Often readers find my posts on this subject too long and I'm sure there are some readers here who will also find my posts too long. I advise such readers simply to not read my posts. But due to the encouragement of ninja 9 months ago, I will post instalment #3.-Ron in Tasmania
-------------------------------------------
2.7 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963
2.7.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications of this birth process and/or events in my ante-natal and neo- natal phases of my life, I do not examine here, however important they may be in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called: (a) Attention-Deficit/Hyperactivity Disorder (ADHD) or (b) Oppositional Defiant Disorder, but it is difficult to disentangle those features from those of BPD.
2.7.2 For the most part, though, I did not manifest BPD symptoms like: elated mood, grandiose behaviours, decreased need for sleep, racing thoughts or hyper-sexuality. Children are developmentally incapable of many manifestations of BPD described in adults; for example, children do not "max" out credit cards or have four marriages, pre-puberal and early adolescent age equivalents of adult mania behaviours. Still, as David Healy emphasizes in his book Mania: A Short History of BPD, some doctors are now associating BPD as beginning in utero. Scientists are also making progress in finding the biological markers for depression, anxiety, and obsessive-compulsive neurosis. Markers are essential to understanding the anatomical basis of mental disorders, diagnosing them objectively, and following their response to treatment, as well as perhaps preventing psychosis in those at high risk.
Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is difficult, if not impossible, to excavate my memories from those years at this late stage of my life. It is not my intention to comment further on these early years except for the occasional passing reference when it seems appropriate.
2.7.3 I would like to make a few remarks here on the biological, physiological, bases of BPD drawing on recent studies. The language I am drawing on here is difficult and I advise readers to pass over this section if they find it too complex in terms of the medical terminology I am using. The neurobiological abnormalities associated with BPD, the abnormalities characterizing episodes of mood disturbance in BPD, help elucidate the aetiopathogenesis, that is, the cause and development of BPD. There are immunological, neuroendocrinological, molecular biological and neuroimaging abnormalities characteristic of BPD. I will summarize these abnormalities in the following section, 2.7.4.
2.7.4.1 Trait neurobiological abnormalities of BPD include heightened pro-inflammatory function and hypothalamic–pituitary–adrenal axis dysfunction. Dysfunction in the intracellular signal transduction pathway is indicated by elevated protein kinase A activity and altered intracellular calcium signalling. Consistent neuroimaging abnormalities include the presence of ventricular enlargement and white matter abnormalities in patients with BPD. This may represent intermediate phenotypes of BPD. In addition, spectroscopy studies indicate reduced prefrontal cerebral N-acetylaspartate and phosphomonoester concentrations.
2.7.4.2 Functional neuroimaging studies of euthymic patients implicate inherently impaired neural networks subserving emotional regulation, including anterior limbic, ventral and dorsal prefrontal regions. Despite heterogeneous samples and conflicting findings pervading the literature, there is accumulating evidence for the existence of neurobiological trait abnormalities in BPD at various scales of investigation. The aetio-pathogenesis of BPD will be better elucidated by future clinical research studies which will investigate larger and more homogenous samples. These studies will also employ a longitudinal design to dissect neurobiological abnormalities that are the underlying traits of BPD from those abnormalities related to episodes of mood exacerbation or pharmacological treatment.
2.7.5 Through middle and late childhood, say, the age of 6 to 12(1950-1956) into the puberty cusp of 12/13 in 1956/7, I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved: (a) a lack of control of my emotions, impetuosity, lack of emotional restraint, hyper-sexuality and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. It should be emphasized in this context, though, that mania is now considered by many in popular culture as a pleasantly grandiose, somewhat overactive feeling and behaviour orientation, but is not considered as evidence of a disorder or of a maniacal posture. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constituted groping and an attempt to kiss a girl who did not want to be kissed. In addition, in my years of late childhood(8 to 12) I was involved in: (a) stealing items from shops and selling them; (b) one breaking and entering experience in which the charge was dropped and (c) excessive intensity expressed in sport and other activities.
Adolescent BPD and adolescence generally presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems even more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience, even though she did not know that I even had BPD, is now in my memory bank and in the greater appreciation for my mother than ever before.
2.7.6 Although the symptoms of BPD that I exhibited in childhood and adolescence are largely not described here, I could go back to my birth and, indeed, to conception itself and my in utero, ante-natal, life as I intimated above, for possible origins and manifestations of BPD. The relationship with my mother, my sexual proclivities, my OCD tendencies could all be described, could be gone into, in more detail and I do mention my OCD tendencies again in this statement. I have also written about this subject briefly in my memoirs. I do not attempt in this now quite lengthy account to describe this period of my life in more detail, nor do I discuss my death wish or my suicidal tendencies during the many years of BPD beginning in the last months of my adolescent years, in October of 1963, during which I experienced the death wish for the first time due to the intensity of my first depression. Before the official diagnosis of manic-depression in 1980 my death wish was only associated with a few periods of intense D. I do not allude to this death wish except en passant and, then, only in the most cursory fashion.
2.7.7 I don’t think I will ever know enough about the early years in my life before the age of 18 anyway, to assess whether my short periods of behavioural disorientation were examples of: (a) a mild-mania, hypomania, (b) BPD, (c) an affective disorder of some kind like schizo-affective disorder or (d) just a mild form of OCD. The very validity of the diagnosis of BPD in paediatrics and in adolescent studies is now in question becoming, some say, a simple catchall applied to explosive and aggressive children and other kinds of idiosyncratic behaviour. Others say that many behavioural abnormalities are finally being recognized as part of a single disorder or existing on a single continuum.
2.7.8 Keeping sexual stimuli under control has always been a struggle for me to regulate so that thoughts of a sexual nature did not claim too great a share of my attention. With the years, the more than half a century since 1956/7, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.
2.7.9 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my sexual and other aberrations (stealing, breaking and entering, excessive intensities) at puberty and then in adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of BPD became quite clearly apparent, pathological and, in retrospect, could be called part of BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially. It does not surprise me that the third leading cause of death among people aged 15-24 is, in fact, BPD. I could very easily have been one of those dead souls especially back in the early 1960s when there was such little understanding of this illness.
2.7.10 One can read about this intensity of depression in many fields of literature and of mental health, although the word ‘depression’ does not seem to have entered the lexicon until about 1900. The desire to die at that time was overwhelming. But I did not talk about it to anyone except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams at university and I continued with my first year studies in liberal arts.
------------INSTALMENT #4 TO COME IF DESIRED