The Old Scale
I mentioned in The Art Of Seeing Depression chapter that we often talk about where we are on a scale. I mentioned the bottom half of a scale that goes from one to 10, but did not bring up that there are no real standards. People like to compare it to a scale for physical pain, and mention how one person’s 10 is another person’s seven. The same thing happens with spicy food; I usually order a seven or eight out of 10, but sometimes it is deadly hot and other times fairly mild.
The one to 10 scale is common among many support groups. When people check in and introduce themselves at a support group, or when they start a session with a doctor or therapist, they often indicate where they are on the scale. What I've learned from the workshops I've facilitated is that nobody really knows what this scale means.
The one through 10 scale may be common among many support groups, but there is not much sense in it. First of all, a five is not even half way. There are five levels above and only four below. Worse yet, nobody seems to know the difference between a four and a two.
One possible solution is to change the scale to zero at the middle, with plus one through five for mania and minus one through five for depression.
I think there are too many levels to differentiate, and prefer a scale of one through three. No matter which one you pick, the common misconception is that when you get to the deepest depression you will kill yourself, and when you get to the highest mania, everyone else will wish you were dead. 🙂
Depression and bipolar are very deadly. Forty percent of us sooner or later attempt suicide; 20 percent of us succeed. Some people attempt suicide when they get to minus two, others when they get to minus one. There isn't an exact place on the scale where it happens. It is different for every individual. We can’t assume that we know where on the scale any individual will be when a suicide attempt is made.
On the upper end of the scale, the common belief is that the further up we get, the less rational we become, and the more we start acting in a way that endangers ourselves and others.
The common conception is that the pain of depression is just progressively worse as you go down through four, three, two, and finally one, where you are at the greatest risk of suicide.
Out of fear that we will flip out and kill ourselves, we think that we need to stay at zero all the time. We can use drugs and therapy to keep us there, but we become bored. As far as we are concerned, we might as well be dead. We stop taking our medicine and end up flipping out, just as we feared.
The real problem is that we are trying to live an existence that has no ups or downs. If forced into a life that is boring, we are not going to stay on the program. It is not a life worth living. Staying at zero is not functional and will never satisfy us in the long run.
Another problem with the scale is that it has minus for depression and plus for mania. Why would we say mania is a plus? The reason that some people say mania is a plus, is they have never had to put up with someone who is out of control. Those of us who have been manic, or have had to put up with a manic person, know it can be a minus every bit as bad as depression.
Although the “thermometer-based” scale accounts for calling someone a hothead, it does not account for mixed states. In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and depression occur simultaneously: “for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage all at the same time.”10
To accommodate mixed states and the concepts I am going to build in this chapter, the chart ought to look more like the one below:
The New Scale
Everyone has normal highs and lows. At times, they can be perceived as a minus even for normal people. Many times, the actual characteristics are those of a mixed state, a little depressed and agitated at the same time. Our new scale accommodates the negatives associated with any normal range of experience. Those with bipolar or depression live in fear of these normal highs and lows, but without the range of experiences that fit in area 1 on the chart, life is not worth living.
At least once in life, everyone will experience the range of mood in the two area. It includes hypomania and situational depression. Mild hypomania is felt when we cram for an exam, or are so excited about tomorrow that we can’t sleep. Situational depression is when something happens to us that causes us pain.
Situational depression is usually caused by the loss of a loved one or something that has meaning, but can be triggered by any event. When we get to that level, the details are consistent for almost everyone. We should open our eyes and try to understand it. It is the same for so many people that we can all describe it clearly, as I did in The Art Of Seeing Depression chapter.
If you view the white areas as the range of “normal” people, it illustrates that they experience the more extreme states less often, and for a finite length of time. Bipolar and depressed people get there all the time. Sometimes, it is just the beginning of a slide into clinical depression or mania.
There is another state that “normal” people never experience or fully understand. This other state includes clinical depression and real mania. Area three is for those extreme states.
It is so much more extreme, that people who have only experienced situational depression have no idea what it is like. As explained in The Art of Seeing Depression chapter, this is not a matter of degree, it is a difference in kind.
There are very clear, and very painful aspects to clinical depression. It has four components: physical, mental, emotional, and spiritual. They are described in the chapter Is My Experience Valid? and in the following chapters on the lives of the saints.
It is unfortunate that so many people with clinical depression have to experience this state with so little real understanding.
We begin to gain control when we start on a program of drugs and therapy. The drugs calm us down in a major way. They help us to find a range we can function in. Unfortunately, some doctors over-medicate and we are stuck at zero where life is not worth living. But that isn’t the goal. The goal is to stop the worst of it from happening.
Therapy helps us reach a point called Acceptance. Until we accept our condition, there is nothing we can do; we are in denial. Some people say, "There's nothing wrong with me. I don't need medication. I'm going to take care of it myself. I've got it all handled." That is delusion. It is an attitude that will not get you anywhere. Acceptance is the first step we must take before we can make any progress.
Our therapists and clergy help us to begin Introspection. As we pay closer attention to our thoughts, actions, and spiritual lives, we start to understand what is happening.
Once we begin to see ourselves the way others see us, we realize that we can take Action; there are very concrete things that we can do to change ourselves. We can take our medication, follow the advice of our therapists, change our diet, exercise, adjust our sleep patterns, and do all kinds of things that will help us to gain control. I outline some of them later in this book. Once we take action, we find it is easier to stay in control with lower dosages of medication and less dependence on therapy.
At first, I had to go to the doctor every day and take massive doses of lithium. It wasn’t long before I only went once a week, then once a month, and finally, once every few months. Now, I see therapy and drugs as a small part of my program. I'm also taking action.
We eventually develop Awareness of how we react to things and the choices that we can make. This leads directly to stability because we have less fear and less panic about staying in a narrow range. This is the beginning of realizing what The Depression Advantage is all about.
When we come to awareness, we understand what's going on, and everything changes. We start to realize that everyone goes into normal highs and lows, and they are not necessarily all bad. Yes, highs and lows have their bad points, but they also have their good points. A mature view of the normal experience of life is that nothing is all bad or all good. It’s a combination: there are good things to learn even from our low points. They make us stronger, inspire us to introspect, and help us realize what has meaning to us.
The same can be said for hypomania and situational depression. It seems at first that getting into a situational depression is nothing but horrible. However, if you introspect enough, and you actually start looking for it, you see that great good can come from even our worst experiences.
We are able to help other people. We are able to understand other people's circumstances; We empathize better. Going through those experiences ourselves makes us stronger and better people, once we see how to learn from them. It is possible for everyone who has these experiences to see them for what they are: a combination of good and bad. Those of us with mental conditions have more opportunities to learn from our experiences and grow to become better people.
In a book called The Depression Advantage, one might hope that this page would include an easy answer. We explored the negatives of all the stages and came up with reasonable approaches to the easy stuff, but this is where the challenge is. How can anyone see an advantage to the worst states?
I've been to the hell of clinical depression many times and could not see any good in it. Just like on the negative side, the intensity of clinical depression is such that those who have not been there may never fully understand. As I mentioned in The Art of Seeing Depression chapter, we have to change our way of “seeing” to begin to notice what has been there all along.
When I started looking at it like James Turrell would, and tried to see in that darkness, I started realizing that it wasn't all pain. There are insights that I could have only learned by being there. Those insights are at the core of The Depression Advantage.
To everyone else, changing our behavior is the only thing that matters. Depression and pain are the strongest catalysts there are for creating behavioral change. They have helped me to fundamentally change the way I treat other people.
As you read about the lives of saints later in this book, you will find that I am not alone in my belief. Many saints have said that it was the intensity of extreme pain that helped them to see everything differently. They too credit pain with causing their behavioral changes.
A New Paradigm
The old paradigm of mental illness will never get us to the advantage. Looking at only the negative side of anything will never give you the real picture. When seeing your condition from only the negative, it is understandable how you could conclude that life is hopeless, and settle for a diminished life. The paradigm is not only false, it affects everything you do and keeps you from ever leading a better life.
The new paradigm is about seeing the whole picture. Only by looking at both the bad and good of our condition, can we see what is possible. There is no denying that the bipolar or depressive condition has horrible down sides, but until you accept the possibility of seeing the good, you are condemned to a hell with no possibility of parole.
It is a four sided thing we're talking about. There are physical, mental, emotional, and spiritual components. It is a much more complex picture than most people would believe. When we start to see the complexity of it, we start to realize that the life of a normal person is missing a lot of opportunities. Is it a bad or a good thing that we have depression? It depends on how we react to it.
Although I have been familiar with the lives of many saints for a long time, it was not until I started to see the good in depression that I saw how it was central to the lives of so many of them. I began to realize that Saint Francis and Saint Theresa talked about the same things. Saint John of the Cross wrote a book called The Dark Night of the Soul11about how depression is a path to enlightenment. The painful times in their lives changed them fundamentally.
Saint Francis hung out with his friends, partying all night. When he faced depression, there was something about it that fundamentally changed his life. He became a person who people revere and an example we should all strive to follow.
What is it that made his experience a transformation, yet does not have the same effect on all of us? It's not that he was born that way. He chose to look at his experience and find profound meaning in it. Why can't we? If that is possible, don't we have the opportunity to grow from our experiences? Is there something from these experiences that we can learn from? Is it all bad? Or, is there the possibility that we can learn something that has real meaning and can make a difference in our lives?
It is not the situations that make us who we are; it is how we choose to react to those situations. Saints became saints because of the way they reacted to the challenges in their lives. They kept trying to change, learn, and improve.
I think mental conditions - and personally, I refuse to call them an illness anymore - have the opportunity to teach us things that other people will never experience. It is the best opportunity of our lives. It is so rich, that when I look at my opportunities to live in that world, versus the narrowly defined world of a so-called “normal” person, I choose the hardships of my life every time. Yes, it has its hells, but it also has its heavens.
Footnotes:10 http://en.wikipedia.org/wiki/Bipolar_disorder#Mixed_state
11 The Dark Night of the Soul, translated by E. Allison Peers, 1990 Random House, New York
Comments are closed.