Rerun: My Life as an International Awardee

From Oct 2009 ...

In the first piece to this series, I recalled my shock and dismay over being informed that I was to receive the Mogens Schou Award for Public Service, a major international award. In the second installment, I related how hearing Nobel Laureate John Nash at the 2007 APA in San Diego helped me understand the importance of what a little bit of recognition can do for one's recovery. To pick up where I left off ...

Three weeks following the APA, I was off to Pittsburgh for the Seventh International Conference on Bipolar Disorder to collect my Award. I knew I would be overexcited - hypomanic in a bipolar context - and as a precaution I arranged to have a platonic conference date to act as my frontal lobes.

The conference organizers comped me with a hotel suite (a suite!) that had real towels, plus a view out the windows. To contrast with the first conference I attended in 2001, back then I had a Priceline deal at a hotel a good long walk away from the venue.

I recall back in 2001 registering and helping myself to coffee and Danish, plus a yogurt and a juice, while trying to juggle my conference materials as I sat myself in a cramped space and attempted to make small talk with a very attractive European pharmacy expert. The Joe Cool act didn't fly. My coffee was slopping over the rim of my saucer, and the only way I would be able to negotiate my Danish was if my elbow were to suddenly sprout fingers.

Nevertheless, I managed to get through the day without totally embarrassing myself.

On the evening of Day Two of that conference I made my first minor faux pas (that is to say, the first one that I noticed). I hadn't bothered to take my sport jacket to the second day of the meeting. But now we were being shuttled off to a more formal setting at the Carnegie Museum, and I couldn’t exactly go up the elevator to retrieve my jacket.

I was definitely out of place as I gamely introduced myself to Michael Thase MD, one of the Conference organizers. A roving photographer asked a group of us to pose. Me, Dr Thase, and a darkly-tanned blond Dutch pediatric psychiatrist in open-toed stilettos. I so totally did not belong in this picture.

The occasion was the first-ever presentation of the Mogens Schou Awards and dinner, where I managed not to further embarrass myself. Later, the shuttle dropped us off at the conference venue, and I set off on my own into the night, back to my hotel.

Fast Forward, June 2007: The second evening of the conference was once again reserved for the Mogens Schou Awards and dinner, once more held at the Carnegie Museum. This time, I showed up dressed to kill, in a black business suit and a Thomas Pink shirt that probably threw me back for far more than my suit.

The cocktail hour portion of the evening was coming to a close. It was time for me to move forward toward a small stage platform and hover. On a small table were four Plexiglas Awards, resplendently bathed in discreet overhead lighting.

David Kupfer MD, head of the psych department at UPitt, issued some opening remarks and handed over the first Award of the night - Education and Advocacy - to Adriano Camargo, president of the Brazilian Association for Affective Disorders. Ellen Frank PhD of UPitt and a pioneer in a certain type of talking therapy for bipolar - then presented two Awards to the University of Barcelona powerhouse research team of Francesc Colom PsyD, PhD and Eduard Vieta MD, PhD. There was one Award remaining on the table.

Michael Thase approached the podium, with the Public Service Award in his hand. "I'm pleased tonight," he began, "to show our gratitude for the man who is my favorite person in medical journalism ..."

SuddenIy I was on the podium, shaking hands with Dr Thase. Then I had the Award crooked in my arm. The applause died down. It was my turn to speak.

I could have told these people what it was like for me back in 2001. But no one had to know that. This was my moment, my time. I belonged in this picture.

But life has a way of intervening. The next day, a certain psychic undertow began to kick in. I woke up much later than usual and spent the last day of the conference in a sort of anti-climatic semi-coma. By the time I flew out the next day, I felt a cold coming on. Back on my mountain, my mood dropped like a manhole cover. My batteries were dead. No energy. I needed to hibernate.

None of this Award going to my head business for me. My brain and my immune system have a way of keeping me in my place. Before enlightenment - draw water, chop wood. After enlightenment - draw water, chop wood.

I found it gratifying that I was not exactly the same person drawing water and chopping wood, but the positive strides I was making in moving my life forward had blinded me to the fact that I was pushing myself way too hard. That plus the fact the last two or three years of my life were catching up with me. Too many life-changing events compressed into way too short a period of time with nothing but factory-reject vulnerability genes to handle the load.

Curse you, 5HHT polymorphism!

My Life as an International Awardee - Conclusion

In the first piece to this series, I recalled my shock and dismay over being informed that I was to receive the Mogens Schou Award for Public Service, a major international award. In the second installment, I related how hearing Nobel Laureate John Nash at the 2007 APA in San Diego helped me understand the importance of what a little bit of recognition can do for one's recovery. To pick up where I left off ...

Three weeks following the APA, I was off to Pittsburgh for the Seventh International Conference on Bipolar Disorder to collect my Award. I knew I would be overexcited - hypomanic in a bipolar context - and as a precaution I arranged to have a platonic conference date to act as my frontal lobes.

The conference organizers comped me with a hotel suite (a suite!) that had real towels, plus a view out the windows. To contrast with the first conference I attended in 2001, back then I had a Priceline deal at a hotel a good long walk away from the venue.

I recall back in 2001 registering and helping myself to coffee and Danish, plus a yogurt and a juice, while trying to juggle my conference materials as I sat myself in a cramped space and attempted to make small talk with a very attractive European pharmacy expert. The Joe Cool act didn't fly. My coffee was slopping over the rim of my saucer, and the only way I would be able to negotiate my Danish was if my elbow were to suddenly sprout fingers.

Nevertheless, I managed to get through the day without totally embarrassing myself.

On the evening of Day Two of that conference I made my first minor faux pas (that is to say, the first one that I noticed). I hadn't bothered to take my sport jacket to the second day of the meeting. But now we were being shuttled off to a more formal setting at the Carnegie Museum, and I couldn’t exactly go up the elevator to retrieve my jacket.

I was definitely out of place as I gamely introduced myself to Michael Thase MD, one of the Conference organizers. A roving photographer asked a group of us to pose. Me, Dr Thase, and a darkly-tanned blond Dutch pediatric psychiatrist in open-toed stilettos. I so totally did not belong in this picture.

The occasion was the first-ever presentation of the Mogens Schou Awards and dinner, where I managed not to further embarrass myself. Later, the shuttle dropped us off at the conference venue, and I set off on my own into the night, back to my hotel.

Fast Forward, June 2007: The second evening of the conference was once again reserved for the Mogens Schou Awards and dinner, once more held at the Carnegie Museum. This time, I showed up dressed to kill, in a black business suit and a Thomas Pink shirt that probably threw me back for far more than my suit.

The cocktail hour portion of the evening was coming to a close. It was time for me to move forward toward a small stage platform and hover. On a small table were four Plexiglas Awards, resplendently bathed in discreet overhead lighting.

David Kupfer MD, head of the psych department at UPitt, issued some opening remarks and handed over the first Award of the night - Education and Advocacy - to Adriano Camargo, president of the Brazilian Association for Affective Disorders. Ellen Frank PhD of UPitt and a pioneer in a certain type of talking therapy for bipolar - then presented two Awards to the University of Barcelona powerhouse research team of Francesc Colom PsyD, PhD and Eduard Vieta MD, PhD. There was one Award remaining on the table.

Michael Thase approached the podium, with the Public Service Award in his hand. "I'm pleased tonight," he began, "to show our gratitude for the man who is my favorite person in medical journalism ..."

SuddenIy I was on the podium, shaking hands with Dr Thase. Then I had the Award crooked in my arm. The applause died down. It was my turn to speak.

I could have told these people what it was like for me back in 2001. But no one had to know that. This was my moment, my time. I belonged in this picture.

But life has a way of intervening. The next day, a certain psychic undertow began to kick in. I woke up much later than usual and spent the last day of the conference in a sort of anti-climatic semi-coma. By the time I flew out the next day, I felt a cold coming on. Back on my mountain, my mood dropped like a manhole cover. My batteries were dead. No energy. I needed to hibernate.

None of this Award going to my head business for me. My brain and my immune system have a way of keeping me in my place. Before enlightenment - draw water, chop wood. After enlightenment - draw water, chop wood.

I found it gratifying that I was not exactly the same person drawing water and chopping wood, but the positive strides I was making in moving my life forward had blinded me to the fact that I was pushing myself way too hard. That plus the fact the last two or three years of my life were catching up with me. Too many life-changing events compressed into way too short a period of time with nothing but factory-reject vulnerability genes to handle the load.

Curse you, 5HHT polymorphism!

My Life as an International Awardee - Part II

In a recent blog piece, I brought up the shock and dismay I experienced more than two years ago over being singled out for a major international award, named in honor of a legend who revolutionized psychiatry. But I also noted the hard work I had put in to merit such an honor, in the first place. To continue:

At a convocation lecture delivered by John Nash at the 2007 APA 40 miles down the road in San Diego, I got an unexpected insight into what something like a Mogens Schou Award can do for your recovery. John Nash (pictured here) is the mathematician who shared the 1994 Nobel Prize in Economics, upon whose life the book and movie, "A Beautiful Mind," is based. A good case can be made that whatever drove Dr Nash to experience paranoid delusions initially allowed him to make the kind of novel connections upon which ground-breaking mathematical theorems are based.

Schizophrenia rarely just descends full force on an individual. Years of eccentric and erratic and sometimes brilliant behavior tend to precede the definitive break. Various recovery advocates like to point out that Dr Nash’s schizophrenia remitted naturally, without meds. That may be true, but Dr Nash in his Nobel autobiography acknowledges he lost 25 years of his life to his delusions.

Nevertheless, in his talk to the APA, Dr Nash raised the possibility of an adaptive advantage to schizophrenia, with his own games theory twist. I’m presuming he was referring to schizophrenia in its more benign manifestation, what the experts refer to as the prodromal phase, that quirky quiet time before the entire brain tragically implodes and robs its owner of the gift of rational thought. Or perhaps a form of “schizophrenia lite,” what psychiatrists call schizotypal personality disorder, characterized by oddball thinking and weird social behavior without the delusional psychosis.

Indeed, at the same conference, I heard prominent psychiatrist Nancy Andreassen MD, PhD of the University of Iowa advance a similar thesis. Newton, she said, entertained unusual beliefs and had a psychotic break later in life. The eccentric Einstein had a son with schizophrenia in his family and displayed schizotypal traits. James Watson (of Watson and Crick fame) also had a son with schizophrenia.

"So we can say that three of the most important discoveries in modern science were done by men who had association with schizophrenia," Dr Andreasen pointed out. "What’s the odds that occurred by chance? There must be something there."

It turned out that Dr Andreassen’s research uncovered a far more obvious connection to creativity - namely bipolar. Still, the general thesis is valid. Our brains don’t have the same filters as normal brains. Too much stuff coming in, what the experts refer to as “low latent inhibition.” We have trouble tuning things out - thoughts, feelings, senses. Our in-trays are always overflowing, frequently overwhelming.

Meanwhile, our neurons don’t communicate in the same predictable patterns. We make novel connections. At the time of her talk, Dr Andreassen was investigating an area of the brain called the association cortices. If I understand Dr Andeassen correctly (and also taking into account latent inhibition), in a creative mind the association cortices can pull the background noise of a refrigerator (which most people manage to ignore) from one part of the brain, an unpleasant childhood memory (which most people have long ago put to rest) from another, a weird observation about Hannibal and his elephants from yet another (what is it with my obsession about Hannibal?), a reptilian urge to throw Richard Simmons off a cruise ship and into a school of sharks who are slow picky eaters (now you are relating), and come up with the grand unified theory of everything, which is kind of my mission in life, along with “enjoy the peanut butter.”

The catch is one needs what they call strong “executive function” to keep track of this crazy internal dialogue and take charge. Think of the “I” in the control room. When you respond with “but roosters don’t lay eggs” to a classic brain-teaser, you can give this little guy all the credit.

But when the “I” fails - typically in response to too much happening at once - bad things happen. No one is home, no one is in charge. Thoughts and feelings and senses inerrantly find their way of disorganizing into chaos.

Maybe the outcome is a panic attack, perhaps a psychotic break or a manic episode or explosive anger. Another way of looking at it is the brain is finding its own way of taking refuge. The frontal lobes may even shut down, which is how a lot of people view their depressions. Or the entire operating system may refuse to boot up, which is one way of looking at autism.

Sylvia Nassar’s terrific book, “A Beautiful Mind,” serves up John Nash as a classic case study of all that can go right and all that can go wrong in the brain. Dr Nash's great creative work was done in his early-mid twenties, before his illness manifested in full. But Nassar’s account gives us the unmistakable impression that this particular beautiful mind was always a case of schizophrenia waiting to happen. From Day One, he was an outsider, an outlander from West Virginia with a weird way of looking at the world and a noticeable deficit in social skills. Even in a profession notorious for its oddballs and cranks, John Nash never quite fit in.

In short, a man with no ordinary brain, understood by few. Thoughts connected in startlingly original ways. On one hand, it produced a stunning piece of rationality - games theory - that was so novel that his contemporaries failed to fully grasp its significance. On the other, this same remarkable brain morphed into astonishing irrationality - he actually thought he was the king of Antarctica - a tragedy that robbed its owner of a quarter century of his life.

And here he was, at the podium at the APA, trying to explain this strange phenomenon of a thinking machine of nearly limitless dimensions spewing out gibberish. Figure out a law of nature that governs such an occurrence and you will get a branch of science named after you, guaranteed, or a religion - take your pick.

Dr Nash was talking to the right people, people profoundly interested in the mysteries of the human psyche, but - like me - they found his message terribly difficult to comprehend. It didn’t help that Dr Nash was reading in a monotone off a densely-typed, jargon-laden script held very close to his face. One minute into the talk and I was looking this way and that way into a sea of glazed eyes. Some of the attendees began discreetly ducking out, and I considered doing the same. Then I reconsidered. You don’t walk out on a Nobel Laureate, I decided. (Donald Trump, yes, and I would make sure to knock over a chair on the way out, stupid asshole.)

Suddenly, Dr Nash started talking about his return to sanity and my ears pricked up. Significantly, he mentioned that his recovery began when his reputation finally started catching up with the acclaim he felt he deserved.

Now I could relate - me Mr 400 Math SAT, him Dr Uber Equations. It turns out on one level at least, the two of us had a lot in common. Say what you want, recognition counts. Whether from a Nobel committee or the top bipolar experts in the world, or for that matter the local bowling league, it’s sure nice to get a pat on the back.

We toil mightily, nameless nobodies never anticipating so much as a simple thank you. Too often, we put up with thoughtless behavior and abuse. Too often, we have nothing to show for our labor, held in contempt, written off as not like everyone else. But we persist, either because we’re driven to do so or because it’s the right thing to do. We take our small comforts where we can find them - a handshake, a compliment from afar, a small act of kindness.

But our lot is that of an outsider. Just ask that skinny kid afraid to get on the school bus. Then - one day - the bus door opens and there’s a whole seat to yourself near the front. That cute redhead you kind of have a crush on breaks off a piece of jelly donut for you. The cool tough guy in the leather jacket with the duck’s ass haircut strolls from his throne in the back, claps a hand on your shoulder, and lets you know there is always a place in his circle for short nerdy kids with glasses.

You try to make a coherent reply by way of a lame joke, and the whole bus breaks out in appreciative laughter. Some idiot tries to rain on your parade, and you respond with, “Eat it raw,” like you know what it means. The bus driver shoots you a questioning look, but you just grin, as if to say, don’t worry, I’ve got it covered.

You now have everyone’s attention. “Listen up, guys,” you shout down the aisle, voice brimming with confidence. “Hannibal never won a battle with his elephants.”

Shit! Why can’t I just keep my big mouth shut?

To be continued ...

My Life as an International Awardee (How it Helped In My Recovery but Didn't Change My Life)

Rural southern CA, two months after my arrival, Feb 2007: An intriguing heading to an email was waiting in my email box. “Mogens Schou Award,” it read, or something to that effect. The email was from the Seventh International Conference on Bipolar Disorder, to take place later in the year.

I was well familiar with the Mogens Schou Award. It was established in 2001 in honor of the late Danish psychiatrist, who back in the sixties built an airtight case for the safety and efficacy of treating bipolar patients with the common salt, lithium, thereby helping open up a new era in psychiatry. To give you an idea what he was up against, prominent British psychiatrists characterized Schou’s efforts as “dangerous nonsense” and “a therapeutic myth.”

I was at the 2001 conference when Dr Schou was honored as the founding recipient. His frail health at the time - he was in his 80s - prevented him from attending, but he did address us via a pre-recorded video. I was particularly moved by the man’s passion. Here he was, his time on earth running short, urging a younger generation to investigate lithium for treating recurrent depression.

The conference also honored Jules Angst, the legendary Swiss diagnostician who conducted the ground-breaking longitudinal studies that helped give rise to our modern views of both depression and bipolar disorder. In addition, the conference paid tribute to philanthropists Vada and Ted Stanley.

Two years later, at the next conference in 2003, a clear pattern for the awards had been established: Research, Education and Advocacy, and Distinguished (later Public) Service. The line-up that year included Husseini Manji of the NIMH (Research), with a slew of prestigious awards already on his mantlepiece, and celebrated author Kay Jamison (Education and Advocacy), with a MacArthur “Genius Grant” and other honors to pad out her resume. Philanthropist Waltraud Prechter received the Distinguished Service Award.

The 2005 Awards singled out another stellar trio: Family-focused therapy innovator David Miklowitz PhD (Research), Paolo Morselli MD (Education and Advocacy), and lithium pioneer Samuel Gershon MD (Distinguished Service).

So naturally I was curious about what was going on with the 2007 Awards. This was early February. The Awards wouldn’t be announced till the Conference in June. Were they looking for nominations? If so, why contact me?

Please read the attachment, the email instructed, or words to that effect. I opened the attachment. “Yada, yada, yada ...” Then:

“Mogens Schou ... Public Service ...”

Something wasn’t tracking. It appeared as if they were referring to me. Then something like:

“... attend ... to accept ... Award?”

What?!

Surely a re-reading would establish the truth: A Nigerian millionaire wanted to transfer his savings to my bank account, an offer for discounted natural Cialis, a reminder to get my tires rotated ...

But no. I got it right the first time.

Calmly, coolly, I did another re-read, then another.

Only after the fourth reading did I let out an exultant whoop and leap toward the ceiling. Then I brought myself back to earth. This couldn’t be right, I decided. I called the person listed on the contact information to set me straight.

“I’m afraid so,” she said. (Actually, I’m making this part up.) “Unfortunately, it’s true.”

Okay, false modesty is as bad as empty bragging. The truth is I had busted my ass getting out current and accurate information to patients and their loved ones. No one did it better than me. The first 18 months I didn’t make a dime. By the time I landed in southern CA, I was making about $8.00 an hour putting in 60-hour weeks.

My email Newsletter was a free service, so was my website. You could read my blog for free, and my book only set you back $15. From my reader feedback, I know I had helped thousands help themselves to better lives. In the entire mental health industry, there was no better value for your money. So, if anyone deserved this Award it was me.

But hard-scrabble journalists like me never get awards. Hence the surprise.

Paradoxically, one of my initial reactions was this would be a good time to get out of the business, such as it was. Before I ran out of gas. My book had been out for four months, now this Award. My tank was on empty. Maybe now was the time to walk away from it all, at the top of my game. It was a liberating thought.

But no, the Award spurred me to redouble my efforts. I banged out a batch of Newsletters that featured highly-complex, impossible-to-write pieces on brain science. I gave talks. I went on the road a lot.

My first road trip that year nearly ended in a disaster. This involved a 12-day tour back east that included stops in four states and the District of Columbia. I trundled into Reagan National with my three bags only to encounter the return flight from hell. Some of the airline’s ticketing computers were down, and lines were everywhere. People were missing their flights, and my fragile psyche was absorbing all the anxiety and hostility in the terminal.

I got into Philly and casually grabbed a bite to eat, then strolled to the very end of C Terminal only to find I had 15 minutes to run to the other end of the airport to catch my flight at A Terminal. I got there to find the plane was an hour late. Oh-oh. This is too close for comfort for my connection at Las Vegas.

The plane spent nearly an hour on the runway. Naturally I missed my connecting flight in Vegas to San Diego. I felt control over my brain slipping away, I was dehydrated and disoriented and my jaw was throbbing in acute pain. I lost my way more than once negotiating my way to the right ticket counter, and I sensed myself asking for directions with far too much aggression in my voice. By the time I get into the right line, I was on the verge of panic. It was 1:00 in the morning Vegas time, which equated to 4:00 in the morning east coast time.

I knew the airlines would put me on another flight, but would they put me up in a hotel?

I was at very high risk if I didn’t get in some serious horizontal time right then and there. The line was moving at the same speed as those terra-cotta Chinese warriors that were buried for thousands of years and the ticket agents were as animated as Rip Van Winkle. I felt my sanity slipping away.

“Look!” I wanted to shout. “I have a chronic medical illness and I need attention RIGHT NOW!”

An airport is the last place you want to lose it. I could see it now: “Agents Subdue Crazed ‘Living Well’ Author.”

Breathe! I told myself. Breathe. One’s breath is the best emergency stress-buster there is. Be nice! I told myself. Whatever happens, be nice to the agent who deals with me. Anger is the ticket to flipping out. Breathe, be nice, no anger.

Soon an agent was handling my case. A ticket for a morning flight. A voucher for a hotel. I would have four hours of precious sleep. The crisis was over. But this was way too close for comfort.

To be continued ...

From Pittsburgh: Awards Night

It’s past 11 PM. I just got back from an awards dinner at the Eighth International Conference on Bipolar Disorder in Pittsburgh. This particular dinner is special to me. Allow me to explain:

The Conference honors the memory of Mogens Schou, the late Danish psychiatrist who pioneered lithium treatment in the 1960s, which revolutionized psychiatry and offered hope to millions. Each meeting, the Conference singles out individuals for outstanding achievement in three categories: Education and Advocacy, Research, and Public Service. The Mogens Schou Award is recognized as the highest honor one can attain in the field of bipolar. Past recipients have included Mogens Schou, Kay Jamison, and such paradigm-shifting researchers as Husseini Manji.

At the previous meeting, two years ago, I received the Mogens Schou Award for Public Service. I could say a number of things, but let’s leave it at the fact that I was flabbergasted, humbled, and honored.

This year’s Mogens Schou Award recipients:

Lakshmi Yatham, for Education and Advocacy: Dr Yatham of the University of British Columbia, through various leadership positions including president of the International Society for Bipolar Disorders has been instrumental in improving treatment and diagnostic standards within the medical profession and amongst the general public.

Guy Goodwin, for research: Dr Goodwin, of Oxford University, has been involved in research into the neurobiology of bipolar and psychopharmacology, including developing the basis for large scale and low budget real world clinical trials, including BALANCE, which you will hear a lot more about fairly soon.

Joyce and Dusty Sang, for public service: In 2004, the Sangs, who have a lifelong commitment to public service, created the Ryan Licht Sang Foundation which has fostered awareness, understanding, and research for child and adolescent bipolar.

At the first available opportunity, I introduced myself to the Sangs and told them how honored I felt that they received the Award. We instantly connected. The Sangs got involved through the suicide of their only child, Ryan, age 24. Joyce pinned a Foundation lapel pin on my jacket, which I will continue to wear in memory of their son and as a tribute to their work.

I found my voice catching several times in the conversation.

As I said, this particular dinner is special to me.