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The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

June 2000, No. 1, Sect. 2

Main Article

(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 newsletter.)

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 "Boredom-Inertia."

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 boxes.

Six States of Physiological Arousal - Activation

Levels of Arousal - Activation

Insufficient Excessive Optimal Arousal Source

Internal Emptiness- Agitation- Relaxation- Exhaustion Manic Meditation (Biochemical)


(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 one’s 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 regressive.

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 Webster’s Dictionaries (Third World New International and New Universal), Roget’s 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, we’ll 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 state.

There’s little doubt about my being a "hot reactor." There’s 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 I’ll 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 client’s Medicare health insurance claim form.

And I can’t 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. Let’s 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 client’s 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 abound.

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 engagement.

2. Manic State

At the farther edges of agitation one discovers mania – from extreme enthusiasm to the psychotic. According to Webster’s 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 following symptoms:

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. (Oh, oh…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 person’s 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 didn’t 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.

Double-edged Depression

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 potential.

Double-edged Depression

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 Exalted regression?

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!

Borderline Obsession

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" I’ll place the word "Obsession." Webster’s 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 it’s 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…I 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; can’t 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…Or, 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: "Don’t say anything."

Not say anything? Won’t he think I’m avoiding doing work? Won’t I be wasting time and money? If not actively thinking, emoting and analyzing what’s 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 I’m bathed in this Maslowian, if not mystical-like, energy. Even with present day hindsight and insight, I’m 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 it’s 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 deity."

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?

Symbolic Birth

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," Webster’s 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, it’s 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. I’m 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 (Jung’s 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: "It’s not obsession, it’s 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 it’s 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!

Symbolic Death

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, it’s 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…Depression 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: garysos@earthlink.net

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 the bris."

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 stressdoc@aol.com or call 202-232-8662. Summer 2000, look for Practice Safe Stress with the Stress Doc, published by AdviceZone.com.

(c) Mark Gorkin 2000 Shrink Rap™ Productions