Tuesday, July 14, 2009

Run to Failure - Pt 2

Originally published in Blog Them Out of the Stone Age on December 10, 2005

"Run to failure" is a term I learned many years ago in a war and technology course. It's used by engineers when designing something that has lots of moving parts. You design, say, an aircraft engine. You build a prototype and let it run until it fails. Then you root around the prototype until you locate the specific part that failed. You figure out why it failed, design and manufacture an improved version of the part, install it and then run the engine until the next failure. You repeat the process until you have an engine that meets or exceeds the required specifications. That's "run to failure."

Over the last two decades, I've used "run to failure" numerous times to improve the system I've evolved to protect myself from the sort of acute manic episode that evidently killed Rigoberto Alpizar. An analogous concept would be the "lesson learned" analysis commonly employed by the armed forces: you create a doctrine, then revise it in light of practical experience -- war games or actual battle.

I described the core of the system in a previous post. Briefly, it's to marshal as many resources to combat the illness as I can: medications, therapy, good sleep hygiene, regular exercise, and so on. Equally important is to have in place a strong network of friends and colleagues who know that I have the disorder and have been briefed about its symptoms. This network has proven itself so thoroughly that the question of whether to be private or "out of the closet" about the disorder is a settled issue with me. It is better to have as many people know about the condition as possible.

True, there are downsides. I've no doubt that my openness makes some people uncomfortable and that they rationalize their discomfort by telling themselves -- and perhaps others -- that it is "inappropriate" or that I have "boundary issues." It is even possible that I could never get a job in another university. Tough. One of the things I learned in the Army is that you do what is necessary to accomplish the mission. My first mission is survival. Other considerations take a back seat.

The network protects me in two basic respects. First, I have around me a number of people who have received a memo detailing the symptoms of bipolar disorder and explaining what to do in the event they develop concerns about my behavior. The first step is to approach me and inquire. If they're not satisfied with my response, the memo has the name and phone number of my therapist and psychiatrist. The next step is to contact them and relay their concerns. As a last resort, they are authorized to direct me to go to a hospital emergency room, in which I event I am to go there, period. I get no say, since in the nature of the case, my ability to make wise judgments is in question.

Second, on very rare occasions, when I know that I have "decompensated" to a fairly serious degree but when my psychiatrist and I are on the case, so to speak, and working through a treatment plan to get me "recompensated," I will employ a regimen borrowed from one of my hospital stays but which I conceptualize in military terms. At the heart of it are the three general orders I learned in basic training and which are so ingrained in me I can recite them from memory even in the midst of a complete psychotic break:
1. I will guard everything within the limits of my post and quit my post only when properly relieved.

2. I will obey my special orders and perform all my duties in a military manner.

3. I will report violations of my special orders, emergencies, or anything not covered by my instructions, to the commander of the relief.

The idea of adapting these general orders to cope with the bipolar disorder occurred to me when I was first hospitalized for mania in 1986. I felt that I could not fully trust the medical professionals around me -- they gave me meds that back-fired, for instance -- and at the same time I understood that something was definitely very wrong with my own capacity to judge. It seemed a no-win situation.

Trying to think while acutely manic is like trying to read a newspaper in a high wind. I remember saying to myself, "A no-win situation. A no-win situation. I've been in a no-win situation before. When was it?" Finally it came to me: Phase I -- the indoctrination phase -- of basic combat training. During that phase, recruits are constantly placed in situations or asked questions to which there is no correct response: you'll get bitched out for anything you do or say. The purpose is to break down a recruit's resistance and to make them more receptive to training. It also reproduces, in very modest fashion, some of the stress one is apt to experience in combat.

One of the first things we had to do in that environment was to memorize those three general orders. In many respects they were the key to getting out of Phase I and into more advanced phases (there were four in all) in which we were treated more and more as real soldiers. As soon as my manic mind was able to grasp Phase I as the no-win situation I had previously experienced, the next step was obvious. I would use the three general orders as the template to regulate my conduct in the hospital.

Part 1 - Part 2 - Part 3 (coming)

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License.