fighting psychosis with psychosis

This method isn’t for the weak-minded:

But I’m not a bit weak-minded and the strategy described below suggested potential when I tested it on myself. (That makes this an n=1 study—hardly scientific—but exploratory research has to start somewhere!).

Background: I carry a long and well-documented case of bipolar disorder, and have become skilled at handling the “lows”. However, the manic “highs” still catch me by surprise. They come fast and full-blown, and I’ve often (until recently) acted recklessly when they occur. The resulting social damage proves costly.

Moreover, a full-blown mania often brings with it some degree of psychosis; realize of course that psychosis lies on a spectrum, it is not binary (sane vs. insane). For my part, I become grandiose and make decisions based on information filtered through that grandiosity, i.e., at some level disconnected from reality.

Now this state is basically a “drug high”, in that it is a chemical situation in my brain causing the mania. As a youth I tried cocaine and the feeling compares.

The psychiatric medicine I take controls the worst of the disease, especially the “lows”, but fails to inoculate me completely against mania. So I still have to learn how to effectively handle these “drug highs” as I don’t expect them to ever go away completely.

It becomes a management game:

So I got to thinking: “Why not intentionally induce manic psychosis in a safe, controlled environment so I learn how to pilot the condition?”. In doing so I’ll develop skill at managing unexpected manic episodes when I experience them in the real world–I’ll strengthen my mental power over them.

This is kind of like becoming well-practiced at meditation when you are relaxed, so that the skill proves easily accessible during an anxiety attack. (For me, the manic episodes impact me far more than anxiety, which also affects me; I’m just trying to draw a useful analogy here. In other words, I’ve ruled out meditation and mindfulness as short-term solutions to my mania challenge, though I’m certainly developing these tools for my long-term repertoire).

So I took a hit of LSD to induce grandiosity, euphoria, and delusional thinking; and then worked diligently and intently through the resulting altered state to learn how to handle the condition effectively, to learn how to take control.

The strategy worked! My recent subsequent manic episode came on quickly and intense, but I was able to recognize the state immediately and take appropriate countermeasures before making any reckless decisions.

Image from https://en.wikipedia.org/wiki/Lysergic_acid_diethylamide.

thriving vs. merely surviving

Often I lose sight of my longterm goal (to thrive) to make room in my psyche for my short term survival goals related to preventing self harm. Realized this morning that this behavior only “positively” feedbacks into the distress itself—that giving a measured quantity of attention toward thriving will better dampen the distress in the long run. (We call this dampening “negative” feedback in control engineering—the terms don’t sound intuitive: In engineering, “negative” feedback is the good kind of feedback when you want to keep something stable [1]! See the bottom of this post for pictorial examples of the two types of feedback).

So on that note, here are two ways I’m directing attention toward thriving:

Mindfulness proves a well-known strategy for improving mental health [2]. However, the only mindfulness activity that has ever worked for me so far is live performance, whether music or giving a speech. So to increase my mindfulness time, I plan to increase my stage time.

Moreover, I plan to add a mindfulness component to my instrumental practice time. (This has never worked in the past—I become too distracted, but I’m confident I can substantially improve the skill this time). So I’m going back to basics: Fingering exercises on my sitar and basic stick technique on my new drum set. I’m relatively new to both instruments so think that the activity of building mindfulness skill as part of building my instrumental skills will complement each other well.

Inventory of successes: I’ve always been one to count my blessings, but now I’m adding a weekly inventory of each week’s successes. Writing them down. Makes me feel great. Directs my emotions toward states that permit delivery of energy toward thriving!

An Example of Each Type of Feedback Loop

Just extra credit for ambitious readers…

This image comes from [3]. The top part shows how negative feedback keeps a basic ecological system stable. Similar negative feedback loops regulate serotonin production by the brain [4], a key process in stabilization of mental health.

The second part shows how positive feedback causes both system variables, success and motivation, to feed each other’s growth. A mental health example: Consider a system containing only the two variables “mania” and “lack of sleep”. In a person with bipolar disorder, one will feed expansion of the other. This effect is known as “snowballing” by systems scientists; as a snowball rolls down a hill it gets larger, and as it gets larger, its capacity for adding snow increases so it gets larger still.

References

  1. https://en.wikipedia.org/wiki/Feedback
  2. https://www.goodtherapy.org/learn-about-therapy/types/mindfulness-based-interventions
  3. https://www.scisnack.com/2015/08/04/why-negative-feedback-is-good-for-the-climate/
  4. https://link.springer.com/chapter/10.1007/978-1-4684-3860-4_26

a perceived bluff and an honorable suicide

I am not a rational person, and this is not a rational story.

It started three weeks ago. The inflection points nearly killed me.

Some background: I’ve romantically loved a woman whom I’ve called “Carol” on this blog consistently for the last two years. She rejected my advance and cut me out of her life soon after. The latter I could never handle; being cut out of her life. I mean I really could not handle it and sank into severe depression. During the last two years I pursued other women and men, but was unsuccessful, so my heart continually turned to my grief surrounding Carol.

Periodically I would try to reconnect with her, and the result was always a disaster. She continued to cut me off.

Lovesickness set in, despair and depression set in, suicidal ideation set in. I held myself together as best I could: Wrote songs. Wrote stories for this blog. Pursued comprehensive medical treatment.

But the severe depression continued, and I realized about four weeks ago that she treats me with antagonism and hostility—that more is going on than romantic rejection. I knew I did not deserve such hostility.

And I realized that antagonism and hostility—and being completely cut off—from the person I cared most about in the world was driving my suicidal ideation.

So I told her very bluntly that I need her to treat me better. That I need kindness from her. I explained what her treatment was doing to my mental health in very clear—and medical—terms. I told her that the situation was severe and acute. I explained that I really just need a little kindness and compassion.

I published that letter in my post “publishing a cry for relief“.

To her credit, she responded to the acute nature of the situation by getting someone she knew to call my mother.

However, she accused me of “threatening” suicide and “trying to place the blame on her.” (To be fair, I can understand this interpretation). She implied that I was bluffing.

There was no bluff, and I did not threaten anything. I merely stated the “facts” as I saw them. Admittedly, my viewpoint and approach is distorted by mental illness and irrationality, but I was trying to solve a problem: I simply needed her to treat me better so I wouldn’t feel suicidal.

The issue here is that nothing else I’ve tried in the last two years has attenuated the suicidality, so I had to try something drastic. I was desperate for relief and determined to survive.

The point is, I might be mentally ill, but I’m also extremely decent. I hold myself to high standards of character.

So I would never threaten suicide as a ploy, to manipulate. I would never use it in a bluff.

When a person says they are suicidal and need kindness, they mean it.

As it was, she demanded (with the most hostility I’d ever heard from her) that I never contact her again. I received no kindness and compassion. No empathy.

Pearls to swine.

So here is where things get apeshit:

I was afterward tempted to go through with suicide to prove my integrity. To show that I was not manipulating her or bluffing for attention. To prove my honor and character.

Its MUCH more dangerous when thoughts of suicide take on feelings of “honor” and “heroism”.

The serpent was subtle.

publishing a cry for relief

Here is a letter I wrote about four weeks ago. I’m publishing it now because these stories must be made public for the world to become a better place:

———–,

I’m sorry but I’m extremely suicidal and need (and wholeheartedly trust) your intervention. You know I’m no drama queen, you know I struggle with mental illness, and you know I’ve always been 100% honest with you. So please take me seriously. I’m not trying to manipulate, but I am trying to alert you to a serious problem. I’m putting this matter on your conscience—a sin of omission on your part could prove fatal.

First, know that I do everything I can to manage my bipolar disorder to the best of my ability. I take my medication and limit my vices. I see two counselors, one weekly and one monthly. I practice deep faith. But as you’ve noticed my best management is sometimes not enough and I’ve had to take multiple leave of absences from work.

Second, please do not call 911. A psychiatric hospital is not a safe place for a transgender person. (I know this from experience). It is also not a safe place for someone like me who fights tool-and-nail to preserve their life, as that environment is full of folks who have completely given up. (Again, I know this from experience). If you insist that I go to the hospital, I’ll go, but we need to talk about it first because a hospitalization also will have serious consequences regarding my access to transgender-related medical care.

Its the “fighting tool-and-nail” bit that prompts me to contact you—I will never quit on life while I can think of new approaches to survival.

The driving factor behind my suicidality is that I cannot handle your hostility toward me, your antipathy toward me, your complete dismissal of me. If you happen to find me a threat, I can’t handle that either (I’m harmless). I’d simply “write you off” if I could, but you know I value you too much to achieve that.

I just can’t handle how you treat me. So please stop!

I don’t need the relationship with you that I envisioned two years ago, but I do need you to talk with me. I need us to create a better outcome than the one we currently share. I need you to demonstrate some understanding and kindness toward me.

Please act on this information. The situation is really fucking dangerous.

Please also understand that I try my absolute best to show respect for you at all times. The proof is that I managed to shut up completely about my feelings for 1.5 years, despite intense angst. But in this case my urgency for survival trumps your request for silence. You know my character—you know my decency—you know I wouldn’t draw you into this crisis if I felt there was any other option.

Silence equals death. Please allow me to request your help.

With humility,

Emily

draft lyrics about bipolar disorder and gender dysphoria

I wrote these lyrics a decade ago to explain bipolar disorder to myself. They also are about distraction-seeking behavior with regard to the stress of gender dysphoria:

I was a kid driving blind when I wanted distraction
Looking for God or a new manic high
Looking for privilege or a new discontentment
Looking for someone to blame

I, I had the best of intentions
I, I had the best laid plans
I had the best of intentions
I had the best laid plans

Checked in ecstatic…
…and checked out of mind
Checked back in, for a quick look around

estrogen deficit disorder

Potential correlation: I’ve recently upped my estrogen dose, and have recently been happier than I’ve been at anytime in the last two years. What if the two are related? What if my brain expects a certain baseline level of estrogen to function best that it never received until now?

There is evidence that hormone administration improves psychological functioning in transgender people (see my post “the science of gender identity (part 3: psychology)” for a discussion of this evidence.

Perhaps I finally hit a (psychiatrically) clinical dose.