A Maniac Explains Mania

I’d like to explain how I visualize the workings of my own brain.

At first glance, it’s just a big bag of neurons. People don’t seem to differ all that much in the actual weight of the brain. I take this to mean that there is not a lot of difference in the number of neurons, or that  such a number doesn’t tell us very much about the very great differences we see in the efficiency of people’s brains.

The other real and quantifiable thing about the brain is its enormous number of synapses, which communicate between one “up stream” neuron and a number of “down stream” neurons. I picture the differences in “efficiency” or “power” of the brain to be a matter of how the neurons are wired together: the number of connections, the usefulness of the connections, the mysterious ability to make and break connections, which, from the perspective of the brain’s owner, emerge as ideas and associations between ideas.

So, some people’s brains work better than others because of the way the are wired, or, more specifically, how efficiently they can be re-wired: how quickly and easily new connections can be made and old ones broken. It is also generally accepted that brain function in general and efficiency in particular involves suppression of connections - about what you ignore as much as what you regard as relevant.

It turns out that one key function of sleep is the burning off of old connections. The connections that survive do so because of heavy re-use and multiple pathways.  After a good night’s sleep, it feels like things are a bit clearer and the bullshit that was bothering you the night before (or during the night) seems to have faded in importance somehow. There is a deep connection between sleep and mania, which I will come back to.

Intelligence

I see IQ as a very rough gauge of long-term mental efficiency. An IQ test measures exactly the ability of the brain to make connections over the long haul and in the immediate situation. There are many problems with the test itself, but I take it for granted that there is such a thing as mental efficiency and that an IQ test gives us a rough way of at least comparing the mental efficiency of two individuals with more or less the same cultural background, formal education etc.

Since mental efficiency is, at bottom, a chemical process, it is not surprising that chemicals can make gross changes to the underlying process for better or for worse. This would be true of chemicals circulating in the brain (such as serotonin) or chemicals introduced into the brain such as cocaine or prozac.

So, let me tell you how I see my own mental efficiency.

When I was 16, the Canadian Armed Forces gave me an intelligence test. I think an hour was allotted to the test. I finished it in 15 minutes and got 100%. This tells me that the test was basically designed to distinguish between people in the 80 to 100 IQ range -- the military wishing to ensure that its soldiers can at at least understand, remember and obey instructions. I was “off the scale” on this test, just as my van would be off the scale if its speedometer only went up to 30 KPH.

When I was in my late 20’s I got another IQ test in the process of being admitted as a candidate for the United Church Ministry. In this case, the needle pointed to 145, but by that time my brain had deliberately been throttled down by medication due to a past (and likely future) of “bipolar illness”.

Soon after that time, I joined #Mensa, an organization obsessed with IQ. To get into Mensa, you need to score over 130 in any one of three tests. This takes a crude measure and makes it cruder. Ideally, you would take the three tests scores x,y,z and characterize people in 3-space (x,y,z), then draw a boundary. Or at least take an average. My experience with Mensa was that everyone was pretty bright, everyone had a good vocabulary and an ability to follow a conversation. Some were very successful (well known columnists, publishers etc.). Some were total failures in real-life terms. Looking back, I could say that one important difference between Mensa members was the ability to break connections (abandon old ideas or at least imagine what it would be like to be wrong). I also noted, at the time, that there was a notable absence of professionals who must be very smart to be in their profession at all. For example, there was only one medical doctor (not a regular) and I was the only one lecturing at a University level. I don’t think that real “geniuses” have time to sit around and sip coffee with “wanna be” geniuses. They get all the genius contact they need in their daily lives.

I also felt that I was much “smarter” than most of the Mensa folks I met in the sense that I could create new ideas, toss old ones aside, explain and elaborate ideas much faster than than the folks I met. The big difference was that the Mensa people were usually quite able to understand what I was talking about and discuss things politely.

Bottom line, I think I can operate quite well at a speed reflected in the 145 score, taking into account that the speed is “throttled down” by medication (Lithium and Prozac then, now Tegretol).

I got a clue about the effect of these medications when i needed to switch -- #Lithium was destroying my kidneys. #Prozac went out with the lithium and both were replaced by #Tegretol. The effect was stunning and I mentioned it frequently to my doctor. All of a sudden, I could remember things (where I parked the car, left my keys etc.). I attribute this difference to the subtraction of Prozac, which is known to somehow enhance on the ability to forget. Remember the “burning off” function of sleep? If you can’t burn off connections, you wind up with too many and sleep doesn’t help. So, introduce Prozac and you enhance the ability of the brain to burn off connections that are not “needed’. Of course your brain doesn’t know in advance what is “needed”, in fact that’s the entire purpose of the brain in the first place. So Prozac burns off extra connections (great for treating #PTSD) and makes it easy to forget irrelevant facts like where you parked the car.

Subjectively, there is another factor at work, which i attribute to Lithium and (now) Tegretol. These drugs seem to just slow things down, which, in my model, means they slow down the process of making new connections. Without these drugs, I’m flooded with new ideas all the time, a condition known as “mania”.

Speed Bumps

I had my first “nervous breakdown” in 1969 at the age of 22. I had just completed my Master’s degree thesis, which involved many late nights (I needed exclusive use of the “mainframe” computer because the program I was working on required 360K!!). I was also self-medicating with marijuana. Looking back I think the marijuana was an attempt to slow things down, but of course, marijuana has a twin effect: you are flooded with new ideas before you finally fall asleep.  I was also self-medicating with LSD, a chemical that blows away any restrictions on connections, making everything in the world utterly wonderful. The two together worked significantly alter what it felt like to be “me” both in short term and (as it turned out) the long term.

For many years, I suspected that my drug use “caused” the condition that doctors came to call “bipolar”. I now think in different terms. I think that, left to itself, my brain would run at IQ 165 (well into “genius” territory) but would have the tendency to burn out or “run off the road” -- a situation that we all came to call a “nervous breakdown”. So I need the drugs to operate smoothly.

The problem is that the drugs operate as very messy and inefficient governors. Instead of having a throttle that can keep my speed in safe range, instead I have the ability to throw sugar in the gas tank. There is a huge difference between the various ways that Lithium, Prozac and Tegretol act as “sugar”, but the target is always the same -- to slow down the rapid creation of connections and assist in dissipating “crazy” connections. In my experience, Tegretol does this more efficiently and with fewer side effects than the (more or less standard treatment) Lithium/Prozac.

The Role of #Quetiapine (Q)

Q seems to have become a popular drug to treat manic symptoms. It works well for short-term mania associated (for example) with stressful situations or drug use. Some doctors want to use it long term to “slow down” people who they can see are driving too fast for the road conditions. These doctors will even subtract Tegretol from the picture (which I see as a drug that makes everything work more smoothly at a slower  pace). The idea is to make the patient “drive” with just one control -- his foot on the brake. You step on the brake until you and everyone around you is satisfied that you are driving safely.

I use Q as an emergency brake only. If things are getting a bit scary, I can tromp on the Q break, get a good nights sleep or two and cope until control is resumed.

I clearly remember the days when I learned to drive a car. I had one friend going through the same process who seemed to peddle his car with one foot on the brake and the other on the gas. Relying on just Q alone would be like fastening the accelerator to the floor and driving with just the brake. I use Q to just tap on the brake from time to time when I encounter the steep hills, and sharp corners I encounter in life. I can take my foot off the gas by slightly increasing Tegretol to a bit closer to maximum recommended dose (the “red line” for that particular control). If things get really scary, i can tromp on the break (Q) and pull over to catch my breath.

Bottom Line

I have a mental Ferrari, capable of driving at speeds of 165 mph or better, but with a tendency to catch fire and explode at those speeds. I have a few thrilling days followed by a “crash”, hospitalization and a long recovery. I can “throttle it down” with Lithium to about 130 or drive a bit faster -- 140 -- with Tegretol, which basically makes the mental “car” more stable and steerable at high speed. The “car” is still dangerous at 140 but, in the 43 years since I first drove it into a wall, I’ve learned to drive pretty safely at that speed, with my foot always on the Q brakes.

There are many signs that I’m headed for the ditch.

• Ranting and emotional outbursts (scaring the crap out of the “passengers” in the car)
• Massive, rapid formation of connections. Everything is connected to everything else.
• Charisma. I can see lots of perfectly valid connections that are not obvious to those driving at safe speeds of under 120. This can be impressive. The problem is that there are too many ideas and the thrill of riding with me quickly turns to panic.
• Humour. A joke is basically the unexpected connection between two “paradigms” or ways of seeing things. I can be pretty funny, which is another classic sign of mania.
• Sweeping plans. Everything gets connected into one big lump.
• Inability to sleep. Sleep is necessary to burn off those connections and the inability to sleep is a strong indicator that connections are being formed at an unhealthy rate -- the natural balancing process has been somehow overwhelmed.

I don’t think of mania as a consequence of a high IQ. It’s just the inability to control the mental “vehicle” at whatever speed is “normal” for that vehicle. I have encountered quite a few very stupid maniacs, driving all over the road at speeds under 100. These are the people who, for example, connect the ideas in the Bible with fears of nuclear war, climate change, asteroid hits and volcanoes. Like me, they can lie awake at night, unable to stop their brain from coming up with amazing insights (aka stupid ideas) that must be immediately communicated to the whole world.

So that’s the way I think of my situation. It’s only a metaphor, a working model that enables me to achieve some kind of practical mental picture of what is happening as I twiddle with the knobs that are mysteriously connected to the workings of my brain and, ultimately, what it feels like to be “me”. I hope this is helpful to my friends and family. Perhaps it might help a few of those other folks who have been cursed with a brain that needs knobs to twiddle with.