Posts Tagged ‘affect regulation’
Do you experience major mood swings? In this blog posting, you will gain new perspectives on your condition. As well, you will learn about treatment approaches and coping strategies.
I will share some thoughts with you regarding bipolar disorder from four vantage points: biological, psychological, social and spiritual.
Heredity plays a major role in the transmission of bipolar disorder. Although there is much speculation, the biological basis for this condition is not known. Extensive genetic research is being pursued, in an attempt to identify the mechanisms that render an individual vulnerable to this disorder.
Lithium remains the first line medication for classic bipolar disorder, also known as Bipolar I. This condition is characterized by full blown manic episodes, with or without alternating major depressive episodes. Other forms of bipolar disorder, including Bipolar II (major depressive episodes, alternating with period of hypomania), and rapid cycling bipolar disorder are best treated with an anticonvulsant mood stabilizer, such as Lamictal (lamotrigine). Hypomania is a less severe form of mania.
Bipolar depression usually requires the addition of an antidepressant medication. Extreme mood states can trigger psychotic symptoms, a break with reality. In this case, an antipsychotic medication, e.g. Abilify (aripiprazole), may be necessary.
From a psychological point of view, bipolar disorder may be viewed as a decreased capacity to regulate emotional states. Affective self regulation is impaired in people with certain personality structures. Narcissism is characterized by unstable oscillations between grandiosity and insecurity. Borderline personalities experience and manifest rapidly shifting, intense affective states.
These personality traits may often be traced back to early childhood experience. Phyllis Greenacre, a child psychoanalyst, wrote that “the infant is seen in the beam of the maternal pathology.” Some mothers are prone to have a split perception of their children. Such mothers (often themselves borderline personalities) will alternately idealize and devalue their children. These children, in turn, will tend to internalize a correspondingly split view of themselves. With the idealization, euphoria and grandiosity may ensue. Devaluation of the self will likely manifest as depression.
In a depth psychologically oriented therapy, the therapist takes on the role of a symbolic parent, whose function is to serve as an accurate mirror of the patient’s personality. Tensions and contradictory aspects of the patient’s psyche can be accurately reflected and articulated, without splitting. This process promotes the integration of the personality, and the stabilization of mood states.
A cognitive behavioral therapeutic approach would help the patient to monitor closely her own thoughts, or self-talk. The patient learns to catch and to correct those thoughts that are either excessively idealizing or devaluing of the self. Since thoughts are triggers for feeling states, thought correction will tend to minimize excessive mood swings.
Unstable, labile mood states make it extremely difficult to function at work, or to maintain relationships.
Getting help with mood stabilization in a social context is vitally important. Try seeking feedback from a significant person in your life regarding your behavior, as well as their perceptions of your mood states. This kind of objective feedback from a trusted friend or family member can greatly help you to become more self aware.
Support groups, and group psychotherapy, can serve a similar function. A good resource for finding such groups in your area is the Depression and Bipolar Alliance (http://dbsalliance.org).
There is a Buddhist image of viewing yourself as the host, and your emotions as your guests. Achieving this perspective will powerfully help you to stay grounded, even in the face of intense oscillating mood states.
Drawing strength from all of these internal and external resources will help you to achieve a level of integration and self awareness that you may never have attained, in the absence of a mood disorder.
Dissociation refers to the splitting off of painful experience from awareness. Dissociation is the hallmark of trauma. A child experiences abuse or neglect as an unbearable catastrophe. Dissociation is the psychic defense of last resort. Unable to cope or to flee, the child simple “spaces out.” People sometimes refer to this state as “going out of body.”
In the context of the original traumatic situation, this defense preserves the child’s sanity. Unfortunately, dissociation tends to persist as the primary mode of psychic functioning throughout the lifetime of the individual. Such people have great difficulty in knowing or communicating what they are feeling. These deficits lead to an impoverishment of the person’s emotional life. Such people tend to experience themselves as ephemeral, or insubstantial. They usually have great difficulty in achieving or sustaining intimacy in their relationships.
There has been speculation regarding both biological and psychological causes of dissociation. From a neurologic standpoint, studies have shown a decreased corpus callosum in traumatized people. The corpus callosum connects the two hemispheres of the brain. The right hemisphere processes emotional experience. The left hemisphere includes the language region of the brain, in most people. A constricted connection between the two hemispheres could result in a limited capacity for recognizing and articulating emotional states.
From a psychological point of view, Joyce McDougall, a French psychoanalyst, believes that dissociation is the effect of exposure to overwhelming emotion that threatens to attack an individual’s sense of integrity and identity.
Within a developmental context, a child acquires the capacity for emotional experience, regulation and expression, through the parent’s capacity for attunement to the child’s emotional state. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can impair the child’s capacity to experience his own emotional states.
Psychotherapy offers a reparative experience for a person suffering from dissociation. Suffering is actually a misleading term. Many dissociated people are unaware of their own dissociation. Often, such a person seeks psychotherapy due to a spouse’s frustration with them.
Working with a profoundly dissociated person in psychotherapy is challenging. The engine for psyche change is psychic distress. If the distress itself is dissociated, there may be minimal motivation to engage in psychological work. Moreover, it is difficult to establish an emotional connection of any depth with a dissociated person.
Often a starting point involves gradually drawing the person’s attention to her state of dissociation. The therapeutic process is one of symbolically reparenting the child. The therapist, unlike the actual parent, is able to register and to articulate her patient’s emotional states. Through repeated interactions in which the therapist is able to service this function accurately, the patient gradually internalizes the process. As she incrementally acquires the capacity to recognize what she is feeling, the therapy gains traction.
As a person develops increasing awareness of his own emotional states, both present and past experiences come to life. It becomes possible to narrate, to process and to release the previously frozen residue of early trauma. As parts of the self that had been dissociated become available for integration, the personality becomes richer, more complex, more textured and more vibrant.
Dissociation makes people feel like ghosts or robots. Experience has an “as if” quality. Integration of a full range of feelings gives rise to a robust, embodied passion for life.
As Walt Whitman wrote in “Song of Myself”:
“Urge and urge and urge,
Always the procreant urge of the world.”