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Extending (md 8)

My new psychiatrist recently said something that I have been saying for a while (which makes him look smarter to me :)): “Bipolar disorder is not a mood disorder, but an energy disorder.  We go through cycles of expansion and contraction.”  My central depressive symptom is a painful contraction, like each cell is in a vice.  Sometimes the mood change lags behind by a couple of days – once it never happened at all, just seven days of painful contraction …no sadness or discouragement or nasty self-talk, nuthin’.

So when I am depressed – contracted – like today, Mania-depression 8 (“definite physical contraction”) sometimes the best treatment is anything that helps me to extend.  Expansion may be too big a stretch, but if i can reach out, push out, lean into life – anything that can get me back out from being curled up into a little ball.

I woke up at 5:30 a.m.: not quite enough sleep, having gotten to bed at 11:30, but I knew I wasn’t going to get back to sleep, so I knew that what I needed to do was to extend – get up – but instead I contracted back into the bed, trying/pretending to be asleep and just making myself miserable.  Finally, at the last possible time, I extended by getting up and going to dance (Asheville Movement Collective ecstatic dancing – see the page at the top).  I had to really push to get there on time.

Then, on the dance floor, I was confronted with a big blank canvas for painting contraction or extension.  (Sometimes extending left me expanded, but it continues to feel useful to make the distinction.  Extending is the effort to push out of contraction.  Expansion is what happens when it works.)  Some of the time I pulled in on myself.  But some of the time I extended.  I extended my energy and my body – moving vigorously through the space.  I extended towards other dancers – moving in and out of their space, dancing around them.  This is more complex: that other dancer can respond in a variety of ways.  In one instance, she danced away sooner than I would have wished.  In another, I finally moved away because I couldn’t handle how open she seemed.

Sometimes I can't find anything to do but to contract; other times, with a lot of effort, I can extend out.

Sometimes I can’t find anything to do but to contract; other times, with a lot of effort, I can extend out.

Overall, I was very confronted with all my issues about moving towards other dancers – all my insecurities, my mental trips about “Do they want me?”  And today that felt very productive.  Whereas another I day I might have just said, “I’m depressed, I’m contracted and I’m having a terrible time”, today I said, “I’m confronting some of my trickiest interpersonal issues.”  That seemed workable, important, valuable.

After dance, I completed the second part of my extending commitment for the morning – going to church.  Over the last year, I have been doing a lot of pulling away from this community – which has at times past been very important to me.  Sometimes I have been critiquing the church, sometimes I have just said that I hate going there when I’m depressed.  Today I said, “This place pushes all my buttons around belonging.”  This is such a  more useful way to think about it.  It’s also a place where I like/care about/love a lot of people – and they feel this for me.  If it also stirs the pot, gets me to work on my key issues, why would I not want to be there?  When I’m up, I love being there.  When I’m down, it’s an opportunity to practice extending.

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There is a bill (the Murphy bill) on the floor of the House of Representatives that many people I respect say would set mental health treatment back 30 years.   You can read the piece below from the Depression and Bipolar Support Alliance of Tennessee (more about DBSA tomorrow) and then, if you are moved, call your representative (http://www.house.gov/representatives/find/.

http://www.dbsatennessee.org/1/post/2013/12/action-alert-sen-murphy-bill.html.

 

There was a time when I had no awareness of when I was getting manic – I just knew that I felt good, so bring it on!  Over time, I have become sensitized to more and more subtle cues that I am “getting high” – and I know that it has lots of risks.  Mania has some genuine gifts – as does depression – but the more ungrounded you get, the more risk of errors in judgement (spending too much money, starting unrealistic projects, etc.), interpersonal damage and the inevitable crash.  So grounding is key: how to keep your feet on the ground when the adrenaline starts to surge.

When you've been really low, all you want to do is to come up. Keeping your feet on the ground is both a skillset and a discipline.

When you’ve been really low, all you want to do is to come up. Keeping your feet on the ground is both a skill set and a discipline.

There are many strategies for grounding, from sitting and walking meditation to gardening.  I’ve tried lots of them, with more or less success.  Some, like walking/swimming/dancing, psychotherapy and talking with my friends are just part of how I regularly operate.

But I’ve got a new one: getting sick!  A couple of weeks ago, I came out of about two weeks of being down and started to come up.  Day 1 of being not depressed looked pretty balanced – call it a 6 (Peaceful State) on my Mania-Depression Scale.  But knowing the way my energy state tends to swing, I was watchful.  Then on Day 2, two things happened: I started to tip into mania (call it a 5, “slightly expanded”) and I came down with a cold.  And getting sick grounded me!  It turned out to be a nasty cold, which went on for ten days, getting worse for the first seven or so.  My up cycle lasted about eight of those ten days.

During those eight days, I frequently said to friends things like: “I physically feel like crap, but I’m not manic.  I’m not depressed and I clearly have tipped into the up end of the continuum.  My spirits are good, but I’m not speedy.  All in all, getting sick has not been a bad trade-off. ”

It felt great to not be emotionally down, but being physically down kept me from getting high - which itself felt pretty good.

It felt great to not be emotionally down, but being physically down kept me from getting high – which itself felt pretty good.

What’s the takeaway from this?  “Don’t try this at home?”  My current lesson from it is: Life is always working on me.  It’s trying to get me balanced.  It will use whatever strategies it can to teach me how to stay grounded when I am high and how to pull myself up to the surface when I am low.  I don’t want to use getting sick as a regular strategy for dealing with mania, but with a little luck I have integrated some subtle balancing capacity – or moved the needle a degree or two.  I’ll keep getting opportunities to practice grounding myself and hopefully I’ll have some muscle memory of what it was like here to be not depressed, but not high.

Often in my life, I am sad about intimacy and connection that I don’t have.  It’s so much better to feel sad for a good reason.

This last weekend I visited my son and daughter-in-law and granddaughter in Louisville, KY for Thanksgiving.  The visit was almost perfect.  The vibe with my son was really great: he was so available and present, so warm and informal and gracious with me.  My daughter-in-law was sweet and interested in my reports about my life.  My six-month-old granddaughter was amazingly present and alive and happy.  I was relaxed and had fun.

And when I came back I got sad.  I wasn’t sad because of anything that had not happened – I was sad because it was so good…and because I had to say goodbye…and because I have so much history of saying goodbye to my son…and because it is going to be a while until I see them.

It’s been hard to sort out this abundant sad from depression, because it’s looking like depression and that may also be going on.  I had been a little up for about ten days, through the visit, and the goodbyes may have broken the back of the up mood and swung me down.  But I also have a history of coming down after visiting my son.  So I do myself a disservice if I just call this depression.  I have touched into some very sweet connection and I no longer can touch it (even though it is still there).  And I feel sad.

Teeth

My friend Maggie: “I can see your teeth.  That’s a good sign – it means that you’re smiling.”

Me: “It means that I remembered to put them in.”

I have given the name “complex healing states” to states that have some of the qualities of up and down.  A complex healing state is different from a psychiatric “mixed state”, which combines some of the toxic symptoms of up and down.  Here the difficult symptoms of one of the poles is combined with one of the positive gifts of the other side, e.g. something encouraging may happen when you are down – when it never usually would happen.  Most of psychiatry is solely focused on symptoms and does not recognize that mania and depression each hold gifts to be harvested.  More on complex healing states is in the page/tab at the top of the blog.

Complex healing states are healing fundamentally because they get the two sides mixing it up – up and down learning from each other, rather than polarizing from each other.  But additionally, they are healing because they say they are.  It’s actually a little more complicated than that.

You don't have to feel good to be healing - you just need to take your down state and make it more complex.

You don’t have to feel good to be healing – you just need to take your down state and make it more complex.

When someone is really depressed, they may genuinely believe that nothing helps.  I’m a prime example: when I am deeply depressed, one of my mantras has been “nothing helps and nothing matters”.  So when someone says “Why don’t you go for a walk?”, the answer of someone in a state like that is likely to be, “Tried it – didn’t work.” And that answer can come to all manner of interventions that seem like they might help.   You don’t believe they’re going to help, so you’re liable to not do them.

If however your goal is not to feel better, but just to make things more complex, then you’re liable to try it – because there’s not just a chance of succeeding, there’s almost a guarantee of succeeding.  If you do something that tends to sit on the up polarity – if you walk the dog, if you write, if you call a friend, you have just made your state more complex.  And if you are either taking on faith that complex healing states are good, or if it seems intuitively plausible to you that they are good, or if you have already had the experience of them being good for you, then when you create a complex state – when you take a down state and make it complex – you get encouraged.  Because you are doing something that you believe can help.  And guess what, being encouraged helps – right there, things start to shift.

A complex day (6 CHS)

It’s been a complex day – a day where I have inhabited a complex healing state.  You can read more about my concept of complex healing states in the page (tab) at the top of the blog, but in short they are states where up and down co-exist.  Today I started out depressed (have been for over a week): I had a very hard time getting out of bed and wasted an hour trying to be asleep – getting up an hour later than the 7 a.m. when I like to start my day.  This left me in a foul mood.  My biochemistry has not left that zone.  My mood is still down.  I’m liable to wake up tomorrow in as bad a mood as I was this morning.

But several things have gone on to make my day more complex – things that would not usually happen when I’m down.

  • I spent an hour on the phone with my friend Byron.  We do this every week, splitting the time and giving each other very good listening.  This often lifts my mood, but mostly did not today.  What was exceptional for me was that, as I laid out my fairly ambitious work agenda for the afternoon, I committed myself – more than achieving my goals – to loving myself as I did my work.
On one call, I committed to loving myself regardless of accomplishments. On the next call I practiced it.

On one call, I committed to loving myself regardless of accomplishments. On the next call I practiced it.

  • My afternoon did not go as I planned.  A friend who has been in a florid manic state called shortly after I got off the phone with Byron and kept me tied up for almost an hour. And I felt very unsuccessful in my attempts to ground her.  When I got off the phone, I spent another hour digging up resources for her (she’s in another state) and sending her a couple of long emails.  This threw my agenda way off – and somehow another hour evaporated.  But I told myself that all this is part of being a resource for people with bipolar disorder – and was not off my mission.  And I genuinely care about this person.  I was not accomplishing my original goals, but I was accomplishing my higher goal – I was loving myself.
  • I went for two good walks.  Now that’s something that I’m capable of doing when I’m down, though I have been doing it much less since my dog died four weeks ago.  That’s also been part of me not getting up in the morning: “What’s there to get up for?”  Going for the walks was nonetheless not so unusual.

    What was unusual was this: I genuinely appreciated the afternoon sky.  Granted it was pretty remarkably beautiful.  But when I’m as depressed as I have been today, I don’t appreciate beauty.  I don’t enjoy music – even music that in a better mood I totally rock with.  I don’t like visual art – museums and galleries are a waste of time.  And I don’t appreciate nature – even great skies.  But today I did.  I bet it had something to do with my earlier commitment to love myself and then loving myself right in the middle of my goals for the afternoon falling apart.

Appreciating a beautiful sky may seem like a no-brainer, but when you are depressed this kind of beauty can feel like one more assault: "I'm so messed up that I can't even appreciate this."

Appreciating a beautiful sky may seem like a no-brainer, but when you are depressed this kind of beauty can feel like one more assault: “I’m so messed up that I can’t even appreciate this.”

So a base of depressed, but several things that don’t usually happen when I’m depressed.  I’ve created a new rating on my Mania-Depression Scale (page at the top of the blog) to reflect this kind of state: 6 CHS (Complex Healing State). Six is right in the middle of this 11-point scale.  I call a regular 6 “Peaceful”.  I don’t call it “Balanced”, because a 6 CHS – which definitely is not peaceful – is also a kind of balance, holding within it light and dark, up and down.

I believe that this state is powerfully healing – maybe even more so than a “Peaceful” state.  It is the place where up and down learn from each other, stop warring against each other.  It works to reduce the wild fluctuation of up and down, because the two poles are not polarizing – they are integrating.