Case Study: Janet, 56, Menopause, Psychosis, Bipolar Disorder, Borderline Tendencies

Janet, 56, was bursting in her every capacity – as mother of two teenage daughters, wife of a Long Covid-suffering income producer, daughter of an ailing mother with dementia, sister of a libertarian, care-free brother whose involvement with his kids contrasted starkly with her own, friend of contacts she had not had for three years since lockdowns, and undergoing her own menopausal transition. 

She had spent the first term of the school year under severe stress, committing herself fully to support her two adolescent daughters, and inserting herself further into every fibre of their lives.  She acknowledged that this was the reverse of how her brother was managing his children’s transition into early adulthood.  Her own sleep had not been great to start the term with, and the built up worry, anxieties, and pre-existing mood control issues were exacerbated by the stress.  Afraid of losing control, and the pending next stage of her own life once her children were going to go to university and leave the house, she compensated with surrendering any own motivations to perceived helpfulness and dedication. 

Janet’s career as a casting director had been put on hold when she met her older husband John, whose banking career enabled them an adoption of two infant girls as she was infertile due to an autoimmune condition.  In perceived competition with John’s two adult boys from a previous marriage, the girls were enlisted in the same schools.  Insecurity and racism plagued their early upbringing, and they were now completing their Six Form (11-12^th grade) in an acceptable private school.  So big had the strain been on them, along with individual trauma, that both had mental health issues we resolved with neurofeedback training before and during term. 

Janet had developed a paranoid cynicism that preceded all social interactions, as if to purposefully conjure up antagonistic reactions in an attempt to prove the worst and thereby achieve some sense of control and certainty.  She was ever more convinced of intrinsic racism and antagonism towards any of her causes, and complained about the abolition of social distancing and other Covid measures that had happened over a year ago by now.  Her overbearing intensity was difficult to dispute, and it appeared that her children, and husband, were suffering from her lack of self-insight.  She would frequently break down when out of sight of her children, upset when her husband, himself suffering from Long Covid symptoms, found the occasional energy to call her ‘neurotic’.  It would take a year after her daughters for her to commence neurofeedback training for herself. 

 Unlike her daughters, and her husband, Janet found it difficult to even tolerate opinions and views other than her own.  Any perceived opposition, no matter how well-meant, would trigger her, and she had a tendency to infer the worst.  Physiologically aroused, she would immediately turn combative and seek to quell any source of dissent or alternative point of view.  This inflexibility applied to the most mundane of issues, such as changes in recreational plans for the day, to political views and current affairs, as well as deep-rooted convictions regarding the Covid pandemic and its resolution, which was being handled completely unsatisfactorily three years after the first lockdown.  Janet’s autoimmune condition made her feel particularly vulnerable, and to her, masking and social distancing provided the minimum necessity in public interactions.  She saw herself as the only agent of sense and pragmatism in her household, and therefore set the rules.  The family was confined to isolation from the first lockdown.  Physically, they were staying at home and not going to restaurants theatre shows as in the past.  Socially, movements and interactions were severely constrained and limited to family outings.  Meetings with friend were rare and heavily vetted, in particular with respect to Covid protocol observation but also perceived sense of responsibility.  Volunteering projects, birthday parties and even cinema outings were off-limit.  Living between two homes, both far from school and other classmates, furthered this separation.  Her daughters were meanwhile the only ones in their class to wear N95 facemasks at all times – a condition that eventually got relaxed regarding outdoor breaks.  Janet was driven by her perceived need to be involved and in control. 

As a result, Janet was finding it difficult to feel part of something bigger – the outside world had firmly conspired against her, and from a neural perspective, this caused great instability.  Her moods were also subject to violent, and fast, swings.  Smiles and motivation could cede to despondence and crying in despair within a few hours.  It was as if her fighting spirit was the only thing that could fire up her will power, at great emotional and energetic expense.  Combat was her main driver, and she would find antagonism in anything and everyone, any fault triggering a polarised perception.  School provided an outlet, as she got involved in every any aspect of her children’s education, trying to impose mask mandates there and actively communicating with teachers about coursework and teaching methods.  Only parents with common grievances were part of her circle, and still this fluctuated by topic. 

Unable to fall asleep easily, she would research the internet late into the night, and she was woken up easily at any time.  Janet’s mind was racing at all times, and she felt like she was having to defeat internal voices of dissent when left to her own devices.  She had long felt a dissociation from her body, and couldn’t remember the last time she had been given a hug.  Her daughters’ growing desire for independence, and the prospect of complete solitude once they would graduate in a year’s time, frightened her.  She was distrustful of medical doctors, especially as most had ceased to wear face masks, and had only one (paid) confidant in form of a psychotherapist who was willing to agree with her on everything. 

Janet’s obsession with “wanting to be there completely” for her daughters’ final two years of school was placing a burden on her environment.  She was at war with the headmaster, in particular regarding the laxer Covid protocols; teachers, concerning their methods and interactions; society at large for the cessation of vigilant pandemic measures she considered premature; her husband, whose despondence she could not attribute to her domination on all issues; and even her daughters’ search for privacy and independence, which she took personally in a highly emotional manner.  Seemingly well-intentioned, her actions were socially disruptive.  On a long-awaited family summer vacation, she prevented her daughters from mixing with peers out of fear that they would be drawn into illegal activities that the law would interpret differently with respect to them due to their ethnicity.  Dinners were cut short when she felt others’ views were out of order, a frequent occurrence.  Her daughters were showing signs of strain throughout the summer, one threatening self-harm and the other suffering from panic attacks.  Both overcame their challenges with neurofeedback training.

Janet’s body began to give.  A year after her daughters’ neurofeedback training, driven by the same ideals and obsessions, Janet began to experience cardiovascular issues.  Heart dysrhythmia was diagnosed and treated with medication.  She found it difficult to accept the advice of rest and detachment.  Thoughts became intrusive, and even her therapist found the courage to voice their concerns about her trajectory to her.  It was just before Christmas that she decided to reach out for neurofeedback training, whose success she’d witnessed in both her daughters. 

We began with a brain map, which confirmed her relational thinking, mood and sleep disorders, various trauma markers, and sources of anxiety.  Knowing, and fearing, that “this could change me”, we talked through the findings, which have an objective nature due to being based on physiology, or observed functional connectivity between brain areas, rather than being a subjective award of pathologies by an authority, for most of whom she harboured deep contempt.  The fear, “could this change me”, had already been objectively overcome with her commitment to an initial brain map and session; subjectively, the prospect of achieving better sleep and reduced internal chatter had become sufficiently appealing. 

As a former casting director, Janet retained her interest in art and theatre, and chose her favourite films to watch in session.  Quickly engaged with the content, sessions felt non-invasive enough for her to tolerate.  Neurofeedback sessions obviated the need for overt introflection, by contrast to talk therapy, and avoided triggering her with the result of reanimating her combative style.  Her views were not questioned, and her brain trained to achieve a healthy sense of detachment in the first instance.  This took a few sessions, during the course of which she noticed her sleep improving drastically.  Being able to let go of her thoughts at night and settle into a deep state of relaxation was previously a feared scenario, yet this began to feel more natural and energising with every session.  After five sessions, she noticed how her behaviour and reactions had began to change.  No longer anticipating the worst in every situation, she felt a calm optimism and motivation that she could not recall having experienced for a long time.  Relations with her supportive husband improved to everyone’s relief, and her daughters’ were positively surprised by her evolving lack of invasiveness.  For the first time, it appeared that Janet was able to recall her own frustrations in her childhood at being micromanaged by her parents, and share this admission with her family.  To everyone, it felt as if a weight was being lifted. 

Encouraged by the positive feedback from her immediate environment, Janet continued with weekly neurofeedback sessions.  At one point, she felt particularly emotional after a session, and found herself confiding in her brother on a long phone conversation that night.  She felt lighter as a result, but was plagued with some remorse and guilt about how she had been acting.  A supportive environment helped her achieve self-forgiveness and a more positive outlook.  Reminded of her progress, she drew strength from the shape of her changed trajectory.  It was as if people started to come closer to her, piercing an invisible wall she had built up around herself.  Janet began to feel part of a social fabric that had an enabling quality and created a source of stability.  Her moods and motivations became more stable, and she resumed interests in art that she had parked long ago.  Within two months, Janet was talking to people from previous work-related circles who encouraged her to resume projects she had previously excelled in.  Meetings followed, and melded into a social life.  Physically, Janet felt better rested and ensconced in her body; hugs mattered, and her sensitivity was reciprocated.  Embedded in a supportive environment, Janet began to flourish.  Intrusive thoughts became ideas, and fears turned into surmountable challenges.  She wished that she had begun training earlier, in parallel with her daughters, and was now living in the moment.