Contents
What Kuro5hin Does for Me
[Top]
What kind of sanity can Kuro5hin possibly give me that my doctors, with all
their years of training cannot? Simple: the expression of human
emotion. My schizoaffective disorder renders me largely incapable of it.
You will surely protest that my writing clearly demonstrates that I am by no
means an unemotional person. And that's the very point I'm trying to make.
If it weren't for my writing, which takes place mostly at Kuro5hin, I would be
almost completely incapable of expressing any emotion whatsoever.
The symptom is known clinically as
"flat affect". "Affect" is the clinical psychological term for one's emotional
expression; for one's affect to be flat means that one is devoid of any emotional
expression.
And if any of my Kuro5hin friends were ever to encounter me in Meatspace, that would
be by far your overwhelming impression of me: I am a blank slate, hardly ever able
to crack the barest of smiles, even when I try.
But you see, flat affect is not the absence of emotion. I am under the
impression that even many mental health practitioners don't know it's true nature,
as those of us who experience it are so unable to make our feelings known to our
therapists. No, flat affect is not the absence of emotion, but our inability to
express it outwardly, publicly, in such a way that other people are
able to connect to us.
I am unable even to express my feelings towards my own wife Bonita. One of the
reasons she became so fascinated with me so early in our relationship is that she
is quite keenly attuned to human feelings; she can read the feelings of anyone
like the pages of a book.
But not my feelings. To her I am, in her words, "an enigma".
Imagine my lifetime of torment, when I tell you that for my entire existence I
have known the very heights of passion, that most tranquil of joys, the lustiest
of libidos, the sweetest of sorrows, the torment of seemingly-endless despair,
furious anger, well you get my drift, my list could go on and on. I am a
helpless little boat tossed constantly by the stormy sea of my feelings.
My Kuro5hin friends will already know from my writing that I am among the
most emotional of men, quite often irrationally so. So you must
certainly understand my lifetime of repeated, inevitable disappointment that
my overwhelming experience in trying to relate to other human beings has always
been an absolute...
Utter...
Failure...
To connect.
Because so much of human relationships are based so intimately on our emotional
expression, our empathy with the emotions of others, or our fearful reactions
to their wrath.
For all my life, I have been largely unable to even register 1.0 on the
Emotional Richter scale.
Except when I write.
It didn't come automatically; I had to work hard, over a period of years, to
learn to express my feelings through my writing. Thus most of my
earlier written work is purely technical, meant to inform but not to
convince or to convey any sort of feeling.
I often despaired at my inability to express my feelings in writing, but
one way or another I learned to do so. It wasn't by any educational method
I set out to practice.
It was largely by writing diaries, and followup comments to the diaries and
stories of others, at first
at Advogato, and then
here at Kuro5hin.
Just as riding a bicycle is a skill one can learn but cannot be taught,
I learned to express my feelings right here in Kuro5hin, in my writing.
Just ask trane and Orion Blastar Again - they are schizoaffective too.
Orion Blastar Again experiences flat affect. I don't know
as again I never asked, but I suspect trane's
notorious
misogyny is the result of his inability to ever connect emotionally with a woman.
Another Way Out
[Top]
There is one other way I can express my feelings, and I am able to do so
in a way that far exceeds any expression I can accomplish with my writing.
Hence my endless
diaries
espousing
its
importance
to me,
my struggles against
its seemingly-insurmountable difficulties, my grand plans to go back to school
at well-over forty years old to study...
Music
I was able to express myself in my music for many years before I could do so
in my writing. My piece Recursion, my own personal favorite of my own compositions,
was composed during a period in my early twenties when I was almost continuously
suicidal for a period of several years.
By expressing my sorrow through playing Recursion, I was able to find some
meaning in my seemingly-endless torment of despair. The worst
torment can be borne by almost anyone if they know it serves some higher purpose.
The worst torment of all is to suffer for no good reason whatsoever.
How Music Expresses Emotion
[Top]
nombre
claims that one cannot really express emotion through music. Most
people are certain that music expresses emotion because of their own
experiences with it, but that's not a rigorous argument. The fact
that one can, and how it is expressed, is well-known.
I discussed this a while back in an essay called
I
Have So Many Questions About Music. I considered the question of
why music matters so much to us. The reason I gave is that music makes
us feel connected to others. To feel connected is a desperate need, not
just of humans but of many animals as well. It is a need that can be
satiated for a time through music, but that can never be completely
fulfilled:
Thousands of years ago, the Buddha explained that the
fact that
we are ultimately all alone in the Universe is the cause of much of
humanity's despair. Many of the ways we seek to fill this void, such as
striving for wealth or love, ultimately cause even more sorrow than they
cure. Buddha's solution is to simply accept our loneliness. Such acceptance
is the cause of the deep, abiding sadness many Buddhists feel.
But we can forgot our sorrow for a little while by using music to connect ourselves
to each other. I explain how we are connected by quoting
Philip Dorrell:
In order for the listener to perceive patterns of neural activity in
the speaker's brain, there would have to be some relationship between
neural activity patterns in the speaker's brain and neural activity patterns
in the listener's brain, in a way which preserves the geometric nature
of those patterns, at least to a sufficient extent that the patterns
can be perceived. This implies some form of "neural mirroring".
The mirroring does not necessarily have to be very accurate -
it just has to be accurate enough that some observation can be
made of the patterns of activity in the speaker's brain.
Then I explained:
Music makes us feel connected because it transports a complex and
time-varying neurological and psychological process from the brain
of the performer to the brain of the listener. It enables us to
think the thoughts, and to feel the feelings of another living being.
It enables us to become one with them, and in this way pierce the
boundaries that separate us, so that for a few fleeting minutes
we no longer feel so alone.
I'm afraid I never finished that essay. After my wife read
my explanation of
Why I Write, she said "You're chasing a White Rabbit down its
rabbit-hole". She was right: five days later I went to the
emergency room. I told the doctor that every previous time I
felt the way I did then, I soon required admission to a psychiatric
inpatient unit. He sent me on my way with enough Librium to stun an ox.
My psychiatrist called me later that day. After I told him
what happened, he said "If you're having some kind of psychotherapeutic
breakthrough, taking medicine for anxiety will lessen its effect."
Heeding his advice, I did not take any more.
Schizophrenia's Negative Symptoms
[Top]
I wrote in
Living with Schizoaffective Disorder that being schizoaffective was like being
manic depressive and schizophrenic at the same time. (There is also a more common
form of schizoaffective disorder that is like being a "unipolar" depressive rather than manic
depressive.) The symptoms I described included mania, depression, dissociation, auditory
and visual hallucinations and paranoia.
Mania and depression are the symptoms I share with manic depressives. It turns out
that dissociation is a symptom of neurosis, not schizophrenia as I first thought. The
hallucinations and paranoia are the symptoms I share with schizophrenics; these are
known as "psychotic" symptoms, or disorders in thought, while mania and depression are
"affective" symptoms, or disorders in mood.
Each of these psychotic symptoms are classified as positive symptoms, in that they
add something to my experience that should not normally be there. Completely unmentioned
in my essay are the negative symptoms,
so-called because an experience or behaviour that is normally present is missing or
diminished.
Flat affect is such a negative symptom: emotional expression that is normally present
is missing. One can also be missing emotion entirely, which happens to me sometimes, but
flat affect is still present even when my emotions are otherwise normal.
One cannot
tell by watching someone whether they really feel flat or just appear that way. My
affect is flat when I feel joy but cannot smile, or feel sad but cannot cry; instead I
show only a pokerface. I may try to force a smile to show others my happiness, but
it won't appear genuine. They will have the sense that I'm just faking it.
Bonita often expresses frustration at being unable to get any reaction out of
me. I tell her "I really am happy to see you. I'm just not able to show it."
Flat emotion isn't the simple absence of emotion: everyone is calm at times.
Instead feelings don't appear in response to events that would normally stimulate
them. One reacts to news both happy and tragic with dispassion or disinterest.
One no longer finds pleasure in activities that one once enjoyed.
Some of the other negative symptoms are catatonia, poor or inappropriate social skills,
difficulty in speaking or thinking logically, and social isolation.
Some of the negative symptoms, especially flattened affect, lack of emotions and
social isolation are also symptoms of severe depression. It is often difficult to
correctly diagnose many mental illnesses because some symptoms are common to several
possible diagnoses. Most symptoms come and go over time, so one must observe
the patient over a long period of time to see if new symptoms eventually show
themselves.
More Serious Than You Would Expect
[Top]
You might ask whether flat affect is really all that serious, given that
one can still experience normal emotions, just not express them. Am I not able to
enjoy life just like mentally healthy people?
Yes one can, but is unlikely to unless one finds a way to overcome or
compensate for flat affect. Left untreated, flat affect all by itself can
be devastating or even fatal.
Flat affect prevents us from forming or enjoying normal
human relationships. Schizophrenics and schizoaffectives have difficulty finding
friends, enjoying the company of other people, starting or maintaining romantic
relationships, and getting or holding jobs.
It's actually worse than that. Flat affect makes us sicker than we would
otherwise be.
Schizophrenia can have a sudden or slow onset. Slow onset schizophrenia is
very common, with the transition from health to full sickness often taking a number of
years. Quite often the appearance of new symptoms is so slow as to be unnoticable, with the
first sign of trouble being that the sufferrer has become so crazy as to be brought
to a psychiatric inpatient unit by the police.
The reason that one's friends and family do not notice is that the sufferrer gradually
withdraws from human contact. Sometimes subtle paranoia causes one to distrust strangers
who might otherwise become friends. Flat affect prevents others from enjoying our company,
so others withdraw from us.
Social isolation is very dangerous to the mentally ill.
One way sane people stay
sane is that others around us let us know when we are straying from the rational path. If
I were to post something crazy here at K5, one of you would probably say "Hey Mike, what you just
said is crazy". If I'm not too delusional, that may be all the treatment I need to
stay healthy.
If others don't enjoy my company, I won't enjoy theirs. Thus flat affect leads
schizophrenics to avoid even trying to make friends, even if we are not paranoid. Eventually
there is no one to correct our delusional thinking, and our thoughts stray farther and
farther from reality.
I claimed flat affect can be fatal: suicide is very common among schizophrenics. Complete
isolation is a very lonely experience, often a heavier burden to bear than we are
capable of carrying.
At my first therapy session after my first hospitalization in November of 1984, my
therapist urged me always to live with other people, never to get a house or apartment where
I lived alone.
The Therapeutic Treatment of Flat Affect
[Top]
All of the negative symptoms are notoriously difficult to treat. It is much
easier to stop something abnormal than to add something which is missing.
While antipsychotic medication has been available for decades, it didn't work
very well at first. "Classic" antipsychotics like thorazine and haloperidol require
such large doses that they often cause terrible, debilitating side effects. Some
patients found them so unbearible they refused medication, preferring their delusions
and hallucinations to the tremors, seizures and sedation caused by their medications.
Treatment of schizophrenia was revolutionized with the discovery of the "atypical
antipsychotics", starting with
Clozapine, licensed by the FDA in 1989.
Lori Schiller wrote in her book The Quiet Room that her severe
schizophrenia so resisted treatment that she was hospitalized for many years
before being accepted for treatment with Clozapine during its experimental trials.
She now lives independently and is able to hold a job.
I myself have taken Risperdal since my
hospitalization for mania and psychosis in the Spring of 1994. It is
also recommended for bipolar mania.
At the time of my hospitalization, it had been on the market for only a few months, and
seemed to be regarded by the hospital staff as a wonder drug.
All the antipsychotics reduce the activity of the neurotransmitter dopamine as an
excess of it is the immediate cause of psychotic symptoms. The
atypical ones also effect serotonin and sometimes other neurotransmitters.
The classic antipsychotics were largely ineffective for treating negative symptoms.
Atypical antipsychotics are thought to be somewhat helpful, but I cannot tell if there
is any difference
as a result of my Risperdal. I'm not usually aware when I don't express my feelings though,
and emotional expression is often subtle, so it is quite possible that it helps me without
my being able to tell.
However, I have come a long way in overcoming flat affect: when I commenced
psychotherapy back in Santa Cruz in 1986, my complaint was that I was unable ever
to get a date, let alone a girlfriend. When I terminated therapy in 2000, I did so because
I was moving to Newfoundland for my wedding to Bonita. We recently celebrated our
sixth anniversary.
Not often, but sometimes, I am able to bust out and jump for joy. And sometimes,
when overcome with grief, I am able to cry.
What made the difference? Practice:
one can learn to express emotion through conscious effort.
With enough conscious practice, affective expression can become unconcious and natural.
However, even after all these years I usually seem stoic and unemotional. That is, except
when I play music or write, or am incredibly overcome.
My therapist warned that it was likely to take some time to reach my goal, but she asked
me to regard every attempt to attract a woman as practice towards gaining the skills I
needed to succeed someday. And friends, that's what I did: during some sessions she
assigned me the task of chatting up a strange girl, and at the next we would
discuss my experience, as well as how I could do better next time.
While consciously forcing a smile appears insincere, with enough practice and
experience one can learn to smile spontaneously. I doubt I will ever be as expressive
as I would have been had I never gotten sick, but at least can now live a more or
less normal life.
To Know My Passion
[Top]
At a very young age I
chose to lead a life of the mind: I wanted to be a scientist when I grew up. I
was accepted to the California Institute of
Technology to study astronomy in 1982; my lifetime goal was the Nobel Prize in
Physics. Things looked promising at first, as I was hired by a Caltech astronomer
to help with his data analysis and observing work. We coauthored
a few papers in the
Astrophysical Journal and spent time at the sixty and two hundred inch
telescopes at Palomar Mountain. I had it all!
Or so it seemed. It all came crashing down when I had my first manic episode in the
Summer of 1984. My first hospitalization was in November, for acute anxiety. I was
diagnosed with schizoaffective disorder in July of 1985, during a six-week hospitalization
for
profoundly severe mania.
Very few who share my diagnosis are able to provide for themselves as I do. Most have to
get by on their government disability checks, be cared for by their families, or try to make
it on the street, homeless and tormented by madness and despair.
My madness took all I had from me: my education, my career, my reputation and many dear
friends, most of whom refused ever to speak to me again. But I was determined not to let
it take everything: I wanted my life back.
While I was accepted to transfer to the University of
California Santa Cruz, I often got poor grades because of my illness. My
therapist quickly realized I must find a job to support myself.
At the time I looked, dressed
and acted just like any other crazy street person, so she was astounded
when I showed her my resume one day. As a career in Physics no longer seemed a possibility, our
therapy began to focus on finding a new career. I began to teach myself to program computers
from books using a Macintosh 512k my roommate and I bought secondhand. I got my
first career programming job in November
of 1987; I have since been steadily employed as a software engineer for
nineteen
years. I received my B.A. in Physics from UCSC in 1993.
But I had a problem: as a software engineer, I still lived a life of the mind. That's
not good for someone with flat affect, or any kind of mental illness. As I recovered
I began to enjoy the experience of my own thoughts and feelings more, but I experienced
little of the real world, and other people experienced little from me. It didn't help
that I was a hopeless geek.
My wife and I met online in late 1997. During my first visit in January of '98, Bonita
noticed my tendency to "space out", or retreat into my thoughts, which was so severe at
times that I became completely unaware of my surroundings, unable even to hear her
speaking to me. When she urged me to live in the real world, I protested that I had a vivid
imagination, and preferred living in my head. A Shambhala
Buddhist, she urged me to meditate that I might learn to be
mindful. She pointed that I was
particularly unmindful as I was prone to bump into other people because I was unaware
of their presence.
While reluctant to leave my inner world, I discussed my tendency to space out with my
therapist upon my return. She too urged me to give it up.
I am not clear what made the difference, but I don't space out anymore. Most likely
it's from being with Bonita, as I previously spent very little time speaking
with other people.
After a hiatus of several years, I took up my piano again when we moved
to Nova Scotia in the Fall of 2003.
Stress from my consulting
work caused my paranoia and hallucinations to appear again for the first time since
1994. I knew that playing my piano was one of the few things that I could do completely
on my own
to comfort myself when I was wigging. I have been taking
piano lessons
since January of '94, and a few months ago started appearing at a local
Open Mic. While I am a long way from passing my music school audition, I am
very determined.
These last three years have been a struggle for my wife and myself. While I
avoided the hospital, I have required
emergency room treatment five times since moving to Canada, the last time just
a couple weeks ago.
Many times I did not earn enough to get by.
But on the whole, I am improving. If you saw me today you would never
suspect I was just in the emergency. I just got a good consulting contract, and this morning
will be turning down a highly paid permanent position that I was offerred because I like my
new client's work better.
Along with my music, my writing, especially that published at Kuro5hin, was a critical
component to my recovery.
Music alone is not enough, you see. My piano so far is only a one-way emotional expression, as I
am only just beginning to feel I play well enough to jam with other musicians or
play in a band.
I am eager to do so, I know very well how much better it feels to play music with others as I used to play the
conga in drum circles at the beaches of Santa Cruz.
While I can express feelings by playing piano, even complex feeling, being instrumental
music those feelings are raw and pure, with no factual content. It is only through my
writing that I am able to explain why I feel the way I do, and to emote in a conversational
way, by carrying on discussions with all of you.
All You Need To Know
[Top]
For over twenty years I desperately sought
the key to happiness. It's easy for me
to tell you what that key is;
to obtain it is quite another matter. Timothy Miller explained it on page 80
of his book
How To Want What You Have:
A sincere and scholarly religious seeker occasionally experimented with mescaline.
While spending an evening in his study amid his books, music, and works of art, rapturously
intoxicated, he suddenly figured out the secret of happiness. After recovering from his initial
exhiliration, he realized he could not trust himself to remember the secret, so he wrote it on a
slip of paper where he would be sure to find it later. Sure enough, he felt groggy the following
morning, recalling only dimly that he had discovered something momentous. When he eventually came
across the slip of paper, he recalled that he had written the secret of happiness on it, and that
he had felt quite certain of its power and correctness at the time he had written it. Hands
trembling with anticipation, he unfolded the scrap of paper. He had written,
"Think in different patterns".
I know you won't believe me, but after twenty years spent learning how, I can reassure you that all
it really does take to be happy is to think in different patterns. There are many ways to learn:
for me there is
therapy, medicine, music and writing. (And yes, meditation, but I'm afraid I'm not a very good Buddhist.)
But you must understand that to think in different patterns must be a lifelong quest, as we
otherwise slip back into the bad old unhappy thought patterns. One must seek endlessly because
the path itself is the goal.
If you are unhappy, I urge you too to learn to think in different patterns.
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