Monday, August 31, 2009

Name My New Cat - Update


Thank you, all, very much for all your great suggestions. As you know from a recent blog piece, a stray cat adopted me. Okay, here's where I stand. This little furball very much has a queenly aspect, at least till she hears the crackle of the cat food bag crinkling in my hand. The catch is the queen names have been done to death: Cleopatra, Nefertiti, and so on.

Little meowgirl also has the way of the enchantress, so I'm also thinking along the lines of Sappho (ancient Greek erotic poetess) and Circe (who beguiled Odysseus and crew).

Yesterday, a friend took a good long hard look at the photo on my iPhone and came up with Sheba. Another done to death queen name, I'm thinking. Then, suddenly, Bathsheba popped into my head. Bathsheba, as you may recall, is the Bible babe (pictured here) who made the mighty King David all weak in the knees (but strong in the loins), which kicked off a sequence of events that involved the usual lust and bliss followed by an unwanted pregnancy, which resulted in David dispatching husband Uriah the Hittite to certain death in battle, thereby incurring the wrath of God, who visited ultimate calamity upon the House of David.

(Something we can all identify with, obviously.)

The next thought that popped into my head was that a good shortened name for Bathsheba would be Batty.

As things stand right now: I'm leaning toward Bathsheba and Batty, but nothing is final yet. I've narrowed my choices to queen names (the more obscure the better) and enchantress names. So - feedback on Bathsheba and Batty, please, and ideas on queen and enchantress names. Please use the comments below ...

Guest Blog - The God Negotiations: Acts II and III


Yesterday, Act I to Elizabeth's masterpiece. Today, the concluding acts.

Act II

God was right! He always is, you know. If you cover your body in garbage bags, very easily obtainable in these amazing free shopping places called dumpsters, you stay nice and warm throughout a Cleveland winter and the weird people don’t bother you. It’s as if they aren’t even there!

Down on the streets of Cleveland, I was getting very chummy with this nice guy named Joe, and we were sharing this delicious elixir called Wild Irish Rose. Spring was springing, the rats dancing most gracefully, and all I had to do was look up at the sky and see the most serene beauty, a different picture every day, indeed every minute sometimes. Joe had just made me the most glorious crown out of aluminum foil that really worked in keeping the extra-terrestial bureau of investigation from extracting my most precious thoughts, and which Joe said was most becoming on me, when God turned me into water vapor. The last thing I heard was Joe moaning, why does this always happen whenever I meet a nice chick?

Then I was going up, up, up into the clouds, and the next thing I knew I was in God’s office. Some weird music was blaring, the lyrics going something like War, huh, good God y’all. What is it good for? . . . The office was an absolute disaster. God was sitting at his desk playing solitaire on his computer, still in his bathrobe. Well, he always wears a bathrobe, even to work. Who’s going to stop him? He’s God!

I had to shout The Serenity Prayer in His ear three times before He recognized my presence. Just hold on, He said. I might win this one. But He didn’t, sighed, and turned to me. Sorry, forgot all about your appointment, He said, looking more than a bit dour. Like the last thing he wanted was the presence of another soul.

You called me, I said, quite annoyed by being pulled away by all the fun I’d been having in Cleveland but trying to keep my cool. Didn’t want to be smooted. Or smited. Whatever.

Right, forgot, He muttered. Where’s that file?

He finally found it under a pile of Weekly World Newspapers. Have you considered that life I was telling you about?

I was thinking maybe You have something better in there. Maybe a Guess model. Any of those in your file?

Oh, no, you don’t want to be a Guess model, he said. That’s a terrible fate.

Well, I didn’t know what to say. They seem so happy in their photos, but I didn’t pursue it. Instead, I just asked, What else do you have in there?

He shuffled some papers around and pulled out a form. I have a very promising life as a worm, He said. There. That sounds good.

A worm? Are you kidding me? Who wants to be a worm?

Well, they are quite evolved. If you happen to get cut in two, you live on as two worms, which could help you to unkink some philosophical quandaries. Plus, it would be a chance for you to actually do some good for the planet earth. Darwin was very interested. . .

No, no, no. They’re too icky. Make me something a little less icky, please. I’d like to be human.

He muttered under his breath for a while, saying things like, oh, sure, they all want to be human, and so few of them who think they are really are. Really, I should have let Satan take over. This job is just too much pressure sometimes.

Why, oh why, is God always saying things like that? He’s omnipotent, omnipresent, omniscient and all the rest, yet His office is a disaster and you can’t get Him on the phone for months on end.

O.K., He says. If you insist on a human form, I’ve got three choices for you: a Catholic bishop with a taste for choirboys, a diamond miner in Africa, and that one I was telling you about.

A diamond miner in Africa! That sounds absolutely idyllic! Zebras and giraffes and amazing flowers, and all I have to do is find a few diamonds?

You think? You think worms are icky? The ants in Africa are huge! Plus it says you get your hands chopped off at the age of 15 and spend the rest of your life looking around for someone to feed you. I don’t think you’re ready for it, though, he says. Too spiritual. He crumples that form in his hand and throws it at the wastebasket, missing.

Oh. I sit there for awhile, mulling it over my remaining two choices. I twist a lock of my hair around my finger and try to look cute. He just scowls at me. Don’t even try it, he growls.

I was thinking, I do like hats. Bishops get to wear these fabulous hats and beautifully embroidered vestments and tell people what to think in glorious cathedrals with amazing stained-glass windows. And I do like choirboys myself, just not that way. That’s the only trouble. Hmmm. Meanwhile God played more solitaire on his computer. Finally he turned to me and said, I’ve been playing this game all afternoon, and I just can’t seem to win. Look, take the first option. Just take it and get out of here. You’re wasting my time.

Is that a command? What about free will?

You have three minutes, He said, turning the sands of time from His Yatzee game.

I pondered and pondered and swiveled myself around and around in the desk chair God had so benificiently provided for me. Fun! Finally I said O.K. So what’s so great about this life You’re trying to sell me on? Anything else on that form You can tell me? Any perks?

He looked at the form. You get to be a woman and have a child. That’s really cool. And you meet some wonderful people who will help you along. Oh, and every once in a while you laugh so hard that water spurts out your nose, and there’s a 7-11 down the street from you that sells excellent Indian convenience food for cheap. But back to the main problem you’ll have. Let me tell you, the cures for your disorders are there—you just have to persist. You find them and then that’s the end of it. Sort of like an Easter egg hunt. What the heck else could you want?

I know, I really do know, that God loves me infinitely, so I figured I’d take His advice.

O.K. I said. I’ll take it.

Act III

There is no Act III. Or rather, I’m living it.

Sunday, August 30, 2009

Guest Blog - The God Negotiations: Act I


This masterpiece from Elizabeth:

John McManamy wrote in his book that he has a feeling that he chose his fate before he was knit in the womb, so to speak. That he has a feeling that he was offered options and actually chose to be bipolar in a pre-womb, metaphysical state. This is an idea I’ve had about myself for many years. I told John that we with mental illness should create our own religion. I guess, though, he’s too busy providing people knowledge that could save their lives. Go figure.

So I’ve been thinking about this choosing-your-life idea for some time, and came up with my latest version of me picking my own bipolar life. Let it rip. Here’s the opening scenario:

Act I

Situation: It seems necessary that I have to be born into another planet-earth life once again, and God and I are discussing options. He takes out a file from his rather disorganized cabinet.

He pulls out a form from the file. He says, here’s one you might want to consider. It requires you to have many disorders that are pronounced incurable. Let’s see. Sexual abuse in your teens. Something termed chronic fatigue in your twenties. Then it says fibromyalgia in your thirties. Then a diagnosis of bipolar as you reach 40. Hmmm. Says it should have been diagnosed earlier on that one. Darn, I need a better editor. Need to get rid of that word “should.”

Doesn’t sound so bad, I say. That looks like a breeze. Remember that past life when I lived in a small agrarian New England town that ran a lottery that required us to stone to death one innocent person a year to make the crops grow better? Didn’t work. And those people I had to live with were so boring! Plus all those kids I gave birth to and loved who died in their infancy. Seven dead out of nine!

Look, He says, don’t get snarky. Just be quiet and let me continue. You people who think they can remember past lives are getting on my nerves. You all say you were Cleopatra or Atilla the Hun or some such. Wrong! As for you, you were not in a short story. Believe me, I’ve wiped your memory clean in an ECT contraption. You are getting too imaginative again, so watch it. Here, do this crossword puzzle till you calm down.

Then He leaves me in a cubicle for eight hours with nothing but this crossword puzzle, a pen that doesn’t work, a computer with many, many viruses, a razor blade, a raven feather, and a woman in the next cubicle who keeps blathering about the bras she’s about to order from Victoria’s Secret. I tell you, it seemed like an eternity.

When He comes back, He looks at the blank puzzle and says, what have you been doing all this time?

The pen you gave me was out of ink, I simper. And what’s a six letter word for stupid? Plus, You’re the Expert, so I must ask you. Should I show more or less cleavage?

He ignores this most urgent question, and dismisses my excuses for not completing His assignment. Don’t you know by now that blood is an excellent ink?, He asks. Are you totally out of it?

So let’s get on with it, He says, pulling at his snowy white beard and trying to be kinder. Try to focus. Keep on-point. He says to me. O.K. More on this potential life. Here’s the objective of the life I’m proposing for you. You spend most of your life trying to heal yourself. On this form it says that lots of people termed “assholes” get in your way. Gosh, I really need better editors. Told them many times not to use that word. They just don’t listen.

I say, O.K. God, or gosh if you’d rather be called that, what do you have in mind? All I have to do is cure myself of a few ailments and then I get a mansion in heaven? I hear there are many mansions, some with pool tables in the basement. Any still available? Do they include mineral baths and servants way wiser than I am but whom I can keep in near-poverty and at my service, attendant to my every emotional tizzy, like in the classic Hollywood movies?

He answers, the real estate market here in Heaven is a bit farked up at the present moment. However, I do have an opening for a basement efficiency in a district of Indian computer service providers.

O.K., I say, getting excited. That sounds fine, as long as I get fed decently.

Well, He says, pulling at his long snowy beard and showing deep wrinkles around his eyes—He should really see a plastic surgeon about that—let me review the form. Says here that you can get a junior bacon cheesburger, plus a small fry and a small drink consisting of caffeine, refined sugar, and many artificial ingredients for under $5. Is there anything else that can complete your order?

O.K., I say. Do you mind if I sleep on this decision? I’m feeling a bit woozy.

No problem, He replies. Being that it’s January in Cleveland and a bit chilly, just go downtown. There are some really nice grates on the sidewalks that blow hot air up from hell that you can sleep on. Pretty cozy. Lots of people who talk to me sleep there.

More to come ...

Friday, August 28, 2009

Flying Home














October and November tend to be weird months for me. Early October, 2006 saw the publication of my book: "Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn't Tell You That You Need to Know."

The book represented a major personal triumph for me, but life is seldom simple. It's amazing, in hindsight, how I didn't see it coming, but we never do. One day I was winding down from a round of book-related speaking engagements and radio interviews, making a mental note to pick up a Thanksgiving turkey, the next my marriage broke up.

I had been married (for the second time) for nearly three years, living in central New Jersey. On December 1, ten days after my break-up, I boarded a one-way flight to San Diego, wanting to sleep and never wake up.

I collected my bags and stepped outside the terminal. In the dark, I made out cruise boats in the brightly lit harbor and the silhouettes of palms. Under the circumstances, I could be forgiven for thinking I had set down in the middle of a holiday resort rather than waiting for my ride in an ugly airport. The balmy temperature lent to the illusion.

Paul drove up and I got in. San Diego Airport is located in the heart of the city. If this were New York, you would literally have planes taking off and landing in Central Park. I recall thinking how convenient this would be for me, that is until Paul got driving.

We got onto Interstate 8 going east and kept going. And going. Then civilization literally ceased. No lights no buildings, nothing. Surely, this had to be some kind of anomaly, I thought. Surely, some kind of satellite city would materialize, a St Paul, a Fort Worth, a Newark, even.

Meanwhile, I had the strange sensation of being airborne. Our wheels were on the ground, but we had gone from sea level to above 2,000 feet in the space of 30 minutes. Oh crap, I could only think, what have I gotten myself into?

At 3,500 feet we got off at an exit that could have featured in a slasher movie. Then we were in total darkness. My worst fears were realized. We were in the country. The country! Probably completely off the grid in a void where zip codes don't exist.

We got out of the car and I gazed up at the unfamiliar sight of stars in the sky, unbelievably bright stars, pristine in the mountain air, with nothing standing in the way of me and something billions of light years away, maybe only millions.

I woke up the next morning to a searing Van Gogh sun against a brilliant cobalt blue sky. Where there should have been a Walmart was a valley surrounded by 4,000-foot peaks. Time to check out my new neighborhood.

All the houses appeared to have be built out of box kite material, only not nearly so sturdy, seemingly wind-tossed at crazy angles. Oddly, though, the overall effect was harmonious, blending in with the rocky and hilly terrain. A straight line or level surface would have stuck out like a sore thumb.

A short walk and the houses gave way to horse farms. In contrast to the sky, the hues of the landscape were muted. The trees and vegetation here are testimonies to perseverance rather than abundance. Water is scarce, exceedingly so. Only the rocks flourish – boulders, outcrops, summits. The wind was blowing in from the desert and had a decidedly flinty tang.

Back in the old days, a wrong turn on a mule wagon spelled certain death. The Mexican border is about 10 or 15 miles away. These days, those seeking the American Dream are prepared to risk everything negotiating this treacherous northern passage.

I rounded a curve and suddenly I was the only person on this planet. Just me and splendid desolation. Any second, I expected to come across Buddhist prayer flags fluttering in the stiff breeze. Perhaps a wise Indian shaman who could tell me why the hell I was here.

Talk to me, land, I found myself saying. I felt a spiritual tug, but I was confused and out of sorts. I was badly missing the life I had just left behind, but I knew in my heart this was the place I needed to be. If any healing were to occur, it would happen here, in these mountains, where I could clear my head, establish a sense of perspective, and slowly come to terms.

But I had a major shock in store when I came back from my walk and inspected the pantry.

Hmm. Cans of refried beans (is there an air raid shelter out back?). Soup in packets (desiccated chemical nodules that no amount of super-heated water could ever satisfactorily dissolve). I mopped some beaded sweat from my brow. Rice-a-Roni, I read on one box. Something salty that claimed to be food on another. The type of cans you only see in food drives.

I already knew what was coming next. I’ve seen grown men cry over the sight, but my reaction is always one of anger and disbelief. How is such a thing possible in a world that gave us Shakespeare and Sophia Loren? I could only think. Why? But there is no logical answer to explain man’s inhumanity to man. Just the inscrutable wording on the box:

Ramen noodles!

“What a piece of work is a man! How noble in reason, how infinite in faculties, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god! The beauty of the world, the paragon of animals! And yet, to me, what is this quintessence of dust?”

But I’m a highly-trained professional and it was time to take charge. In a calm and authoritative voice I told Paul and my other housemate: “Put your hands to your sides and slowly step back from the pantry.”

Don’t worry, I assured them, demonstrating to them that the skillet I had in my hand would be used for cooking real food, assuming I could locate some. But hey, I love a challenge. It's the one thing I have in common with Jesus - I've got the loaves and fishes thing down pat.

Life is about the little things. Several days later, seven FedEx cartons containing my life arrived at my door. By now, I had the food situation under control and was preparing a chili. Priorities are priorities. I ripped open the carton containing my kitchen gear and dived in for my zester. A minute later, I was in business. Zest-zest-zest – one peel to a lime into the pot, plus the juice. Now my chili had the missing zing and zap. Now I had a real chili going. A simple kitchen implement and suddenly I felt at home. My non-zester possessions could wait for later.

To be continued ...

Thursday, August 27, 2009

Name My New Cat


A month ago, I arrived back home from a day of water volleyball and recuperative chilling out only to discover that my cat Bullwinkle was not there to greet me. Immediately, I knew something was wrong. The little furball literally attaches herself to me like velcro. Every morning at 3, she would demonstrate the strength of our karmic bond by climbing into my bed and affectionally jamming her paws into my eyeballs.

I acquired her as a kitten some 10 months earlier. She is not the type to run off. I live 3,500 feet up in the mountains and not all the animals are friendly.

A friend asked me if I wanted another cat. No, I said, still grieving Bullwinkle. I'm not ready. Same answer to another friend.

Two weeks went by.

Me-owww!

A very sad meow. Bullwinkle? Couldn't be.

I looked out. Nothing. Then another meow.

Hey, Little Guy, I called out. A huge pair of pointy ears connected to a tail walked into view.

Me-owww!

The poor little thing looked like she (definitely a she) hadn't had a bite to eat in weeks. I grabbed a handful of dry food intended for Bullwinkle and emptied it into a dish and set it outside the door, along with a dish of water and a dish of milk. The food was gone in a micro-second, along with a second helping.

Then the little waif walked in the door and made herself at home. In nothing flat, she was sleeping on my lap. That night, she curled up in bed with me.

That was two weeks ago. This little furball isn't going anywhere. Ready or not, I have a new cat in my life. Time to set up an appointment with the vet. Time to give her a name. That's her in the picture. Names, please? Comments below ...

More Cool Stuff


Yesterday, I described a conference session I attended this year in which Daniel Weinberger of the NIMH was the presenter and 2000 Nobel Laureate Arvid Carlsson was in the audience. The focus of the piece was that neither brain science nor psychiatry was ever the same following Dr Carlsson's discovery of dopamine. This blog post zooms in on the similarly seismic effects of a study that Dr Weinberger participated in:

I first ran across Dr Weinberger (pictured here) at the 2003 APA in San Francisco, in relation to a gene that influences a different neurotransmitter, serotonin. I was an innocent, about to have my eyes opened:

Dr Weinberger told his audience about a study that came out of his lab, published in Science the year before (Ahmad Hariri, lead author). In the study, the researchers rounded up healthy subjects and put them into a brain scan machine (not all at the same time, I presume. I think they lined them up one at a time). The individuals were divided into two groups, those who had a certain variation to a particular gene, what they call the short allele to the serotonin transporter gene, and those who had the long allele.

The serotonin transporter - or serotonin reuptake pump - is the target of SSRI antidepressants. Based on this knowledge, researchers knew there had to be a genetic smoking gun somewhere, but they were stumped. The problem was they were looking for a "depression gene" or a "bipolar gene." Genes, unfortunately, don't conform to the way we classify psychiatric disorders.

In 1998, for instance, a German team came to the conclusion that "no association between alleles conveying functional differences in serotonin transport gene expression and major depressive disorder or bipolar disorder could be found."

Basically, genes act as "on-off" switches. But they don't switch on "depression" or "bipolar" or anything else. Instead, they activate proteins that regulate how cells function and and organize themselves into interacting with other cells. This in turn may influence whether a certain individual is predisposed to depression or bipolar, but you're not going to find that out by looking for a direct link.

It's simple mechanics really. First link the gene to the cellular function it influences. Dr Weinberger and his team already knew that a certain region of the genome, SLC6A4 with the chromosomal address of 17q21, is responsible for the cellular activity that involves vacuuming excess serotonin from the synapse between the neurons.

But then what? What was the connection to behavior? On one hand, Dr Weinberger and his colleagues needed to build on the work of Dr Carlsson's generation; on the other, they needed to throw away all their preconceptions.

As the study subjects' brains were being scanned, they were made to perform a simple cognitive task involving looking at images of "scary" faces. If you have any doubts about what a two-dimensional image can do to the brain, simply turn on Fox News without the sound. Seriously, just the sight of those idiots - don't get me started.

It turned out that the "short allele" people - that is, those with a certain variation to the gene in question - in reaction to the scary faces, a certain portion of their brains lit up like a Christmas tree. You guessed it, we're talking about the amygdala, which features mightily in my adventures with raccoons and skunks.

As we know, the amygdala mediates fear and arousal, and is directly and indirectly wired into all areas of the brain. Think of the amygdala as a simple smoke alarm. It can detect smoke, but it's too dumb to know whether the smoke is related to grilled meat or a five-alarm fire. The thinking areas of the brain will eventually provide you with the info you need to make a rational decision, but all that takes too way long to boot up.

In the meantime, it's prudent to sound the alarm, even if it is a false alarm. But what if the alarm is over-sensitive or won't shut off? It's one thing for your fight or flight response to kick in at the sight of a predator (or Dick Cheney with a face lift) at the door, but what if you keep having the same reaction to, say, the UPS guy?

When the amygdala goes off, we are reacting rather than thinking. We are operating out of fear. As Dr Weinberger explained to his audience, "this could be the first study to link genes to emotions."

What does this mean? Let's turn to a closely related study:

About 35 years ago, researchers from the University of Otago recruited a "birth cohort" of more than 1,000 infants born in Dunedin, New Zealand, and subsequently assessed them every two or so years. Had my daughter (who was born in Dunedin) arrived five years earlier, she might have been part of that cohort. Then again, had she been born five years earlier, I wouldn't have been the father.

"Longitudinal" studies of this sort represent the gold standard of population research, as opposed to "retrospective" findings based on recalled events. Over the years, this cohort has been to medical and psychiatric and behavioral research what wild Tanzanian chimps have been to Jane Goodall.

On July 18, 2003, the journal Science published the latest installment coming out of Dunedin. The year before, the same research team had identified certain childhood risk factors in antisocial behavior, together with a strong link to a suspect gene (acting on the enzyme MAO-A). This time, the researchers (Avshalom Caspi, lead author) analyzed the cohort for stressful events over the past five years, such as death in the family, losing a job, or breakup with a partner and this time their attention was directed at the very same gene that featured in Dr Weinberger's study.

Lo and behold, of those meeting the criteria for at least four recent stressful events, 43 percent of the short allele people experienced depression vs just 17 percent with the long allele.

In a field where researchers are accustomed to teasing out frustratingly small statistical blips, these numbers represent something truly seismic.

It is important to note that the researchers did not identify this variation as a "depression gene." Rather, drawing the short genetic straw makes one susceptible to stress and its downstream effects (which may include depression). One also needs to have regard for the fact that not all depressions are caused by stress.

Think of the short allele as a "vulnerability gene." Those with the long allele, by contrast, may be regarded as the proud owners of a "resilience gene."

To further clarify the resilience factor, the depression rates for those with the long allele did not vary, regardless of whether they had experienced zero recent stressful events or four or more. Those with the short allele, by contrast, only experienced this same low depression rate as the long allele people when not exposed to any major stress, period.

As Dr Weinberger described it at a subsequent APA, this particular gene "impacts on how threatening the environment feels." Or, as his colleague Andreas Meyer-Lindenberg put it at yet another conference I attended, the short allele "impairs your ability to respond to what life throws at you."

Noted the Dec 19, 2003 Science: "Together, these studies suggest that the gene variant biases people to perceive the world as highly menacing, which amplifies life stresses to the point of inducing depression."

Science was reporting on what it considered the top ten scientific breakthroughs of the year. This pair of findings (plus several others) ranked number two. The origin of the universe came in first, and we’re not about to argue with that.

So it's not nature vs nurture. It's more like nature via nurture. But it's even more dynamic than that. The brain isn't simply influencing how we perceive and respond to our environment; our environment, in turn, is literally building our brain. We're not stuck with the same brain cells we were born with. Your brain is literally changing right now, as you are reading this. You might not be able to trade in your hair-trigger amygdala for one a bit less sensitive, but you can literally set to work building your own neuronal work-arounds.

The upshot of all this is that literally every idea about how we think and feel and behave is now in play. Dogma may be dead, but wisdom and insight are thriving. If you're big on biological psychiatry, the brain studies are coming in thick and fast. Likewise, based on precisely these same studies, you can make a case for bringing back Freud. Similarly, if you're bullish on the precepts of the ancients, you can brandish the exact same evidence.

The same applies to centuries-old philosophical foodfights involving the distinction (if any) between the mind and the brain.

Eventually, new findings will resolve a lot of these debates, but in turn the facts are bound to raise a lot more questions than they answer. In the meantime, that strange interlude we call life is demanding we make choices right now.

Wednesday, August 26, 2009

Cool Stuff I Love Talking (and Writing) About


If you're a serious researcher wanting to know more about your field, you don't waste your time attending the Annual Meeting of the American Psychiatric Association. The week-long meeting is largely regarded as a junket where clinicians can pick up the CME credits they need to remain in good professional standing.

But if you know what you're looking for, you can learn a hell of a lot. In eight years of APAs, I've had the honor of listening to three Nobel Laureates, plus numerous others who deserve a free trip to Stockholm. I particularly enjoy hearing the brain scientists, who are kind enough to dumb down their presentations for the psychiatrists, which means people like me can kind of follow along.

Here's how it works: When Daniel Weinberger of the NIMH is at the APA and happens to mention the COMT Val 108/158 Met variation, he pauses to explain what that means. Not only that, he has cool PowerPoint slides that even psychiatrists and Geico cavemen can follow. When the same Dr Weinberger is at, say a schizophrenia research conference, addressing an audience that includes 2000 Nobel Laureate Arvid Carlsson (pictured here), he doesn't even bother to let on what the COMT Val-Met variation is all about. He just assumes everyone knows. And forget about a cool PowerPoint.

Research conferences don't intimidate me. Remember, raccoons respect my piss. In San Diego in 2009, at the International Conference on Schizophrenia Research, I approached a table where very smart people were drinking their morning coffee, and introduced myself as the only C student at the table. The line worked so well I used it the rest of the day. It didn't take me long to get into the spirit of this particular conference, and soon I was referring to my coffee as my "neuro-cognitive starter."

Naturally, I knew exactly what to say to the likes of Dr Carlsson. Being a journalist, I assumed a totally professional demeanor and introduced myself as someone about to become a grandfather who would like to thank his son-in-law for his participation in the effort - who happens to be a neurosurgeon in training - if he (Dr Carlsson, that is) would be so kind as to provide an autograph.

Dr Carlsson, to his credit, smiled indulgently, and graciously signed the back of my program. His co-Laureate, Eric Kandel, did the same for me a few years earlier at the APA in Atlanta when I told him about my nephew who is as smart as Einstein. "I really admire your work," I burbled to Dr Carlsson, as my parting remark. I'm sure that was the high point of his life, coming from a C student.

A little background: Dr Carlsson literally discovered that dopamine is a neurotransmitter. Finding a new neurotransmitter was to brain science what the discovery of Uranus was to astronomy, only far more significant. At least, back in William Herschel's day, we knew what a planet was and what it did. By contrast, as late as the early 1960s, we had only the vaguest idea how brain cells - neurons - communicated.

Back in those days, scientists were divided into two hostile camps that literally didn't talk to each other - those who believed cells instant-messaged each other electrically and those who thought that chemicals were the prime agents. So for Dr Carlsson to even arrive at the concept of neurotransmitter and dopamine, first he and his contemporaries had to figure out the Newtonian physics of that mysterious inner universe we call the brain.

We now take it for granted that a neurotransmitter is a packet of chemicals that is delivered from one nerve cell across a gap (or synapse) to another nerve cell. The neurotransmitter glutamate, for instance, literally instructs neurons to get excited. It's all about chemicals outside the brain cell setting off chemical reactions inside the brain cell (after first being assembled inside a different brain cell). Technically electricity is also involved, but we don't need to go there.

Had Dr Carlsson stopped right there, he certainly would have earned his plane ticket to Stockholm. (Wait, Dr Carlsson is Swedish - he probably only had to drive across town to collect his prize, assuming he could find a place to park.) But no, Dr Carlsson connected dopamine deficiency in the brain to Parkinson's, which led to L-dopa and other agents for its treatment, thereby significantly improving the lives of countless millions.

That isn't the end of the story. Dr Carlsson's discovery literally opened up the field of biological psychiatry, which posits that - hello! - the brain is not undifferentiated tofu. You can argue till the cows come about whether the mind and brain are the same or two entirely different entities, but when all is said and done, how we react to the environment around us and how we anticipate our future is mediated through the elegantly intricate processes of the meat housed inside our skulls.

We think with our meat. Newtonian meat, quantum meat, highly specialized units of meat, 100 billion cells - as many as the stars in the Milky Way - arranged in infinite connections switched on by some 16,500 genes out of a total of about 25,000 in the human genome.

So when I told Dr Carlsson I admired his work, I really meant it. Not only that, I was in awe of it. I would have felt the same way had I a chance to shake Einstein's hand. So - seriously - I didn't mind at all that I looked like a fool. Every day, when my very smart son-in-law is conferring with neurologists and prepping for surgery with a precious life hanging in the balance, he is literally performing his work in the very considerable shadow of Dr Carlsson. And now he has Dr Carlsson's autograph hanging from his wall.

To be continued ...

Tuesday, August 25, 2009

Guest Blog - Cellphones and Unintended Circumstances


Another gem from Elizabeth:

The word keeps coming out that cellphones are dangerous to use while driving, even if you are wearing that Bluetooth thing on your ear that make you look like a cyborg. People ask, why should that be any different than talking to someone in your car?

I suggest that electronic communication system devices make you not really there even though you’re there.

Ever been on an elevator with someone having an intense conversation on the cellphone? I have, many times, and the frequency is increasing. Shoulder to shoulder with people on an evelator and there’s someone with us hissing loudly on her cellphone that “you did too sleep with that bitch.” Or some guy yelling “don’t even tell me you care about me.” These people seem totally clueless to the fact that they are in a very small space among many strangers who are hearing their most personal business. This is really changing elevator etiquette.

I can’t help noticing how much technology is altering how we communicate, and how much—or rather little—we notice or care about the people in our immediate environment as a consequence.

I teach at a couple of college campuses. Campuses were once places where you met new people, and your education extended far beyond the classroom to talking about the material you’ve been exposed to with students you’ve met in those classrooms. Cellphones are really changing all that.

Why extend yourself to new people in your immediate environment when you can just call up the people you’re already comfortable with on your always-available cellphone?

I always smile and nod a hello to anybody who passes by me. But more and more, people just don’t seem to be present: they’re on their cellphones.

When the cellphone phenomenon first started to bloom, I’d think the person talking next me was talking to me. When that person failed to respond, I’d think, maybe this person needs a new med. But no. This person is on her cellphone. I really don’t exist for her.

A whole new layer of alienation, brought to us by a device that greatly extends our ability to connect.

Talk about your unintended consequences!

Sunday, August 23, 2009

Tooting From Greater LA - IIl


This is my housemate, Paul Cumming, with his Advocate of the Year Award, presented at a luncheon at the NAMI CA conference held yesterday in Torrance.

Paul has been a tireless advocate for years, working quietly behind the scenes, a champion of people with fresh ideas, a defender of those with no voice, and an unrelenting thorn in the side of those who wish we would all go away.

Significantly, three of the featured speakers at the conference - Tom Wootton (author of The Bipolar Advantage), Kathi Stringer (quality improvement innovator), and Gene Johnson (founder of Recovery Innovations) - owe a lot to Paul.

Paul is the frequent flyer point man for Network of Care, an innovative mental health web resource that is helping millions improve their lives.

Saturday, August 22, 2009

Tooting From Greater LA - II

video

I'm at the NAMI CA conference in Torrance. Above is a seven-second video I shot last night on my iPhone.

That's Nathaniel Ayers you're looking at and listening to. Nathaniel Ayers is "The Soloist," whose life is recounted in Steve Lopez's book of the same name and in a movie of starring Jamie Foxx and Robert Downey Jr.

Mr Ayers was a cellist attending Julliard when he experienced a major psychotic break. He wound up in LA's notorious Skid Row where he lived homeless for more than two decades. Mr Lopez, a columnist for the LA Times, discovered him on the streets playing a violin with two strings. What began as a reporter-subject relationship developed into a bond far greater. Steve was able to convince Nathaniel to move into public housing, but had some lessons of his own on how delusional thinking doesn't just apply to those with mental illness. In the end, Steve had to learn to accept Nathaniel for who he was rather than what he would like to turn him into.

Anyway, here we were, sitting down to dinner, when Nathaniel, with no introduction, got up on stage and started playing. Adlibbing. Very much Bach-inspired, but very free form with no breaks for a good 30 minutes.


After dinner, we were told we were going to view an incompleted and shortened documentary, "The Chorus," about life on LA's Skid Row. I braced myself to be bored out of my mind for the next hour, only to encounter the most incredible experience ever from nine years of attending mental health conferences.

The documentary followed six or seven Skid Row residents for several months. Gradually, we got to know these individuals and identify with them. We laughed, we cried, we got outraged, filled with hope, were swept off our feet and hit in the gut.

Then the lights came on and the people responsible for the video and some of the cast, along with Nathaniel Ayers, got up on stage. The image here is from my iPhone. I hope I get the name right here. This is Linda, who was also an extra in "The Soloist" and one of the star attractions in "The Chorus." She is belting out - and I mean really belting out - a Gospel tune.

The documentary is simply too good not to find a distributor. When it comes out, trust me, "The Chorus" is a must-see. As I said, the documentary and the live cast and crew experience, together with Nathaniel Ayers, constituted my most incredible experience in nine years of attending mental health conferences.

Friday, August 21, 2009

Tooting From Greater LA

I’m in Torrance, CA - part of greater LA - for a state NAMI convention. A brief recap:

Yesterday, Thursday, 1:30 PM: I arrive at the hotel after three hours of freeways and head straight to a pre-conference leadership training session where advocate Kathi Stringer is rocking the house on a topic called quality improvement (QI). Kathi comes from the aerospace industry, which is big on not having airplanes fall out of the sky. The mental health industry, by contrast, has much lower standards, or no standards.

Basically, if we were to hold our treaters and providers accountable to their own rules - ones already written into law and into contracts - we could change mental health advocacy entirely and actually get things done.

I met Kathi a year ago via my good friend Paul, who is also at the conference. I join up with Kathi and Paul and others in the afternoon. It’s 10:30 PM by the time I feel I better excuse myself for the evening, but it’s midnight when I finally retire.

This morning, 8:15: I run into Bettie Reinhardt at the Starbucks in the hotel lobby. Bettie is the executive director of NAMI San Diego, which is the gold standard for local NAMIs throughout the US. All the credit goes to Bettie. She will be stepping down in January, after 17 years of service. Several months ago, thanks to Bettie, I joined the board of NAMI San Diego.

Bettie and I make sure we’re at least a half an hour late for the opening session, which makes us just in time for the keynoter, Tom Wootton. Tom is the author of The Bipolar Advantage and the Depression Advantage. Back in 2006, I actually spent a week in Chicago with him as he made presentations. Tom is a paradigm-shifting thinker and a brilliant presenter, though his ideas can run ahead of his audience, which he acknowledges.

His main thesis is that the term “disorder” is accurate only in the sense that we lack the skills to manage our “condition” (not illness). Tom’s counter to “Bipolar Disorder” is “Bipolar in Order.”

A PowerPoint of a Ferrari goes up on the screen. A Ferrari has a stable platform so you can go around corners, he explains. But if you try to follow it in a mini-van with stuff loaded on top, you will flip over. Both vehicles are stable in the garage, he goes on to say. But I don’t want to be stable in a garage, he concludes. I want to be stable while I’m driving.

If we better learn how to manage our behaviors, he says, so we are not simply reacting, we can lead great lives within a wide range of emotions.

This is a far different message than what our doctors and therapists tell us, and certainly what NAMI audiences are used to hearing. Tom gets a positive reception. But he also says things such as, “depression can be a beautiful experience,” and I see some faces visibly recoiling.
After the talk, I say a quick hello to Tom’s wife, Ellen, who has been instrumental to her husband’s success. Later, another quick hello to Tom. I’ll catch up with both later in the conference.

More later ...

Thursday, August 20, 2009

Onion News: Obama Has Bipolar




Citing "extreme self-confidence" and "euphoric, inexplicable sense of hope," Onion News reports that Obama has just ended a three year manic period that included his first six months in office. Now, according to The Onion, Obama is sleeping on a couch in the Oval Office, watching reruns of NYPD Blue.

Wednesday, August 19, 2009

Guest Blog - Empathy or Rage: Your Choice


It is my pleasure to introduce Elizabeth as a contributor to "Knowledge is Necessity." This is the first in what promises to be a lot more. So, without further ado:

I’ve been thinking about the value of empathy a lot lately. We with mental illness hope that our loved ones will understand our lot. We know all too well that our symptoms show most glaringly through our words and actions, as much as we try to keep this from happening. We do our best, and wish for understanding and forgiveness when we do or say something stupid. But perhaps while we hope for that, we could meanwhile concentrate on developing our own empathy. This just might make the world better—for ourselves and those around us.

Every once in a while I read something that makes a big click in my brain. This happened when I first read James Baldwin’s “Notes of a Native Son” many years ago, and it happens every time I read it, or indeed any of Baldwin’s work. He was one of the great American thinkers concerning race relations, or any relations, writing in the 20th century, and in this essay he talks about his first voyage out into the world beyond Harlem. He was young, with a job in New Jersey that gave him his first real taste of a racist world. It was 1943.

The main problem for Baldwin (pictured here) was that he couldn’t get served in any restaurants around him. “We don’t serve blacks,” was the constant response, yet he kept on going into these restaurants because he was a pugnacious, indignant young man, and rather than bending to the insane racist rules around him, he answered to an overwhelming need to stand up to it.

He was the one black man around him that stood up. As a result, gangs of children took to following him as he walked down the street, taunting him. He was reaching an insanity brought on by outrage.

One evening he and a white friend decided to step into a restaurant for dinner. The usual thing happened: the waitress said, with apology in her face, that “we don’t serve blacks.” It was the last straw: Baldwin really lost it, and threw a half-empty water pitcher at her, thankfully missing. He managed to run—fast!—while his friend stayed at the restaurant long enough to misdirect the police.

Later that night in his room, in shock, Baldwin reflected on the incident:

I could not get over two facts, both equally difficult for the imagination to grasp, and one was that I could have been murdered. But the other was that I had been ready to commit murder. I saw nothing very clearly but I did see this: that my life, my real life, was in danger, and not from anything other people might do but from the hatred I carried in my own heart.

What I think Baldwin means by “real life” is the life of the soul. We who have experienced searing mental pain have found ourselves on the edge of such epiphanies all too often, if only in our own little worlds. Mental illness compels us to experience moments when the clash of the insanity we feel within and see without comes to a head.

Is there any value to searing mental pain? Baldwin used his little restaurant breakdown to examine his heart, to examine the hatred within and without, and became one of the most remarkable people on the planet. He could well have lived his life in rage, and we would have lost a great voice. Coming from a white, racist world, I would not have been able to understand the racial strife around me, or root out the racist assumptions I grew up with. He has helped me to see a little more clearly.

In speaking of the racist white people all around him, he called them “innocent,” a choice of word that totally jarred me. Doesn’t he mean “ignorant”? But no, he chose that word carefully. A word akin to blameless, “free of guilt due to lack of knowledge of evil,” according to my handy-dandy on-line dictionary. Ignorant, on the other hand, just means lack of knowledge or education. Evil was what Baldwin was grappling with, both within and without.

We can’t cure race hatred through mere information any more than we can cure the damage of severe mental pain through mere information. What’s common to life-induced breakdowns like Baldwin’s and mental breakdowns brought on largely, or partially, by mental illness, is an insane clash, which we can respond to in one way or another. We can become angry and hateful and bitter and afraid, or use the experience to evolve ourselves as human beings. There needs to be a turning of the heart. All too often, these turnings are life-threatening experiences, not necessarily concerning the life of the body but the life of the soul.

When faced with the pain of injustice or a neurological crash, we can choose the automatic response of frustration and try to smash it all, or step back and decide to choose the path of empathy and try to refine our own damaged souls.

And when we mentally ill try to figure out how to deal with our own breakdowns, maybe it would be worthwhile to do what Baldwin did: consider it a gateway into more understanding of yourself, and more empathy for others.

Tuesday, August 18, 2009

Why Are You Asking Me?


October and November tend to be weird months for me. Early October, 2006 saw the publication of my book: "Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn't Tell You That You Need to Know."

The book represented a major personal triumph for me, but life is seldom that simple. It's amazing, in hindsight, how I didn't see it coming, but we never do. One day I was winding down from a round of book-related speaking engagements and radio interviews, making a mental note to pick up a Thanksgiving turkey, the next I was dazed and disoriented in a Red Roof Inn, suddenly single.

I had been married (for the second time) for nearly three years, living in central New Jersey. On December 1, ten days after my break-up, I boarded a one-way flight to San Diego, wanting to sleep and never wake up.

"Living Well with Depression and Bipolar Disorder" was the result of six years of writing on my illness. In January 1999, after a crushing round of severe depressions and a lifetime of denial, I was diagnosed with bipolar. I had been a financial journalist, and now I turned to writing about my illness, first for a website, then my own email newsletter, then my own website.

I was not afraid to write about my personal experiences, but first and foremost I considered myself a reporter. I went to the same conferences psychiatrists and researchers went to. I read their journals. I listened, I asked questions. I also listened to another group of experts, patients and loved ones.

I may have connected the dots in a way that no one else had before, but the book wasn't about me. I was simply passing on wisdom and insights I had learned from others and I had at least 300 footnotes to prove it.

But, in public, the audiences I spoke to had entirely different perceptions and expectations, which I failed to register for the longest time. For instance ...

NAMI's membership in large part comprises the parents of individuals with severe mental illness (mainly schizophrenia). These parents have struggled with a health care system that seems specially designed to fail their sons and daughters. Most have been told their kids will never get well. Then, they see me - me with a diagnosis - speaking to them on a very complex topic without notes.

For instance ...

DBSA is run by patients living with depression and bipolar. I'm one of these individuals. We all learn from one another, which can only work if we all accept each other as equals. Thus, an individual on disability brings the same insight and wisdom to the table as someone who has just been awarded a McArthur Genius Grant. But DBSA groups do bring in expert speakers, and suddenly I was one of them.

One day in the spring of 2007, at a DBSA group in Washington DC, someone happened to ask me this: "What do you do for your own recovery?"

Why on earth do you want to know? I could only think. I'm the same as the rest of you.

Ask me about the fine points of brain science, I wanted to respond. Grill me on the ins and outs of diagnosis and treatment. Diet, exercise, sleep - no problem. I had the expert answers at my finger tips and I didn't even need a life line.

Hannibal crossed the Alps with elephants, Abyssinia is what they used to call Ethiopia, and when Emil Kraepelin coined the term manic depression back in the early twentieth century he was talking about unipolar depression as well as what we now refer to as bipolar disorder.

I was stumped. It made no sense to me that someone else would view me as some kind of example of recovery. I blurted out something incoherent, and waited to be rescued by someone wanting to hear me expound on neuroplasticity or spell opthamologist or something.

I was still living in denial when I gave two presentations at a national DBSA conference that summer in Orlando. One of the organizers, without consulting me, had put on the program that I would be talking about recovery. Ha!

No way I was going to lecture people in how to run their lives. Ruin their lives, perhaps - I was an expert at that. But run? You gotta be kidding.

Recovery starts with knowledge, is how I began. Here's some cool stuff I learned, was the gist of what followed. The rest is up to you. Oh yeh, and I broke up one of the talks with a didgeridoo interlude. (You can check out why didgeridoos make perfect sense to me here.)

That's not the way you work yourself up from break-out speaker to keynoter, I learned. Or, for that matter, ever get invited back to speak again, not with two audiences primed to hear about recovery.

Apparently, there was this thing called a recovery movement. Recovery is for YOU to figure out, I wanted to scream. It has nothing to do with me.

But a funny thing was happening. I was changing. The person talking about my book in the summer of 2007 was not the same person who wrote it in late 2004-early 2005. Recovery is a journey, they say. Mine began one crazy October morning nearly 60 years ago when I literally forced my way out of a birth canal that my mom, on doctor's orders, had been blocking by holding her legs together.

Then life intervened.

Much later, on a weird November evening in New Jersey, a certain stage of my journey came to a precipitous and definitive end. A new stage was opening up. A leap of faith, one-way to San Diego ...

More to come ...

Monday, August 17, 2009

A Cosmic Bargain


The following piece is a blast from my past, something I wrote about eight or nine years ago. One version appears on my website, mcmanweb.com, and another in my book, "Living Well With Depression and Bipolar Disorder." Here's the latest, with a minor edit or two:

Many spiritual beliefs teach us we pick the lives we're born into, and many times I have played the scene in my head, of me more than a half century ago ready to disembark the godly planes as I negotiate with my cosmic broker the terms for my upcoming earthly existence. I have been singled out, he informs me. I can have all the worldly success of a trust fund baby, he lets me know. The catch is I will BE a trust fund baby. The other path, he tells me, leads to a deeper humanity and spirituality through a trail of a thousand sorrows.

I am clearly being honored. Precious few souls, I realize, are presented with such spectacular options. Nevertheless, I find myself trying to strike a better deal.

Can't I have the spirituality and humanity, I ask, with the trust fund baby success, without the sorrows? And the cosmic broker only laughs. He sees my hesitation, then presents me with another choice - of a successful but modest professional life, a family, security, perhaps a light karmic obligation or two. He catches the wistful look in my eyes, of a simple dream denied by someone who has already made up his mind. He reaches over and hands me the thousand sorrows documents, which I sign without reading.

God, I hate you! I hear myself crying out many years later. But God doesn't hold this against me. God knows the deal, even if you and I can only imagine it.

(Thanks to Elizabeth for reminding me of this piece.)

Sunday, August 16, 2009

Trapped!


Things close in. I need to get out. Mental illness is simple, really. We get overwhelmed, overloaded. Too much of one thing, too much of everything. Too much thought, too much emotion, too much sensory input. Too much of nothing, even. Think of a fire in your brain or of being trapped deep underground, unable to breathe. There is no way the brain can respond rationally.

The brain copes, instead, by flipping out or shutting down.

Nearly 20 years ago, in a hot tub, I relived one of these experiences with a New Age practitioner. I felt myself in some dark cavern of hell, struggling, desperate to get out. Oddly, I found myself humming a tune from Offenbach's "Orpheus in the Underworld." Thankfully, my practitioner stayed with me and helped me effect my escape. Light, fresh air, deliverance. I flopped onto the deck of the tub, spent, exhausted.

Slowly, I collected my wits and speculated out loud that this is what it must have been like when I was born. Not that my mom was about to corroborate my account, of course. Funny thing, though, next time I saw her, with no prompting, she started talking about my birth.

It was a very quick delivery, she informed me. I was out instantly, practically born in the elevator. This did not square with my hot tub experience. Then, as an afterthought, my mom happened to say: "The doctor told me to hold my legs together."

Holy crap!

Let me attempt a reconstruction, from the baby's point of view: Here I was, venturing out from the security of the womb, in some biological equivalent of an extremely confining crawl space. There was no going back, but I could take some comfort in my forward progress. Things were closing in, it was a scary situation, but I was ready. I made my big push, and ...

I couldn't get out!

Talk about a fetus with attitude, I literally forced my way to the surface, where I entered the world kicking and screaming in unsanitary conditions. Instantly, I was whisked away into an isolated ward, where my mother jokes I bonded with a nun. I have no reason to doubt her.

Please don't tell anyone about this ...

Friday, August 14, 2009

Les Paul: Guitar Hero














"When you're my age, you know that the end is in sight. How do you handle it? You live for the moment. The past is gone and the future isn't here yet. And you ain't gonna change it, no matter what you think. And so the most obvious thing to do is right now." - Les Paul, last year, at age 93.

Les Paul's remarkable career began at age 13, in 1928, playing guitar in a traveling cowboy band. In 1941, using parts from a telephone and radio mounted on a piece of wood, he devised the first solid body electric guitar. In 1952, Gibson went into production with its celebrated Les Paul model. The world would never be the same.

From a background instrument that could barely be heard, the guitar became a lead instrument, capable of an immense array of sounds that transformed virtually every genre of music and set the scene for rock 'n roll.

Les Paul also single-handedly invented multitrack recording, once again changing how we hear music. He performed with the likes of Nat King Cole and Bing Crosby, and during the 1950s recorded his own string of hits as a soloist and with his wife, vocalist Mary Ford.

In celebration of his 90th birthday, in 2005 he recorded an album featuring guest appearances by Eric Clapton and other luminaries. The album earned him two Grammy awards to add to an earlier performing Grammy from 1976 as well as technical Grammys.

In 1983, he began doing weekly gigs in a small New York club, Fat Tuesday's. In 1995, he changed venues to the Iridium, another small venue, where he continued to perform until June this year. Les Paul died yesterday. He was 94.

On today's NY Times is an extraordinary 15-minute video interview from last year, at age 93, recorded before and during a recent Iridium gig. The image above is a screenshot from the video.

Thursday, August 13, 2009

My Favorite Mental Health Blogs


If your main interest is staying ignorant and resentful and unwell forever, there are plenty of bloggers out there eager to help you stay the way you are. If you are actually interested in gaining insight into what makes you tick and in figuring out what treatments and recovery techniques work best for you, the list is much shorter.

Following are my blogging heroes, highly-intelligent and principled individuals whose mission is to enlighten and inform:

Beyond Blue. No one does it better than Therese Borchard. Her combination of wit and intelligence and practical advice, with a deeply personal dimension, is without equal. I recently had the privilege of reading an advance copy of her book of the same name, and this is part of the endorsement I sent to her publisher:

"Let me count the contradictions: perfectionist-screw-up, brilliant-confused, depressed-hilarious ... Therese is a saint in pursuit of a masterpiece, and BEYOND BLUE is Exhibit A. This is The Book of Job as Art Buchwald might have written it, had he been as talented as Therese. Wise, compassionate, and funny beyond measure, Therese ultimately offers up healing."

About.com - Bipolar. Kimberly Read and Marcia Purse are the equivalent of those NFL quarterbacks who neither rack up statistics nor personal glory - all they do is win football games. Kimberly and Marcia were blogging way back before the neologism, blog, was coined. Unlike virtually every blogger out there, this veteran tag team neither draws attention to themselves nor dazzles readers with seductive prose - and that is their strength.

Instead, for more than a decade, in their own quietly reliable fashion, Kimberly and Marcia have served up reports of new research, new insights, and new developments - information that facilitates us in making intelligent choices without the distortions of overweening egos.

Postpartum Progress. It is highly unusual to cite a blog as the best resource for any given subject. For instance, there may be some great cancer bloggers out there, but to find out what you need to know about cancer you would probably go the American Cancer Society website. Not so for postpartum mental illness. The place to go is Katherine Stone's Postpartum Progress.

Katherine achieves the rare trifecta in passionate advocacy, personal experience, and state-of-the-art information, with each component in service to the others and thus creating a sum much greater than its parts. If you are a woman, or know someone who is, this blog is essential reading.

ADHD Roller Coaster. Gina Pera puts a song in my heart every time she butts heads with antipsychiatry nutjobs and the idiots who legitimize them. Sample this attack on Bill Maher and a panel of dunces:

"They’re entitled to their own opinions, as they say, but not to their own facts. And when their deluded opinions target my friends with ADHD — on the airwaves, in print, or on the Internet — it leaves me at once angry and heartsick at their cold-hearted, mingy-minded meanness, never mind ignorance. ..."

Gina's focus is ADHD, and her blog is by far the best on the topic, but it is as a passionate advocate of reason that she truly shines. The opposite of antipsychiatry is not pro-psychiatry. It is pro-consumer, pro-patient, pro-family member. Pro-wisdom, pro-empathy, pro-science, pro-intelligence. No question about it - Gina is our leading spokesperson.

The Happiness Project. We're all experts in misery. But if we want to get unstuck and get to well, we need to acquaint ourselves with the concept of happy. Gretchen Rubin is a highly-regarded author who, in pursuit of a book, has spent a year "test-driving every principle, tip, theory, and scientific study I could find, whether from Aristotle or St. Therese or Martin Seligman or Oprah."

From her latest offering: "The biggest challenge of a happiness project isn’t figuring out what resolutions I should make, but actually sticking to my resolutions. Somewhat to my surprise, I've found that I have quite a lot of trouble keeping my resolutions related to play ... "

Holy cow! I can really relate to that. My guess is all the rest of you are thinking the same thing.

Prozac Monologues. So far, I have singled out established authors, all of them very well-known in their respective fields. Willa Goodfellow's Prozac Monologues, which got started up in April, is my tribute to a new kid on the block. Don't be put off by her latest offering, which is highly complimentary of my work - that was how we met. Then I read her other pieces, and was floored by the homework she turned in.

Let's put it this way: Until I encountered Prozac Monologues, I thought I was the only one who had ever mentioned, anterior cingulate, in a blog. It can be very lonely blogging on topics ignored by everyone else, and suddenly I'm not alone. (The anterior cingulate modulates emotions in the brain.)

Promising bloggers have an unfortunate tendency to burn out, so I urge all of you to drop a comment on her blog site offering encouragement. To Willa: It's very easy for bloggers to get discouraged, particularly when dealing with depression. But clearly we need you. Stick with it ...

***

No doubt, I am leaving out dozens of worthy bloggers. If you have a favorite, please put your recommendation in the form of a comment below. Trust me, I will follow up.

Wednesday, August 12, 2009

Duck Soup



A comment from Elizabeth inspired me to upload this classic Marx Brothers mirror scene from "Duck Soup." Earlier in the movie, Chico famously challenges Groucho: "Who are you gonna believe ... me or your own eyes?" Life is like that. Enjoy ...

Tuesday, August 11, 2009

Crazy Economics: What Do Me and Alan Greenspan Have in Common?

















Let’s review the evidence:

In late October last year, former Fed Chairman Alan Greenspan told Congress that “those of us who have looked to the self-interest of lending institutions to protect shareholders’ equity, myself included, are in a state of shocked disbelief.”

Last week, I entered an ATT&T store with the sole purpose of updating my plain vanilla account. I left with an iPhone. I am in a state of shocked disbelief.

Classical economics holds that, when it comes to money, individuals and markets make rational decisions. Ha!

Okay, what is going on? An article by Gary Stix in the July Scientific American offers some insight. In the wake of the worst financial meltdown since the Great Depression, classical economic dogma is being exposed to serious scrutiny. In the meantime, behavioral economics is getting a second look.

Classical theory makes sense when markets are in a state of relative equilibrium. Like the brain or the environment, the economy is a nonlinear self-regulating system with its own internal logic. Even when things go wrong, the invisible hand of the market place has an uncanny way of setting things right.

Indeed, classical economics would work perfectly if only people weren’t involved. Unfortunately, classical economics can’t account for stupid human tricks. And sometimes when things go wrong, markets fail to self-correct.

Enter behavioral economics. According to Scientific American:

“Emotion-driven decision making complements cognitive biases - money illusion’s failure to account for inflation, for instance - that lead to poor investment logic.”

In one experiment, subjects made financial deals as their brains were being scanned. When presented with a result that only looked like a gain if you didn't think things all the way through, the ventromedial prefrontal cortex (VMPFC) lit up. The VMPFC is wired into risk and reward, as are the more primitive nucleus acumbens and amygdala, which mediate greed and fear, respectively.

In other words, high emotion and faulty cognition have always been a recipe for disaster, whether in choosing a mate or making an investment. Some of the cognitive biases we are prone to include overconfidence (we all think we’re better than average), herding (tendency to follow crowds), and availability (giving undue weight to recent events).

Scientific American quotes Andrew Lo of MIT: “Economists suffer from a deep psychological disorder that I call ‘physics envy.’ We wish that 99 percent of economic behavior could be captured by three simple laws of nature. In fact, economists have 99 laws laws that capture 3 percent of behavior.”

And there we have it.

What was going on in Alan Greenspan’s mind when he thought that markets could self-regulate forever? What was going on in my mind when I bought an iPhone?

Monday, August 10, 2009

In the Final Analysis ...


It was a hot Saturday out in the high desert at the resort where I venture out to play water volleyball. We were chilling out between games beneath a canopy, enjoying a communal luncheon spread. (My pasta salad featuring my home-grown cherry tomatoes was a big hit.)

Suddenly “Bill” piped up: “Government can’t even deliver the mail. I hate to think what they’ll do to health care.”

I don’t know about you, but the government does a great job delivering my mail. Too much of it, in fact, way too much. Bills, junk mail, jury summonses. Why can’t they lose some of it?

Bill takes pride in being a former Marine - a government employee in a government service, in other words. Does he see the contradiction?

My volleyball associates have been very gracious and welcoming to me, and I very much enjoy their company, so I tend to let their random Limbaughisms go uncontested. What is weird is that many of them have taken a far bigger financial hit this past year than I have, yet they remain true blue.

Last week, while in LA, I raised this issue with a good friend of mine. “These individuals are acting against their own rational self-interest,” I told her, or words to that effect. It made no sense.

Back in a previous life I was a financial journalist, so this behavior comes as no surprise to me. Classical economics assumes that people and markets behave rationally with regard to money, but every day on the job I witnessed the world blithely contradict this notion.

Time to ‘fess up: Last week, I popped into an AT&T store to update my cell phone account. Here is my non-negotiable stand on cell phones: I use cell phones to make and receive calls on the road. At home, I use my cell phone as a paper weight. I am not interested in using a phone as a camera or a music player or as a personal planner or storing photos or text messaging or video games or cool ringtones ...

A phone is a phone. I have boundaries, and I will never change. I’m adamant about that.

“Why don’t you show me the iPhone?” I said to the sales clerk. It just popped out of me.

Then: “Never mind. Just sign me up for the thing.”

I swear, this is a true account.

I got my iPhone home and downloaded every conceivable app under the sun: Music, photos, games, GPS tracker, restaurant guide, a bubble level, even something called iFart. Then I broke into my iTunes collection and made a great ringtone out of the opening to Louis Armstrong’s “West End Blues.”

Right now, I’m composing this piece on a laptop while listening to Alison Krause via a “smart” radio station iPhone app.

Moral: Anyone who believes we are rational beings governed by rational decisions is sorely delusional. Likewise, any social or political or economic theory predicated even remotely on the concept of human rationality is fundamentally flawed.

In the final analysis, we’re apes with iPhones. I’m cool with that.

More to come ...

Sunday, August 9, 2009

Skunk!


Let it be known throughout the land: Raccoons respect my piss.

In a recent blog piece, I reported on my “solution” to unwelcome raccoon visitors entering the house through the cat flap.

A couple of nights ago, I heard a mysterious scratching outside my bedroom door. A neighborhood cat? Return of the raccoons? I made a noise, then heard the flap of the cat door, signaling the sound of the animal in full retreat.

At two in the morning, I woke up, put on my glasses, and went to the kitchen for a glass of water. I spotted something furry out of the corner of my eye.

 A skunk!

It’s a good thing I had my glasses on, or I might have mistaken the critter for my long-haired calico cat Bullwinkle. I have a bad habit of scooping Bullwinkle off the floor and nuzzling my face into her fur. Close call.

So here was the skunk, promenading in my direction across the living room floor as if he (let’s assume the skunk was a he) owned the place. Not a trace of fear.

“I laugh at your peeess!” the skunk sneered in what I swear was a French accent. “I hold your entire species in contempt! You are unworthy of the dis-stink-shun of odious! You want smell? Allow me to demonstrate smell!”

No!

“Peeess, ha!”

Slowly, very carefully, I backed into my bedroom and closed the door. The battle of the amygdalae was on.

Being fellow mammals in confrontation mode, our respective brains were now operating very similarly. Our limbic systems were both alerting us to danger and governing our immediate reactions. In particular, the amygdala - which mediates fear and arousal - was kickstarting our “fight or flight” response. Already, I was in a heightened state of awareness bordering on panic.

Think of the amygdala as a 911 call and the limbic system and autonomic nervous system as rapid responders. In nothing flat, my entire being was mobilized to face the threat. Adrenaline flowing, heart pounding, neurons zapping, breathing accelerating, digestive sugars pumping raw energy into the muscles.

In one microsecond, I was primed to fight like a kung-fu master on steroids or run faster than Michael Phelps can swim. But millions of years of evolution never anticipated the exigencies of modern living gone bad, namely me trapped in my bedroom with a skunk just outside.

I needed to think things through.

But our brains don’t work that way. Survival depends on instant reaction. Only later does actual thinking enter into the picture. Which explains why in the modern world we do stupid things such as panic and fly off the handle and start fights and fall in love and otherwise act against our own best interests.

Moreover, the cortical areas don’t automatically take over, even when they do come back online. In theory, the thinking parts of the brain are supposed to modulate the reactive parts of the brain, but too often it works the other way around.

“Bang on the door! Make noise!” That was what my limbic-influenced cortical regions were telling me. Bad thinking.

Pepe Le Pew was working off an amygdala almost the same as mine, only the “end” result of an alarmed reaction, from my point of view, would be far more consequential and dramatic.

So here was trick: Under no conditions could my amygdala set off his amygdala, and the only thing to prevent that from happening was for my cortex to take charge.

Scratch-scratch-scratch. Pepe was now on the hardwood floor just outside my room.

Scratch-scratch. Now he was on the concrete. The only thing separating me from a living weapon of mass destruction was the bedroom door - a door with cat flap.

Bang on the door! Make some noise!

No! Cortex to the rescue. “Just wait!” said the voice of reason with not a second to spare. “He’s headed out the other door. All you have to do is breathe.”

A sound. The cat flap, but not in fully-committed mode. Slowly, carefully, I opened the bedroom door a crack and peered out. The skunk was stalled three-quarters of the way through the cat door, tail inside, fully upright.

“Hurry him up!” said the panic-influenced part of my brain. “Bang on something! Now!”

“Wait, you idiot!” my voice of reason cut in. “In case you haven’t noticed, the operating end of this walking violation to the Geneva Convention has not yet left the building! Don’t - I repeat - don’t! Don’t, don’t, don’t, don’t ...”

One Mississippi, two Mississippi ...

An eternity, another one, and another. Then - the welcome sight of an unfurling tail disappearing through the door followed by the definitive sound of the final flap. Deliverance!

My elation at having prevented a “situation” from escalating into nuclear destruction was dampened by the realization that skunks think my piss is a joke. Clearly, this is going to require years of intensive therapy to get over.

In the meantime, Pepe, I implore you - not a word to the raccoons. Please?

Monday, August 3, 2009

Happiness - Why Are We So Bad At It?


In my most recent blog piece, I touched on a topic I admittedly know very little about - happiness. The piece stemmed from my latest reader poll which unambiguously validated our expertise in its diametric opposite - misery.

Boy, can we do misery (trust me, I can teach the subject on a graduate level). But what about happiness? Two months ago, I came across a terrific feature article in Atlantic Monthly by Joshua Shenk (author of Lincoln’s Melancholy), entitled, What Makes Us Happy? I’d been meaning to blog on the piece ever since, so better late than never:

Mr Shenk’s article is a tribute to the dedication and persistence of Harvard psychiatrist George Vaillant (pictured here), who accomplished the impossible by keeping what had been a 30-year longitudinal study going for an additional 42 years.

In 1937, a team of researchers recruited 268 male Harvard undergraduates, a cohort that included JFK, Ben Bradlee, and other luminaries. The original funding came from department store magnate WT Grant, and hence became known as the “Grant Study.”

Longitudinal studies - ones that track populations over long periods of time - typically die of neglect. Funding sources dry up after say five or ten years, and researchers have no choice but to turn off the lights. This is one reason we know so little about mental illness. If you want to know whether, say, depression is bipolar waiting to happen you need to follow the same people around for at least two decades. Try getting funders to commit to that.

Dr Vaillant took over the Grant Study in 1967 when it was on life support, but with the best years of life just ahead. The subjects were men of privilege destined to great lives, but by 1948 twenty of them displayed severe psychiatric difficulties. By age 50, nearly a third met Dr Vaillant’s criteria for mental illness.

Dr Vaillant is no stranger to mental illness. When he was 10, his father stuck a gun in his mouth and pulled the trigger. His mother immediately pulled up stakes and moved the family to Arizona. A clean break. No memorial service. No seeing the house ever again.

According to Shenk:

“His central question is not how much or how little trouble these men met, but rather precisely how—and to what effect—they responded to that trouble. His main interpretive lens has been the psychoanalytic metaphor of ‘adaptations,’ or unconscious responses to pain, conflict, or uncertainty.”

Further:

“Vaillant explains defenses as the mental equivalent of a basic biological process. When we cut ourselves, for example, our blood clots—a swift and involuntary response that maintains homeostasis. Similarly, when we encounter a challenge large or small—a mother’s death or a broken shoelace—our defenses float us through the emotional swamp. And just as clotting can save us from bleeding to death—or plug a coronary artery and lead to a heart attack—defenses can spell our redemption or ruin.”

The least healthy responses, according to Vaillant, include psychosis, which may make reality tolerable to the person experiencing them. A step up are “immature adaptations” that include various forms of acting out (such as passive-aggression). “Neurotic” defenses such as intellectualization, repression, and disassociation (removal from one’s feelings) are quite normal.

Healthy (mature) adaptations include altruism, humor, anticipation (looking ahead to future discomfort), suppression (a conscious decision to address issues later), and sublimation (finding outlets for feelings).

According to Mr Shenk:

"Much of what is labeled mental illness,” Vaillant writes, “simply reflects our ‘unwise’ deployment of defense mechanisms. If we use defenses well, we are deemed mentally healthy, conscientious, funny, creative, and altruistic. If we use them badly, the psychiatrist diagnoses us ill, our neighbors label us unpleasant, and society brands us immoral.”

This perspective is shaped by a long-term view. Whereas clinicians focus on treating a problem at any given time, Vaillant is more like a biographer, looking to make sense of a whole life—or, to take an even broader view, like an anthropologist or naturalist looking to capture an era. The good news, he argues, is that diseases—and people, too—have a “natural history.”

In their youth, the men were twice as likely to engage in immature defenses over mature ones, but as they grew into middle age they were four times more likely to use mature ones, a pattern that continued into old age.

As well as healthy adaptations, education, stable marriage, not smoking, not abusing alcohol, some exercise, and healthy weight proved reliable indicators for happy lives. As Shenk describes it:

“Of the 106 Harvard men who had five or six of these factors in their favor at age 50, half ended up at 80 as what Vaillant called ‘happy-well’ and only 7.5 percent as ‘sad-sick.’ Meanwhile, of the men who had three or fewer of the health factors at age 50, none ended up ‘happy-well’ at 80. Even if they had been in adequate physical shape at 50, the men who had three or fewer protective factors were three times as likely to be dead at 80 as those with four or more factors.”

And this sobering nugget: “Of the men who were diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63.”

Ironically, according to Vaillant, positive emotions make us more vulnerable than negative ones. Whereas negative emotions tend to be insulating, positive emotions expose us to rejection and heartbreak.

Perhaps it takes a brave individual to be happy. Perhaps happiness does not elude us so much as we elude it. Food for thought ...

Much more in future blogs ...

Saturday, August 1, 2009

Latest Poll Results - It's Official: We're Miserable


What a lousy week. In July, I asked you how your “last seven days" went. Out of 127 responses, only four of you (3%) replied, “couldn’t have gone better.”

By contrast, seven times as many of you (28, 22%) told me your week “totally sucked.”

Okay, let’s check out the adjoining categories. One in five of you (23, 18%) said the last seven days went “pretty well.” Add that to the three percent of you who had a great week, and - guess what? - it still rounds off to a pathetic one in five who could look back on a positive week.

Contrast that to four times as many of you - nearly half - who had a negative week. We arrive at this by adding the “totally sucked” group to the one in four (31, 24%) who reported the week “posed a serious challenge.”

Filling in the middle, one in three of you (41, 32%) reported that the last seven days “had its ups and downs.”

How would I have answered this poll? At the beginning of July, I came back from a road trip with a moderate depression and what I thought was a bad leg cramp. Put me in the “posed quite a challenge” week.

Then the leg cramp intensified into excruciating pain that kept me flat on my back for eight days looking up at the ceiling fan. Sciata. Life “totally sucked.”

Could I squeeze a good week out of my entire month? No. “Serious challenge" was the best I could do.

Granted, July was an anomaly for me. I like to think in any given month, I can cobble together at least two weeks that “went pretty well.” As for “couldn’t have gone better,” you gotta be kidding. Never in my entire life, not for a seven-day stretch, anyway.

I have bipolar. You’d think I could count on at least one reliable hypomania to rocket me through a week I would never forget. But in case you haven’t noticed, hypomania isn’t all its cracked up to be. Mine come preloaded with high anxiety and road rage. So - whenever I hear some stupid doctor saying we go off our meds because we’re addicted to our manias, well, never mind.

Obviously, our population has extreme difficulties with the concept of happy. Meanwhile, we have miserable nailed. I suspect the general population is similarly - though not as excessively - predisposed.

Maybe we’re simply not meant to be happy, and the sooner we acknowledge this the happier we’ll be. Maybe our perception of happiness is totally wrong, and we become miserable chasing after the wrong things. Maybe life is all about successfully negotiating its special challenges, instead. Maybe the best we can hope for is quiet acceptance.

Who knows? What this admittedly unscientific poll clearly tells us is that an overwhelming majority of us are having considerable difficulties negotiating this rather ubiquitous presence called life. Obviously, we need to do a better job.