Sunday, August 4, 2013

Mental Health Disorders and "Reality"

This isn't going to be what I'd like it to be because I don't, in my current state of residence, have access to all my notes and books nor do I have the mental energy to go through and search online to find all the stuff I'd previously researched and try to reconstruct it. So we'll just have to make do with what I can do on the fly. Which is probably a good thing because what I'd like this to be would run three thousand plus words or so, not something anyone has the time nor interest to plow through.

As I made at least somewhat clear in the previous post, we all have our own realities and those realities change as our brains change which is like ... all the time. But that's normal human change almost everyone goes through. As I was building to in the previous post, which I hope you have read as a prerequisite  of this post, the state changes and reality changes experienced by those with schizophrenia and bipolar are rather different from that. I can only briefly touch on each of these today but hopefully it's enough to start opening some minds.


Schizophrenia is many things, many probably not quite as how you imagine them. For one thing it is NOT hearing voices. The phenomenon of hearing voices is quite different and not - or at least not necessarily - anything to do with schizophrenia. This is a massive myth, unfortunately one that is propagated by educated people with "Dr" in front of their names. But go to a meeting of Hearing Voices Network and/or read through the copious amount of material they could give you and you'll find out something very different from mainstream medical opinion. This does not mean that some people with schizophrenia may not experience, as part of their delusions, hearing voices, only that hearing voices does not necessarily equate with being schizophrenic. So let's set that aside right away. What we are talking about are delusions which are described somewhat incompletely here. 

Rather than try to broadly describe schizophrenic delusions - which can vary greatly from person to person - I'll work instead with a very well known case study: that of one John A Beautiful Mind Nash. John Nash, if you don't care to follow the link and learn more about him, was - probably still is at the age of 85 - a mathematician. But not just a mathematician; he was one of the most brilliant mathematicians among a collection of the many of the most brilliant mathematicians on the planet at the time (the late 40's to mid 50's of the last century at Princeton University). He would win a Nobel Prize for his ground breaking work in game theory. And it wasn't just that he was brilliant, it was how he was brilliant. He could, it was said, simply do things with his brain that no one else could do (part of his brilliance was in being a maverick among his peers). So we're talking one very smart man here. And not long after this wonderfully brilliant man developed game theory he began, around 1959 or so, to experience delusions (if you have seen the movie on Nash's life you'll have to set that aside as it was really rather fictional I can tell you). It is hard, even for the most excellent biographer of Nash Sylvia Nasar (the more accurate portrayal of his life and experience with schizophrenia), to describe Nash's delusions because he never actually gave an interview to her so instead all there is to go by is his behaviour and second party accounts from family and former colleagues. 

It is not possible to completely describe here within the constraints of a small column all of what Nash experienced and did while delusions took possession of his mind. In 1958 he was working on extremely advanced mathematics. Then the inner realities of Nash began to change. It started mildly. He started to feel that all men who wore red ties were part of a communist conspiracy against him. Not long later he was chasing around Europe as an "attache" of aliens in charge of contacting embassies on a new world order and world government that was coming. And this was, it's important to understand, completely and one hundred percent real to him in his mind. He believed it was real, as he told a colleague some years later, because it came from the same place in his mind as his math theories did. His behaviour changed completely and utterly to follow his new reality. He became for all intents and purpose unemployable. He more or less lost all interest in mathematics as the new "realities" took over. He was institutionalized undergoing treatment that included the barbaric insulin shock therapy which had untold and long term effects on his mind (he would later refuse any  institution or treatment and his wife was said to have rejected electroconvulsive therapy for him because she feared what it'd do to his mind).

The take away here is that schizophrenia can produce new inner realities over which the sufferer has no control. No one knows for sure where the delusions come from or why. Schizophrenic delusions can happen to almost anyone from any background. While Nash gradually, over many years (and famously without medications), was able to distinguish his delusions as not real and get back to "real" reality, for most people this is extremely difficult. The delusions can come and go over the years and each time they're absolutely real. It is a reality virtually no one outside the sufferer can imagine. Which is part of what makes it so difficult for the sufferer - they're the only one that can "see" it and this can be extremely frustrating (and this frustration, I argue in my book, becomes a huge part of the "illness"). I once talked to a man "to whom Jesus spoke" and gave him tasks to do. He was absolutely sincere in how real this was yet no one would listen to him. Though he'd gotten used to this rejection and appeared very nonplussed about it, I could still sense the frustration in his voice, not to mention his bewilderment at why no one wanted to hear, through him, what Jesus had to say. He thought it so important and couldn't grasp why no news services wanted to interview him on this. 


Bipolar can be quite similar to schizophrenia in that it can produce delusional thinking and indeed one can be misdiagnosed as the other. Kurt Vonnegut's son Mark in his book Just Like Someone Without Mental Illness, Only More So describes what sounds much more like schizophrenia to me but he was diagnosed with and treated for bipolar. Whatever it was, he managed to deal with it quite well having gotten accepted at Harvard Medical school (albeit against very long odds) and became a successful doctor (except for the relapse time). Like schizophrenia, bipolar can create some pretty wacky stuff in one's mind all of which is one hundred percent absolutely real to the person in whose brain it's happening. I can personally attest to this. The younger Vonnegut doesn't describe swings of mental states or manic depressive episodes (I use the term "manic depressive episodes" to denote the depressed state of bipolar, a condition I think is different from unipolar depression), something which further makes his diagnosis suspect to me. 

Bipolar is essentially swings in state (I dislike the word "mood") between mania and depression. Mania is many things so it's hard to precisely define here. I once described it as whatever one's personality is with manic chemistry layered over top of that. If you tend towards creativity, you'll be manically creative. If you tend to do stupid stuff, you'll do manically (and epically) stupid stuff. If you're an abusive a-hole, you'll be a manically epic abusive a-hole who can do violent things. I don't know where to begin and end in describing mania. I could describe mine but it's different from many people's. My mania is very often different from itself. They're like some boxes of chocolates; no two are alike. Whatever it is, it'll be an elevated state in which you are impelled to do stuff very different from what you'd normally do (or maybe, like some creative bipolars, your normal stuff much better than you ever do). This - for however long it lasts - will be your reality. And what mania does as part of making this your reality is remove all insight or judgment. No matter how lunatic whatever it is you're doing, it will make absolute sense to you at the time. Including, tragically, maybe jumping off of a building because you're convinced you're Superman. Yes, it can be like that. Like with schizophrenic delusions, no one knows where these manic bouts come from or why. It just happens. Just like that <snaps fingers>. There are thought to be triggers but these don't always necessarily happen first. 

Then the worst sufferers (though not all apparently) of bipolar will experience an abrupt change from this "up and energetic" state down to the absolute blackest, deepest, darkest depths of depression humanly imaginable. Just. Like. That. (or at least many times for me anyway). Then this becomes the new reality. Like with the highs, there will be very impaired insight. This is part of what makes manic depression such a suicide danger - killing oneself makes absolute sense (never mind the desire to escape the darkness and psychic pain) and your mind will be in complete agreement. Rather than the runaway optimism of mania, manic depression is all about the darkest negativity and pessimism you can imagine. As great as you thought you were when manic, you'll think you're as awful when in the grip of manic depression. It'll be like an oil derrick pumping your worst memories and thoughts into your mind. And because you're robbed of insight and it's just the way manic depression works, this negative darkeness will be your reality. It is completely and utterly hideous. And yet so real. And you can't do anything about it. It's hard to tell which lack of insight is worse - that at the high end or that at the low end. 

Then there are "mixed episodes". This is a whole different reality altogether again. This is the nuclear power of mania coupled with the darkness of depression. Or maybe just acting like a totally out of control (because you are out of control) asshole. Because your mind has been taken over by something else and that's your reality for that particular time and you're just quite sensibly acting on that reality. 

You can "rapid cycle" through these highly different states in kind of an internal roller coaster or yo-yo where your entire mental state - or reality - is changing from one to the other and back again so fast you have no idea what is what. You'll want to put a gun to your head and pull the trigger just to make them stop. Trust me, they will drive you that insane (don't worry, most people don't get to that state). The longer this happens in your life the harder it is to treat and the worse your long term prognosis is.

None of these states - these inner realities - you have any control over. They just happen. Generally you'll be utterly unaware of them coming; it'll just be how your brain is for those weeks or months. With therapy and great effort one can learn to be more self-aware and deal with them better. Or not. It depends.

Medication kind of helps but only by turning you into a zombie, yet another inner reality to get used to. (this is for many though not all people ... medications WILL change you though and only maybe for the better ... this is a deep and controversial subject, however, though it is a favourite of mine). 

Oh - and aside from these wild reality changes that schizophrenia and bipolar can bring, we still get all those normal changes that everyone else gets which we looked at in the last column. Just like you, we can be grumpy, moody, giddy and all that stuff. In the case of bipolar, that might just get amped up several gazillion watts. You just never know. It's all kind of like having your mind run by a roulette wheel; who knows where the ball stops. It's important here now to understand just how different these changes in inner realities are from "normal" changes in reality. We're not talking changes due to feeling grumpy or happy or things like that. And you can have insight into those changes; you can tell "oh, I'm just crabby today. I'll feel better tomorrow". Not so with schizophrenia or bipolar. Lack of insight is a big part of these disorders (at least for the higher ends). So if, from the previous piece on reality, you thought your hold on it was tenuous, just imagine what it's like for schizophrenic or bipolar peeps!

This is not to sound negative, only to give some ideas as to the difficulties that those with schizophrenia and bipolar go through. Both these disorders literally take over a brain and make it something else, producing wildly different realities. But there is hope. That, however, is for another column. 

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