The dopamine delusion: why I think there’s more to it than brain chemistry

So, a few months ago I was sitting in my psychiatrist’s office, telling him about THEM. I was crying a bit, although not as much at the urgent GP appointment two days previously. That was before I’d put my antipsychotics up and deployed PRN benzos, when THEY had me in a much tighter grip. Everything that went wrong, I explained, felt like cumulative, incontrovertible evidence that malevolent forces were watching me, messing with me, taunting me. My psychiatrist listened carefully then asked whether I had any sense of who THEY might be. “They’re not – they don’t represent any kind of body,” I tried to make him see. “I don’t think I’m being watched by an organisation, they’re not MI5 or the CIA or anything. They’re more…supernatural than that. It’s like they’re outside my reality but able to manipulate it. They’re watching me from somewhere else.” As I spoke I had a vision of something like Mount Olympus inhabited by beings even more capricious, and certainly more malicious, than the Greek gods.

There was a certain look on my Consultant’s face that I didn’t remember seeing in any of our previous sessions. It was very careful expression, an expression that said: “You are telling me something really strange and irrational, a belief in which I cannot share, but I understand that you believe and I am endeavouring to be respectful.” Then he said, “Well, Charlotte, we would see that very much as the result of faulty dopamine levels. So our first line of action would be to look at another medication increase, to see if we can redress that balance.”

I looked at him. I had (have) the greatest of respect for the way he has actively involved me in deciding which treatments to try and for his support for my self-management plan. But – this was it? This was all he had to offer in terms of commenting on my experience? The content, so immediate and so strange to me, seemed to be of no particular interest to him. I didn’t know what to say; the only way I could imagine coming to terms with my experiences and perhaps reducing the terror they engendered was to pick apart the meaning.

Some weeks later I ran across an amazing TED talk, The voices in my head, by Eleanor Longden. I hope you’ll watch the talk (it’s less than 15 minutes’ viewing) but here’s a summary anyway. Longden began to hear a voice at a time of stress when she had left home for university and was experiencing pressure of work. The voice didn’t trouble her, but she mentioned it a friend who was horrified and urged Longden to see a doctor. Events progressed rapidly, and soon Longden found herself in and out of psychiatric inpatient units. Meanwhile, the rather benign original voice became something more diverse and something that seemed sinister and unpleasant.

Longden’s current approach is the opposite of taking more and more antipsychotics in an attempt to subdue her voices via stablising dopamine levels. She now sees the content of her hallucinations as meaningful, even useful; she feels the voices have a purpose, that they do something potentially beneficial for her. For example, what may seem like a negative, critical voice advising of the dangers of going outside can be seen as representing a part of Longden’s psyche that knows she needs downtime, that is encouraging her to pull back from the outside world and challenging her conscious belief that she “should” be out and about, working, socialising.

This talk was a breakthrough for me. I was already convinced that there must be something behind the very specific content of my paranoia, that there must be a reason why I “meet” supernatural beings out to thwart me, while another person might believe they are under surveillance by the security services and yet another feels everyone can see them as if their life is a live broadcast. And so I began to ask myself whether there was any way in which THEY could be an attempt at self-protection by some deeper part of my psyche. It was completely new for me to think of my delusions in terms of what effect they had, and whether that effect could be helpful/adaptive, rather than dwelling on the emotions they caused.

A very common theme in my paranoid ideation is one of being thwarted. It seems to me that THEY know that I am looking for help – whether through connecting with service user friends on Twitter or trying to get an appointment with a doctor – and place deliberate obstacles in my way. Phone calls to the surgery drop. My Twitter account is hacked. Support websites go down. From where does this arise? I sometimes joke that the subtitle of my memoir ought to be, “Failing to get meaningful help for 25 years.” Ever since my earliest symptoms I have put myself out there again and again, asking for help from GPs, psychiatrists, midwives, counsellors, helplines, only to find that promised help does not exist or in fact makes things even less tolerable. I am beginning to see that this sense of being thwarted by THEM probably comes from a profound pessimism about the reality and quality of help on offer. Perhaps that hurt part of me, the part that had to carry on alone for so many years, fears getting my hopes up again. Perhaps the feeling that it’s not worth trying because THEY will intervene is a mechanism for protecting me from further disappointment.

Another common theme in my paranoia is THEM using tech. Sometimes THEY use my computer or Twitter to watch me; at other times THEY trick me into communicating with them by hijacking social media accounts of people I love. Stepping back and looking at my online presence, I actually perform a huge balancing act on a daily basis, deciding how much of myself I share online with almost 5000 followers and what is better kept private. I have, however, rarely stopped to consciously think this through. It’s probably no coincidence that his type of idea first came to the fore when I had just begun writing my book; what I was considering putting out there was much more personal and more detailed than the content of this blog. Being wary, stopping work for a while, was no bad thing. As a general rule I try to suppress my anxieties about who reads the book and what they make of it so that I can carry on writing, but maybe I need to think more carefully and explicitly about the differences between “me”, “Charlotte Walker the writer” and “@BipolarBlogger the prolific tweeter.”

The element I find hardest to understand – and I would welcome comments on this – is that when paranoia is kicking in, certain colours and patterns (on fabric, folders, furniture, etc) become “dangerous”. I am afraid to touch them and will go out of my way to avoid doing so. The colour issue has some pretty obvious resonances, in that the “riskiest” colour is a dark red, like dried blood. It’s funny, because I am probably bothered less by blood than the average person; I used to deliver babies, after all, and happily signed up as the work self-aider dealing with everything from copious nosebleeds to clients with very recent self-injury. Nevertheless there is a very deep connection in the human mind between blood and danger, while the patterns are far more bizarre. I have a particular problem with dark coloured shapes on a paler background, and a sense that the shapes have the capacity to move on their own. I have never seen them do this, I just sense that they can, and that this is where the danger comes from. If the shapes have points giving an apparent direction of travel – arrows, say, or teardrops – this makes them extra dangerous. I am struggling on this one and as I say observations are welcome.

Maybe you’re thinking I could benefit from psychotherapy, rather than trying to puzzle this stuff out on my own. You’re right of course, but this isn’t something that’s available to me on the NHS. My Trust appears to take the line that if you’re bipolar you only really need CBT for mood recognition and management, and I had my eight weeks of it over two years ago. I guess I could push my Consultant, but given the lack of importance he attaches to exploration of content, I can’t see me getting anywhere, especially in the face of current budgetary constraints. I would go to a private therapist if I could, but with my income so patchy that’s not an option right now. So it’s just me, THEM, and this blog.

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About purplepersuasion

30 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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12 Responses to The dopamine delusion: why I think there’s more to it than brain chemistry

  1. Hang inthere. Sometimes, you can think of a better resolution by yourself.I was a lab rat and misdiagnosed for too many years.

    • I don’t for one second thing I am misdiagnosed. I simply think I am interested in different aspects of the bipolar experience to the ones my psychiatrist seems interested in!

  2. JJ says:

    I absolutely know many of the things you describe – active lines, shapes and an unshakeable knowledge that some power out there is disapproving of my very existence. I love the idea of trying to see the subtext & the thought that maybe it’s not a malevolent force. Thanks for the link to the ted talk, I will certainly watch it as anything, however strange, that helps, well helps. I am also incredulous when the psych just talks about more anti psychotics, he just doesn’t understand the enormity and totality of the feeling. Thanks Charlotte, I don’t feel so alone!

  3. aett1974 says:

    Colours, yep Red normally a lava flow I cant step on trapping me in the open plan living room come kitchen till the other half comes home (mildly amusing to think of it now) but most of my paranoid episodes have been around organizations trying to interfere. I keep trying to tell myself I’m not actually that important and they would not waste the funds but you know how it goes. A dodgy past where I may have upset the powers at be always worry me. And yes CBT is useless for combating paranoia other than maybe the don’t catastrophrise the shebang. Me, them and the others to ….

    • I do indeed know how it goes…of course I am aware that it’s all very narcissistic to think there’s another dimension out there just for the sole purpose of keeping tabs on me…but of course delusions and hallucinations are bound to be self-referential, since as far as I understand things they are out brains trying to make sense of what is happening to us!

  4. whythispath says:

    I loved Longden’s Ted talk. I’m so glad it was helpful to you personally. Separating the way that these delusions affect you emotionally and analyzing them to find how they could help you seem very rational. As for patterns being dangerous, you may look more into what people with eating disorders refer to as “trigger” foods and see if you find any helpful patterns there. What you describe reminds be of irrational food choices a friend of mine told me about.

  5. Such an honest post, Charlotte! Thanks for sharing :)

  6. I completely understand and applaud you for searching beyond his/her interests towards helping you. I honestly believe that is usually a must. You’re an insipiration. :)

  7. weavergrace says:

    I think of how people with bipolar hundreds or thousands of years ago managed it. Did they need to manage it? Did everyone have bipolar, as they lived cyclic lives in harmony with the sun, moon and planets?

    I like to think of bipolar as a gift, or wonderful sense of reality. These ideas were challenged today when I felt outrageously and explosively angry in response to the stress I have been managing. My therapist reminds me that this is part of the bipolar chemistry. I like to think of it as a nurturing mother reminding me that I need to take it easy and retreat to recover from the stress.

    • Whatever I feel about my BP, there is no WAY I experience it as “nurturing mother” :-S I see some experiences as *adaptive* – something *I* have developed to deal with dis/tress. So are lots of horrible mental health symptoms. Sorry I… I just can’t relate to that whatsoever.

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