Wednesday, August 11, 2010

At 2 Kilobunnies!

I'm listening to Mozart's Divertimento in E flat major, KV 166, as I write this.  More about that later.

For now, make a joyful noise!

I am four weeks out of my depression now and it is heavenly.  How can I express the joy of not being depressed?  Of being able to attend to life's little details without fear?  Of having the courage to confront people, places and things when they upset me and swiftly resolve the emotional matter at hand?

Through long practice I am quick to forgive.  That is, my practice is not to let things fester in relationships, to expose any block to honest relations as early as possible in the course of conflict.  This does not mean I meekly submit to the other person's position; quite the contrary, I am willing to fight for my own.  But when the process is completed, I want the way between us to be cleansed, for pure water to flow from one heart to another, unimpeded by the secret dissatisfactions with others that plague us. 

After suffering depression for two-and-a-half years of the last four, I am ready to take my place in society again.  I have plans for the future, plans I do not feel at liberty to share, but they are achievable so long as I maintain vigilance over my mood.

Manic-depression is much like diabetes in this regard; adjustments in dosage and sometimes medications must be made frequently in order to anticipate the direction in which the mood disorder is progressing when the internal milieu changes.  In other words, when Kathleen told me tonight (as I recall her saying, though she denies it), "You've crossed the line into mania."   (She denies saying this but admits that she said I "was out there" and chose to eat her dinner separately. 

What did I do?  Object to her assessmen?  Defend myself?  No, I went straight to the medicine cabinet and swallowed 10 mg. of Abilify (a third-generation antipsychotic) to temper the rise in my mood.  I was not delusional, I was not physical or combative; let's just say that my engine was running too hot.

It is not uncommon after a serious depression to slip into mania in rebound, because you feel so good and it's such a relief that you want to feel better and better until you feel too good.  What is that like?  Here are a few examples:

1) Listening too fast  (I leap ahead in conversations, confident that I have deduced the point being made before the other speaker is finished.) 

2) Increased physical energy.  My pace in my daily one-hour hike with J. Alfred has increased.  Sometimes I walk him at night as well.  (Picture below.)

3) Reduced need for sleep.  For three nights in a row I needed no more than 4 hours.

4) Creative thoughts that encompass a variety of disciplines, from theology to medicine.  My mind generates hypotheses and systems of categorization and comparison, including the design of clinical trials in psychiatry.  Strangely, I feel drawn to the field again; indeed, it seems as if I never left it. 

5) A tendency to impute to others my irascibility.  When to myself it appears I am only protecting my boundaries, others may perceive an overreaction.

6) Decrease in appetite (with accompanying, thank my stars, weight loss).  I feel ike an air fern, like I could live on air.

7) A heightened sense of wonder towards everything, but especially toward the glories of Nature--the cliffs of Mendocino, the tunnels and arches of rock that pierce them, can overwhelm me almost to the point of joyful tears.
My training in psychiatry was rudely interrupted at the age of 29 by a bipolar depression necessitating ECT.  In discussing my illness with the department chairman, a warm human being named Floyd Westendorp, it was decided that psychiatry was too close to home for a good prognosis.  I might have been set off by other mood-disordered patients, something I call "cross-kindling." 

Kindling is a change in the mood regulators of the brain, a cascade of increasing activity in mania and decreasing activity in depression.  In depression there is a paucity of thought, an obsession with the same problems over and over in mind-numbing repetition without solution.  In hypomania, which is as far as my present mood has ascended, thoughts flow like water, ideas flock like birds, vistas open up that stretch an entire lifetime.  It's spring in Craig's brain, though small compensation for depression-- depressions outnumber mania and hypomanias 3:1 in bipolar disorder.

The point is, I'm managing my illness and listening to that best observer of me and my mood, my wife.  I know she has my best interests at heart, and if she opines my engine is running too hot I've got to cool it down, both for my benefit and the relief of mankind, as left unchecked I can become rude, insistent and physically coiled like a snake ready to strike.  I'm hyperalert, able to monitor more stimuli, able to solve near any problem with amazing alacrity.

When coming out of a depression the brain, often with the assistance of medications, can overshoot the target and bring on mania, in whose wake destruction usually follows--disrupting the lives of everyone close to the patient.  This is why psychiatrists more fear mania than depression; there are liability issues.  This is also why psychiatrists will make a depressive wait for a month to get an appointment, but upon hearing that a patient is manic, will make room for them in their schedule that day.  This is is a sad state of affairs, as to the patient the depression seems more of an emergency than the mania.  But how are doctors to know this unless we, the sufferers, tell them?

Many doctors are dense, more attuned to the imposition of science on the human body than to the body's natural signals.  In each of us lies the secret to healing, but it takes a very good clinician to tease that process out, one who respects the experience of the patient, even if it includes psychoses--which can be powerful, life-changing visions.  Psychiatric patients need to be treated as whole creatures, not collections of symptoms.  The rude classifications of DSM IV, the standard manual for psychiatric diagnosis, are primitive and operational by necessity, but qualifying for five of nine traits in a personality disorder doesn't tell the patient or the clinican what the actual damage is; that must be worked out over time, with much patience, effort, and appropriate time for the patient to muse upon past hurts and fears, understanding their origin and learning to forgive in order to attain true freedom, which is peace of mind.

Since taking the Abilify I have calmed significantly.  My typing is not rushed.  It is easy for me to focus.

One thing I did while still depressed was to order the entire works of Mozart--170 CDs--for mental health.  I thought by listening to the master of reconciliation in music that I might reconcile with myself, and it's working.  It's been especially wonderful recovering from depression to the soundtrack of Mozart.  Like the Grateful Dead, his music is essentially happy, buoyant, often light and uplifting.  A recent study, in fact, maintained that classical music was of help in depression, and Mozart was mentioned as an example.

I've been devouring medical journals of late.  I feel a call back to science and away from poetry.  How this plays out remains to be seen.  But I'm glad, I'm so glad to have a life, and a solid ambition for the future. 

2 Kilobunnies,


p.s. Above a picture of J. Alfred Prufrock and below a link to the ten professions most afflicted with depression.

Workers and depression risk

Tuesday, August 03, 2010

Three Weeks Out of the Pit

I haven't blogged in a while, as I previously said I had little more to say about manic-depressive disease.  Below an offering for today that may relate to others afflicted with either pole of affective disease. 


For the second morning I woke with akathisia (related to "restless leg syndrome), which I described to K as feeling like "an overfull bladder spasming."   Indeed, this is how it feels, as if there is an uncomfortable energy in every limb that constantly begs for movement, as if you were a marionette being vibrated on a string, helpless to stop your craving for motion.  I took some medication and it calmed down.  But it did wake me early and I have stayed awake, finishing a wonderful novel by Elizabeth George entitled "What Came Before He Shot Her."  Great descent into the modern slums of London.

This is my 56th year, the eighth cycle of seven. I knew it would be a revolutionary year, but had no idea it would begin with a return of depression. As my sister Elise says, “Chaffins need to work.” I think everybody does. It’s a shame so many people have jobs that bore them, that don’t challenge them, though if they do their jobs to their utmost there will still be some satisfaction in it, however small. It’s estimated that 85% of American workers don’t like what they’re doing. How much this has to do with life choices and how much with one’s attitude toward the universe is not clear. Some people are eternally dissatisfied instead of being thankful for the process and hopeful towards some result.

The linearity of life is inescapable; so time wears us out, so death summons us all, and our last years are in many ways the least fulfilling, with little work and less ambition. I would prefer to work until my dying day, especially since I have had such a long break from it. And who better to promote sanity than one who has been to the other side and come back? Who knows the fragility of the human psyche better than I? Not many practicing psychiatrists, I’ll warrant. And this gives me the great advantage: personal knowledge of extreme psychiatric symptoms—both manic and depressive psychoses, two sides of the same coin of narcissism—in one you are superhuman, in the other sub-human.   Whether I gather the courage to return to training and later, practice, is a huge question I can't deal with here in view of my deserved disability status.  But I harbor a small hope it could come true someday.

I must remind myself that even while depressed I have not proven incompetent. I just think I'm incompetent.  I think my writings and communications make no sense; I fear any advice I give is mistaken; I feel I don't have the right to say anything about anything to anyone.  I need confidence during my depressions if I should return to work someday and the illness arise.   Enduring depression has to be the centerpiece of my planning.  This would be the hardest thing for me, guaranteed.

And how much would the kindling of patients with affective disorders vibrate sympathetically with mine? Here is a danger as well. I must construct a routine and a reliable personality to sustain me through dark times. As Kathleen said, “Whether depressed or not, you’re still Craig.” There is an essential Craigness to me which others can see while I’m depressed but I cannot. Of what does this continuity consist? To the depressed it appears as only a semi-functioning persona, a convenient fiction meant to represent a person who is either not real, not deserving of existence, or not able to cope with any emotional contact. The bell jar may be thought of as more opaque than Plath described it; instead of being exposed to all, perhaps we hide from all under the shield of their habituation to elements of our personality. Others may perceive a solid where we see absolute permeability, as if any influence could pass through us at any time and feed the winds of our perpetually descending cyclone, that all stimuli are caught in the vortex of self-negation so that each stimulus is acutely painful, more than anything expressions of love from others, as the feeling of love, or its benefit, is entirely incomprehensible to the depressive, which explains my religious feelings of shame and guilt—I am like the sinner who not only would not lift his eyes to heaven but would grovel before the altar like an animal begging euthanasia. How can a psyche like that receive the love of God? It would be a bloody miracle if it did; it would go against the grain of everything depression stands for, everything of which it is the incarnation, the prison of self, the door locked from the inside forever.

Metaphors fail in this illness as everyone who has suffered it knows. Being only three weeks out of severe clinical depression (8 kilorats for those who have followed my blog), it is not surprising that at times I have frissons of terror, of falling back into the snake pit, of instant regression to a depressed state. But I think euthymic kindling is taking place, like a new green shoot in the gray soil of my brain, perhaps reorganizing the actual architecture of my cortex; perhaps my brain is plastic enough that this good kindling can last a good while, as it has in the past, though the relapse rates even for even adequately treated bipolars is usually one year or less.  

1 Kilorat,


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