Mania: Paradigm Shift

• Manic Traits: An EP/SB Description by James Brody, 4/5/97
  
  

Teen Alpha's (see other postings on the "Jeannie Lee Effect") exuberance declined a bit as the days grew shorter. He increasingly spoke with his parents about private school and obtained their support for "whatever would make him happy." (1) He complained more to me about being confined during the day ("The honor students get to leave whenever they don't have a regular class and I need the break more than they do"), about teacher attitudes, and about homework.

I called his healer and took the Zoloft from 50 mgs up to 75 mgs per day. The irritability left Alpha and his parents didn't have to spend $10K for a local private school for the rest of the year. He was calm but still remembered his thoughts about some of the school staff, cognitions that I knew to be relatively accurate from dealing with one of the same personalities nearly 15 years ago.

According to Alpha:

Vice Principal Horton is the chief thorn. "He smiles to your face, nods as if he agrees with you, and still hands a suspension but does it by mail or by calling your parents. No one likes him and I don't think he likes anyone else."

Alpha feels himself in tighter with his guidance counselor this year. "Mr. Jones even said in a meeting to Horton, "Alpha's right in this case and you are interrupting him and shouting. Let him talk. I couldn't believe it, I had somebody on my side." Perhaps the first ally.

Principal Crabbe told me that he "sees a change in me from last year, that I'm trying and will work with me." A very important ally, one that could neutralize Horton.

Mr. Ringer (the most senior and the best paid) teaches chemistry and things almost didn't work between the two personalities. However, Alpha persevered and earned the top grade on a recent examination. Ringer commented, "Well, now we know that you're really pretty smart." Bingo! Respect extended, another alliance forms. He was having dominance contests with one teacher who was handing him a series of one-liner sarcasms. Alpha talked directly with that teacher, explained his feelings, and the sarcasm disappeared. One more alliance, Alpha senses that he might win this thing called school.

A little Zoloft in a 190 #, no body fat, 17 y.o. male with outcomes including: no fights with other kids this year, no leaving classes in a rage, the unsanctioned grudge game against the regular football team never occurred, there has been no police contact ... all different from last year's explosive kid who would have LED the secret scrimmage against the varsity to "prove a point that the best players aren't on the team" and who regularly fought dominance battles with teachers, the school administration, and his father. And his parents have not had to go to war with the school to stop unfair treatment of their son. (See Note 1 again!)

A little Zoloft and Alpha plans to work in his father's business, currently netting $1+ million a year, instead of doing a immediate Sulloway and working for an hourly rate in an auto shop. (2)

Of course, it's only halfway through the year but Alpha now has two significant allies that he didn't have last year and further has gained some respect and trust from every one of his teachers except for 1st period. "She never yells but always has a big smile when she gives you a detention or suspension." That class is dropped; it was an elective that he didn't need.

Alpha's very bright with many topics; the dominance buttons obscured his ability and competed with his willingness to "work for" teachers that irritated him. The dominance relationships are now more of a matrix arrangement in which he is given respect and he reciprocates with cooperation. I think Zoloft helped him drop his guard momentarily.

Alpha is wants to be assigned to the Resource Room. "I need somebody looking over my shoulder." This is the first instance in 20 years of my hearing an oppositional child/teen agree to have someone check on him or her. I challenged him on his sincerity and he explained, "I don't mind IF I KNOW THAT THEY ARE ON MY SIDE."

Certainly, all of us can smell the bipolar cooking and another practitioner might well have started depakote or lithium. Alpha came to me , through his parents, for difficulties with rage. I had stumbled on the irritability changes with SSRIs several years ago; 25 mgs of Zoloft does appear to evaporate "road rage" as well as other things irritable husbands do. (Several of these guys complain of feeling doped, drowsy, or more irritable on 50 mgs; their mates concur.)(3)

Alpha reflects the need for a "paradigm shift," for relabeling for fundamental treatment concepts. We are not treating amorphous, impersonal unbalanced mixes of juices. Instead, the ancient motives of dominance, respect, standing, and achievement are manipulated concurrently with serotonin ... our 1 billion year tool for self esteem. The SSRIs are not "antidepressants" because the more relevant continuum is inferiority-dominance-grandiosity rather than mood. In the future, we use mood shifts as signals to look further for social gains and losses, for changes in the pecking order, rather than allowing moods to be the key variable and attributing mood changes solely to day length, imbalanced juice, or to inevitable cycles, products of defective genes. (4)

NOTE:

1) Suomi (1997) comments, "high reactive infants reared by unusually nurturant attachment figures are relatively precocious socially and typically rise to the top of their group's dominance hierarchy." Suomi's observations startled me because they reinforce the importance of adults' being responsive to children's strategies and because they could apply to a number of mother-child pairs that I know. Teen Alpha and his parents are certainly part of that group. (Please see accompany posting on parents as extended phenotypes of children.)

2) Alpha is the younger of two children from rather active, sometimes combative parents. He ought to bolt and found (or founder) his own empire (Sulloway, 1996). And he may yet do so. 3) Even the current "Newsweek" (Cowley & Underwood, 1997) has a paragraph about serotonin and controlling aggression. There were hypotheses a few years ago that excess serotonin levels were correlated positively with aggression. My hunch is that aggressive behavior can exist for multiple reasons. High serotonin levels may exist independently of the availability of serotonin to receptor sites or high serotonin supports grandiosity, an attitude of being impervious to any sort of consequence, and indirectly abetting aggression that is elicited and reinforced by economic or territorial gains.

4) Goodwin & Jamison (1990) in 938 pages on "manic depressive illness" make no references to evolution or to external triggers. I suspect they are somewhat representative of current theoreticians on bipolar disorder. Kuhn's (1992) writings suggest that the BPD (bipolar disorder) establishment will resist changes but such appears to be the nature of scientific communities and other reactive organizations. Nonetheless, I suspect that the "disease" analogy of BPD will fade (unless you want to argue that infectious personalities are truly infectious); a "fuzzy trait" characterization will ascend. There may even be work differentiating familial incidence of varied types of alpha dysfunctions ... that mating, grandiosity, political power, and economic power may appear differently in different families and perhaps in relation to different genes in combination with environmental triggers.

We will also likely separate grandiosity from high rate behaviors, dissociating the latter from mania since they occur in mania, ADHD, and agitated schizophrenic states. Lithium slows everything down for some people and has been compared to a filter that makes the world gray. It can confuse them and impede their memory. Grandiosity, however, may continue in people who are taking lithium; thereby accounting for the manic attitude that "I can make it on free will, without my medicine." Risperidone, a serotonin blocker at some sites and anecdotally considered to be an antimanic medication, could eventually be valued most for cutting grandiosity. (See related posting on "A Yellow Post-It.")

REFERENCES:

Cowley G & Underwood A. (1997) A little help from serotonin. Newsweek, December 29, pp. 78-81.

Goodwin, F & Jamison, K. (1990) Manic Depressive Illness. NY: Oxford.

Kuhn, T. (1992) The Structure of Scientific Revolutions. (3rd Ed), 1992, Chicago: Univ. of Chicago Press.

Sulloway, F. (1996) Born To Rebel: Birth Order, Family Dynamics, and Creative Lives. New York: Pantheon.

Suomi, S. (1997) Nonverbal communication in nonhuman primates: Implications for the emergence of culture. In Segerstrale, U. & Molnar, P. ( Eds) Nonverbal Communication: Where Nature Meets Culture. Mahway, NJ: Erlbaum, pp. 131-150. (References to the original articles cited by Suomi were excluded above but are available on request; send me an email, jbrody@compuserve.com)

• Published: Teen Alpha by James Brody, 7/14/98