Friday, September 13, 2013

Psychiatry - the Emperor with No Clothes

This may come as a surprise to you but there actually is no medically based diagnostic test for any psychiatric illness. The second sobering thing to understand is that the diagnostic process that is used for any psychiatric illness cannot in any way be described as "accurate" and upon closer inspection certainly not scientific. "Diagnosis" - if it can be called that - is performed by observing "behaviours" and then checking them off a list. The behaviours are described in the DSM - the diagnostic and statistical manual, the "bible" of psychiatric diagnosis. To understand psychiatric diagnosis, we first have to understand this manual and how it gets put together. 

This is from the Neuroskeptic

In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.
Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.
It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.
Others were worse. Depression, had a frankly crap kappa of 0.28, and the new ‘Mixed Anxiety-Depressive Disorder’ came in at -0.004 (sic). It was completely meaningless.

This, by the way, was performed and compiled by the DSM-V committee in which the psychiatrists were hand picked. What this essentially boils down to is that the people who are authoring the manual upon which psychiatric diagnoses are based can't even accurately diagnose anything using their own criteria. Let me repeat that for you - the very people responsible for compiling the new (and since released) diagnostic manual that psychiatrists around the western world will depend on for diagnostic guidance and criteria cannot diagnose anything accurately based on their own diagnostic criteria. 

You might also be surprised at how "disorders" get included in the manual; they're voted in by - get this - a show of hands. 

Canadian psychologist Tana Dineen reports, “Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM-IV [and ICD-10] are terms arrived at through peer consensus”—literally, a vote by APA committee members—and designed largely for billing purposes.

The “science-by-vote” procedure is as surprising to a layperson as it is to other health professionals, who have witnessed DSM voting meetings. “Mental disorders are established without scientific basis and procedure,”
[my bold - brad] a psychologist attending the DSM hearings said. “The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. Then it’s typed into the computer. It may reflect on our naiveté, but it was our belief that there would be an attempt to look at the things scientifically.” [my bold - brad]

In 1987, a “self-defeating personality disorder” was voted in as a provisional label. Used to describe “self-sacrificing” people, especially women, who supposedly choose careers or relationships that are likely to cause disappointment, the “disorder” met with such protest from women it was subsequently voted out of DSM-IV.

Yes, you read that correctly; "disorders" can be voted in and then, on the basis of a protest, be voted out again. There is nothing medically scientific about voting "disorders" in and out of existence. Homosexuality was once a "disorder" that was only removed (for the 1980 edition) after strong protest from gay activists. 

And there's more. This from lead DSM-IV committee member Allen Frances, who in a (year) 2000 interview with Wired magazine, declared,

"There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it." ... "These concepts [of distinct mental disorders] are virtually impossible to define precisely with bright lines at the borders."

Frances became so alarmed at where the new DSM-V was going that he has become an outspoken critic of the entire diagnostic process and of psychiatry itself. 

And finally, the lead psychiatrist over the formulating of the DSM-V openly admits that there is little or inadequate "scientific research" done to back up the diagnostic claims in the DSM.

"A primary purpose of this group then, was to determine why progress has been so limited and to offer strategic insights that may lead to a more etiologically-based diagnostic system. The group ultimately concluded that given the current state of technological limitations, the field is years, and possibly decades, away from having a fully explicated etiology- and pathophysiology-based classification system for psychiatry." [bold all mine - brad]

Michael B. First, M.D. A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers. Published in May 2002.

So not only is there no clear etiology for any psychiatric disorder, by their own admission they're possibly decades away from having one (granted this quote is from eleven years ago and neuro-imaging technology has advanced considerably since then).

And this isn't mentioning the ties to drug companies that many DSM committee members have or how much funding the pharmaceutical industry supplies to the American Psychiatric Association

And just to give further idea, there's this. This was from a neuroscience paper the source for which I no longer have. My apologies. 

neuropsychiatric (NP) disorders ... can still be viewed as part of the most complex disorders that are of unknown etiology and incomprehensible pathophysiology. The complexity of NP disorders arises from their etiologic heterogeneity and the concurrent influence of environmental and genetic factors. In addition, the absence of rigid boundaries between the normal and diseased state, the remarkable overlap of symptoms among conditions, the high inter-individual and inter-population variations, and the absence of discriminative molecular and/or imaging biomarkers for these diseases makes difficult an accurate diagnosis.”

This is essentially neuroscience confirming what Dr. Frances admitted - that "there are no bright lines between the borders" and that they have no idea what causes anything. 

I will repeat - any neuroscientist will tell you that the human brain is the most complex device in the known universe. Even with the most mind boggling advanced and highly tuned instruments yet devised, bleeding edge neuroscience doesn't even really fully comprehend what is going on in there and why. Do you honestly believe that someone going by a corrupted and highly unscientific check list is going to know? I'll say again - I was seen by about twenty psychiatrists. None of them had the same thing to say. None of them could explain anything to me. None of them gave any indications they understood why these things were happening to me in my mind. Aside from a routine CAT scan to rule out concussion damage and a test to analyze my brain activity while sleeping, no actual medical tests were ever performed. And this will be true of anyone ever "diagnosed" with a mood or psychiatric disorder. This is not medical diagnosis, not even close. It's modern day voodoo at best. I'd go with a tarot card reading before I ever put myself in these people's hands again. They have about the same scientific basis. 

And then - then! - these people, after this simple check list "diagnosis", are going to pull out a prescription pad and prescribe either a drug or more likely a combination of drugs to "fix" what they "think" is "wrong". Drugs which, as I've written before, lack any kind of scientific validity for long term efficacy, drugs which could induce suicide or violent behaviour or cause critical structural changes to the brain including tissue loss.

Back to the four year old who was killed by a "psychiatrist" and for whom Tufts Medical Center felt "The care we provided was appropriate and within responsible professional standards" (60 Minutes, 2009). Seriously? Drugging a four year old to death is "within reasonable professional standards"? Where were these people during brain anatomy classes? Read any neuroscience book. The brain is still in rapid development stage at that age. Not only are behavioural issues common at that age as the developing brain struggles to make sense of and adapt to a seemingly bizarre world but it is beyond comprehension that brain altering chemicals could ethically be given to children whose brains are still developing. Yet "paediatric bipolar disorder" is now a common diagnosis and infants as young as three or four are put on cocktails of powerful drugs. And brain development goes right up past adolescence (the brain also undergoes massive changes during the teen years) and this age class is increasingly drugged (and off label at that - the drugs were never approved for non-adult use). And this isn't "Billy Bob Psychiatry" hanging a shingle out in some back water town, this is a major medical centre. And this is who we trust with our one and only precious brains?

No. I say no. And this is only the tiny, tiny tip of the iceberg of what I found for psychiatric misdeeds, the financial ties between the pharmaceutical industry, the FDA and the American Psychiatric Association and what is available for long term studies and research into psychiatric drugs (and thus psychiatry itself) efficacy. You might want to watch some of former drug company sales rep Gwen Olsen videos in which she describes how drugs are pushed to psychiatrists' and doctors' offices, old age homes and schools in order to "gain market share" and "make sales quotas" like they were widgets or some other kind of everyday product and not something that we trust to treat our brains. 

Psychiatry doesn't have a shred of clothing to wear. They have no scientific basis for diagnosis and they prescribe medications that have no scientific validity whatsoever. These are drugs that the effects of which are unobservable in the human brain (unlike medications for other medical conditions) "treating" conditions for which no biological etiology has ever been established and accepted (please try to find one - I'd be interested in seeing it. But head to the Nobel Prize committee first; they'd be interested in this discovery). I see no validation whatsoever for the "Dr" in front of their names that they so proudly flaunt. They get by entirely by the infamous "God complex" - they simply believe they "know". By what criteria? Nobody knows. A reading of psychiatric history is a reading into some of the worst horrors ever inflicted on innocent people (psychology is not innocent of this either). The barbaric practices of ice pick lobotomies and insulin shock therapy (you'd have to read about this to believe it) are not far in their past. Under their watch we have seen an explosion of people debilitated by psychiatric illnesses, including a thirty-five fold increase among children.

Personally, I wouldn't trust them to treat a headache. Anyone who's been successfully "treated" by mainstream psychiatry most likely did so through belief in their doctor and placebo effects which makes it no different or better than the shamans and witch doctors that still operate in many cultures (my friends in the Filipino community told me some fascinating stories of this). If someone claims to have been successfully treated, I'd ask for the before and after medical tests that prove that. There are none. "Successful treatment" just means that you were one of the lucky ones. Or the condition just passed normally as they did for thousands of years before "modern" psychiatry began getting involved in our brains and behaviours.

Given the hundreds of "disorders" in the DSM that cover just about every human behaviour imaginable and the completely sham system of diagnosis (described by many as merely a system to justify insurance claims and writing prescriptions) or the medicalizing of perfectly normal human behaviours (bereavement following the death of a loved one is now considered a "disorder" in the new DSM-V), I find myself highly sceptical of anyone claiming a psychiatric disorder (and given the distinct possibility that the drugs to treat it are actually prolonging or worsening it). 

This is NOT to say that psychiatric disorders do not exist or that there are not people who genuinely suffer from them, only that there's a good chance one was misdiagnosed (over diagnosis is a widely recognized problem ... a story possibly for another day but "ADHD" would be one that would be firmly in the cross hairs) or that one is simply "suffering" from being human and therefore not perfect. Situational unhappiness, temper tantrums, mood swings, acting out and dozens of other behaviours were not "disorders" until a combination of perfectionist seeking society started overreacting to them and modern psychiatry, backed by the profit seeking pharmaceutical industry (and statistics will show that "disorders" sky rocketed after these two linked up about five decades ago), decided - and I do mean decided, see again the vote by a show of hands - that so much of normal human behaviour is an "illness" that can be made to go away by a simple pill (or likely a cocktail of them).

This is an industry that has no clothes. And I see no sign of them acquiring any any time soon.  

[I apologize again for the formatting issues. It all looks normal and the same in my composition box but when I post it, the formatting is all strange - brad]

Wednesday, September 11, 2013

More Bipolar Psychology - Broken Ego Defenses

I first conceived of and wrote this piece proposing that "broken ego defenses" are a major factor in depression of all kinds (uni-polar depression and the depression found in bipolar, schizophrenia and other disorders) in the fall of 2013. The concept of "broken ego defenses" has fascinated me ever since. As such, I've since that time done much, much more research, both in understanding the neuronal and brain network workings of "ego defenses" and in real world study of human behavious. Shakespeare once wrote, "All the world is a stage." I could very well say, "All the world is a research lab." When I'm trying to understand a human behaviour and underlying science behind it, I study everybody and everything.

So I've long wanted to do a major rewrite of my original piece and I'm finally getting around to it.

What we're going to look at here also ties in a great deal to what we look at in the post on empathy and bipolar, or empathy in all highly empathetic people.

The word and concept of "Ego" gets a bad rap so first of all we need an understanding of what your ego is.

A simple dictionary definition lists: self-esteem, self-importance, self-worth, self-respect, self-image.

Nothing wrong with having any of those traits!

In the psychoanalytical sense, ego is defined as "the part of the mind that mediates between the conscious and the unconscious and is responsible for testing reality and a sense of personal identity".

"Sense of personal identity" is the most important thing to take away there for our purposes today.

And in philosophy and metaphysics, it is considered "a conscious thinking subject". I'm pretty sure we all qualify here, although I certainly know those times when it feels like we're neither conscious nor thinking!

So we'll accept for our purposes for this post/chapter that "ego" means things like our concept of our own personal identity and self-esteem, self-image, etc.

I think then that we can think of "ego" as "the self".

And I think we can all agree that when we are in mental health crises and as these start to stretch from weeks or months into years and our lives and relationships all start to fall apart and go to shit, that our "self" takes an absolute pummeling.

Or it is also very possible that it was our "self" taking this pummeling that began the crisis and downward spiral in the first place.

Or it is even more possible that our "self" was pummeled in childhood and never developed healthily in the first place and that is the issue behind adulthood mental health issues. The more I study and the more I talk to people, the more I see this is a huge and widespread issue (though I shall leave childhood abuse and trauma for a different post and approach for now). I have to be clear that this is not an issue for me personally but it is now clear to me that it is for many.

As important as the 'self' is, it is yet another aspect of our mental health that psychiatry does not deal with at all with their "chemical imbalance" and pharmacological treatment approach

Despite "modern" psychiatry and the intensive and wide spread use of drug therapy in the last several decades, the number of mentally disabled people who are on US's SSI disability rolls tripled between 1987 (the year Prozac hit the mental health landscape) and 2007. In the same twenty year span the number of children who are considered "disabled mentally ill" rose thirty-five fold. RobertWhitaker makes a strong case in his book Anatomy of an Epidemic that a good deal of this can be explained by the debilitating effects of the drugs themselves. I heard a talk by Dr Tony Stanton some in the spring of 2013 in which he described his experiences running Seneca Center, a center in Washington State for unwanted foster children. One of the biggest problems most of the kids had was a lifetime of being forcibly medicated to "dampen" their "issues". He described how these kids' spirits rekindled and came alive after being numbed for years being on the drug cocktails they were forced to take (I attended a workshop of Tony's later that year to learn more and had the pleasure to be able to discuss these issues at length with him). My personal experience is that the worst two and a half years of my life were when I was on psychiatric drug cocktails.

After spending thirty months in a horrifying downhill slide from the summer of 2010 to the end of 2012 while under the care of numerous psychiatrists and all the mind numbing and brain damaging drugs (1) they pumped me full with, I started off the year 2013 wondering "why?" the mental health care system failed me (and tens of thousands of others) so badly and all I do is keep searching for the answer.

And I while I felt better in many ways when I stopped taking medications, I continued to be plunged into very dark periods and struggles.

So if coming off drugs wasn't completely the answer then what is it? Why do some of us suffer so badly? I just kept asking why and pursuing the answer. I've argued for some time that a lot of the issues with bipolar (and other mental health disorders such as schizophrenia) are largely psychologically based and that a big part of the problem we have is that these issues are not only not recognized, they are not dealt with by the system at all.

Let's now get more into one such psychological factor.

Broken Ego Defenses

I first learned of the concept of "ego defenses" in Alan Deutschman's book Change or Die in which he examines why change is so difficult for many people, groups, organizations and so on. In his opening chapter he looks at the human psychology of denial, rationalization, etc. The more I learned about these psychological defenses of the core self, the more I realized, "hey, that's what I have trouble doing! I can't block these things out or rationalize them away or project blame onto others!" Interviews with and observations of many others told a similar story.

So let's have a bit more of a look at what these are about. From Deutschman:

When we find ourselves in seemingly intolerable situations and feel overwhelmed by tension, anxiety and a sense of powerlessness, or when the harsh realities of our lives threaten to crush our self-esteem, our minds activate a powerful built-in automatic psychological strategies to help us cope. We shield ourselves from the threatening and humiliating facts.

[above emphasis mine - BGE]

Freud called these "ego defenses" and even though many of his ideas have been discredited in the past century, this one particular idea has survived all the critics and become accepted as hard fact.

The book The Ego and its Defenses analyses forty-eight different defenses. Some of the categories are familiar to everyone. We all know about number three, "denial" - literally denying that the problem exists. Number seven is "idealization", which is what happens when you fall so madly in love with the wrong person that you're blind to the person's faults and misdeeds even though they're blatantly obvious to friends and family. And who among us hasn't been guilty of number thirteen, "projection" - blaming others for our own faults? And does a day go by without any one of us engaging number fourteen, "rationalization" in which we come up with creative excuses and stories to cover up the real motives for our behaviour?

We can laugh about these - when we see them in others of course - but these are crucial for day to day survival (and is why we evolved them). These are subconscious mechanisms that kick in automatically without conscious input or even awareness (which is why they work). They work well below your conscious level silently kicking aside anything that threatens your ego - you - from psychological harm. Denial is even what allows you to drive a car - it pushes aside all the danger of possible accidents from your mind so that you can drive without being crippled by fear.

Ego defenses allow you to justify your daily actions so that your esteem and confidence stay intact even though you may daily do or see things that could be damaging to you.

"Rationalizations" are the post hoc inner dialogue we experience that "justify" our actions. This can calm down a lot of inner stress and discomfort by "spinning" a different version of events that removes blame and culpability from "you" or "justifies" what was demonstratively to someone else a bad decision or harmful action. It doesn't matter how your rationalizations look to others, what's important - its sole job - is to keep your ego safe and from melting down from emotional overload.

Another interesting psychological "self-defense" mechanism is known as "self-enhancement bias" which is nicely described and summarized in How Our Delusions Keep Us Sane. This is a kind of amalgamation of beliefs that include an optimism bias and views of ourselves that protect us from despair. The brain can literally create delusions that make us feel stronger and better equipped than perhaps what we truly are in order to face life's battles.

Let's briefly look at this so called "psychological harm".

What is meant when we say psychological harm is in fact psychological pain. In numerous posts now I've alluded to the fact that the brain experiences and reacts to so called psychological pain exactly the same as physical pain that we experience when, for example, we hit our thumb with a hammer. Just then as physical pain triggers the stress response system, psychological pain does as well.

Thus what much of my subsequent study on this subject has revealed more precisely is that these psychological defense systems are really protecting the self from stress for it is the complicated neurobiology of stress that will cause health problems of all kinds and the kinds of mental breakdowns we experience.

Stress is the big killer, folks, and "ego defenses" help protect us from it.

What I've also learned is that when we think of something as "psychological", it has a physiological basis in the brain. In other words, it doesn't arise out of nowhere, the brain produces it. It would require a longish essay to explain this but briefly let's think of consciousness. Everyone in brain studies agrees consciousness exists but nobody knows exactly how the brain produces it. Most neurobiologists and neurologists would agree though that it emerges from physical properties of the brain. And so it is with so called psychological effects. We may not be able to pinpoint exactly where they are located in the brain but we can observe and note their existence and that this existence emerges from physiological properties in the brain. And so it is with so called "psychological" pain. As I've outlined elsewhere, the brain experiences and processes so called "psychological pain" very similarly to physical pain.

To better understand these "ego defenses" then and for our purposes here, I feel it's best to look at them as a necessary "shield" against potentially crippling psychological pain or extreme mental and/or emotional discomfort.

While all of these defenses - this psychological shield - play essential roles in getting "you" through life they can, as we should know, cause harm (a topic for another day, I'm afraid) but as long as you're functioning relatively normally - handling day to day responsibilities fine and can get through the day without experiencing overwhelming stress and melting down - that's the main goal as far as these psychological defenses are concerned. Our belief systems are a part of this as beliefs and stories are created to justify your daily decisions and long term plans (no matter how kooky they may appear to others). What's important is that you are relatively confident and self-assured.

A big issue with many of those of us suffering major mental health disorders is that we are anything but confident and self-assured. This becomes a large part of our dysfunction and inability to engage in society and work places. Why would this be? As I wrote in mental health disorders and reality, suffering (suffering as opposed to living with) from the harsher cases of schizophrenia's delusions and bipolar's severe swings between polar opposite states of mind can severely alter one's concept of reality. It can get to the point - and it has with me - that you don't know what to believe or even know who you are. This is where I was at when I wrote originally wrote this piece. My states of mind would change so often and so radically that I could literally no longer believe anything in my own mind. I'd venture that those with schizophrenia go through the same thing. It's incredibly destabilizing. (2)

For the brain and its mind boggling array of subconscious systems that run your life to operate properly it needs some semblance of day to day stability. This is why most people fall into comfortable routines without their realizing it - their brains are more comfortable that way. And the more comfortable they are the more secure their ego defenses become and the more comfortable their ego systems become the more the routines will be re-enforced. With secure ego defenses one can go through a certain amount of life disruption and those defenses will leap to the rescue. "That's not important!" (denial) "Not my fault" (denial and/or projection). "It was all I could do!" or "They deserved it because <insert reason>! (rationalization) and so on. These may take a day or two to kick in after the initial emotional shock but eventually they will and you'll find yourself more or less at peace with whatever happened.

Now here's the thing with us mental disorder peeps. We get hit with double whammies. First we'll get hit with great internal disruption - psychotic delusions or a severe manic depressive cycle or a long episode of major depressive disorder. Your inner realities WILL get rocked. This WILL cause external life disruptions (if it doesn't cause life disruptions you are not by definition "ill") which further rock your inner world. But no problem, it may take a while but your ego defences will bail you out ("that wasn't so bad" "that didn't really happen" and so on). But then it happens again. And again. And again. Schizophrenia and rapid cycling bipolar can be extremely disruptive like this. And the more these internal and external disruptions happen, the more your inner brain circuitry is going to get rocked too as intense inner conflicts arise and competing subconscious operating systems in your brain fight to right the ship.

High amounts of inescapable stress will occur (inescapable because the source is your own brain) and this will further damage the operating systems (uber amounts of evidence for this). After a while it just all starts to melt down (and hospitalization is usually necessary). It is my argument that one of the victims of all this internal chaos and stress is the ego defence system. It just simply becomes too confused and doesn't know what to protect from what. For ego defences to work, I posit, they need a solid mental foundation to work upon. Well guess what, with a neuropsychiatric illness that solid mental foundation went out the window a long time ago.

Therefore overwhelming amounts of unpleasantness gets through and pummels the shit out of your ego and your sense of self. This, I also believe, is where much psychic pain originates. Without our ego defences to protect us, all the unbearable shit from life and our own inner hell beats down upon us like a thousand suns. It all becomes incredibly hard to deal with. Or it may over correct and over protect or otherwise malfunction and this is why you'll often see violent behaviour from those with schizophrenia or bipolar (and why four cop cars and and a minimum of six officers showed up for my recent 911 call). We can't construct pleasant realities because all our inner systems have been rocked too much and too often and have no idea what "reality" to construct. Belief in our selves and our world crumble. This is why we often become agoraphobic and isolated.

We can laugh about ego defence systems - until they're broken. Then it's truly a case of you don't know what you've got till it's gone.

People who can "deal" with their mental health issues likely haven't been hit as hard or for a variety of possible reasons have stronger ego defenses . For those of us who are not so blessed, or who simply go through more severe forms of the disorder more often and over a longer period of time, we ain't so lucky. We'll get tied to the whipping post - and good lord it feels like we're dying (Allman Brothers Whipping Post). And it's the psychic pain that we endure that will become a major part of our suffering. And this, to get to the larger and most important point, is a large reason why suicide is so common among those with schizophrenia, bipolar disorder and major depression - our critical core selves are no longer adequately protected. I realized that when I come out of a bad episode and examine why I felt so dark and suicidal, those systems - denial, et al - aren't shielding me from the worst painful stuff. And it really is like being tied to the whipping post.

(1) - At some point I'll get to recounting my life as it became on psychiatric drugs and under the care of psychiatry.

(2) - Since this writing I have done enormous amounts of work to stabilize my mental states and life circumstances and am now in a much better place mentally.


Since coming up with this concept, I've done considerable more research and real world observations. I've interviewed many people about how they experience life, life difficulties and the harsher realities of life and it continually astonishes me what the average person doesn't see or notice in life or can simply brush aside. Or what they simply deny exists (climate change would be a glaring example here). And when I talk to them about it and try to understand why they can't see what I see, it's almost literally as though they're "blind" to problems or suffering in others or they greatly downplay its significance.

I've also since done far more research and gained far more experience in identifying psychological stressors and the sources for what many of us know as "psychic pain" (or psychological emotional pain as opposed to physiological sources of pain).

And what I've concluded is that many of us who suffer psychiatric conditions worse than others cannot - because of how certain brain regions within us are structured - shield ourselves like many people can. Everything gets in, everything gets processed far more intensely.

When I examined myself in comparison to others who live more or less calm, untroubled and happy lives, what they are oblivious to I get in deep and searing detail.

There is growing evidence that those within the schizophrenic and bipolar spectrum and, I'd argue, those with long term major depressive disorder have brains that are wired and structured fundamentally differently and not only do we take in much more sensory information than the average person, we process and store it differently. Hence we tend not to be able to shield ourselves from the harsher aspects of life and instead get bombarded with it. This is why we both feel much more inner pain than the average person but also why we tend to hit overwhelm so easily.

So to summarize, those with so-called strong "ego defenses" simply don't take in or process as much sensory information as we do plus their brains are able to block out (or simply not see or experience) the harsher realities of life whereas for those of us not so blessed, it all gets through and this is a major source not only of our suffering but are triggers for what I'll term "psychiatric episodes" (suicidal meltdowns, psychosis, manic episodes, crushingly black depressive episodes and so on - plus the searing inner pain).

I am certain that there is a neuronal basis for all of this and have seen much growing evidence. In late 2013 I had a brief email exchange with Steven Pinker. I was asking him some questions about his 1997/2009 book How the Mind Works and he kindly replied and directed me to the answers. I asked him whether he knew anything about the neuronal basis for ego defenses. He replied that he was "sympathetic to these ideas" and sent me suggested reading for more up to date science on the concepts. Various health and life circumstances and the ever long to-do list for the blog have prevented me from looking into them further, however.

The reason I say it's neuronal in basis is that it's important to understand this because it's important for you to understand that it's not "you" being "weak", a "wimp", "too sensitive" and so on, it's how your brain is structured and processes information and creates your conscious experience (which is all brains do). What this also means is that, because of the "plastic" (from the term neuroplasticity) ability of brains to break down old connections and form new ones, it IS possible for a lot of this to be overcome and for you to build up better "ego defenses".

Since originally writing this piece, I have found that part of lacking the "ego defenses" that others have is being a highly empathetic person. I introduce an understanding of empathy in this post. Though that is about empathy in bipolar people, much of what we learn there can be applied to all highly empathetic people. What I have learned is that part of building stronger "bego defenses" and thus reducing the amount of emotional pain we suffer, is better understanding our empathetic selves and learning to manage it better.

BGE - February, 2016

Monday, September 9, 2013


Ultimately it comes down to this.

Ultimately you'll be left to fight this alone. The drug pushers can't help you, all they know how to do is make random stabs in the dark and write prescriptions. I know that it appears to "help" some people and this re-enforces this practice but for many it does not work and they end up unable to function and on long term disability (Robert Whitaker cites the numbers, taken from US government sources, in his book Anatomy of an Epidemic) or commit suicide (estimates are that one in five people who are truly bipolar (as opposed to the misdiagnosed kind or minor hypomania) will commit suicide). No empirical or long term study data exists to support true efficacy of psychiatric drugs while data does exist pointing to the brain damage it causes. Psychiatric drugs such as SSRI antidepressants are strongly linked to suicide (as are other psychiatric drugs) so it is possible that long term drug use is a factor in that high suicide number. I myself became much more suicidal when on psychiatric drugs. At any rate, psychiatry is not a help to my situation and by extension the mental health care system because their entire model is based on psychiatry and drug therapy.

Ultimately family have to distance themselves from you. After a while they can no longer handle the intense mood swings between maniacal highs to suicidal lows. People are wired to distance themselves from unstable people. This is nobody's fault, it's just their own instincts of self preservation functioning normally. Hell, even unstable people don't want to hang around unstable people (all the friends I made while in psychiatric hospital eventually stopped contact. Which you can't blame them for. They just want to get on with their lives, not be reminded of the time they were in the loony bin.) 

It takes great courage and uncommon levels of empathy to step outside one's self preservation mode and my family simply could not do that or sustain that. I really believe they tried but ultimately they listened to their instinct to back away. That's what my daughter had to do. She was daily witness to the swings between the highs of love of life enthusiasm and runaway optimism and suicidal depression and hospitalizations. She just simply could not handle or watch it any more. She's highly sensitive herself and HAD TO distance herself to protect herself. It's either self protection mode or they simply deny what is happening and pretend everything is fine and that there's nothing wrong, something that I found unacceptable. 

There's intense inner pain but worse pain is when people who "love" you deny that pain. They will see you and be social as long as they can live in their own fantasy world that everything is OK. If that is "love" then yes indeed, love hurts. I can do without that kind of "love". Others will flat out tell you that they can no longer handle your situation and that they “have their own things to deal with”. Others will tell you that you are just drama making and attention seeking. Which, whatever, that's just the way people are. The end result is abandonment though. What makes it hard is the comparison to stories of psychiatric survivors and the roles undying family support played. Sometimes, just sometimes, I wonder why I didn't get that support. Some very valuable financial support I got, and was very grateful for, but not the vital emotional support.

One thing that will affect how you're impacted by a mental illness is how emotionally sensitive you are. I am, I have to admit, extremely sensitive. I've talked to other bipolar peeps who've told me the same thing, that extreme sensitivity is a big part of their issues. This is where the psychic pain comes from. I'm not always like this but when I am, I'm extreme. (true bipolar is a world of extremes) And it seems the more the illness runs its course the more sensitive you are to psychic damage. This is also a hallmark of borderline personality disorder (extreme sensitivity to facial expressions and tones of voice causing violent mood swings) which is often, according to Psychology Today's Taming Bipolar (which, by the way, was the genesis for this blog title), "comorbid" with bipolar. Psychic pain is beyond explanation. There's no "data" or "research" to back it up or any way to look at it or measure it in a lab. It just is. David Foster Wallace and other writers describe it best. Foster described it as a sheet of flame at one's back while standing at an open window. Psychic pain eats at me like battery acid. And it can come from anyone, anywhere and any time. I can't tell you how much work I've put into controlling this but I just can't. Whatever it is, it hard wired now. It's why I battle agoraphobia. Any contact with any human can add to the pain and thus contribute to a complete suicidal melt down. All it needs is that one flick of a match to trigger it. It's beyond bizarre and incomprehensible to virtually all people but there ya go. It's daily hell to deal with it. I can go for days thinking I'm "dealing with it" well (doing all my little CBT stuff) but then it'll all come searing back and erupt without warning. Then the next thing I know I'm handcuffed in the back of a police car and off to the psychiatric ward again. Ultimately, I can't live like this - walking on the eggshells of my own mind not knowing when or why I'll melt down again. This alone is madness making. 

Ultimately I can't live on welfare. I am a proud working man. My entire sense of self is built around earning an honest living exchanging my value with someone for their money. That, deeply in my view, is the right and honest way to live. On welfare I have no value. I am not one of those who can "manufacture" value out of this situation and make it seem acceptable. Oh, I tried, I tried to put all kinds of positive spin on it but ultimately I can't. I am a man who always paid his own way. A man who was proud to have owned a home. I am a middle class man with a middle class background who lived a middle class life. The pain and shame of subsisting on welfare is unbearable to me. It is not what I was born to live. I was born to chase dreams, build a modest amount of wealth to take care of myself in old age. Losing that and falling to this is unquestionably the worst psychic pain I feel. I know I am supposed to practice "acceptance" and "letting go" but I just cannot. I can for a spell but then it too will come searing back out of the blue and the pain of the flames on my soul will be great. 

Ultimately, I can't live without my mind. I've lost everything I've ever worked for and then some (I owe tens of thousands of dollars). I lost my ability to work. All I have left is my mind. Then I lose that. There are days when my mind just will not respond. I can't read or do any writing, let alone the tougher research that has been my purpose. Days of utter waste go by. I can deal with a few hours. But when it becomes days I get incredibly distressed and frantic. Insanity is like that. It is, I'm sure of it now, the accumulative brain damage from years of manic depressive cycling and the years of constant stress. I've lived below the poverty line for more than five and a half years which research now shows produces brain altering stress. Mental instability produces its own kind of stress. There was years at a high stress job (not just high pressure, that I can handle, but stress about getting paid or not, unreasonable demands and many other things a person with extremely low tolerance for stress is badly affected by). Constant and rapid cycling changes of state appear to cause brain damage (as autopsies on deceased bipolar people reveal) and other research shows that stress can break down the brain at the neuronal and axon level. Plus, in bipolar depression the brain can just literally shut down. The stories of people in the throws of bipolar depression being completely non-functional are legion. Kay Jamison's An Unquiet Mind describes this very well (though I found her depictions of her "mania" a bit specious). There's just no doubt in my mind that the brain shut down I experience is part of the long term outcome of bipolar disorder. I tried and tried and tried to fight against this and deny that it was happening and I've improved over the worst that I experienced in previous years but it still just hammers me. And though I can rationally understand all of this I just utterly can't stand feeling so non-functional. The one dream I have remaining is to research and write about this disorder and when I can't even do that I get extremely distressed and dark feeling. My writing and research was the one way I felt I could contribute to society and "earn" the government cheque I receive. When I can't even do that I feel even more worthless.

Ultimately, this is not a life. Lying around, confined to my room and non-functional so often. I was always a man of adventure, passion, exploration and full of life. My life almost always had meaning. I've always had lovers and love and travel and romance and chased my dreams. Now I have nothing and am scared shitless to even dream about anything more. I look at this today and it's not life. Not in my books. Rising each morning and merely drawing in breathe is not life. And being totally and utterly helpless to pursue what I feel life is is literally maddening.  Or sometimes I just can't stand being a useless sack of shit welfare bum (my former working class values speaking).

I cannot even begin to tell you how hard I've worked at this. I work on my positive difference making fundamentals all the time. I am not a negative person. I smile most of the time and say kind things to people. I work like hell to have a positive attitude about everything. I read positive materials. I've retrenched probably a hundred or more times in the last five years. This doesn't work out? Retrench. That doesn't work out? Retrench. Retrench and retrench and retrench. I've retrenched all the way down to being a welfare bum. I can retrench no further. I've done everything they told me to do. I've been in the hospital four times and each time I was the hardest working person on the ward doing everything possible to get better. I've done things that I had to develop myself (based on latest neuroscience). I work almost every hour of every day at dealing with the frustration of living below the poverty line while dealing with a major mental health disorder and calming myself not to feel that frustration. And this hurts like fucking hell too. No one can see how hard I work. No one knows how hard this is. NO ONE. (in my life, not in the world. I am of course aware that many others have gone through this) One could look in my room and see me lying on the bed with my eyes closed. What's going on is that I am working like hell to avert a full catastrophic melt down. Or trying to build up my mind. It's incredibly hard work. But what do they see? A welfare bum lying around on his ass doing nothing. People will see me melt down and think that I'm just weak and not trying. What they don't see is the dozens of other times I worked through a melt down to avert it. What they don't see is the hundreds of hours I've put into research and the work I do to build up my mind. When one is seeing a person re-habbing from physical injury or illness or fighting cancer, everyone can see how hard they work. Not with mental illness. It is truly the silent illness. And you'll suffer it alone. Which leads to the final blow.

Ultimately, I cannot do this alone. Can NOT. Personally, I think I've displayed superhuman strength to get this far (and my psychologist, who was more familiar with my struggles than anyone on earth, agrees). But I'm like the fucking rat in the water stress test. The water stress test is when they put a rat in a tank of water it can't escape from. It has to keep swimming to stay alive. They'll leave the rat in until it dies. At some point it'll just give up and stop swimming. Then they'll examine it. They'll find that all kinds of things in the brain and nervous system just simply break down. The non-stop stress of struggling for survival will just start to break things down. I've been swimming non stop in the water stress test trying to stay alive for more than five years. Things are breaking down. 

Things HAVE broken down. I need help. I really, really, REALLY need help. I think my own program is good and would work but I cannot do it alone. I need feedback. I need support during the rough times. I need someone to hear me. So it was that for four months I looked forward to the free therapy program offered by the local university. It saved my life last year. And it is the ONLY resource that I have found that that worked for me (and trust me, I've hunted down every resource available and NONE worked out). This was ALL I had. So I literally counted down the days waiting for the new session to begin (they run with the school term from September until early May). They told me I was welcome to come back in the new session. In my darkest times I told myself to just hang in until therapy could start again. So the time finally arrives. They tell me that they have to reject me. My case is "too tough" for them (apparently handling my case was extremely stressful on my previous psychologist). What little wind I had in my sails was instantly gone. I cannot even begin to describe how devastating this was. 

This is what I mean about ultimately facing this alone. When your situation is bad enough and you've been in the system long enough, you WILL end up facing it alone (simpleton pill pushing psychiatrists don't count. Their toxins made me a hundred times worse and I've never met a professional group more dimly uncomprehending of human suffering). Family can't help; they're simply not equipped. No friend could handle something like this. This therapy - this free therapy - was the only hope I had for help, the only hope I had for not fighting this so fucking alone. And now that hope is crushed. Just like every other hope I've had since this began. This is not "depression talking", this is literally no hope left. There are no other options. This was IT and now it's gone.

I feel like the character of Jesus Christ in Jesus Christ Superstar from the scene “Gethsemane (I only want to say)” when he cries "tried for three years, seems like thirty". It truly is like that. This suicidal madness started three summers ago and I've fought it for three years. But it seems like thirty. Seems like ninety. I can fight no more. 

The brain has some remarkable survival tools for getting through dark times. That's how it evolved. We wouldn't be here as a species if it didn't. But this is what happens in brains with this kind and degree of mental illness - all that stuff breaks down. That's part of the illness, you see? With other illnesses other things are broken but the human mind is intact. The "indomitable human spirit" is merely a survival tool in the brain. A person will get down and go through extreme darkness but their essential survival tool remains intact to pull them through. But with mental illness the very thing that's needed to fight is the very part that is broken. This is why people commit suicide - that survival tool is either broken or was overwhelmed. This is what 99.9% of the population - and the medical field itself - don't understand. The essential survival tool in the brain breaks and simply cannot go on. 

Ultimately I don't know what the big deal about death is, I really don't. I don't consider this suicide, I consider it self administered euthanasia. I want to end this and to end it on my own terms. In a stretch between July of 2010 and late last year I suffered through many mania driven states of suicidal madness (during the dreaded mixed states when it's thought that most bipolar suicides occur) or horrific states of suicidal psychosis (hallucinations of great violence to myself and demands to carry it out). These always involved violent deaths. I have no idea when these may return nor does anyone. There's no "book" on this. When they do, I just know that I'll have no control over them. The brain shuts off any kind of concious cognisance. The madness is in full control then. Most people have no idea what this is like because quite frankly, few people survive this (and my suicide expert psychologist agreed. She utterly could not believe what I survived). I don't want to go violently. I want to go peaceably. So I want to choose my own terms and place and time. That's all I ask for in life now - to go on my own terms. I feel I don't have to justify this or explain it to anyone. ANYONE. I don't care for anyone's Biblical morals about this that say that "only God can take a life". Fuck that. I believe ownership of one's life is the ultimate divine right. I'll do with my life what I feel is right. You'll argue that this is "selfish". And I'll argue that your wanting me to continue to suffer is selfish and a worse kind of selfishness. I was not put on earth to suffer, that I know. I have nothing to say to people that believe that to suffer is to be noble. I see no nobility in suffering. I will accept no judgement from those who cannot feel or know my pain. Pain is relative and this is too much pain for me to bear. All I want is to be respected for my views.

I have a plan. And a place (roughly. the spirit of the place is what's important, not the exact location). I want to go peaceably overlooking a peaceful scene. My grandfather died in his sleep in his favourite recliner. I always thought that was the perfect way to go. I want to go like that. I just need to acquire the right material. 

I have things to tie up first. I want to e-publish my book first and finish a series of stories for my daughter. Then it will be time. 

[PS - I have been in a very dark state for a week now (well this bout of bipolar depression  and darkness started in late May but I mean this particular stretch of particularly bad darkness) and was very dark when I first conceived this post. This post isn't nearly as dark as when I first conceived it. I had to considerably calm myself down before I wrote it. ]

The Psychology of Bipolar Continued - Frustration

When I started my search into neuropyschiatric disorders in early 2013 and both evaluated my own case and that of dozens of other cases I read (some at great length and in great detail), I came to the conclusion that some of the greatest difficulties of bipolar disorder for those who cycle through highs and lows are less about the illness itself but are psychological in nature. I identified three factors that I thought played significant roles; confusion, frustration and the nocebo effect. 

When you get hammered with a psychiatric disorder like bipolar or schizophrenia or serious clinical depression or anxiety disorder the truth is nobody will truly know what's going on in your particular case and circumstances nor know precisely what to do. This is particularly true of doctors. Psychiatrists are only slightly better. Except in rare cases where somehow the roulette wheel of life lines you up with a psychiatrist who is more than a pencil pushing prescriber of drugs and actually knows what's going on AND can explain it to you and your family, you will get no one in the entire mental health care system who knows what he or she is talking about.

To further compound the confusion and frustration, you'll get all kinds of completely useless and probably detrimental "advice" from almost everyone you know, most of it projecting their own experiences and ignorance. All of which is going to be a fire hose of gasoline on the fire already going on in your mind. In other words, a lot of high stress and anxiety inducing confusion. 

Also thrown in the mix - largely because of above mentioned confusion and lack of anyone able to know what's going on and take charge and explain anything clearly - will be the mind's unfortunate ability to make mountains out of molehills or if you truly do have mountains, make them much bigger as well as throwing in some volcanic eruptions and landslides for good measure. I am talking about the nocebo effect, which is the opposite of the placebo effect. The nocebo effect is the mind's imagination run viciously amok. No one - least of all me - is arguing that what's going on with you is all a figment of your imagination, but the fact is that the mind will tend to make things far worse than they may actually be. Trust me, calming down a lot of "nocebo beliefs" about my condition was a massive part of improving my mental health and getting a grip on what was really going on and why. 

I introduce and talk nocebo in this piece. Better sorting through, understanding and navigating the confusion that comes with mental health crisis is the main point of the entire blog. 
In this piece, however, I'd like to focus on frustration.

I make no secret of my distaste for pharmaceutical drugs as treatment for mental health disorders and one of the reasons is that drugs can have no effect on psychological aspects of a disorder and in fact may exacerbate them instead (1). Drugs may be able to “knock down” mania (the main goal of psychiatry in treating bipolar) but this is not without detrimental effect to the brain and cognitive functioning of the patient. The change in personality and the loss of cognitive functioning alone will have a strong psychological effect on the patient. For everything I write about in regards to mental health disorders I generally have the studies and data to back up what I write, but what you will read here are purely my own thoughts and ideas, albeit ones based on enormous amounts of research and much self examination (some of which came out of my nearly thirty hours with a psychologist) and, as I said, based on numerous case studies of others. 

In my research into mental health disorders starting in early 2013, I had some of my own insights, insights in which I did my own connecting of the dots. For my thoughts on the psychological effects on those suffering psychiatric illnesses I found no research – or at least not yet – so this is all me. I started off using mostly only myself as a “research subject”, examining my own emotions and the basis for them, but by reading through numerous case studies and talking to others either online or in hospitals I could see this thread of frustration run through virtually every case and I came to conclude that it's quite safe to say that the frustrations we face during our struggles become a major factor in our inner turmoil

Since the great flood of insights that came to me in early 2013 and from what I learned from much study into bipolar cases since then I have been very carefully observing and making notes into my own daily mental conditions. I've argued before that my case is not that untypical for those who cycle through bipolar highs and lows so I believe my findings into my own states can be at least somewhat reasonably projected as typical. I'll also argue that my combination of being deeply and widely read and experiencing the mental and emotional ups and downs of a bipolar patient makes my “data” not only very relevant but perhaps better than what can be found under normal clinical conditions. I am also a very outside the box thinker who tends to look at problems from different angles. It is my firm belief that whether you suffer from bipolar disorder, have a family member who does, are a clinician or are just interested in learning more, there will be much to take away and apply from my views and ideas. But enough. All I can do is lay out my thoughts and let the chips fall as they may.

From examining my own case and bipolar mind and, again, in talking to other bipolar people, I also think it's safe to conclude that bipolar is sort of a self-perpetuating factory of plutonium grade frustration. Mania just tends to place very high demands on us and others and not being able to meet those demands, which are very, very powerful and real feeling, just generates monstrous (almost literally) amounts of frustration which can often spill over into anger if not outright hostility. 

I'll start with my current state and state the frustrations I feel that are directly related to bipolar cycles. Earlier this year I was in a high state, or mania if you will (I address the idea that mania is always the boogeyman it's made out to be and needs to be "destroyed but will leave that for now). For those of us for whom mania can be a creative and energetic force, things come so ridiculously easy. Ideas, thoughts, insight can come amazingly fast and not only that, one will be blessed with great energy to keep up with it all. If I were to chart my productivity on a graph, the bar representing a six or seven week period earlier this year would have literally been off the chart. I conceived of and pounded out a hundred and sixty thousand words of my book within those weeks. Honestly. 

Now? The complete and utter hundred and eighty degree opposite. I have almost zero energy and motivation and my brain is like mud. (2) I very much want to carry on with the research and writing I started but my mind has trouble reading, comprehending and retaining material like it did earlier this year. This is major frustration number one. It's like normally being a healthy fit marathoner then suddenly being partially disabled and barely being able to walk. This is almost unfathomably frustrating. 

And I strongly believe it would be the same for anyone who goes from being a mental super athlete of the manic state to the disabled mental mud of manic depression (the term I use for the state opposite to mania). There's so much work I want to do but my brain, mental and physical energy just won't cooperate. It's extremely frustrating. Again, I think anyone who's used to being highly physically active then suffers a debilitating long term injury can relate. How bad is this frustration? I wrote earlier about bipolar and suicide and make the case for this contrast between these states being so unbearable for some people that they commit suicide. Yes, it can be that bad.

I've been there on the edge of suicide in these states.
As someone who's cycled through these phases many, many times there's this “oh no, not again!” frustration. Every single time I've been manic I've either not understood I was manic (mania is famous for this. It can give the person great insight into everything except the fact that they're manic!) or just believed that somehow this time I wouldn't crash or descend into manic depression. Yet every time I do. Every. Single. Time. Every time I think to myself, I scream to myself, “fuck!!!! Not AGAIN!!!”. This time I was extremely aware of what could happen and did amazing amounts of work to prevent it yet because of life events beyond my control it happened anyway. (3) 
Extremely frustrating. And again I think anyone with health or injury issues who does lots of work to avoid them happening only to have them reoccur can relate. And again I think anyone who experiences manic depression again after believing that it wouldn't happen to them again would feel this same pain and frustration.
While it doesn't for everyone, bipolar can eventually cause major life changes. Bipolar and stress go hand in hand (a topic for another day) and long term stress WILL break down the brain and body. Plus you get the mental shifts and depression. What this will lead to is employment issues. As in unemployment issues. And this causes – guess what – more frustration. Bipolar people, at least those of the better highs as I've described, will by nature be proud, generally confident and independent and having unemployment and the resultant cash flow issues and inability to work, find work or hold a job if they can find work WILL BE extremely frustrating. This is where I'm at now. It's extremely frustrating and it's hard to see where the end is. This uncertainty and inability to see the end is even more frustrating. Anyone with employment issues can relate. Just not being able to be a normally functioning productive person contributing to society is extremely frustrating in itself.

Your brain won't be the same way two days in a row. It's kind of like a roulette wheel.  One day it's one way, feeling not too bad and you think things are on the upswing. The next day you've been pile driven right back down into the depths of darkness, despair, hopelessness and your brain is stuck in molasses. And there's lots in between. This makes it hard to plan your life. What mental state can you count on? You can't. So it's very hard to make plans. This is all super frustrating.

Sex. Yes, sex. We are people and like any people we have sex drives (often in mania too much sex drive). But here you are; you've got a major mental illness, you're unemployable and probably broke or very low on money and probably have any number of issues. Well guess what, this doesn't put one on any list of desirable mates. Countless studies will confirm that people with major mental health issues, especially bipolar and schizophrenia will tend to become isolated. There are many reasons for this (and again, a topic for another day). So finding a meaningful relationship becomes very difficult. You'll have to trust me on this. Myself, I am feeling this frustration big time. For me it's something I'm not used to so it's a new frustration for me. Schizophrenics I am pretty sure suffer this more than any other mental illness as their lives tend to be the most disrupted. I know almost everyone can relate to relationship difficulties. We will all vary on this, of course, but sexual frustration is very real and very hard on a lot of us.

Frustration begets frustration. Dealing with frustration doesn't help one deal with life stuff and frustration can often cause more life difficulties which leads to more frustration which leads to more difficulties and so on.
No one understands what's wrong with you. Bipolar – or any mental health issue – is dreadfully misunderstood. There's lots of stigma. Or outright denial of there being anything wrong. My family largely was like this. I once made great pains to describe it all in emails and the emails were ignored. The family mostly brushed it off as nothing or as a lot of drama making on my part. This was, and is, EXTREMELY frustrating. And hurtful. For a long time I just had to stop communicating with family (and thus become even more painfully isolated). And this is true of almost everyone I know in the bipolar community. It's very frustrating and painful to be going through something so difficult (and in my case, potentially fatal) and get so little understanding and empathy. I think anyone with a rare disorder that's poorly understood and difficult to see in a person can relate.

As part of this lack of understanding and empathy comes one of my “favourites” - unsolicited advice. People will feel they can tell you all kinds of things in the name of “well meaning” advice, 99% of it useless and ultimately frustrating. Ironically, some of this can come from people who may have milder forms of bipolar who somehow escape the worst of it. They'll think, “hey, I've got bipolar. Why can't you deal with it like I do?”. These can be the most frustrating especially when one is in the depths of suicidal despair. There have been many times in the last several years when I've wanted to poke people's eyes out with a red hot poker.

Hhhmmm, it's little wonder, now that I think on all this, we often end up becoming isolated.

All of these things add up to a great deal of frustration and, I argue, this becomes a large part of the soup one with bipolar is going through. All these issues are real (and there may be others that I haven't described here) and not only are they frustrating, they're deeply upsetting. While not the illness per se, they become a great part of the sufferer's psychological make up. And more frustrating yet is that the docs don't get stuff like this. There's no pill to prescribe, you see (though they could well try, probably with anti-anxiety drugs).

And speaking of the drugs, I'll argue that these cause a great deal of frustration. They certainly did for me and my research tells me that I'm not alone. Lithium has bad side effects (a Parkinson’s like hand tremor for one). Anti-seizure drugs for epilepsy that are given for mania have bad side effects, not the least of which is impairment of cognitive functioning. Ditto with anti-psychotics. Anti-psychotics also cause considerable weight gain something that for a life long thin, athletic guy I found humiliating. There is a lot of research on all of these side effects (which I hope to get to in more detail in a future column). I found all of these are extremely frustrating to deal with. I hated all of it (and these are among the reasons I rejected pharmaceutical treatment for my condition).

There are ways to deal with all this frustration. One is being aware. I used all kinds of meditation techniques, cognitive behaviour therapy and other distracting techniques. But this is one of the “fun” things about bipolar. Pressure can build within and it'll just erupt and there's nothing a  person can do about it until it's over. Bipolar just kind of works like that. With improved insight and lots of work one can learn to prevent some of them but not all of them. Not if there's too much frustration, life difficulties and stress going on. Sometimes all it takes is that one twig too many on your back to break.

And the unfortunate thing is that the system is not built to recognize core psychological difficulties such as frustration. The system is designed to do one thing – dispense drugs to “knock down” symptoms. The doctors are not psychologists trained in listening to other problems. So while we might be suffering from a lot of frustrating side issues and are being worn down by these frustrations, there is very little in the way of resources for dealing with these issues.

It is my very firm belief that there are many strong psychological factors in how people suffer with psychiatric disorders that are not recognized nor researched enough. When I examined my own case deeper this is what I found and it's what I could see when reading people's case histories. I'm going to continue to explore what I think are the psychological factors of psychiatric illnesses and post what I can.

Addition - January, 2016. 

Since originally conceiving and writing this piece two and a half years ago I have done a great deal more study into the brain and body's stress response system and have learned that while psychological in source, frustration is another powerful emotion that will chronically activate the stress response system and thus high levels of frustration and anger will lead to grave physiological damage as well. Learning to better understand and tame my "frustration polar bear" has been very critical in learning how to better manage my moods and mental states. 

(1) Since first writing this piece I have backed away somewhat from my position that drug therapy can't help with something like frustration. That was certainly my experience, and I know my experience matches that of a great many others, but I've had to realize that my experience and that of those similar to me is not universal. For a certain percentage of people drug therapy can knock down a great deal of the inner thought turmoil which for them may be the greatest source of frustration and confusion. With the worst of the troublesome thoughts knocked down, they can get their feet under themselves, feel more in control therefore get their lives better in order and thus experience less frustration. 

I continue to maintain that drugs therapy will prove detrimental in the long run and long term studies (following patient outcomes over five, ten and fifteen year periods) bear this out. 

(2) Exactly a year after writing this post, by the way, and the debilitating lack of energy and motivation continues. (see the link below to understand why)

(3) I've since discovered what's going on with the crashes out of manic states and the resultant horrible lack of energy and motivation which I begin to talk about in a three part series starting here[minor updates, changes and edits as of May, 2015]

Notes from December, 2014:

I'm now really glad I wrote this piece because I kept revisiting it and realizing more and more how toxic frustration was for me and how much it was delaying my recovery. So learning to better deal with frustration has also been a major focus of mine in improving my mental and physical health. 

It is my hope that my readers can look at their own lives and identify sources of frustration and learn to handle it better and/or to let go of sources of frustration.