Thursday, February 17, 2011

The Manic-Depressive's Progress

April 2007, I have another hyper-manic episode, after 4 years of un-medicated progress?

‘What progress? You had another delusional mania, you classic Bipolar 1, You!’

Well progress of a self esteem kind, a growing, glowing ember of self respect.

In 2003 I started training as a volunteer telephone counselor at Lifeline Sydney, followed by 18 months on the phones with bi-weekly 4 hour shifts, 10pm-2am, mostly week nights.

‘Why do you want to be a counselor? - Is there any money in it?’ A friend had asked.
‘I need to invest in self respect,’ I told him.

Those bi-weekly, wee hour shifts were the beginning of my education in counseling skills, and that eerie feeling one gets after giving someone advice, “was that about them or me?”
I did learn to listen more though, and I remember well some of the more challenging calls. The transsexual who’d been pistol wiped by a lover, challenging my conservative core, the fear of my own sensation as my muscles tensed from the beginning of conversation. Never before or since have I heard such heart felt human pain.

2005 continued the new trajectory with enrolment in a counseling degree at the Jansen Newman Institute. There were monthly sessions of challenging group therapy for two years, although it became a challenge I relished. Group therapy followed the Yalom method with its ‘illumination of process,’ interactions between members, which are discussed to uncover underlying motivations.

The why did you say that at this particular time, in that particular way and what were you feeling? Who in the group reminds you of a significant person in your past?
In group I got to feel the transference phenomenon, which is easily recognized as a plausible idea by the mind, yet denied by unconscious motivation. The felt experience of transference has a powerful affect on self reflection, although the resistance to its conscious awareness soon takes hold again.

Towards the end of 2006, I was coming to a felt awareness of my resistance to emotion while engaged with a client, where emotional expression would have been advantageous to them, yet I always resisted going there despite my best intentions.

‘The client is supposed to be the one with resistance,’ I complained to my supervisor.

The two most important insights I gained at Jansen Newman were that, "all behavior is communication" and "its always about you!" About me that is. Sounds narcissistic I know, yet some say that primary narcissism is the very root of self esteem.

So in Febuary 2007 I started a Gestalt therapy coarse to help improve my felt sense of me. Early success helped fuel a growing sensation that I could give up my disease diagnosis and move beyond the self imposed constriction that had seen me through 27 years of Bipolar Disorder. Emotional constriction was how had I coped during this long period of flirting with various medications with disastrous manic highs and even worse depressions. I withdrew into a self protective shell.

Fellow students at Gestalt described my approach behaviors as, “as if coming from a hiding place behind the bushes.” Yet this awkward hesitant approach to life was how I’d managed to help raise four children, build a home and even a successful business before I sank into a clinical depression in 1997.

By 2007, I had left my wife and had four live in relationships, always falling in love quickly and always leaving. In late 2006 I’d done it again, gone back for a month and allowed the lady to seek her rejection revenge, which resulted in a late March, mania rising.

At this time in my life I was convincing myself that I needed to go through the classic manic-depressive cycle and allow it to unfold, believing it was part of a developmental need. I even countenanced the idea of it being a self stimulated right of passage, an adolescent phase of emotional growth missed.

To cut a long story short, I ended up being locked up against my will for the very first time in my life. From bitter experience I knew that by the time I'd agreed to see a psychiatrist, I was on the waning side of a hyper manic phase. I’d gone to ease my families concern, with the idea in mind of showing my four sons how Bipolar is over diagnosed as disease. Its an idea still firmly in mind, although the time scale of such a process is much longer than I imagined.

How could I be so high functioning, work wise and keep myself relatively stable for such long periods, and have the strict medical model of disease? It was an interesting encounter, that first one, an encounter with the man who four days later would take away my liberty.

I'd spotted his reaction, a tensing of the shoulders as he read the notes from the previous nights encounter with a psych nurse. He had not seen me during his relaxed stroll down the corridor, past the waiting area on his way to the reception desk. I shook my head slightly as he walked back to his office, studiously avoiding a glance in my direction, my eyes following him all the way, in hope of an emphatic connection.

I had so hoped for a meeting of minds with a my fellow man, after more than two decades wondering what might have been. How life might have worked out if I’d seen a different psychiatrist on that first occasion. What if I’d found the priest I searched for on that first night of manic euphoria, wanting to ask if he thought I was having a religious experience? Always the Jesus thing, and always with such joyous spiritual exuberance. An early out of body experience had possibly played a part in the spiritual ideation.

Of coarse he didn’t hear what I said, just kept asking me the usual questions from his formulaic chart, the list of symptoms. Had I experienced disturbed sleep, racing thoughts, a heightened sensuality, sexuality and rising irritation, and he could see that I was over emotional. "The ratios and statistics of psychology and psychiatry," many therapists and counselors say. Some managers of counseling services won’t have the grad students anywhere near a client session, that requires sensitivity and empathy.

Person centered therapy requires an ability to be in the moment, together with the client in an exploration of all that can be sensed and articulated. Sadly my thirty something brother in psychiatric guise, brought an assumption to the encounter based on what he'd learned in school (university)and perhaps an experience of the times, with drug induced psychosis? Crystal Meth, seemed to have brought a sense of vigilance to public hospitals that had not been present, during my experience in the 1980's.

Perhaps that was the reason for his reaction when reading my referral notes four days previously. I was shocked at the new regime of care on the locked ward, more oriented to the welfare and health of the staff than the patients. Psych nurses would leave the safety of their secure enclosure in one hour shifts it seemed. They'd come and sit in quiet observation with a clipboard in hand, occasionally ticking boxes about observed behavior.

'Psych nurses used to talk to the patients,' I said to one older nurse, and her resentment of orders from the young Turks on high was palpable. I was reminded of those scenes from "one flew over the cuckoo's nest," and America's more violent society. What I'd seen in my young psychiatrist's reaction was an unconscious sense of threat, that his reliance on reason and logic kept him unaware of. Unaware, in the sense that his reaction was conditioned by past experience that made a preemptive assumption about me, that one size fits all, of diagnostic criterion.

I remember a role play at Lifeline training where a young psych student was failed from the coarse for to little empathy skills. I remember describing a friends experience of separation to her. He'd kissed his wife and daughter’s goodbye one morning and came home to an empty house, didn’t even find a note of explanation.

After her “ring, ring, hello this is Lifeline, can I help you,” I’d launched into the tail of disbelief and despair, explaining that all I had left was the phone books I sat on as I poured out my heart to her.

‘That must be lonely for you?’ She’d replied.
'Fucking lonely!’ I retorted.

The same missing empathy was present in that 2007 encounter with “I have more power than a policeman,” psychiatrist. No man to man conversation, no recognition of my 27 year experience or recent psychology training, no interest in the human being sat before him. The meeting had been prescribed in his head before i even entered the room.

‘You are hypo-manic and will become hyper-manic without medication,’ he told me when I'd tried to explain myself.
‘I’m already three weeks into it, I’m coming out the other side of hyper now.’

He did let me go home on that first visit, providing I took his prescription, he conferred with my oldest son and the knowing looks between two university graduate’s may have counted against me. Four days later I was perfectly honest about an argument I’d had with my son two days earlier and how I’d gone for a very long walk to discharge the energies of frustration and anger. "Why was I so very over emotional during this last few weeks," he asked me. Twenty seven years of frustration about what life might have been, no grounds for grief to him.

I protested as he called an MD to come and sign the paperwork for involuntary incarceration, didn’t the fact that I had done a full days work for the first time in a over a week, say something? I was self employed, a tradesman doing part time counseling, any stay over 10 days or so would see me in financial frustration too.

‘What about my clients, my customers?’ I asked him.

The six days I spent in a locked public ward, before winning my freedom, is a story worth a chapter by itself of coarse, and here a book is not my intention. Needless to say, that encounter set me off on my current sojourn towards more freedom from my internal machination’s. Furious reading has been the mainstay of my slow evolution from infantilized patient, looked upon as a poor creature of weakness, towards a confidence that with time and effort I can know myself, as the Oracle suggested to more ancient men.

You can read an account of my encounter with a Judge and how I was allowed to leave, with an apology for my wrongful sectioning here>>

Reading has led me to men like Allan Schore, Stephen Porges, Silvan Tomkins, Jaak Panksepp, and Peter Levine, to name but a few, although especially important to me these ones are. After a crushing suicidal depression in 2007, following hospital stay and the subsequent isolation, I stumbled on Allan Schore’s “Affect Dysregulation and Disorders of the Self,” and that word affect, began to ring a bell.

Along with Porge’s “Polyvagal Theory,” Tomkins “Affect Theory,” and Peter Levine’s ideas and methodology in his, SomaticExperienceing program for releasing energy in the symptomatic victims of Trauma, I now feel stronger and more certain of my self awareness, than at any other time in my life.

I am now 5 months and counting away from a manic episode last September, October, 2010, and prior to that I had made my first fumbling effort’s to write down my new awareness of ‘affect’ in the story When Sasiprapha Smiles. An awareness that has expanded through the experience of my 2010 six week long, un-medicated mania. My "King David" mania as I now laughingly refer to it, no shame this time around and no crushing depression either.

I’m still engaged in reading and re-reading, the second and third time is a bit like seeing a movie again, being surprised by the little things you had not taken in the first time around. Sasi Smiles is an interesting exercise in approaching a core subject, my emotional arousal and how I have constricted it’s expression for a lifetime. Freud noted how we displace deep emotional issues that we fear sensing onto another object, for want of a better word. In this first effort to articulate my understanding of ‘affective states’ as the essence of life’s experience, as some neuroscientists have described, I find a way to approach the subject and write the story that I‘ve promised myself for over a decade, my biography, my anatomy of mania.

There are articles to write about the working’s of my gizzard’s and how I believe that mania could be symptomatic of exit from a trauma that had become a lifetime trait. I have ideas about the neural networks in the brain that may be partly responsible for such ‘affective states,’ but here I simply wish to layout some background to my current life situation, some of the ‘how’ if not the ‘why’ of my getting here. Perhaps “Bipolar from the Inside Out” could be a good title for a biography, time will tell, nearly six months on I’m still waiting for that classic decent into depressive hell.