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Thursday, August 11, 2011

Happiness, sadness, everything in-between, and our common humanity as sometimes "inappropriate" beings

I've been reflecting a lot about something we all have in common, as humans.  Moods.

Happy mood/Sad moods.  Energetic moods/Blah moods.

Love/Hate. Affection/Indifference. Interest/Boredom. Comfort/Anxiety. Excitement/Dread. Clarity/Confusion.

We all understand these ideas, these moods, these emotional and mental states.  Then psychologists, psychiatrists come along and entomb these simple terms by turning them into terms of art, professional slang, DSM-IV diagnoses, complex conceptual tools to "professionalize", "rationalize", "mystify" these simple ideas about these emotions which everyone at one time was able to apprehend and communicate, without professional therapeutic help.

According to the old joke, when you're an inmate in prison and one of your comrades yells out "Joke number 374", everyone on the cell block laughs uproariously.  Mere visitors to the prison have no idea what the laughter is all about, because they haven't lived in the prison and heard the same jokes being told over and over again, aloud in the next cell.  Even the prison guards laugh as each joke number is called out.

DSM-IV talk by therapists and other psychological professionals bears a very close family resemblance, in the Wittgensteinian sense, to prison joke numbers.  But today, we, the lay, non-professional, public have bought into this way of thinking about "mental illness", especially the mood "disorders" which many of us have at one time or other experienced.  By mood "disorders" I mean those moods which are disruptive to some aspect of our lives in such a way that we feel a need to talk about it with someone, rather than just let it pass through us like the rest of the river of our experience.

Anyone who's ever browsed through the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, known more generally by its cryptic and creepy-sounding acronymn, DSM-IV, knows that it's a dense, internally self-contradictory, confusing, welter of detailed instructions for labeling the wide range of emtional states experienced by all human beings, in some form, at one time or other.  But it IS a complicated document.  Almost as complicated as The Code of Federal Regulations of the United States of America, the French Code Civile, and, reaching back in history, the Code of Hammurabi (1,760 B.C.) , the Corpus Juris Civilis (Roman; 529-534 A.D.),  the Law of Manu (Hindu), the Mishnah (in Jewish Halakha law), the Canons of the Apostles (Christian Canon law), and the Qur'an and Sunnah (Islamic Sharia law).

As for the part of DSM-IV which deals with Mood Disorders, including Depression, Mania, and Manic-Depressive disorder, I want to suggest a simpler rubric for thinking about these emotional states.  My hope is that such a change in the way we look at Mood Disorders may help us to humanize other people who currently suffer from one of the many mood disorders and, hopefully, by recognizing our common humanity on this issue, refrain from stigmatizing people who have, or we think they have, a mood disorder which troubles us as empathetic onlookers.

Take a look at this diagram:

                         -10  _____-5______ 0________+5________+10      
    Dangerously sad                        Neutral/Flat                             Dangerously happy

Notice that I have not used the terms "depressed" on the minus end of the scale, nor "manic" on the plus end.
I'm sure that almost all of us know what it means to be sad or happy, and everything in-between.  Fortunately, not everyone knows what feels like to be dangerously depressed or dangerously manic.  Be that as it may,
like many things in life which require judgement, and estimates, and hard calls, I cannot suggest a precise algorithm by which to place any particular feeling-state we may have at any particular moment into its precise location on the "Very sad" to "Very happy" diagram, above.  However, I bet most of you could, if asked, tell me about where your emotions of the moment should be pinpointed on the diagram.

"What's the point of all this?", you may be thinking about now.  Here's the point: if all of us, at every moment, are experiencing moods which can be placed somewhere along the continuum represented by the above diagram, then we are all in this "Mood Business" together.  If you're a +1 at this moment, and that guy's a (or seems to you to be a) +8, you're both still together, riding your emotions, at different points on the continuum, but you are riding, together, on the same continuum.  And if you're a +1 today, because you're "happily" in a relationship, but it's gotten a bit stale, and you're friend is +8 because he, too, is "happily" in a relationship but has been making changes to his life which leaves him feeling quite more ebullient that you're used to seeing him seem to be, what's the point in stigmatizing your friend, or pushing him away, or telling him he probably should be medicated to "stabilize his mood" and, I suppose you mean, bring him "back down" to the level you're at, a +1, or maybe even down into the negative, sad, depressive mood your friend was in a year ago, before he began changing his life and re-creating himself?

If you're currently at a +1 and can't possibly imagine yourself at a much "higher", "happier" point on the continuum, think back to the time or times when you were "in love" with your spouse or someone else.  Or to that time when you graduated from high school, or college, or graduate school, the time before you started working in the career you eventually came to hate to go on doing every day of your working life.  At those times, when you were "in love", or perhaps mainly "in lust", or just beginning a new phase of your life, where do you remember you were on the continuum?  +8, +10, beyond category +10?  And at those times, would it have been helpful for your friends to say to you, "The way you're feeling is really inappropriate.  Until you change and get back to the way I used to know you, I just can't bear to be around you.  I find your behavior obnoxious, offensive even.  I will not be abused by you, by the way you treat me when you're feeling this way.  So happy.  So up.  So superior-sounding.  As if you've finally discovered the secret of happiness.  I'm telling you this.  I know from experience that this state you're in will not last.  I'm warning you.  But I can't bear to be with you when it seems to me you're destroying you're life.  You may be happy now, but tomorrow I fear you'll come crashing down, and I just can't sit idly by while that's happening."

In Dr. Kay Redfield Jamison's wonderful memoir of "An Unquiet Mind: A Memoir of Moods and Madness", she openly, bravely, and beautifully describes her history of severe manic-depressive illness.  She was reluctant to write the book because of her extensive experience of being stigmatized not only by laypeople, but also by psychological professionals, one of whom, a male psycho-analyst, exhibited extreme prejudice against her once she revealed her condition to him.

At this point, there are two quotes from Dr. Jamison's memoir which are pertinent and wonderfully revealing.
On page 202, she writes of her reluctance to reveal her illness to people. 

 "Too, I have been very concerned, perhaps unduly so, with how knowing that I have manic-depressive illness will affect people's perception of who I am and what I do.  There is a thin line between what is considered zany and what is thought to be--a ghastly but damning word--'inappropriate,' and only a liversish gap exists between being thought intense, or a bit volatile, and being dismissively labeled 'unstable.'"

Then, on pages 208 to 209, Dr. Jamison recalls a luncheon with the head of the department of psychiatry at Johns Hopkins, where she had moved from UCLA medical school, to reveal to the department head that she was manic-depressive.  She already detailed for the reader the careful supervisory structure she developed to make sure that her fellow psychiatric clinicians were properly supervising Dr. Jamison's care of her psychiatric patients in therapy.  After gathering her courage, at last she revealed her condition to the department head, who suddenly "reached across the table, put his hand on mine, and smiled. 'Kay, dear,' he said, "I know you have manic-depressive illness.'  He paused , and then laughed.  'If we got rid of all of the manic-depressives on the medical school faculty, not only would we have a much smaller faculty, it would also be a much more boring one.'"

Those of you who know me well, and knew me last summer, when I began my final slide into a fully suicidal depression beginning late in August, 2010, which fully and dangerously depressed state continued until the beginning of January, 2011, have seen me go from -10 on the continuum to +8.  After reading Dr. Jamison's memoir, in which she describes the phenomenology of her truly psychotic and dangerous manias, as well as the same for her fully depressed depressions, I now am confident that I did hit bottom last fall, and was a true -10.  However, even in my most "energetic" times since the beginning of January of this year, 2011, I have never been psychotically manic or a +10, despite what those of you who think you know me better than I, and my psychiatrist, Dr. Jacobs, and my psycho-therapist, Ray Oakes, THINK you know me.  In fact, when I last checked in with Dr. Jacobs, this past Monday, he thought I was about a +3 and that I had been about a +5 when I saw him in early July, just after getting back from my West Coast Adventure.

I will write more about why I think people who include even some of my friends whom I've known and loved for 35 years, have stigmatized me, distanced themselves from me, and feel uncomfortable in my presence.  Some of this I believe is based on their love for me, and some of it I suspect is based on their own internal psychological and spiritual struggles.  

In the final analysis, we can only tell stories about ourselves and each other's emotional and mental states.  Every perception, every theory, about oneself, or others, is, like any scientific theory, a hypothesis, a hunch, which could be right, wrong, or somewhere in-between.  Not to admit that, to recognize the truth that, we don't know, in any final sense, anything, really, about ourselves, let alone others in whose skins we've never lived, is the height of naivete, folly, self-absorption, cruelty, and, frankly, self-loathing. 


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