Bipolar Disorder & CRP
Bipolar Disorder & the Consciousness Restructuring Process, by Iona Miller, 2000
by Iona Miller
Asklepia Foundation, ©2000
ABSTRACT: CRP addresses this psychobiological disorder in terms of non-linear dynamics instead of as a battle of opposing states. Using Ernest Rossi’s Dream-Protein Hypothesis, a theory of this disease process is developed which accounts for much of its phenomenology. It examines the complex dynamics of learning and memory, which lead to greater creativity, stability, and healing in therapy.
Bipolar disorder consists of dramatic mood changes, characterized by irrational shifts in behavior and temperament. It used to be called manic depression, because of the alternating between normal, manic and depressive states. Rather than far poles of a linear oscillation, this effect is revisioned as related states of one primary attractor which accounts for them all. Bipolars experience both behavior and mood disorders, rooted in a runaway feedback loop modulating highs and lows. This disease is akin to a Hydra, the multiheaded monster from Greek mythology. It is a virulent disorder with multiple faces, making diagnosis difficult. Bipolars experience dramatic changes in sleeping patterns, eating habits, may drink excessively or suddenly begin to abuse drugs. Excessive activity, spending sprees, reckless driving, foolish business investments, infidelity, etc. can create problems. Moods and behavior are as changeable as weather’s unfolding divergence.
This mood disorder disrupts normal emotional states, such as happiness or sadness. On the down side it includes depression, passivity, lethargy, fatigue, and at the extreme, delusions, hallucinations, and thoughts of suicide. The elated pole includes wildly racing thoughts, expansiveness, agitation, restlessness, excitement, irritability, grandiosity, hyperactivity, and again, when severe, delusions, and hallucinations which repeatedly sweep over the person, altering normal personality. CRP helps ameliorate swings, reducing need for medication.
Keywords: Consciousness, psychotherapy, dreams, dreamwork, bipolar disorder, manic depression, attention deficit disorder, pressured speech, hypergraphia, dual diagnosis, mixed mania, rapid cycling, cyclothymia, lithium, chaos theory, fractals, creativity, hypomanic, Ernest Rossi, Dream-Protein Hypothesis, healing, Creative Consciousness Process (CRP)
WHAT IS BIPOLAR DISORDER?
The older term for bipolar disorder, manic depression, brings up more questions about the disease than it answers. Its name has been in flux for decades; in the nineteenth century it was called melancholia, which only described one state of the total cycle. Bipolar, as a term, makes the process sound like an oscillation between two poles, but we might better revision it as under the influence of one characteristic non-linear attractor which displays a cyclic nature, such as the Lorenz attractor. This attractor has the power in the psychobiology to eventually pull all normal states into its dynamic non-linear orbit, subsuming all energy to its unfolding manifestation. Separating personality from the illness is a challenge for both doctors and mental health professionals.
Diagnosing bipolar disorder proceeds by a process of elimination. Responsiveness to lithium treatment separates the bipolar from the schizophrenic, a frequent early misdiagnosis. Unipolar disorder, or major depression, does not arrive with the elations seen in bipolars. Few absolutes exist in the diagnosis or treatment of manic depression. It is, at times, an amorphous disease, lacking solid boundaries and a clear shape, and this is reflected in the healing journeys. It is considered full remission when an individual has remained symptom free for at least six months.
A very noticeable characteristic of manic depression is a changed sleeping pattern. A person may sleep very little, not sleep for days, or sleep for ten or fifteen hours a day. This is a cardinal sign of onset of a manic-depressive episode. Eating habits may range from binges and gorging to near starvation, perhaps with a sudden commitment to vegetarianism or other dietary notions.
In the same vein, a manic-depressive may self-medicate, drinking excessively or suddenly begin abusing drugs. Drugs of choice include cocaine, amphetamine, MDMA, or Ecstasy, and sometimes heroine. Stimulants deplete the brain of “feel good” chemicals, and this imbalance can trigger initial or chronic cycles. The exhileration of the highs becomes so coveted, and the lows so desperate that attempts to self-medicate lead to a spiral of increasing depression, loss of self-esteem, and suicidal thoughts. This pain can lead to irritability, displays of anger, and even violent outbursts.
Excessive activity is another feature of mania, and the typical examples include spending sprees, reckless driving, and foolish investments. Sex drive is often heightened dramatically, and an otherwise faithful companion may become exhaustive or wildly promiscuous.
Telltale moods and racing thoughts or “flights of ideas,” are other indicators of emotional states. Symptoms sweep over the manic-depressive dramatically altering the normal personality on a chronic basis once the onset of the disorder begins. Symptoms may be mild, moderate, or severe (with or without psychotic features).These are not just passing moods or whims, but all-consuming obsessions that produce bizarre behavior.
The person has a limited attention span, distractability, where attention is easily drawn to unimportant or irrelevant external stimuli. Children or adolescents with affective disorders are often misdiagnosed with attention-deficit disorder (see ADD amd CRP). Manic depression is only beginning to be recognized as arising in childhood.
Feelings of elation, exaggerated overconfidence, and grandiosity are often translated into boasting, unrealistically ambitious work plans, or lavish spending. “Pressured speech” leads to nonstop monologs that may go on for hours, with words or sentences holding no order or logic. Ideas just tumble out. Puns, rhymes and “klangs” may dominate a person’s speech.
It is not unusual for a manic-depressive to be fascinated by a certain piece of music or a particular musical instrument. Another strange symptom is hypergraphia, or an obsession with writing, with the person producing pages and pages of idiosyncratic scribbling. Delusions or hallucinations may emerge, such as hearing voices or seeing UFOs or religious figures, or other sights.
There may be paranoid thoughts and paranoid behavior. Delusions can include grandiose beliefs, a person may think she has special skills or talents, or is related to a famous person. Mania also encompasses “ideas of reference,” such as being the object of attention and whispers by friends and strangers, or receiving messages within media broadcasts. Hallucinations and delusions are more common features when the first manic episode comes early in life, in the teens. Substance abuse may be the trigger, but not the cause of onset.
Manic depression coupled with a substance abuse problem is called “dual diagnosis.” It’s a complicated diagnosis because it immediately raises the question of which trouble came first and whether one problem is fueled by the other. Psychiatric symptoms, particularly depression generally precede substance abuse, reinforcing the self- medication theory.
Once alcohol or drugs accent a person’s mania and depression, they feed on one another. Chronic drinking amplifies a person’s mania and depression. And substance abuse highlights psychiatric symptoms and adds behavior problems. On the other side, constant, debilitating depression aggravates drinking. Sometimes drugs can trigger depression, mania, or even psychotic thoughts in a person who is otherwise healthy, such as cocaine psychosis (acute toxicity).
Symptoms of depression include depressed or irritable mood most of the day, nearly every day; diminished pleasure or interest in all, or almost all, activities; significant weight loss and lack of appetite; insomnia or hypersomnia nearly every day; psychomotor dysfunction; fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or inappropriate guilt beyond self-reproach; indecisiveness; recurrent thoughts of death. Depression may be mild, moderate or severe, with or without psychotic features like delusions and hallucinations. Six months with no significant signs or symptoms is considered a full remission.
There are a few types or degrees of the disorder. Mania and depression do not occur in even opposition and may appear simultaneously, paradoxically. “Mixed mania” or “mixed states” express as overlapping moods, hyperactive while feeling depressed and unhappy with oneself. Half of those diagnosed manic-depressive have this mixed mania. It defies containment, with mood swings more changeable than the weather.
“Rapid cycling” is when the disease process moves quickly back and forth between mania and depression. Rapid cyclers may have four or more episodes a year, with no relief in between disordered states. The cycle can be as regular as clockwork and sometimes relates to seasonal changes. It is often aggravated by antidepresssant drugs. Thus, attempts to relieve the suffering by doctors may worsen depression and cycling. Very rapid cycling bipolar disorder is also more likely to resist lithium treatment. A condition called Bipolar II is not quite manic depression and not quite major depression.
Cyclothymia is a less grievous, often subclinical, form of manic depression, so it often goes undiagnosed or treated. It is one notch down in severity from Bipolar II. It is closer to a personality disorder with repeated episodes of depression and hyperactivity, and while these impair social functioning, they do not usually lead to hospitalization. As described by Berger and Berger (1991):
“A person suffering from cyclothymia can be thought of as the walking wounded. While the exaggerated mood may not be intense or long, the illness can bring about a string of unhappy and painful crises although a person may continue to function (albeit marginally) at work and home. Someone with this disorder may be moody, irritable, anti-social, unstable, impulsive, and volatile. The cyclothymic sometimes abuses drugs or alcohol. He may have marital problems or be promiscuous; start projects or jobs that he never finishes; change jobs or homes constantly; argue loudly, then feel very contrite; swing between feeling inferior and feeling grandiose and superior; or go on spending sprees.”
“To be diagnosed as cyclothymic, a person must have gone through episodes of mildly manic and depressed moods for at least two years. Another feature is that it often appears in a person’s childhood or teen years. The underlying mood in cyclothymia seems to be depression, and many of its victims progress to more marked depression and a bipolar II diagnosis. Others may live their entire lives without medical attention or treatment, and are simply known as very moody people who can’t hold down a job, drink excessively, and go through many marriages or romances. In short, they barely cope or cope miserably.”
Diagnosis may be lumped under the catchall category of Schizoaffective disorder until symptoms are defined and treatment options tried which push the diagnosis in a clearer direction. Only time reveals the true nature of the illness and the best way to treat it. Numerous physical conditions must be ruled out, including hormonal or metabolic disorders, epilepsy, tumors, blood disease, and metal toxins, or drug treatments.
CONVENTIONAL TREATMENT OF BIPOLAR SYNDROME
Manic depression is a tangle of heredity, biology, and environment--a collection of causes. Diagnosis procedes by interview, using a variety of scales. Since they are subjective, it is also useful to take a family history from a family member or friend. Affective disorders run in families and through generations, and so probably have genetic origins. The emotional atmosphere in a family influences a person’s response in treatment and the course of the illness.
This interview highlights the connections between episodes and critical life events. Manic-depressive people are notorious for denying the illness in the manic, depressed, or remission state. They are likewise notorious for their lack of insight into their own behavior, at least while they are ill. Despite intellect, education, or tangible evidence, they may not perceive their behavior as unusual, much less bizarre.
Brain chemistry, hormones, and emotional life have all been examined as causes of the disorder. Chemistry and biology interact with life course, inseparably. Some people have more natural resilience to recovering from personal disappointment than others do. An inherited lack of emotional resilience may be the predisposing factor. That doesn’t mean it is the cause of developing the affective disorder. This resilience could be programmed in the brain in its neurotransmitter systems, such as the norepinephrine and serotonin systems.
Drug treatment varies for different individuals and is most often combined with psychotherapy. The therapy is done by someone other than the doctor assigning medications. Lithium remains the mainstay among the few drugs aimed solely at both poles of this disease. Not all bipolar patients improve with only lithium.
Lithium acts as a kind of security guard, halting the movement of unique proteins that set off a chain reaction leading to mania or depression. At least, that’s the theory. A typical daily dose ranges from 600 - 2400 mgs. It only begins to work aafter days or even weeks. Troubling side effects are hand tremors, acne, stomach cramps, weight gain, and fuzzy thinking.
Other drugs target specific symptoms. They include antidepressants, antipsychotics, anticonvulsants, and antianxiety drugs. But drugs are not a panacea and come with a price. The wonders of chemical modification carry serious, sometimes frightening, and occasionally devastating side effects.
The anticonvulsant Carbamazepine (Tegretol) is given to those who don’t improve on lithium, and are rapid cyclers (4 or more per year). It eases mania and anxiousness but also depression and feelings of despair and hopelessness. Average dose ranges from 400 to 2000 mgs. daily. More is not necessarily better, and dose must be monitored to achieve balance, or there is dizziness, sleepiness, double vision, slurred speech, and loss of coordination.
Drugs do not cure manic depression, they simply relieve its symptoms, and not very well at that. For the fortunate, a drug can deliver a lifelong remission. For the unfortunate, the symptoms will return, regardless of which medication they are on.
TRANSACTIONAL THERAPY AND MANIC DEPRESSION
T.A. describes the assessment, development, and treatment of manic depression, especially in those with more subtle forms of the disorder, and proceeds without medication. Developmental foundations of this structure result from three distinct factors: (1). parenting from a competetive frame of reference; (2). early emphasis on doing (or not doing) things; (3). and a grandiose approach to thinking, feeling, and doing.
The inner Child makes two separate adaptations to the two sets of Parent messages. The Adult self has resulting difficulty solving problems. The separation is maintained by denial as a primary defense, making them poor reporters of their own history. They often enter therapy for treatment of depression, complaining of lack of energy, disinterest in work, and general difficulty with motivation (Loomis and Landsman, 1980, 1981).
“Doing things,” “getting things done,” is a primary issue which takes precedence over feelings. Questions about anger, sadness, loneliness, or fear are either redefined or avoided. One type of bipolar needs to be constantly doing something to feel worthwhile, and the other can’t seem to complete anything. When a high degree of agitation is present, they try to do too many things and don’t do any of them well. Thinking is grandiose, but energy is diffuse, not goal-directed.
The bipolar’s early experience of parenting impacts ego state development and life script decisions. During both highs and lows, the Adult is periodically “blocked-out.” The decision to abdicate Adult executive responsibility is made during the first two years of life in response to “overwhelming” parental inconsistencies and contradictions.
The young person adapts to the unpredictable nurturing with elation, and to periodic, but unpredictable abandonments with depression. This produces an internal Parent-Child dialogue which is as inconsistent as the early parent-child experience.
One type of bipolar disorder comes from sudden withdrawl, either psychological or physical, of available nurturance between six months to five years of age. These security-seeking individuals become dedicated people, motivated by duty with a high investment in doing things well (whether for the firm, party, or church).
A second type is more passive-dependent and demanding, expects to be taken care of by others, and empowers others with their happiness or unhappiness, success or failure. A third type decides not to incorporate the original parents, and actively does things as a means of escaping both himself and closeness with others.
In the competition between parents and child for who will avoid agitation, competition is eventually acted out within the context of doing (or not doing) things. In these families, no two people can be thinking, feeling, or doing the same thing at the same time. This applies to feelings and areas of knowledge. The competition can begin as early as the spoon-feeding stage, with a paranoid or manic-depressive parent.
In competitive families, survival is connected with winning or losing; parents model inconsistency and agitation. Parenting alternates between very good and very bad. There are outbursts of verbal and/or physical abuse unrelated to the child’s infractions. During these drastic swings the self is experienced as either very good or very bad. Denial is the defense by which this discrepancy is maintained.
Overnurtured children fail to deal with the narcissistic injury of discovering they are not the center of the universe. Undernourished children develop a fantasy of the Good Parent who will someday provide the desired nurturing. Neither idea is tested against reality and is therefore carried into adulthood.
Life Script issues for the bipolar include injunctions of Don’t Be, Don’t Feel, and Don’t Be Close. Don’t Be comes from angry parental outbursts and withdrawl of affection and nurturing. Don’t Feel centers on the agitation around feelings that are experienced as overwhelming. Don’t Be Close is the injunction behind the high level of agitation and activity in these families who keep moving to avoid intimacy (especially if one parent has a bipolar structure).
The family’s competetive frame of reference leads to Don’t Be You and Don’t Make It injunctions--denial of certain aspects of the self. Parents model the fact that problems can’t be solved within or without the competetive frame of reference. They may also model how to pretend, keep secrets, and even go crazy as an “out.”
Alternatively, parents may be grandiose, suggesting “You can do anything in the world you set your mind to,” and on the other hand issuing a competetive challenge. “Just try to please me,” is the message, but “You’ll never beat me,” is the subtext. These messages may come from the same or both parents. They combine with Hurry Up, Try Harder, and Please Me functioning a bit stronger than Be Perfect and Be Strong.
The ego state network of bipolar structure comes from parental modeling, counterscript messages, injunctions, and script decisions. The pathology is more serious the younger the trauma begins and script decisions are made. Alternately grandiose and punitive messages, and separate Child adaptations to those message produce an Adult who discounts significance and therefore has difficulty solving problems.
A great deal of energy is invested in maintaining the denial which keeps the two sides of the structure apart. When manic, they may deny ever being depressed or suicidal; when depressed they may deny having ever done anything worthwhile. Yet this inconsistency is not perceived as internal conflict.
This primitive defense mechanism takes a tremendous amount of energy to maintain in adult life. These energy problems are experienced as beyond their control, coming over them from nowhere. When denial periodically breaks down, there is a “leak” from one side of the structure to the other. This leak is experienced as growing into a powerful energy shift outside of their control.
Conditional Ok-ness requires that one keep moving, keep performing, keep doing things to survive or gain approval. This conditional system creates an angry “I’ll show you” position, or “I’ll beat you at your own game.” Therefore, the adult learns to discount the significance of both internal and external stimuli.
On the depressed side, the inner discounting parent withdraws or withholds strokes. The child reacts to the depressive parent by deciding they must be bad and will never make it. They decide not to feel and not to exist; the situation seems hopeless, and is internally and externally recreated over and over.
Once this dichotomous structure is in place, tremendous energy is invested in maintaining it. On the manic side the person becomes involved in excessive activity to avoid being depressed. On the depressive side they describe trying not to get invested in anything for fear of not being able to do it well enough and reexperiencing being told they are not OK.
Natural Child feelings are locked out when energy is misdirected toward maintaining one or the other adaptation. Those who can’t mobilize their energy avoid the manic side of the structure as actively as the manic fears depression. Bipolars generally present for treatment in the depressed swing of the cycle.
To summarize, the structure consists of two, seemingly incompatible adaptations to chaotic parenting with mixed messages and double-binds (“Damned if you do; damned if you don’t”). Denial maintains the internal contradictions. As long as the internal grandiose and competetive structure is maintained, the person has difficulty in solving problems, and continues to discount the significance of stimuli.
In T.A. therefore, the overall goal of treatment is integration. The therapist needs to come from a non-competetive place. Contracts need to be made not to run from disclosure, closeness, or contact with the therapist (No Running Contract). The therapist must enact a realistic nurturing parent, avoiding gradiose expectations, by caregiving in a healthy manner. There will be limit testing, so clear boundaries are essential.
Clients change rapidly when they lower their defenses and give up the denial that maintained the structure. The therapist must pace and adjust to these rapid changes. The first priority is dealing with behavioral manifestations. The second is dealing with developmental and script issues. The third is the structural and integration issues of the syndrome.
There are relevant therapeutic tasks at each of the five typical stages of treatment.
The five stages include the following: (1) lower defenses, (2) decontamination work, (3) exclusion work, (4) integration, and (5) resolution.
Each has specific goals: (1) set basic contracts, deal with behavioral manifesstations, achieve and maintain social control; (2) confront grandiosity and discounting, emphasize use of Adult for problem solving, transactional and game analysis; (3) deal with developmental and script issues, provide realistic Nurturing Parent, provide integration messages; (4) facilitate decision to alter (rather than adapt sstructure), facilitate decision to give up fantasied Nurturing Parent, teach increased awareness and control of energy cathexis; (5) facilitate natural, realisstic use of options for thinking, feeling, and doing. (Loomis and Landsman, 1981).
Contracts include not a No Run caluse, but also a No Secrets or Lies of omission or commision, and a No Suicide/No Homicide agreement. When denial no longer contains the homicidal rage of the manic side the depressed infant struggles with existential issues. Clients learn to slow down the manic Child and assess the significance of all relevant stimuli before doing things without adult considerations of consequences. While this decreases the excitement of the Child by processing everything through the Adult, the Natural Child’s spontaneity eventually becomes available.
New messages counteract grandiosity: “Most problems have a solution;” “You are capable of solving problems.” This ameliorates the need for hypomanic activity to avoid feeling depressed, and moderate depression to avoid the discomfort of being manic. The notion that one must be polarized as either totally manic or totally depressed is confronted as grandiose, mutually exclusive, and internally competitive. The competetive drives are reduced and that energy is freed up for creativity. Energy is available in a more economic fashion.
Attention is paid to the familiar transactions and games with which the client furthers the manic-depressive script decisions. The bottom line or script pay off of this structure is to end up all alone and not existing (a younger construct than death). It holds true whether the overt behavior appears to be engaging or rejecting of others. The real problem is maintaining the defensive internal barrier.
Rapid shifting from one ego state to another means experiencing difficulty maintaining the Adult. This is a natural result of the common theme of early infant depression (0-3 months). The attempt to close out external stimuli comes from experiences of either fear or grief. Associated sensations can only be described by terms such as “non-existence,” “waves of sadness, grief, fear, or anger which are all-consuming.”
Each manic-depressive is unique. Some have been over-nurtured, some abused, some expected to never win, and some never to lose, but the key issue is existence, “I exist, therefore I am bad.” Bipolars have built eleaborate internal structures which can be identified, worked through and integrated. They, themselves need to decide to alter their basic structure, not just adapt to it.
Once they abandon denial of thoughts, feelings, or behavior as an alternative for solving problems, grandiosity and discounting are no longer necessary. They can choose when and how they will compete. Then the Natural Child can express more freely. They learn to identify the difference between sadness related to tangible loss and their previous dark, lonely depressions. They report a natural realistic use of options for thinking, feeling, and doing things with excitement and spontaneity that is fun to share. This enables them to continue developing as autonomous, flexible, and productive people.
A DYNAMICAL APPROACH TO BIPOLAR DISORDER
Those seeking psychotherapy for bipolar disorder need to check out the orientation of the process they intend to employ. Therapists have different philosophies of treatment, even though one third to one half use an eclectic approach. Client motivation for change is the highest predictor of success in therapy. Rapport is another essential quality--good chemistry. The therapist should understand the initial grief reaction and the shock of learning about manic depression and feelings of hopelessness and despair that sometimes accompanies acceptance of this condition.
The CRP process uses the language of complex dynamic systems (CDS) and Chaos Theory to model the forms of disorders or dis-ease and the healing dynamic. This system describes the way nature, herself, works toward growth and evolution. CRP is a healing journey which generally begins with a dream.
Journeys take place in REM and facilitate a fundamental restructuring of consciousness wherein disease patterns are dissolved and spontaneous healing and self-creation emerges. This process helps access the power of the placebo effect and a variety of mind/body healing channels, which operate at levels from those of quantum physics and genetics, to neurohormonal and neurological feedback loops.
There is order even in disorder. There is order, manageable chaos (fractals) and unmanageable chaos. The fractal dimension expresses the complexity of a particular fractal form. “Fractal” comes from the Latin fractus, which mean broken or fragmented. Fractals delineate a whole new way of thinking about structure and form -- even the forms of dis-ease, which take root organically in the body and psyche.
Magnify a fractal again and again and more detail emerges from its infinitely embedded structure. The same self-similar patterns repeat, over and over, no matter what level you care to examine. You look closer and closer and still see the same form. A single image is infinitely reiterated. Thus, a wealth of structure emerges from simplicity. So, too, the dis-ease process can be seen at the physical, emotional, mental, and spiritual levels. Yet, the form remains the same.
It helps to conceptualize the bipolar disorder in dynamic terms. Tiny variations are amplified on every bounce in Chaos Theory, and this holds true in manic-depression. The mask-like shape of the Lorenz strange attractor is used to model weather and climate. It can also be used to model the bipolar syndrome with its internal climate, which ravels and unravels emotional storms and temperature changes. Creating fair and foul weather, it constantly folds back on itself. It is, at times, an amorphous disease, lacking solid boundaries and a clear shape, and this is reflected in the healing journeys.
In terms of the natural healing process, bipolar disorder indicates and describes a breakdown in the cycle, a fragmented worldview permeating all levels. It produces over-compensating swings attempting to correct imbalance. In bipolar disorder, there classically is a psychobiological disruption of circadian cycles disturbing sleep cycles, leading to rebounds from sleep deprivation, for one example.
Mania and depression appear as opposite states, when they are, in fact, simply connected but in a non-linear way. Energy is “dammed up” in the depressive phase, then when the dam breaks, overexpended in the manic phase, which depleats it, leading to cycling.
Chance fluctuations, or “noise,” in the electrical signals of the brain interfere with the signal’s message in self-destructive ways. The body can modulate mental experience and mental experience can modulate the molecules of the body. Excessive trauma or psychosocial stress can lead to a suppression of growth processes in the brain.
The traumatic situations are most often self-generated. Consequences of behavior are completed ignored. A bipolar episode where an individual can wind up being carted off in a straight-jacket for attacking a police officer when stopped for a simple traffic infraction can be considered somewhat traumatic!
CREATIVITY AND MADNESS: MYTH OR FACT
Research shows a remarkable tie between artists and affective illness. Among groups of proven creative people, affective illness strikes upward of 80 percent; around 43% of those are manic depressive. Among writers, 80% will probably have an episode of affective illness in their lives. The general percentage may be even higher, as artists in nonverbal fields (painting, sculpting, dance) are less likely to seek treatment. Also artists are able to find catharsis in their work, naturally providing themselves with an art therapy, a sign of the natural healing process coming forward.
“Where exactly does the creative process intersect with mental illness? Intense creativity...closely resembles shades of mania, or what’s called hypomania. They report increases in enthusiasm, energy, self-confidence, mental quickness, rapid ideas, and an elevated mood.”
“The feelings most useful to a creative hypomanic are heightened emotional sensitivity, absence of inhibitions, and prolonged concentration or intensity. Many say they need much less sleep during these times, and some awake at three or four o’clock in the morning, unable to sleep and ready to work. All the evidence points to hypomania as most resembling creative fervor.” (Berger and Berger).
When hypomania crosses over into full-blown mania, however, the distortions of the condition yield work with little artistic merit. On the other hand, the depression, of course stifles creativity completely. It can be incapacitating, and it takes energy to create.
“The similarity between early stages of mania and creative fervor has led to research on the link between cyclothymia (mild manic depression) and creativity. Unlike previous research that first identified creative people, then examined their mental history, researcher Ruth Richard started with a group of seventeen manic-depressives and sixteen cyclothymics, then examined their creative accomplishments. According to her Lifetime Creativity Scale, cyclothymics showed the second highest level of creativity.”
“On this scale, the most creative accomplishments were by immediate relatives of manic-depressives. Consistently, the siblings, parents, and children of manic-depressives have exhibited unusually high levels of creativity. (Not surprisingly, relatives of writers also produced many more cases of psychiatric illness than nonwriters’ relatives.) 41 percent of writers’ siblings showed creativity versus 18 percent of nonwriter’s relatives. Interestingly, relatives’ creative activities extended beyond writing to art, music, dance, and even math. Families of writers were riddled with both creativity and mental illness.”
“Thus, creativity and mental illness not only appear in the same people but in the same families. While this obviously suggests a genetic connection, no proof of this has been found yet. Mental illness and creativity seem to be irrefutably, mysteriously, tied together. Nevertheless, this connection is a dangerous one because it can distort the true nature of each. This partnership can paint an attractive picture of mental illness by suggesting it carries special talents and the seeds of extraordinary artistic creation. On the other hand, creativity may appear to be a product of sickness and chaos, with fabulous works of art composed by unhinged minds. So this partnership has to be kept in perspective. We have to be wary of generalizations about either madness or genius, recognizing that often they do not intersect and are usually at war with each other.” (Berger and Berger).
Ernest Rossi (1999) has developed a pertinent creativity hypothesis: “Enriching life experiences that evoke psychobiological arousal with positive fascination and focused attention during creative moments of art, music, dance, drama, humor, spirituality, numinosity, awe, joy, expectation, and social rituals can evoke immediate early gene protein cascades to optimize brain growth, mindbody communication, and healing.”
“[The] psychotherapeutic approach can contribute to psychobiological arousal, enrichment and relaxation; it may be possible to help people find optimal levels of mental stimulation to facilitate actual growth in the hippocampus of their brain to encode new memory, learning and behavior...optimizing psychobiological growth and healing.”
ROSSI’S DREAM-PROTEIN HYPOTHESIS ON HEALING
Rossi (1999) describes a mind/body communication channel that is pertinent both to bipolar disorder, but also to CRP in that it may describe another way healing manifests from REM. He describes how immediate-Early Genes (also called “Primary Response Genes” or third messengers) play a central role in the dynamics of waking, sleeping, dreaming, and mind-body healing at the cellular level.
There is evidence that “immediate-early genes (IEGs) function as mediators of information transduction between psychological experience, behavioral states, and gene expression. A wide range of behavioral state-related gene expression (from relaxation, hynosis and sleep to high arousal, performance, stress and trauma) culminate in the production of new proteins or homeostasis, physical and psychosocial adaptation.”
Behavioral states modulate certain patterns of gene expression. Interaction between the genetic and behavioral levels is a two way street. Genes and behavior are related in cybernetic loops of mind-body communication. How does this relate to manic depression?
A look at the systems related to IEGs, shows that they affect all the systems disrupted in bipolar disorder. They are expressed continually in response to hormone messenger molecules mediating processes of adaptation to extracellular signals and stimuli. Extracellular stimuli come from the outside environment, including temperature, food, sexual cues, psychosocial stress, physical trauma, and toxins. IEGs are fundamental in the sleep-wake cycle, appetite regulation, sexual response, and reactions to stress, trauma, and toxins.
There are persistent alterations in IEG expression in the process of adaptive behavior on all levels from the sexual and emotional to the cognitive. They can transduce relatively brief signals from the environment into enduring changes in the physical structure of the developing nervous system as well as its plasticity in the form of memory and learning throughout life. If external cues can modulate cell function through regulation of gene expression, this could also be true for internal cues.
IEGs are also fundamental in the regulation of REM-on, REM-off neurons, neuronal networks that are associated with REM sleep and dreaming. That makes them significant in CRP as molecules which can modulate mind, emotions, learning and behavior. They influence the rhythm of the natural healing process and circadian and ultradian rhythms of the body, in general. Ultradian rhythms are those shorter than the 24-hour circadian rhythms.
Milton Erickson discovered that his therapy sessions usually took from one and a half to two hours to come to natural closure. Later it was discovered that this delineates the natural work cycle that is harmonious with our own internal rhythms. CRP unfolds in a similar time-frame. IEGs modulate this process. This ultradian time frame is related to the activation or deactivation of the expression of specific genes and can occur in a matter of hours or even minutes.
“Most arousing environmental stimuli that have been studied can induce immediate-early genes within minutes, their concentrations typically peak within fifteen to twenty minutes and their effects are usually over within an hour or two. These time parameters IEG expression and their ultimate translation into the formation of new proteins correspond to the parameters of a complete work cycle of mind-body communication and healing. The changes in gene transcription and new protein formation initiated in this time frame, however, can lead to lasting changes in the central nervous system by converting short term memory to long lasting learning by the process of long term potentiation. . .the activation or deactivation of the expression of specific genes can occur in a matter of hours or even minutes.
This mechanism assesses the duration and intensity of prior waking and/or the homeostatic or executive mechanisms that bring about sleep. This is likely the mechanism that is disturbed in the manic depressive which results in sleep disorders. Sleep deprivation leads to a wide variety of psychotic and non-psychotic symptoms. This system is also associated with the neuronal network associated with the dynamics of REM sleep. Deprivation of REM and dreaming creates its own phenomenology.
“The study of IEGs indicates that sleep and wake, as well as synchronized and desynchronized sleep, are characterized by different genomic expressions, the level of IEGs being high during wake and low during sleep. Such fluctuation of gene expression is not ubiquitous but occurs in certain cell populations in the brain. Thus...IEG induction may reveal the activation of neural networks in different behavioral states. Do the areas in which IEGs oscillate during sleep and wake subserve specific roles in the regulation of these physiological states and a general ‘resetting’ of behavioral state? Is gene induction a clue to understanding the alternation of sleep and wake, and of REM and non-REM sleep?”
In Rossi’s Dream-Protein Hypothesis, “new experience is encoded by means of protein synthesis in brain tissue...dreaming is a process of psychophysiological growth that involves the synthesis or modification of protein structures in the brain that serve as the organic basis for new developments in the personality...new proteins are synthesized in some brain structures associated with REM dream sleep.”
Rossi generalizes the dream-protein hypothesis, “to include all states of creativity associated with the peak periods of arousal and insight generation in psychobiologically oriented psychotherapy.”
Enriched internal and external environments leads to the growth and development of new cells. IEG cascades lead to the formation of new proteins and neurons along with increased synapses and dendrites that encode memory and learning. On the other hand, excessive trauma and psychosocial stress can lead to suppression of growth processes in the brain. When psychotherapy contributes to arousal, enrichment, and relaxation it facilitates actual growth in the brain to encode new memory, learning and behavior, optimizing growth and healing.
“Communication within the neuronal networks of the brain is modulated by changes in the strengths of synaptic connections...meaning is to be found in the complex dynamic field of messenger molecules that continually bath and contextualize the information of the neuronal networks in ever changing patterns. Most of the sexual and stress hormones...have state dependent effects on our mental and emotional states as well as memory and learning, a constantly changing dynamical field of meaning.”
CIRCADIAN CYCLES: The Biological Clock. In mammals the master clock that dictates the day-night cycle of activity is known as circadian rhythm. It resides in a part of the brain called the suprachiasmatic nucleus (SCN), a group of nerve cells in a region at the base of the brain called the hypothalamus. But cells elsewhere also show clock activity (Young, 2000). Within individual SCN cells, specialized clock genes are switched on and off by the proteins they encode in a feedback loop that has a 24-hour rhythm.
The molecular rhythms of clock-gene activity are innate and self-sustaining. They persist in the absence of environmental cycles of day and night. Bright light absorbed by the retina during the day helps to synchronize the rhythms of activity of the clock genes to the prevailing environmental cycle. Light hitting the eye causes the pineal gland of the brain to taper its production of melatonin, a hormone that plays a role in inducing sleep. The fluctuating proteins synthesized by clock genes control additional genetic pathways that connect the molecular clock to time change in physiology and behavior.
This circadian cycle is disrupted in bipolar syndrome as evidenced by the sleep disorder and mood disorders it manifests. Identifying the genes allows us to determine the proteins that might serve as targets for therapies for a wide range of disorders, from sleep disturbances to seasonal depression.
Normally, the pineal rhythmically produces melatonin, the so-called sleep hormone. As day progresses into evening, the pineal begins to make more melatonin. When blood levels of the hormone rise, there is a modest decrease in body temperature and an increased tendency to sleep. Body temperature must be dropping for sleep to ensue. Levels of the stress hormone cortisol usually fall at night also.
Bipolars break the circadian pattern; it is fragmented or chaotic. They seem to have no circadian rhythm at all, resting and becoming active seemingly at random. Clinical research has isolated a single gene named period or per, which seems to be activiely involved both in producing circadian rhythms, in setting the rhythm’s pace. Another co-active gene is called timeless, or tim. The two proteins stick together when mixed, suggesting they might interact within cells.
The production of PER and TIM proteins involves a clocklike feedback loop. The per and tim genes are active until concentrations of their proteins become high enough that the two begin to bind to each other. When they do, they form complexes that enter the nucleus and shut down the genes that made them. After a few hours enzymes degrade the complexes, the genes start up again, and the cycle begins anew. We begin to wonder how the clock could be reset.
Jadwiga Giebultowicz of Oregon State University identified the PER and TIM proteins, and notes that biological clocks are spread throughout the body; each tissue carries an independent photoreceptive clock. In research, these clocks continued to function in tissue dissected from the host. The diversity of various cell types displaying circadian clock activity suggests that for many tissues correct timing is important enough to warrant keeping track of it locally.
In 1997 Joseph Takahashi’s research team isolated the Clock gene: “the CLOCK protein --in combination with a protein encoded by a gene called cycle--binds to and activates the per and tim genes, but only if no PER and TIM proteins are present in the nucleus. These four genes and their proteins constitute the heart of the biological clock...they appear to form a mechanism governing circadian rhythms through the animal kingdom, from fish to frogs, mice to humans.”
“It seems that some output genes are turned on by a direct interaction with the CLOCK protein. PER and TIM block the ability of CLOCK to turn on these genes at the same time as they are producing the oscillations of the central feedback loop -- setting up extended patterns of cycling gene activity.”
“Perhaps one of these, or a component of the molecular clock itself, will become a favored target for drugs to relieve jet lag, the side effects of shift work, or sleep disorders and related depressive illnesses.” (Young).
Rossi’s research suggests that the 90-120 minute ultradian rhythm is a fundamental “work cycle of life” that is entrained by the circadian cycle. The psychobiological basis of much psychopathology related to early sexual and stressful life events suggests that molecules of the body modulate mental experiences and mental experience modulates the molecules of the body. A sudden fright, shock, trauma and stress can evoke “hypnoidal states” that were related to amnesia, dissociated and neurotic behavior (ref. Bipolar, PTSD, MPD). Off their meds, bipolars forget how sick they can be.
Rossi suggests a new research frontier for the psychobiological investigation of many classical psychotherapeutic notions, such as repression, dissociation and emotional complexes. He suggests they are related to “(1) the primary messenger molecule-cell receptor systems of the psychosomatic network, (2) Immediate-early genes and target gene expression, (3) protein formation and learning and (4) state-dependent memory, stress and traumatically encoded mind-body problems.”
Enhanced memory associated with emotional experiences involves activation of the messenger molecules of the beta-adrenergic system, the arousal phase mediated by the rhythms of the neuroendocrinal system. He suggests a non-linear dynamics to the chronobiology of sleep, dream, and hypnosis.
The periodicity of self-hypnosis may be related to the psychobiology of ultradian rhythms or the natural work cycle. In bipolars, this self-hypnotic cycle may go awry and become non-rhythmic, nonrestorative. 90-120 minutes is the basic rest-activity cycle during both waking and sleeping. There is also periodicity in the imagery experience as demonstrated by REM.
Special stressors, motivations, demands and expectations in normal living can shift the normal ultradian and circadian pulsations in arousal and stress hormones on all levels from the behavioral to the cellular-genetic. This process is best described by non-linear dyanamics of chaos and adaptive complexity theory.
This research is integrating work on the creative dynamics of psychotherapy and holistic healing in theory and practice. It focuses on a chronobiological approach to the deep psychobiology of sleep, dreams, hypnosis, and healing in psychotherapeutic practice. When the 90-120 minute ultradian cycles of mindbody communication unfold over time they display alternating rhythms of activity and rest.
There is a normal peak in cortisol just before awakening. Also, ultradian peaks of cortisol secretion that lead to psychophysiological states of arousal every 90-120 minutes or so are typically followed by about 20 minutes of ultradian peaks of beta-endorphin that lead to rest and relaxation, that Rossi labels the Ultradian Healing Responses, a natural but flexible and highly adaptive ultradian rhythm of activity, rest, and healing.
The chronobiological dynamics of new protein formation are fundamental to healing and psychotherapy. For Bipolar Disorder, psychotherapy can entrain the ultradian and circadian rhythms by physical and psychosocial stimuli and recalibrate internal clocks, facilitating mindbody healing.
Rossi summarizes how “self-organizing systems of mind-body communication across all levels from the cellular-genetic to the psychosocial and behavioral could lead to a unified psychobiological theory of awake, sleep, dreaming, hypnosis, and healing.”
Research in the areas of behavioral state-related gene expression, psychoimmunology, and state- dependent memory, learning and behavior is integrated with the chronobiology of ultradian rhythms as a new window into the psychobiology of trauma and stress as well as brain growth and healing.
BIPOLAR DISORDER AND CONSCIOUSNESS RESTRUCTURING
APPENDIX: Body Changes Over 24-hour Period
1:00 AM: Pregnant women are most likely to go into labor. Immune cells called helper T lymphocytes are at their peak.
2:00 AM: Levels of growth hormone are highest.
4:00 AM: Asthma attacks are most likely to occur.
6:00 AM: Onset of menstruation is most likely. Insulin levels in bloodstream are lowest. Blood pressure and heart rate begin to rise. Levels of stress hormone cortisol increase. Melatonin levels begin to fall.
7:00 AM: Hay fever symptoms are worst.
8:00 AM: Risk for heart attack and stroke is highest. Symptoms of rheumatoid arthritis are worst. Helper T lymphocytes are at their lowest daytime level.
Noon: Level of hemoglobin in the blood is at its peak.
3:00 PM Grip strength, respiratory rate and reflex sensitivity are highest.
4:00 PM: Body temperature, pulse rate and blood pressure peak.
6:00 PM: Urinary flow is highest.
9:00 PM: Pain threshold is lowest.
11:00 PM: Allergic responses are most likely.
American Psychological Assn, DSM-IV
Berger, Diane and Lisa (1991); We Heard the Angels of Madness: One family’s struggle with manic depression, William Morrow and Company, Inc.: New York.
Loomis, Maxine and Landsman, Sandra, “Manic-depressive structure: assessment and development,” Transactional Analysis Journal, Vol. 10, No. 4, October 1980, pp. 284-290.
Loomis and Landsman, “Manic-depressive structure: treatment strategies,” Transactional Analysis Journal, Vol. 11, No. 4, October, 1981.
Rossi, Ernest (2000); “Sleep, dream, hypnosis and healing: behavioral state-related gene expression and psychotherapy,” in Sleep and Hypnosis: An International Journal of Sleep, Dream, and Hypnosis, 1:3, 1999, pp 141-157.
Young, Michael W., “The tick-tock of the biological clock,” SciAmer, Mar 2000, pp. 64-71.
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