Wednesday, February 3, 2010

Tom Wootton - Visionary or Out of Touch?


In my most recent blog piece, I indicated that my friend Tom Wootton’s new book, "Bipolar in Order," was a piece of shit and don’t buy it. I’m sure one day Tom will thank me.

But I come neither to praise nor bury Tom. My friend is at the center of a very important dialogue that he helped create. On one hand, he comes across as a brilliant visionary thinker miles ahead of everyone else. On the other, it’s easy to dismiss him as an unmitigated idiot totally out of touch with the real world. I’ve met both Toms. Let’s start with the visionary:

Tom’s first book, "The Bipolar Advantage," should have been called "The Manic Advantage." Convincing others to view their illness in a positive light has always been a hard sell, but, compared to depression and psychosis, there is much to like about mania. I guarantee that if a “mania stabilizer” were to come on the market - one that could keep us in a high productivity, high creativity, high sociability state forever without flipping us over the top or crashing us to the bottom - there would be one hundred percent compliance.

Indeed, I had written extensively on the subject before ever encountering Tom. In particular, I had a beef about psychiatrists medicating our personality out of us. When I raised this with John Gartner, author of “The Hypomanic Edge,” he likened the situation to the pitcher in Bull Durham, the guy with the 100 MPH fastball who keeps beaning the mascot. “We want to slow it down just enough so that he can deliver the ball where it’s supposed to be”, Dr Gartner explained to me, say to 95 MPH, not 50 MPH.

Make no mistake: Mania has wrecked my life more than once. But we should be wary of those who would indiscriminately clip our wings.

When I met Tom in 2006, his thinking was way ahead of mine. “I don’t want to be 80 percent better,” I heard him tell a workshop at a DBSA conference that year. “I want to be 120 percent better.” I never thought of my illness that way, but Tom had a point. Bipolar confers upon us a host of advantages that leaves the rest of the world for dead. So, if we could get out of our illness mindset and learn to master our gift of fire without getting burned we could be better - yes, better - than everyone else.

It’s all about that mania stabilizer. Too often, we can’t handle the overload. We flip out. We crash. But suppose we could train our minds to remain in control? Tom raises this point in his latest book, and I was treated to a sneak preview of his thinking at a NAMI CA conference last summer in greater LA.

In his talk, Tom displayed a PowerPoint of a Ferrari. A Ferrari has a stable platform so you can go around corners, he explained. 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 went on to say. But I don’t want to be stable in a garage, he concluded. I want to be stable while I’m driving.

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

A wider range of emotions includes depression, and here Tom has a much harder sell. The dominant view is expressed by Peter Kramer MD, author of “Against Depression,” who contends in a NY Times piece that “depression is not a perspective. It is a disease."

Most of us would readily agree, but then again, where does introspection and thinking deep end and depression begin? Besides, who wants to be happy all the time? In his book, “The Depression Advantage,” Tom focuses on the lives of Christian and eastern saints, and how their despair was the necessary prelude to spiritual breakthrough and growth. Likewise, Tom observes, in our own lives, our descents into darkness can sensitize us into achieving higher awareness and superhuman insights.

So, if you are experiencing depression and thinking deep without being incapacitated, is it truly depression? Who knows? More accurately, is it an illness? No way, Tom contends. True, no one wants to experience the devastation of depression or mania, but living within a very narrow emotional bandwidth also sucks. If we can learn to operate within a much wider bandwidth, says Tom, then our lives are going to have much greater meaning, with many more possibilities.

You may have issues with this, but there is no denying that Tom is on to something. Just so he doesn’t overreach.

Next: Tom overreaches.

7 comments:

Dawn said...

Good Evening John,
Same artist, teacher, friend here who at 51 years old, is just coming around to a year without depression. Your line "besides, who wants to be happy all the time." startled me into a gasp. Recoginizing illness and finally gettting appropriate meds hasn't made me "happy all the time." Isn't this often the uneducated view of psych meds; anti-depressants or others? Just another escape mechanism from life (painful life)? Sadly, it was my view, it almost cost me my pretty good, just pain-soaked life.
Now, I live in frank amazement at how I can live without having to work sooo hard at everything (not crying, not reacting, not hiding, not feeling physically agitated).

It sickens me to read depression and advantage in the same sentence. Despair necessary for spiritual breakthroughs? Really, how much? for how long? If despair is so good, why bother aleviating it?

A book which influenced my thoughts on taking
psyche drugs which I recommend to anyone grappling with the mysteries of health and medicine is Ether Day by Julie M. Fenster. A chronicling of the slow discovery and use of ether to relieve pain during surgery. Part of the slowness, a full 50 years after it's discovery, was the prevailing religious thought that it was God's intent for men to suffer, and unlikely that we could reduce it much.

Every time I hear something like "depression advantage" I think, ok, there's another 50 years.

John McManamy said...

Hi, Dawn. I hear you. I could have used a better word than happy. What I was driving at - a theme from earlier blogs - is a lot of us need our contemplative "down" times. I also need my "up" times. Tom takes this a lot further and pushes it to the limits and beyond. It's an idea that needs to be put out there, but it also needs the kind of skeptical scrutiny that you applied. That's how we learn. Please keep posting.

infoanalysis said...

I saw Tom speak last night in Portland. He was impressive because he claimed no sleep the night before, yet still appeared calm and collected.

Of course even manic depressives can have insomnia or lose a night's sleep and not have an episode.

Tom said some puzzling things. He had taken 1500 mg of lithium and tested in a therapeutic range, but because it was so caustic to his system, he requested that his doctor reduce it all the way down to 450mg. The doctor claimed that it was the lowest dosage legally permissible. Funny the pills come in 300 mg increments yet he was not allowed to go lower than 450mg? people take lower dosages. Also I never heard of anyone being in a therapeutic range, as indicated by blood levels, at both 1500 and 450. He went on to say that he completely went off the medicine thereafter. Was lithium ever helping him? He did bring up the Placebo issue. But more importantly from, my perspective, not responsive to lithium makes the diagnosis questionable. Lithium has a very high rate of efficacy with TRUE manic depressives.

Whenever I hear anyone speak about hallucinations I become suspicious. It is rare that TRUE manic depressives experience hallucinations, unless during an acute episode. He said that if you ever get those hallucinations just use them to your advantage. He mentioned the term schizo affective disorder. It was at this moment that I began to wonder what illness he had. Some people will be depressed during times of their lifetimes and at other times they may be euphoric even to a psychotic level. But this still does not make someone a TRUE manic depressive. This is a deadly disease, telling people that he has the magic bullet using illusion of proofs based on colored coded graphs is simply dangerous for young people who may have just experienced their first episode, skeptical to accept their diagnosis. Magic science in the minds of the impressionable and inexperienced can have devastating results. It is true that as one becomes more experienced with the illness they may be able to escape these extremes by awareness of what exactly is happening. I was concerned about a very young man who appeared to be all too happy to follow any pied piper that thwarted the advice of his own psychiatrist.
He mentioned a woman who ran a marathon in a deep depression. Running is the best natural antidepressant there is, but to be in a severely depressed state and to run a marathon-- absurd. And who was gaging her mood anyway? It is true that one can learn from the experience-- never to let yourself there again at any cost.
He also boasted that they will provide guidance in the workshops by people who have achieved this self mastery. Who gages the level of self mastery and for how long will the be in self mastery before another episode?
Mania is the most addictive drug there is. It is a slippery slope after one is in a hypo-manic state into a full blown psychotic state. It is common knowledge of the increased productivity and energy one experiences in this elevateds state, but preventing oneself from going over the edge is beyond what has been proven time and again. The allure is too great and the projects and great aspirations of the sufferer make it all but impossible to pull back from the precipice. Experience from past episodes does help in self awareness and the fear of haunting memories of the depression that very possibly will follow-- should be a great deterrent, but everyone has their limits. The most dangerous and unique aspect of this condition is that just when the patient feels the most self actualized, unlike any other illness, they are most likely in a very unstable and psychotic state. Hubris in the absence of temperance is not sustainable for anyone.

John McManamy said...

Hi, Info. Very interesting. Sounds like we share similar impressions. Maybe Tom's doc did refuse to go way down on the lithium dose, but there is obviously no legal minimum. Docs obviously fear lawsuits if they take patients off meds or lower doses, but this is not the same as illegal.

Re schizoaffective - First Tom was bipolar, then he claimed he was dx'd with schizophrenia in addition to BP and other stuff. Now he's claiming schizoaffective. Docs misdiagnose people with this all the time, so he may well have received this dx. But his stories suggest a condition quite different. More like someone who experiences fleeting psychosis comorbid with bipolar. I'm not a doc. I'm just a journalist with a journalistic bullshit meter. Tom is a brilliant visionary, but alas ...

Joyce said...

Greetings fellow travelers,
My son has been diagnosed severely depressed with paranoia at age 19, schizoaffective, at age 20, and now appears to be bi polar. Of course, the newest diagnosis book scheduled to come out, DSM 5, will do away with the diagnosis of SZA altogether, and consider it a type of bi polar. In fact, most recent research indicates that ALL serious mental illness is in fact just different locations on the self same spectrum, with different manifestations.

The trend seems to be doing away with labels altogether, and simply to treat each PERSON. After all, diagnoses, while necessary for insurance and social security benefits, do not necessarily help consumers reach a place of wholeness. Stigma is attached to labels.

As for me/us, I pray that my son will someday, soon, agree to try a newer generation of medicine to help him manage his mania and mitigate his depression, without taking away his creativity and spirituality. That will require a skilled psychotherapist, and that will require resources, which require a diagnosis. So there we are.

Sending intentions for resiliency and recovery to all those affected by any kind of brain disorder.
Love, Joy

polarpaul said...

I agree with Joyce that it's important to treat people individually. If there's one thing I've learned in my many years of attending support groups it's that people will respond differently to the same medications and that finding the right combination can be difficult and may stop working.

Unfortunately, I was never able to find the right combination for me but have found that switching to a lower carb diet and dealing with my frustration and anger issues has prevented me from having either a manic or depressive episode for the last seven years. I haven't personally met someone else with a similar experience and the same diagnosis (bipolar I), so I wouldn't recommend following my example.

Too often in my experience, the doctors over promised and ignored evidence that the medications didn't prevent my episodes (20 years). A more honest and open dialog about what's working or not working seems to be important in developing the necessary trust between the patient and psychiatrist. An unwillingness to go on meds simply because they're not natural means there may be a high price to pay. Getting surgery isn't natural either, but you hear less concern about this.

Nevertheless, I think learning how to take better care of yourself regardless of your medication status is important as you can lower your stress levels and be more honest with yourself rather than reacting based on fear or other similar strong emotion which may not end up being in your best interest.

It is interesting that Tom Wootton talks about how only a small percentage of the people can achieve a high level of self mastery and uses an analogy with professional athletes. While these athletes have to train and work hard, they also have genetic traits that allow them to compete at the highest levels too. Following this logic, presumably there could be genetic predispositions that could put limits on how much self mastery an individual with bipolar can achieve? Working closely with your psychiatrist, therapist, and support team (friends and family) seems like the best way to discover what your limits are in a safe manner so you can optimize your health.

Getting off medications as a goal doesn't seem like the way to go as being healthy should really be the focus. If you can live a healthy fulfilling life without medications that's great, but I wouldn't count on it or insist upon it either.

There seems to be a lot of concern about medications taking away your creativity or turning you into an emotionless zombie. Poor medication management can certainly create this situation so once again good communication between you and your psychiatrist is essential.

In contrast to Tom Wootton's claims, I have never been very creative while either manic or depressed as I lacked sufficient focus or energy, respectively, to create. A life of chaotic mood swings isn't a good environment for creating and the evidence suggests you'll most likely need medications to manage your moods. Be patient and work hard to find a treatment plan that is effective for you rather than insisting on limiting yourself to non-medication solutions.

It's okay to test your limits, just manage your risks or you may end up moving backward or perhaps even end up killing yourself due to extremely dysregulated moods. Don't confuse the how you'd like the world to be with how it is or how people tell you it is. An open mind and flexibility plus having people you can trust are essential on this journey.

polarpaul said...

I agree with Joyce that it's important to treat people individually. If there's one thing I've learned in my many years of attending support groups it's that people will respond differently to the same medications and that finding the right combination can be difficult and may stop working.

Unfortunately, I was never able to find the right combination for me but have found that switching to a lower carb diet and dealing with my frustration and anger issues has prevented me from having either a manic or depressive episode for the last seven years. I haven't personally met someone else with a similar experience and the same diagnosis (bipolar I), so I wouldn't recommend following my example.

Too often in my experience, the doctors over promised and ignored evidence that the medications didn't prevent my episodes (20 years). A more honest and open dialog about what's working or not working seems to be important in developing the necessary trust between the patient and psychiatrist. An unwillingness to go on meds simply because they're not natural means there may be a high price to pay. Getting surgery isn't natural either, but you hear less concern about this.

Nevertheless, I think learning how to take better care of yourself regardless of your medication status is important as you can lower your stress levels and be more honest with yourself rather than reacting based on fear or other similar strong emotion which may not end up being in your best interest.

It is interesting that Tom Wootton talks about how only a small percentage of the people can achieve a high level of self mastery and uses an analogy with professional athletes. While these athletes have to train and work hard, they also have genetic traits that allow them to compete at the highest levels too. Following this logic, presumably there could be genetic predispositions that could put limits on how much self mastery an individual with bipolar can achieve? Working closely with your psychiatrist, therapist, and support team (friends and family) seems like the best way to discover what your limits are in a safe manner so you can optimize your health.

Getting off medications as a goal doesn't seem like the way to go as being healthy should really be the focus. If you can live a healthy fulfilling life without medications that's great, but I wouldn't count on it or insist upon it either.

There seems to be a lot of concern about medications taking away your creativity or turning you into an emotionless zombie. Poor medication management can certainly create this situation so once again good communication between you and your psychiatrist is essential.

In contrast to Tom Wootton's claims, I have never been very creative while either manic or depressed as I lacked sufficient focus or energy, respectively, to create. A life of chaotic mood swings isn't a good environment for creating and the evidence suggests you'll most likely need medications to manage your moods. Be patient and work hard to find a treatment plan that is effective for you rather than insisting on limiting yourself to non-medication solutions.

It's okay to test your limits, just manage your risks or you may end up moving backward or perhaps even end up killing yourself due to extremely dysregulated moods. Don't confuse the how you'd like the world to be with how it is or how people tell you it is. An open mind and flexibility plus having people you can trust are essential on this journey.