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Depression (Unipolar) - Cosmo Magic to Cyclothymic:  Highs, Lows and States of Flow
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Cosmo Magic to Cyclothymic: Highs, Lows and States of Flow
Mark Gorkin, LICSW,

Initial musings on anxiety and physiological arousal and an unexpected interview with Cosmopolitan Magazine stimulate personal examination of the Stress Doc's own intense and fluctuating mood states. One mood cycle and an "aha!" yields a compact model for envisioning levels of arousal-activation.

What makes us anxious? This question has been meandering in my mind. Recently, through both professional and personal roles, Ive been directly or indirectly involved in a variety of tension-generating scenarios:

-- government employees and contractors anxious about or intimidated by a volatile, periodically verbally explosive and potentially violent office mate

-- a self-employed, highly technical employee concerned about a new client drought and having to more aggressively network and market; hell be pushing outside his comfort zone

-- a 30-something woman dissatisfied with her stint in therapy, wants to change counselors and to bypass a closing session with her therapist anticipating an angry, hurtful and guilt-producing exchange

-- a shy computer specialist asks for help in breaking the ice with a new acting Division Head whom he perceives as "brusque"

-- a high strung woman who acknowledges feeling anxious during the break in a workshop; she must keep busy, the word "relax" isnt in her vocabulary

-- and my own pit in the stomach when presenting a fee to a workshop/consulting client and theres a pregnant pause on the lineAm I being selfish or greedy? Perhaps theyll take their business elsewhere...

But anxiety or, more broadly, physiological arousal doesnt just get jump started by aversive stimuli or a problematic situation. According to Elaine Aron in, The Highly Sensitive Person, "Stimulation is anything that wakes up the nervous system, gets its attention, makes the nerves fire off the electrical charges that they carry. Stimulation doesn't just come outside but also from our body -- such as pain, hunger, thirst or sexual feelings or as memories, fantasies, thoughts or plans...Arousal may appear as blushing, heart pounding, hands shaking, foggy thinking, stomach churning, muscles tensing and body parts perspiring." Stimulation can vary in intensity (like loudness or lustful excitement) or duration (usually short if real intense lustful excitement ;-). Arousal levels are also affected by stimulus novelty (joyful surprise to shock) and complexity (from optimally challenged to overwhelmed or bored).

Intense and exciting possibilities don't just turn on my motor; actually, they often quickly have my engine racing. In fact, one of those catalytic cyber moments just occurred. A writer for Cosmopolitan Magazine called waking me from a post-lunch nap. She wants some hands-on stress tips for managing an anxiety or panic attack. We conclude the phone interview with my singing her lines from a "Shrink Rap." She then wonders who wrote the lyrics. HelloCan you imagine. I told her, "Just wait. Some day I may no longer be just a legend in my own mind!" She agrees to my sending her the lyrics as a possible sidebar inclusion in the July issue. (She also asks if I have a book. Do I have a book? Hey gang. Lets not blow this deadline!)

Cosmo and Cosmic Cravings

And as soon as we hang up, the mind-body is juiced with adrenaline; the electricity is running through me. Wired is wonderful! The feeling is similar to when meeting a woman who turns me on, especially on multiple levels mind-body-spirit. The state of "romantasy" quickly kicks in: Is she the one? And if we go out and seem to have a real good timeHow come she doesnt return my call? Is she involved with someone else? Has she sensed my intensity? Have I pushed her away already? And if we've previously added sex to this combustible mix, now why am I feeling so dependent so quickly? My agitation seems bordering on mania: "an excessive, persistent enthusiasm or craving; or obsession or craze for," as defined in Websters New Universal Unabridged Dictionary.

When it comes to a woman that "turns me on," I seem to go from 0 to 100 in a few barely perceptible ticks of the testosterone; from fantasy to romantasy in a heartbeat. Maybe it's being a Type A New Yorker. Despite sixteen years in New Orleans, I never did pick up a Southern accent. Perhaps its pursuing (and forever generating anew) artistic goals and elusive dreams or madly circling around a fog covered and fame shrouded mountain career path that keeps performance anxieties revved up. My standing arousal level often hovers between 30-50 on the emotion-motion meter. Is this why I like hiking in mountains...To get off the fast lane path and to help slow down my motor?)

Suddenly, an "Aha!". Its not just the excitement of the Cosmo pub or the fantasy ideal womanI crave, perhaps Im habituated to, this physiological juice, these mind-body chemicals coursing through me. Could I be an adrenaline and testosterone addict?

For years, make that decades, very challenging work and periodically pursuing magical (and, obvious in hindsight, elusive) women have been standard operating -- psychological and biochemical -- procedures for pulling me out of my depressive base. Of course, pursuing an unconventional path while often struggling to hurdle that creative status and financial success bar reinforced the feelings of despair, self-doubt and moodiness. Frequently, a self-induced electric current provided a jump start after my battery was run down.

Another "Aha!" For many years my father received shock therapy for his mood disorder, which was originally diagnosed as manic depression. To escape the biopsychological emptiness and ennui, have I become reflexively habituated to my own self-medicating jolt? And while not a direct issue, problems with alcohol run on both sides of he family tree. A propensity for addictive behavior one might say. And certainly for some denial.

It was only five years ago that I finally accepted that psychotherapy and jogging alone could not touch the biochemical piece of my long-standing clinical depression. Still, much like Pavlovs dog, a Cosmo interview or a Cosmo girl almost immediately triggers flying and fantasizing. These provocative stimuli, like that Pavlovian bell, still can elicit remnants of a deep hunger and present day salivation. Formerly, when my clinical depression was untreated, my biochemical gauge often hovered near empty. So despite my long-term trial with Prozac, perhaps this emptiness-excitability pattern is a leftover habit if not a trait of habituation.

Predisposed and/or Addicted to Mood Swinging

Or maybe underlying all the various personality disorders and dependencies is 301.13, the DSMs "Cyclothymic Disorder": "the presence of hypomanic symptoms and numerous periods of depressive symptoms that do not meet criteria for a Major Depressive Episode." (Some feel Cyclothymia is a milder form of Bipolar Disorder.) Theres a too close for comfort psychic fit beyond my fathers original diagnosis; a number of the symptoms ring true, especially when I'm "on":

  1. grandiosity (fueled by resentment or rage and a cover for humiliation and shame)

  2. decreased need for sleep during the manic episodes

  3. more talkative than usual

  4. flight of ideas and racing thoughts

  5. distractibility (especially by my own obsessions and free associations)

  6. increase in goal-directed activity or psychomotor agitation

  7. excessive involvement in pleasurable activities that have a high potential for painful consequences (like impulsive romantasy pursuits).

And now it finally hits me diagnostically. Okay, sure theres been a narcissistic sense of self-importance or occasional grandiosity. And yes a need for admiration, perhaps some whiny feelings of entitlement because of my creative quest and struggles. (Also some entitlement of favorable or special treatment for past and more recent trauma endured.) And yes, I have been envious of others achievements while I labored in a darkly labyrinthine, "Am I going anywhere?," career/artistic path.

But, theres not a diminished capacity for empathy. I certainly have become less and less exploitative of others as my depressive moods diminish and my integrity and self-worth have increased; and for the most part, Ive become more humble than haughty. Maybe what I thought was a self-absorbed/self-centered personality dimension was at least influenced by some biochemical or bipolar dynamic.

This differential diagnostic thinking presents another possibility. Not just narcissistic nourishment but some interactive mix of mind-body-chemistry, complexity and creativity compels the public performer and writer roles: the stage (or computer screen) enables me to both act out and integrate drives and needs to be both dynamic and dy-manic. (And if you keep pushing the psychic envelope, whats nextdemonic?) Talk about being on the aggressive and performance edge. And after an intense program, if Im not totally wiped out, (people frequently comment on my energy and intensity as a workshop leader and speaker) it can take hours for the churning chemistry and racing thoughts to return to normally obsessive-introspective baseline levels.

Tea and Sympathy

Yes, with senses and mind focused the cyclothymia seems fairly palpable. Why do these epiphanies take so long; all those decades before fully acknowledging my chronic depression? Todays realization yields a psychic clearing, not unlike when a morning sunshine burns off a heavy mountain mist. Horizons and landscapes loom large and seem newly framed and focused; unforeseen connections and possibilities are beckoning.

But yesterday, the mist was thick at the tea house, its soft background jazz and muted ambiance the right fit for my ennui. Feeling vaguely inert. Nothing was cooking, inside or out. Waiting for the editor to send the next to last installment of the book manuscript for my review. (After a final explosion, we seem to have achieved a détente. My concession: she and the house set the parameters of the forest and I try to plant as many trees as possible while editing out wordy weeds and uninspiring shrubs.) There was no lingering self-righteous rage to get me pumped up. Makes me wonder how often we latch onto relatively trivial irritations or exaggerate an insult so that mostly self-induced anger at others becomes a way to escape a low energy, running on empty if not depressed state. Aggression as self-medication. My father was an expert at that one, even without the alcohol.

Soon Im getting antsy with my boring state. What do I work on next? Yet, at the same time, not having a big workshop looming or a major writing deadline lurking, pretty mellow is an apt description...if I can allow it. Maybe the Jasmine Pearl and simple sugared ginger scones are doing their thing. Suddenly, the double-edged nature of physiological arousal jumps at me: too little and Im sliding into a depressed funk, too much and Im surging into mania. And then theres the search for that optimal level of physiological arousal with its chemical and creative edge -- making work and love productively exciting as opposed to destructively crazed. It's an exciting edge that, for the moment, I seem to have stumbled upon.

From Mood to Model

And in this agitatedly mellow mood, trying to make sense of this edgy yet fluid, if not somewhat volatile mind-body state, I visualize my "Four Faces of Anger" matrix. Can this be a template for representing states of physiological arousal-activation? But this schema will need two extra boxes:

1) levels of physiological arousal-activation:
a) insufficient level
    b) excessive level
    c) optimal level.

2) source of physiological arousal-activation:
    a) internal biochemical-psychological stimuli source (or the deficiency thereof)
    b) external environmental-psychological stimuli source (or the deprivation thereof)

Interrelating these two dimensions yields Six States of Physiological Arousal - Activation:

A. Internal Source of Arousal-Activation
1. Emptiness-Exhaustion (Insufficient Levels of PA-A)
2. Agitation-Manic (Excessive Levels of PA-A)
3. Relaxation-Meditation (Optimal Levels of PA-A)

B. External Source of Arousal-Activation
1. Boredom-Inertia (Insufficient Levels of PA-A)
2. Phobia-Panic (Excessive Levels of PA-A)
3. Alertness-Animation (Optimal Levels of PA-A)

Here's a sketch of a homemade matrix.

Six States of Physiological Arousal - Activation

Levels of Arousal - Activation


Insufficent Excessive Optimal

Arousal Source


Internal Emptiness- Agitation- Relaxation-

Exhaustion Manic Meditation


(Cognitive-Affective) ---------------------------------------------------------------------


Boredom- Phobia- Alertness-

External Inertia Panic Animation


The above matrix clarifies somewhat a thorny dimension. The Source of Physiological Arousal - Activation Categories are not absolutely discrete, that is, Internal or External. One can envision a gradation or continuum (as seen above) from Biochemical (Internal) to Environmental (External) Sources with Cognitive-Affective (or Thinking-Feeling) moving fluidly along the spectrum. Sometimes Cognitive-Affective is more representative of internal stimulation, other times it is primarily of the external variety.

Or, one might speculate that the interaction of inner sources of arousal-activation (biochemical) and outer sources of arousal-activation (environmental) is what yields or significantly shapes the cognitive-affective dimension. And cognitive-affective processing in turn surely influences how biochemical and environmental arousal-stimuli are perceived and experienced and reacted or responded to.

Actually, it is the rich historical and ongoing mix of the biochemical (including genetic predisposition), cognitive-affective (conscious and unconscious) and environmental (interpersonal roles and communicational relations) comprising a specific individual within a specific family, work organization and/or socio-cultural system that determines aptitude and motivational strengths and vulnerabilities, the limitations and opportunities as well as the processes and products of a person's life journey. And for us humans there is much individual variation. For example, skydiving or public speaking may evoke arousal states of agitation or panic for one person and an optimal level of animation, if not relaxation, for another.

Clearly, all the dimensions of the matrix excite or inhibit each other in an ongoing feedback loop, affecting the functionality and vitality of our lives. The dimensional interplay influences the ability to: a) manage one's psychophysiological arousal and the resulting emotions, b) process and make sense of past, present and future self-world information, including memories and dreams, goals and visions and c) respond to everyday problems and opportunities.

A Closing Example

By way of illustration, let's go back to that unrequited phone call. If I leave a voice mail message with a woman to whom I'm very attracted (someone who is a trigger -- which I pull -- for my hypomanic response) and she doesn't return the call that day (stress by omission) I'm a bit perturbed, starting to get agitated. As 24 hours move to 48, my rising agitation may now be accompanied by feelings of rejection, some abandonment feelings and memories fueling further resentment. Stress levels can be further exacerbated with such defeating self-talk: "I need her so badly. I'm tired of being so lonely." Or, "What did I do wrong?" From internal irritation and rumblings to external "provocation," a minor panic state is setting in. Why is it so hard to rationalize the fact that the timing or chemistry or compatibility just may not be the right?

Clearly, it's my interpretations of the silent void and the concomitant feelings of loss and longing that shape the nature and intensity of the stress gestalt. The interpretations jump start the hypomanic rollercoaster -- with the initial infatuated highs. Then, with the first signs of delay or disappointment -- it's feeling deflated if not crashing down. Clearly, taking Prozac has smoothed out the mood disorder ride some which, for me, reinforces how much the biochemical dimension is involved in this stress-mood gestalt. So, will I finally screw up my courage and call, prepared to accept any and all possibilities? Will being quietly centered and optimally present help overcome my habituated, narcissistic and mood disordered ways?

Well, dear reader, I have to sign off for now. Perhaps, the sketching of this model is beginning to whet your appetite. Next newsletter will begin to define and explain the various states. I will also expand the two optimal states of arousal-activation into four "powerful" modes of being/responding. It's "food for thought" hopefully worth waiting for and it's a model to help us...Practice Safe Stress!