The Stress Doc Letter
Cybernotes from the Online Psychohumorist
June 2000, No. 1, Sect. 2
(Editor's Note: Due to the length of the Excessive Arousal-Internal Source
segment, the segment on "Phobia-Panic" States will appear in the next
Shrink Rap: Excessive Arousal-Internal Source: "Agitation-Manic"
The April and May 2000 Stress Doc Newsletters have broadly sketched a model
for examining how states of physiological arousal impact our
perceiving-thinking-feeling-behaving self. The two variables are degree of
arousal -- from overaroused to underaroused and the source of arousal --
internal or external. The previous newsletter focused on insufficient
arousal-activation states: "Emptiness-Exhaustion" to
Here is a compact 2x3 matrix model of "Six States of Physiological
Arousal - Activation." The two basic dimensions -- "Arousal
Source" and "Levels of Arousal - Activation" -- and the resultant
Six States of Physiological Arousal - Activation
Levels of Arousal - Activation
Insufficient Excessive Optimal Arousal Source
Internal Emptiness- Agitation- Relaxation- Exhaustion Manic Meditation
(Environmental) Boredom- Phobia- Alertness- External Inertia Panic Animation
As previously explained, the "Arousal Source" is a gradient, from
the biochemical (Internal Stimuli) to the environmental (External Stimuli). The
"Cognitive-Affective" (or "Thinking-Feeling") dimension
interacts with, affects and is affected by both biochemical and environmental
stimuli. Nature and nurture forge a complex blend. Both sources and
arousal-activation states excite or inhibit each other in an ongoing feedback
loop. The dimensional interplay influences the ability to: a) manage ones
psychophysiological arousal and resulting emotions, b) process and make sense of
past, present and future self-world information, including memories and dreams,
goals and visions and c) generate an array of responses to everyday problems and
opportunities from the adaptive or innovative to the dysfunctional or
Today, due to the Stress Doc's uncontrolled verbosity, the focus is just on
Excessive Level x Internal Arousal Source: "Agitation-Manic." Ideas
and descriptions will draw upon Websters Dictionaries (Third World New
International and New Universal), Rogets International Thesaurus: Fifth
Edition, the Diagnostic and Statistical Manual (DSM) IV and personal reflection.
The dictionary provides a broader framework for viewing the essence and
potentialities of these states. The DSM sharpens the functionality-dysfunctionality
focus. And before concluding this series, well even examine the boundary
lines between Internal and External Sources of Arousal as well as the borders
between Levels of Arousal - Activation. These border and boundary lines may
actually evoke synergistic interactions for "The Creative Edge."
II. Internal Source - Excessive Level
A. Agitation - Manic State of Arousal
1. Agitation. If inertia involves a lack of or resistance to activity,
agitation may well be its complement:
1) the action of moving, 2) moving back and forth, 3) the state or condition
of being moved to and fro violently, steadily or with a fluttering effect.
These definitions evoke associations to such diagnostic states as agitated
depression and a predisposition to mood swinging, especially with a strong
hypomanic component. (More shortly.)
And, in fact, another Websterism:
4) mental excitement or emotional perturbation: a tremulous and disturbed
Theres little doubt about my being a "hot reactor." Theres
always morning tension, if not anxiety, contemplating the challenges of the day,
like today: a) facilitating a conflict mediation session amongst two Branch
managers and a Division head, b) wondering how Ill pull together in some
accessible format this essay, c) nervously waiting for this final phase of the
book rewriting/editing process to come to a close. Or most traumatic, trying to
decipher and transcribe Egyptian hieroglyphics. Okay, so a slight case of
hyperbole. The frustration generated trying to fill out a clients Medicare
health insurance claim form.
And I cant overlook the basic hypertension that kicked in after a year as
a stress and violent prevention consultant for the US Postal Service. This was
just another example of taking on an outrageous assignment several years back to
rescue me financially and to compensate (in hindsight) for diminished serotonin
efficiency induced mood disturbance. Sure, these challenges also boost skillsets,
ego and adrenaline levels and generate a motivating external environment, which
gets me out of my self-absorbed depressive self. Still, after a while, agitation
becomes a "normal" resting state.
I believe highly sensitive people, both by nature and nurture including
enablers and approval seekers, the acutely empathic and/or the emotionally
intelligent are often restless, subjected to fairly sudden yet, at times,
fairly predictable psychophysiological mood swings. Lets include some
creative types as well. According to psychologist, Dr. Kay Redfield Jamison, in
her work, Touched with Fire: Manic-Depressive Illness and the Artistic
Temperament, one finds a "mixture of elation and some gloominess, feeling
of isolation, sexual pressure and fast emotional responses." (And despite
the book's title, this volatility can also occur in bipolar conditions of less
than psychotic proportions.)
This array of sensitive individuals may be subjected to or flooded with more
internal (and external) stimuli or sources of arousal than they can make sense
of or manage. If the agitational pressure or "inner compass" (a clients
metaphor) keeps spinning faster and faster one may be thrown into the outer
reaches of this cell the manic state. However, if this sensitive soul can
focus the agitation or somehow only swing out to the hypomanic edge and not fall
into the pathological abyss, then expansive vistas and reflective possibilities
Fortunately, the world of semantic meaning is double-edged. A final
descriptor for "agitation":
5) earnest and thoughtful consideration.
As we will see, reflective and disciplined agitation when combined with mild
to moderate mania provides a fertile field and psychic base for creative
2. Manic State
At the farther edges of agitation one discovers mania from extreme
enthusiasm to the psychotic. According to Websters Third International:
1) excessive or unreasonable enthusiasm: a violent desire, passion or
partiality 2) excitement of psychotic proportions manifested by mental and
physical hyperactivity: disorganization of behavior and elevation of mood.
While the Diagnostic and Statistical Manual of Mental Disorders outlines the
following diagnostic criteria for a non-psychotic "Manic Episode":
3) a distinct period (often a sudden and rapid escalation) of abnormally and
persistently elevated, expansive or irritable mood with some combination of the
a) inflated self-esteem or grandiosity, b) decreased need for sleep, e.g.,
feels rested after only three hours of sleep, c) more talkative than usual or
pressure to keep talking; manic speech is typically loud, rapid and difficult to
interrupt. Often it is full of jokes, puns, plays on words and amusing
irrelevancies. It may become theatrical, with dramatic mannerisms and singing.
if the folks in white coats ever saw me doing a "Shrink Rap"
in full regalia Blues Brothers hat, black sunglasses and black tambourine
it would be all over. Actually, an insatiable drive to become a public
speaker may have been an intuitive realization: I needed a stage for acting out
my manic side.) If the persons mood is more irritable than expansive, his or
her speech may be marked by complaints, hostile comments and angry tirades. d)
flight of ideas, i.e., a nearly continuous flow of accelerated speech, with
abrupt changes from topic to topic, usually based on understandable
associations, distracting stimuli or plays on words, e) distractibility is
usually present, and is evidenced by rapid changes in speech or activity as a
result of responding to various irrelevant external stimuli, such as background
noise or signs or pictures on the wall. Still, while there may be some
connection between mania and attention-disruptive hyperactivity, many folks with
a bipolar condition, when not in extremis, are able to be incredibly focused and
productive, f) increase in goal-directed activity or psychomotor agitation often
involves excessive planning of, and participation in, multiple activities, e.g.,
sexual, occupational, political, religious. Almost invariably there is increased
sociability, frequently of an intrusive, domineering or demanding nature. Along
with the above mentioned grandiosity, I better understand my predisposition to
confuse narcissism and mania. (Not that both didnt occasionally compete for
the leading role.) g) frequently, expansiveness, unwarranted optimism,
grandiosity, and lack of judgment lead to such activities as buying sprees,
reckless driving, foolish business investments, and sexual behavior unusual for
the person. h) another common feature is lability of mood, with rapid shifts to
anger or depression. The depression, expressed by tearfulness, suicidal threats
or other depressive symptoms may last moments, hours or, more rarely, days.
Occasionally, the depressive and manic symptoms occur simultaneously, or may
alternate rapidly within a few days.
Several years back I encountered a depressive period related to a fear of
learning computers, concomitant shame regarding my technophobia, a seemingly
stalled career path, and my brother moving to Washington, DC (which heightened
sibling rivalry issues with my more financially successful younger brother). A
week or so after crawling out of the black hole, grappling with these lyrics
further resurrected my mood and psyche. "Double-edged Depression" both
captures the cyclical nature of certain mood disorders as well as their creative
Waves of sadness, raging river of fear Whirlpooling madness till I disappear
Into the depths of primal pain... Then again, no pain no gain.
Depression, depression Is it chemistry or confession? Depression, depression
Dark side of perfection.
Climbing icy spires, dancing at the ledge The Phoenix only rises on the
jagged edge. In a world of highs and lows Hey the cosmos ebbs and flows.
Depression, depression It's electrifried obsession. Depression, depression
So I'm pumping iron and Prozac, too What else can a real man do? In a life of
muted dreams How about a primal scream? AHHHH...
Depression, depression Even inner child rejection. Depression, depression
Hallelujah for creative expression!
While manic episodes often follow psychosocial stressors, the genetic
predisposition and biochemical reactivity place it in the Internal-Excessive
cell. Along the border between "Agitation-Manic" and
"Phobia-Panic" Ill place the word "Obsession." Websters
presents two definitions which appropriately have an outer and inner locus:
1) act of the Devil or a spirit in besetting a person, or impelling him to
action 2) the persistent and disturbing intrusion of an anxious and inescapable
preoccupation with an idea or emotion.
More specifically, DSM defines "obsession" as
3) persistent ideas, thoughts impulses or images that are experienced, at
least initially, as intrusive and senseless for example, a parent having
repeated impulses to kill a loved child, or a religious person having recurrent
blasphemous thoughts. The person attempts to ignore or suppress such thoughts or
impulses or to neutralize them with some other thought or action. The person
recognizes that the obsessions are the product of his or her own mind, and are
not imposed from without (as in the delusion of thought insertion).
And with all of these states there can be a fine line between the
biochemically, neurotically and creatively obsessive.
Mandala Madness: From Mystical Manic to Academic Panic
Let me spin a tangled tale based on these obsessive strains. The setting is
my late 70s-early 80s doctoral student days in New Orleans with its obsessively
endless search for just the right dissertation topic. This holy grail, not quite
thirty mindset basically paralleled my elusive search for Ms. Right. Not
surprisingly, these two immature ego-driven and depression-driven processes
eventually propelled me into familiar (yet also novel) territory back into
therapy. But this time its psychoanalysis, three times/week, with a Tulane
Medical School psychiatry resident. (Psychoanalysis in "The Big Easy."
Now this has oxymoronic potential.) The $10/session fee, clearly a bargain, was
still an act of faith for a fairly starving doctoral student.
After a short introductory period, I opted for lying on the couch. Voila
took to self-absorbed, in my own world psychic reverie like a Jerry Springer
guest takes to a TV camera. A narcissist with a captive audience; cant get
better (or scarier) than that! Naturally, I thought my analyst was fortunate: my
free association was endlessly fascinating. ;-)
Actually, once ensconced in the primal prone position, deep and intensive
early childhood grieving, for months on end, was the norm. Eventually, there
arose awkward attempts at shaping soulful stirrings with a singing heart and
dancing mind. Poetry proved to be a kaleidoscopic lens into the obsessive self
was it an obsessive lens into the kaleidoscopic self?
Then one day the words and tears, sounds and images were silent and still.
Very strange considering my seemingly endless wellspring for introspection and
psychobabble. While lying on the couch, an uncommon pronouncement for my
therapist: "I have nothing to say." So he makes a most brilliant
counter: "Dont say anything."
Not say anything? Wont he think Im avoiding doing work? Wont I be
wasting time and money? If not actively thinking, emoting and analyzing whats
the point or my purpose?
Okay, let me humor him. So I remain quietly still, my mind off duty. And
within thirty seconds "it" happened: suddenly Im bathed in this
Maslowian, if not mystical-like, energy. Even with present day hindsight and
insight, Im not sure what proportion was a pregnant moment of
self-actualization and what hypomanic chemistry. Anyway, the sensations ranged
from the serene and sensual to the expansive and ecstatic, with plenty of
emotional markers in between. Not to mention an out of body experience with my
spirit self, perhaps, hovering on the ceiling looking at my corporeal self.
Perhaps this out of body state in some way also mirrored or captured my
emotional splitting as a child. Dissociation was necessary to try to block out
the looming psychic tsunami and unspoken family terror that often seemed on the
verge of devouring my remaining shreds of sanity.
And its possible that this out of body epiphany was in reality a dream
state or, as mentioned, some manic-like manifestation. As the DSM notes,
diagnostic criteria for Manic Episodes may include: "delusions or
hallucinations whose content is entirely consistent with typical manic themes of
inflated worth, power, knowledge, identity, or special relationship to a
Actually, the grandiosity and obsessional thinking would come shortly,
post-session. While on the couch I was in some space-time that ebbed and flowed
between childlike delight and disorientation and a sense of primal connection.
There was also this intimation of another parallel process: my being an integral
part of some cosmic wholeness (oh, oh
those inflated themes) and that all
emotions, all experience the good and the bad, the shameful and joyful, from
being mean-spirited to being magnanimous coexisted within me and rightfully
(not wrongfully) so. Again, with hindsight, the experience seems to have been a
pure self embracing moment; a phenomenal yet, alas, also ephemeral state of
self-acceptance and self-love that had eluded me for most of my three decades on
earth. But for the first time in conscious memory, I had tasted the fruit of the
primal garden. What symbolic salvations and serpents loomed, overtly or
covertly, on the horizon?
Later that evening, while making another halfhearted attempt to engage with a
dissertation topic, I pushed the books and notes aside. There was only one
burning question: "What the hell happened on that couch today?"
When it comes to "obsession," Websters was definitely on the
mark. An agitated-obsessed state was growing in intensity. Perhaps I was
possessed by some spirit, passion or some alien idea or purpose. I surely felt
compelled to impose some order upon this unprecedented encounter; to glean
higher meaning from the day's sublime chaos. Being a master of psychobabble, not
surprisingly, emotionally charged words like "serene" and
"sensual," but also "tender" and "playful,"
"aggressive" and, even, "ecstatic" were aligning themselves
vertically on the notepad. But this was a much too verbal and linear arrangement
for an experience that captured a profound and ineffable sense of
interconnectedness and wholeness.
Well, its beyond the scope of this essay to detail exactly how I went from
a linear listing to an intricately structured, multi-octoganal conceptual map of
creative personality integration. Suffice to say, without any premeditation, a
Mandala (a Sanskrit term for "magic circle") began to emerge. It was
thirty-six hours later that the word itself percolated up from my unconscious.
To this point, I was clueless about Eastern mysticism and about the Mandala as a
symbol for inducing deeply meditative states of consciousness.
Now I vaguely recalled that the pioneering psychoanalyst Carl Jung studied
the Mandala as a cross-cultural, geographically far flung symbol of the
collective unconscious of the human species. Im not sure about the universal,
but this homegrown Mandala was definitely a visual symbol. But it was also a map
of my heretofore seemingly confused, if not chaotic path, of individuation (Jungs
reconciliation of our seemingly oppositional psychic states introversion and
extroversion, anima and animus, overt persona and subterranean shadow sides,
etc.). This spontaneous outpouring was my intuitive vision for approaching, if
not fully recovering, psychic wholeness.
In this fairly frenzied creative state, one thing was clear: I had discovered
my dissertation topic. And for the four months of pondering and ruminating over
the "perfect" words arranged with Periodic Table precision in an
intuitively derived multi-octoganal structure, I was mostly in hypomanic heaven.
At the time, friends and colleagues thought I was seriously
"obsessed." More likely, their actual impression was, "Off the
academic wall." I recall parrying the obsession label with the following:
"Its not obsession, its devotion." And I was truly devoted to my
creative offspring, But, with hindsight, (and many years of therapy) this
emotionally labile and existential gumbo of the near manic and the near mystical
was transformed into: a) obsessional devotion in the short-term, b)
dysfunctional desperation in the mid-term culminating in profound academic
exhaustion and, finally, c) long-term inner faith and ongoing commitment to
complex self-exploration and creative expression.
Of course, the were many self-aggrandizing hills and depressive valleys on
route. Much more than discovering a dissertation topic was at stake. Because of
its complex and creative essence, the Mandala was also surely a
self-vindicating symbol of my uniqueness. Deep-seated self-doubts, shame and
inadequacy would be eradicated by this magical visualization. I would be
"born again." Grandiosity thy name is Gorkin!
Perhaps not surprisingly, after two years of obsessive pursuit of the
ineffable, and continually fighting more traditional and realistic dissertation
advisors, the only tangible result was profound burnout and dropping out of the
doctoral program. Though there was a silver lining: eventually becoming an
expert on stress and burnout. Now, two decades later, I can quietly smile at the
one line descriptor of my passionate, if not obstinate, denial and defiance, my
doctoral days of "sturm und drang": "When academic flashdancing
whirled to a burnout tango."
In hindsight, the first four months of giving birth to the Mandala was a
singular experience -- from the hypomanic and the mostly the joyful; it was
filled with new learning curves, including architectural-like drawing and
learning to lay down thin strips of drafting tape. No small accomplishment for
someone who was totally overmatched by and ashamed of his barely passing
performance in Mechanical Drawing in high school.
And, perhaps most important, without fully conscience intent, the Mandala
also proved to be a hidden treasure map: that my inner psychic landscape could
be both fertile field and ingenious guide for an uncommon and artistic career
path. So obsession is definitely double-edged.
Actually, its probably multifaceted. I suspect obsession results when we
are overloaded with more biochemical and environmental, cognitive and affective
data than we are aware, or that we can process and make sense of. Obsessive
thinking and compulsive (or addictive) behavior is an attempt to channel (or
cover up) the outpouring of cognitive-affective floodgates.
Or, according to the DSM, compulsions are repetitive, powerful and
intentional behaviors that are performed in response to an obsession, according
to certain rules or in stereotyped fashion. The behavior is designed to
neutralize or to prevent discomfort or some dreaded event or situation
and anxiety are common. Frequently there is phobic avoidance of situations that
involve the content of the obsessions.
So when instead of craving something because of internal emptiness,
ego-driven needs or biochemical addiction, you irrationally fear and
ritualistically avoid some environmental stimuli, you start moving into the
realm of phobia and panic.
Reader's "Higher Power of Humor" Section
WOW! From: firstname.lastname@example.org
A Jewish Texan buys a round of drinks for all in the bar and announces that
his wife has just given birth to a baby boy weighing 20 pounds which even for a
Texan is atypical.
Congratulations shower him from all around, and many exclamations of
"Wow!" are heard. A woman faints due to sympathy pains.
Two weeks later, he returns to the bar. The bartender says, "Say, you're
the father of the Texas baby who weighed 20 pounds at birth. How is he doing?
What does he weigh now?"
The proud father answers, "Fifteen pounds."
The bartender is both puzzled and concerned. "Why? What happened? He
already weighed 20 pounds at birth. How is it he lost so much weight?"
The Texas father takes a slow swig from his long-neck Lone Star, wipes his
lips on his shirtsleeve, leans into the bartender and proudly says, "Had
Seek the Higher Power of Humor: May the Farce Be with You!
Mark Gorkin, LICSW, "The Stress Doc," is the Internet's
and America Online's "Online Psychohumorist". An experienced
psychotherapist, "The Doc" is a nationally recognized speaker, and
training and OD consultant specializing in Stress, Anger Management,
Reorganizational Change, Team Building and HUMOR! An expert advisor for
www.AdviceZone.com and iVillage/allHealth, his writings are syndicated by
iSyndicate.com and also appear in a wide variety of online and offline forums
and publications, including AOL/Online Psych and Business Know How, Mental
Health Net, 4Therapy.com, HRHub.com, SelfhelpMagazine.com, Financial Services
Journal Online, OpportunityWorld and Counseling Today. Recently, he has been
quoted and/or featured in such publications as Cosmopoli tan Magazine, Bloomberg
Report/News, Forbes Magazine, FoxNews.com, Dallas Morning News and The
Washington Flyer. The Doc also leads his national "Shrink Rap and Group
Chat" for AOL/Digital City and WebMD.com. Check out his USA Today Online
"Hotsite" Website -- www.stressdoc.com . For info on his workshops or
for his free newsletter, email email@example.com or call 202-232-8662. Summer
2000, look for Practice Safe Stress with the Stress Doc, published by
(c) Mark Gorkin 2000 Shrink Rap Productions