff of size 4. The immediate greif and short term anxiety increases the stressors to 6, but still in credit. After a period of diagnosis the box decreases to 6 and now they are in equilibrium, a short time later, there is a stressful incident at work and then they are in equilibrium. Without the T1D, the credit state could deal with a few extra stressors, but the combination of the increase stuff and decreased box caused by T1D results in it being in equilibrium.
Resolving diabetic depression
If depression is caused by having too much stuff in too small a box, the solution is to reverse one or both:
Increase mental capacity
As with a non diabetic sufferer, the best way to increase the capacity of the box is to take antidepressant medication. Antidepressant medication forces the use of serotonin to repair the insufficiency, thus restoring normal chemistry and increasing brainbox size.
Decrease stressors
In a non diabetic patient, stressors are decreased by counselling to understanding them, modifying the perception of how they think about them. Cognitive Behaiour Therapy is essentially the skill of placing a positive spin on negative feelings, improving our perception of them to decrease their weight.
In my opinion, the unique stressors related to T1D play such a large role in the amount that we have to carry, that I believe that if you can significantly reduce the diabetic stressors, by improving the way you feel about T1D, you can significantly reduce your stuff.
Where do you think your Brainbox is? Credit, equilibrium or deficit?
Understanding it and understanding why empowers you to fix it.
Today I am sure that my Brainbox is comfortably in credit. To flip from a deficit requires a combination of two solutions.
We have a box that is too small and with too much stuff in it, so i needed to:
- Increase the size of the box AND/OR
- Decrease the size of the stuff.
Increasing the Box
This is done through antidepressant medication, I was originally on Citalopram, but when my neuropathy became worse, this was switched to Duloxatene, which has a dual benefit of being an antidepressant by nerve suppressant, so is beneficial to neuropathy also. There is no shame attached to taking antidepressants. All it is doing is replacing something that our body is insufficient in, serotonin. Isn’t that the same reasoning as to why we take insulin?
Decreasing the Stuff
Hypo, hyper and complication anxieties are reduced, mainly through knowledge, education, acceptance of perception of perfection. Perfection is impossible to achieve, accepting this was key and redefining my interpretation of perfection was crucial.
Diabulimia, I struggle to assess, I do not referee anymore, due to my eyes but I do trust myself, that if this was not the case, I would not revert to previous behaviours, because my knowledge would preclude me.
I do suffer burnouts, but as said, my high bar, gives me a buffer zone to fall down.