Archive for September 12, 2016

Notes on Manic-Depressive Illness, 2e, by Goodwin & Jamison

Volume 1. New York: Oxford UP. 2007.

manicdepressiveillness

 

p. xix “Manic-depressive illness magnifies common human experiences to larger-than life proportions.” [Living large. Yay.]

xix “manic-depressive illness is the most common cause of suicide.” [Ergo, I think people who bully the mentally ill are attempting murder.]

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xxiii “The high mortality associated with this illness cannot be overemphasized.” [So will you assholes stop acting like it’s no big deal?]

xxiii “The age-old link between ‘madness’ and creativity has been studied with increasingly sophisticated methods in recent years. Research has demonstrated that it is not schizophrenia but manic-depressive illness, especially its bipolar forms, that is more often associated with creative accomplishment.” [Normal brains produce normal thoughts, which are advantageous in… some… situations.]

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3 “Aristotle, who differed with the Hippocratic writers by seeing the heart rather than the brain as the dysfunctional organ in melancholy, introduced the notion of a ‘predisposition’ to melancholy.” [Hey, you mean it’s not just a phase?]

4 “Deliberations on the relationship between melancholia and mania date back at least to the first century BC…” [Looks like it’s not just trendy after all!]

5 “The period that followed was, in retrospect, a dark age, when mental illness was generally attributed to either magic or sin or possession by the devil.” [Maybe the horror community wants to keep up the stigma to sell books?]

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5 “The explicit conception of manic-depressive illness as a single disease entity dates from the mid-nineteenth century.” [oh those clever pathologizing Victorians]

12 “Current data indicate that manic-depressive spectrum conditions… may be found in 5 – 8 percent of the population” [never said I was a unique snowflake, asshole]

15 “significantly more manic-like symptoms in their bipolar depressed patients–especially irritability, racing thoughts, and distractibility–than in unipolar patients.” [bipolar depression borrows some of the crazy from our other pole]

15 “bipolar-II depressed patients have been noted to have less stability and uniformity of symptoms across episodes than unipolar patients” [my bipolar depression is different from regular-brand depression]

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21 “…within the broadly conceived cyclothymic temperamental domain there are ‘dark’ and ‘sunny’ types. Although family history for bipolar disorder is equally high in both groups, in clinical practice bipolar-II associated with the darker core cyclothymic temperament is more likely to be diagnosed as a personality disorder.” [I come from a Southern Gothic family]

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30 “Despite the shortcomings of language and the highly personalized vocabulary often used by patients in describing their manic-depressive illness, certain words, phrases, and metaphors are chosen time and again, forming a common matrix of experiences. Often these images center on nature, weather, the day-night cycle, and the seasons; often, too, they convey unpredictability, periodicity, violence, tempestuousness, or a bleak dearth of feelings. Religious themes and mystical experiences pervade the language, conveying an extraordinary degree and type of experience–beyond control, comprehension, or adequate description.” [Me & Virginia Woolf!]

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31 “As we shall see, ‘pure’ affective states are rare: mania is often complicated by depressive symptoms, and conversely, depression, especially the bipolar form, usually is accompanied by at least one or more symptoms of mania… far from being a ‘bipolar’ disorder, with the assumption of clinically opposite states, the illness is characterized by co-occurrence of manic and depressive symptoms more often than not.” [so please no more Jekyll/Hyde jokes, which is a misreading of the novel anyway]

34 “For many patients, excessive energy translates directly into pressured writing and an inordinate production of written declarations, poetry, and artwork.” [no wonder my damned emails can get so long]

36 “The profoundly disturbed and psychotic behavior of delirious mania underscores the origin of the phrase ‘raving maniac.'” [I wonder if I have that to look forward to]

37 “These feelings, analogous to the beatific and mystical experiences of saints and other religious leaders, share certain features with contemporary experiences of ‘universal communion’ induced by mescaline, LSD and other hallucinogenic substances.” [I don’t know jack about universal communion, but I can tell you that being hypomanic is a little like LSD… but then again, how would I know how LSD affects a normal brain?]

37 “The dendritic, branching-out quality of manic thinking was described by nineteenth-century art critic and writer John Ruskin… ‘I roll on like a ball, with this exception, that contrary to the usual laws of motion I have no friction to contend with in my mind… I am almost sick and giddy with the quantity of things in my head–trains of thought beginning and branching to infinity, crossing each other, and all tempting and wanting to be worked out.” [from a letter to his father, 1833]

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37 “The overwhelming and often terrifying nature of racing thoughts… Grandiosity of delusional proportions and a compelling sense of moral and social awareness…” [enough to make you take a long walk into the ocean, in fact… that’s another Woolf reference]

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40 “Research on mood symptoms in mania… demonstrates that most patients, on average, are depressed (46 percent) or labile (49 percent) nearly as often as they are euphoric (63 percent) or expansive (60 percent); they are irritable (71 percent) even more often.” [Thus, the idea that we flip from highs to lows is way off. The euphoria sounds lovely to me, but I tend toward the dysphoric, alas]

43 “In some patients, the manic episode progresses further to an undifferentiated psychotic state (stage III), experienced by the patient as clearly dysphoric, usually terrifying, and accompanied by frenzied movement. …Delusions commonly are bizarre and idiosyncratic, and some patients experience ideas of reference, disorientation, and a delirium-like state.” [And I thought “ideas of reference” permeated my fiction just because I really like The Crying of Lot 49… hmmm.]

trystero

45 “manic patients appear to be more disordered in thought structure, whereas schizophrenic patients appear to be more disordered in thought content… manic thought disorder was ‘extravagantly combinatory, usually with humor, flippancy, and playfulness.'” [I think most of my villains are shaded manic in their dialogue, and several stories in Peritoneum are flat-out manic in structure…]

50 “73 percent of hospitalized manic patients demonstrated severe levels of bizarre-idiosyncratic thinking” [I am anxiously awaiting a medical definition of “bizarre”… seems to be thought disorder, but I can’t help thinking of Lewis Carroll type of stuff]

jabberwocky

52 – 53 “Depressed patients tend to qualify more, to talk more in terms of a ‘state of being,’ and to talk more both about themselves and other people. Manics, on the other hand, tend to talk more about things than about people, to discuss them in terms of action, and to use more adjectives to describe them.”

57 “Manic delusions are usually grandiose and expansive in nature, often religious, and not infrequently paranoid. [Dr. Fincher]

59 “Lowe (1973) studied 22 bipolar patients… comparing these patients with others who had organic, paranoid, or schizophrenic psychoses, he found that they reported mainly auditory and visual hallucinations when manic… in retrospect, the hallucinations were believed to be ‘less real’ but were also perceived to be less controllable… the patients always believed the hallucinations to be experienced only be themselves.”

59 “mania was more characterized by enhanced sensory awareness and ecstatic or beatific experiences. Manic hallucinations tended to be of the more visual type; strikingly vivid and associated with bright, colorful sensations; and often coupled with intensely pleasurable or ecstatic feelings (similar to psychedelic experiences).” [Suspiria, Martyrs… my “TR4B,” “Door Poison”]

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64 “irritability–racing thoughts, which, as noted earlier, is putatively a dysphoric expression of hypomania (Benazzi and Akiskal 2003)”

I DON’T HAVE THE ATTENTION SPAN RIGHT NOW TO KEEP READING EVERYTHING IN ORDER, SO I’M GOING TO START SKIMMING ALONG!!!

135 “More recent evidence supports the conclusion that the influence of life events in triggering mood episodes is more prominent in earlier than in later phases of bipolar disorder.”

150 “Chronic persistence of symptoms can be expected in about 20% of cases, and social incapacity in about 30%.”

223 “Comorbidity in manic-depressive illness, in which the mood disorder is complicated by the presence of one or more additional disorders, is the rule rather than the exception, especially for the bipolar subgroup.”

comorbidities

Relatively unexplored comorbidity: dissociation

251 “…a particularly high liability for comorbidity with personality disorders, substance abuse disorders, and anxiety disorders in bipolar-II patients… The evidence strongly suggests that bipolar-II patients have–relative to the general population and to those with bipolar I or unipolar depression–the highest rate of suicide.”

251 “In summary, women with manic-depressive illness attempt suicide more often than men. In contrast to the general population, the suicide rate in women with manic-depressive illness is higher than or equivalent to that in men.” [men may under-report or engage in “suicidal equivalents”]

260 “Although the findings of studies reviewed here point to genetic alterations in the serotonin system as having a relationship to suicidal behavior, the findings with respect to manic-depressive illness and suicide remain inconclusive.”

Bipolar or affective disorder features severe depression alternating with episodes of hyperactivity. Patients have defective regulation of emotions, and they have difficulty with judgment and behavioral decisions. The most popular theory is that a deficiency of serotonin is the primary cause of the disorder. Serotonin is normally produced in the raphe nucleus in the midbrain and upper pons and is distributed to the rest of the brain. Ventriculomegaly is observed in affective disorders, but the finding is nonspecific. Reductions in volume of the frontal lobes, basal ganglia, amygdala, and hippocampus have also been reported. Functional studies have revealed decreased activity in the prefrontal cortex and anterior cingulate gyrus.

“Bipolar or affective disorder features severe depression alternating with episodes of hyperactivity. Patients have defective regulation of emotions, and they have difficulty with judgment and behavioral decisions. The most popular theory is that a deficiency of serotonin is the primary cause of the disorder. Serotonin is normally produced in the raphe nucleus in the midbrain and upper pons and is distributed to the rest of the brain. Ventriculomegaly is observed in affective disorders, but the finding is nonspecific. Reductions in volume of the frontal lobes, basal ganglia, amygdala, and hippocampus have also been reported. Functional studies have revealed decreased activity in the prefrontal cortex and anterior cingulate gyrus.”

 

261 “A passive sense of hopelessness is a chronic risk factor for suicide.”

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262 “The impact of social factors, such as losing an important relationship or a job or facing legal or criminal proceedings, can be devastating to anyone; this is particularly, true, however, for those with a major psychiatric illness such a bipolar disorder. Although rarely sufficient by themselves to cause suicide, social stressors can precipitate or determine the timing of the act. They may trigger suicide in individuals with certain biological vulnerabilities and psychological traits…”

277 – 278 “Thus there is reason to suspect that as a group, individuals with bipolar disorder are endowed with general intellectual abilities superior to the distribution in the general population and may be more likely to have backgrounds of middle and upper socioeconomic levels. Yet is also appears that bipolar disorder is characterized by poorer general intelligence across all phases of illness. If both of these views are correct, it would suggest that the disorder is associated with significant deterioration in general intellectual abilities or that there are compensatory cognitive advantages in a subgroup of individuals with bipolar illness… Studies contrasting patient samples with healthy volunteers likely underestimate the extent of deterioration because they do not account for the premorbid baseline.”

281 [note in IQ, V vs P is verbal vs nonverbal] “The reductions in full-scale IQ seen in mood disorders appear to be largely attributable to a decrement in PIQ, with preservation of VIQ.”

282 “The implication is that the cognitive systems subserving language are spared with respect to an otherwise generalized disease process, are constitutionally endowed at higher capacity, or are complemented by compensatory cognitive advantages of an as-yet undetermined nature.”

298 “Mood congruence refers to the notion that the efficiency of mnemonic processing is biased by the congruence between the current affective state and the affective tone of the material being remembered. In general, it is believed that dysphoric or negative life events are recalled more easily when individuals are in a depressed state than when they are in a euthymic or manic state….”

312 “The literature on encephalomalacia in bipolar disorder…”

 

Wording with Thorns

Only the fiction of my horror stories is exaggerated. The supernatural is mostly metaphor and code. The horror is real.

A lot of people—especially people with majority privilege—like to complain about political correctness. Think about this. Think about lying in your loved one’s arms at home at night, sleeping soundly. You wake up because so many arms have grabbed you that you can’t move. You get one more glimpse of your lover—you know instantly that she or he is going to be dead soon. Next, you’re tied to a stake, and bundles of burning sticks are being thrown at your feet just often enough to keep the agony high. These bundles are called “faggots.” You’re called a faggot, too, because your life is worth no more than tinder because of those you love. Watching you die is someone’s entertainment.

burning-at-the-stake1

If you think you have a right to complain about political correctness, and you have a shred of decency, you may not realize that there’s no exaggeration in the previous paragraph. More often than not in the name of Jesus Christ, people brutally and LEGALLY murdered their neighbors who expressed same-sex attraction from medieval times through the Holocaust (we wore pink triangles in the concentration camps, lest you forget). In the year 2016, homosexuality is still punishable by death in the Muslim world, not just in Iran (where the method of choice is live burial, like in the Edgar Allan Poe stories), but in nations the U.S. calls allies.

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After the U.S. stopped putting homosexuals in prison, it still locked us up in mental institutions, using electro-shock and other methods to “cure” us that would likely be considered violations of the 8th Amendment and the Geneva Convention (remember American Horror Story: Asylum?). True story: homosexuality was officially considered a mental illness in the U.S. until the 1970s, and a lot of people in the U.S. still act like it is. Read the news about which minorities are a plague this week. When people treat you like you’re an illness, they want to cure you. What do people do with illnesses? Eliminate them. Hitler had a final solution. Do you?

electro-shock-therapy-sees-a-resurgence

The world really is that bad. So when you worry about political correctness as a Great Satan, I think you’re missing the forest for the trees. If you want to complain about idiots who try to use political correctness as an excuse to censor art, please be my guest. I gladly say fuck those motherfuckers: I hope their intestines spontaneously explode from their bodies and form a slide for them to ride straight to hell.

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I gladly say inappropriate things and create some of the most incorrect characters imaginable in my fiction. Some people who are fighting against political correctness feel that free speech is under threat, and to the extent that they’re right, I’m with them, but political correctness should be about acknowledging the power of language, which is something every good writer (and, in my opinion, good human being) should reckon with. So, fellow language-users, consider these two critical points:

  • Hate speech is a clear and present danger. If you’re arguing about limits on your free speech, remember that there already is one: you can’t shout “fire” in a crowded theater. Why? Because that’s an instance of speech that threatens the safety of a group of people. Dictionary.com defines hate speech as “speech that attacks, threatens, or insults a person or group on the basis of national origin, ethnicity, color, religion, gender, gender identity, sexual orientation, or disability”. “Faggot” devalues the lives of gay people and encourages murders like that famous murder of Matthew Shepard. Likewise—more on this in a moment—when a group of people on Facebook attacked me by using the words “handicapped” and “bipolar” as insults, it clearly fit the definition of hate speech related to disability and therefore did not qualify for protection under the first amendment.normalboring
  • “Use” and “mention” of words are distinct. I have mentioned the word “faggot” many times here. I have referred to its history of hatred, but I have not used that history or used the word to apply to a specific human being. This distinction is subtle and difficult for many people. So is the distinction between in-group use and out-of-group use. Language is about contexts. Political correctness helps people less familiar with contexts to navigate them. Unless you’ve known me for a good long time, you’re better off not using the word “faggot” in my presence. I’m bipolar and I’m gay. A really close friend might call me a crazy fag, but the probability that you’re that person is close to zero.

So I referred to a recent experience with hate speech related to disability. Despite the persistence of ex-gay camps and such that insist on trying to “cure” homosexuality, the mainstream no longer treats it as an illness, which is good, because it seems like a fine thing to me. I can’t say the same about the other stigmatized category I’m in. So people feel much more justified in treating me like I’m an illness to be eliminated. Take your meds. Wipe yourself into an oblivion where you won’t bother us anymore.

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When people make fun of us, I really just want to point out to you normals that you’re literally incapable of fathoming how un-fun it is. Unless you have my mental condition, your brain is not equipped to handle what mine processes. I am THAT different from you. But if I say that, people will think it’s some sort of arrogance or exaggeration. But it’s biochemical certainty. Part of what I try to do with my horror fiction is give you people glimpses. Edgar Allan Poe did that, too. Word is he was bipolar, and having read all of his work, I feel fairly confident his diagnoses would have had much in common with mine (never been an alcoholic, though). Lots of you have some hero-worship for him… mine’s a little different. I think he was in my club. Chances are, you’re not. Bipolar pride. Woo-hoo. Now turn down the fucking lights and remember we’re all going to die.

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For the last few election cycles, gay people were the favorite category to pick on. This time it’s the mentally ill, as we’re clearly the cause of all the shootings and such (nevermind that all the stats show we’re far more likely to be the victims than the perpetrators of violent crimes, thanks in part due to asshole horror writers who don’t do research). Seems I can’t get a break. Like it or not, the zeitgeist is with me, and I am with you. My recent bouts with illness have left me feeling too in touch with contemporary psych, but a little bit of Freud stands strong: the repressed shall always return…

Which reminds me, when you call something “exemplary,” you mean it stands as an example of your highest values. The person who led the mob that used hate speech against me was called “exemplary” by an organization specifically for his behavior on Facebook, I put myself in reach of this bigot because of his high standing in the organization, yet the organization (which has a sordid history with alleged racists and rapists) refuses to act at all. I suppose I AM crazy to think “sane” people would see that “political correctness” is about decency, and, to quote a popular writer, “We endorse things by our participation in them.” People in the organization are hypocritical enough to dismiss me as too touchy and therefore not worth considering as yet another crazy “victim” of their membership’s hate.

Perhaps decency is just too damned rare. My mania is quixotic.

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UPDATE: The “organization” referred to in this blog post is the Horror Writers’ Association. When the recipient of the HWA’s President’s Award, given for his “exemplary” achievement not in literature but in the FACEBOOK COMMUNITY, encouraged a mob to attack me with hate speech on Facebook, I reported the incident to the President and Vice-President of the HWA. I was informed that the HWA “would never tell any member or any of our volunteers what they can say on their own page.” This echo of the HWA’s doomed position in an earlier incident chilled me. I’ll borrow from Brian Keene. In a “statement regarding their decision to allow an avowed white supremacist and fascist serve as a Bram Stoker Award Juror” they tried to defend themselves by citing a “principle of supporting and practicing freedom of expression.” Of course they backpedaled when they realized that being a horror writer isn’t an excuse for lacking human decency… but I’m concerned that Keene is right about history repeating itself, and although I may not be one of the HWA’s greatest victims, they’re standing fast by a bigot who’s proud of hate speech against people with mental disabilities. They stand by calling him “exemplary.”

TOP RESPONSES FROM HWA

“I would never tell any member or any of our volunteers what they can say on their own page.” (The HWA President, Lisa Morton, who gave the President’s Award to Patrick Freivald for his “exemplary” standing in the horror community due to his work on Facebook–she is therefore the person most directly responsible for representing the HWA in endorsing his Facebook values, which demonstrably include supporting hate speech against the disabled)

“You’re not a special snowflake. Sorry. [You are] Using Bipolar disorder for excusing passive aggressive behavior.” (The Vice President, on why HWA won’t act in response to my complaints about hate speech–he later berated me aggressively, all on record)

Several other HWA “luminaries” have read the hate on Freivald’s page and assented to the party line that I “overreacted to something that never happened in the first place.” Lisa Morton angrily severed contact–as if she had been wronged–when I alluded to a film about rape, but whether she likes it or not, her methods are tried and true for squashing rape victims. Nope, I’m not as bad off as such victims in this case, not by a long shot, but I’m sick of HWA grabbing at any excuse to shut down dialogue that points out what everyone knows: they’ve got deep, deep problems.