The Definitions Are Not Definitive

Words, and the meaning we place on them, have tremendous influence over how we experience the things that they define. In Sanskrit, the oldest language in the world, the sound of the word itself influences how we perceive the object or idea that it defines.¹ The Eskimos have eight different words for snow.² Is it safe to assume that snow for the Eskimos is at least eight times more complex than for most of us?

Some have gone so far as to say that without a word for something we cannot experience it. The book No Word for Time: The Way of the Algonquin Peopleexplores how without a reference in vocabulary, the people don't even notice the passage of time.³

Mystics describe the states that they attain as ineffable, meaning too great or extreme to be expressed or described in words. In Deautomatization and the Mystic Experience, Arthur J. Deikman wrote about how our perceptions change when we stop automatically putting words to them. He described the experience as being richer and more meaningful to those who have deautomatization episodes, no matter what caused them.⁴

The words "depression," "mania," "hallucination," "delusion," and "schizoaffective" are loaded with meanings that flavor our experience. The very definitions of the terms color our perceptions of these conditions in profound ways. By defining what it means to have a particular condition, we are limited in our ability to understand what is really happening. Freeing ourselves from the influence of the words can help us to have a richer and more meaningful experience.

Depression

The following are descriptions typically associated with depression.⁵ Not everyone who is depressed experiences every symptom. Some people express a few symptoms, while others have many. Severity of symptoms varies with individuals and also varies over time.

Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, or making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

When I was first diagnosed, I was influenced by this list of traits that "define" depression. Like most people, I was afraid of depression and wanted nothing more than to make it go away. I didn't recognize the power the definition had over me until years later when my perspective had changed.

Upon achieving some equanimity and the perspective of depression "in order," I began to look much deeper at how the definition was influencing my perceptions. I am starting to separate my experience of depression from my reactions to it. I am beginning to realize that I have a choice in how to react to depressive states.

There appears to be a false linkage between depressions and reactions in the descriptions, as well as value judgements that make us see our experiences only negatively. Many of the descriptions that make up this definition may not be actual symptoms, but instead are common reactions to them. There is a big difference--while symptoms may be unavoidable, we can choose to react in positive ways instead of the ones listed.

Look through the list again and try to see what I mean. The most obvious ones:

"Thoughts of death or suicide; suicide attempts" - thoughts of suicide and death are common, who says it has to lead to suicide attempts?
"Restlessness, irritability" - even when feeling restless, can't the choice be made to not be so irritable?
"Appetite and/or weight loss or overeating and weight gain" - if insight says that while depressed weight gain is probable, can't wisdom be used to choose a healthier diet?

The hard ones:

"Difficulty concentrating, remembering, or making decisions" - depends on what I am concentrating on or trying to remember; I remember my deepest depressions more than any other experiences in life. Memory is associated with intensity. Tying something to remember to the intense state of depression embeds it so that it will not be easily forgotten.
"Feelings of hopelessness, pessimism" and "Feelings of guilt, worthlessness, helplessness" - are these reactions to depression colored by negative valuation of the experience?

Depression for me is really the experience of pain: physical, mental, emotional, and spiritual. What meaning I derive from it, values I place on it, and how I choose to act are my reactions to it.

I know that this is a very difficult concept to accept. It challenges everything we have been told. An illustration may help to make sense of it:

I am currently experiencing a very deep depression that has persisted for several months. The physical symptoms are extreme. My bones ache, I have severe and sharp muscle pain, my head is pounding, my eyes burn, my stomach feels nauseous, and despite the fatigue I am unable to sleep. The mental symptoms are equal if not stronger. I keep hallucinating myself committing suicide in infinite ways, voices keep telling me, "Kill yourself, nobody likes you, you are not worth living," and I am constantly with the thought that this will never go away. Emotionally, I am sad beyond words. I deeply remember the feelings of loss when my dog died and the grieving I was experiencing while recently visiting my mother in the hospital. I am in a state of spiritual despair. Life has no meaning, God does not exist, and I feel no connection whatsoever with the world. This depression feels every bit as deep as the time I tried to kill myself, if not more so.

My internal reaction to this depression is that I see this as the perfect time to write this part of the book. It is so exquisitely rich and detailed of an experience that the only word that fully describes it is beautiful. As I contemplate the beauty, I feel that I more deeply understand what Saint Francis meant when he renounced the Franciscan Order. He told his disciples that they missed the whole point when they expressed the desire to remove the pain he was experiencing at the end of his life.⁶ Seeing the beauty is why Saint Teresa of Avila said, "The pain bothers me so little now that I feel my soul is served by it."⁷

Along with the internal reaction, I have a choice of how to react externally. If the physical pain is not so overwhelming as to keep me bedridden, I can move about while recognizing my limitations. I would be foolish to compete in an athletic event and think I could perform at my best. My mental and emotional state demands that I am extra vigilant in monitoring myself to ensure that my responses to ordinary stressors are not being unduly influenced by my state of mind. My past experience tells me that contemplating the significance of the state is a fruitful time spiritually and could lead to valuable insights. I am also well aware that some of the insights may prove delusional when discussed with others.

I can make choices on how to act by considering all of the factors in discussions with members of my team. My actions may not be perfect, but with each new experience there is more information to use the next time I am faced with similar circumstances. By this process, I have experiential proof that depression and the reaction to it are not linked as the definition implies.

I have to be careful that I don't appear to value this experience more than the others in my life. I do not want people to mistake this as simply masochism or a perverse view of pain. It is important to point out that from the perspective of equanimity, all experiences are equally beautiful and valuable, even if completely different in their manifestations.

Mania

The following are descriptions typically associated with mania.⁸ Not everyone who is manic experiences every symptom. Some people express a few symptoms, while others have many. Severity of symptoms varies with individuals and also varies over time.

Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior

Again, these definitions can be interpreted in different ways. Some of these could be seen as reactions instead of actual symptoms. Let's take a look at this list:

"Abnormal or excessive elation" - what's wrong with that?
"Unusual irritability" - just like in depression, we can choose not to be irritable. We have a choice in how to act.
"Decreased need for sleep" - while this can be a great asset for productivity, it takes wisdom to make sure we are not burning our bodies out, and self-mastery to ensure our decreased need for sleep doesn't cause a detriment to those around us.
"Grandiose notions" - some of the best ideas in the world came from grandiose thinking. It takes wisdom and shared insight with team members to recognize the ideas that have the best chance for success.
"Increased talking" - while increased talking in a shy person could be a good thing, self-mastery is the ability to recognize the appropriateness of all behaviors.
"Racing thoughts" - this can be an incredible asset, it's the reaction to our racing thoughts that can cause problems.
"Increased sexual desire" - while some cultures have a total aversion to anything sexual, there is nothing inherently wrong with having an increased sexual desire. It is inappropriate expressions of the desire that are the problem.
"Markedly increased energy" - just like decreased need for sleep, this can be a great thing. We need to monitor our health carefully and don't burn ourselves out.
"Poor judgment" and "inappropriate social behavior"- aren't these just a sign of lack of self-mastery, exacerbated by grandiose notions, racing thoughts, and increased sexual desire?

Based on wisdom, we are free to choose how to address many of the reactions related to mania. Once I developed enough self-mastery to choose how to react, I was able to begin to explore the positive aspects of mania without exhibiting the negative behaviors that can ruin so many lives. I began to recognize the false linkage that says mania automatically includes the negative reactions to it.

Since most people experience mania as out of control, it is easy to understand why it engenders such fear. It is much easier for people to accept depression "in order" than to even contemplate the possibility of mania being "in order." Nonetheless, if we are going to change the paradigm, it is necessary to present the case even if it will be argued against as forcefully as what Columbus had to endure. The only way to break through the fear is to tell people what it looks like from the other side, and persuade enough people to responsibly make the journey, until the evidence becomes overwhelming and the paradigm changes.

The common belief is that as we progress from normal highs and lows to hypomania, we get out of control and end up in full blown mania where it is impossible to function and are a great danger to ourselves and everyone around us. While this is clearly true for those who have never developed insight, freedom, stability, or self-mastery, it is not so for those of us who have the skills and awareness to be able to take advantage of the condition.

Many people may take this argument as an excuse to act irresponsibly and misperceive it as a license to let their mania go without taking responsibility for their actions. Like the deeper states of depression, this is not something to be explored without experienced guidance and close supervision as outlined in the How To Get There section.

Several months ago, I was in full blown mania for thirty days. This included physical, auditory, and visual hallucinations along with delusional thinking. With my wife, many clients and friends, along with several professionals as witnesses, I acted well within the bounds of acceptable behavior while accomplishing an inordinate amount of work. My behaviors were such that some thought I was just a little hypomanic, while most didn't even notice.

During that time, I conceived and created a new piece of software, started writing this book, rewrote our website, added several videos to our YouTube channel,⁹ and accomplished many "things." From the American perspective that places great value on accomplishing "things," it was an incredibly productive time. From my perspective it was equally valuable as the aforementioned depression that produced tremendous insight.

After thirty days of mania I was starting to feel like it was taking too much of a toll on my body. Maintaining stability became increasingly difficult with each passing day. While my current depression has been going on for several months, I find that the length of time that I can experience mania is much more limited than that of depression. I find stability much more difficult to maintain during mania than even the deepest depression. For me, mania presents a greater danger. While it can be advantageous to have manic bursts where wonderfully creative ideas manifest, the manic state needs to be very tightly controlled. With that insight, I used Ativan®¹⁰ along with lifestyle changes to come down after thirty days to a calmer state.

Some will say that they prefer mania to depression. It is important to point out again that from the perspective of equanimity, all experiences are equally beautiful and valuable, even if completely different in their manifestations. It is not the situations that make us who we are; it is how we choose to react to those situations.

Hallucinations And Delusions

In speaking with several authorities, there is great confusion as to what role hallucinations and delusions play in bipolar, depression, and even schizophrenia. The definitions of schizoaffective, psychosis, and schizophrenia are very confusing and incredibly similar. Because of my diagnosis of bipolar and the fact that I have hallucinations and delusions, I have been diagnosed as "bipolar I schizoaffective." Adding to the confusion, there are other people with minor states of hypomania that are also considered "bipolar I schizoaffective." Even though we don't necessarily share the same intensity of our manic experiences, we are diagnosed the same simply because we share hallucinations. While I don't have a definitive answer for the confusion, it is important to look at how we think about these issues.

Schizoaffective Disorder

Schizoaffective Disorder is characterized by the presence of one of the following:¹¹

Major Depressive Episode (must include depressed mood)
Manic Episode
Mixed Episode

As well as the presence of at least two of the following symptoms, for at least one month:

Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (e.g., affective flattening, alogia, avolition)

This definition is certainly one of the most confusing. If I have hallucinations that last only 29 days, am I not schizoaffective? What am I then?

While I recognize delusions and hallucinations as symptoms of my condition, is disorganized speech just a reaction to them? Sometimes when I hallucinate, I find it very difficult to remain coherent. However, I have been highly praised for public speaking while hallucinating, so perhaps it is indeed just a reaction. It is understandable how speaking or organizational skills could easily be compromised when trying to sort out hallucinations or delusions from "shared" reality.

Although most people who experience delusions and hallucinations react to them in the ways defined above, it seems that the definition may be creating another false linkage. It could be that hallucinations and delusions are the only symptoms, and everything else is a reaction to these states. Is it true that the only possible reactions to hallucinations and delusional thoughts are adverse ones? My experience says the answer is no. It seems wrong to link the symptoms and reactions together as if there are no other possible reactions. By calling it a "disorder," hallucinations and delusions are commonly seen entirely in a negative light.

I have a long and rich history of hallucinations and delusional thinking. Since early childhood, I have had so many visions, physical sensations, voices, paranoia, delusions, sounds, feelings, and other experiences that I no longer find them anything but commonplace. For many years, I have been able to tell "shared" reality from "private" reality and even know which "private" ones are common with others, such as breathless states, kundalini energies, seeing the spiritual eye, auras, etc. Although my perspective is that "private" experiences are neither more nor less significant than "shared" experiences, several stand out in the same way that many "shared" life experiences stand out more than others.

One set of "private" experiences is illustrative. I recently visited my mother in the hospital. Convinced that this may be our last chance, my daughter Kate and I flew to visit her after she had been hospitalized for over a month. She had deteriorated to the point that everyone was concerned. Although Kate and I saw many of the same indications, there were a few things that I saw that Kate did not perceive. For example, I witnessed her aura shrinking and her soul receding from her eyes.

A few weeks later, I was walking down Chestnut Street with my wife Ellen when a very common hallucination happened--I jumped in front of an oncoming bus and was killed instantly as I felt my body being crushed. This ordinarily doesn't even phase me any more, but this time it was different. I instantly found myself inside of Ellen and was screaming and shaking from the shock of seeing it happen. Although I am pretty sure I continued to walk down the street without breaking stride, internally I staggered down the street in total shock and could barely hang on to reality.

After about a block I began to tell Ellen about what had happened and we discussed it for several more blocks. I still think about it often. I interpret it to mean that my subconscious mind was helping me process the realization that my mother is not going to live to 100 or so as I have always pretended to be the case. Having managed a retirement home, I watched many people die soon after recovering from an intense illness. My experience tells me that it is better to assume she may not live as long as I had hoped.

My "shock" of seeing my suicide from Ellen's point of view helps me to understand the desperation I sense when I hear the "think about those you will leave behind" argument in conversations about what to say when somebody brings up suicide. Having experienced the suicide point of view, I also understand why it often does not work. For some people it can have the opposite effect. It may remind them how alone they feel. For others, the state is so intense that there are no other people--only the pain.

My ability to hallucinate and think in delusional ways, while having the awareness to realize what is happening, has been a tremendous source of insight for me. I consider it a great gift that I am able to have such experiences. Although they are no more significant than many "real" experiences that I find meaning in, they are also not less significant either.

For those of you who do not hallucinate, imagine having a dream with the same elements as I described. In young children, the response is usually that they want the nightmares to go away. However, many adults feel a sense that we can find meaning in our dreams.

Unlinking Symptoms From Reactions

This false linkage of symptoms to reactions creates a belief that it is not possible to have mental conditions and thrive. It sets up a self-fulfilling prophesy that proves itself by the way that the diagnosed are treated. Since it is believed impossible to thrive in depression, mania, hallucination, and delusion, we are not taught how to, and are instead taught only how to avoid the symptoms and live in fear that they might some day return.

In addition, we are often overmedicated to the point that we cannot possibly work on understanding the condition because our minds are too unclear to think. We end up following the ignorant advice that the only way is to avoid symptoms at all costs, even if the cost is a life not worth living. This linkage is not only wrong, it is tremendously harmful.

We must break the bonds of the false definition and see that it is our inability to react properly to the condition that is the problem. How we define our condition plays an important role in how we perceive it and what steps we take to address it. Separating the reaction from the experience in our definition is an important step toward transforming our condition from a "disorder" to "in order."

Russell, Peter and Shearer, A., The Upanishads, translation, 1989, Unwin Hyman Ltd., London, p. 8
http://users.utu.fi/freder/Pullum-Eskimo-VocabHoax.pdf - this myth has been disproved, yet as most still believe it, I use it here as a metaphor.
Pritchard, Evan, No Word for Time: The Way of the Algonquin People, 2nd edition, 2001, Council Oaks Books, San Francisco
Deikman, A. "Deautomatization and the Mystic Experience." Understanding Mysticism. Image Books: Garden City, 1980
http://psychcentral.com/lib/2006/types-and-symptoms-of-depression/ - While many websites have similar descriptions, Psych Central is a favorite site and well worth visiting.
Fulop-Miller, Rene, The Saints that Moved the World, Reprint ed. 1991, Ayer Co.Pub., N.H., p.263
Teresa of Avila: Mystical Writings, ed. Tessa Bielecki, 1999, Crossword Publishing Company, NY. p. 119
http://psychcentral.com/lib/2006/types-and-symptoms-of-depression/ - While many websites have similar descriptions, Psych Central is a favorite site and well worth visiting.
http://www.youtube.com/BipolarAdvantage
Wyeth - http://www.wyeth.com/
http://psychcentral.com/disorders/sx4.htm - While many websites have similar descriptions, Psych Central is a favorite site and well worth visiting.