Category: Annals of Bipolar Recovery

In a previous post about anger, I noted that I have a hard time feeling it, let alone venting it publicly. That’s because I learned to associate anger with danger to myself; and I came to fear that, if not contained, my own anger might even make me dangerous to others. I mentioned two reasons why genuinely feeling the anger internally, and externalizing publicly, is important: if I don’t, it can manifest as sadness; what’s more, anger marks out my boundaries and my values.

I’ve been assigned a little more “anger homework” whose results I’ll share here.

First, and this is something applicable to everyone: drawing on DBT materials, I’ve reflected on another reason to “embrace anger”, at least up to a point. It has an evolutionary function. Anger belongs on the “fight” side of that familiar “fight or flight” opposition. As such, it “organizes our responses”, so that we can mobilize resources to defend ourselves. At the same time, more positively, anger is a motivator. It shows up when we are stymied, and can keep us moving forward despite the obstacles.

Harnessed appropriately, then — as the old Public Image Limited song “Rise” goes — anger is an energy.

My homework also yielded thoughts on my own relationship to anger: what tends to cause it in my own case and how I tend to react.

Surprisingly, though I do get vexed (I love that old-fashioned word!) when I myself feel mistreated and disrespected, my “triggers” don’t tend to centre on myself. Anger arises in the face of unfair and unsafe behaviour – which can include being unfair to me or unsafe for me, but needn’t. What’s anger-making are violations of the rules which ought to apply to everyone, but which this person disregards; the appearance that the person considers themselves special, and “above the law”. (Hence my well-known pet peeves about speeders, red-light-runners, cue jumpers, etc.)

Why are these my triggers? On the one hand, reverence for rules was driven into me – and I choose that metaphor ‘drive into’ advisedly – as a young child. On the other, other’s disrespect of the rules did me great physical and emotional harm.

If the unsafe and the unfair is what typically gives rise to anger in my own case, how do I respond? Not, except in very, very rare cases, by yelling and breaking things. I may use my most powerful coolheaded weapon, my discursive reason. Given the opportunity, I will “accost the culprit” – yes, that’s how, in my righteous intellectualizing, I’ll conceive of it! – with compelling premises and ironclad inferences. Take that rule-breaker. Failing that, say with respect to a long-gone speeder, I’ll compose an entire mental essay. (Yes, more righteous intellectualizing.) Alternatively, I may simply choose the silent treatment.

See the pattern? Cold abstract reason over heated emotion. Cold control as opposed to heated action. (Even the triggers are pretty abstract and rational.)

What’s the right approach, if not these? There’s a concept in DBT of “opposite action”. It shows up in aversion therapy. For instance, a person with hemophobia, whose impulse is to turn away from the merest sight of blood, is encouraged perform the opposite action of looking squarely at a few drops. Maybe even, after a time, touching blood. The “opposite action” in my case would not be hotheaded screaming in a violent rage! The opposite action, for me, would be thoroughly feeling the emotion in the body, even expressing the anger, but tempering that perfectly natural (and functional) reaction with warm compassion; and, instead of an icy judgmental attitude, a soft acceptance of truth on the other side.

How’s that for homework?

An essential part of Dialectical Behavioral Therapy, borrowed from Buddhism, is acceptance of certain painful facts as inalterable. Indeed, not just acceptance – total, complete acceptance. Radical acceptance.

I’ve found this very, very hard. Among the things I especially find tough to accept are: change; loss (including especially the death of my loved ones); unfairness; conflict; and my mistakes/limitations.

A first step that has helped, as I’ve work towards tolerating these, is clarifying what radical acceptance is and is not. It isn’t being helpless. It isn’t being trapped. It isn’t condoning the awful. It isn’t shutting off the negative emotional reactions. Instead, it’s being objective, an emotional adult – recognizing reality as it is, evaluating it as genuinely difficult – and then choosing to accept. It’s opting to let go of old hurts, stubborn habits, unhelpful beliefs and fears. Far from a trap, radical acceptance involves refusing to be fused with your emotions and thoughts; it’s a peculiar a kind of flexibility, viz., purposely “leaning in” to what’s difficult. To anticipate, it’s about willingly embracing it.

It has also helped, as I’ve struggled with radical acceptance, to keep firmly in mind how it can help. Obviously, it’s better to not always be struggling for control. In addition, and somewhat paradoxically, recognizing what I can and cannot change, where the hard boundaries of my powers lie, confers a feeling of safety. I can then at least trust myself within those proper bounds.

If that’s what it is, and why it’s helpful, how is one to practice radical acceptance? There’s a complex and demanding DBT technique I am practicing. It has five stages – each of which, by the way, can benefit from the help of others:

1. Observe that you are fighting reality

2. Describe the actual reality, including why it hurts

3. Cease fighting that reality

4. Embrace it

5. Act, mentally and physically, in light of acceptance.

Unsurprisingly, it is stages three through five which are the toughest. I have “mantras” that I say inwardly to myself, when I’m suffering but have at least managed stage two. I repeat sub-vocally:

• Change is constant
• Loss is constant
• Limits are constant
• Unfairness is constant
• Mistakes are constant
• Conflict is constant

Often, my Cllum-C mantra (mnemonic pun intended) at least gets me to cease fighting the hard realities.

In a nutshell, the point of radical acceptance is that no one can defeat all the badness. The difference is between those who accept this – who recognize it as part of our common humanity – and those who do not. I’m trying to move from the second group into the first.

I have an awful time allowing myself to feel angry. A recent example. Some students have been brashly abusing a new university policy. Many would naturally feel irritation at their disrespect for rules, and at the unfairness to those who take the policy to heart. I resisted those feelings – and got myself anxious and depressed as a result.

Why do I repress angry emotions? Because anger is several times over frightening. The anger of others meant physical danger when I was young; it was associated with chaos. (Just the sight of that fist above makes me cringe.) I worry that others might reject me if I expressed anger towards them. I worry that, though my behaviour has always been gentle, my feelings of anger would turn to violent venting if I didn’t tamp them down. Solution: sublimate.

Why shouldn’t I repress anger? To begin with, I tend to experience the anger as something else – sadness, fear – just as I did the other day. More deeply, expressing anger in proper measure is closely connected to having proper boundaries. At a minimum, not admitting anger gets in the way of an authentic expression of boundaries. Not showing your “inner boundaries”, you can’t pursue your own goals. Worse, being unable to feel anger, you have no “inner boundaries”; and without them, there is no “authentic you”.

Proper boundaries, after all, track values, and those are a huge part of one’s identity. You are (at least in part) what you want for yourself and for others. So, no anger, no boundaries; no boundaries, no values; no values, no me.

So, what are my values? They are… a topic for another post.

An important tenet of DBT is that behaviours and emotional outbursts, including unhealthy ones, have different kinds of causes. The causes aren’t just (conscious and unconscious) beliefs and desires; nor are they just electrical signals carried by chemicals in the brain.

In addition, these varying causes form a chain:

Vulnerability → Prompting event → Interpretation and other intermediate links → Problematic reaction → Consequences

In my own case, the “problematic reactions” aren’t things like abusing alcohol or drugs, angry explosions, etc. Mine are inner feelings – especially overblown fear and sadness – and the outer expression of those feelings – such as freezing up and sobbing uncontrollably.

Part of DBT therapy is analysing these chains. “Chain analysis” has a descriptive and a prescriptive part: not just identifying the links in the chain, but therapeutically breaking the maladaptive chains and replacing them.

A recent example. The vulnerability: I was alone, with too many tasks to complete, on a grey and cold afternoon. The prompting event: I saw an East Indian girl in a pink jacket with short dark hair. The problematic behavior: I started sobbing, repeatedly clenching my hands and toes, lowered my chin to my neck, closed my eyes; and I felt dreadful grief and hopelessness. The consequence: the young girl and her grandfather noticed me with shock and became frightened.

As for the interpretation, I thought:

• “That girl looks like Moon and Saima when they were young”
• “My little girls are gone”
• “They loved me back when they were that age, but do they love me now?”
• “My life is full of loss”
• “Everything around me ages and dies”.

This amplification of the prompting event – via the intermediate links – is what yielded an outsized physical and emotional reaction, the sobbing, etc. Then there was a subsequent chain. (Cue a downward spiral.)

The vulnerabilities came to include my present state of desperately grieving, of being even more emotionally fragile. A new prompting event on the scene was the very fact that I reacted so strongly to the initial one, and that this hurt others. A resulting “meta-chain” went:

• “I am a bad person because I’ve upset this poor family”
• “That I reacted this way shows that I am sick and won’t get better”.

As you can tell from this example, I’ve become pretty astute when it comes to recognizing the varying causes and the chains. My present homework is to focus on the prescriptive bit. I’m working on four aspects right now.

1) Checking the facts. Is my interpretation complete and accurate?

(In the example, checking the facts would involve asking: “Have I really ‘lost’ my girls?” “Am I truly getting worse?” “Did I do so much harm that I’m an awful person?” The facts were: No, no and no.)

2) Identifying more effective links. Where could I have replaced a problematic link? Which links are such that, had I conceived things differently, the consequence would have been avoided?

(I might have interpreted the scene as: “It’s nice that that girl is happy”; “Her coat reminds me of wonderful Winter outings with Moon and Saima”; “Change and loss are constant and universal, they aren’t specific to me”.)

3) Recalling DBT skills during a prompting event. Which techniques would have forestalled the chain?

(I could have paused, mindfully, to focus on and describe the initial sensations in the body when I first saw the girl.)

4) Strategizing about how to prevent such a chain next time.

(But not by avoidance of, e.g., seeing happy children outdoors!  Nor by quashing the feelings entirely. That’s aversion rather than prevention.)

A massive part of my depression is grief. Horrible, deep, abiding grief.

A recent homework assignment from Dr. D, then, was to think about the function of grief. If one can see that it has a purpose — at a time and for a time — maybe one can reckon with it. Or reckon with it just a little better.

Here, based on some google searches, a few academic articles, and a bunch of introspective pondering, are five functions I came up with.

1) Bonding

Grief plays a role in bonding prior to a loss. It encourages us to protect existing bonds by making us sad when we are apart. That means that we learn to protect things we love, so as to not feel the grief (cf. pain as negative feedback). In this sense, grief is the flip side of close emotional attachment. Grief, in other words, is a specialized sort of sadness: it’s the reaction to “extreme parting”.

Grief is also important after a loss, to encourage bonding with supportive others. To share the grief. To seek help.

2) Pausing/resting

The period of grieving allows one to take a moment for oneself. A moment for saying goodbye. A moment for recovering energy for the difficult task ahead.

3) Boundary marking

Grief, in its great force, delineates the past from the “new terrain” going forward. It is so obvious to the sufferer and those around them that it cleaves time, marking the past as genuinely and definitively on the other side of the boundary. That too is an important function.

4) Recognition

The grieving period is the time for accepting that the loss is permanent, final. That one’s world has irrevocably changed. Being on that far side of the before/after boundary, no more protecting of the loved one is possible.

5) Prompt for relearning

After the pause, and with the boundary firmly in place, grief starts the process of adjusting to the world as changed by the loss. With the support of those one has become bound to, the sufferer can learn to live with the loss, the new reality, in a healthy way: psychologically and socially.

In light of this, ideally…

• grief can serve its purpose and then subside;
• there’s no need to cling to it;
• but no need to fear it either.

Leaving all this abstract homework behind and coming back to myself, I have never been able fully to do the recognition and relearning steps.

A crucial lesson will be to convince myself that the deceased are not owed my grief. That is, my grief isn’t a sign of how much I loved those who I’ve lost.

About me and the motivation for blogging.

I have been battling chronic depression pretty much my whole adult life. My diagnosis is Bipolar II. My first really serious depressive episode occurred when I was 28, shortly after my first wife Hamila died of cancer. But, in retrospect, I think I was experiencing hypomanias and depressed periods from about 17 forward.

Things got much worse half a dozen years ago, as I entered my 50s. What had been depressive periods tied reliably to dates – e.g., Hamila’s birthday and the anniversary of her passing – became more frequent and unpredictable. The hypomanias were swapped out for anxiety attacks.

I was in a mess and feeling hopeless. For the last 18 months or so, however, I have been under the care of a psychiatrist who actually treats me. I’ll call her “Dr. D”. Yes, she monitors my meds. But she also gives me homework exercises based in Dialectical Behavioral Therapy, an offshoot of Cognitive Behavioral Therapy (CBT) owing to Prof. Marsha Linehan of the University of Washington. Its emphasis is on “building a life worth living” and it draws heavily on Buddhist theory and practice.

The point of this blog is to share the results of all that homework. I hope it will speak to readers. I hope too that it will prove therapeutic for me.