Finding the Words

It’s been five weeks since … I still don’t have a label for it. It just is.

Well I guess I could say “my old wounds got torn open, setting me back a year or two in my recovery to how I felt and functioned about 18-24+ months ago.” (‘Recovery’ – to the degree to which I find that term relevant – isn’t a unidirectional, continuously-getting-better process. It’s complicated and messy and all over the place. So this can’t be a setback, just an unexpected and more-difficult-than-anticipated part of the journey. Perhaps a necessary part? It’s certainly reminded me of how vulnerable I am – but also how resilient I am.)

I’m inclined to say “that’s a bit melodramatic” but, well, it’s my truth. Coming back from that hasn’t been easy. For a while I took a break from activism, particularly the being-a-leader-in-a-grassroots-organization stuff. I’ve been getting back into it, almost to the point where I feel like I’m “pulling my weight” again – putting in effective work commensurate with the roles I have. But I’m also addicted to Terraria, my apartment is as messy as ever (what an understatement!), and my relationship with Fox … let’s just say both my therapists seem to agree it should be my primary focus. And one basically suggested he should quit his job so he’ll have energy to put into our relationship.

It’s been about 3.5 weeks since I visited Ron in the hospital and 2.5 weeks since ze was released. Ze lost zir job and couldn’t go back to zir parents’ house because their terms were unreasonable to the point of being unhealthy, so ze is currently homeless. People are doing what they can to help and ze says ze feels better. Ze seems better too – most of the time. Sometimes zir “speech seems pressured” but it’s usually connected to particular topics, and it’s possible to move the conversation elsewhere. Ze listens to me.

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Hypomanic and Depressed at the Same Time

I read an article today and now my world makes so much more sense. In a Depression Bipolar Support Alliance (DBSA) “Ask the Doc” article, Dr. Mark Bauer, MD states that:

“[T]he most common mood state in bipolar disorder is a mixture of hypomanic/manic and depressed symptoms. In fact, the classic picture of bipolar disorder having a course alternating between the poles of high and low moods is an over-simplification.”

He goes on to explain mania and hypomania more clearly, basically describing them as hyperactivation – feeling “sped up” and driven. This can feel good (e.g. grandiosity), bad (e.g. irritability), and everywhere in between. In other words, mood and activation level are two different things.

Ergo, we can think of bipolar disorder as

“a condition of recurring depressive periods punctuated by periods of hyperactivation – and sometimes these periods of hyperactivation alternate with slowed down, depressed periods, but at other times they overlap.”

That. Is. My. Life. It’s very rare for me to experience a period of time with no depressive symptoms; at best my symptoms become few and mild enough that I don’t meet the criteria for clinical depression for a couple days to a few weeks. But periods of hyperactivation… just look through my blog and you’ll see my posts about “I’m going to do this new thing that will change the world,” staying up all night composing, “now I’m getting better and I’m mad at Fox all the time,” and most recently “Let’s Play Skyrim!”

I usually feel better during my periods of hyperactivation because 1) I have energy to do things and 2) I’m hyper-focused on something that’s meaningful to me, at least while the hyperactivation lasts. Sometimes I don’t feel so good because I want to Do All The Things!!! but I can’t focus on one thing to do, so my mind is a jumbled mess. I’ve also tried to be a part of too many different groups at once, which invariably results in me feeling overwhelmed, backing out, feeling guilty, and my depression symptoms becoming more severe. As far as I can tell, all of my periods of hyperactivation have occurred at times when I also met the criteria for mild depression. (Possibly also moderate depression.) In other words, I’ve never had a discrete hypomanic or manic episode.

I try not to put too much importance on labels; what’s really important is that the needs of the person with a mental health issue are being met. But having a label creates a container for my experience; I can understand it and talk to other people about it and know I’m not the only one who’s had that experience. Finding labels that accurately describe my experiences helps me feel safe. I obviously can’t diagnose myself, but the label “bipolar disorder” seems to become more accurate the more I learn about the experiences it’s intended to describe.

I know I’ve been “depressed” lately because I’ve been feeling sad and/or grumpy, isolating, having trouble eating full meals, apologizing for my existence, and thinking “I want to die” when I’m tired. I feel like it’s only a matter of time before my world starts unraveling (again): I worry about Fox’s safety, our rats’ health, my own health, the house burning down, etc. Calling these experiences “depression” helps me separate a bit from them, accept them, and engage in self-care.

Dr. Jekyll Experiments with Whole Tones

I’m taking a course in piano improvisation for music therapy, which is both really cool and nerve-wracking. We get to go far beyond the conventions of traditional Western music, to explore musical expression more broadly. We’re simultaneously learning to appreciate the emotional effects of intervals (the specific sound created by playing two particular notes simultaneously or consecutively) and developing a working knowledge of “alternative” modes and scales. It’s nerve-wracking because one never knows when one will be called upon to do this brand-new thing in front of the entire class, and I tend to lack confidence in my piano skills.

The solution is, of course, to practice – both to improve my skills and confidence, and to play with all the new toys that are being handed to me each week! I was feeling rather bored yesterday, alone in my messy apartment without Fox to help me focus my energy. I’d already played The Sims 3 for a few hours and wanted to do something different, so I decided to improvise on piano for a while.

I practiced the whole tone scale, which does not have any half-steps and creates a very dream-like feeling. On the piano it can be played by choosing a key to start on (e.g. middle C), then skipping a key between each one you play. There are two basic whole tone scales; you can start and end on any pitch in either of them.

Whole tone scales for piano starting on C-natural and D-flat. Together they use every key within a minor 9th on the piano.

Whole tone scales for piano starting on C-natural and D-flat. Together they use every key  on the piano within a minor 9th.

I started out by just playing the scale that starts on C-natural, first in the right hand and then in the left. My right hand began to try making more creative melodies, while my left searched for some kind of accompaniment (which in my mind means playing at least two notes simultaneously, preferably with a rhythmic pattern). I made the conscious choice to avoid intervals that are considered consonant (peaceful) in Western music, prioritizing dissonance (tension) and sounds that were unfamiliar.

That led my music to become quite harsh, expressing a mix of anxiety and anger that was almost completely nonverbal. I abandoned the whole tone scale and other ways of organizing pitches (specific audible frequencies) into what is conventionally considered music, relying more and more heavily on tone clusters. There were rhythmic elements and patterns in my playing, but no real meter (a way of organizing rhythm). In other words, I was literally banging on the piano with open hands and had very little intentional control over individual fingers. As time went on, the improvisation became increasingly chaotic.

Themes emerged in the music such as a “rumbling” in the lowest register that I sometimes played with both hands, sometimes with the left hand only. The right hand would flee from this dark ominous rumbling and scramble “up” the piano into the high register, where the sequences of pitches I played were rather frantic. I had the mental image of struggling to climb a slippery rocky incline where I couldn’t find a secure grip. The abyss and/or some horrible monster waited below. At times there was a call-and-response structure to the music, in which one hand would play something (while the other hand was silent), then the other would respond with similar rhythmic patterns (while the first hand was silent).

I quickly interpreted the dark ominous rumbling to be the voice I hear when my depression symptoms are at their worst, telling me I’m worthless, alone, etc. The self-destructive urges that at best undermine my short-term goals and at worst tempt me toward suicide. My inner demon, my true mental illness, my internalization of the abuse I’ve experienced, etc. etc. etc. It has no redeeming qualities, yet I allow it to seduce me.

The right hand could only scramble so far up the keyboard before it had nowhere else to go, so it would come back down toward the rumbling, sometimes joining it. There was no rest, no slowing down and organizing, no creating intentional patterns, no stability. I think my attempt to explore beyond Western music became an excuse for avoiding it, thus depriving myself of most if not all of techniques I currently have in my repertoire for restoring stability, calm, and a sense of wholeness (which I should be using music to promote). I was “up the creek without a paddle” – because I’d intentionally left both my paddles at home.

There was a part of my mind that urged caution, reminding me that I was alone with no one to pull me out of the abyss if I needed them to. I was not with Wakana in therapy, where an exploration like this might prove useful – and could be done safely. It urged me not to go too deep, to come back, to be careful and compassionate toward myself.

But another part was fascinated. It wanted to sit back and observe and analyze everything that was happening. It assured my cautious mind that I could handle this, that it would pull me back when necessary. This is the part that’s enabling me to write about my experience like an objective researcher writing a case study. I think it’s the part of the human psyche that finds serial killers so fascinating. – and, admittedly, part of why I study psychology.

I found the whole experience so interesting, I decided to intentionally cause it to happen again so I’d have an audio recording. If only I hadn’t deleted the file when I hit my first obstacle to transferring it from my phone to my computer. I’d really love to hear what I played, and to analyze it…

The title of this post is a reference to the musical Jekyll & Hyde, which is based on the novella The Strange Case of Dr. Jekyll and Mr. Hyde by Robert Louis Stevenson. In the musical, Dr. Jekyll begins experimenting on himself in order to find a way to remove the evil in his father’s soul. He instead creates Mr. Hyde, an alter-ego who embodies and acts upon all of Jekyll’s “evil” urges – unchecked by morals or concern about his standing in society.

A double exposure image featuring Richard Mansfield as both Dr. Jekyll and Mr. Hyde, taken by Henry Van der Weyde circa 1895. Public domain image downloaded from the Wikipedia Commons.

A double exposure image featuring Richard Mansfield as both Dr. Jekyll and Mr. Hyde, taken by Henry Van der Weyde circa 1895. Public domain image from the Wikipedia Commons.

I’d be tempted to say I write about my “Mr. Hyde” on this blog all the time, but I only disclose part of it. I can admit to suicidal thoughts, habits I know are unhealthy, the temptation to give up on everything, frustration in relationships, anger, guilt, etc. I don’t use this blog to share my thoughts that are racist, wish dishonorable death upon certain politicians, objectify others for my own sexual gratification, devalue other people’s perspectives, etc. To do so would be inappropriate and harmful. I only mention these things now because I believe they are some of the human tendencies Mr. Hyde represents – and we each have our own version of him. We can’t separate him from the “good” part of our psyche, but we can limit his influence on our behavior. Perhaps we can even help him change to be less “evil.”

I think the more important character to examine is Dr. Jekyll, the one who unleashes Mr. Hyde. In the musical his stated intention is to cure his father, who is comatose. He isn’t allowed to experiment on other humans due to the risks involved, so he experiments on himself instead. The song “This is the Moment” reveals that his motivations aren’t really all that altruistic; he’s motivated by pride. He wants to prove himself, to prove “them” wrong. He’s not really being heroic. He’s being reckless.

Watch Robert Cuccioli perform “This is the Moment” on YouTube

Okay, so maybe the first time he transforms into Mr. Hyde it’s an accident. He had no way of knowing that would happen, right? Fine. The problem is that he keeps doing it, over and over, until he loses control. He prioritizes his research over his Self – and the safety of others.

You’re probably wondering what all this has to do with whole tones. Well I started out by practicing whole tone scales, then trying to improvise with them, but I was reckless. I didn’t do anything to ground myself, like going ahead and using a consonant interval (C and E) or playing one of the ostinati we’d practiced in class. (“Ostinati” is the plural of “ostinato,” a short musical phrase played over and over.) Without a predictable pattern, comforting intervals, something to keep me calm and ordered, I had no protection from the chaos.

Okay, so I banged on the piano for a while and made a lot of noise. It was during the day. Anyone who heard it was probably just a bit annoyed by it, then went on with their lives. I might have been the only one who heard it.

The problem is that I knew it was risky to allow my musical improvisation to become so chaotic, but I did it anyway. I felt unsafe – otherwise I wouldn’t have had thoughts urging caution; it wouldn’t have mattered that I was alone. I knew I was unleashing powerful forces I wasn’t prepared to deal with on my own. But instead of stopping the improvisation and moving on to something safer, I decided to go back, to go deeper into the abyss.

I’ll admit, it was kind of fun to romp around. When I needed to come back, I moved myself more and more toward consonant intervals. I played a G-major chord, regained conscious intentional control over my fingers, and explored tonal music for a while. I don’t remember exactly how I felt when I ended the improvisation, but I thought I was okay.

I wasn’t okay. My mind was in utter chaos. The light was too bright. There were too many colors and sounds. The clutter in my apartment that I can usually block out (or even find comforting) was overwhelming. Every thought splintered into several more. Each word brought on an association: an image or a song. That association would lead to another and another and another… it was all going too fast! I couldn’t focus my energy. I could barely move. All I could do was sit and put my head down and try to find something that wasn’t stimulating.

I texted Banji and told her: “I feel like I’m in the middle of a crowded room with hundreds of conversations going on around me, ten TVs set to different channels and blasting, ten radios also set to different stations and blasting, and there’s no escape!” She replied, “hugs,” and I sent her more texts describing how it had happened. I felt the tension melting away as I did so. Eventually I decided to take a shower, which provided sensations I find comforting (and pleasurable) and that brought me back into my body: in a word, grounding. My mind picked one (or maybe two?) thing(s) to focus on. I was even able to read a chapter of Yalom (The Theory and Practice of Group Psychotherapy) during a Skype homework session with Banji.

I’m going to take it as a learning experience. At first I thought maybe whole tone improvisation was contraindicated (not a good idea) for me, but I think the more important lesson is the importance of grounding. There needs to be some kind of home base that can be referenced at any time and provides the foundation for the music experience.

More importantly, I can’t experiment on myself – no matter how much what I learn might benefit my future clients, or how “fascinating” it is. My safety has to come first; I need to recognize and respect my own boundaries.

Diagnosis and Identity

A trusted friend who has bipolar and works in a mental health setting pulled me aside the other day; he said he’s observed some possible symptoms of mania in my behavior. He presented the information as something that might help explain some of what I’m going through, and more importantly as a tool I can use in my creative endeavors. Use the unbridled, chaotic energy to create; edit when the mind is calmer. I don’t think I want to edit when I’m depressed because then I’ll probably get rid of a lot of good material, but I digress.

To be honest I’ve been wondering about the possibility of there being a manic – or, more likely, hypomanic – component to my… madness. I do seem to have times when the depression lifts – just enough that I think I’m starting to get better, but not enough to say I’m “in remission” or “have recovered.” These times are often accompanied by a whirlwind of energy in which I become engulfed in a new project – which I tend to abandon completely when the next wave of depression hits.

I never really pursued the possibility of mania/hypomania being part of my madness for a few reasons:

  • I thought it required elevated mood; to the degree that my mood becomes “elevated” it would probably fall within the range of “normal” non-depressed emotions.
  • Questions on screening tools that explore the possibility of mania/hypomania tend to begin with “a period when you were not yourself and…” I’m always myself.
  • I’m not comfortable talking about some of my experiences with mental health professionals because I don’t want them to pathologize experiences I consider(ed) to be spiritually meaningful.
    • Some of the voices in my head may become abusive, but others can be supportive. It might be different, but I often find it adaptive. I’d be lonely if they all went away.

But now I’m thinking this is a possibility worth looking into. I pulled out the DSM-IV-TR and reviewed the relevant symptoms with Fox. (We don’t have a copy of the DSM-5 and I’m inclined to keep it that way, considering the concerns people have raised about it.)

The DSM-IV-TR clarifies that the mood in mania/hypomania can be elevated, expansive (?), or irritable. We’ve both noticed that I seem to have some of the additional symptoms: (3) more talkative than usual or pressure to keep talking, (4) flight of ideas or subjective experience that thoughts are racing, (5) distractibility, (6) increase in goal-directed activity. Additionally, it is possible for depressive symptoms to be present at the same time as manic/hypomanic symptoms. Hypomanic episodes can be as short as 4 days and do not require there to be marked impairment in functioning (e.g. taking huge risks) to be diagnosed.

I’m not really in any rush to ask a professional to put a stigmatized label on me, but I do think this is important. It can help me understand myself and navigate my life and experiences. Awareness of it might help me find useful ways to channel the energy when it hits and possibly even cope better when it dissipates.

If I pursue treatment, particularly medication, it changes what I need; Fox said that medications for bipolar disorders are better understood and tend to be more effective than those available for unipolar depression. I’d need to do some research, but I do feel more hopeful about finding something that works for me (preferably with minimal side effects / other health risks).

Finally, it’s very important to me to represent myself as accurately as I can on this blog. One of my goals is to give people who have never experienced madness / mental illness an insider’s perspective of what it’s like (for me). If I say I have one disorder but I “really” have something else, I’m misrepresenting the first disorder and doing a disservice to everyone involved.

For now I just want readers to know that I’m not sure what my diagnosis should be. At the end of the day we’re all people with dynamic issues and behaviors that don’t really fit into neat categories.