ABSTRACT: CRP addresses this psychobiological disorder in terms of
non-linear dynamics instead of as a battle of opposing states. Using
Ernest Rossi’s Dream-Protein Hypothesis, a theory of this disease process
is developed which accounts for much of its phenomenology. It examines
the complex dynamics of learning and memory, which lead to greater creativity,
stability, and healing in therapy.
Bipolar disorder consists of dramatic mood changes, characterized by irrational
shifts in behavior and temperament. It used to be called manic depression,
because of the alternating between normal, manic and depressive states.
Rather than far poles of a linear oscillation, this effect is revisioned
as related states of one primary attractor which accounts for them all.
Bipolars experience both behavior and mood disorders, rooted in a
runaway feedback loop modulating highs and lows. This disease is
akin to a Hydra, the multiheaded monster from Greek mythology. It
is a virulent disorder with multiple faces, making diagnosis difficult.
Bipolars experience dramatic changes in sleeping patterns, eating habits,
may drink excessively or suddenly begin to abuse drugs. Excessive
activity, spending sprees, reckless driving, foolish business investments,
infidelity, etc. can create problems. Moods and behavior are as changeable
as weather’s unfolding divergence.
This mood disorder disrupts normal emotional states, such as happiness
or sadness. On the down side it includes depression, passivity, lethargy,
fatigue, and at the extreme, delusions, hallucinations, and thoughts of
suicide. The elated pole includes wildly racing thoughts, expansiveness,
agitation, restlessness, excitement, irritability, grandiosity, hyperactivity,
and again, when severe, delusions, and hallucinations which repeatedly
sweep over the person, altering normal personality. CRP helps ameliorate
swings, reducing need for medication.
The older term for bipolar disorder, manic depression, brings up more questions
about the disease than it answers. Its name has been in flux for
decades; in the nineteenth century it was called melancholia, which only
described one state of the total cycle. Bipolar, as a term, makes
the process sound like an oscillation between two poles, but we might better
revision it as under the influence of one characteristic non-linear attractor
which displays a cyclic nature, such as the Lorenz attractor. This
attractor has the power in the psychobiology to eventually pull all normal
states into its dynamic non-linear orbit, subsuming all energy to its unfolding
manifestation. Separating personality from the illness is a challenge
for both doctors and mental health professionals.
Diagnosing bipolar disorder proceeds by a process of elimination.
Responsiveness to lithium treatment separates the bipolar from the schizophrenic,
a frequent early misdiagnosis. Unipolar disorder, or major depression,
does not arrive with the elations seen in bipolars. Few absolutes
exist in the diagnosis or treatment of manic depression. It is, at
times, an amorphous disease, lacking solid boundaries and a clear shape,
and this is reflected in the healing journeys. It is considered full
remission when an individual has remained symptom free for at least six
A very noticeable characteristic of manic depression is a changed sleeping
pattern. A person may sleep very little, not sleep for days, or sleep
for ten or fifteen hours a day. This is a cardinal sign of onset
of a manic-depressive episode. Eating habits may range from binges
and gorging to near starvation, perhaps with a sudden commitment to vegetarianism
or other dietary notions.
In the same vein, a manic-depressive may self-medicate, drinking excessively
or suddenly begin abusing drugs. Drugs of choice include cocaine,
amphetamine, MDMA, or Ecstasy, and sometimes heroine. Stimulants
deplete the brain of “feel good” chemicals, and this imbalance can trigger
initial or chronic cycles. The exhileration of the highs becomes
so coveted, and the lows so desperate that attempts to self-medicate lead
to a spiral of increasing depression, loss of self-esteem, and suicidal
thoughts. This pain can lead to irritability, displays of anger,
and even violent outbursts.
Excessive activity is another feature of mania, and the typical examples
include spending sprees, reckless driving, and foolish investments.
Sex drive is often heightened dramatically, and an otherwise faithful companion
may become exhaustive or wildly promiscuous.
Telltale moods and racing thoughts or “flights of ideas,” are other indicators
of emotional states. Symptoms sweep over the manic-depressive dramatically
altering the normal personality on a chronic basis once the onset of the
disorder begins. Symptoms may be mild, moderate, or severe (with
or without psychotic features).These are not just passing moods or whims,
but all-consuming obsessions that produce bizarre behavior.
The person has a limited attention span, distractability, where attention
is easily drawn to unimportant or irrelevant external stimuli. Children
or adolescents with affective disorders are often misdiagnosed with attention-deficit
disorder (see ADD amd CRP). Manic depression is only beginning to
be recognized as arising in childhood.
Feelings of elation, exaggerated overconfidence, and grandiosity are often
translated into boasting, unrealistically ambitious work plans, or lavish
spending. “Pressured speech” leads to nonstop monologs that may go
on for hours, with words or sentences holding no order or logic.
Ideas just tumble out. Puns, rhymes and “klangs” may dominate a person’s
It is not unusual for a manic-depressive to be fascinated by a certain
piece of music or a particular musical instrument. Another strange
symptom is hypergraphia, or an obsession with writing, with the person
producing pages and pages of idiosyncratic scribbling. Delusions
or hallucinations may emerge, such as hearing voices or seeing UFOs or
religious figures, or other sights.
There may be paranoid thoughts and paranoid behavior. Delusions can
include grandiose beliefs, a person may think she has special skills or
talents, or is related to a famous person. Mania also encompasses
“ideas of reference,” such as being the object of attention and whispers
by friends and strangers, or receiving messages within media broadcasts.
Hallucinations and delusions are more common features when the first manic
episode comes early in life, in the teens. Substance abuse may be
the trigger, but not the cause of onset.
Manic depression coupled with a substance abuse problem is called “dual
diagnosis.” It’s a complicated diagnosis because it immediately raises
the question of which trouble came first and whether one problem is fueled
by the other. Psychiatric symptoms, particularly depression generally
precede substance abuse, reinforcing the self- medication theory.
Once alcohol or drugs accent a person’s mania and depression, they feed
on one another. Chronic drinking amplifies a person’s mania and depression.
And substance abuse highlights psychiatric symptoms and adds behavior problems.
On the other side, constant, debilitating depression aggravates drinking.
Sometimes drugs can trigger depression, mania, or even psychotic thoughts
in a person who is otherwise healthy, such as cocaine psychosis (acute
Symptoms of depression include depressed or irritable mood most of the
day, nearly every day; diminished pleasure or interest in all, or almost
all, activities; significant weight loss and lack of appetite; insomnia
or hypersomnia nearly every day; psychomotor dysfunction; fatigue or loss
of energy nearly every day; feelings of worthlessness or excessive or inappropriate
guilt beyond self-reproach; indecisiveness; recurrent thoughts of death.
Depression may be mild, moderate or severe, with or without psychotic features
like delusions and hallucinations. Six months with no significant
signs or symptoms is considered a full remission.
There are a few types or degrees of the disorder. Mania and depression
do not occur in even opposition and may appear simultaneously, paradoxically.
“Mixed mania” or “mixed states” express as overlapping moods, hyperactive
while feeling depressed and unhappy with oneself. Half of those diagnosed
manic-depressive have this mixed mania. It defies containment, with
mood swings more changeable than the weather.
“Rapid cycling” is when the disease process moves quickly back and forth
between mania and depression. Rapid cyclers may have four or more
episodes a year, with no relief in between disordered states. The
cycle can be as regular as clockwork and sometimes relates to seasonal
changes. It is often aggravated by antidepresssant drugs. Thus,
attempts to relieve the suffering by doctors may worsen depression and
cycling. Very rapid cycling bipolar disorder is also more likely
to resist lithium treatment. A condition called Bipolar II is not
quite manic depression and not quite major depression.
Cyclothymia is a less grievous, often subclinical, form of manic depression,
so it often goes undiagnosed or treated. It is one notch down in
severity from Bipolar II. It is closer to a personality disorder
with repeated episodes of depression and hyperactivity, and while these
impair social functioning, they do not usually lead to hospitalization.
As described by Berger and Berger (1991):
“A person suffering from cyclothymia can be thought of as the walking
wounded. While the exaggerated mood may not be intense or long, the
illness can bring about a string of unhappy and painful crises although
a person may continue to function (albeit marginally) at work and home.
Someone with this disorder may be moody, irritable, anti-social, unstable,
impulsive, and volatile. The cyclothymic sometimes abuses drugs or
alcohol. He may have marital problems or be promiscuous; start projects
or jobs that he never finishes; change jobs or homes constantly; argue
loudly, then feel very contrite; swing between feeling inferior and feeling
grandiose and superior; or go on spending sprees.”
“To be diagnosed as cyclothymic, a person must have gone through episodes
of mildly manic and depressed moods for at least two years. Another
feature is that it often appears in a person’s childhood or teen years.
The underlying mood in cyclothymia seems to be depression, and many of
its victims progress to more marked depression and a bipolar II diagnosis.
Others may live their entire lives without medical attention or treatment,
and are simply known as very moody people who can’t hold down a job, drink
excessively, and go through many marriages or romances. In short,
they barely cope or cope miserably.”
Diagnosis may be lumped under the catchall category of Schizoaffective
disorder until symptoms are defined and treatment options tried which push
the diagnosis in a clearer direction. Only time reveals the true
nature of the illness and the best way to treat it. Numerous physical
conditions must be ruled out, including hormonal or metabolic disorders,
epilepsy, tumors, blood disease, and metal toxins, or drug treatments.
CONVENTIONAL TREATMENT OF BIPOLAR SYNDROME
Manic depression is a tangle of heredity, biology, and environment--a collection
of causes. Diagnosis procedes by interview, using a variety of scales.
Since they are subjective, it is also useful to take a family history from
a family member or friend. Affective disorders run in families and
through generations, and so probably have genetic origins. The emotional
atmosphere in a family influences a person’s response in treatment and
the course of the illness.
This interview highlights the connections between episodes and critical
life events. Manic-depressive people are notorious for denying the
illness in the manic, depressed, or remission state. They are likewise
notorious for their lack of insight into their own behavior, at least while
they are ill. Despite intellect, education, or tangible evidence,
they may not perceive their behavior as unusual, much less bizarre.
Brain chemistry, hormones, and emotional life have all been examined as
causes of the disorder. Chemistry and biology interact with life
course, inseparably. Some people have more natural resilience to
recovering from personal disappointment than others do. An inherited
lack of emotional resilience may be the predisposing factor. That
doesn’t mean it is the cause of developing the affective disorder.
This resilience could be programmed in the brain in its neurotransmitter
systems, such as the norepinephrine and serotonin systems.
Drug treatment varies for different individuals and is most often combined
with psychotherapy. The therapy is done by someone other than the
doctor assigning medications. Lithium remains the mainstay among
the few drugs aimed solely at both poles of this disease. Not all
bipolar patients improve with only lithium.
Lithium acts as a kind of security guard, halting the movement of unique
proteins that set off a chain reaction leading to mania or depression.
At least, that’s the theory. A typical daily dose ranges from 600
- 2400 mgs. It only begins to work aafter days or even weeks.
Troubling side effects are hand tremors, acne, stomach cramps, weight gain,
and fuzzy thinking.
Other drugs target specific symptoms. They include antidepressants,
antipsychotics, anticonvulsants, and antianxiety drugs. But drugs
are not a panacea and come with a price. The wonders of chemical
modification carry serious, sometimes frightening, and occasionally devastating
The anticonvulsant Carbamazepine (Tegretol) is given to those who don’t
improve on lithium, and are rapid cyclers (4 or more per year). It
eases mania and anxiousness but also depression and feelings of despair
and hopelessness. Average dose ranges from 400 to 2000 mgs. daily.
More is not necessarily better, and dose must be monitored to achieve balance,
or there is dizziness, sleepiness, double vision, slurred speech, and loss
Drugs do not cure manic depression, they simply relieve its symptoms, and
not very well at that. For the fortunate, a drug can deliver a lifelong
remission. For the unfortunate, the symptoms will return, regardless
of which medication they are on.
TRANSACTIONAL THERAPY AND MANIC DEPRESSION
T.A. describes the assessment, development, and treatment of manic depression,
especially in those with more subtle forms of the disorder, and proceeds
without medication. Developmental foundations of this structure result
from three distinct factors: (1). parenting from a competetive frame
of reference; (2). early emphasis on doing (or not doing) things; (3).
and a grandiose approach to thinking, feeling, and doing.
The inner Child makes two separate adaptations to the two sets of Parent
messages. The Adult self has resulting difficulty solving problems.
The separation is maintained by denial as a primary defense, making them
poor reporters of their own history. They often enter therapy for
treatment of depression, complaining of lack of energy, disinterest in
work, and general difficulty with motivation (Loomis and Landsman, 1980,
“Doing things,” “getting things done,” is a primary issue which takes precedence
over feelings. Questions about anger, sadness, loneliness, or fear
are either redefined or avoided. One type of bipolar needs to be
constantly doing something to feel worthwhile, and the other can’t seem
to complete anything. When a high degree of agitation is present,
they try to do too many things and don’t do any of them well. Thinking
is grandiose, but energy is diffuse, not goal-directed.
The bipolar’s early experience of parenting impacts ego state development
and life script decisions. During both highs and lows, the Adult
is periodically “blocked-out.” The decision to abdicate Adult executive
responsibility is made during the first two years of life in response to
“overwhelming” parental inconsistencies and contradictions.
The young person adapts to the unpredictable nurturing with elation, and
to periodic, but unpredictable abandonments with depression. This
produces an internal Parent-Child dialogue which is as inconsistent as
the early parent-child experience.
One type of bipolar disorder comes from sudden withdrawl, either psychological
or physical, of available nurturance between six months to five years of
age. These security-seeking individuals become dedicated people,
motivated by duty with a high investment in doing things well (whether
for the firm, party, or church).
A second type is more passive-dependent and demanding, expects to be taken
care of by others, and empowers others with their happiness or unhappiness,
success or failure. A third type decides not to incorporate the original
parents, and actively does things as a means of escaping both himself and
closeness with others.
In the competition between parents and child for who will avoid agitation,
competition is eventually acted out within the context of doing (or not
doing) things. In these families, no two people can be thinking,
feeling, or doing the same thing at the same time. This applies to
feelings and areas of knowledge. The competition can begin as early
as the spoon-feeding stage, with a paranoid or manic-depressive parent.
In competitive families, survival is connected with winning or losing;
parents model inconsistency and agitation. Parenting alternates between
very good and very bad. There are outbursts of verbal and/or physical
abuse unrelated to the child’s infractions. During these drastic
swings the self is experienced as either very good or very bad. Denial
is the defense by which this discrepancy is maintained.
Overnurtured children fail to deal with the narcissistic injury of discovering
they are not the center of the universe. Undernourished children
develop a fantasy of the Good Parent who will someday provide the desired
nurturing. Neither idea is tested against reality and is therefore
carried into adulthood.
Life Script issues for the bipolar include injunctions of Don’t Be, Don’t
Feel, and Don’t Be Close. Don’t Be comes from angry parental outbursts
and withdrawl of affection and nurturing. Don’t Feel centers on the
agitation around feelings that are experienced as overwhelming. Don’t
Be Close is the injunction behind the high level of agitation and activity
in these families who keep moving to avoid intimacy (especially if one
parent has a bipolar structure).
The family’s competetive frame of reference leads to Don’t Be You and Don’t
Make It injunctions--denial of certain aspects of the self. Parents
model the fact that problems can’t be solved within or without the competetive
frame of reference. They may also model how to pretend, keep secrets,
and even go crazy as an “out.”
Alternatively, parents may be grandiose, suggesting “You can do anything
in the world you set your mind to,” and on the other hand issuing a competetive
challenge. “Just try to please me,” is the message, but “You’ll never
beat me,” is the subtext. These messages may come from the same or
both parents. They combine with Hurry Up, Try Harder, and Please
Me functioning a bit stronger than Be Perfect and Be Strong.
The ego state network of bipolar structure comes from parental modeling,
counterscript messages, injunctions, and script decisions. The pathology
is more serious the younger the trauma begins and script decisions are
made. Alternately grandiose and punitive messages, and separate Child
adaptations to those message produce an Adult who discounts significance
and therefore has difficulty solving problems.
A great deal of energy is invested in maintaining the denial which keeps
the two sides of the structure apart. When manic, they may deny ever
being depressed or suicidal; when depressed they may deny having ever done
anything worthwhile. Yet this inconsistency is not perceived as internal
This primitive defense mechanism takes a tremendous amount of energy to
maintain in adult life. These energy problems are experienced as
beyond their control, coming over them from nowhere. When denial
periodically breaks down, there is a “leak” from one side of the structure
to the other. This leak is experienced as growing into a powerful
energy shift outside of their control.
Conditional Ok-ness requires that one keep moving, keep performing, keep
doing things to survive or gain approval. This conditional system
creates an angry “I’ll show you” position, or “I’ll beat you at your own
game.” Therefore, the adult learns to discount the significance of
both internal and external stimuli.
On the depressed side, the inner discounting parent withdraws or withholds
strokes. The child reacts to the depressive parent by deciding they
must be bad and will never make it. They decide not to feel and not
to exist; the situation seems hopeless, and is internally and externally
recreated over and over.
Once this dichotomous structure is in place, tremendous energy is invested
in maintaining it. On the manic side the person becomes involved
in excessive activity to avoid being depressed. On the depressive
side they describe trying not to get invested in anything for fear of not
being able to do it well enough and reexperiencing being told they are
Natural Child feelings are locked out when energy is misdirected toward
maintaining one or the other adaptation. Those who can’t mobilize
their energy avoid the manic side of the structure as actively as the manic
fears depression. Bipolars generally present for treatment in the
depressed swing of the cycle.
To summarize, the structure consists of two, seemingly incompatible adaptations
to chaotic parenting with mixed messages and double-binds (“Damned if you
do; damned if you don’t”). Denial maintains the internal contradictions.
As long as the internal grandiose and competetive structure is maintained,
the person has difficulty in solving problems, and continues to discount
the significance of stimuli.
In T.A. therefore, the overall goal of treatment is integration.
The therapist needs to come from a non-competetive place. Contracts
need to be made not to run from disclosure, closeness, or contact with
the therapist (No Running Contract). The therapist must enact a realistic
nurturing parent, avoiding gradiose expectations, by caregiving in a healthy
manner. There will be limit testing, so clear boundaries are essential.
Clients change rapidly when they lower their defenses and give up the denial
that maintained the structure. The therapist must pace and adjust
to these rapid changes. The first priority is dealing with behavioral
manifestations. The second is dealing with developmental and script
issues. The third is the structural and integration issues of the
There are relevant therapeutic tasks at each of the five typical stages
The five stages include the following: (1) lower defenses, (2) decontamination
work, (3) exclusion work, (4) integration, and (5) resolution.
Each has specific goals: (1) set basic contracts, deal with behavioral
manifesstations, achieve and maintain social control; (2) confront grandiosity
and discounting, emphasize use of Adult for problem solving, transactional
and game analysis; (3) deal with developmental and script issues, provide
realistic Nurturing Parent, provide integration messages; (4) facilitate
decision to alter (rather than adapt sstructure), facilitate decision to
give up fantasied Nurturing Parent, teach increased awareness and control
of energy cathexis; (5) facilitate natural, realisstic use of options for
thinking, feeling, and doing. (Loomis and Landsman, 1981).
Contracts include not a No Run caluse, but also a No Secrets or Lies of
omission or commision, and a No Suicide/No Homicide agreement. When
denial no longer contains the homicidal rage of the manic side the depressed
infant struggles with existential issues. Clients learn to slow down
the manic Child and assess the significance of all relevant stimuli before
doing things without adult considerations of consequences. While
this decreases the excitement of the Child by processing everything through
the Adult, the Natural Child’s spontaneity eventually becomes available.
New messages counteract grandiosity: “Most problems have a solution;”
“You are capable of solving problems.” This ameliorates the need
for hypomanic activity to avoid feeling depressed, and moderate depression
to avoid the discomfort of being manic. The notion that one must
be polarized as either totally manic or totally depressed is confronted
as grandiose, mutually exclusive, and internally competitive. The
competetive drives are reduced and that energy is freed up for creativity.
Energy is available in a more economic fashion.
Attention is paid to the familiar transactions and games with which the
client furthers the manic-depressive script decisions. The bottom
line or script pay off of this structure is to end up all alone and not
existing (a younger construct than death). It holds true whether
the overt behavior appears to be engaging or rejecting of others.
The real problem is maintaining the defensive internal barrier.
Rapid shifting from one ego state to another means experiencing difficulty
maintaining the Adult. This is a natural result of the common theme
of early infant depression (0-3 months). The attempt to close out
external stimuli comes from experiences of either fear or grief.
Associated sensations can only be described by terms such as “non-existence,”
“waves of sadness, grief, fear, or anger which are all-consuming.”
Each manic-depressive is unique. Some have been over-nurtured, some
abused, some expected to never win, and some never to lose, but the key
issue is existence, “I exist, therefore I am bad.” Bipolars have
built eleaborate internal structures which can be identified, worked through
and integrated. They, themselves need to decide to alter their basic
structure, not just adapt to it.
Once they abandon denial of thoughts, feelings, or behavior as an alternative
for solving problems, grandiosity and discounting are no longer necessary.
They can choose when and how they will compete. Then the Natural
Child can express more freely. They learn to identify the difference
between sadness related to tangible loss and their previous dark, lonely
depressions. They report a natural realistic use of options for thinking,
feeling, and doing things with excitement and spontaneity that is fun to
share. This enables them to continue developing as autonomous, flexible,
and productive people.
A DYNAMICAL APPROACH TO BIPOLAR DISORDER
Those seeking psychotherapy for bipolar disorder need to check out the
orientation of the process they intend to employ. Therapists have
different philosophies of treatment, even though one third to one half
use an eclectic approach. Client motivation for change is the highest
predictor of success in therapy. Rapport is another essential quality--good
chemistry. The therapist should understand the initial grief reaction
and the shock of learning about manic depression and feelings of hopelessness
and despair that sometimes accompanies acceptance of this condition.
The CRP process uses the language of complex dynamic systems (CDS) and
Chaos Theory to model the forms of disorders or dis-ease and the healing
dynamic. This system describes the way nature, herself, works toward
growth and evolution. CRP is a healing journey which generally begins
with a dream.
Journeys take place in REM and facilitate a fundamental restructuring of
consciousness wherein disease patterns are dissolved and spontaneous healing
and self-creation emerges. This process helps access the power of
the placebo effect and a variety of mind/body healing channels, which operate
at levels from those of quantum physics and genetics, to neurohormonal
and neurological feedback loops.
There is order even in disorder. There is order, manageable chaos
(fractals) and unmanageable chaos. The fractal dimension expresses
the complexity of a particular fractal form. “Fractal” comes from
the Latin fractus, which mean broken or fragmented. Fractals delineate
a whole new way of thinking about structure and form -- even the forms
of dis-ease, which take root organically in the body and psyche.
Magnify a fractal again and again and more detail emerges from its infinitely
embedded structure. The same self-similar patterns repeat, over and
over, no matter what level you care to examine. You look closer and
closer and still see the same form. A single image is infinitely
reiterated. Thus, a wealth of structure emerges from simplicity.
So, too, the dis-ease process can be seen at the physical, emotional, mental,
and spiritual levels. Yet, the form remains the same.
It helps to conceptualize the bipolar disorder in dynamic terms.
Tiny variations are amplified on every bounce in Chaos Theory, and this
holds true in manic-depression. The mask-like shape of the Lorenz
strange attractor is used to model weather and climate. It can also
be used to model the bipolar syndrome with its internal climate, which
ravels and unravels emotional storms and temperature changes. Creating
fair and foul weather, it constantly folds back on itself. It is, at times,
an amorphous disease, lacking solid boundaries and a clear shape, and this
is reflected in the healing journeys.
In terms of the natural healing process, bipolar disorder indicates and
describes a breakdown in the cycle, a fragmented worldview permeating all
levels. It produces over-compensating swings attempting to correct
imbalance. In bipolar disorder, there classically is a psychobiological
disruption of circadian cycles disturbing sleep cycles, leading to rebounds
from sleep deprivation, for one example.
Mania and depression appear as opposite states, when they are, in fact,
simply connected but in a non-linear way. Energy is “dammed up” in
the depressive phase, then when the dam breaks, overexpended in the manic
phase, which depleats it, leading to cycling.
Chance fluctuations, or “noise,” in the electrical signals of the brain
interfere with the signal’s message in self-destructive ways. The
body can modulate mental experience and mental experience can modulate
the molecules of the body. Excessive trauma or psychosocial stress
can lead to a suppression of growth processes in the brain.
The traumatic situations are most often self-generated. Consequences
of behavior are completed ignored. A bipolar episode where an individual
can wind up being carted off in a straight-jacket for attacking a police
officer when stopped for a simple traffic infraction can be considered
CREATIVITY AND MADNESS: MYTH OR FACT
Research shows a remarkable tie between artists and affective illness.
Among groups of proven creative people, affective illness strikes upward
of 80 percent; around 43% of those are manic depressive. Among writers,
80% will probably have an episode of affective illness in their lives.
The general percentage may be even higher, as artists in nonverbal fields
(painting, sculpting, dance) are less likely to seek treatment. Also
artists are able to find catharsis in their work, naturally providing themselves
with an art therapy, a sign of the natural healing process coming forward.
“Where exactly does the creative process intersect with mental illness?
Intense creativity...closely resembles shades of mania, or what’s called
hypomania. They report increases in enthusiasm, energy, self-confidence,
mental quickness, rapid ideas, and an elevated mood.”
“The feelings most useful to a creative hypomanic are heightened emotional
sensitivity, absence of inhibitions, and prolonged concentration or intensity.
Many say they need much less sleep during these times, and some awake at
three or four o’clock in the morning, unable to sleep and ready to work.
All the evidence points to hypomania as most resembling creative fervor.”
(Berger and Berger).
When hypomania crosses over into full-blown mania, however, the distortions
of the condition yield work with little artistic merit. On the other
hand, the depression, of course stifles creativity completely. It
can be incapacitating, and it takes energy to create.
“The similarity between early stages of mania and creative fervor has
led to research on the link between cyclothymia (mild manic depression)
and creativity. Unlike previous research that first identified creative
people, then examined their mental history, researcher Ruth Richard started
with a group of seventeen manic-depressives and sixteen cyclothymics, then
examined their creative accomplishments. According to her Lifetime
Creativity Scale, cyclothymics showed the second highest level of creativity.”
“On this scale, the most creative accomplishments were by immediate
relatives of manic-depressives. Consistently, the siblings, parents,
and children of manic-depressives have exhibited unusually high levels
of creativity. (Not surprisingly, relatives of writers also produced
many more cases of psychiatric illness than nonwriters’ relatives.)
41 percent of writers’ siblings showed creativity versus 18 percent of
nonwriter’s relatives. Interestingly, relatives’ creative activities extended
beyond writing to art, music, dance, and even math. Families of writers
were riddled with both creativity and mental illness.”
“Thus, creativity and mental illness not only appear in the same people
but in the same families. While this obviously suggests a genetic
connection, no proof of this has been found yet. Mental illness and
creativity seem to be irrefutably, mysteriously, tied together. Nevertheless,
this connection is a dangerous one because it can distort the true nature
of each. This partnership can paint an attractive picture of mental
illness by suggesting it carries special talents and the seeds of extraordinary
artistic creation. On the other hand, creativity may appear to be
a product of sickness and chaos, with fabulous works of art composed by
unhinged minds. So this partnership has to be kept in perspective.
We have to be wary of generalizations about either madness or genius, recognizing
that often they do not intersect and are usually at war with each other.”
(Berger and Berger).
Ernest Rossi (1999) has developed a pertinent creativity hypothesis: “Enriching
life experiences that evoke psychobiological arousal with positive fascination
and focused attention during creative moments of art, music, dance, drama,
humor, spirituality, numinosity, awe, joy, expectation, and social rituals
can evoke immediate early gene protein cascades to optimize brain growth,
mindbody communication, and healing.”
“[The] psychotherapeutic approach can contribute to psychobiological
arousal, enrichment and relaxation; it may be possible to help people find
optimal levels of mental stimulation to facilitate actual growth in the
hippocampus of their brain to encode new memory, learning and behavior...optimizing
psychobiological growth and healing.”
ROSSI’S DREAM-PROTEIN HYPOTHESIS ON HEALING
Rossi (1999) describes a mind/body communication channel that is pertinent
both to bipolar disorder, but also to CRP in that it may describe another
way healing manifests from REM. He describes how immediate-Early
Genes (also called “Primary Response Genes” or third messengers) play a
central role in the dynamics of waking, sleeping, dreaming, and mind-body
healing at the cellular level.
There is evidence that “immediate-early genes (IEGs) function as mediators
of information transduction between psychological experience, behavioral
states, and gene expression. A wide range of behavioral state-related
gene expression (from relaxation, hynosis and sleep to high arousal, performance,
stress and trauma) culminate in the production of new proteins or homeostasis,
physical and psychosocial adaptation.”
Behavioral states modulate certain patterns of gene expression. Interaction
between the genetic and behavioral levels is a two way street. Genes
and behavior are related in cybernetic loops of mind-body communication.
How does this relate to manic depression?
A look at the systems related to IEGs, shows that they affect all the systems
disrupted in bipolar disorder. They are expressed continually in
response to hormone messenger molecules mediating processes of adaptation
to extracellular signals and stimuli. Extracellular stimuli come
from the outside environment, including temperature, food, sexual cues,
psychosocial stress, physical trauma, and toxins. IEGs are fundamental
in the sleep-wake cycle, appetite regulation, sexual response, and reactions
to stress, trauma, and toxins.
There are persistent alterations in IEG expression in the process of adaptive
behavior on all levels from the sexual and emotional to the cognitive.
They can transduce relatively brief signals from the environment into enduring
changes in the physical structure of the developing nervous system as well
as its plasticity in the form of memory and learning throughout life.
If external cues can modulate cell function through regulation of gene
expression, this could also be true for internal cues.
IEGs are also fundamental in the regulation of REM-on, REM-off neurons,
neuronal networks that are associated with REM sleep and dreaming.
That makes them significant in CRP as molecules which can modulate mind,
emotions, learning and behavior. They influence the rhythm of the
natural healing process and circadian and ultradian rhythms of the body,
in general. Ultradian rhythms are those shorter than the 24-hour
Milton Erickson discovered that his therapy sessions usually took from
one and a half to two hours to come to natural closure. Later it
was discovered that this delineates the natural work cycle that is harmonious
with our own internal rhythms. CRP unfolds in a similar time-frame. IEGs
modulate this process. This ultradian time frame is related to the
activation or deactivation of the expression of specific genes and can
occur in a matter of hours or even minutes.
“Most arousing environmental stimuli that have been studied can induce
immediate-early genes within minutes, their concentrations typically peak
within fifteen to twenty minutes and their effects are usually over within
an hour or two. These time parameters IEG expression and their ultimate
translation into the formation of new proteins correspond to the parameters
of a complete work cycle of mind-body communication and healing.
The changes in gene transcription and new protein formation initiated in
this time frame, however, can lead to lasting changes in the central nervous
system by converting short term memory to long lasting learning by the
process of long term potentiation. . .the activation or deactivation of
the expression of specific genes can occur in a matter of hours or even
This mechanism assesses the duration and intensity of prior waking and/or
the homeostatic or executive mechanisms that bring about sleep. This
is likely the mechanism that is disturbed in the manic depressive which
results in sleep disorders. Sleep deprivation leads to a wide variety
of psychotic and non-psychotic symptoms. This system is also associated
with the neuronal network associated with the dynamics of REM sleep.
Deprivation of REM and dreaming creates its own phenomenology.
“The study of IEGs indicates that sleep and wake, as well as synchronized
and desynchronized sleep, are characterized by different genomic expressions,
the level of IEGs being high during wake and low during sleep. Such
fluctuation of gene expression is not ubiquitous but occurs in certain
cell populations in the brain. Thus...IEG induction may reveal the
activation of neural networks in different behavioral states. Do
the areas in which IEGs oscillate during sleep and wake subserve specific
roles in the regulation of these physiological states and a general ‘resetting’
of behavioral state? Is gene induction a clue to understanding the
alternation of sleep and wake, and of REM and non-REM sleep?”
In Rossi’s Dream-Protein Hypothesis, “new experience is encoded by means
of protein synthesis in brain tissue...dreaming is a process of psychophysiological
growth that involves the synthesis or modification of protein structures
in the brain that serve as the organic basis for new developments in the
personality...new proteins are synthesized in some brain structures associated
with REM dream sleep.”
Rossi generalizes the dream-protein hypothesis, “to include all states
of creativity associated with the peak periods of arousal and insight generation
in psychobiologically oriented psychotherapy.”
Enriched internal and external environments leads to the growth and development
of new cells. IEG cascades lead to the formation of new proteins
and neurons along with increased synapses and dendrites that encode memory
and learning. On the other hand, excessive trauma and psychosocial
stress can lead to suppression of growth processes in the brain.
When psychotherapy contributes to arousal, enrichment, and relaxation it
facilitates actual growth in the brain to encode new memory, learning and
behavior, optimizing growth and healing.
“Communication within the neuronal networks of the brain is modulated
by changes in the strengths of synaptic connections...meaning is to be
found in the complex dynamic field of messenger molecules that continually
bath and contextualize the information of the neuronal networks in ever
changing patterns. Most of the sexual and stress hormones...have
state dependent effects on our mental and emotional states as well as memory
and learning, a constantly changing dynamical field of meaning.”
CIRCADIAN CYCLES: The Biological Clock. In mammals the master
clock that dictates the day-night cycle of activity is known as circadian
rhythm. It resides in a part of the brain called the suprachiasmatic
nucleus (SCN), a group of nerve cells in a region at the base of the brain
called the hypothalamus. But cells elsewhere also show clock activity
(Young, 2000). Within individual SCN cells, specialized clock genes
are switched on and off by the proteins they encode in a feedback loop
that has a 24-hour rhythm.
The molecular rhythms of clock-gene activity are innate and self-sustaining.
They persist in the absence of environmental cycles of day and night.
Bright light absorbed by the retina during the day helps to synchronize
the rhythms of activity of the clock genes to the prevailing environmental
cycle. Light hitting the eye causes the pineal gland of the brain
to taper its production of melatonin, a hormone that plays a role in inducing
sleep. The fluctuating proteins synthesized by clock genes control additional
genetic pathways that connect the molecular clock to time change in physiology
This circadian cycle is disrupted in bipolar syndrome as evidenced by the
sleep disorder and mood disorders it manifests. Identifying the genes
allows us to determine the proteins that might serve as targets for therapies
for a wide range of disorders, from sleep disturbances to seasonal depression.
Normally, the pineal rhythmically produces melatonin, the so-called sleep
hormone. As day progresses into evening, the pineal begins to make
more melatonin. When blood levels of the hormone rise, there is a
modest decrease in body temperature and an increased tendency to sleep.
Body temperature must be dropping for sleep to ensue. Levels of the
stress hormone cortisol usually fall at night also.
Bipolars break the circadian pattern; it is fragmented or chaotic.
They seem to have no circadian rhythm at all, resting and becoming active
seemingly at random. Clinical research has isolated a single gene
named period or per, which seems to be activiely involved both in producing
circadian rhythms, in setting the rhythm’s pace. Another co-active
gene is called timeless, or tim. The two proteins stick together
when mixed, suggesting they might interact within cells.
The production of PER and TIM proteins involves a clocklike feedback loop.
The per and tim genes are active until concentrations of their proteins
become high enough that the two begin to bind to each other. When
they do, they form complexes that enter the nucleus and shut down the genes
that made them. After a few hours enzymes degrade the complexes,
the genes start up again, and the cycle begins anew. We begin to
wonder how the clock could be reset.
Jadwiga Giebultowicz of Oregon State University identified the PER and
TIM proteins, and notes that biological clocks are spread throughout the
body; each tissue carries an independent photoreceptive clock. In
research, these clocks continued to function in tissue dissected from the
host. The diversity of various cell types displaying circadian clock
activity suggests that for many tissues correct timing is important enough
to warrant keeping track of it locally.
In 1997 Joseph Takahashi’s research team isolated the Clock gene: “the
CLOCK protein --in combination with a protein encoded by a gene called
cycle--binds to and activates the per and tim genes, but only if no PER
and TIM proteins are present in the nucleus. These four genes and
their proteins constitute the heart of the biological clock...they appear
to form a mechanism governing circadian rhythms through the animal kingdom,
from fish to frogs, mice to humans.”
“It seems that some output genes are turned on by a direct interaction
with the CLOCK protein. PER and TIM block the ability of CLOCK to
turn on these genes at the same time as they are producing the oscillations
of the central feedback loop -- setting up extended patterns of cycling
“Perhaps one of these, or a component of the molecular clock itself,
will become a favored target for drugs to relieve jet lag, the side effects
of shift work, or sleep disorders and related depressive illnesses.”
Rossi’s research suggests that the 90-120 minute ultradian rhythm is a
fundamental “work cycle of life” that is entrained by the circadian cycle.
The psychobiological basis of much psychopathology related to early sexual
and stressful life events suggests that molecules of the body modulate
mental experiences and mental experience modulates the molecules of the
body. A sudden fright, shock, trauma and stress can evoke “hypnoidal
states” that were related to amnesia, dissociated and neurotic behavior
(ref. Bipolar, PTSD, MPD). Off their meds, bipolars forget how sick
they can be.
Rossi suggests a new research frontier for the psychobiological investigation
of many classical psychotherapeutic notions, such as repression, dissociation
and emotional complexes. He suggests they are related to “(1) the
primary messenger molecule-cell receptor systems of the psychosomatic network,
(2) Immediate-early genes and target gene expression, (3) protein formation
and learning and (4) state-dependent memory, stress and traumatically encoded
Enhanced memory associated with emotional experiences involves activation
of the messenger molecules of the beta-adrenergic system, the arousal phase
mediated by the rhythms of the neuroendocrinal system. He suggests
a non-linear dynamics to the chronobiology of sleep, dream, and hypnosis.
The periodicity of self-hypnosis may be related to the psychobiology of
ultradian rhythms or the natural work cycle. In bipolars, this self-hypnotic
cycle may go awry and become non-rhythmic, nonrestorative. 90-120
minutes is the basic rest-activity cycle during both waking and sleeping.
There is also periodicity in the imagery experience as demonstrated by
Special stressors, motivations, demands and expectations in normal living
can shift the normal ultradian and circadian pulsations in arousal and
stress hormones on all levels from the behavioral to the cellular-genetic.
This process is best described by non-linear dyanamics of chaos and adaptive
This research is integrating work on the creative dynamics of psychotherapy
and holistic healing in theory and practice. It focuses on a chronobiological
approach to the deep psychobiology of sleep, dreams, hypnosis, and healing
in psychotherapeutic practice. When the 90-120 minute ultradian cycles
of mindbody communication unfold over time they display alternating rhythms
of activity and rest.
There is a normal peak in cortisol just before awakening. Also, ultradian
peaks of cortisol secretion that lead to psychophysiological states of
arousal every 90-120 minutes or so are typically followed by about
20 minutes of ultradian peaks of beta-endorphin that lead to rest and relaxation,
that Rossi labels the Ultradian Healing Responses, a natural but flexible
and highly adaptive ultradian rhythm of activity, rest, and healing.
The chronobiological dynamics of new protein formation are fundamental
to healing and psychotherapy. For Bipolar Disorder, psychotherapy
can entrain the ultradian and circadian rhythms by physical and psychosocial
stimuli and recalibrate internal clocks, facilitating mindbody healing.
Rossi summarizes how “self-organizing systems of mind-body communication
across all levels from the cellular-genetic to the psychosocial and behavioral
could lead to a unified psychobiological theory of awake, sleep, dreaming,
hypnosis, and healing.”
Research in the areas of behavioral state-related gene expression, psychoimmunology,
and state- dependent memory, learning and behavior is integrated with the
chronobiology of ultradian rhythms as a new window into the psychobiology
of trauma and stress as well as brain growth and healing.
BIPOLAR DISORDER AND CONSCIOUSNESS RESTRUCTURING
APPENDIX: Body Changes Over 24-hour Period
1:00 AM: Pregnant women are most likely to go into labor. Immune
cells called helper T lymphocytes are at their peak.
2:00 AM: Levels of growth hormone are highest.
4:00 AM: Asthma attacks are most likely to occur.
6:00 AM: Onset of menstruation is most likely. Insulin levels in
bloodstream are lowest. Blood pressure and heart rate begin to rise.
Levels of stress hormone cortisol increase. Melatonin levels begin
7:00 AM: Hay fever symptoms are worst.
8:00 AM: Risk for heart attack and stroke is highest. Symptoms of
rheumatoid arthritis are worst. Helper T lymphocytes are at their
lowest daytime level.
Noon: Level of hemoglobin in the blood is at its peak.
3:00 PM Grip strength, respiratory rate and reflex sensitivity are highest.
4:00 PM: Body temperature, pulse rate and blood pressure peak.
6:00 PM: Urinary flow is highest.
9:00 PM: Pain threshold is lowest.
11:00 PM: Allergic responses are most likely.
American Psychological Assn, DSM-IV
Berger, Diane and Lisa (1991); We Heard the Angels of Madness: One family’s
struggle with manic depression, William Morrow and Company, Inc.: New York.
Loomis, Maxine and Landsman, Sandra, “Manic-depressive structure: assessment
and development,” Transactional Analysis Journal, Vol. 10, No. 4, October
1980, pp. 284-290.
Rossi, Ernest (2000); “Sleep, dream, hypnosis and healing: behavioral state-related
gene expression and psychotherapy,” in Sleep and Hypnosis: An International
Journal of Sleep, Dream, and Hypnosis, 1:3, 1999, pp 141-157.
Young, Michael W., “The tick-tock of the biological clock,” SciAmer, Mar
2000, pp. 64-71.