Posts Tagged ‘narcissism’
Bipolar Disorder: A Holistic Perspective
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.
I. Biological
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.
II. Psychological
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.
III. Social
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).
IV. Spiritual
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.
A Buddhist Perspective on Healing: Wisdom and Compassion
My immersion in Tibetan Buddhism has influenced my perspective on the healing process. The central tenets of Tibetan Buddhism are wisdom and compassion.
Wisdom in Healing
From a conventional point of view, phenomena are incontrovertibly how they appear. At this level, healing in psychotherapy includes the kinds of work that I have described in previous blogs and radio shows. It is essential to bring dissociated feelings and memories into conscious awareness. Doing so in the context of a caring psychotherapy relationship allows the “working through,” the integration and the release of these emotions. Mourning is central to this process: mourning for both what was wounding and for what was lacking in the patient’s early life.
Another key component of the healing process is working on the patient’s “shadow” side. Trauma propagates through identification with the aggressor. It is a painful, but vital, step to recognize one’s own propensity to hurt others.
From an ultimate point of view, all phenomena are inherently “empty.” I am not qualified to discuss the Buddha’s teachings. So, for our purposes, let me just say that healing is facilitated by the cultivation of the awareness that all of our perceptions, all of our experiences, are like a mirage, like an illusion. We all construct our own “psychic reality.”
This realization is very powerful. It gives us the freedom to construe the past from multiple vantage points. We can achieve release from an identity as a perennial victim of circumstances. We can develop the capacity for what Carolyn Myss has called “symbolic sight.” We can learn to “learn from our experience” (Wilfred Bion). We can develop the potential to do things differently, to experience transformation.
Viewing life as an open field, rather than as a constellation of solid figures, liberates us from fixity, from the unconscious compulsion to repeat the past.
Compassion In Healing
Compassion for others is the antidote for narcissism. Narcissism is the root of all suffering. When we fixate on an “I,” we experience ourselves as fundamentally disconnected, constricted, anxious and depressed. When we cultivate our compassion for others, we feel alive, related and infused with life energy.
Wisdom and compassion are inseparable, like the two wings of a bird. In conjunction with one another, they liberate us from suffering, allowing our spirits to take flight. The darkness of our delusions is dispelled. The radiance of our innate nature shines forth unimpeded. We are free.
Panic Disorder: The Absent Self
Panic disorder is a terrifying, potentially disabling condition. In my experience, it is a specific form of separation anxiety: separation from the self.
Richard was a 39 year old married man living with his wife and their two young children. He was a self employed businessman. He presented with an acute onset of panic attacks. These episodes had been occurring with increasing frequency, during the weeks prior to our first session.
Richard and I worked together in twice a week psychotherapy for a period of four years. His symptoms of panic disorder were relieved by high doses of antidepressant medication, during most of this time.
Early Life
Richard’s early life experience was powerfully influenced by his distant, critical, cynical father. The father, a successful professional, was rarely at home. Richard’s mother was comparatively more available to him. However, she was primarily focused on her husband. Moreover, she was largely preoccupied with her own painful feelings of isolation. As a result, Richard was on his own emotionally.
Polysubstance Abuse
Like Sophia in my previous blog posting, Richard turned to alcohol as a young man. He used alcohol as a way of deadening and escaping from his psychic pain. Some years later, he began regularly using cocaine.
When I met Richard, he was drinking 6-9 drinks per day, as well as the occasional bottle of wine. Despite this clearcut pattern of alcohol abuse and dependence, Richard was in complete denial about his alcoholism.
Themes in Therapy
The primary theme in Richard’s therapy was to draw his attention to his repetition compulsion. He abandoned his family and himself much as he had been abandoned. A recurring memory wove like a thread throughout the therapeutic work. Richard had been put out in the back yard whenever he had cried as an infant.
A key dream, to which we often returned, consisted of a brief exchange between Richard and his mother. In the dream, Richard told his mother, “I’m in pain.” To which she replied, “I’m in pain, too.” In other words, Richard was entirely excluded from his parents’ minds.
As a young unemployed adult, Richard literally went hungry. His wealthy parents withheld financial support.
As a mature adult, Richard abandoned his own family, through alcoholism and workaholism. He was absent to himself as well. He would often work for long stretches, without eating or sleeping. He was entirely out of touch with his emotional states. Alcohol and work were his psychic refuges of unconsciousness.
The Therapeutic Work
The initial therapeutic task was building Richard’s capacity for mindfulness regarding his own self states. This work began with developing his attention and appropriate responsiveness to basic bodily sensations, e.g. eating when hungry. This process of growing self awareness then extended to his emotional states. During the early phases of our work, Richard would compulsively play video games, when he was neither drunk nor working. Gradually, he learned to make space for his own psychic experience. He developed an increasing repertoire of healthy activities in synch with his emotional states.
The next major hurdle in therapy was overcoming Richard’s denial of his addictions. To put it briefly, this achievement was won as a result of a two year long intrapsychic and interpersonal tug-of-war. Once Richard joined AA and CA, our therapeutic work truly blossomed. The step work and the psychotherapy were mutually synergistic.
Within the context of the fourth step (“performing a searching and fearless moral inventory”), it became possible to draw Richard’s attention to his abandonment of his family. This was an extraordinarily painful phase of the work.
Another key component in Richard’s healing process involved helping him to recognize and to neutralize his own inner critic. This voice was a direct internalization of his critical father.
Finally, through a combination of the psychotherapy and the twelve step programs, Richard overcame his narcissism. He developed a genuine, growing capacity for concern for others. This transformation in his character was deeply moving for both of us. Our own relationship with each other was immeasurably enriched accordingly.
Outcome
Richard became clean and sober. His panic attacks resolved, off all medication.
His marriage dissolved. His business went bankrupt. His life, as he had known it, came crashing down around him.
Yet, paradoxically, Richard was happier and more grounded than he had ever been in his life. He had a greatly enhanced capacity for intimacy.
Once again, we encounter the archetype of death and rebirth: the phoenix rising from the ashes.
When I called Richard to request his permission to tell his story, he readily assented. “I tell my story all the time in the [12 step] meetings,” he said. “And, guess what? I’ve just celebrated my fifth year of sobriety.”
When I ponder the question of the meaning of life, I no longer have to search for an answer.