Wednesday, December 12, 2012

bipolar depression

No Bipolar Depression Now?
Its been over five years since I experienced my last episode of classic bipolar depression, back in June/July 2007. I have been dealing with bipolar disorder for 32 years now and since 2007, three episodes of bipolar mania have not been followed by depression.

After all these years, I may have altered my classic cycles of manic-depressive  - bipolar disorder. Altered with important insights gained from self-education and the organic integration of three, six week long, manic psychoses. Over the last decade I have made a concerted effort to educate myself, hoping to find a better way of self-managing my bipolar condition, my over-sensitive constitution, without psycho-tropic medications. Of coarse, only time will tell?

After thirty two years experience, my bipolar experience is not following a classic manic-depressive, bipolar cycle. Leading me to question whether my hard won education insights have allowed me a natural integration of episodes of manic psychosis? There has been a five year period, free of the shame filled, self-stigmatizing, self-defeating label, of a mental illness? Three times since 2007, I have experienced mania's euphoric psychosis, hoping to benefit, by allowing an episode to run its full coarse. That is to say I have allowed the experience to unfold, after educating myself beyond the common belief of mental illness, as a disease of the brain.

Since 2007, I have not sort any kind of help from the medical profession and I have kept myself away from judgments of my experience as a mental illness, requiring medications. Consequently I am finding far less mindful intrusion of the kind of shameful memories and self-stigma, which used to trigger a depressive rebound reaction, after previous manic episodes of such length and emotional intensity.

These days I do not feel overwhelmed by helplessness as I have following previous delusional periods of mania. Nor have I felt a pressure to conform to expectations, now that I am in a period of my life when I can afford to allow my experience to unfold, and to manage it in my own way. I’m lucky though, I don’t have to many commitments to others, that I need to fulfill these days, and I can take my time to digest and reflect on the manic episodes without the stress of work a day life.

Another factor is that I had not been living alone, as I was following a manic episode in 2007. I was in a full time relationship with someone who has no knowledge of my bipolar condition because, she hardly speaks English and I don’t speak enough of her language to explain it to her. Up until six weeks ago, I lived in Thailand, away from the the Western medical model of mental illness, which seems more 'object' orientated and less holistic than its Eastern counterpart.

In that relationship I was forced to limit my mind's constant rationalizations of primary needs, and go back to a communication style, of eye contact, touch and gestures. A more physical, primary process form of expressive communication, which forced me to be more aware of the sensations within my body, than I had been in decades. Forced me to communicate with a "felt-sense," rather than my old thinking and talking persona. Such primary process communication seems to demand more of an ‘in the moment’ awareness of both myself and the other person. This relationship experience also allowed me a better sense of the distance, that I had created between awareness of body sensations, and my thinking mind, an over-intellectual sense-of-self, unconsciously acting as an avoidance of internal feelings.

Its the kind of felt awareness that the wonderful Gene Gendlin introduced to the world with his Focusing Therapy and his extensive writings on the "felt-sense." Watch him explain this strange place where implicit-self, unconscious self, meets conscious-self, when we go inside and attempt to heal our mind-body split;

Education has given me the insight of mind, to understand what the collapse sensations of a depressive impulse really are, and to resist the unconscious urge to amplify sensation and feeling, with thoughts.

In the years since my last episode of depression, there have been no visits to psychiatrists or other medical professionals, no relationship interactions with others, based on the belief that I am sick and only medications can keep me stable. Three full-term psychotic mania's passed by now without the depressive rebound, from delusional experiences that were uninterrupted, for the purpose of allowing a studied reflection once my energies had returned to normal levels. Changed circumstances of different culture and different relationship played an important "affective" part in my changing experience of bipolar disorder.

Also there are a variety of ‘sensation exercises’ that I practice, in an effort to change my sense-of-self, from one that had its locus of energy in my head too much, to one that is as much body sensation based as thought based. Every morning when I wake I spend ten minutes doing deep breath work to oxygenate my blood stream, bringing a wider sensory awareness for example.

Another factor in my freedom from depression, is a determined pursuit of knowledge and a slowly growing change in self-interpretation, that has been ongoing for the last eight years. A gradual change that has included, formal training in counseling and reading up on as many of the therapies and theories as I could. The sojourn into self-education led me towards the latest concepts in brain/body neurobiology, in an effort to understand what goes on inside me, to stimulate those observable behavior patterns we call symptoms.

A growing understanding of neurobiology has led me into an increasing awareness of the sensations produced by my body/brain nervous systems, which I believe cannot be separated from the brain alone, in the observable symptoms of manic-depression. The systemic nature of brain/body interactions through the autonomic nervous system in particular, is complicated, which is why its easier to think of mania or depression as a chemical imbalance, solely within the brain.

Yet a five year effort to understand the machinations of my complex brain, nervous system interactions, has also led me to conclude that ‘trauma’ and the evolutionary nature of our autonomic nervous system, underpins manic-depressive reactive cycles, and that mania is really an attempt to ‘exit’ a traumatic experience conditioning, of the autonomic nervous system.

So has knowledge, experience and circumstances, contrived to prevent a descent into depression, so characteristic of my previous, classic manic-depressive cycle? Or am I some how managing to hold myself above an inevitable fall? Only time will tell of coarse and I’m open to life's persuasion (stress), yet as each passing week holds a new pattern in my thirty two year journey, I’m am optimistic that something inside me has actually changed.

Self-Educated knowledge, like my reading of Allan N Schore's amazing work on human development and the implications of neurobiological research. Consider;

"In patients who as infants experienced “dead spots” in their subjective experience and subsequently characterologically access pathological dissociation, this “glue” of the right brain emotional-corporeal implicit-self too frequently fails in stressful moments of arousal dysregulation. Thus there is a deficit in implicitly generating and integrating what Stern (2004) calls “now moments,” the basic fabric of lived experience created in continuous small packages of interactions with others.

These are the smallest molar unit of lived interactive experience exhibiting temporal and rhythmic patterning, and they operate at an implicit/procedural “core” level of consciousness. Dissociation is commonly understood as “a basic part of the psychobiology of the human trauma response: a protective activation of altered states of consciousness in reaction to overwhelming psychological trauma” but it is important to note that this restriction is not just of explicit but more importantly implicit consciousness.

The fragile unconscious system of such personalities is susceptible to mind-body metabolic collapse, and thereby a loss of energy-dependent synaptic connectivity within the right brain, expressed in a sudden implosion of the implicit self, a rupture of self-continuity, and a loss of an ability to experience a conscious affect. This collapse of the implicit self is signaled by the amplification of the affects of shame and disgust, and by the cognition's of hopelessness and helplessness.

Because the right hemisphere mediates the communication and regulation of emotional states, the rupture of inter-subjectivity is accompanied by an instant dissipation of safety and trust, a common occurrence in the treatment of the right brain deficits of severe personality disorders

In parallel work Zanocco (2006) characterizes the critical function of empathic physical sensations in the enactment and their central role in “the foundation of developing psychic structure of a human being.” Enactments reflect “processes and dynamics originating in the primitive functioning of the mind, ” and they involve the analyst accomplishing a way of interacting with those patients who are not able to give representation to their instinctual impulses.

These early “primary” activities are expressed in “an unconscious mental activity which does not follow the rules of conscious activity. There is no verbal language involved. Instead, there is a production of images that do not seem to follow any order, and, even less, any system of logic”. Note the implications to implicit primary process cognition and right brain representations.

Enactments occur at the edges of the regulatory boundaries of affect tolerance (Schore, in press), or what Lyons-Ruth describes as the “fault lines” of self-experience where “interactive negotiations have failed, goals remain aborted, negative affects are unresolved, and conflict is experienced.

In a groundbreaking article Welling (2005) notes that intuition is associated with preverbal character, affect, sense of relationship, spontaneity, immediacy, gestalt nature, and global view (all functions of the holistic right brain). He further discusses that “There is no cognitive theory about intuition” (p. 20), and therefore “What is needed is a model that can describe the underlying formal process that produces intuition phenomena.” _Allan N Schore.

Is bipolar mania, a spontaneous, "intuitive" process of primary process activity?

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Important Attachment Relationship Interrupted - What Now?

December 2012: Its been six weeks or so, since I was forced to leave Thailand and begin a new phase of my life, back here in Australia. In the past, the loss of an intimate relationship, has triggered my most intense episodes of bipolar's mania, followed by severe depression. There has been a two month period of high stress and heightened emotions, which in previous years would have culminated in a long period of clinical depression. My new circumstances could not be too much more conducive, to a depressive collapse and suicidal thinking? Yet my mood remains stable, with no resort to medical intervention or psychotropic medications. Take a peek at where and how I'm living now;

What should I think about being here & how can it be an experience I need to have?
Three square meals per day and free accommodation until I find work and save enough money for a deposit on private accommodation.
As a society, we certainly do more to relieve an existential crisis than other societies, were family support takes its age-old place on the front line of human survival.
Thank God, it was not "impossible" for me to stay here.

I've been here in the past to fix the broken elevator and reacted to the sights, sounds and smells of this place with a fearful and ignorant sense of judgment. A fearful need to feel strong and superior, in judging other people as lesser than, as loser's, the lowest of the low. "I must be ok, because I'm so obviously better than you," in that endless status competition we call civil society. A sense of judgment securing my deep need for a sense of security. My ego's endless drive to feel certain, to feel safe, while remaining cut-off from an internal sense of security. My need projected onto objects, like a better car, a bigger house and bank account, unaware that I was treating these human souls I once viewed as pitiful, as nothing more than objects. I'm sure I remember something from Christian Sunday School about Mosses and advise about NOT worshiping false idols/objects? So here I am, testing my new self-regulation and appreciation for life, and the sanctity of the human soul, and coping pretty well with my "existential crisis," so far.

In my self-imposed quest to learn more about my "mental illness," is this a new cycle, in my ongoing recovery process. Do I really have a brain disease, or was I suffering from a profound dis-ease within, for decades? As Paris Williams points out so well in Brain Disease or Existential Crisis?;

"In spite of over a hundred years of research and many billions of dollars spent, we still have no clear evidence that schizophrenia and other related psychotic disorders are the result of a diseased brain. Considering the famous PET scan and MRI scan images of “schizophrenic” brains and the regular press releases of the latest discoveries of one particular abnormal brain feature or another, this statement is likely to come as a surprise to some, and disregarded as absurdity by others. And yet, anyone who takes a close look at the actual research will simply not be able to honestly say otherwise. And not only does the brain disease theory remain unsubstantiated, it has been directly countered by very robust findings within the recovery research, it has demonstrated itself to be particularly harmful to those so diagnosed (often leading to a self-fulfilling prophecy), and it is highly profitable to the pharmaceutical and psychiatric industries (which likely plays a major role in why it has remained so deeply entrenched in society for so many years, in spite of our inability to validate it)." _Paris Williams.

What do YOU think? Why haven't I experienced bipolar depression again, if the illness is just like cancer or diabetes? Am I just lucky, or have I really learned how to self-manage my condition by gaining more education and awareness of my inner-self? How much do know about your brain and nervous system?

My Bipolar Recovery Method?
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Bipolar Anger & Toxic Shame
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