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BioPsychoSocial Medical Office, Inc. |
Kamal Artin, MD Diplomate, American Board of Psychiatry and Neurology 4482 Barranca Pkwy, Ste 130, Irvine, CA 92604 , Tel (949) 451-1789 Fax (949) 451-1431 |
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Correlation of Mood and Creativity and the Role of Treatment July 23rd, 2006 Abstract Objective: Many patients who suffer from a mood disorder are reluctant to follow treatment recommendation, especially pharmacological intervention. Some with an artistic temperament argue that treatment would have a negative effect on their creativity. The purpose of this article is to review the literature on the mood or affective disorders, what to look for in the workup and symptom cluster to establish the diagnosis, what studies have been done on the link between the two, and the effects of treatment on creativity. Method: Using keywords such as affective disorder or mood disorder, and creativity, the available and relevant literature on pub med was reviewed. In addition to some of the standard available books in the filed, a popular websites was also reviewed, as noted in reference list. Results: Episodic changes in the functioning of mind do not have a social and cultural boundary. One of the most studied spectrum of mental illness that has been associated with episodic changes is affective or mood disorder spectrum that includes dysthymia, cyclothymia, major depression and bipolar disorder. Many studies have suggested a link between affective disorders and creativity, both of which happen to be episodic. The creative patients suffering from any of the disorders in this spectrum might question the need for treatment either because of fear of stigma or the negative effect of the treatment on their creativity. Conclusion: The link between creativity and mood disorder is controversial, yet clinicians agree that treatment has a positive effect on patients' overall wellbeing and creativity. Introduction Episodic changes in the functioning of the mind could lead to creativity, mental illness, or both. Benjamin Rush, the father of American Psychiatry and a signer of the Declaration of Independence, had once said, "From a part of the brain preternaturally elevated, but not diseased, the mind sometimes discovers not only unusual strengths and acuteness, but certain talents it never exhibited before; talents for eloquence, poetry, music and painting, and uncommon ingenuity in several of the mechanical arts are often evolved in this state of madness"(1). Contrary to the stigma that mental illness afflicts only the socially disadvantaged, uneducated, lazy, and violent individuals, it seems that personal and social background is not a major factor in the illness of many great minds, such as Vincent Van Gogh (2), Nikolai Gogol (3), Abraham Lincoln, and Winston Churchill (4), to name a few. The purpose of this article is to review the literature on the mood or affective disorders, which is notable for episodic changes in the functioning of the mind that can be indicative of the illness, creativity, or both. Establishing diagnosis of an affective disorder The details of a comprehensive diagnostic interview and work-up to establish the diagnosis can be found in major psychiatric text books. As an example, Hagop Akiskal, an expert on mood disorders, has described the details of mood or affective disorder spectrum in Sadock and Kaplan’s textbook of psychiatry that include dysthymia, major depression, cyclothymia, and bipolar disorder (5). What differentiates patients with affective disorder from others is that their episodic illness manifests itself with certain signs and symptoms. Instead of reviewing all of the textbook’s criteria of affective disorders spectrum, I will try to highlight major clinical sign and symptoms and elements of diagnostic interview and work-up in clinical practice. While dysthymia is characterized by chronic mild sadness and pessimistic attitude for at least two years in adults, a major depressive disorder might manifest itself by persistent sadness, crying spells, loss of interest, fatigue, poor concentration, lack of self esteem, and changes in eating habits for at least two weeks. The depressed patient might feel overwhelmed with daily activity, become irritable and argumentative, and even think of giving up on life. In severe cases, the depressed individual might lose any ability to function and become delusional or start hallucinating. Cyclothymia might present with mood swings such as low grade depression, agitation, or elation and impulsivity lasting few hours to few days but frequently during the year. In cases of bipolar disorder, the individual might present a manic or mixed episode with symptoms such as irritability, fidgetiness, dysphoria, high energy, no need for sleep, grandiosity, engaging in intensified simultaneous activities such as dancing, singing, drawing, writing, excessive talking and phone calls, and impulsive intimate relations; this could end in a down-swing, with increased feelings of guilt, preoccupation with past unpleasant experiences, and suicidal thoughts. The symptoms might last few days to few weeks or even few months at times. In cases of psychotic experiences, individuals might have mood-congruent grandiose delusions, such as being the Savior, and having hallucinations, such as seeing the "Light" or hearing messages from God or people. It is not unusual for these individuals to also have incongruent nihilistic delusions and hallucinations, such as the belief that the world will soon be coming to an end, based on whatever messages they believe they've been given. If left untreated, these individuals might engage in unusual and risky activities, such as sudden promiscuity and polygamy, expansive business contracts, and even attacking others for perceived threats. Patients with clear thinking processes might describe their condition as a great experience, an enjoyable chaos, or a chaotic discomfort. If artistic, the patients might express their inner turmoil through their writings, drawings, playing music etc. In severe cases, the expression of their talent might be too disorganized and chaotic to he point it losing its artistic quality. During the interview, patients might attribute their distress to life events, conflicts during upbringing, the influence of mind- altering substances, and personality disorders. While these could play a role, with careful questioning and collateral information from family members, often the clinician detects episodic changes of affect in the patient regardless of baseline personality and psychosocial events. As persons, patients with affective disorder might be rational, calm, considerate, and productive or have personality traits of cluster B (dramatic, histrionic, manipulative, self-centered, impulsive), cluster C (avoidant, anxious, pessimistic, obsessed), and even cluster A (suspicious, eccentric, and odd). Regardless of their baseline personality, the afflicted patients might feel, think, and behave differently during episodes of illness, if afflicted with an affective disorder. Although a family history of mental illness might be denied, careful interviewing can reveal disturbances in some family members. One needs to ask about the conditions, changes, habits, and personality of blood-related family members, such as grandparents, parents, siblings, aunts, uncles, nieces, nephews, and cousins. In the interview, one might detect excessive alcohol consumption, use of elicit drugs, anxiety, mood changes, ritualistic and obsessive behavior, episodic grandiose ideas and planning, impulsivity, euphoria, frequent relationship changes, and excessive fights and arguments in the family. One needs also to ask about self-medicated approaches of family members, such as use of herbs, light box, and even alcohol or illicit drugs. In terms of past psychiatric history, it is not unusual to hear about minor ups and downs of the patient, dating back to childhood or adolescence. Some might have been already treated for inattention and hyperactivity as children. Some might have already seen a counselor for crying spells, behavioral changes, agitation, depression, impulsivity and rebellious behavior. Review of their medical history, especially in regard to endocrine abnormalities, seizures, head injuries, strokes, migraines and other neurological disorders, as well as review of routine laboratory work-ups, is essential. Inquiring about past hospitalizations, medication trials, their effects and side effects, as well as psychotherapeutic treatments, are important in pinpointing a diagnosis and optimal treatment options. One needs also to ask about factors that have lead to periods of stability. In terms of mental status, patients with affective disorders might be restless, fidgety, hyperactive, or slow and psychomotor retarded. They might be withdrawn or evasive. Their speech might be rapid, expansive and loud or slowed and soft, their mood might be depressed, irritable, nervous, or expansive; their affect could be congruent or incongruent, depressed, tearful, or euphoric. They might have a circumstantial or tangential thought process and be preoccupied with racing, obsessive, suicidal, violent, grandiose, nihilistic, and paranoid thoughts. Their perception might contain illusions, and hallucinations. Their insight and judgment might be compromised. Based on adequate information from the interview and the patient's presentation, the clinician makes the diagnosis and recommends treatment. If adequate information is not available, the clinician usually awaits resolution of possible factors, such as toxicity or other medical illnesses, job or relationship loss, lack of social support, or legal or other conflicts, before making a clear diagnosis of an affective disorder. Studies on creativity and affective disorder: Rothenberg describes creativity as an artistic ability that helps with establishing an identity as a necessary foundation for life long motivation (6). Nowakowska C, et al (7) compared self-report measures of temperament and personality in a study of 49 patients with bipolar disorder, 25 with major depression, 32 creative controls, and 47 normal controls. Patients with mood disorders and creative controls had common temperamental traits. Bipolar and creative controls had the additional commonality of increased openness compared to normal controls. The study suggested underlying neurobiological commonalities between people with mood disorders and individuals involved in creative disciplines. In other words, the creative individuals and patients with mood disorders had common temperamental traits. Andreasen et al (8) compared symptom clusters in 30 writers and their relatives vs. 30 controls and their relatives. Compared to10% among the controls, about 43% of the relatives of the writers group had symptoms of mental illness, predominantly affective disorders with a tendency toward the bipolar subtype. Jamison KR. (9) investigated periods of intense creative activity and hypomania in poets, novelists, playwrights, biographers, and artists and noted that among 47 prize winning artists 38% had been treated for affective disorders. Ludwing (10) reviewed biographies of 1004 persons in the New York Times and noted that the rate of manic episodes was three times higher among artists compared to the entire staff (10 vs. 3%). Post (11) reviewed the biographies of British writers and noted 82 out of 100 had symptoms of at least one of the of bipolar spectrum, which included bipolar psychoses, unipolar psychoses, severe depression, mild depression, brief reactive depressive traits, and cyclothymic traits. Co-morbid cluster B and C personality disorders, substance use, impulse control disorders, attention deficit hyperactive disorder, and anxiety disorders are common phenomenon in patients with bipolar disorder. Aksiakal (12) suggests that such co-morbidities might testify to the evolutionary context of affective disorders. Lara DR et al proposed a bimodal approach to understanding co-morbidity and affective disorders (13). In a study by Simeonova et al. (14), 40 adults with bipolar disorder, 20 bipolar offspring with bipolar disorder, 20 bipolar offspring with ADHD, and 18 healthy control parents and their healthy control children completed the Barron-Welsh Art Scale (BWAS). The art scale rating of adults with bipolar disorder was 120% higher (sg.), offspring with bipolar 61% (nsg), and offspring with ADHD 40% (nsg). Rothenberg A (15) criticizes the connection between bipolar illness and creativity and points out that sampling, methodology, presentation of results, and conclusions of the studies are inconclusive due to inadequate or absent controls, biased selection procedures, and single interviewer-experimenter bias. Despite the controversy most investigators agree with Andreasen NC and Glick ID (16) that creative individuals are most productive when their affective symptoms are under good control with treatment. Role of treatment After assuring safety and comfort of the patient, investigating etiological factors and providing treatment based on those factors is the key. Paul McHugh considers personality, life story, behavior, and diseases, alone or in combination, as factors that affect people’s mental life (17). Personality traits could be an asset, if utilized properly, and a liability, if misdirected. Treatment of personality vulnerabilities is the guide to patients becoming aware of their strengths and weaknesses. Creative patients tend to value autonomy to express their talent in the way they see fit. If they work in a collaborative atmosphere, they might need to be reminded of the need for a compromise between autonomy and collegiality to avoid conflict. In terms of personal history from a dynamic perspective, unresolved conflicts, such as traumatic experiences, and developmental tasks, such as competition and connection to the same sex parent, pressure toward independence, and establishing identity, might lead to symptoms in creative individuals. This in turn could lead to an inner suffering and chaotic life, if there is no treatment. With a supportive and reframing therapeutic approach, the inner turmoil could sublimate into artistic activity. From a behavioral and developmental perspective, being raised in a dysfunctional family, without adequate guidance in developing healthy coping skills, can cause patients to become oppositional, act out, and take risks, such as using alcohol and drugs at early age; they might even be taken advantage of and become victimized and traumatized by more disturbed people whom they trusted easily. This in turn can lead to development of mistrust and a confrontational attitude toward authorities, such as teachers, employers, and even physicians. McHugh (17) argues that the main focus of the treatment of behavioral disturbance is interrupting the behaviors that have had a negative impact on the patient’s life. Then guidance in positively utilizing inner strengths becomes the next step; in the case of creative individuals this can bring out remarkable artistic expressions. From a biological perspective, episodic changes in creativity and mood, with depressive, hypo-manic, mixed, and manic symptoms, as well as symptom clusters of mood disorders in some family members, are evidence of an endogenous affective disorder, such as bipolar illness. In such a case, biological intervention, in which a balance between the least harmful and most efficient treatment is the goal, becomes necessary to keep the individual sane and yet creative. Such an approach would range form no interventions to daily visits and hospitalization. While spontaneous recovery is possible without treatment, the risk of spontaneous recurrence of symptoms is much greater if the patient is not treated. Education about available pharmacological treatment and the risks and benefits of treatment and the lack of it is important to assure compliance. For treatment-naïve depressed patients, a trial of an SSRI is a good choice. Those who have failed SSRI’s, a novel agent such as venlafaxine, bupropion, or mirtazapine are reasonable alternatives. Tricyclics such as nortriptyline, amitryptiline and imipramine or MAOI such as phenelzine and parnate might be more effective for treatment refractory depression. If there is an evidence of bipolarity, among the pharmacological choices, Lithium has remained the standard mood stabilizer. Schou (18) noted in a study of 24 patients with mania that Lithium attenuated or prevented recurrences of the illness and increased artistic productivity in 50% of the patients, produced no change in productivity in 25%, and decreased productivity in 25%. The severity and type of the illness, individual sensitivity, and habits of the individual in utilizing manic episodes productively might explain the difference in the effect of lithium. Judd et al., (19) noted that lithium led to slowing of cognition among 3 out of five normal subjects. According to similar studies, discontinuation of lithium increased productivity (20) and improved memory (21). Substitution of lithium with divalproex sodium fully or partially reduced the cognitive, motivational, or creative deficits attributed to lithium in 7 bipolar patients (22). Although most anticonvulsants and atypical narcoleptics are now used for management of bipolar illness, there is no data available yet on their affect on creativity and productivity. Conclusion: The association of creativity with affective disorders is a controversial subject. Changes in the function of the mind can lead to creativity, mental illness, or both. Many great minds have suffered from mental illness; however, romanticizing madness as a creative force is of no benefit to suffering individuals. Proper diagnosis of affective disorders, co-morbid illnesses, and psychosocial factors are very important for proper treatment. While biological intervention is the key for the treatment of the symptoms of the illness, psychosocial interventions, such as behavioral modification, guidance, and reframing, are necessary for the treatment of behavior, temperament, and life history. Creative individuals are more productive when they are treated. References:
Individual vs. society, a Comparative Analysis August, 2005 Introduction I have often been asked what is the role of psychiatry among the medical and social sciences. People turn to physician when faced with a dysfunctional organ in their body. They turn to social scientist when cultural, ideological and governmental dysfunctions affect their society. I believe people turn to psychiatrists, the physicians of brain and mind, when having difficulty that might have a physical or societal etiology. The society as the sum of individuals is not immune from the influence of its members who have difficulties with their feelings, thinking, or behavior. Such an influence might cause disturbances in culture, ideology, and government in a society. Once the society is disturbed, its members are faced with three options: submission, fight, or flight. Personally, I happened to chose the third option in 1983 when faced with engraved disturbing elements of the society; I left Iranian Kurdistan for Europe and then United States hoping to evolve and speak freely first as an individual then as a contributing member of the society. The disturbances of mental life of individuals have been classified based on their nature such as disease, behavior, personality, and life story (1). Similarly, the nature of sociopolitical disturbances in a society could be classified based on their nature related to geographical location, governing style, cultural characteristics, and historical events. Many societies have witnessed significant sociopolitical disturbances under a single theory rule, absolutism. Thank to the efforts of democratic movements some of those societies have become free and some are in process of liberation. On an individual level, some people with traumatic experiences of oppression are vulnerable to develop abusive behavior, especially if they are not connected to healing, supportive, and preventive health institutions (2). Such individuals, if not guided and healed, might create a society of abusers. George Orwell has very well described such a pattern in the society in his classic novel, Animal Farm. The purpose of this article is to stimulate thoughts in what measures to take to help and guide liberated but previously abused people and societies to heal, so they can prevent developing any abusive behavior toward others in a heterogeneous society. To my knowledge and in order to give a meaning to my professional and personal interests, I think the most efficient and appropriate way to eliminate and prevent suffering is to have a bio-psycho-social approach to the health of individuals and societies. Historical Background With the development of society, mental health has made a significant progress as well. Around the time of colonialism, when native people were exploited and terrorized (3), romantic psychiatrists thought that mental illness was related to passions that drive people to choose evil which, in turn, leads them to inner corruption (4). Enlightenment led to American, French and the Industrial Revolution in the 19th century. At that time Benjamin Rush, the Father of American Psychiatry and a signer of the Declaration of Independence, thought that mental illness was a brain illness. From the late 19th and early 20th century on, the field was influenced by the work of psychiatrists such as Emil Kraeplin for his medical or “categorical” approach, Sigmoid Freud for his analytical or “neo-romantic” approach, and Adolf Meyer for his combined biological, psychological, and social approach. At the same time the world witnessed two disastrous world wars. During World War II, academic medicine and psychiatry were partially responsible for Nazi’s racial and social hygiene program in Germany. Hitler’s machinery of death killed not only 6 million Jews but many people with mental retardation and other so called biological degenerates (3). Since the 2nd half of the 20th century much progress has been made. We know today that like most illnesses, mental illness and psychosocial difficulties have no ethnic, class, or gender boundaries. Even the most powerful people may become mentally ill or victim of traumatic experiences. Abraham Lincoln once had said: “I am now the most miserable man living; whether I shall ever be better I can not tell; I awfully forebode I shall not; to remain as I am is impossible; I must die or be better” (5). Yet, we know he recovered and made a major contribution to the history of mankind, by abolishing slavery. Likewise, the community of holocaust survivors with the worst traumatic experiences has been able to recover and contribute to the progress in many areas such as science, technology and humanity today. Mankind has achieved much, yet many continue to suffer because of disturbances in individuals and societies. Type and Nature of Disturbances in Individual vs. Society Disturbances in feelings, thinking, and behavior of individuals resemble disturbances in culture, ideology, and government of a society. An individual who persistently feels sad, miserable, hyper, nervous, or empty is likely to have an emotional disturbance. Likewise, a persistent social trend toward isolation, aggression, irresponsible pleasure seeking, resistance to innovation, and appreciation of death instead of life might be a sign of a cultural disturbance. An individual’s disturbance might show itself through persistent bizarre, nihilistic, obsessed, expansive, and suspicious thoughts. A society’s disturbance could present itself in the form of accepting ruling ideologies such as anarchism, isolationism, fanaticism, expansionism, and fascism. A disturbed individual might behave withdrawn, impulsive, dramatic, self injurious, or violent. The government in a disturbed society might act isolative, oppressive, reactionary, aggressive, or wild. Paul McHugh and Phillip Slavney, two contemporary prominent thinkers at Johns Hopkins University, have differentiated mental disturbances based on their nature that includes individual’s diseases, life story, personality, and behavior (1). Likewise, one could attribute the suffering of societies to geographical location, historical events, cultural characteristics, and system of government. Disease or Broken Part An individuals’ mental disturbance might be related to biological factors. He or she might have a disease such as a chemical imbalance or a broken part in the brain that might cause psychosis, agitation, confusion, depression and even thought of suicide. Such individuals need immediate intervention with medications, hospitalization, and at times even electroconvulsive therapy for stabilization and recovery. Likewise, a society’s misery could be related to geographical location, being broken part, lack of resources, industry, jobs, and security. Ideal intervention in such a case would be intensive financial and technical support by national and international communities in form of helping societies help themselves in order for them to recover and flourish; priorities in such a case are usually are given to building roads, factories, schools, hospitals, cultural centers, etc. Historical or Traumatic Experience Traumatic life events play a major role in the suffering of many people. An individual who has experienced torture, physical or sexual abuse, hunger, and neglect will have a very difficult time to lead a normal life. He or she will need much reframing and comfort to be able to recover. In term of society’s trauma, here is how a town that became the victim of a trauma has been described: “In every street and alley women and children rolled over one another. The sound of crying and groans rose from every house in the town. Many families who were sleeping were subjected to chemical bombing before the sun rose “(6). Suppression, assassinations, displacement, bombings, genocide, and other form of assault break the backbone of any society. In this modern age unlikely one would expect a battered spouse to be patient and tolerate abusive behavior because of concern over damaging the unity of a dysfunctional family. Likewise an oppressed society unlikely would be pleased with maintenance of the territorial integrity of an entity whose dominant groups have been abusive; in such a case, the oppressed people will ultimately do everything they can to be able to determine their destiny and become equal and and independent from the oppressors! To expedite this process, such oppressed societies need much understanding and international support, security, and guidance to become a regular member of the international community and unite with the rest voluntarily. Maladaptive Behavior Another cause of an individual’s suffering is maladaptive behavior such as addiction in alcohol, illicit drugs, eating, sex, gambling, and criminal activity. Interrupting behaviors and relapse prevention is the key for recovery in such cases. Likewise, a government might preoccupy people’s minds with unreasonable rituals, superstition, and fantasies of earthly or heavenly pleasures, yet engage in exploitation, terror, drug trafficking, assassinations, mass murder, and neglect of its citizens. Some leaders are unfamiliar with cooperation or pluralism; some overlook the society’s bigger picture for short term party gains, some become too busy with internal pitiful conflicts; some assign responsibilities to individuals based on bribery and favoritism; some close an eye to serve those who dominate them; and some run their lives based on a corrupt philosophy of as if the end justifies the mean. The appropriate intervention would be to stop governments and leaders from such behaviors with whatever it takes to help and protect innocent people so they can enjoy the peace and prosperity of the civilized and progressive world. Dimensional Characteristics Every individual has certain strengths that help him or her to handle challenges in life. Despite positive qualities, individuals might have temperamental vulnerabilities such as extreme shyness, impulsivity, immaturity, defiance, self-centeredness, lack of knowledge, etc. These vulnerabilities are another reason for the suffering of individuals. In such a case one needs guidance to be aware of his or her strengths and weaknesses to handle daily challenges best they can. Many societies are in favor of openness, tolerance, democracy, rule of law, friendship, hospitality, and peaceful coexistence. Despite these positive cultural values, some societies might be underdeveloped, lack knowledge of politics, ethics, philosophy, art, literature, music, technology, architecture, etc. Some societies might prefer to remain ethnocentric, resist change, or impose their norms on others. Some societies might value fanaticism and appreciate death more than life. Some societies might consider gender discrimination, male polygamy, honor killing, and capital punishment as norm. In such cases, education, education, education, and guidance are the key; emphasis on secularism, while respecting people’s private matters such as religion, is very important. The heritage of societies needs to be appreciated, protected, and developed so people can relate to positive aspects of their culture and identity and improve their self esteem. Once there, they might appreciate other people’s culture and welcome change, progress, and voluntary unions. Conclusion: According to World Health Organization (WHO), “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(7). This might sound idealistic, especially since evaluation and treatment of complete health is economically not feasible in managed care era. However, without the ideas of our idealists, we would have remained cave men and women. Since we claim we are not cave people any more and do not want to be just prescribing robots either, contemporary psychiatry should at least strive for a bio-psycho-social approach to mental health; this means that one should consider biological, psychological, and social factors in evaluation and treatment of individuals who have disturbances in their feelings, thinking and behavior. Along the same line, contemporary psychiatry should not shy away from making the societies aware of disturbing elements in their culture, ideology and government. In short contemporary psychiatry should be multidimensional and have a intermediary role between medical and social sciences! References:
Ocean and Emotion (a 1001-words essay) June 10, 2008 Emotion, thought, and behavior are complimentary elements of the mind in the brain and differentiates humans form other beings. Brain and mind are also complimentary the way earth and life relate to each other. Life on earth is impossible without the ocean, and so is mind in the brain without emotion. A newborn’s life starts on earth with a strong emotional and behavioral response such as crying and screaming. Thoughts come upon development and modify the behavior further. Lack of thinking makes emotion run our lives, and a balance between feeling and thinking make us behave, hopefully with a purpose. Without ups and downs or difficulties in life we feel good. If we have a loss, it is also normal to feel sad; if we are not sure about something, our nervousness is a natural human response, and if we gain what we are looking for it is logical to feel great. While feeling sad, nervous, or great is a normal human emotion, a prolong persistence of these major feelings is similar to being in a turbulent ocean.
If we feel sad and the sadness affects our liveliness to the point that we can not focus, eat, sleep, mate, relate to others, and so we lose our energy, motivation, and ability to function for few weeks, then we are suffering from depression. Depressive emotion might range from mild sadness to severe melancholy and could impact our thinking and behavior. In a severe depressive state we might think life is useless; our perception might become nihilistic with delusions and hallucinations. In a delusional depressive state we might think our life is coming to an end by illnesses, financial difficulties, abandonment by our significant others etc. In a hallucinatory state we might even hear massages telling us how miserable we are and that we should do something violent about it. Along the way our behavior could deteriorate from gradual isolation and inactivity to angry outburst and put ourselves or people we perceive as intolerable in danger. If we were swimming with such a depressive or angry emotion we would gradually sink to the bottom of the ocean. When we feel insecure about our ability to handle life challenges, we might lose confidence and become worried how others perceive us. Feeling nervous could prevent us from recognizing that others are not above us regardless of their status. We might think they are worthless compare to those with more fame, knowledge, wealth, and success. We might become preoccupied with thoughts about pity failures and so we forget that it is humane to be imperfect. Nervous feelings and anxious thoughts might make us avoid life challenges. We start depending on others excessively to make decisions for us. By avoiding life challenges we gradually fall behind and become further disappointed at ourselves and so become anxiously depressed. In contrary to melancholic depression which brings down our liveliness, in an anxious state we might be hyper vigilant. The elevated anxiety state ranges form basic worries about major life challenges such as keeping our job to major preoccupations with basic things such as what clothes, shoes, and perfume to wear to be accepted by others. We might become obsessed with certain repetitive thoughts and engage in ritualistic behaviors compulsively. In a panic state of anxiety our mind might start racing, and our brain might order other organs such as our heart, lung, and intestinal tract to speed up too. If we were swimming with such an anxious emotion, we would gradually behave like a restless ocean. When we feel persistently great about ourselves and our liveliness increases to the point that we need less sleep and become energetic, overconfident, and hypersexual, we might think nothing could stop our elated state. Feeling exceptionally great and thinking that we are more than a normal human being might make us engage in risky and dangerous behavior. This hyper emotional state could vary from slight cyclic elation to severe episodic mania. In severe cases we might have grandiose delusion of possessing skills and ability that no body else has. We might even hear messages telling us that we have a mission to do something extraordinary such as saving the world. We might become oversensitive, intolerant, and angry at those who doubt our ability and act out by hurting them. In such an elated or angry state of emotion, we feel we are on top of a magnificent and endless wave in the ocean. Seeking help is necessary for patients with any of the above unusual persistent emotions. Even if they are athletic swimmers, the sooner they prevent drastic changes in their liveliness and subsequent drowning by depression, anxiety, and elation, the better chance they have to recover. Talking to their loved ones, their friends, their neighbors, their community members, and their spiritual guides are all good ideas. However, the best course of action to balance your emotion would be to see a mental health professional. A medication could push patients out of clinical depression. With an antidepressant depressed patients might gain some momentum to swim further, if they were in the ocean. However, depending on its force and direction the forceful push might sink them more or make them rise first and then sink deeper. Such a quick rise and sink is more likely to happen, if they have episodic mania and depression. In this case a mood stabilizer or neuroleptic helps patients float and swim smoothly. Anxiously depressed and restless patients might benefit from medications that often are used for mania or depression. However, anxiously dependent patients might develop other forms of dependency, if they rely only on a quick fix medication. Beside finding the right medication or stopping the wrong ones to correct an imbalanced emotion, psychiatrists are expected to give people enough rope made of education, experience, and compassion. The rope could help patients swim to the coast of recovery and be saved form a sinking, restless, or turbulent ocean. |
