The thrill is gone

One day I go to my computer and there is nothing left to write. Nothing of wisdom or beauty that is. Everything has been already done, all the important voices have already been recorded and Ralph Waldo Emerson’s painful truism is unveiled clear as day: all my best thoughts have been stolen by the ancients.  And yet, just yesterday, there was a torrent of words that poured onto the page.

How to understand these variations in our being? I learned from Sheila, a patient at a government-run hospital where I worked.  Sheila oscillated between a frenzy of artistic and social activity —some of it wonderfully productive and some terribly painful, even to her— and periods of stability where she would be a paragon of the compliant patient.  How she would be depended on a number of variables in her personal life including whether or not she was taking psychiatric medication.  The changes were often unpredictable.  Weeks after being elected “patient of the week” and receiving kudos from staff and peers for her mood stability, Sheila would stop taking her prescribed psychiatric medication and become unhinged.  Then she was like a lioness guarding her young, proud, fiercely beautiful and quick to violence if she perceived a threat.

The stable and the wild parts of Sheila did not talk much to each other, in fact they were barely aware of each other’s existence. Like the winter and summer, they occupied different seasons.  During group-therapy sessions she would inform everyone with an air of almost religious righteousness that taking medication was the way to stay balanced.  Then a few weeks later, in my office, she would toss her head with the nonchalance of an alcoholic at a champagne brunch and declare that she had been—cheeking—pretending to take medication and spitting it out afterwards.  A few more weeks would pass and she was back in her avatar as untamed feline, a majestic but fearsome portrait.

One day in my office she made a poignant case for the choice that she made periodically to sacrifice her stability for something else .You see doctor, when I’m myself, without the medication, you may say I’m mad but I paint, I write, I take walks and have interesting conversations with people. Yes I’m very reactive.  If something drives me crazy I act crazy. Yes I get in trouble and forget the rules and walk naked in the hallway when I’m upset but I feel alive.  Even on days I’m miserable at least I feel something.  When I’m on those medications you guys give me I don’t feel anything at all.  I go about my business without a trace of emotion and my boyfriend can leave me and I’m totally calm—I just go to work like nothing happened.  I know you guys think I’ve been really healthy for the last three months because I haven’t got in trouble and I’m taking my meds but what’s the use of looking healthy if you’re dead inside?

Stability in other words is wonderful if its organic but should not come at all costs.  When we are functioning smoothly, like Sheila on meds, like a well oiled machine, we may also risk getting to an internal space where we feel dead inside at times. There is a poignant particularity to the internal space that she describes.  It is filled with hopelessness and stagnation—like sitting in front of the computer negating words before you write them—but underneath is also a muffled, barely audible cry for an absent juice a cry that is begging for a listen.

The juice is the water of our inner world, anything but boring, calling to us like a song that must be sung or a cake that must be baked.  The juice is the inspiration that invites us to create, converse, relate.  On days when we feel split off from ourselves, we experience ourselves as blunted. We are not in touch with our own aliveness. We cannot touch our own juice.  We go to work and tend the house with an automaticity that renders the tasks devoid of meaning.  We remind ourselves how we ought to be grateful for the largess that we have, for the good husbands, mothers, children, for the secure home and upcoming retirement, but none of these reminders really comfort. External barometers of health and happiness and all the safety and security in the world are cold comfort when the thrill is gone.

We need some numbness I suppose.  There is only so much we can tolerate of ourselves and of that juice. Like Sheila we become overwhelmed by ourselves:  by the painfulness of our own feelings or the taboo in our own desires, and then we need something to forget. We may not use prescription pharmaceuticals to manage that but I would argue that all of us use work, relationships and our own inner ability to shut-down or open up as ways of titrating how alive we are and how much we are living versus existing. Like Sheila, I think many of us alternately choose numbness or aliveness, sometimes for weeks or months.  Other times there is no choice and aliveness or numbness claims us.

Perhaps what I repeat most often to myself and my patients in one form or another is this: we need our wild side.  We need it as much as we need our sanity and we need the two to know and live with each other. Inasmuch as being organized and moving forward with our lives is important, so is being in touch with the cry for something more.  We get our juice, that thrill from our wildness. Easy to forget, if we are valued and relied upon by our outer world and our jobs for predictability and efficiency.  In the current cultural zeitgeist that hugely values control and productivity, I feel we are losing tolerance for our own wildness, our own most primal desires and feelings.  We have become so efficient and focused on keeping track of our tasks that we lose or risk losing track of our selves. 

If I stopped to reflect upon why I can’t write a word on the computer I might realize that there is a sea of pent-up emotion that I have been admirably concealing all morning in the interest of meeting the deadline for that piece of writing. The thrill is not gone, there is just something in me that won't let me get to it.  When the thrill is gone we are usually just dammed up, the beavers of our own protective defenses holding us back from the lush wetlands that lie just beyond. 

Yours, mine or the machine's?

She had walked in to my office with a slightly deferential air but through the veneer of respect, I could tell she was seething.  So, she said moments after the pleasantries, we have been telling Manish that he needs to get it together, for the sake of his family, for the sake of his children, and for his own sake. I listen silently, wondering what is coming next.  But doctor, I hear you have been telling him that whatever he is feeling is ok? I open my mouth and then close it.  Do you know doctor, she says looking me through eyes that suddenly looked veiled with pain, how much I would like to be the one having a breakdown?  But I can’t afford to, he can’t afford to and we need your help in getting him to buck up, move on, stop feeling sorry for himself and starting acting normal.

Breakdowns are often seen as being irresponsible and selfish.  This is particularly true amongst people of Indian origin for whom family responsibilities and role-expectations typically play a huge role in an individual’s psychic make-up.  When a breakdown happens, what has typically worked does not work anymore, and the family system feels a shift in its overall levels of efficiency and functioning.  Yet efficiency is not life’s only goal. Reacting with compassion to other people’s breakdowns, difficult though it may be, is critical to helping heal it.

I struggled for weeks with Anjana’s conceptualization of her depressed son—who had recently made a suicide attempt—as someone who was lazy and avoidant of his family responsibilities.  While I do think its possible to use emotional problems to avoid responsibilities, I don’t think its fair to say that emotional difficulties are generated by a desire to avoid responsibilities.  In other words, not going to work may be an outcome of a terrible depression but it’s rarely the case that someone is generating a depression principally to avoid work.  At the hospital where I saw Manish, the biomedical model of depression offered this counter to Anjana: “your son is not lazy, he has an illness called depression that can be treated by a medicine and some psychotherapy”. I myself always felt the need for an explanation that was a little more lucid than “it’s a disease”. Depression is much more complex than the common cold or the chicken pox and to group them together as “diseases” may appear efficient in some ways yet is rather limiting, not to mention peculiarly disempowering to the person experiencing it and strangely empowering to the medication  (to be discussed further in another blog post). 

My own counter to Anjana was two-fold: first, I told her I thought Manish needed some time to process and accept the fact that he had been abandoned by his wife (a recent event that occurred prior to the onset of this “depression”) and second, being characterized as lazy and avoidant by his family was making him feel worse, not galvanizing him into improving himself as they had expected.

However talking to Anjana about this did very little. I had to show her—by pointing out Manish’s defensive body language and responses to her during a three-way meeting —that Anjana’s injunction to him to “buck up” was actually putting him down.  When she could actually notice visually that her son was reacting very poorly to her comments Anjana quickly capitulated.  An intelligent woman who was truly fond of her son, once she could see that she was hurting him further she became willing to drop the repetitive rhetoric about family values that she had been spouting and was available to listen to Manish in a different way.

My guess is that although there was a breakthrough in that moment, unless she became very motivated to change, Anjana would probably tell Manish again that being depressed was a dereliction of duty. Although she wanted Manish to get motivated and change she herself—apart from that breakthrough moment when she saw how much her son needed her to change—did not have a motivation to change. Manish was the designated patient, not Anjana.  As a therapist, though I had intervened to facilitate more productive, less violent communication between the mother and son, because she had not identified herself as a patient, I had not addressed Anjana’s sense of anger in our first meeting, nor her envy.  Yes envy.   Days after they left the hospital and years later today, I still hear the poignancy of her words echoing: Do you know doctor, how much I would like to be the one having a breakdown?

Family Systems theory in psychology—embodied by psychologists such as Murry Bowen, Salvador Minuchin and Virginia Satir—conceptualizes individual breakdowns as manifestations of dynamics that are taking place in the bigger system of the family.  According to Family Systems theorists, if we are going to think of depression as “symptoms” of an illness then at minimum it's important to acknowledge that the illness is also happening in a larger whole, even if the symptoms are happening in one person (anyone who has felt physically sick or unable to speak for hours after reading a photoessay on the war in Afghanistan can understand the logic of this argument).

There’s plenty to read about intersecting family dynamics and it impact on individual mood in the popular press as well as in the psychological literature so I won’t say much more about it here.  What I want to emphasize is that breakdowns—periods of time that demand authentic attention and where we cannot or must not continue living the way we have been living—do not stand aside from human experience, they are part of the human experience.  Ignoring your own sadness or anger in order to “get on with it” not only begs the question of what the it is we are getting on with, but also demands from us the automaticity of efficient machines.  Shutting out the voices in ourselves that are asking for healing by robotically continuing with our day to day functioning robs us of the very humanity that distinguishes us from the glass and plastic computers that serve us.

Of prisons and protection

One of my favorite good old boy psychoanalysts, D.W. Winnicot, has a fantastic (if at times hard to comprehend) essay, written sometime in the sixties, called Fear Of Breakdown. In his article, Winnicot defines a breakdown as a capsizing of the individual’s defense organization.  When this happens he says there is a consequent arising of an “unthinkable state of affairs that underlie the defense organization”.

Winnicot thinks of the Self as a cauldron of bubbling emotions, memories, images, ideas and experiences that are held in place (and generally kept out of our conscious thinking) by the tight lid of the “defense organization”.  By “defense organization,” Winnicot is referring to a protective mechanism or buffer that helps us keep under wraps certain aspects of our emotional life that for one reason or another we cannot freely express (e.g. it is socially acceptable or “not how I am supposed to be” or it will “hurt someone I love”).  Defenses are what allow us to go to work and “act normal” on the morning we had a dramatic miraculous-feeling spiritual experience or on the afternoon we heard about the death of a loved one.  Defenses are also what contribute to our sense of feeling inauthentic or feeling “like I just can’t be myself”.  On one hand defenses keep us away from ourselves by distracting from certain emotional truths that are unfolding inside of us.  On the other hand defenses help us to “get on with our lives,” they give us the space to shop at the supermarket or crunch numbers at work by providing a break from the fullness of our emotional lives.

A few examples of defenses:  one common one is constant insistence on cheerfulness and fun, belying underlying hurt, emotional pain or anger.  An individual or group who is defending like this may feel or even appear upset, but reiterate “I’m fine” or “I am having such a good time, isn’t this just wonderful?”  Another socially acceptable defense is a constant focus on work and productivity, thereby circumventing underlying memories or emotion that might arise if the individual were to reduce these energy-consuming activities. An example of a defense that helps calm the system without actually addressing the deeper trouble could be overeating or over-exercising in order to come to terms with hard-to-digest emotions that are not addressed but rather “consumed” or “worked out” via eating and exercise respectively.    A more rigid defense could be the action of a gay man who gets married to a woman and even convinces himself to have sex with her, not because he wants to but because he feels unable to deal with how doing otherwise would shake up his conservative family.  Another defense might be the action of a very ambitious person who avoids applying for all job opportunities due to a fear of rejection or failure which is in conflict with her ambition.  In each of these examples, the defense is an armor that protects an underlying vulnerable emotion.

While necessary at times and even for periods of time, defenses are not tenable forever.  They protect us from the blow of our emotional rawness but they also expose us to the alternate blow of an efficiently functioning but mundane reality that lacks the richness of emotions.  Defenses also break down, either when they have been holding so long they cannot hold anymore or when the hitherto silenced unconsciousness pushes through with a scream. For the part of us that has been waiting for a bite of freshness and authenticity such a breakdown of the defenses may be a palpable (albeit painful) relief.

Over a lifespan, I think being human means gradually finding ways to be at home with the range of our emotions such that the armor of the defenses becomes less necessary and less compulsive.  Claiming the privilege of our human-ness includes allowing our defenses to drop in order to commune with the underlying vulnerable emotion instead of striving to go through life looking "put together". Having the cauldron of true feelings bubbling over and spilling may feel like a breakdown, but being able to lift the lid and see what’s cooking inside of us and even scent our surroundings with the aroma of this inner richness is a delicious freedom.  Then, as conflicts are resolved and unvisited places in our psyches are invited to show themselves, we begin to feel at liberty to live from a less defended and more authentic place.

Breaking down a Breakdown

By “breakdown” I mean a constellation of internal and external events. The experiencer—and sometimes close witnesses—become aware of at least three co-occurring phenomena.  First there is a dramatic (meaning very obvious) shift of energy heralding a shift from the outer world to the inner world.  Sleepiness, sleeplessness, melancholia, manic excitement, tearfulness, exuberance, sustained irritation, any of these may be examples of this noticeable energy change, the key is that is a shift from before.  Second there is often a mental preoccupation of some kind.  This could be more general (death, world peace, personal liberation) or more specific (a sense that one has chosen the wrong career path or a conviction that a certain person or relationship is toxic or for some other reason needs to change).  Finally there can be an intense and unusual communication of this energy shift and mental preoccupation.  The communication is not necessarily comprehensible to everyone and can occur in many forms including withdrawal (becoming very isolative or feeling alone a lot), unconscious artistic representational communication (for example kitchen items strewn about the bedroom to indicate feeling confused), verbal communication (for example telling all the neighbors that one is leaving town forever), or some kind of self-harm behavior (could be a refusal to attended a much sought interview or something as striking as a suicide attempt).  These constellation of phenomenon can be occurring at a very intense level—enough for a doctor to call it a name such as depression or bipolar disorder—or at less intense level to the extent of saying “I really am not myself” or “I really lost it the other night”.  They can also occur more persistently at a lower level of intensity:  for example a whole year or six months of feeling like “things are not quite right”.

Inwardly the unconscious is bubbling up like primordial soup.  Relegated too long to the realm of dreams or pushed down due to social sanctions or rules, the unconscious cannot be held back during a breakdown.  Previously suppressed thoughts or emotions burst forth with the ferocity of un-dammed waters.  The individual is overwhelmed by material that was once neatly organized or tightly compartmentalized. The unconsciousness-in-spate includes personal material—the lost loved one that was not fully mourned, the turns in the road that were not properly acknowledged, the dreams that were cast aside because some other duty called the dreamer—and may also include elements of social and community material such as political struggles, celebrity lives and concerns of global war and peace. Massive efforts might be made to keep this material under control (e.g. a struggle not to think about a loved one who passed away) but these efforts generally feel futile.

As they are meant to be.  Being in the throes of a breakdown means being overwhelmed by one’s inner world.  It means one’s outer life cannot go on as it once has because the inner life is demanding more attention.  My belief is that there is deep value in giving the inner life the attention it needs.  This may mean making arrangements to forgo all external tasks for a period of time (whether a day or a week or more as necessary and feasible) and staying in a safe setting where one can meditate, dream and write or paint about the material that is coming up from inside.  Or it may mean entering a longer term psychotherapy which allows “pockets” of time once or more times a week to drop the external world for an hour or so and along with a supportive therapist conjunctly attend to the sounds and stimuli of the inner world.  Whether one chooses a more or less intensive retreat depends both on the person’s material situation and the intensity of the inner material that is coming up.  Sometimes the intensity of what the medical doctors call “symptoms” may be a good guide to the level of attention that is needed by the inner world.  Any work in the inner world will of course affect and ripple into the outer world, ultimately I believe creating the conditions for a fuller life.

One of my mentors, Dr. Yung-hi France described the process of a breakdown as  “the suffering of a soul which has not discovered his meaning”. Although it may appear at times irresponsible, confused or fragmented, I think a well attended to breakdown is a muck-encrusted journey to numerous treasures.  It is not my intention of course, to suggest that when we totally lose it that the results are pretty. Completely loosing track of ourselves always involves considerable suffering.  In addition, relationships are often adversely affected by an individual’s retreat into an inner world so the suffering ripples out from individual to the people around him or her.

Yet relationships are equally affected when the inner world is neglected.  How many times have we heard of someone complaining that his or her lover, father or friend has been checked out, tuned off or working like a zombie for years? 

Breakdowns are beautiful as symbols of a search for meaning amidst a sense of meaningless. I believe, as it has been said before by the poets, that the search for meaning is perhaps the most vital and pressing demand of the human experience.   I’ll say more about this in another post, but I think human striving towards meaning is as poignant as the lightly falling, sometimes torrential afternoon monsoon rain.

Raison D'etre

Why a whole blog to talk about breakdowns?  Breakdowns—periods or moments when we become flooded by our internal reality sometimes to the exclusion of outer reality—are arguably one of the most terrifying phenomenon that many of us could contemplate.  Yet we speak very little about breadowns.  Emotional collapse tends to be received with a sense of shame and dismay that far exceeds a response to physical collapse.  Any of us is much more likely to talk about our flu or our cold even our heart disease or chronic pain faster and more willingly than our moments of darkness, hopelessness or absolute insanity.  Disintegration, amongst the most feared of human experiences, is a bit of an outcaste, in need of a voice.   

When I first wandered onto the psychiatric unit of Stanford Hospital as a student I had two thoughts that would not go away no matter how hard I tried to erase them.  One, this is the most scary place I have ever been and two, this fear is enough to make me collapse too, overnight I will morphed from doctor in training to a patient.

No countering third. There was no part of me that spoke up and said you are so mentally strong and healthy nothing like this is ever going to happen to you. The fact was and is that I simply don’t believe that’s true.  I think depression, anxiety, even psychosis are part of the human condition and could arise in anyone.  Some of us just have more controls in place than others.  

Half a year into that placement on the acute psychiatric unit I was increasingly convinced that psychic collapse was not the most horrible thing in the world.  There is something about the controls removed, the curtain gone and the accompanying deep and vulnerable emergence of a self-in-pain that overflows with a kind of humanity.  Certain truths become unveiled that otherwise would never have a chance to come to light.  And so I started to believe, that while painful, breakdowns were not useless and perhaps not necessarily to be avoided at all costs.

Most of us fight hard to protect ourselves from breakdowns, much harder than we are even aware of I think.  And some of us may have—whether diagnosed or not—a vulnerability to breakdown, something in us that cannot fight or simply drops the fighting and just receives the breakdown in whatever form it takes, be that a dropping into a swamp of grief or communing with spirits whose form and voice is known only to ourselves.  And there is some benefit there, some value to communing with the forces within us that want our attention that we keep out of awareness for so much of alive.

Our inner world is pawing at us, inviting us, demanding from us, in our dreams and often in our waking life as well.  When we have a breakdown, it’s a chance to give that inner world our undivided attention for a period of time.  Instead of arresting or patching up the falling apart of the outer façade, when we open our arms to embrace our inner world then we can learn something interesting during our breakdown.  The stories that are unheard come to light, the yearning of something deep inside us is bared, and even though there is outer chaos, even though we are unable to perhaps attend to our day to day functioning with the efficiency we once did, the mystery that is being unraveled within is worth exploring.