Wednesday, December 31, 2008
Tuesday, December 30, 2008
Life is about first impressions - a voice, a sight, an aroma - and how we filter and ultimately link them. Often, we fail to see how the dots connect. Life is like that. Life, basically, is a first draft.
Over time, we acquire wisdom and insight. We become better people. We learn to find a measure of joy and peace of mind. But we also know that nothing is permanent. That life has a way of reducing us to nothing.
Next thing, we're groping frantically, looking for new dot to connect ...
Monday, December 29, 2008
There is very good science to support the proposition that pets promote mental health. But did you know they can also lift your water volleyball game to new levels?
I acquired Rocky and Bullwinkle about four months ago, when they were kittens five weeks old. Instantly, I was wearing them like an extra article of clothing. If I'm at my computer they're at my computer, if I'm in bed they're in bed, if I'm in the bathroom, well never mind ...
Literally, I'm forever peeling these little fur balls off my lap, my chest, my legs, my shoulders, my head. Then there's the constant challenge of heading them off at the pass. Off the keyboard, off the kitchen counter, off the prime real estate on the mattress.
Now it's time to discuss water volleyball. I started playing the game on most Saturdays about two years ago. At first I couldn't hit anything, but soon I improved to a level where I really sucked. Then I plateaued. For two years, I amazed my fellow enthusiasts with my singular ability to make gravity unpredictable.
You see, all my life, me and gravity never got along.
Then, about a month ago, something funny happened. Actually, something statistically improbable, which is a polite term for impossible. In the pool, I became the Four Horsemen of the Apocalypse. Literally, the ball didn't have a chance against me. I tracked it like radar. I swatted it in mid-flight like King Kong smacking bi-wing airplanes. I dispatched it on inerrant trajectories that left everyone in the pool slack-jawed in amazement.
There is a very elegant mathematical theory to explain what happened, but essentially it boils down to every dog has his day. Now that I had mine, I could go back my normal dysfunctional relationship with gravity.
But the next week, something really funny happened. I didn't suck nearly as bad as I used to. And the week after, I exhibited flashes of my eye-popping Apocalyptic brilliance. What was going on?
Earlier, I had consulted an expert, a friend who hustles pool. He told me that my body has literally learned all the moves, and that it is my tendency to over-think that sabotages my performance. Apparently, this is a universal human failing.
Yeh, right, I thought. How could my body have possibly learned water volleyball moves? It's not like I actually practiced.
I brought the matter up with Paul, who is responsible for introducing me to water volleyball. I was seated in the living room with my laptop, peeling cats off me. Deftly, with my right hand, I snatched Bullwinkle off my left shoulder and flicked her to a soft landing on the carpet. A micro-second later, without looking, I had Rocky in my left hand, ready for launching.
Suddenly, a light bulb went off. A revelation, one of those Newton under the apple tree moments. I looked at Rocky, squirming in my hand with one of those "what is YOUR problem" looks.
I got it! I shouted excitedly. It's the cats!
All day, all night. At work, while relaxing, in my sleep, I'm forever peeling cats off of me. I explained how all my life I had been hopelessly uncoordinated. Now, thanks to the cats, that was no longer the case.
My pool hustler friend was right. My body had learned the moves.
Not only that, practicing on the cats was way better than using a volley ball. You see, cats have legs. They keep returning to you. You don't have to retrieve them. Volley balls, on the other hand, just keep rolling away.
It was the only explanation, I told Paul. All my life, my limbs have been free-lancing on me. Now, because of the cats, my arms were virtual extensions of my body rather than independent organisms. I could actually will them to do what I wanted them to do. In my sleep, literally.
To Paul's credit, he humored me. But I could see he wasn't convinced.
A day or two later, when I got back in the pool, I served nine straight points before firing the ball into the net. Then, next time serving, another nine straight. It had to be the cats. Yes, everyone in the pool agreed, it had to be the cats.
Right now, Bullwinkle is on the ledge of my window. In a second, she is about to put two paws on the top of my computer screen, then she will shift her weight in a way that will require my intervention.
Hmm, I'm thinking. Instead of just grabbing her and flicking her away, what if I swatted her and put a topspin on her? That would really improve my performance.
Aw, Bullwinkle, I didn't mean that. Here, come sit on my lap.
Oh, oh. Accusing cat eyes. "I am NOT your volleyball!" she let me know, before ducking through the cat door.
Could this be the end?
Saturday, December 27, 2008
I coined the term, "Knowledge is Necessity," nearly 10 years ago, soon after I started writing about my illness. It was - and still is - my mission statement. It's the reason I am here. I ended every one of my email Newsletters with the phrase, and it featured on my Website. Now it is the name of my new Blog.
Way back, I was simply referring to the necessity of becoming our own experts. I had already learned the hard way that our illness shows no mercy on the ignorant.
Over time, I came to realize there was an additional dimension to "Knowledge is Necessity." It's called "Know Thyself." We may have all the book knowledge in the world, all the street knowledge, but the simple fact is all the accumulated wisdom on the planet means nothing without self-knowledge.
Who am I? I had to keep asking myself. It's a question I'm still asking ...
Some earlier musings on my Website
Friday, December 26, 2008
The other day, I picked up Silvia Nasar's "A Beautiful Mind," and instantly I was hooked.
The book chronicles the life and times of John Nash, the mathematical genius who lost decades of his life to schizophrenia.
"How could you," a colleague asked back in 1959, "believe that extraterrestrials are sending you messages?"
"Because," Nash replied, "the ideas that I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously."
In 2007, I had the occasion to hear Dr Nash speak at a convocation at the American Psychiatric Association's annual meeting. He held a densely-worded typescript up to his face and proceeded to read in an interminably relentless monotone. I would have made a beeline for the door, but you don't even think about such things in the presence of a Nobel Laureate.
Okay, I lie. I thought about it.
Then something he said made my ears perk up. "My recovery began," he related, or words to that effect, "when my reputation finally started catching up with the acclaim I felt I deserved."
Speaking of schizophrenia and creativity: At a different session at the same APA meeting, Nancy Andreasen MD, PhD of the University of Iowa pointed out that Newton was a wild and crazy guy who had a psychotic break at age forty, that Albert Einstein was an eccentric who had a son with schizophrenia, and that James Watson was a bit of a loose cannon who also had a son with schizophrenia.
Thus, the three most important discoveries of the modern scientific era, Dr Andreasen said, had something to do with schizophrenia. What are the odds of that?
In the 1970s, Dr Andreasen pursued the schizophrenia connection in a survey of the Iowa Writer’s Workshop. She expected to find a percentage of well-adjusted individuals with schizophrenia in their families, only to find herself "absolutely astounded" to discover instead that 80 percent of them had some form of mood disorder.
Confessed Dr Andreasen: "This is a great example of starting out with the wrong hypothesis and coming up with a completely different answer."
In her talk, Dr Andreasen discussed a study she is working on, involving scanning the brains of artists and scientists, including Nobel Laureates, as they perform simple tasks. She is expecting to find greater than usual activity in the association cortices in the brain, where unconscious processes play out.
Dr Nash's great creative work was done in his early-mid twenties, before his illness manifested in full. But the author of "A Brilliant Mind" gives us the impression that John Nash was always a case of schizophrenia waiting to happen. From Day One, he was an outsider. Even in a profession notorious for its oddballs and cranks, John Nash never quite fit in.
We tend to identify mental illness by severe episodes and breaks with reality. But there tends to be long lead-in periods, with clear warning signs. Psychiatrists refer to these under-the-radar symptoms as "prodromal" states. Maybe something will happen, maybe not.
So here is a man with no ordinary brain. Thoughts connect in startlingly original ways. On one hand, it produced a stunning piece of rationality - games theory - that was so novel that his contemporaries failed to fully grasp its significance. On the other, this same remarkable brain was responsible for equally astonishing irrationality, a tragedy that robbed its owner of three decades of his life.
How could this be? We are still learning ...
Check out my article on creativity.
Wednesday, December 24, 2008
This is my tribute to the spirit of the holidays, shot during a hot and dry California summer.
I started producing my own videos in the spring of '08, during a time I was coping with severe burn-out. The videos helped animate me, brought me back to life. I felt a healing take place.
Until March this year, I never owned a camera. Then I bought a cheapo digital camera and took some very bad pictures of my daughter's wedding. A couple of months later, I got a decent camcorder, then FinalCut Express and I suddenly I was like a kid with new toys.
When my father was my age, bad health forced him into early retirement, a defeated man. I had a lot of my earlier years taken away from me. But here I am, making movies.
Anyway, a happy - and healing - holidays to all.
13 YouTube videos
An article on healing
In a recent blog post on Psychology Today, Nassir Ghaemi MD of Tufts University frankly discusses the "steroid problem of academia."
This concerns ghost authorship. What happens is common practice in journal publishing, especially in psychiatry. A drug company will design and write its own study, complete with its own spin favoring the drug in the study. Then the company invites respected academic researchers to front the study as authors. The study then appears in a medical or psychiatric journal. (For more detail how this works, check out my website article.)
What's in it for the "authors" is fame and academic distinction. In a university publish or perish environment, there is intense pressure on academics to rack up credits any way they can. The problem, says Dr Ghaemi, is that "some of our experts get their fame artificially, their achievements appearing greater than they really are."
In his blog, Dr Ghaemi reports how a department head actually encouraged him to engage in this type of fraud (he refused). Dr Ghaemi also reports how, fairly recently, a past president of the American Psychiatric Association and another luminary expressed complete surprise to him that this type of thing was going on. (This ignorance is astounding in light of the fact that eight or nine years ago, about a dozen journals worldwide ran simultaneous editorials highlighting the situation and promising corrective action in their own publications.)
Dr Ghaemi has devoted much of his professional life to researching the use of antidepressants in treating bipolar depression. His research has been influential in convincing psychiatrists to think twice before prescribing. His data shows that not only is the benefit problematic in a bipolar population, but there is risk of switching patients into mania and rapid cycling.
Not surprisingly, you will not find drug companies stampeding to fund studies to prove Dr Ghaemi right.
How serious is the problem? Early in 2008, in preparing for a grand rounds lecture I was to deliver to a psychiatric hospital in Princeton, I came across a 2006 study published in the American Journal of Psychiatry, which is put out by the American Psychiatric Association. The study concerned bipolar patients on Zyprexa, and was designed and written by Eli Lilly, which manufactures the drug.
The article listed Mauricio Tohen MD, DrPH as the lead author of the study. In all likelihood, Dr Tohen most likely did have a major hand designing and writing the study. A PubMed search of "Tohen M, olanzapine" reveals 92 published articles he authored between 1998 and 2008.
Dr Tohen is virtually unique in psychiatry in that he is affiliated with Harvard and Mass General Hospital AND is employed by Eli Lilly. In addition to Dr Tohen, the article listed eight other authors. Three of the names were instantly recognizable as prominent academic thought leaders.
According to the abstract of the study:
"Compared to placebo, olanzapine delays relapse into subsequent mood episodes in bipolar I disorder patients who responded to open-label acute treatment with olanzapine for a manic or mixed episode."
But the study data, not mentioned in the abstract, told a far different story. In fact, eighty percent of the patients in the study stopped taking their Zyprexa.
When I raised this to my audience of clinicians in my talk, I asked if anyone thought this was deceitful. All hands went up. I would go further, I said. I would say it's immoral.
Zyprexa is an antipsychotic with a high side effects profile, and it's not surprising that four in five bipolar patients choose not to take it, even if they are otherwise doing well on it. As Holly Swartz MD of the University of Pittsburgh told a symposium at the 2006 APA annual meeting: "If a patient doesn’t stay on it, it doesn’t do any good, even if it works.”
No doubt, I ranted and raved far too much in my talk, but as a patient I represent the greatest stakeholders in this debate. Am I going to end up in crisis - or worse - as a result of a well-meaning doctor sending me out the door with the wrong prescription based on deliberate misinformation?
Does anyone see a blatant violation of the "do no harm" principle at work?
I have no objection to productive partnerships between industry and academia. Indeed, drug companies would be incredibility stupid not to tap into this invaluable brain trust. Likewise, academics deserve to profit handsomely from any research that improves our chances of leading productive and rewarding lives.
What I object to is drug companies debasing psychiatry by employing its best and brightest as errand boys. Meanwhile, far too many highly-dedicated researchers are forced to leave the field due to lack of funding. We are left struggling in the dark. Our doctors get treated to infomercials.