Globally Parkinson’s is the second most common neurodegenerative disease after Alzheimer’s with some 6 million cases. Unfortunately, case numbers are on the increase with a figure of some 12 million sufferers being projected by 2040.
What is Parkinson’s?
It is a progressive disease, which gets worse over time. The rate of decline can be highly individual and variable indicating that there might be more than one type. Currently, there is no treatment that can slow down the rate of degeneration. Outward signs are typically a slowing down of movement, rigidity, and tremors at rest. These are often accompanied with other debilitating changes such as; cognitive deficits, sleep disturbance, loss of smell, bladder dysfunction, gastrointestinal dysfunction, cardiovascular problems, depression, and anxiety. These later symptoms tend to precede the more recognised outward signs.
The causes of Parkinson’s are still unclear however there are a number of hypotheses being investigated. Despite Parkinson’s affecting many parts of the nervous system the principal area of investigation has focused on the brain. One area of interest is part of the midbrain called the Substantia Nigra. This region forms a major pathway of the brain that is critical for facilitating motor movement. It appears that in Parkinson’s patience that the dopamine neurons in the Substantia Nigra gradually die leading to the malfunction of this pathway, consequently resulting in the characteristic motor problems.
A distinctive pathology in Parkinson’s is the clumping of misfolded proteins within neurons (brain cells). Research indicates that these are toxic to neurons and play a key role in driving Parkinson’s. Unwanted proteins are normally cleared by the cells' different types of protein degrading processes. Some evidence points to these systems being overwhelmed by the misfolding protein leading to neuron death.
Parkinson’s has also been linked to problems with the Mitochondria. Mitochondria provide cells with the energy to carry out vital functions. They are highly dynamic and can fuse together or break up in response to cell energy demands. They can also transport to other areas of a cell that needs them most. In Parkinson’s, this process can become impaired meaning that the mitochondria are unable to sustain proper function. As they become old or damaged mitochondria are removed and replaced. It is this recycling process so to speak that is thought to be disrupted, leading to the accumulation of damaged or worn-out mitochondria.
Another idea is that the cells called ‘Glia’ that surround neurons may have a role in Parkinson’s. As dopamine neurons are lost another neuron called microglia takes up the debris, triggering an immune response. Once activated they release inflammatory Cytokines which activate neighbouring microglia and another type of glial cell called astrocytes. Chemicals released by the microglia and astrocytes have been shown to injure neurons.
It remains unclear as to which mechanism drives the disease process in Parkinson’s. But what is clear is that in time more areas of the nervous system develop pathology. And one emerging idea is that this happens through the transmission of the misfolded proteins.
Living Successfully with Parkinson’s
As was already alluded to, Parkinson’s can be a highly individual disease, with symptom severity varying from individual to individual. But despite the long-term prognosis being one of progressive decline, much still can be done by the individual to move towards finding a way of living that still engenders hope, possibility, and growth. Learning to live successfully with any condition can be hard, but not impossible.
A Solution-Focused (SF) approach has been successfully applied to Parkinson’s for many years now, both within the hospital and private practice settings. One of the beauties of SF is that the client is seen as the expert, they know which symptoms predominate, when a new symptom develops and when the medication is not working. SF does not overly focus on the problem, but rather looks to help the client move towards a preferred future. Being future-focused and client ‘expert’ centred allows a co-constructing process to take place that details what a successful life could look like. SF is a ‘question-centric’ practice, that is it uses questions to help the client build a clear picture of their preferred future. There are no standard questions as such as the questions are formulated very much around the individual. That being said, there are a number of questions or variations of questions that are regularly used.
Typically sessions begin with establishing a clear direction of travel for the session.
Q) For you to have thought that this was a valuable use of your time today, what would you like to have achieved by the end of it?
Q) What are your best hopes from us talking together?
The conversation can then move on to what a preferred future might look like. Paradoxically the preferred future is mostly based on instances of successful past events. It is the positive experience of the past event that acts as the motivation towards repeating ‘what worked’. These historical ‘what worked’ events can just be brief in nature and could easily be missed without investigation but they can act as a useful signpost towards a preferred future.
Q) How would you know that you have achieved [X] (X being the described preferred future)?
Q) What would living well look like for you?
Q) How would other people know that you have achieved [X]?
Q) If [X] was to happen tomorrow, tell me 10 things that you would notice?
Another area of importance is the recognition of the client’s own resources or how they have coped up until now. As is so often the case, recognising one's own strengths doesn’t always come easy. But through the mining of the descriptions of their lives, they discover for themselves ‘hero moments’. These moments are amplified and focused on which encourages self-efficacy and self-confidence.
Q) What is it that keeps you going?
Q) What skills do you possess that will improve your chances of making your best hopes happen?
Q) What are you most proud about?
Q) What is it about yourself that tells you that you can move towards your preferred future?
Q) What is it that friends and family know about you that makes them confident that you can successfully achieve your preferred future?
Becoming more self-aware is also another important aspect of the SF processes. This process can give the client important insights into how they successfully navigate their day-to-day lives. Surprisingly it is in the mundane description of day-to-day living that important insights can be brought to the fore. They can then be examined and encouraged to do more of.
Q) What does a good day look like?
Q) What are the first signs that tell you it's going to be a good day?
Q) Are there any aspects of your preferred future that are already happening?
As you can see it is through the descriptive processes that questions elicit an awareness of ‘things that work’. Once recognised the client can then look to do more of the ‘things that work’. It is important to state again these ‘things’ can be highly individual and can seem peculiar or even unrelated to the problem on initial inspection. But from the position of the client as the ‘expert’, these solutions must be respected. As Parkinson’s can be highly individual, any support must recognise the expertise of the Parkinson's client. As SF respects this ‘expertise’ it lends itself well to enabling the Parkinson's client towards a more successful way of living with the condition.