Saturday, January 31, 2009

Have Our Treatments and Therapies Failed Us?

"What best describes your condition in the past 30 days?" I asked my visitors, here at "Knowledge is Necessity." Nearly 200 people replied over late Dec and Jan. The results were not exactly encouraging:

Nearly one in four (24 percent) replied they were in crisis or close to crisis. Four in ten (42 percent) reported that they were stable but not well. Thus, a full six in ten of those who responded to my poll indicated that they are in pretty bad shape.

Contrast these results to the mere 14 percent who were evenly divided in being back where they wanted to be or better than they ever could have imagined.

In the middle, one in five (18 percent) reported they were on the way to recovery. Hopeful or false hope? Who knows? Perhaps we can split the difference.

No matter which way you parse the totals, the results are not encouraging. Granted, the poll is unscientific. Granted, the results could be totally skewed. But even accounting for all the distortions in the world we have clear evidence that our treatments are failing us, our therapies are failing us, and - let's apportion blame responsibly, here - we are failing us.

One advantage of this simple poll over far more sophisticated surveys is that those who responded were the judges of their condition. Patients, themselves, defined success or failure by their own criteria. In clinical trials and other studies, doctors typically fill out a symptom checklist (with patient input) and interpret the results. Having few illness symptoms typically means you are well, even though you may not feel well.

The world we live in is far different. For a lot of us, we have other things to deal with besides just our illness symptoms. On the flip side, a lot of us have learned to lead very enviable lives, despite a huge panoply of symptoms.

"Well" is how we define well, not how others define it for us. Even accounting for the fact that people who go online to find out more about their illness may be worse off than those who don't, we are dealing with an astronomical 86 percent who reported feeling well short of well.

Something is clearly wrong.

Friday, January 30, 2009

Illness or Personality?

I answer questions as an "Expert Patient" at BipolarConnect. Two days ago, Dark Angel asked, "Why does bipolar seem like your personality?"

The question goes right to the heart of how we see ourselves, and is central to every issue we discuss here at "Knowledge is Necessity."

"Welcome to a lifelong quest for self-knowledge," I began. Okay, let's see if we can figure this out:

The experts distinguish between "state" and "trait." A state equates to an illness episode whereas a trait is part of your personality. Let's use hypomania as an example:

People tend to pair "exuberant" with "personality." Exuberant is seen as beneficial, and, most important, people see YOU as in control.

In hypomania, for the purposes of this conversation, we are talking about over-exuberance. Not only that, hypomania is often a sign that we are really about to lose control of our brain, or that we have already lost it.

I would contend that for many of us hypomania is a normal part of our personality, only in this case we're mixing bad with good. For some, it may be a rational choice to accept the bad with the good. Others understandably want no part of hypomania.

The DSM sheds some interesting light on the topic. According to the DSM, we are in hypomania when we experience "unequivocal change in functioning that is uncharacteristic ... "

In other words, we are talking about a "state" that is not a true part of our personality.

I would argue that for many of us this is not necessarily the case. Nevertheless, the DSM is making a valid point. Keep cranking up the volume, and, at a certain point, we are definitely not ourselves. We are not in control of our brains.

Think of two individuals who are "up." They are thinking alike, they are acting alike. But one is behaving rationally and in character while the other is not. Same behavior, yet a profound difference. One may be on his game, the other may need meds. On and on it goes.

Hypomania is just one example. We need to apply this ruthless self-examination to all our behaviors, as well. This includes our depressions and anxieties, as well as a range of personality quirks.

For many people, our illness is fully integrated into our personality. Others rightfully view their illness as an interloper. Well-meaning experts, including friends and family, are not hesitant to proffer advice, but, in the end, you are the only expert in knowing where you stand. But this kind of wisdom only results from responsible self-enquiry. Welcome to "Knowledge is Necessity."

Thursday, January 29, 2009

Are Bipolars Smarter than Everyone Else?

A study published in January's American Journal of Psychiatry found a strong correlation between people with lower childhood IQ scores and an adult diagnosis of mental illness.

The study was performed on the "Dunedin Cohort," a thousand-strong group of New Zealanders who have been tracked since their births in 1972-73. It was from this population that we got the first strong evidence involving the link between genetic vulnerability to stress and depression, which has led to a lot of re-thinking into cause and effect across the whole panoply of mental illness.

The current study involved a lot of the same researchers as the stress-depression study. The cohort was administered IQ tests at ages 7,9, and 11. Psychiatric evaluations were made at ages 18, 21, 26, and 32. The researchers found that "lower childhood IQ was associated with increased risk of developing schizophrenia spectrum disorder, adult depression, and adult anxiety."

Intriguingly, "higher childhood IQ predicted increased risk of adult mania." The authors of the study do caution, however, that this particular finding may represent a statistical anomaly.

Back in the 70's, Nancy Andreasen MD, PhD of the University of Iowa spotted a measurable bipolar-creativity link, and Kay Jamison's "Touched with Fire" of 1996 put the issue out in front of the public. But she also noted that:

"Thinking can range from florid psychosis, or madness, to patterns of unusually clear, fast, and creative associations, to retardation so profound that no meaningful activity can occur."

Indeed, the psychiatric literature is full of studies pointing to serious cognitive flaws in bipolar patients. In a study published in 2004, for instance, Deborah Yurgelun-Todd PhD of Harvard and her colleagues scanned the brains of 11 stable bipolar patients while performing a mental processing task, and found significant delays in their ability to respond with correct answers compared to 10 healthy controls.

The study also found decreased activation of the brain region responsible for processing the task compared to the controls.

That same year, at the APA annual meeting, I heard Dr Yurgelun-Todd propose that cognitive deficits should be regarded as a core feature of bipolar disorder.

In the current study, the authors point out that "lower childhood IQ may be a marker of neuroanatomical deficits that increase vulnerability to certain mental disorders." They also note the debilitating effects of stress and trauma.

What to make of all this? Some days our brains are running on rocket fuel; other days, molasses. Neither state is solely good or bad. Our best work often occurs at either pole. So do our worst moments.

Technically speaking, if our brains were manufactured goods, there would have been a product recall ages ago. But, here's the rub: Knowing that's the case, are you ready to turn yours in?

Further reading from mcmanweb: The Thought Spectrum

These days, my internal operating system is far and away the worst aspect of my illness I have to contend with. Moods, shmoods – I actually follow some of the advice in my book, "Living Well with Depression and Bipolar Disorder." But when my brain unexpectedly cuts out on me, what am I to do? These are no mere senior moments. The software simply isn’t loading right. When it happens, I know it and the people around me know it. This has been going on for as long as I can remember.

If you don’t think this is any big deal, then ask yourself: Knowing what you now know about me, how safe would you feel with me as an air traffic controller?

Wednesday, January 28, 2009

Happy Birthday, Jackson Pollock

Today, Google reminded me it's Jackson Pollock's birthday.

"Fuck Picasso!" Eddie Harris as Pollock shouts in a alcoholic stupor one minute into the film, "Pollock."

Seems Pollock had an attitude.

Pollock was the great abstract expressionist artist, part of the vibrant post-war New York bohemian scene that totally changed how we view the world and relate to it. His breakthrough moment in the movie shows Pollock laboring in the barn that is his studio in the Hamptons (back when Long Island's Hamptons was a cheap place to live). His wife Lee Krasner (played by Marcia Gay Harden) looks approvingly at her husband's canvas - lustrous Zen drips - and remarks:

"You've cracked it wide open."

Don't ask me why, but I instantly connected to those drips. Even as a kid, those drips spoke to me.

A couple of years ago, I experienced the joy of touring New York's MOMA with my grown daughter from New Zealand. We stood in front of a Pollock. I watched her face, resisting, quizzical. Suddenly her expression changed, she lit up. She "got it."

Pollock was a notorious alcoholic, and a strong case can be made that he was self-medicating his undiagnosed bipolar. He would have been 97 today. Instead, one summer night in 1956, in a drunken stupor, he drove his car off the road killing himself and a woman passenger. He hadn't done a painting in two years.

Further reading from mcmanweb:

"The paintings are like a reverse Rorschach test, where nothing bears the faintest semblance to anything we can see, yet each drip, each splatter, individually or as a grouping or as a whole, seems to act as the perfect register to how we think and feel."

Monday, January 26, 2009

Another Trick Question

You are depressed. The DSM checklist reveals you have nine depression symptoms out of nine. Question: Is your condition diagnosable as a depressive episode?

Not necessarily. "Checklist psychiatry" tends to influence how we view ourselves, but beneath the symptom menu to every Axis I DSM entry we find other qualifying criteria, such as a time period (two weeks for a major depressive episode). Also, before a diagnosis can be made, other possible causes (such as bereavement or a general medical condition) need to be ruled out.

The most intriguing qualifier, though, concerns functionality. With regard to depression, the episode must be severe enough to cause "significant distress or impairment in social, occupational, or other important areas of functioning."

Virtually identical wording appears across the Axis I panoply of episodes and disorders, including mania, anxiety, and schizophrenia. The prominent exception is hypomania.

So, in theory, it is possible to walk into a psychiatrist's office looking like a DSM basket case and yet obtain a clean bill of health. In practice, this is unlikely to happen. But suppose, just suppose, that we could have depression and not be depressed, that we could have a panic attack and not panic. And so on and so on.

Wait! I know what you are about to say. But before you call me crazy, I ask you to indulge me for a moment or two. Just suppose ...


Is Bipolar Cool?

Something major has happened in the ten years since I've been diagnosed with bipolar. Back then, it was an illness you concealed. It was a shame you hid. Friends, family, and colleagues had a way of only seeing the diagnosis, and what they chose to see was not good.

To disclose your diagnosis was to risk everything: friends, relationships, livelihood.

Then something started to change. Over time, bipolar morphed into something that could be "cool" to have. Mind you, those struggling mightily with their illness saw nothing cool about it. Neither did their suffering families. But the flip side was the stigma was diminishing, and this had to be good news.

Part of the trend had to do with the recent recognition of bipolar II and various forms of "soft" bipolar. In other words, bipolar wasn't an all-or-nothing disease. You could be a "little bit" bipolar. And a little bit was cool. Even the way-out-there bipolars could make a claim to cool.

Van Gogh, Hemingway, Woolf - how cool was that? Okay, they all killed themselves. But maybe if they were alive today - the thinking goes - that wouldn't have happened.

Over the years, I have urged individuals to embrace their entire illness - the good as well as the bad. If we simply viewed ourselves as patients who suffered, I kept saying, we would always wind up stuck well short of recovery.

Last night, I went to Facebook and searched under "bipolar." If the word appeared anywhere on a profile page that a member created, Facebook would find it for me.

My results revealed "more than 500" finds. I suspect many thousands. There were a great many examples to choose from, but let's go with three:

First, there were those whose lives seemed part of a weird Andy Warhol movie. These weren't exactly people you would be seeking out as Facebook friends. Then again, their bipolar credentials carried an air of exclusivity, as if to challenge the world. In the past, these people would have been shamed for failing to meet the standards of society. Now, there was an air of pride and defiance. They weren't about to please you. You had to please them. Too bad if you weren't good enough.

Then there were young hotties who advertised themselves as a bit on the wild side. Most of them, I suspect, had never seen a psychiatrist. But they proudly proclaimed themselves as "semi-bipolar" or "must be bipolar." Forget for the time being the dangers of romanticizing one of the worst illnesses on the planet. Instead, focus on the fact that these young women - part of a new generation - view bipolar as something positive, as a credential they can use (and misuse) to make new friends.

Finally, there were those I like to call bipolar role models. The image that stuck with me is that of a very attractive woman in her thirties or forties. She is in a smart pants suit, in stylish heels, posing in front of her Cadillac Escalade. I'm bipolar, is the underlying message, and not only am I making it in your world, I'm really kicking ass.

These are just some of the new faces of bipolar. They are a reflection of a changing world, a world that they (we) are changing. It is the face of a new bipolar cool.

A new generation - the Facebook Generation - is out there, in your face. They are not hiding in the closet. For good or bad, they are wearing their bipolar as if it were something to be embraced and envied rather than an entity to be feared and despised.

The rest of society is likely to embrace this change, as well, but possibly at the expense of being indifferent to our pain.

In the meantime, we are looking at tons of upside. Here's hoping ...

Saturday, January 24, 2009

The Bipolar Time Warp

This is the most popular video from my YouTube Collection. The reason may have to do more with Rocky Horror fans searching "Time Warp" than the video's intrinsic worth. But viewer feedback to both the video and the mcmanweb article on which the video was based indicates I that I may have struck a chord.

I wrote the article sometime in 2000. I shot my video in early summer last year. It was my first venture into "acting," rather than simply narrating. It was also the first video where I started using studio lights - actually cheap work lights I picked up at the hardware store. For some reason, I thought lighting only applied to Hollywood. Then my orange face from my previous video forced me to rethink that notion.

Enjoy ...

From my mcmanweb article:

Bipolar is the equivalent of being stuck in bumper to bumper traffic in a race car. The world is simply too slow and people too dull-witted to accommodate you. The initial advantage over one's fellow man inevitably gives way to frustration and occasional rage. Sure, at first you experience the exuberation of weaving in and out of traffic as you leave the world behind in your rearview mirror, but now there are more cars, all closer together, backed up for miles on end. Your engine is revving hard, but you find yourself banging your head against the dash in utter despair because you are desperate to pop the clutch and floor it, but all you can do is hopelessly idle and suck other people's fumes.

Ooh-Boy Ruminations

Francesco writes: "My thinking had and continues to be shaped a great deal, by the writings of Thomas Szasz."


Francesco's comments to a recent blog post here were very thoughtful and much appreciated, and I hope he continues to post. As for the S-name, one look at the photo above and you see why every neuron in my limbic system lit up like a Christmas tree.

Thomas Szasz is a giant in the mental health movement, a deep thinker, and an uncompromising champion of our cause. The catch is that these days I hear his name invoked in the context of various nihilist anti-science, anti-intellectual agendas.

Believe me, I hate these people.

Dr Szasz was a catalyst for the reforms of the 60s and 70s that put an end to institutions and their concomitant abuses, and for this alone he deserves our undying gratitude. Dr Szasz also recognizes that psychiatric imprisonment isn't just about walls and restraints. It can be a subtle state of coercion that gets us buying into the idea that unapproved behavior needs to be medicated out of us.

It's a complex argument, but trust me, Dr Szasz has a point. Too often, we simply assign values to symptoms with no thought to context. Yes, depression is a bitch, but it can also be a time of healing, of recouping and regrouping. I know - I have experienced this.

But Dr Szasz and his followers would have us believe that we actually choose to have depression - or psychosis or a panic attack. It's as if the brain were nothing more than undifferentiated tofu. It's one thing to take psychiatry to task for imposing a particular set of values on us. It's another to deny, as Dr Szasz does, that there is no biological component to our behavior.

Dr Szasz's influence has fallen by the wayside in the face of scientific discovery. But psychiatry may suffer a similar fate. Psychiatry shows every sign of embracing science, but to what end? As long as they fail to address the basic question - What is good? What is bad? - then Dr Szasz will remain relevant.

Perhaps science can offer an insight. In behavioral genetics, there is neither a good gene nor a bad gene. Depending on context, the same gene variation may be an asset or a liability. Can the same be said of symptoms? For instance, hypomanic behavior may yield bad results. But what if we learned to control the hypomania?

These are issues that go to the core of our beings, to what we experience, to what we want out of life. This is a conversation we need to have, that we need to own. Antipsychiatry would love to crash this party. So would psychiatry.

From mcmanweb:

The Two Toms

My totally surreal encounter with the Bizarro World parallel psychiatric universe of Tom Cruise and Thomas Szasz and how it didn't change my life.

Friday, January 23, 2009

Name One Good Thing About Depression. Okay ...

My friend Tom Wootton has published a book called The Depression Advantage.

Whoa! I hear you saying. What can possibly be advantageous about depression?

Mania? The creativity, the productivity, the good times. You can make a pretty good case for some kind of mania advantage. Indeed, Mr Wootton's earlier book is called "The Bipolar Advantage."

But depression?

In my own case, depression has left me for dead more times than I can count. "Finish the job, yourself," Fred (my name for my depression) keeps mocking me. Fred has left me alone, washed up on a strange shore, lost, disoriented, isolated. He has stolen time from me, years of it, lost years, years I will never get back.

As for the years I have remaining, Fred says nothing, just gives me that look.

So, again, what can possibly be advantageous about depression?

Believe it or not, I have two concrete case studies from my own life. Case study number one:

My first marriage broke up in the 1980s. Because of a precious young daughter, the break-up was especially rough on all of us. This occurred several months into a new job. I was one year out of law school. It was my first management position. It involved a discipline (journalism) I had no training for, working in a field (finance) I had no inkling of.

In short, I was an impostor. I had no hope of keeping the charade going. Any second, I was going to call attention to my total incompetence and lack of experience. Any second, someone was going to lower the boom. Since the economy was in a severe recession, losing my job would amount to the equivalent of being pushed from a plane without a parachute.

The stress was getting to me. My behavior was bordering on unpredictable.

Then came my marriage break-up. Once I got over the initial shock, a numbing thudding depression settled in. Oddly enough, a protective depression. In my slowed-down state of mind, the rest of the world no longer seemed so threatening. Likewise, my equally slowed-down behavior brought me into sync with the people around me, allowed me to fit in, settle down, buy precious time.

Make no mistake. I was alone, unhappy, miserable. But my depression acted as vital mental ballast that steadied me, allowed me to keep my cool, to buckle down and learn on the job. I made it through my first year, then my second. After three years - with my reputation firmly established - I was able to move on to greener pastures.

Don't get me wrong. I hate depression. I wish I never had it. I wish no one ever had to experience it. Ever. But if you were to challenge me to name one good thing about depression, well, I just did.

Lots more on this in future blogs ...

Thursday, January 22, 2009

My Loved One Doesn't Understand. Really?

"My husband gets angry," Abigail writes on BipolarConnect. "It makes no sense when I'm in crisis ... I can't help it when I'm crashing or in a panic. He cannot understand ..."

A loved one who doesn't get it - a good many of us have been there. Back in the old days, my response would have been along the lines of a suggested reading list for her husband. Then, perhaps, a dialogue could start.

But my thinking has come a long way since then. I am a patient, but I have also experienced first-hand the frustration of a loved one.

First I acknowledged Abigail's concerns, but then I suggested it would be more constructive to view matters from her husband's perspective:

"When YOU act up or act out," I wrote, "HE is the one who suffers." Even the most compassionate person in the world can only put up with this for so long.

Loved one's hate the "can't" word, I continued. "You may think you are asking for sympathy and understanding. A loved one interprets this as a complete lack of sympathy and understanding from you."

They need to be hearing that you are taking responsibility, even if you are having difficulty managing. Something along the lines of: "I really appreciate this makes life hard on you. It's not easy for me to control my behavior at times, but I'm working on it, and I could really use your help on this."

Now, instead of an adversary, you may have an ally. You've owned up to the problem. You've accepted responsibility. You've acknowledged your loved one's feelings. You've given him a reason to hope.

Believe me, this is music to a loved one's ears.

"If your husband is to understand you," I wrote, "first you need him on your side. You need his good will and support. For that to happen, you need to be the initiator, you need to set the good example. If he's smart, he will start to respond positively."

Coupled with this is the reality that loved ones need to see tangible signs of change. Talking a good game is not enough. If your loved one strongly hints at something, then you need to be acting on it. If this means putting the top back on the toothpaste, then put the top on the toothpaste.

You can also score brownie points by taking your own small initiatives, say by getting out of bed in the morning 10 minutes earlier.

Naturally none of this is easy when you are the one who is ill, but the stakes are enormous. There are no guarantees, but we are talking the difference between a sympathetic loved one who represents by far the best thing going for you and a stranger in your home and in your bed. Believe me, from one who has lived both sides of this equation, the effort is worth it.

As I concluded to Abigail: "Your old approach hasn't worked. Time to try something new."


I answer questions as an "expert patient" on BipolarConnect, part of HealthCentral. By far, the vast bulk of the questions involve living in personal relationships. Much more on the topic in blogs to come.

Also, please share your own wisdom and insight by clicking the "Comment" link.

Wednesday, January 21, 2009

Post Inaugural Reflections - Beyond Reason?

There were a zillion memorable images from yesterday's Day of National Jubilation, but the one that struck me most was that of a US Marine helicopter diminishing to a speck on the horizon.

The passengers on that flight were the former President and former First Lady.

Former President! It was over. The national nightmare had ended.

So can we now expect an era of rational government?

Not so fast. Two days ago, NY Times op-ed columnist David Brooks mentioned a book that came out in 1962, entitled, "The End of Ideology." The book reflected the thinking of the day, namely that the intense ideological-political schisms of the past were over. Now the country could settle down to rational governance and pragmatic decision-making.

The major flaw in the book, of course, was that this happened to be the Sixties. The Sixties! The Industrial Age and all its assumptions was numbered. The Information Age with all its uncertainties was crashing the party. Civil rights, Vietnam, women's rights. As David Brooks describes it:

"People lost faith in old social norms, but new ones had not yet emerged. The result was disorder. Divorce rates skyrocketed. Crime rates exploded. Faith in institutions collapsed. Social trust cratered."

The collapse of the old order intensified ideological conflict, as conservatives and liberals battled over whose values - social, moral, cultural, political - would prevail. For four decades, there was literally no let-up. Politics turned personal, nasty, ugly - crazy.

But nothing is permanent. Even before people had heard of Obama, a book by Rick Warren, "The Purpose Driven Life," implied that opposites were reconciling into a sort of probational equilibrium.

Obama's ascension to high office, Brooks argues, may be a reflection of this new order. Problems that were impossible to fix when people were at each other's throats - problems such as health care - may be doable now.

But here's the catch. Whether we are talking economics, politics, or personal relationships, the choices we make are never purely rational. We are in the thick of the worst economic-financial collapse since the Great Depression. Two things can happen:

The crisis may actually wake us up, concentrate our collective minds in such a way that, as a society, we actually start thinking rationally. Think of the limbic system on high alert, marshaling our frontal lobes into a state of preternatural clarity and awareness.

Or the crisis may stress us out in ways that throws reason out the window. This time think of the limbic system inciting our frontal lobes into a state of panic. We either blindly lash out or freeze like a deer caught in the headlights.

FDR's first one hundred days in office is the classic example of a rational response to crisis. Together, the country united to save Western Civilization.

By then, Europe was in the clutches of an irrational response. Fascist/Nazi governments were entrenched in some countries, Communists in others. The rest were flailing in pathetic states of conflicted indecision. Civilization didn't stand a chance.

Seeing that speck of a helicopter disappear into the miasma of a DC afternoon filled me with great - and admittedly irrational - joy. But that joy is tempered by my knowledge that our brains are not wired to think rationally. We are betting the success of the new Administration and the future of this country - our entire civilization, for that matter - on the totally opposite assumption.

Tuesday, January 20, 2009

Bipolar Singing Blogger Smackdown, Part 2!

No question about it. My fellow bipolar blogger Therese Borchard of Beyond Blue came out swinging in Round One. In this - Round Two - she clearly decided to put me away. Call her butter 'cuz she's on a roll, this bipolar babe, she definitely smokin'!

But wait ... Little did she know - this manic mcman, he know how to turn smoke into B-B-Q!

Hope you got your rope-a-dope down for Round Three, Therese!

Soon coming to Pay Per View ...

Noon, Jan 20, 2009


Monday, January 19, 2009

Inauguration Day Reflections

I will keep this brief:

On the first Tuesday of Nov 2004, I went to my evening support group thinking I had fired the President. I returned to find this wasn't the case. Instantly, I spun into a depression. I couldn't focus on my usual work, so to keep busy I pulled out a book manuscript I had been working on. Two and a bit months later - this time four years ago - I had a draft I could show to people. In Oct 2006, HarperCollins published "Living Well with Depression and Bipolar Disorder."

I like to joke to people that I owe the book to George Bush.

Last November, I hired a new President. Let's just say I'm not working on another book.

We All Have a Dream

I have a dream ...

So does fellow mental health blogger Therese Borchard. Last year, on Martin Luther King day, she served notice that:

"I have a dream that one day I won't hold my breath every time I tell a person that I suffer from bipolar disorder, that I won't feel shameful in confessing my mental illness."

You might say we missed the civil rights bus. Ignorance, fear, stigma, discrimination - it's still out there. And every year, our society harvests a strange fruit:

"I have a dream that suicide won't take more lives than traffic accidents, lung disease, or AIDS, that together we can do better to reduce the 30,000 suicides that happen annually in the United States, and that communities will lovingly embrace those friends and families of persons who ran out of hope, instead of simply ignoring the tragedy or attaching fault where none should be."

A lynch mob of indifference. A broken healthcare system, pathetically little devoted to research, a society that turns its head the other way. We're on our own, facing the new day with unreliable brains, living in dread of the failed boot-up:

"Mostly, I dream about a day when I can wake up and think about coffee first thing in the morning, rather than my mood - is it a serene one, a panicked one, or somewhere in between? - and fretting about whether or not I'm heading toward the black hole of despair. I dream that I'll never ever have to go back to that harrowing and lonely place of a year ago. That no one else should have to either. But if they do (or if I do), that they not give up hope. Because eventually their tomorrow will be better than their today. And they will be able to dream again too."

A dream that we can dream. Against all odds, we are still standing. You, me, Therese. Think of your worst moments. Those dark days, when a dream that you could dream was all that kept you going.

A dream that we can dream. Our population, more than anyone, knows the power of a dream.

"We have some difficult days ahead of us," Dr Martin Luther King told a gathering in Memphis. "But it really doesn't matter with me now, because I have been to the mountain top ... and I've seen the Promised Land."

It was as if he knew what was coming next. The next day, a bullet raised him into Heaven.

I, too, have a dream. I dream a Martin Luther King will emerge from our ranks. He or she will unite us, lead us, shame society, break down barriers. We may not get to the Promised Land in our lifetimes, but he or she will get to the mountain top, give us a vision of the Promised Land.

And our children and our children's children will give thanks.

Saturday, January 17, 2009

The Bipolar Singing Blogger Smackdown

I just came across this from my fellow blogger, Therese Borchard of BeyondBlue.

Okay, Therese. You think you can sing, well I have an answer to that. As you can see from my video, not only do I sing, I sing very badly.

So if you're up to it, Therese - any time, any place - you bring your posse, I bring mine. The Bipolar Singing Blogger Smackdown. Bring your tap shoes, if you got 'em.

Friday, January 16, 2009

It's a Mad World, After All

Way back when I was crazier than I am now but believed I was normal, I was a financial journalist. I worked in New Zealand and Australia and published three books. Two of them challenged the conventional wisdom of the day, namely that rational self-interest governs all individual decisions regarding money, and that the marketplace is the collective expression of an infinite number of common-sense decisions at work.

Needless to say, I was a voice in the wilderness.

Ten years ago, following my diagnosis, I started writing on my illness. Here, no one was trying to pretend they were normal. I was crazy covering crazy. I felt right at home. So much so that I could pass for normal, even when I told people I was crazy.

I think I was a financial journalist for a full year before I realized that a balance sheet and a profit and loss statement were two different things. To compensate for my obvious deficits, I developed an acute sense of logic.

Wait a second, I said to myself one day. Here, we have economists - nerdy mathematician types - trying to predict human behavior? Nuh-uh, I thought. We're talking psychology here, a discipline based on the proposition that people act irrationally, even against their obvious best interests.

As if to prove my point, one day I flipped out and quit my job on a daily newspaper. The rest of my time in Australia I was (rationally) treated as radioactive.

All you need to do is spend a day in a mall to see that the real world behaves far differently that the one imagined by PhD economists. The entire marketing and advertising industry recognizes this. Their practitioners work on the principle that consumers can be manipulated into making spectacularly irrational choices. If you don't believe me, take a look at all the SUVs on the road.

Conversely, marketers and advertisers are smart enough to know that consumers can make them look spectacularly stupid. That just when you think you have buyers all figured out, they will come at you with something totally out of left field, such as refusing to purchase safari suits, even at steep discounts. Imagine.

Needless to say, the advertising industry employs psychologists. People who know what dopamine can do to the brain, not to mention how our irrational fears and desires and impulses drive our decisions.

If only economists and financiers could be so smart.

In a New York Times piece published yesterday, op-ed columnist David Brooks finally 'fessed up. According to the old way of thinking: "The classical models presumed a certain sort of orderly human makeup. Inside each person, reason rides the passions the way a rider sits atop a horse."

More: "People respond in pretty straightforward ways to incentives. The invisible hand forms a spontaneous, dynamic order. Economic behavior can be accurately predicted through elegant models."

A funny thing happened on the way to 2009 - a complete financial-economic meltdown, an event that classical economics could not predict, much less explain. According to Brooks:

"Reason is not like a rider atop a horse. Instead, each person’s mind contains a panoply of instincts, strategies, intuitions, emotions, memories and habits, which vie for supremacy. An irregular, idiosyncratic and largely unconscious process determines which of these internal players gets to control behavior at any instant."

It's a crazy world, after all. We crazy people had it right, all along.

Thursday, January 15, 2009

When Your Meds Fail - Is Heidi Klum Lying?

Your life isn't going right. Your doctor diagnoses you with clinical depression and prescribes an antidepressant. The antidepressant doesn't work or partially works or makes you feel worse. What now?

The American Psychiatric Association in its 2000 Practice Guideline for treating depression suggests going with a different antidepressant. This recommendation is backed up by the NIMH-underwritten STAR*D clinical trial results of 2006.

Fine, but what about if your second antidepressant fails? The APA recommends keep trying, but STAR*D shows the success rates drop off dramatically at this stage. What gives?

For one, it may be time to revisit the diagnosis. Psychiatric treatment guidelines are based on the fallacy that your doctor has nailed your diagnosis on the first try. But, more commonly, those of us with bipolar tend to first get misdiagnosed with depression.

Even those correctly diagnosed with depression may be out of luck. Psychiatry tends to treat all depressions as alike, with one-size-fits-all antidepressants. There is, for instance, a clear distinction between chronic and recurrent depression, and a body of expert opinion that says antidepressants may be problematic for the latter.

This distinction is way too subtle for your average psychiatrist. But eventually they may wise up and try a bipolar diagnosis and prescribe a mood stabilizer (or antipsychotic). But what if a series of trials on mood stabilizers fail? Or only yields partial results? What now?

Way too many of us are struggling. Check out the poll at the top left corner of this page. At the time of writing this, of 58 people who have responded so far, 25 say they are stable but not well and 12 that they're in crisis or close to crisis. Only eight are where they want to be or feel better than they ever could have imagined.

This is where the frustrated clinician often starts blaming the patient. The meds are supposed to work. That pharm rep who looks like Heidi Klum said these meds work, and she wouldn't be lying, right? It has to be your fault.

Time to revisit the diagnosis? Again?

More in my next blog ...

Further reading from mcmanweb: When Your Second Antidepressant Fails

Wednesday, January 14, 2009

Mindfulness - Living in the Present

Here it is, my latest video.

I wrote my script on Sunday, spent Monday morning plotting my shots, Monday afternoon actually shooting it, and Tuesday editing it.

The message to the video is simple: "We forget. The present is where life is happening - here, right now."

Producing my three-minute, 24-second video was a lot more complex.

I did my first video on mindfulness at the end of June, but it was only last week when the idea for a second one congealed in my head.

The first part of my video is based on an ancient Zen parable. "Getting" Zen, though, poses a major problem, which explains the long gestation for the script. Then it occurred to me to explain the Zen thing with reference to an earlier Zen experience of mine. Zen explaining Zen. That's why it's Zen.

I live a mile and a half from a state park in southern California. A natural boulder formation was perfect for my purposes. But I was shooting in 50 MPH wind conditions that posed special problems. I performed one difficult stunt jumping from a boulder only to discover the wind had blown my camera and tripod to the ground.

Then two indoor scenes before going back outdoors to recreate my Zen experience from two years before. The setting sun had to light up a distant peak just right. One cloud in the wrong place and I could forget about shooting. After waiting 30 minutes, the peak lit up like someone had illuminated it from the inside. I was a very happy boy.

Back in the "editing room," my rough cut showed as much promise as a fallen soufflé. I refined my cut into 28 clips spanning three minutes, four seconds. (From memory, the shower scene in "Psycho" involves something like 55 edits.) One of the clips, spanning five seconds, involves nine rapid-fire images of paintings, representing the mind in turmoil.

The wind gusts had played havoc with my "live" narration, so I had to go with more voice-over than I had intended. I picked two classical pieces and a surfer instrumental from my royalty-free library as my soundtrack music, and suddenly I had air in my soufflé. One of my scenes involved five layers of sound, and for dramatic effect in my "distant peak" shot I "turned up" the wind.

Then tweaking and more tweaking. My final major decision for any video I do involves whether I roll with short credits or long credits. I decided to go with long credits, 20 seconds worth.

As you can see from the video, I'm having way more fun than any human should be allowed to have. I shot my first video in March last year, using only a webcam and the primitive film-editing program that came with my new iMac. In late April, I made the leap to a high-end camcorder and FinalCut Express.

The 16 videos I have done so far represent my own healing. Learning something new helped pull me out of the extreme burn-out I was feeling last year. Suddenly, I was motivated. Suddenly, I was having fun.

I had also found a new way to reach out to people with my illness.

If Spielberg calls, tell him I'm busy ...


This video is based on my mcmanweb article: Mindfulness - Living in the Present.

Monday, January 12, 2009

Borderline Personality Disorder - No Them, Know Them, Know Thyself

In two of the last blogs I did for BipolarConnect, I brought up the topic of borderline personality disorder. The second piece drew 25 comments, so apparently I struck a chord.

People with borderline manifest symptoms that superficially resemble bipolar, but in an explosive and unpredictable manner that people at Ground Zero describe as something akin to walking on eggshells.

My main point was that it is nonproductive to think of borderline as a separate diagnosis that affects other people. There is no true "us" and "them." Regardless of our diagnosis - or whether we even have one or not - we all have personality issues in abundance. These issues can make our lives hell (as well as for the people around us), plus they pose major obstacles to our recovery.

In the context of bipolar disorder (my diagnosis), it pays to think of ourselves as having bipolar "with other stuff going on."

By understanding borderline, we are in a better position to understand ourselves and make the appropriate course corrections. It's part of the "Know Thyself" philosophy here at "Knowledge is Necessity."

My initial enquiry into borderline began about three years ago, when I joined the board of a state mental health group and immediately encountered a steady progression of people who made my life miserable. For my own emotional safety, I had to resign my position.

When I started connecting the dots, I realized my recent bad experience was no exception. That all my life I had been a regular borderline magnet. My first reaction was I hated these people. I hated their illness, and I wanted nothing more to do with them.

Then I realized that the very thing we hate most tends to be the thing that resides deep inside of us. Jung called it the shadow self. I may not have had borderline, but I was forced to confront my personality issues.

"I am Joseph, your brother," reads a line from the Bible. I'm not quite ready for that, but I'm working on it.

Lots more in future blogs.

Further reading from mcmanweb: Borderline Personality Disorder

"Those who live with individuals with borderline describe the experience as akin to walking on eggs. By contrast, Anne compared her dealings with people to 'walking on shifting boards.' The world is far from a safe place, and the ground beneath her could collapse any second."

Also from mcmanweb: Poisonality

"Distinguishing a bad hair day from a mood episode from a personality disorder meltdown is notoriously difficult. Even Mother Teresa had her off-moments, and no doubt Gandhi had unresolved issues he needed to work through."

Sunday, January 11, 2009

FDR and Lincoln

We are one week away from inaugurating a new President. Reference has been made to both FDR and Lincoln regarding the challenges facing Barack Obama.

FDR was cut down in the prime of life with polio or a polio-like affliction. Not only is he unquestionably the greatest President of the twentieth century (by virtue of saving western civilization), his story of how his disability changed him into a better person is inspiring.

My FDR video is the first I shot using a camcorder. I was in Washington DC at the time - early May, 2008 - trying out my new camcorder at the FDR Memorial.

I shot my Lincoln Memorial footage later in the evening. My visits to both memorials were like a religious experience. I felt myself in the presence of something far greater than me. I read the words of both men inscribed on their respective memorials and felt the tears flowing.

Lincoln, as most of us know, was depressed nearly all his adult life. Of all things, his unremitting sadness and despair ennobled him, filled him with rare insights, and prepared him for the grim task ahead.

The crisis we are facing today equates to those that kept FDR and Lincoln awake late into the evening. There are many lessons to learn from these two great men, but the big one is the example they set in their devotion to a higher purpose and their empathy for the suffering of others. Their virtues are saintly ones, tempered by down-to-earth realism.

Hopefully, this is the example that the incoming President chooses to follow.

From mcmanweb: Lincoln and His Depression

"In Lincoln’s depressions, we see the illness in its full destructive horror, one that nearly succeeded in cutting short the life of a promising young man and made the rest of his existence miserable. This is the side of depression with which we can all unfortunately identify. But we also see an aspect to his depressions that equally resonates with us – how our suffering can strengthen us, ennoble us, and embolden us, often to achieve the impossible."

Saturday, January 10, 2009

Trick Question

Here's a question I used to pose to my audience when I was giving talks in 2006-2007:

Emil Kraepelin was the pioneering diagnostician who coined the term manic-depression back in the early twentieth century. These days, we use the term bipolar. Question: What was the term Kraepelin used to describe unipolar depression?

Answer: Manic-depression.

That's right - manic-depression. To Kraepelin, both illnesses were part of the same phenomenon, or more precisely the same recurring phenomenon. People cycled in and out of depression. Some just happened to cycle up to a higher level than others.

In the 1950s, Jules Angst and others separated out a class of individuals with CHRONIC depression. These are the true unipolars. They don't cycle. They stay in their depression, often year in and year out.

Those with RECURRENT depression, on the other hand, exhibit a similar pattern to those with bipolar. The leading researchers of the day were pretty much in agreement on this. Then along came the DSM-III of 1980, which completely got it wrong.

The DSM lumps chronic and recurrent depression together and separates out bipolar. The treatment implications are enormous. These so-called unipolars are treated the same, regardless of their depressions, and given antidepressants while the bipolars get mood stabilizers.

Thus, a large population of unipolars are being treated with meds that not only may not work, but may, in fact get them worse.

Jim Phelps MD describes this very well in his 2006 book, "Why Am I Still Depressed?" For the clinician view, check out Goodwin and Jamison's definitive text, "Manic-Depressive Illness." Fittingly, the subtitle reads: "Bipolar Disorder and Recurrent Depression."

In my talks, I was speaking to very smart people. Yet, of the thousands I wound up addressing, not one came up with a correct answer to my question. The DSM is propagating a myth, aided and abetted by modern psychiatriy. Patients and loved ones are paying in full measure for this mistake.

Further reading from mcmanweb: The True Meaning of Manic-Depression.

Friday, January 9, 2009

Mindfulness - My Ultimate Mood Stabilizer

Around this time 10 years ago, a crisis intervention team was figuring out what do do about my antidepressant-induced mania. Changing my diagnosis to bipolar and putting me on a mood stabilizer was a good first call. They also recommended cognitive therapy, once I stopped bouncing off the walls and ceiling.

"Cognitive therapy," I recall myself saying between bounces. "What's that?"

The psychiatrist on the team briefly explained.

"Ah, mindfulness," I replied.

Three blank stares.

"You know," I said, kind of floating above my chair. "The Buddha. He came up with this stuff 2,600 years ago."

Humor him, said the look on their faces. A Buddhist maniac - they come in all shapes and sizes.

The cognitive therapy, needless to say, turned out to be applied mindfulness, and proved very useful to my recovery. No one, of course, gave the Buddha any credit. Later, I learned about dialectical behavioral therapy (DBT), which loudly champions the Buddha and mindfulness.

These days, needless to say, mindfulness is all the rage. There's even something called "mindfulness-based cognitive therapy," which I can assure you is a redundancy.

Anyway, here I am, not bouncing off walls, still singing the praises of mindfulness. Think of the mind watching the mind. Think how useful the art of being aware can be in nipping baby mood episodes in the bud, managing stress, and otherwise reeling in a runaway brain.

Mindfulness is my number one recovery tool. It is my real mood stabilizer. But practicing mindfulness requires considerable discipline, and, if you're like me, takes years to achieve a certain level of proficiency. So please think twice before changing your relationship with your chemical mood stabilizer.

My mindfulness video is one of the first I shot shortly after buying a camcorder and film-editing software last year. I hope to shoot more mindfulness videos once I work up some more scripts.

For more on mindfulness, check out these two articles on my mcmanweb site:

Mindfulness - The Ultimate Mood Stabilizer

“'Mind precedes its objects,' reads the first line of the Dhammapada, the best-known of the Buddhist scriptures. 'They are mind-governed and mind-made.' ... "

Mindfulness - Living in the Present

"Life is a bitch. No one gets off this planet alive. We have to savor our good moments while we can. But, of course, we will miss them completely if we keep getting stuck inside our own heads."

Thursday, January 8, 2009

Making Peace With Our Loved Ones

At least half of the correspondence I get from readers comes from loved ones, including family members and sweethearts. Without exception, they are at a loss and their stories are heart-breaking. They are the innocent bystanders of our illness.

I've also had ample opportunity to listen to loved ones at various mental health venues, plus I am forever engaging them (or, rather, they are engaging me) in conversations in coffee shops, on public transport, everywhere. More recently, by virtue of a broken marriage to a woman with bipolar, I've have had an opportunity to sit in with a DBSA-run friends and family support group.

Believe me, our loved ones see our illness far differently than we do. We may complain that they don't understand us, but far too many of us fail to recognize the horrible abuse we have put them through.

Believe me, to live with a person with a mental illness is to live in an abusive relationship. Until we own up to this hard cold truth, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

I cannot disclose what takes place in our friends and families group, but I can mention this much: A father was in tears, at the end of his rope. I felt I needed to jump in, but as a patient. We put you through hell, I said, or words to that effect. But you are the best thing we have going for us. We can't do it without you ...

I noticed the look on his face. I noticed the others in the room were listening intently. No doubt, they had heard this before, but from fellow family members. What made my little homily significant was that this time the words were coming out of the mouth of a patient.

At last, came the thought, someone who understands.

Understanding. Isn't that what we are all looking for?

Much more in future blogs, including what loved ones need to know about us ...

From mcmanweb: Family and Relationship Fallout

Wednesday, January 7, 2009

My Utterly Realistic Cole Porter Dream

Last night I dreamed I interviewed Cole Porter. The fact that Cole Porter has been dead for 45 years did not at all diminish the realism of my dream.

Cole Porter is arguably the leading contributor to that world cultural treasure we refer to as the Great American Songbook. Without him and the likes of Gershwin and others, just about every singer and quite a few musicians would be out of a job.

To add to the realism of my dream, my cell phone connection was bad and I had to keep walking from place to place to hear his voice. I can't recall a single word he said, but I can assure you he came across as the urbane and witty guy who wrote these lyrics:

Birds do it, Bees do it,
Even educated fleas do it,
Let's do it, let's fall in love.

Of course no one disputes that the greatest moment in all cinema is Fred Astaire wooing Ginger Rogers to "Night and Day" in "Gay Divorcee." Pure silver screen magic, is all I can say.

The song also represents Frank Sinatra's first hit as a solo artist. In all, Sinatra recorded "Night and Day" four times. Porter much preferred Astaire as a singer to Sinatra. Clearly, Astaire was the embodiment of Porter's urban sophisticate, but Sinatra's muscular version of "I've Got You Under My Skin" makes a strong case for swinging vulgarity.

A horse riding accident in 1937 at the height of his career resulted in compound fractures in both thighs, complicated by a bone infection, that left him a cripple and in excruciating pain the rest of his life. Still, in public at least, he maintained his upbeat persona and continued to produce hits until his health seriously deteriorated in 1958. He died in 1964.

Must movie rental: "Gay Divorcee" starring Fred Astaire and Ginger Rogers.

An MGM classic: "Kiss Me Kate," based on the Broadway hit. Anne Miller's seductive song and dance to "It's Too Darn Hot" is one of many show-stoppers.

Recommended listening: "Frank Sinatra Sings the Select Cole Porter." Make sure you're getting Sinatra from his incomparable Capitol Records years, accompanied by Nelson Riddle. It doesn't get any better than this.

"Ella Fitzgerald Sings the Cole Porter Songbook." Okay, okay. It does get better - delightful, delicious, and de-lovely, in fact.

A jazz master: Pianist Art Tatum's masterful interpretations of "Begin the Beguine" and other standards would have you believe that Cole Porter wrote specifically for him and other legendary jazz instrumentalists.

Plus: "De-Lovely" soundtrack from the recent film based on Cole Porter's life, starring Kevin Kline. Reinterpretations by Alanis Morissete, Elvis Costello, Natalie Cole, and others demonstrate why Cole Porter's appeal is timeless, that, literally, he is "the top ... the steppes of Russia ... the pants on a Roxy usher ... "


For articles on composers with mood disorders (Beethoven, Tchaikovsky, Mahler, Liszt, Chopin), check out the Famous People section of

Tuesday, January 6, 2009

Noncompliance - Time for Psychiatrists to Practice Real Medicine

In my most recent blog, I mentioned a grand rounds lecture I delivered last year to a psychiatric facility on meds compliance. In the talk, I made two comparisons: 1) A psychiatric drug trial to a cancer drug trial, and 2) A hypothetical oncologist appointment to a psychiatric appointment.

The first clinical trial was an Eli Lilly trial of bipolar patients on the antipsychotic Zyprexa. These were patients who responded well to the med in the initial going. Despite that, 79 percent dropped out of the study after 48 weeks. Believe it or not, Eli Lilly actually found a way to put a positive spin on the findings.

This study is all too typical of long term studies on virtually all classes of psychiatric meds, with drop-out/noncompliance rates averaging about 70-80 percent. In one trial, 100 percent of the patients dropped out. In other words, no one finished the study.

The second trial I referred to was an AstraZeneca study of breast cancer patients on tamoxifen. In that study, 26 percent dropped out after one year, almost the exact inverse of the Zyprexa study. But rather than put a positive spin on the finding, AstraZeneca was so alarmed by the high drop-out rate that they stopped the study.

What is going on? Both drugs have horrible side effects, but one group of patients is obviously buying into long term treatment and the other isn't. Could the difference lie in what doctors are telling their patients?

Consider the gist of the message the oncologist gives to a patient:

"It's going to be hell, but there's an excellent chance your cancer will go away."

I made sure all the heads in the room were nodding on that point before proceeding to my next PowerPoint. Now here's what I know too many psychiatrists are telling their patients, I said:

"What are you complaining about? These meds work. Something must be wrong with you. You're much better off than you were before. You need to stay on these drugs for the rest of your life."

I sensed the hackles in the room rising, but plowed straight into my next PowerPoint:

"What the cancer patient may be thinking: One year of hell - if that's what it takes to get my old life back, I'm willing to put up with that.

"What I know the psychiatric patient is thinking: This is the best you can do? You mean I am going to have to spend the rest of my life - like this?"

By now, my audience of clinicians was turning into a lynch mob. But it was only going to get worse. Up until now, I had only been presenting the facts. Now I was about to tell this group of highly-educated and highly-experienced clinicians how to do their jobs:

There is the crucial "window of opportunity" phase in the doctor-patient relationship, I said. The patient has been brought out of crisis and has been reasonably stabilized, but is clearly not well. For many patients, a long hard road lies ahead. You have one chance to get your patient to buy into long-term treatment, and you need to be brutally frank about presenting the bad news along with the good.

First the bad news: These meds are not magic bullets. You may have to put up with significant side effects in the short term. It may take time to dial in your meds just right. You may not feel like yourself. You may want to quit altogether.

Now the good news: I am going to work with you on your recovery. As your knowledge and skills improve, I will be in a better position to help you. You will also be in a better position to help yourself. Trust me, there is light at the end of this tunnel.

So how did this go over? No sooner did I wrap up my talk than I was looking at empty chairs. Literally, it was as if the fire alarm had gone off.

I rest my case ...

Monday, January 5, 2009

Clinicians - The Worst Purveyors of Stigma?

In a previous blog, I mentioned an email interview I recently completed with I Am Bipolar.

"Have you ever experienced negativity or stigma from people who have become aware of your condition?" Michael, who runs the site, asked.

Hmm. Interesting question.

"Ironically," I replied, the worst stigma came "from clinicians and fellow patients, the very people who are also my best supporters."

Clinicians have long accepted me as a journalist. In 2007, in fact, they even honored me with a major international award. But I am not one of them and never will be. Last year, I was invited to give a grand rounds lecture at a psychiatric facility in Princeton. I accepted with some trepidation. It is not my place as a journalist to tell others how to do their jobs.

I showed up with a talk on medications compliance. I'm sure the 50 or 60 clinicians in the audience expected me to blame patients for being too stupid to work the child-proof cap to their meds bottles and such, and indeed I did touch on that. But I also blasted the pharmaceutical industry for aggressively marketing meds that often made us worse rather than better, as well as clinicians who should know better, at the expense of the individuals they are supposed to be serving.

I wasn't just some antipsychiatrist spouting off. My PowerPoint contained reams of citations from the leading psychiatric authorities, including conferences I had attended and first-rank journal articles and editorials. But it was also my duty to wrap it all up and tie it in a bow. With reference to the fact that over the long-term some 70 to 80 percent of patients either drop out of clinical trials or are in some degree noncompliant on antidepressants, mood stabilizers, and antipsychotics, I pointed out the obvious:

"Just sending a patient out the door with a prescription is not treatment."

I wasn't all negative. I mentioned how compliance rates could be improved upon by employing psychoeducation, support groups, various talking therapies, books, websites, and so on. But this did involve the need to build trust with patients and spending time with them, plus being proactive in referring them to other services and sources of information. Again, just sending a patient out the door ...

As soon as my lips stopped moving, the room emptied faster than a high school Latin class at the three o'clock bell. No one approached me for a polite handshake or to follow up on any points I made, or to request more information. Only one person bought my book.

As I said, it is not my place to tell others how to do their job, particularly when nothing I said could be interpreted as a pat on the back, and my discomfort clearly showed in my talk. But even taking all of that into account, I was truly amazed by the magnitude of this group snub. Had I a PhD or an MD or an MSW to my name, I would have been treated with far more civility. But I happened to be a journalist who was also speaking as a patient.

The biggest complaint I get from my readers, I said in my talk, doctors who don't listen. Boy, did they prove me right.

Future blog: Stigma from patients. Stay tuned ...

Saturday, January 3, 2009

There is Always a Somewhere

In September last year, suicide claimed the life of my good friend Kevin. He was all of 28. This is the video I did soon after, "The Road to Nowhere." Don't be fooled - there is always a somewhere.

Thursday, January 1, 2009

Some Observations on Stigma

Today, I completed an email interview with Michael, a patient who has recently set up an excellent website, I Am Bipolar.

"What more do you think can be done to change the public’s perception of mental illness?" he asked.

That one really got me thinking. "We (patients) have to take more responsibility and stop blaming others," I responded. "We need to recognize that our behavior has put those around us through no end of grief and that they have every right to never want to associate with us."

That was just my warm-up. We tend to think of stigma as something we have to put up with from the general population - and, believe me, there's more than enough of it to go around - but we're not going to get very far doing nothing for ourselves and waiting for others to change.

I've seen far too many patients on the cusp of recovery but going nowhere - stuck - and I can't help thinking a victim mindset has a lot to do with it. Not only do these patients hurt themselves, a lot of them hurt the rest of us. All it takes is just one person to play the bipolar card on someone once too often to turn a would-be sympathizer into a one more reason my life is difficult.

Fortunately, people are capable of forgiving us for our outrageous behavior, but first we need to ask, and second we need to demonstrate good faith.

Meanwhile, we need to make an effort to become role models, to start acting as if we have something to offer the world. An enlightened public is more than willing to embrace us and put up with some of the craziness that goes with the whole package, provided that we set out to become a positive force in their lives.

There has been a major sea change in public attitudes since I was diagnosed 11 years ago. Yes, we are still exposed to a lot of, "He's acting weird, must be bipolar." But we're also hearing more of, "Wow, she's so amazingly smart and creative and personable, must be bipolar."

Next thing, we'll have a bipolar President. Wait, we've already had at least at least three (John Adams, TR, LBJ). More on stigma in a future blog ...

Complete IamBipolar Interview