Thursday, December 31, 2009

iPhone Photo of the Day - Trees in the Sky

Today I was walking through a pine forest on the crest of Mt Laguna, 6,000 feet above sea level, about 10 miles from my home.

Rerun - Some Observations on Stigma

It is fitting to close out the last day of 2009 with a blog piece from the first day of 2009. Enjoy ...

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

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

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

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

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

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

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

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

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

Complete IamBipolar Interview


A very warm thank you to all my readers. This blog began as an experiment in 2009, as a way of tackling new and challenging topics and reaching out to a wider audience. I am particularly heartened by the many new bonds I have established, and look forward to strengthening these associations throughout 2010. To each and every one of you, a happy and hopeful 2010.

Wednesday, December 30, 2009

My Friend Kevin - Looking Back

The end of the year is both a time of looking back and looking ahead. So it is that I am reflecting on my friend Kevin Greim, who, on a miserable muggy New Jersey morning in September, 2008, threw himself in front of a train. He was 28.

Five years ago, I was facilitating a DBSA support group in Princeton, NJ. In walked Kevin, exuding a goofy charm, baseball cap on backward. But there was something about his presence that indicated he was no mere goofball. The others in the room felt it, too.

As we grew closer, he began opening up to me. Kevin was a Jehovah’s Witness. It was a faith he had arrived at rather one he was born into. As he explained to me and others, his faith provided handrails. His life now had purpose, direction. His ultimate goal was to do full-time missionary work.

But he had his setbacks, his dark moments. And his illness, his illness ...

I recall a long conversation with him over coffee, in which he recounted to me a number of difficulties he was dealing with on the missionary path.

Life as a missionary wasn’t meant to be easy, I responded sympathetically, especially if you are God’s chosen. I paraphrased a key passage from Second Corinthians for him as best as I could:

"Thrice was I beaten with rods, once was I stoned, thrice I suffered shipwreck, a night and a day I have been in the deep."

Paul was on a mission, literally a mission from God. His first two Letters - Romans and First Corinthians - reflect the optimism of one with God on his side: confident, bossy, out to change the world.

Second Corinthians, written many years later, reflects a different Paul: weary and disenchanted, struggling to keep his faith. Acts of the Apostles reports Paul being set upon and left for dead by a mob in Antioch and at the mercy of another in Ephesus.

My take, as I related to Kevin went like this: Here’s God telling Paul in effect, “You presume to act in My name, well then ... let's see how sincere you are after a mob has tried to crack open your skull, you find yourself holding on for dear life to a piece of boat in the open sea, your friends have turned on you, your followers have abandoned you, and your love is returned in endless measure with unbridled hate.”

It's not in God's nature to make things easy, I went on to tell Kevin. You want an easy life, then do something easy. You want to accomplish something, well don't expect any breaks. The nature of things is that you will be tested.

Of all things, my bleak little homily had the effect of cheering Kevin up. I think my friend felt that he alone was responsible for his own difficulties. Having his mettle tested by God was an entirely different proposition.

Kevin, in turn, told me something I did not know: In Nazi Germany and elsewhere in Europe, the Witnesses stood up to Hitler. At great risk to their own personal freedom and safety, they befriended Jews, they patronized Jewish businesses. Ultimately, 12,000 were sent to the camps, where 2,000 died. A purple triangle on their prison garb identified them by their religion.

I thought of other faiths that had virtually rolled over and played dead for Hitler. These Witnesses had guts, I could only think. 

Kevin is gone. But today, thanks to my friend, you are reading something positive about Jehovah’s Witnesses, perhaps for the first time in your life. I like to think that Kevin succeeded in his mission.

Tuesday, December 29, 2009

Rerun - My Favorite Mental Health Blogs

I originally ran this in August. The end of the year is a suitable time for a rerun. Note: Two of my favorite bloggers on this lists have books just about to come out: Therese Borchard (Beyond Blue) and Gretchen Rubin (The Happiness Project), both which I very highly recommend. (Click the links for my reasons.)

Enjoy ...

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." - 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.

Monday, December 28, 2009

My Mental Health Heroes of the Year - 2009

My true heroes in mental health are those whose efforts never come to our attention, yet change lives: A mother who battles indifferent clinicians and bureaucrats on behalf of her kid; a volunteer who arrives early to turn on lights and arrange chairs and greet visitors; a doctor who refuses to give up on a patient, a postgrad research assistant laboring tirelessly on peasant wages; a middle manager who sticks his neck out on a risky hire; a patient who falls down seven times and gets up eight ...

My choices here are confined to the public realm, and are restricted by my limited awareness - a fact which may have excluded worthy candidates but hardly diminishes the accomplishments of those cited here. Further, they all got started toiling in obscurity. Thus, even though I am singing praises to a select few, I urge you to think of this piece as a tribute to all our mental health heroes.

Without further ado ...

Public person hero of the year - Barack Obama. No question about it. This man has put it all on the line in support of the proposition that the government serves all the people and not just the privileged few. We may not get the health care reform we need, but thanks to the President’s heroic efforts it appears we will get a much better deal than the rotten one that insurance companies, death panel nutjobs, and various enemies of the people tell us we should shut up and be grateful for.

Internet hero of the year - Katherine Stone. Katherine’s blog Postpartum Progress is a must-read on a normal day. In May, she outdid herself with a Mother’s Day Rally for Moms' Mental Health, featuring an all-star line-up of “warrior mother” guest bloggers whose contributions cast a bright light on a dimly-lit area of mental illness.

Soon after, in July, Katherine publicly scolded the editors of Time Magazine “for allowing an article on a topic that they clearly knew so little about to be published,” then rallied fellow advocates and experts in a letter to Time. Of all things, in its Person of the Year issue, Time singled out Katherine’s letter as one of its “Letters of the Year” of 2009.

Research hero of the year - David Braff MD. Think of this as homage to all of those brilliant individuals who have dedicated their lives to figuring out new ways to improve ours. Earlier this year, Dr Braff of UCSD received the prestigious Warren Award from the International Congress of Schizophrenia Research. In his Award lecture, I heard Dr Braff discuss “endophenotype,” a field he has pioneered and which is revolutionizing psychiatric research.

Endophenotype allows researchers to investigate an outward feature (phenotype) such as psychosis by looking at underlying phenomena, such as the inability of the brain to filter out sensory stimuli. Today's thinking-outside-the-box translates into tomorrow's practical applications. As this blog says, "Knowledge is Necessity."

Advocate hero of the year- Kathi Stringer. The reason you have probably not heard of Kathi is that she is smart rather than loud. Loud is the unfortunate tendency of mental health advocacy and it has gotten us next to nowhere. For years, Kathi, who is based in Riverside, CA, has quietly championed quality improvement (QI). For years, hardly anyone listened. This year, people are listening.

Kathi comes from a machinist background, where things need to be done right. As an example, if aeronautics refused to apply QI, we would constantly have planes falling out of the sky. QI, which is well-known in every aspect of manufacturing and services, including health, is ignored in mental health. But, as Kathi explains, nearly all the standards we need to improve mental health services are already codified into law and in contracts. We just need smart advocates to act as vigilant watchdogs. Then change can happen, and happen fast.

This summer, at a NAMI CA conference, I heard Kathi lead a workshop on QI. You could have heard a pin drop.

Media hero of the year - “The Soloist.” The movie, based on Steve Lopez’ book of the same name, recounts the real-life relationship between journalist Lopez and homeless music prodigy Nathaniel Ayers. Unlike “Shine” and “A Beautiful Mind,” which end triumphantly on major chords, “The Soloist” concludes on an uneasy note. Rather than the hero-outsider making it in “our” world, we must come to terms with the outsider choosing to remain firmly planted in his. In doing so, we are forced to face our own fears and ignorance.

My guess is that as recently as a few years ago, even the most informed amongst us would not have been ready for this. The fact that the movie met with the success it has is a tribute to our ability to change.

Recovery hero of the year - Abraham Low Self-Help Systems (ALSHS). Recently, Recovery Inc changed its name to Recovery International, then merged with the Abraham Low Institute, which resulted in its present name. Recovery Inc was founded in 1937 by neuropsychiatrist Abraham Low (pictured here), who espoused the radical idea that - with the right cognitive skills and peer help - patients could recover from even severe mental illness. Some 600 self-help groups exist worldwide.

In its new incarnation, ALSHS is retooling to reach out to a wider audience. Stay tuned  ...

My profound appreciation to this year's heroes, both the ones mentioned here and all those who in their own ways are making our world a better place.

Sunday, December 27, 2009

Saturday Drive - Desert View Tower

You gotta love the Old West. I'm 40 miles east of my home, in Jacumba, near the Mexican border, just off Interstate 80. This tower is technically a millionaire's tribute to the workers who labored to carve a road through the impenetrable moonscape that guards the east to west approach into San Diego. In reality, you are looking at a tribute to the glory days of eccentric millionaires. This was built by Bert Vaughan over a five-year span in the 1920s.

This is a view from inside the tower, taken on my iPhone.

An amazing moonscape.

Looking out in the other direction. Below, one of the early roads into San Diego county, probably old Highway 80.

Looking out further into the Anza Borrego Desert and Imperial Valley 3,000 feet below.

Just outside the Tower. Is this too cool for words or what? Thank Merle Ratcliff, an unemployed engineer during the Great Depression.

Down on the desert floor.

Rerun - My Top Mental Health Stories

The near-end to both a year and a decade is a good time to repost this piece, originally published in May. Had the President signed into law a version of health care reform in the interim, I would have expanded this to a Top Eleven list. Hopefully, a Presidential signature will lead a new Top Ten list for the upcoming decade. Enjoy ...

Following is what I view as the ten most significant events or trends affecting all of mental health in my ten years researching and reporting on my illness. Obviously, had I been reporting on say schizophrenia rather than bipolar my list would be different. Then again, only one entry here is bipolar-specific. So, without further ado, in no particular order:

Recognition of child bipolar

Ten years ago, virtually everyone thought you had to be of voting age to qualify for a bipolar diagnosis. A lot of the credit for changing that misconception goes to the parents, who have taken it upon themselves to educate clinicians and educators. There has been a noisy public backlash over labeling and medicating kids, but the alternative of turning your back on them is totally unthinkable.

Key people: Demitri and Janice Papolos, authors of "The Bipolar Child"; Joseph Biederman, Harvard child psychiatrist and paradigm-shifter.

Bottom line: A child who jumps out of a moving vehicle has something very serious going on. Finally, we have woken up and are doing something about it.

Coming of age of borderline personality diagnosis

Surely, the thinking went, there could be no biological basis to this Freudian artifact. Guess what? The brain scans tell a different story. The scientific evidence, coupled with proof that interventions such as DBT work, not to mention the realization that borderline may be one reason why many so-called bipolar patients do not get better, is slowly shaking psychiatry out of its denial and raising public awareness.

Key people: Marsha Linehan, developer of DBT; Paul Mason and Randi Kreger, authors of "Stop Walking on Eggshells."

Bottom line: Countless individuals currently living tortured lives can look forward to a fresh start.

Brain science research

Where to start? The mapping out of stress-vulnerability and thought and modulation pathways, new revelations about plasticity and brain cell growth, new discoveries into how neurons work, new insights into how the brain interacts with the environment, the emergence of brain development as an explanation for mental illness, plus a host of candidate illness genes and the mapping the human genome ...

Key people: Eric Kandel, Arvid Carlsson, Paul Greengard, who shared the 2000 Nobel Prize in Medicine for their work in how neurons communicate.

Bottom line: Very smart people are changing the way we think, and - eventually - how we live.

Validation of talking therapies

CBT, interpersonal therapy, and other short-term therapies focusing on the here and now have been around since at least the seventies. But only in the last decade do we have the studies to prove just how useful these interventions are. Their popularity is growing, along with new applications, including CBT for schizophrenia (once regarded as a waste of time).

Key people: Aaron Beck and David Burns, founder and popularizer of CBT, respectively.

Bottom line: Growing numbers are learning to actively take charge of their own brains.

The spectrum concept

It's not whether you have bipolar - it's how much bipolar you may have. In other words, your depression may be more than just depression. In addition, the spectrum concept is encouraging researchers and clinicians to more closely examine various relationships between supposedly separate illnesses such as schizophrenia and autism - not to mention how such things as temperament and illness interact - and come up with original insights.

Key people: Hagop Akiskal, bipolar spectrum proponent; Robert Cloninger, personality pattern-spotter and paradigm-shifter.

Bottom line: The brain is not organized according to the DSM. Thank heaven for that.

Recovery movement

Earth to psychiatry: We want to get well, not just stable. We want to have lives, not just subsist as over-medicated zombies. In response, patients have taken matters into their own hands, with a growing grass roots recovery movement that trains peer specialists and encourages patients to take positive steps to move their lives forward.

Key people: Mary Ellen Copeland, proponent of WRAP; Daniel Fisher, recovery rabble-rouser; Eugene Johnson, founder of Recovery Innovations.

Bottom line: Psychiatry makes us stable. Only we can make ourselves well.

Patients and loved ones figure out the internet

Suddenly, we weren't alone and isolated. We could talk to each other online, support each other, learn, organize, and advocate. In addition, we could find information on our own from expert sources, then become our own experts. The downside, of course, is what happens with this tool in the hands of the ignorant and unprincipled.

Key people: Martha Hellander, founder of the Child and Adolescent Bipolar Foundation, the first internet-based mental health advocacy organization; Peter Frishauf, founder of Medscape; Deborah Gray, founder of "Wing of Madness," the template for many patient sites to follow.

Bottom line: For better and worse, the internet is where most of us go to for information and support.

Beginning of the end of drug companies

Everything seemed to happen at once: Patients and doctors seeing through the Pharma hype, blockbuster meds losing their patent protection, and no new meds coming out of the pipeline. No longer with any financial interest in influencing psychiatry, Pharma virtually backed out of the game. And with mega lost revenues from loss of patent protection, Pharma may lack the resources to ever get back in it.

Bottom line: Due to their arrogance and stupidity, Pharma fully deserves what's coming, but do we?

Deterioration in services

Not being able to afford meds and the doctors who prescribe them is only a small part of the problem. Lack of access to costly and time-consuming services is major. You name it - long-term therapy, psychiatric rehabilitation, higher education, crisis intervention, social services, vocational training, jail diversion, decent housing - not only is the money not there; the system is seemingly designed to fail us.

Bottom line: In this economy, things are only going to get worse.

Returning vets mental illness time bomb

Vets are returning from Iraq and Afghanistan with high rates of mental illness, or at high risk of mental illness, including PTSD and depression. Add to that the challenges in fitting back into society, then consider what many do to cope, such as drugs and alcohol.

Bottom line: Vietnam vets account for a large percentage of the homeless. Unless we act fast and plan long term, a new generation of vets will join them.

Big story of the next ten years: The current economic crisis

Whichever way events play out, society's most vulnerable will be the hardest hit, and those better off aren't immune either. Nevertheless, before we predict a pandemic of stress-related mental illness, the data shows that people actually experience better health and live longer when times are bad. Something to do with a return to core values?

Bottom line: However we come out of this, nothing is ever going to be the same again.

Saturday, December 26, 2009

Therese Borchard's Amazing New Book

I had the pleasure of reading an advance copy of Therese Borchard’s new book, BEYOND BLUE, which is title of her highly-acclaimed blog. (Long title of her book: "Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes"). Over the last year, Therese has become one of my favorite people. Here is the endorsement I sent to Therese’s publisher:

I don't know how Therese does it - a singularly unique woman who strikes a universal chord, a one-of-a-kind that we can all relate to. 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. This is a book for the ages.

The publisher chopped this to a single sentence back cover blurb (to make room for the other rave endorsements, I might add).

The book goes on sale in January, but Amazon has it in stock right now. I have heard that Amazon orders heavily influence whether book stores will stock certain books or not, so I strongly urge all of you to order from Amazon now.

Any follower of Therese is well acquainted with her keen sense of humor. To give you a feel for her style, I rounded up these extracts (with her permission) from some of her funniest blog pieces. Enjoy ...

Fear of Fish

From a blog piece on competing in a triathalon:

You’d think the paranoia would end as soon as I could exit the sooty pond, but not for an OCDer.

As I sat on my bike seat, I heard a squishing sound.

"I heard the fish. I just squashed it! I knew it!"

"It’s probably the padding in your shorts. Chill out. And even if you managed to catch one, he’ll be dead by the time the ride is over."

"But I can’t ride 14.2 miles with a dead Nemo in my pants!"

Every time I shifted gears, I thought about Nemo, wondering how he was doing. In fact, no matter how hard I tried to direct my thoughts to something else, preferably the race I was participating in, I continued to freak out about the fish.

Like when I passed a chicken farm, about a half of a mile into the run.

"I smell it! It’s a whole family of fish, reproducing as I run! Nothing short of a fish school drying out could smell that bad!"

I finally crossed the finish line singing the tune from "The Little Mermaid": "Les poisons, les poisons, how I love les poisons!"

Which was fitting, because considering all the seaweed (but no fish!) that fell off of me in the shower afterward, you’d think I was "The Big Mermaid."

Trash Night

A year or so ago, I got fed up with my mate's constant begging for sex, so one night I asked him point blank, "What is the minimal number of times a week that you need sex in order to be satisfied?"

"Twice. Absolute minimum."

"Fine," I said. "You get Monday and Thursday. If you don't beg any other night."

It then occurred to me that Monday and Thursday evenings were trash night. We drag out all of our rubbish and recyclables from the last few days and leave the stuff on the curb ... to be picked up at 5 a.m. the next day, when the trash truck compressors will try to wake up our slumbering kids.

Yes, trash night is sex night in our household. Clearly a "Seinfeld" episode in the making.

This concept ... of a scheduled sex session ... was so intriguing to the other birthday guests that trash talk dominated the entire conversation for the rest of the evening.

"What about bulk pick up?" one asked.

"And what if you miss a day?" asked another.

"Eric's lucky," said the guy crossing his legs. "Our trash is only picked up once a month."

Schedule of a HSF (Highly Sensitive Family)

A typical Saturday morning in our highly-sensitive house looks like this:

2:00 a.m. HSH (highly sensitive husband) goes downstairs to sleep on the couch because he keeps getting awoken by the loud snoring of his HSW (highly sensitive wife), who is having anxiety dreams (she missed her final exam because she got carried away with the ice-cream machine at the dining hall--filling up 21 small paper ketchup containers with all the different flavors, all of which are too cold on her highly sensitive teeth).

2:10 a.m. HSH is back upstairs to get a softer pillow for his highly sensitive head.

5:15 a.m. The state of South Dakota on the HSB's (highly sensitive boy's) talking puzzle of the United States wakes up HSH again. He bangs it with his highly sensitive hand, but it won't stop saying "Pierre is the capital of South Dakota. Population, 14,000."

Finally, the miffed HSH goes into his highly sensitive woodshop (the garage) to get a screwdriver to dismantle the thing. As he yanks the IN (insensitive) AA Energizer batteries out of there, it finally shuts up. This reminds HSH of the time his HSW tossed a Winnie the Pooh keychain into the back yard when it got stuck playing the Winnie the Pooh theme song. (Her efforts with a hammer in the woodshop didn't succeed at rendering the thing mute ... So every time she opened the back door to let the dogs do their business for three days--until the AA Energizers finally surrendered--she heard the annoying tune.)


Lots more from Therese in future blogs. In the meantime, don’t delay: please order from Amazon now.

Friday, December 25, 2009

iPhone Photos of the Day - Celestial Bodies

Above: I'm at 6,100 feet at one of the four telescopes of the Mount Laguna Observatory, operated by San Diego State University. That small faint speck to the right of the observatory dome is the moon.

Below: I'm standing from the same vantage point, looking into the sun.

A Holiday Sentiment

And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people.

For unto you is born this day in the city of David a Saviour, which is Christ the Lord.

And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger.

And suddenly there was with the angel a multitude of the heavenly host praising God, and saying,

Glory to God in the highest, and on earth peace, good will toward men. 

- Luke 2:10-14

Thursday, December 24, 2009

Gretchen Rubin Takes on the Happiness Challenge

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.  An article in the Dec 21 New York Times reports on an academic study that found that New York ranks last in happiness. Perhaps Buffalo or Albany was over-represented in the study. But no, New York’s neighbors Connecticut and New Jersey - the two richest states in the nation - were nearly as miserable.

So, can a New Yorker achieve happiness? And should we be paying attention?

Gotham's Gretchen Rubin (pictured here) decided to take up the challenge. Gretchen is a highly-regarded author who 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."

The result is her new book, The Happiness Project: Or, Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun.

In her blog of the same name as the short title to her book, Gretchen observes: "The biggest challenge of a happiness project isn’t figuring out what resolutions I should make, but actually sticking to my resolutions. ... "

Ah, resolutions. These brief extracts from her blog hint at what to expect from Gretchen’s eagerly-awaited book:


I've written before about my resolution to Get more sleep, and I'm bringing it up again, because I'm truly convinced that this is one of the first aspects of life to tackle when you start a happiness project.

It's easy to become accustomed to being sleep-deprived, but it's not good for you. Many researchers argue that not getting enough sleep has broad health consequences, such as raising your risk for cancer, heart disease, diabetes, and even obesity, but in addition to those, it has a profound effect on your happiness.

One study showed that a bad night's sleep was one of the top two reasons for being in a bad mood at work (the other? Tight work deadlines). Another study suggested that getting one extra hour of sleep each night would do more for your daily happiness than getting a $60,000 raise. ...


I have a friend who is a yoga instructor and a friend who is a strength-training trainer. I asked them if they recognized any warning signs in people who are likely NOT to stick to a resolution to start exercising.

They both agreed that there are warning signs. ...

“Well, afternoons don’t work. And I can’t do mornings. I can come Tuesdays at noon, but not this Tuesday. Or next Tuesday...”

The President of the United States works out almost every day! If people really want to exercise, they find the time.

“I’ll squeeze it in at lunchtime. I can just run out between meetings.”

This person hasn’t acknowledged to himself that exercise must be its own priority, and if he doesn’t do that, it’ll always get shoved to the bottom of the to-do list. Which means it won't happen.

“I can’t wait to start. But first, I need to buy some new clothes. And some new shoes. And a mat. And I want to read up on it, too.”

I had a roommate like this. She loved shopping and everything involved in the preparation stage. But once she had all the stuff she needed for yoga or roller-blading or whatever, she lost interest.


When you’re feeling blue or overwhelmed, it’s tempting to try to pick yourself up by indulging in a “treat.” Unfortunately, a guilty pleasure is often just that – an ice-cream sundae, a cigarette, an extra glass of wine, an expensive splurge, and other treats give a short-term boost, but then just deepen your blues as guilt and remorse set in.

I realized that one of my personal “treats” is the decision not to pick up after myself. Instead of trying to tidy as I go, as I usually do, I let small tasks mount up. “I can’t possibly be expected to do something like that,” I tell myself. “I’m too busy/too frazzled/too upset/too rushed. I deserve a break.”

The problem is that, in the end, the mess makes me feel worse. Maybe I enjoy a tiny buzz from flinging my coat onto the hall floor, but the disorder just makes my bad mood deepen. (Plus it’s not nice for anyone else, either.) On the other hand, serene, orderly surroundings make me feel better. Outer order brings inner calm.

Now, instead of “treating” myself to a mess, I make a special effort to keep things tidy when I’m feeling low. ...


The Happiness Project is shaping up as one of the must-reads for 2010. You can pre-order on

Much more from Gretchen in blogs to come ...

One Year Old

Many many thanks to you - my readers - for your support and encouragement. I look at "Knowledge is Necessity" as a collaborative effort. On one hand, this blog is about issues and events "as seen through my eyes." On the other, you are the ones who are giving me the cues of what I need to be looking at.

Thanks to you, my eyes have been opened in endless combinations of unforeseen ways. Here's to another year of a great collaboration. And a happy - and safe - holidays to all.

Wednesday, December 23, 2009

Rerun - My Cats: The Reason I No Longer Suck At Water Volleyball

This is one of my first blog pieces on "Knowledge is Necessity," from late December last year. Enjoy ...

There is very good science to support the proposition that pets promote mental health. But did you know they can also lift your water volleyball game to new levels?

I acquired Rocky and Bullwinkle about four months ago, when they were kittens five weeks old. Instantly, I was wearing them like an extra article of clothing. If I'm at my computer they're at my computer, if I'm in bed they're in bed, if I'm in the bathroom, well never mind ...

Literally, I'm forever peeling these little fur balls off my lap, my chest, my legs, my shoulders, my head. Then there's the constant challenge of heading them off at the pass. Off the keyboard, off the kitchen counter, off the prime real estate on the mattress.

Now it's time to discuss water volleyball. I started playing the game on most Saturdays about two years ago. At first I couldn't hit anything, but soon I improved to a level where I really sucked. Then I plateaued. For two years, I amazed my fellow enthusiasts with my singular ability to make gravity unpredictable.

You see, all my life, me and gravity never got along.

Then, about a month ago, something funny happened. Actually, something statistically improbable, which is a polite term for impossible. In the pool, I became the Four Horsemen of the Apocalypse. Literally, the ball didn't have a chance against me. I tracked it like radar. I swatted it in mid-flight like King Kong smacking bi-wing airplanes. I dispatched it on inerrant trajectories that left everyone in the pool slack-jawed in amazement.

There is a very elegant mathematical theory to explain what happened, but essentially it boils down to every dog has his day. Now that I had mine, I could go back my normal dysfunctional relationship with gravity.

But the next week, something really funny happened. I didn't suck nearly as bad as I used to. And the week after, I exhibited flashes of my eye-popping Apocalyptic brilliance. What was going on?

Earlier, I had consulted an expert, a friend who hustles pool. He told me that my body has literally learned all the moves, and that it is my tendency to over-think that sabotages my performance. Apparently, this is a universal human failing.

Yeh, right, I thought. How could my body have possibly learned water volleyball moves? It's not like I actually practiced.

I brought the matter up with Paul, who is responsible for introducing me to water volleyball. I was seated in the living room with my laptop, peeling cats off me. Deftly, with my right hand, I snatched Bullwinkle off my left shoulder and flicked her to a soft landing on the carpet. A micro-second later, without looking, I had Rocky in my left hand, ready for launching.

Suddenly, a light bulb went off. A revelation, one of those Newton under the apple tree moments. I looked at Rocky, squirming in my hand with one of those "what is YOUR problem" looks.

I got it! I shouted excitedly. It's the cats!

All day, all night. At work, while relaxing, in my sleep, I'm forever peeling cats off of me. I explained how all my life I had been hopelessly uncoordinated. Now, thanks to the cats, that was no longer the case.

My pool hustler friend was right. My body had learned the moves.

Not only that, practicing on the cats was way better than using a volley ball. You see, cats have legs. They keep returning to you. You don't have to retrieve them. Volley balls, on the other hand, just keep rolling away.

It was the only explanation, I told Paul. All my life, my limbs have been free-lancing on me. Now, because of the cats, my arms were virtual extensions of my body rather than independent organisms. I could actually will them to do what I wanted them to do. In my sleep, literally.

To Paul's credit, he humored me. But I could see he wasn't convinced.

A day or two later, when I got back in the pool, I served nine straight points before firing the ball into the net. Then, next time serving, another nine straight. It had to be the cats. Yes, everyone in the pool agreed, it had to be the cats.

Right now, Bullwinkle is on the ledge of my window. In a second, she is about to put two paws on the top of my computer screen, then she will shift her weight in a way that will require my intervention.

Hmm, I'm thinking. Instead of just grabbing her and flicking her away, what if I swatted her and put a topspin on her? That would really improve my performance.

Aw, Bullwinkle, I didn't mean that. Here, come sit on my lap.

Oh, oh. Accusing cat eyes. "I am NOT your volleyball!" she let me know, before ducking through the cat door.

Could this be the end?

Monday, December 21, 2009

iPhone Photo of the Day - Swami on a Surfboard

You were going to get a pic of the ocean north of San Diego, then I happened to grab a bite to eat nearby in Encinitas at a place called Swami's Cafe. There, as I was placing my order, I did a double take at the mural. No, your eyes are not playing tricks on you. That's a likeness of Paramahansa Yogananda riding the waves.

Close observation reveals that Yogananda has achieved a rare state of surfing perfection.

As many of you know, Yogananda is founder of the Self-Realization Fellowship and author of "Autobiography of a Yogi"(1946), which had a profound influence on no end of individuals seeking greater meaning in their lives (myself included). Yogananda is also one of the luminaries who graced The Beatles' seminal "Sgt Pepper's Lonely Heart's Club Band" album cover, another example of perfection, this time in the pop arts.

My mahi-mahi wrap, by the way, was perfect.

Sunday, December 20, 2009

The Ultimate Self-Awareness Dialogue

India, sometime during the second century AD: Indo-Greek King Milanda and his retinue drop in on the famed Buddhist sage, Nagasena. “How is your reverence called?” Milanda asks.

“O great king,” Nagasena responds. “As Nagasena I am known, and as Nagasena do my fellow religious habitually address me.  … Nevertheless this word ‘Nagasena’ is just a denomination, a designation, a conceptual term, a current appellation, a mere name.  For no real person can here be apprehended.”

We should have known better than to expect a straightforward answer from a sage. Fortunately, ancient heads of state had a lot of time on their hands:

“Now listen, you 500 Greeks and 80,000 monks,” Milanda responds. “This Nagasena tells me that he is not a real person. How can I be expected to agree with that?” Then, addressing Nagasena, he enquires that if the party to whom he is speaking is not real, then who is it who consumes food and medicine, guards morality, and practices meditation? And because he really has a lot of time on his hands, Milanda throws in a generous litany of all manner of activities a sage - and a sage in non-sage moments - might indulge in. Finally, he ties a bow on his query with this question:

“What then is this ‘Nagasena’? Are perhaps the hairs of the head ‘Nagasena’?”

This is the cue for a laconic change-up: “No, great king!” Nagasena responds.

“Or perhaps the hairs of the body?”

“No, great king!”

We’ll compassionately spare you the full inventory of teeth, skin, muscles, sinew, and snot, not to mention feelings, perceptions, and so on, and in combination, that flow off Milanda's regal tongue. Now Nagasena turns the conversation around to Milanda’s mode of transportation:

“Please explain to me what a chariot is. Is the pole the chariot?”

“No, reverend Sir!”

The wheels, the framework, the flag-staff, the yoke, the reins, the goadstick? In combination?

At last, Milanda is forced to concede there is no chariot, that it is simply a “designation, this conceptual term, a current appellation, and a mere name.”

So who the hell are we? Draw any lesson you wish from the conversation.

Saturday, December 19, 2009

iPhone Photo of the Day - Cat TV

How much of The Fish Network can a guy take?

My Augustine Depression

A couple of nights ago, I felt myself slide into what I call my Augustine of Hippo depression. Imagine waking up one fine day in 410 AD, only to discover that Alaric the Visigoth has sacked Rome, thereby launching the Dark Ages and making stupidity fashionable. That’s kind of what happened to me one bleak and miserable November evening of 2004 when I returned home thinking I had fired the President, only to discover the very opposite had occurred.

This couldn’t be happening, I could only think. Not in a civilized society.

Augustine’s resulting meditative funk led to “City of God,” mine to “Living Well With Depression and Bipolar Disorder.” Okay, I’m no Augustine - don’t make me any more depressed than I am.

What happened the other night was more of a mini-Augustine depression. I turned on the TV only to discover that the asshole Joe Lieberman had succeeded in forcing both the Senate majority and the Administration to roll over and play dead for him. Real universal healthcare was off the table. In its place was a government hand-out to the insurance industry masquerading as reform.

End of civilization, I decided.

I have a tendency to get carried away. Bear with me ...

This year, the Wilkins Ice Shelf (a whole friggin’ ice shelf!) up and collapsed on us. Earlier, the entire world economic system nearly did the same. What next? A killer comet named after Lieberman?

We know the Roman Empire was in a state of decline long before Alaric and his fellow barbarians dealt the coup de grace. In the third century, the Empire suffered an economic collapse from which it never recovered, resulting in profound changes that set the scene for anarchy, serfdom, and ignorance. Significantly, the middle classes all but disappeared. Thomas Cahill in “How the Irish Saved Civilization” even notes the poetry got bad. More important, as the end drew near, education had virtually vanished. The culture of stupid was fully locked in place.

It’s way too soon to tell whether today’s US equates to the Rome of the third century. Having said that, our culture of stupid is a major worry. Can you name three celebrity airheads with relationship difficulties? Easy. Can you name two Nobel Laureates this year besides Obama? Don’t worry. Neither can I.

A bad economy or a fragile environment is only a crisis if we place no value on the brain power we need to think our way through these situations. But we can't even figure out health care. We've ceded sovereignty to the idiots. Are we really that stupid? Now I’m starting to get worried ...   

Friday, December 18, 2009

iPhone Photo of the Day - Controlled Burn

I shot this today about 20 miles from home. That gray wisp on the mountains is a controlled burn. Six years ago, along this same landscape, firefighters battled Armageddon, the Cedar Fire of 2003 that killed 15 people, including the firefighter for whom this stretch of road is named - Steven Rucker.

Surviving the Holidays

Shortly before Thanksgiving, on BipolarConnect, I offered this holiday advice:

  • Keep your expectations low. We tend to do the very opposite, then find ourselves dealing with the disappointment. You will be a lot better off if you don't think of the holidays as a time to strengthen your bond to your loved one, impress your parents, reconcile with a difficult brother or sister, or be a hero to your nieces and nephews.
  • Take time out for yourself. The holidays put us in situations where we are easily overstimulated and overwhelmed. If you sense a force nine family fight about to break out at the table, don't be afraid to summarily remove yourself from the scene. The same holds true even if there is no family tension, even if everyone is enjoying themselves. You don't need a good excuse to make an exit - any bad one will do.
  • Plan ahead. The less surprises the better. The less last-minute rushing around the better.
  • Figure out your needs. Some of us need to be around people. Some of us are better off taking a Sabbatical from humanity. Don't let family obligations and other duties affect your decision. We are all dealing with a severe chronic illness, with huge consequences when things go wrong. Interpersonal stresses can set us up for a crash and burn at one end, isolation can make us sitting ducks at the other. The only wrong decision is the one you make against your own best judgment.

Finally: Don't be afraid to have a happy holidays. They have been known to happen.

Two of my favorite bloggers, Therese Borchard of Beyond Blue and Willa Goodfellow of Prozac Monologues cover the territory with a lot more depth and insight. On a normal day, their blogs are to me what coffee is to Starbucks. For the holidays, they are a must-read:

From Willa:
From Therese:

Rerun - Mozart, Genius, and Practice-Practice-Practice

I published the following in May. Happy reading ...

Consider Mozart, who wrote his first symphony in utero and performed in his own rock opera at age five months, changing his own diapers (admittedly with mixed results) between acts. Clearly this is genius personified.

Not so fast, writes NY Times columnist David Brooks. Those early compositions of his were strictly kid stuff, and his performing skills as a child prodigy are highly over-rated. The Mozart you encounter in concert and opera halls is the product of an adult mind honed to a fine creative edge through years and years of unstinting effort.

Writes Brooks:

“What Mozart had, we now believe, was the same thing Tiger Woods had - the ability to focus for long periods of time and a father intent on improving his skills.”

Rather than some mystical divine spark or high IQ, genius may be as mundane as practice-practice-practice. Citing two new books - “The Talent Code” by Daniel Coyle and “Talent is Overrated” by Geoff Colvin - Brooks says it helps to have some kind of adult role model as a kid, say a novelist living in your town. Then you might dare imagine yourself writing your own masterwork. Armed with this ambition, you would start reading novels and literary biographies and thus attain a core knowledge of the field.

Mind you, it doesn't hurt if you have a bit more going for you than Lennie in "Of Mouse and Men."

Anyway, here you are - somewhere north of Lennie and south of Einstein - slowly building up your body of knowledge. Next thing, you're engaging in the intellectual equivalent of playing with your food, moving ideas around, divining patterns (excellent for the memory), and otherwise thinking like a novelist.

Then practice-practice-practice until your mind turns labored conscious skills into effortless unconscious ones. But the mind is sloppy, Brooks advises, and tends to settle for good enough. So, you practice your routines slowly. You break down your efforts into tiny parts and repeat-repeat-repeat until the brain internalizes a better pattern of performance.

At the right time, a mentor steps in who provides feedback, corrects your tiniest errors, and pushes you to tougher challenges. By now, your brain is programmed to understand and solve future problems.

According to Brooks, the primary trait is not genius. Rather, “it is the ability to develop a deliberate, strenuous and boring practice routine.” The hard wiring of our genes plays a part, but Brooks concludes, “the brain is also phenomenally plastic. We construct ourselves through behavior. As Coyle observes, it’s not who you are, it’s what you do.”

So back to Mozart. According to critics, as reported in Wikipedia, Mozart composed his "breakthrough work," his Ninth Piano Concerto, when he was 21. The concerto has been assigned a "Kochel listing" of 271, which implies a vast body of work that fell short before the composer hit his stride. Practice-practice-practice.

But for Mozart, good enough was not good enough. After forming a friendship with Franz Joseph Haydn and developing an appreciation for the Baroque masters, Mozart did the equivalent of changing his golf swing, which set the stage for the transcendent pieces by which we know him best.

"The Marriage of Figaro", "Jupiter Symphony", and his "Requiem" - among many others - are the work of a man in his thirties.

In short, geniuses are made, not born. Or are they? Certainly others have labored as long and hard as Mozart only to become industrious drudges lacking that - ahem - divine spark. Think Salieri.

So why don't we forget about outcome - we can't control whether we will end up geniuses or not. But we can control process - the art of constantly challenging and reinventing ourselves through practice-practice-practice. Do we have it in us to become Mozart? Who knows? Can we fashion our modest talents into something more formidable? Chances are you're doing it right now.

Wednesday, December 16, 2009

Mindfulness - Living in the Present

I published this on mcmanweb nearly two years ago. Happy reading ...

A thought-provoking Zen parable goes like this:

A man encountered a tiger in a field. He attempted to escape by lowering himself down a precipice. He looked down and, to his horror, saw more tigers looking up, anticipating their next meal. He looked up and spotted two mice above gnawing on the vine he was clinging to.

Oh, crap.

Then, looking to his right, he sighted a strawberry growing from the cliff face. Reaching over, he grabbed the morsel and popped it into his mouth.

“Mmmm!” he thought. “Delicious!”


I must admit that it took me more than one try to get the point. Kipling was right, I thought. East is east ... But the sentiment resonates in every culture:

“There is nothing under the sun better for man than to eat, drink, and be merry,” reads Ecclesiastes, the most Buddhist book of the Bible. In 1 Corinthians, Paul counsels, “Let us eat and drink; for tomorrow we die.”

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

Very shortly following a move to southern California in the wake of my marriage break-up late in 2006, I happened to look to my right. The valley below was bathed in shadow, as were the peaks that rimmed the valley. But the setting sun happened to magically catch one distant summit.


I was out of my head and into the moment. Tomorrow I could very well fall to pieces. But today was a gift.

Granted, the past and the future provide context, but life is all about the present. If you’re not in it, you’re not playing. To play, you have to pay attention.

Mindfulness incorporates the paradox of no-mind. “When you eat, just eat,” Buddhist teachers advise. “When you sit, just sit.” In a similar vein, “when having sex, just have sex.” Tantric sex is basically mindful sex, fully-engaged and in the moment.

Fine, but what about life’s many unpleasant moments? Who, for instance, wants to be mindful of a toothache? True, Buddhists teachers acknowledge. But consider the “non-toothache.” Non-toothaches are very pleasant experiences. Are you enjoying your non-toothache right now, or are you too busy thinking about what your boss may or may not say to you two days from now?

The practical benefit of mindfulness is that as our awareness becomes more heightened and our thinking more focused, we slowly acquire the ability to reel in our runaway thoughts, or at least slow them down a tad. Slowly, we gain skills in negotiating our way through the present. Slowly, we learn to manage our illness rather than our illness manage us.

We can all recall our exceptionally aware moments. Unfortunately, they tend to occur in highly-stressful and often life-threatening situations, such as skidding on glare ice at 60 MPH. This is when our fight or flight response takes over. The frontal lobes go off-line. We literally stop thinking as the faster-processing and more primitive regions of the brain assume executive control.

Fight or flight is normally associated with an over-reaction, but here we are talking about a rare mental state that can only be described as calm awareness. If we had time to think about the dire straights we were in, we would probably panic. Instead, barring bad luck, we successfully avoid wrapping our vehicle around a tree. On one hand, the crisis is over in a micro-second. On the other, it’s as if time were slowed down.

Athletes refer this state as “the zone.” Something seems to take over. Everything goes right. Nothing goes wrong.

My mind races way too fast and is far too wayward to achieve the full benefits of meditation, but my first attempt produced a mind-popping insight:

I was concentrating on following my breath in and out. I literally could not put two breaths together without losing my concentration. As if that were not bad enough, for the first time in my life I actually watched my thoughts. Without realizing it, I was engaging in a form of mindfulness meditation, of the mind watching the mind. I simply could not believe the crap I was thinking. It was like I had a hundred different radios turned on, all tuned into a hundred particularly bad talk show stations.

Where’s all this coming from? I could only think. This isn’t me.


With that realization, I think I grasped three out of four of the Buddha’s Four Noble Truths. I may have prided myself in my ability to think, but dispassionate observation revealed that I was living in an illusion. My thoughts weren’t real. It was a humbling - and ultimately liberating - exercise.

Over the next four or five years, I managed to stick to a regular meditation practice. When I caught myself “thinking,” without judging, I would let go of the thought and resume my meditation. I never became enlightened, but, among other things, the discipline did teach me very vital skills in concentration and mindfulness, skills I would later apply in managing my illness.

Meditation may not be for everyone, but I do urge trying it at least once. In addition, I strongly encourage taking up a new hobby or resuming an old one, preferably a challenging one. Playing a musical instrument, for instance, even very badly, requires an enormous degree of concentration and awareness. Practice makes perfect.

Hobbies constantly place us in novel situations. We are not sufficiently proficient to be thinking on autopilot. We have to concentrate. We have to be aware. Without realizing it, our minds become disciplined. We learn mindfulness.

I’m the first to acknowledge that my thoughts and feelings often get the better of me. But I am in a far safer and more enjoyable space than I was even a year ago. Tomorrow, my world may collapse on me, but today I have the confidence to face tomorrow, not with trepidation, but with hope.

The tigers will always be lurking at the bottom of the cliff. Enjoy the strawberries, live well.

Tuesday, December 15, 2009

Apathy Matters

This is part of an article I published on mcmanweb in 2005. Just because psychiatry doesn't care about apathy doesn't mean you shouldn't. Read on ...

You know what it’s like. Someone has seemingly pulled the plug and the power drains out. Your get up and go just got up and went. Life, the universe, everything – nothing matters as you shuffle through the clutter on the floor and flop into an unmade bed, your only refuge in a world you have given up on, that has seemingly given up on you.

Apathy is also used to describe indifference, such as to politics or NASCAR racing, but in a psychological context we are talking more like the opposite of motivation, the lack of will to go on and the inability to care about the consequences.

On my Website, Andrea describes it this way:

I am so lethargic and cannot find anyway out. ... I cannot seem to make myself do anything. All I want or seem to be able to do to get out of bed is get the newspaper and try and read it, smoke, or open a can of something or eat a box of ice cream, watch TV or surf the internet, and now a new addiction - buying things on E-Bay! Getting expensive!!! ...

I make jewelry and used to love it, but now can't complete anything and am in such a mess with my beads I don't think I'll ever get them straightened out. I've gained 40 pounds, don't care about my appearance, can't clean the house, etc etc. I feel I have all the symptoms of depression, plus I can't feel any excitement about seeing loved ones, can't think of anything, or anywhere I want to be but in my bedroom.

The Prize Patrol could probably show up on Andrea's door with a check for 25 million dollars, and she would still feel flat. Or even if she levitated to the ceiling in exultation, it wouldn't be long before she went back to her current life in a darkened room, even if that room happened to be part of a new mansion in the Hamptons.

So is apathy part of depression? The DSM is virtually silent on the topic, as is the depression literature. Depression is generally characterized by too much emotion, but the DSM implicitly acknowledges we can experience too little. One of the two major depression symptoms is loss of interest or pleasure, such as in a hobby. Basically, we stop caring.

What’s missing here is that lack of caring doesn’t necessarily stop at pleasure. We can also become desensitized to grief or to something bad happening, but we’re not likely to see psychiatry weigh in on this any time soon.

The people doing the actual talking are the neuropsychiatrists, and they’re not giving depression any respect. In a groundbreaking article in the Summer 1991 Journal of Neuropsychiatry and Clinical Neurosciences, Robert Marin MD of the University of Pittsburgh argued that it is illogical that depressed people, who experience emotional pain, can suffer from a state of mind that is characterized by a lack of emotion.

Martiin Levy MD of UCLA is even more blunt. "Apathy is Not Depression," he and his colleagues assert in bold in the title of an article in the Summer 1998 Journal of Clinical Neuropsychiatry.
Dr Marin and other neuropsychiatrists perceive apathy in the context of brain damage rather than as a sign of emotional distress or cognitive impairment. They see apathy as the result of neuropsychiatric illnesses such as Alzheimer’s, dementia, Parkinson's, or Huntington’s, or else an event such as a stroke, involving disruptions to frontal-subcortical pathways that are fueled by dopamine and acetylcholine

Dr Marin would like to see apathy regarded as a syndrome (sort of like an illness). He also views apathy as a symptom when it is associated with the likes of Alzheimer’s. There is already a precedent in sleep, which constitutes a number of DSM disorders, as well as being listed as a symptom for depression and mania.

Can Dr Marin’s views be reconciled to depression? Yes, when the lack of caring factor is taken into account. In this context, apathy would be a symptom of depression. As a separate entity, it could be that apathy co-occurs with depression, much like anxiety and depression hook up as the Bonnie and Clyde of the brain. One can even make a case for apathy-driven depression.

Obviously there’s much to discuss, but first psychiatry needs to join the conversation.

Monday, December 14, 2009

Rerun - Philosophy: Because We're Mindless Without It

A blast from the past from March. Enjoy ...

Check out the image on the top right. I can think of no better way to illustrate what this blog, "Knowledge is Necessity," is all about. The guy pointing to the sky is Plato, the one with his palm facing the ground is Aristotle.

The two form part of a much larger painting by Raphael - his masterpiece - entitled "The School of Athens." The canvas portrays more than twenty identifiable Greek philosophers - as well as a bunch of unidentifiable ones - clumped in small groups engaged in enlightened discourse.

What's so important about philosophy? Last year, I happened to catch the first three or four episodes in a 60-lecture video series, entitled, "Great Ideas In Philosophy." Oxford scholar and Georgetown professor-emeritus Daniel Robinson PhD explained that something extraordinary happened in ancient Greece.

Prior to Greek philosophy, Professor Robinson pointed out, thinking was essentially religious. Entire cultures were organized around the principle of encouraging everyone to think the same. No one questioned handed-down beliefs.

What the Greeks did essentially changed everything. Socrates and others urged their followers to think for themselves, to take nothing for granted, to challenge everything. In the face of Socrates' withering inquisitions, lazy thinking didn't stand a chance. Athens, it appears, wasn't quite ready for this, and Socrates paid in full measure.

His student, Plato, managed to die in bed, as did Plato's student Aristotle. Without them, our frontal lobes would have nothing to do. Not only did they turn thinking into a profession, they gave us the tools to think. The world was never the same.

Every field of human enquiry bears their indelible stamp: Science, government, the arts, human nature ...

Even religion. The way we appreciate Jesus is through the intellectual framework built by Plato and Aristotle. "The School of Athens" hangs in the Vatican.

The image that illustrates today's blog post is Diogenes. You might refer to Diogenes as the anti-philosopher. When Plato described man as a "featherless biped," Diogenes handed him a plucked chicken.

In Raphael's painting, Diogenes is seated alone, as if shunned by the others. Diogenes serves as a forceful reminder that even today's bold free-thinking is tomorrow's mind-crushing orthodoxy. This tends to happen when we organize our connected thoughts into schools of thought.

The antidote is to be our own philosopher. We learn, then challenge everything we learn. Then we relearn.

Knowledge is necessity, but knowledge is also elusive. It is something we strive for, rather than possess. If someone claims to have it, and offers you a piece of it - stop, think. What would Socrates do?

iPhone Photo of the Day - Yard Art

Ancient proverb: Keep a junk heap on your property long enough and eventually it becomes yard art. Okay, I just made that up one minute ago. I shot this today, one mile up the street from where I live. And, by the way, who removed the clouds?

Sunday, December 13, 2009

iPhone Photo of the Day - Clouds

It's the rainy season, here in the mountains, 40 miles east of San Diego. Two whole days of it. Two days! I took this on a quick walk, when I was able to get out without getting wet. Tomorrow's forecast is sunny. Can't come soon enough ...

Considering Ethnic Perspectives - Part II

In a recent blog piece, I reported on some of the things that came up at a one-day conference I attended on ethnic diversity in the older mental health community. The conference was put on by the Senior Mental Health Partnership, which is a program of NAMI San Diego. To continue ...

Martina Portillo RN, MPH, who is a member of the Hopi Tribe and has had a distinguished career in the Indian Health Service, reported that 57 percent of 3.3 million American Indians/Alaskan Natives now reside in urban areas. “This is a complete reversal since I was little,” Ms Portillo observed. Indians are moving to the cities for the same reasons the rest of us do - jobs and education.

Indian life expectancy, at 72.3 years, is about four years less than non-natives, a “complete improvement” according to Ms Portillo. Where the death rates are significantly higher: TB (750% higher), alcoholism (550% higher, but lower among older men than their counterparts among other races), diabetes (190% higher), unintentional injuries (150% higher), homicide (100%), and suicide (70%, very high in the young population but lower in elders than the general population).

Elders in the Indian population recall their culture being looked down upon as “bad”, with forced boarding schools, banned spiritual practices, and loss of land by the allotment system. Barriers to mental health include differences in cultural beliefs about mental illness, cultural labeling of different emotions, lack of mental health professionals in the system (101 per 100,000 compared to 173 per 100,000 in non-native populations, lack of large scale studies, and lack of cultural orientation for providers (such as in the healing traditions). Rarely do elders seek out available mental health services.

Shifting gears ...

A panel of presenters - Dixie Galapon PhD, Agnes Hajek MSW, and Emily Wu PsyD - from the Union of Pan Asian Communities (UPAC, which serves a vast range of Asian and Pacific Island communities in San Diego) reported that, among other things, Asian elders are confronted by a difference between how Asians and Americans view the elderly. The family matriarch, for instance, rather than enjoying an exalted seat of honor. may suddenly find herself a stranger in a strange land, even within her own family, especially if dealing with Americanized children and grandchildren.

Asian Americans whose families experience a high interpersonal conflict have a three-fold greater risk of attempting suicide compared to the general Asian population. This is true even among those who never had a history of depression. As the panel noted, this points to the strength of family values in Asian communities. Family harmony, they noted, is a value coming from Confucianist (stressing values) and Taoist (stressing balance) beliefs.

An intervention UPAC is working on includes “Problem Solving Treatment” aimed at older adults. Since depression is often caused by problems in life, the object is to help clients regain a sense of control and thereby improve their mood. For instance, people who are engaged in social activities at least two times a week have less depression than those not engaged.

Wrapping up ...

Look around you. Look within your family. The view is probably much different than it used to be. Lot of things to consider ...

Thursday, December 10, 2009

iPhone Photo of the Day - Sequel to the Sequel

I shot this on the Sunrise Highway that traverses Mount Laguna, from a lookout close to 6,000 feet above sea level. I live 10 or 15 miles away as the crow flies, but here I am in an entirely different world, dominated by Jeffrey Pines (note what I call the optional snow, the kind you drive to rather than shovel off your driveway). Yesterday, I was taking photos of palm trees in Balboa Park at sea level in San Diego, 40 miles from where I live. A recent Photo of the Day featured an entirely different environment a mile from where I live at 3,500 feet.

In the space of literally an hour, I can cross into five or six entirely different climate zones, with dramatic changes in weather and scenery.  I've lived in Southern CA for three years and still marvel at the diversity.

Wednesday, December 9, 2009

iPhone Photo of the Day - The Sequel

I'm back home. I shot this in San Diego's Balboa Park. For a polar opposite (and I really mean polar) check out my previous Photo of the Day that I shot in Lexington, MA.

Rerun - Skunk!

This from August ...

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!”


“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?