Bipolar Chris

Chris came home from his first 45 minute Alexander Technique lesson a week later a different person. He was more decisive about where his body was going. He threw off the gloom that had been dogging him and became practically ebullient in his expressed enthusiasms. He was back on track, or so it seemed, for a few days. He rejoined the choir, signed himself up for another credit course at university and was beginning to establish a better sense of what he was doing in a room. This newfound enthusiasm lasted about a week and then, boom, he began to become unglued again.

When I walked through the door at night would I get the lady or the tiger? Sometimes I came home and Chris seemed more or less together and sometimes I came home and he would be staring off into space and showing the old hesitancy. Over the course of the next couple of weeks I noticed that his speaking voice dropped an octave or two. I shrugged off this weird new development as just another possible effect of the Alexander Technique and probably a good thing, but I wasn't sure why I thought so. It may have something to do with my perception that lower toned voices signal confidence.

He appeared to be going through a somewhat manic phase, immediately signing up for a fresh course so quickly after dropping the other two, speaking more quickly and interrupting Ian and me with emphatic but off-base observations. One can only imagine what his classroom performance was like. I began to fear that he would have to drop the credit course he had only recently started. After discovering that he blew through his monthly allowance in one week, we began to dole it out to him in smaller amounts. The bipolar Chris was new to us.

Then his holistic psychiatrist phoned. “I have it!, she announced. “I think I can explain why Chris has been having problems recently.” She had stopped prescribing a certain amino acid supplement since August, believing that Chris no longer needed it. However, she had come to learn that it was important for her patients to continue this supplement for longer periods in order to bring the elevated dopamine levels within a normal range. What Chris had been going through was called protracted withdrawal.

Her muscle testing revealed that Chris's dopamine levels were elevated in his glands and in the central nervous system. As the dopamine system is affected by the serotonin system she recommended an essential amino acid which synthesizes serotonin and niacin. We endured two more weeks of Chris's quirky behavior before the needed product arrived in the mail. The change in Chris after only a few days on the added supplements was astonishing. He was able to sit with us at night and converse in a normal way, not from two rooms away. His sense of humor and playfulness came back.

This again reminded me again of the importance of getting the biochemistry right. I had been focusing of late on Chris's problems as psycho/spiritual in origin, and had been discounting the importance of the biochemistry behind his actions. Once I began to appreciate that extra supplementation could indeed help him regain normal, I felt better and more optimistic about his immediate prospects than I had in a long time.

The second thing I learned is exactly the opposite of the first, meaning that if I thought that Chris's problems were just a matter of getting the biochemistry right, then I would miss the importance of what I have earlier in this blog called the X-factor in schizophrenia. This is a most confounding, unpredictable condition. If you think you know it, you do not. It is also a chicken and egg thing. Does the biochemical imbalance come first, thereby causing mental trauma, or does the mental trauma come first, thereby causing biochemical imbalance? The wisest course of healing action is to keep an open mind and not place all your eggs in one basket.

A stage management problem

Later, I sent Dr. Stern an e-mail to inform her that I had deliberately stayed out of influencing Chris's decision (not to go back on meds), in large part because I was tired of parenting him and that it was long overdue that Chris should learn to make his own decisions. I also said that in the unlikely event that Chris killed himself, that would be his responsibility, not mine, not hers and not Chris's holistic psychiatrist. I added that, had Chris made the decision to go back on the meds, I had no intention of monitoring his intake as I did previously. The chances were high that, left to his own devices, he would be non-compliant with predictably disastrous results, but that's a problem that I no longer wanted to deal with. I was tired of thinking for him. Dr. Stern remained unconvinced about the risk, but Chris and I had made our position clear.

We had escaped the medications but were back to the problem of Chris. If there are multiple reasons for a single event (Chris's wobbly recovery or relapse - what is it?), then there must be multiple solutions. Chris could go through years of psychotherapy (as many patients do) or we could try to hasten his recovery by adding to the mix.

I have yet to personally encounter a psychiatrist who is forthcoming about any therapies outside of their own bailiwick that might help speed the healing process. I hit upon the idea of more Alexander Technique because I was encouraged by the overdue wellspring of emotions it may have provoked in Chris. There was another reason, too. In the 1930s, Kitty Merrick Wielopolska trained under F.M. Alexander and later wrote a book about her eventual recovery from schizophrenia using the Alexander Technique. It only made sense to me that diligent adherence to the Alexander Technique could produce remarkable long term changes in one's life approach.

Chris needed a little convincing because he was wary of further perceptual changes. I tried the tell it like it is approach.

“Chris, do you consider yourself handicapped?” I asked him.

He looked startled. “Uh, no, not really, why?”

“I don't see that you are handicapped, either, but you act handicapped, Chris. Other people may perceive you as handicapped.” I was specifically referring to his trouble entering a room, walking across a room, sitting down in a chair. Entering a room has always been problematic for him as he is so silent that it seems he just pops up out of nowhere. His noticeable recent problems, in addition to making an entrance, were that he didn't seem to know what he was doing in a room. He pauses, walks a bit, pauses some more, reverses direction, etc. He stands while others are sitting, making it socially awkward. When he tries to sit down, it takes him a while to negotiate through the process. Knees bend, it looks like he's going to position himself, and then he hesitates and loses the momentum. I used to think this behavior was due to the medications, but the problem persisted with varying intensity since discontinuing the medications.

I remain convinced there is a large element of acting to his condition. His negotiating his way through a room is also a stage management problem, is it not? Where people refer to schizophrenia as a particularly associated with highly creative people, I take that further to mean that they are also equally creative in the subtle manipulation of emotion. Please hear me out on this. Gary Craig, the founder of Emotional Freedom Technique and others believe that unresolved emotional issues are the main cause of 85% of all illnesses. Resolve the emotional issue and it is very likely that the physical problem will resolve itself. Therefore, what you see is something masquerading as something else, rather like acting. Some cancers, for example, have been know to reverse themselves when underlying anger is resolved.

Chris, I felt certain, was very, very angry.

The Alexander Technique

Just before leaving on our family vacation, Chris took a week-long voice training workshop under the tutelage of his choir director. Several hours of the training involved the Alexander Technique, a technique familiar to many musicians, dancers and actors and people wanting relief from back pain. The Alexander Technique part of the workshop was taught by a highly experienced AT teacher. (Note: The Alexander Technique is not a therapy.)

F.M. Alexander was an Australian actor at the turn of the last century who developed chronic laryngitis. Repeated visits to physicians yielded no solution to his problem so he began to study what it was about his body position that may have contributed to his condition. It took him nine years. He started with the premise that it was the way he held his neck. He needed to move his head forward and up, away from his body, to lengthen his spine. When that did not make the problem go away, he realized that rather than start by correcting specific movements, he needed to look at the general misuse of body movements.

He came to the remarkable insight that even though he felt he was moving correctly, he often was not, and therefore he could not trust his own feelings. Old body habits die hard and try as he did to correct, he would revert to his old habits. He developed a method to execute the procedure even though his body was telling him the procedure felt “wrong”.

“I would stop and consciously reconsider my first decision, and ask myself "Shall I after all go on to gain the end I have decided upon and speak the sentence? Or shall I not? —and then and there make a fresh decision to

a. not to gain my original end
b. to change my end and do something different, say, lift my hand
c. to go on after all and gain my original end

“In each case I would continue to project the directions for maintaining the new use.”

The method forward in this statement by Alexander reminds me very much of Hamlet's famous “to be or not to be” soliloquy (Act 3 Scene 1), which can be interpreted as an action/no action oriented dilemma. The method could lead to destabilizing behavior when executed by someone like Chris, who was struggling with his perceptions of reality in the first place. Some people can become very emotional because the technique can open up a flood of suppressed feelings and emotions.

Existential concerns

Chris will soon be released from the hospital after three months. I am concerned that we will be right back to the situation that prompted his hospitalization in the first place. He knows that he needs to get out, he is bored out of his mind, and yet he is not looking like he can blend in with quote unquote "normal people". He arrived home for the week-end on Saturday morning, attended to his e-mails and fixed a few computer problems. He talked to me very thoughtfully on Saturday evening. Sunday was a different story. We invited him to join us for a lecture and lunch. We went for a walk on the grounds of the lecture hall before lunch. He was in existential despair. He didn't want to spend his day with "old people". I can't fault him there. He said he didn't know what was real anymore - was I real? Was this scenery real? Was the day going to end and the sun go down? He claimed he didn't know. I asked him if he wanted to resume his Alexander Technique lessons when he came home. "No, I have learned everything I need to know", he answered.

The hospital fussed with his medication, introducing a second antipsychotic over my objections. I maintain that despite the elaborate, weird behavior that got Chris committed, his problem cannot be fixed with medication. It is looking likely that I am correct. The doctor is not satisfied with the addition of the second antipsychotic, noting that Chris seemed overall better just after they introduced it in a low dose. So, now they are tapering it back but not discontinuing it. Discontinuing it would be admitting they were wrong. Nobody, not my husband, not the hospital psychiatrist, not Chris's regular psychiatrist nor anybody having seen Chris in his pre-committal state, understands my objection to the medication. It is they who just "don't get it". Chris has problems that persist whether he is on medication or not.

What I think has taken the edge off the situation while Chris has been hospitalized is not the medication but the fact that Chris got away from us, from living in claustrophobically close quarters every day and being treated like the two year old he was becoming. The doctors acknowledge this reality, but medicate anyway. When I object to the fact that this latest med was the fifth antipsychotic Chris has been on, and shouldn't we conclude that antipsychotics don't work for Chris, the clear message I receive in return in that it is foolhardy not to use antipsychotics as one treatment modality. My husband is almost threatening to divorce me if I undermine in any way Chris's staying on medication. He reminds me of the lead-up to the hospitalization. Yes, I am painfully aware of all that but I also know that Chris has exhibited extremely weird behaviour while on medication, beginning with his first antipsychotic. His mind is more powerful than any drug or vitamin. Until he resolves his existential problems, we will continue to weather the storm.

The list of therapies

Psychiatrists say that single events can be over-determined. Rather than there being one reason and only one reason for something happening, there can be multiple explanations for a single event. Chris's current hospitalization is not the result of a single event. The obvious explanation to the well meaning outsider is that he needed his medications.

The less obvious explanations arise from what had been happening in Chris's life over the months leading up to this crisis. Despite the vitamin support that had worked so well for him before, during and after he stopped his medications, something scary was now happening. He dropped his classes, stopped his voice lessons, rambled frequently off-topic, and tested the patience of his family and friends alike. It had all the hallmarks of a return of his psychosis. Did I mention he was angry? He started to express anger for the first time in his life. He scraped the flesh off his knuckles by driving his fist so hard into the wall.

Chris has yet to offer a definitive explanation as to why this recent crisis has happened. He does say he truly missed his younger brother Taylor, who went away to university about the same time that Chris started to change. My husband and I say that we pushed him too hard to think about returning to university full time. Our expectations likely frightened him. Other people had expectations, too. Chris's voice teacher encouraged him to fulfill his considerable potential as a vocalist. I believe that Chris is struggling with the implications of what it means to become well.

I remain convinced that this crisis is a necessary passage for Chris. He is on a more solid platform this time around and will continue to grow in health, thanks to the following:

1. Orthomolecular medicine
2. Medication, when necessary, in low doses and for short duration
3. Energy medicine/EFT/Visualizations
4. Assemblage Point shift and shamanic rituals
5. Magnetic therapy
6. Cathartic psychotherapies/e.g. Family Constellation Therapy
7. The Alexander Technique (not a therapy in the standard sense)
8. The Tomatis Method
9. Psychoacoustics and bioharmonic resonance
10. Time and understanding

In the coming days I will discuss these interventions and more.