Saturday, November 9, 2013

Hopeless Problems, Perfect Answers in Bipolar Disorder

It's difficult to discuss depression because that word describes a whole spectrum of experiences. People often say, "I'm so depressed," when they mean they're disappointed, frustrated or sad. I got a 'C' on my midterm - I'm so depressed. Then there's the kind of depression that occurs with loss, what we might think of as part of the grieving process. Further along the spectrum and we have the clinical disorder with true symptoms of depression. While these various experiences have some features in common, they are very different psychological states of mind.

Many of my clients over the years have suffered from personality disorders, often with severe depressive features. At some unconscious level, they all felt as if they were so damaged that their psychic life was a catastrophe, a kind of post-apocalyptic wasteland, and there was no hope that anything could be done about it. When I was able to understand this and could articulate it to them, it brought a kind of relief: until then, that feeling of being damaged-beyond-repair was so agonizing as to be intolerable, impossible to acknowledge; the fact that we could think about it together made it seem a little less hopeless, at least for a moment.

Often when the hopelessness became unbearable, they'd take flight from it. One day, a client might come in so depressed he or she was practically mute; the next, giddy, talkative and full of optimism. They often made no mention of the prior depression, as if it were a thing of the past. A sudden industriousness had come over them and they began to tackle each and every item on their to-do list. They were going to do everything, change everything, conquer the world. When they were in this state of mind, I often had the feeling that they were keeping me at an emotional distance; if I said anything that called this new enthusiasm into question or tried to remind them of their recent depression, they could easily turn against me and the treatment, as if now I were the problem.

You probably recognize the dynamic - a kind of high-low functioning that characterizes bipolar disorder. Either everything is hopelessly damaged, beyond redemption, or life is wonderful! In mania, it's as if a kind of magic has occurred: the depression has abruptly and permanently vanished.

I believe a similar dynamic occurs in many people who would never receive a diagnosis of bipolar disorder or major depression, people who are occasionally depressed like many of us. The change isn't as dramatic and extreme, but often when the depression begins to lift, a kind of "magic" has occurred. Serial romantics demonstrate this the most clearly. You probably know someone like this, the one who's always falling in an out of love, on top of the world when in the throes of a new romance, in the depths of despair when the affair ends. These people aren't interested in having an authentic relationship, not with themselves or another person, but instead are using the romance drug as a magical cure for hopeless depression.

There are other kinds of "magic". A different job or career. Move to a new city! My next vacation! The variety of magical solutions is endless, but the problem they are meant to solve is always the same: a feeling of hopelessness, the conviction that one's internal world is in such bad shape that nothing can or ever will make it feel better.

Do you ever feel hopeless? What are your familiar magical solutions?

"Retail therapy" has become a familiar joke, a witty description that makes light of the dynamic. Many people turn to shopping as a way to cure a mood or state of mind which they feel can't be met head-on, can't be made better in any realistic way. Indiscriminate sex can be used for the same purpose. Gambling, alcohol, drugs - all the addictions may function in just this way, as a magical antidote to a problem felt to be hopeless.

What's your drug of choice? Next time you feel the "craving", see if you can resist and get closer to the feeling you want to escape. Is it unbearable? Does it feel hopeless?

One of my favorite theorists once said that many people in therapy refuse to suffer their experience - in the old sense of the word, to "submit" to it - and want to be free of it instead. As a psychotherapist, I believe you can't get rid of any part of your psyche; all you can do is try to develop other internal resources to cope with it. Try to stay with your experience, face it head-on and gain some small bit of understanding. If you can bear with it long enough, you may find your way to some imperfect, small but truly helpful way to make yourself feel a little better.

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