: # introduction
At 2013nov16am0830sat there was a knock on my door. Opening it & finding Jenna standing there I observed "ruh-roh Im in trouble now" & let her in. It has been exactly six years since I first formally informed her that she will always be welcome in my home, & since then she has lived with me six times & left, the longest stay being the nine months following 2011apr22. Jennas mental situation is complex, a textbook example of a condition which does not readily succumb to diagnosis upon casual presentation, & in my years working with her I have largely deferred to her self-described DDNOS diagnosis or the schizoaffective label she acquired in a court action, as she generally has no meaningful therapeutic relationships & no reliable pharmaceutical regimen & the priorities thus tend to lie elsewhere (logistics, education, support, &c.). Nonetheless the precisely 30 days she just succeeded in spending with me offered a perfectly controlled microcosmic example of her unassuming, nominally stable, basically functional normal state morphing under a trivial trigger event into a not entirely uncontrollable episodic dysphoric hypomania with pressured speech, autolalia, & psychomotor agitation, then ultimately escalating under further stress into a fullblown manic cycle with racing thoughts which within a matter of minutes convinced her to hurl a regulation bathroom scale at my head with unrestrainably murderous intent.
Although thusfar my voluminous notes & writings concerning Jenna havent examined the spectrum bipolar diagnoses, her behaviour this time around led me directly to dysphoric BDNOS / cyclothymia, particularly once I recognised the phenomenon of pressured speech & the effective uninterruptibility of the vocalisations coupled with the distinctly "irritable" temper. Using the internet to examine anecdotal writeups which are largely reflected in the ICD-10 & DSM-IV makes it clear that Jennas sudden motivation to violence is indeed due to some statistically significant condition rather than just a bad habit engaged in by an uneducated urchin. As someone who now has far more experience with the situation than the occasional mental health worker or law enforcement operative, I feel due diligence dictates that I make available some of my longer term observations & conclusions, & finally propose that her condition, although charming & colourful to street denizens & realestate consortia alike, can no longer be glossed as some amorphously energetic creative euphoria but is in fact a specific symptomology which arguably should at some point be addressed with mood stabilisers & longterm cognitive psychotherapy & real education.
: # Jennas rap: the keys to the kingdom
Anyone familiar with Jenna knows about her celebrated style of "pressured speech", an ongoing, tendentious, self-revelatory rap which has its counterpart in the voluminous handwritten 8.5x11 fliers she posted throughout the Bay in the 90s & 00s. To the uninitiated she is a babbler, talking to herself sometimes a bit too animatedly (perhaps even too provocatively around cops & kids), yet these tales full of sound & fury do in fact signify something other than the random ramblings of an obsessively preoccupied narcissist. Jennas response to what she calls "the voices" is to endure having to talk along with them during hypomanic episodes, which she has done since roughly 1995. Her habit of referring to herself in 3rd person makes her sound schizoaffective albeit without alters, although recently shes developed a pair of interlocutory echolalia type voices which make her sound manifestly multiphrenic. The quieter, earlier voice merely says "uh-huh" whenever the principal pressured voice experiences blocking or hesitates, simultaneously confirming & eliciting the monologue as it creeps forward. A new voice she developed in the 2 years shes been gone however is slightly more verbose & insistent, calling out "Well, then WHAT?" in a pointed way whenever the dialogue between the first two personae falters. Jennas response has become a long, demonstratively helpless sounding "well ..." leading her back into her factual description being patiently detailed for her pair of companion interviewers.
Todays version of Jennas rap sounds almost exactly like a panel discussion you might hear on TV, tidy & presentable, animated & ongoing. But once it starts Jenna simply cannot stop talking along & will stay up for several nights straight entirely without sleep & with few obvious ill effects other than a pronounced hoarseness. Although the topic is "the boyfriends" & herself, it is compelling to her because it is hypomanic & it makes her breathlessly uninterruptable. It is also more than highly autobiographical; I would posit that Jenna is actually experiencing flashbacks to particular moments in her experience, where she lingers in the company of all the participants in various situations, reliving their motivations & attitudes as well as their actions, often reciting their ages as if frozen in an extant constellation which she still perceives clearly via her photographic memory. & although she can restrain the rushing vocalisations for short durations in public & is distractable enough that they can be influenced by the experienced, they simply will dominate her cognitive & speech centres to the exclusion of all else if she can plant herself in a park or a doorway or a friends extra room, where she can curl up under a blanket for days experiencing psychomotor agitations in her hands as she confidently broadcasts the details of her lovelife like a perpetual kiosk for the oversexed mediaplex.
: # methodology: a short historical summary
Jenna lived with me (1) in 2007 for some weeks at an Oakland SRO, (2) in 2008 in Bedford Texas & (3) in 2009 in ftWorth, (4) in 2010 for some weeks in Arcata & then (5) a full 9 months in 2011 in Shasta county & finally (6) the 30 days ending 2013dec16 at the same location. I now realise she was already hypomanic in Oakland & I (like many others) can recall clearly her instantaneous escalations to bonafide mania. In Bedford she was under similar stress & although I noticed no specific hypomanic onset I continued living with her after her manic fit in her workplace & she ultimately smashed my computer & left the state & was promptly arrested for assault on Durant ave in Berkeley. After a year when she returned to ftWorth there was enough pressured speech that she made a point of obtaining meds before we spent 60 days in the car searching for housing in Arcata. I was forced to find a place on my own & she wandered the doorways & woodlands of Humboldt county in a hypomanic state before heading to a Washington campground & ultimately incurring a courtordered stay in a private mental hospital in Mukilteo. Released into my care, she was so doped on lithium that she developed catatonic symptoms during withdrawl, notably cyclical facial expressions & impossible standing postures maintained over unbelievably long periods. She ate effectively nothing for a month & remained quiet & the most amicable Ive ever seen, then suddenly announced she wanted to 5150 herself for depression, one of the few times we havent parted with violent abruptness (although she made no further effort to contact me once I dropped her off). This is a familiar spectrum bipolar pattern: seeking help for the less energetic end of the syndrome but not recognising the need to address any hypomanic episodes before they become fullblown mania.
By early 2011 I knew what Jenna wants is a good friend with a quiet apartment & a car that can reach a northern California walmart, & by the time she had purchased her own vehicle & ruined it driving maladventurously to Winslow [sic] I had a place she could move into where she could pay for the cable. If there is anything like Jennas pre-hypomanic "normal" state it would be her comportment during the next 9 months. She had her own reliable space & was actively viewing the cable feeds, with no undue financial disasters meaning she could pay for her food & Starbucks & even split the petrol (with me paying everything else). It is true that she was in the habit of frantically playing EA Tetris on Nokia 6650fold cellphones & I still have the unit where she achieved her most phenomenal highscores, its D-button battered & cracked from the incessant push of her fingers. Yet it was not until I became stressed over the theft of the car that her first hypomania set in, a few weeks after she traded her Tetris for a Prop215 recommendation, reintroducing the aspect of substance usage for the first time in over a year. I remember noticing a change & ultimately being unprepared for the confrontational evening where she suddenly became manic then called the police needlessly once again. This familiar pattern now makes me realise that in Jennas case there should be a newfound emphasis on prevention & treatment of episodic hypomania, predicated on an awareness of the spectral nature of the escalation process & the need to avoid manic onset.
: # the challenge: a layered approach
Jennas agitated, dysphoric hypomanic state is unfortunately the clearest window into her underlying attitudes & personality, as any listener can hear her discuss her upbringing, opinions, tastes, & motivations literally endlessly & in meticulous detail. Her psychomotor vocalisations are not a communicative act, however, so this is not generally a state for the unwary to try & discuss them with her, as she is prone to irritability when thwarted & may become argumentative & confrontational. Nonetheless some of her fundamental attitudes independent of the hypomania contribute directly to the direness of the episodes, notably her cavalier approach to budgeting which permits erstwhile trivial financial details to become the most stressful of trigger events, & the childish logic she uses during a manic escalation to justify reckless behaviours. It should therefore be emphasised that the hypomanic aspect itself, indicated by the pressured speech, is a psychopathologic issue apart from Jennas attitudinal & personality nuances whose adjustment must be effected via conventional psychotherapy & ultimately ongoing education. In my view management of the hypomanic episodes themselves should be given primacy, & as the tendency to experience fullblown mania decreases, Jenna would ultimately find her consciousness free to engage in development & further growth.
Indeed, in an ideal world a competent medicare practitioner would step forward with the right meds & cognitive treatment & straighten Jenna out in a few months of professionally scheduled compliance. But the reality is were dealing with the last of the uncontacted legacy elites who havent received the memo about the cybertechnocracy. They dont actually need meds, therapy, housing, classes, raves, or lectures about coffee prices & the terrifying spectre of libertarianism. They need Android wm8850mid wifi netbooks with their favourite mp3s properly tagged on an SD card, & this is one thing I was able to provide to Jenna before she left this time. & I can only be grateful to her for although I asked her to walk with me a mile, she has done her best to walk with me two.