Sunday, January 31, 2010

Is Mental Illness an American Disease?

An article by author Ethan Watters in the Jan 8 NY Times Magazine throws down the gauntlet:

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. ...

The article, "The Americanization of Mental Illness," is an adaptation from the just-released book, ‘‘Crazy Like Us: The Globalization of the American Psyche.” In the article, Mr Watters uses the example of a “culturally specific” form of anorexia documented by one researcher in Hong Kong during the 80s and 90s. Unlike Americans with anorexia, those in Hong Kong simply complained of bloated stomachs without dieting or expressing fear of becoming fat. The illness was rare.

Then, in 1994, in the wake of the death of a school girl, the local press attempted to explain the phenomenon using American diagnostic language. According to Watters, “the transfer of knowledge about the nature of anorexia (including how and why it was manifested and who was at risk) went only one way: from West to East.” Not surprisingly, there was an outbreak of “fat phobia.”

Says Watters:

In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness.

This does not mean the illness or the pain is not real, Watters is quick to add. But an illness of the mind needs to be understood in its cultural context. Ironically, says Watters, the western notion (promoted by advocacy groups such as NAMI) that mental illness is a no-fault “brain disease” may have the opposite effect of increasing rather than reducing stigma. According to Watters, citing the research of Sheila Mehta of Auburn University:

The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events.

The author cites a four-decades study that found a steady rise in the American public in their perceptions of schizophrenia as dangerous. Meanwhile, in Turkey, according to a study, “those who labeled schizophrenic behavior as akil hastaligi (illness of the brain or reasoning abilities) were more inclined to assert that schizophrenics were aggressive and should not live freely in the community than those who saw the disorder as ruhsal hastagi (a disorder of the spiritual or inner self).”

Most of us are aware of three WHO studies over the course of 30 years (starting in the 70s) that found that patients outside the US and Europe had significantly lower relapse rates (as much as two-thirds lower in one follow-up). Watters reports on anthropologist Juli McGruder from the University of Puget Sound who spent years in Zanzibar studying families of those with schizophrenia. There Muslim and spirit possession beliefs are incorporated into healing practices. Rather than spirits being “cast out,” they are “coaxed out” with acts of kindness.

Says Watters: “Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.”

The author adds:

The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia.

This negativity is referred to by experts as “high expressed emotion (high EE),” which include criticism, hostility and emotional overinvolvement (such as overprotectiveness). White American families caring for a family member with schizophrenia have notoriously high EE rates, with much lower EE rates among Mexican and other families.

It’s not that American families are unenlightened, says Watters. Rather, they “were simply expressing a particularly American view of the self,” and “applying the same assumptions about human nature that they applied to themselves.”

No one is seriously talking about withholding meds and other western treatments and therapies from individuals in need. But we do need to be mindful, says Watters, that even our best science is far from culturally neutral. Thus:

Offering the latest Western mental-health theories, treatments and categories in an attempt to ameliorate the psychological stress sparked by modernization and globalization is not a solution; it may be part of the problem.

Something to think about ...

Friday, January 29, 2010

Awesome Tree

I just happened to notice this beauty while taking a walk on Mt Laguna. Out came my iPhone. If Spielberg calls, tell him I'm busy.

Rerun - Clinicians: The Worst Purveyors of Stigma

Yesterday, in a blog piece on paradigms and psychiatry, I commented that the profession's major assumptions were under serious attack. In response, one of my favorite bloggers Willa Goodfellow posted two perceptive comments which led me to respond that psychiatry is operating under the fatally-flawed paradigm that they have to be the big know-it-alls. Smart patients with proven success are treated as anomalies to be ignored.

I could have written a lot more. Then it occurred to me - I already have. Following is a piece I published 12 months ago. Please read it in the context of yesterday's piece ...

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

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

Hmm. Interesting question.

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

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

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

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

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

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

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

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

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

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

Thursday, January 28, 2010

Thomas Kuhn, Paradigms, and Psychiatry

Haters of the word, paradigm, have Thomas Kuhn to blame. His seminal 1962 publication, The Structure of Scientific Revolutions, is a regular on all manner of Top 100 lists for books that rocked the world. In my line of work, you can’t browse a website for five seconds before being paradigmed to death.

My latest close encounter was an online book by Todd Finnerty PsyD on the fine points of Depressive Personality Disorder (see recent blog post). Dr Finnerty thoughtfully summarized Kuhn’s main points, which, together with Wikipedia and other sources, spares me from having reread Kuhn (which I did read way back in college).

Here’s the basics:

Forget about the quest for knowledge being an objective inquiry governed by scientists rationally sifting through the facts. That may be their intention, but in reality they are operating within their own particular conceptual frameworks (paradigms) that govern how they think. Thus, if you are living in an era where the ruling paradigm features the earth at the center of the universe, then your typical 15th century Polish heliocentric firebrand named Copernicus is going to come across as a raving lunatic (okay, make that solartic).

Ironically, says Kuhn, the 15th century scientific community, such as it was, was perfectly correct in rejecting Copernicus, as Ptolemy’s model of the universe still proved a superior predictor of observable planetary motion. Only later, with Galileo and others building on Copernicus, did Ptolemy (pictured here) and his world come crashing down.

During a period of normal scientific development, researchers are working off a shared set of general beliefs, which frees them up for working on specific problems. Anomalous findings either get dismissed or folded into the paradigm. But anomalies have a way of accumulating like unwanted snow. The old guard has a legitimate role as keepers of the paradigm, but history is not on their side.

According to Kuhn, the old and new paradigms are so different that they are “incommensurable.” In essence, there is no common ground by which a scientist working within a new paradigm can prove her point based on the assumptions of the old.

For an example of worlds in collision: At the 2004 American Psychiatric Association Annual Meeting, I heard Jack Barchas MD of Cornell University and a pioneer in the field of how biochemistry and behavior interact, recount how as a young investigator an early mentor challenged one of his ideas on these grounds: “How is this justified in the writings of Freud?”

Not surprisingly, Freud soon became to psychiatry what Ptolemy became to astronomy. But was Freud getting a raw deal? At the following year’s APA, I heard Nobel Laureate Eric Kandel MD state:

“A major need of psychiatry in the future is to put the psychotherapeutic arm of psychiatry on the same solid biological footing as the pharmacological aspect of psychiatry."

Dr Kandel was very much moved by Kay Jamison who said if it wasn’t for lithium she would be dead, but that it was really psychotherapy that gave her a coherent view of her life, that allowed her to tie the various strings of her life together.

"We’re in a fantastic phase of psychiatric thought," Dr Kandel concluded. The biology of the mind is the central scientific challenge of the twenty-first century. Molecular genetics and molecular biology, he said, have given us insights that would have been inconceivable 20 or 30 years ago. These advances will revolutionize psychiatry, but hardly eliminate it. Instead, psychiatry will synthesize with molecular biology into what he describes as "the new science of the mind."

Paradigms, paradigms, paradigms.

Wednesday, January 27, 2010

Kiri Sings Mozart

A musical interlude. This aria from The Marriage of Figaro speaks for itself. For a commentary on the type of genius it takes to create such transcendent music, check out this earlier blog post of mine.

Happy 254th birthday, Amadeus!

Tuesday, January 26, 2010

Water Meditation

Yesterday dawned brilliant blue. The mountain streams, gorged on five days of rain, emitted a soothing cascade of mystic sparkles. I settled down, the rock wall at my back acting as an echo chamber. The water sounded a throaty resonant OM. Today, the real world is making its demands. I will always have my waterfall ...

(Shot through my iPhone.)

Monday, January 25, 2010

Introversion and Isolation

The following is a chopped-down version of an article I published on mcmanweb in 2003, plus some additional observations to reflect my current thinking on the topic ...

In May 2003, I asked my Newsletter readers to take an online Myers-Briggs personality test and email the results, along with their diagnosis.

The Myers-Briggs type indicator (MBTI) begins with eight personality functions in contrasting pairs - Introvert (I) or Extrovert (E), Intuitive (N) or Sensing (S), Thinking (T) or Feeling (F), and Judging (J) or Perceiving (P).

The Introvert/Extrovert dichotomy relates to people drawing their energy from being alone or with people rather than simply being either shy or outgoing. Thinking and Feeling are self-explanatory. Sensors tend to focus on the here and now while Intuitives look for meaning and possibilities. Judgers prefer structure in their lives over the messy flexibility of Perceivers.

Falling within these four temperaments are 16 distinct personality types, defined according to the eight paired personality functions, thus INFP, ESTJ, etc.

I analyzed the first 100 responses. Most readers also sent in their diagnosis, nearly all with depression or bipolar disorder. Since most people with bipolar disorder are depressed more than manic, it is safe to conclude that this poll was dealing with a mostly-depressed population. Approximately three-quarters of the respondents were women.

The first eye-popping result was 83 percent of those who replied were introverts, which sharply contrasts with the 25 percent to be found in the general population. According to one reader, who had a strong extrovert score four years ago and a much weaker one when responding to this poll: "Over the last four years I've sunk into a very isolated existence. The mania has worsened despite changes in medication/dosages and I spend most of my time sleeping and avoiding large social functions. I do slightly better in small social gatherings, but up until just a couple of months ago I didn't go anywhere or see anyone other than my immediate family within our house."

The best is yet to come: There were 17 INFJs and 14 INFPs, the largest populations in this study, the "mystics" and "dreamers," respectively, who only account for one percent each of the general population. These groups turned up in higher than expected numbers in at least two online MBTI tests, which may explain the large turnout here.

As for the extroverts: Possibly because it was just one letter off INFP, there were seven ENFPs, “visionaries” who would fit right in with the mystics and dreamers, the only category of extrovert over-represented in this poll. Since other versions of extroverts have descriptions such as “enforcers,” “adventurers,” “helpers,” and “jokers,” you can see what we are missing.

One of the few psychiatric studies using the MBTI, by David Janowsky MD of the University of North Carolina, also found a preponderance of introverts (as well as feelers) among a depressed population.

Several readers commented that their results varied on circumstances and phase of illness. Stephanie wrote that "when manic I'm as sociable as Bette Midler on cocaine and when I'm depressed, seriously come not near me."

Carol, who came up ENTJ back in college and again a couple of years ago when working for a mutual fund company, observed that "if I may draw a conclusion, those of us who can break through isolation and make contact with others, could be better able to keep the depression at bay."

In the meantime, we are left with the disquieting knowledge that our illness can isolate ourselves to the point of virtual no-return. Another study by Dr Janowsky found that 84 percent of 64 suicidal patients he examined were introverts, leading the him to observe:

"The issue of social isolation has been mentioned as a potential risk factor for suicidality. The introverted individual almost certainly has trouble reaching out to others, especially in times of stress and need. Thus the social isolation of introversion may set the scene for suicidality."

In a 2001 article appearing in Current Psychiatry Reports, Dr Janowsky cites various studies to support the proposition that "increased introversion predicts the persistence of depressive symptoms and a lack of remission" (and conversely that extroversion can improve outcomes).

The obvious antidote is to do whatever it takes to get out of the house and into the company of others. This is generally easier said than done, given the nature of our illness, but the stakes are enormous in what could very well be the most important aspect of our treatment.

Based on what I have learned and experienced since writing this article nearly seven years ago, I would make some major changes to include the positive features of introversion. On a personal note, I am an INFP and a hermit by nature. What makes my day is connecting two seemingly unrelated thoughts alone in my room or while out on a walk in the middle of nowhere. I do perk up around people, and in these situations I get mistaken for an extravert, but the effort drains me and I find myself relieved to be back in my comforting isolation.

I pity those who have no comprehension of my rich inner world, but when I originally wrote this piece I realized my isolation was killing me, as it had nearly killed me at other times in my life. Accordingly, I made deliberate efforts to get out amongst people, which no doubt reduced my risk of depression, and had the unexpected result of helping me find the kind of ease within myself that had eluded me my whole life.

Getting out amongst people back then was like plunging into ice water. It’s much easier now, but the water is still cold. Your views, please ...

Sunday, January 24, 2010

iPhone Photo of the Day - Optional Snow

The bad weather is gone. The sun is out. All is good. I shot this earlier today several miles from my home as the crow flies and at least several hundred feet higher in altitude. This is the way it should be - you go to the snow, not the snow to you.

Sports and Fan Disappointment - A Case Study in Suffering (and as a Red Sox Fan Now Living Near San Diego I Know What I'm Talking About)

We know the condition - Severe Utterly Frustrating Fan Eternity Realization Syndrome (SUFFERS). Those unfortunate enough to have grown up in Red Sox households are especially familiar. The acute version of the illness was the famous ball rolling through Bill Buckner’s legs during the sixth game of the 1986 World Series, which the Mets went on to win. The chronic version is coming to the realization that you are stuck for eternity in a perpetual groundhog day of Bill Buckner moments. Think Curse of the Bambino.

The photo here, from the San Diego Union Tribune, best illustrates “fan blues.” If you do not follow football, allow me to explain: Last Sunday, the local Chargers were heavily favored to defeat the New York Jets in a playoff game. As anyone living in Southern CA could tell you, this was the Chargers’ year. No question about it.

I’m a transplanted New Englander and therefore not a true Chargers fan, but having lived here for three years I got caught up in the moment. Of course the Chargers would win the Super Bowl, I figured. How could they not? Especially with my Patriots out of the playoffs. Okay, maybe the Colts would knock them out of contention and maybe the Packers or the Saints would teach them a lesson.

But the Jets? The pathetic New York Effin’ Jets? Ha! No way!

I will make this brief: The Chargers’ field goal kicker, Nate Kaeding, missed three field goals (three fuckin’ field goals!!!) two from very close range. In one of the attempts, the camera covering the ball’s flight path actually swung over to a different section of the stands where the ball presumably landed. The goal posts were nowhere in the frame.

That summed up the whole day.

According to figures that I am making up as I am going along, there were more reported cases of depression in San Diego the ensuing week than there were new outbreaks of swine flu worldwide. FEEMA and the Red Cross sent in teams of psychiatrists and therapists and social workers, but it was no use. They couldn’t contain the epidemic.

The Chargers have never won a championship. (Okay, back in 1963 in the old AFL, but you just know that doesn't count.) Not back in the Air Coryell/Dan Fouts glory days. Not in the Junior Seau era. Then the realization dawned. Life as a Chargers fan would always be an endless succession of missed field goals. Acute SUFFERS turned chronic, and as we know there is no cure for SUFFERS.

Just ask any Red Sox fan. Not even two World Series wins in three years can ameliorate the condition. It’s no use. Despite clear evidence to the contrary, we just know, deep in our hearts the Red Sox will always find a way to lose. Even Yankees fans feel sorry for us.

Today, four teams are squaring off against each other. Two (hopefully one of them the New York Effin’ Jets) are going to be disappointed. The other two will go to the Super Bowl, where one will be disappointed. Alert FEEMA, alert the Red Cross.

Saturday, January 23, 2010

Illness or Personality - What's in YOUR Depression?

Both here at Knowledge is Necessity and over at HealthCentral’s BipolarConnect, I have been investigating the issue of illness vs personality (or temperament). Say you are dealing with depression. In all likelihood, you are thinking that your depression is an alien invader that is robbing you of your personality. But what if miserable is your true baseline?

Why this is important is that medications are designed to treat an illness, not change a personality. An article by some prominent academics on the blog site of author Todd Finnerty PsyD makes a case for the diagnosis of Depressive Personality Disorder (DPD). I had occasion to hear one of the authors, Michael Bagby MD of the University of Toronto, at the 2006 American Psychiatric Association annual meeting in Toronto.

Historically, according to Dr Bagby, minor depression was thought to exist on a spectrum with personality, and "may define a group who are pessimistic, disaffected, and frustrated, perhaps because they see their illness as an intractable and enduring part of their selves."

According to the authors of the blog article: “Depressive personality disorder is not simply a variation of normal psychological functioning.” It is an illness, distinct from major depression and dysthymia.

Appendix B to the DSM-IV lists DPD as “worthy of further study,” but is not included in the main text. The appendix defines DPD as “a pervasive pattern of depressive cognitions and behaviors.” By contrast, classic Axis I DSM major depression is described as an “episode,” with symptoms lasting at least two weeks, while minor depression (dysthymia) is regarded as “chronic” (two years or more).

In other words, if you are undergoing major or minor clinical depression right now, all those around you - including your psychiatrist - assume your brain will eventually boot back up to “normal.” But with DPD, you may already be imprisoned in your own version of “normal.”

According to the authors of the article, a number of studies validate DPD, but the obvious overlap with clinical depression, in particular dysthymia, poses major problems. The authors argue that it is dysthymia that suffers from redundancy, not DPD. DSM dysthymia, they contend, comes across as major depression lite, with nearly the same symptoms but with an arbitrarily-added two-year requirement.

DPD, by contrast, serves up a different symptom list, namely:
  1. Usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness
  2. Self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem
  3. Is critical, blaming, and derogatory toward self
  4. Is brooding and given to worry
  5. Is negativistic (passive-aggressive), critical, and judgmental towards others
  6. Is pessimistic
  7. Is prone to feeling guilty or remorseful
But the real turf DPD may be encroaching on may involve the personality disorders (such as avoidant personality disorder). In particular, there are issues regarding the Five Factor Model (FFM), which is to personality testing what Simon is to American Idol.

The FFM has a good chance of influencing the next DSM as part of a “hybrid” system of classifying Axis II personality disorders. The current DSM is structured according to the type of “categorical” schema that works (to a point) for Axis I disorders. In other words, depression is different from schizophrenia. (Never mind that depressed people can have psychosis and those with schizophrenia can be depressed - that is for another piece.)

This separation is even more problematic with personality disorders, where there is considerably greater overlap amongst symptoms (such as where borderline meets antisocial meets narcissism). A “dimensional” schema not only acknowledges the overlap, but takes into account degrees of severity. As a speaker explained at a conference I attended a few years back: We all have blood pressure. But we have reliable tests to ascertain when our blood pressure is too high.

Think of the FFM as a blood pressure test. The “big five” traits it measures include openness, conscientiousness, extraversion, agreeableness, and neuroticism. A person who passes with flying colors is one who is not likely cave into fear, has his or her shit together, lights up a room, cares about others, and doesn’t readily fly off the handle.

If you were to see these qualities in someone on eHarmony, you would immediately propose marriage to this individual, sight unseen. If for some reason, you failed to initiate contact, you are probably emotionally tied up in knots.

The FFM may crack your case, but here’s the rub. Suppose the results revealed a “neurotic” temperament. According to the authors of the blog article, neuroticism is a pretty airy-fairy term that also embraces other emotions such as anger and anxiety.

It could be you fail to pursue an eHarmony lead because your inner critic is working overtime. You consider yourself worthless. You’re beating yourself up. And now you’re alone and socially isolated. How does that make you feel? Well, depressed.

Okay, suppose you do have a depressive temperament. Does that mean you have DPD? Absolutely not. The authors of the article point out that DPD has a dimensional component, which means we are asking “how much?” So, if you’re the type who prefers staying home alone with a book to going out dancing, you can relax. You may be a lot happier and better adjusted than Joe Cool and Miss Congeniality.

But even if you have been thinking that black is the new pink your entire life, the experts remind us that although our traits are inherited they are not necessarily deterministic. Turning our lives around may not be easy, but we can change, or at least come up with adaptive responses.

The authors contend that DPD should be included in the DSM-V, under personality disorders. We will leave that debate for another time. The point is, in the unending quest for the true me we alone are our own judges. Illness or personality? Perhaps a bit of both? We can’t afford to wait for someone else to ask these questions.

Further reading:

From Knowledge is Necessity

Is There Anything At All Possibly Good About Depression?
Depressed or Thinking Deep?
Breaking Down Personality

From BipolarConnect

Wearing the Mask, Acting "Normal"
Peace of Mind
Personality vs Illness - The Conversation Continues
Personality or Illness

iPhone Photo of the Day - CA Pizza

Here in southern CA, we like our pizzas with palm trees. You gotta problem wit' dat?

Friday, January 22, 2010

Jon Stewart - Mass Backwards

The Daily Show With Jon StewartMon - Thurs 11p / 10c
Mass Backwards
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After the Massachusetts special election Senatorial race debacle, I was ready to fire off one of my depression-driven End of Civilization blogs. But Jon Stewart does it a lot better ...

Meriwether Lewis - Murder or Suicide?

The following first appeared as a piece on my website, mcmanweb, nine or ten years ago. Enjoy ...

Two pistol shots rang out in the wilderness night. From out in the dark a man staggered and fell against a stump then crawled to his lodgings. At daybreak, the woman of the house summoned up the courage to enter the man's room. A piece of her lodger's forehead had been blown off, exposing his brains. He begged the woman or one of her servants to take his rifle and finish the deed, offering all his money in his trunk as a reward.

Another account reports that the lodger was found by one of the servants, busily engaged in cutting himself from head to foot. Minutes later, one of America's great heroes - a true hero in an age of heroes - would be dead. Captain Meriwether Lewis, protégé of Thomas Jefferson, leader of the Lewis and Clark expedition, and Governor of the vast Louisiana Territory was all of 35.

In his book, "Undaunted Courage", historian Stephen Ambrose sets out a compelling narrative of the extraordinary leadership displayed by Meriwether Lewis in taking a small band of men on a spectacular journey of discovery through 8,000 miles of untracked wilderness, much of it occupied by hostile Indians.

Soon, the ambiance would be far different:

"Our vessels consisted of six small canoes, and two large perogues," he wrote in his journals. "This little fleet altho' not quite so rispectable as those of Columbus or Capt. Cook, were still viewed by us with as much pleasure as those deservedly famed adventurers ever beheld theirs; and I dare say with quite as much anxiety for their safety and preservation. we were now about to penetrate a country at least two thousand miles in width, on which the foot of civilized man had never trodden; the good or evil it had in store for us was for experiment yet to determine, and these little vessells contained every article by which we were to expect to subsist or defend ourselves."

The following entry demonstrates his scientific interest in the territory:

"I found by several experiments that a table spoon full of water exposed to the air in a saucer would evaporate in 36 hours when the mercury did not stand higher than the temperate point at the greatest heat of the day ..."

And this description of the Great Falls of the Missouri reveals the mind of a poet:

"...irregular and somewhat projecting rocks below receives the water in it's passage down and brakes it into a perfect white foam which assumes a thousand forms in a moment sometimes flying up in jets of sparkling foam... "

And so it goes, scientist, poet, adventurer, renaissance man gushing forth in a creative stream that would mysteriously fall silent for weeks at a time. Those strange silences would later speak volumes, but the eventual success of the mission all but drowned out any signs of trouble ahead.

Lewis and his men arrived back to heroes' welcomes, and Lewis himself became the toast of the town in Washington DC and Philadelphia. But signs of strange behavior were creeping in. He unaccountably kept putting off the publication of his journals, and drug abuse and deep depressions helped undermine his post as Governor of the Louisiana Territory.

Still, there was no denying his hero status, and soon he would be returning once more to the open arms of his friends and admirers back east. But he never made it back. His mentor Thomas Jefferson was greatly saddened but not at all surprised:

"Governor Lewis," he wrote, "had, from early life, been subject to hypochondriac affections. It was a constitutional disposition in all the nearer branches of the family of his name, and was more immediately inherited by him from his father."

There was no question in Jefferson's mind: "About three o'clock in the night," he wrote, "he did the deed ..."

But many historians have since taken issue:

"It seems impossible," one wrote, "that a young man of 35 ... on his way ... to the capital of the nation, where he knew he would be received with all the distinction and consideration due his office and reputation, should take his own life."

Wrote another: "The Meriwether Lewis they knew did not lose his courage nor his head in times of trial." And still another: "By temperament, he was a fighter, not a quitter."

But the plain facts tell another story, even if no one actually saw Lewis put the gun to his head. In "Undaunted Courage," Stephen Ambrose notes Lewis' depressive tendencies, his odd behavior, and his deteriorating mental condition, including a reported suicide attempt and an army officer's precautionary surveillance mere days before.

As to why so many who should know better simply refuse to face the truth, Dr Kay Jamison in "Night Falls Fast" postulates: "...scholars and laypeople alike find it hard to hold in their minds the thought that a great man could have been deranged or that a courageous man could have killed himself. But such men do. And the same bold, restless temperament that Jefferson saw in the young Meriwether Lewis can lie uneasily just this side of a restive, deadly despair."

In Jamison's mind, suicide was never a blot to Lewis' character, only a tragedy, the logical outcome of a deadly depressive temperament, one that can take down even the best of us, even a hero amongst heroes.

More famous people articles from mcmanweb ...

iPhone Photo of the Day - This Just Ain't Right!

That's SNOW in my backyard! What's wrong with this picture? I live in southern CA, about 15 miles from the Mexican border, that's what. Granted, I'm 3,500 feet up, but still, this is a clear case of climate oppositional defiant behavior.

One week ago, my nephew and I were in our T-shirts, drinking root beer floats outside at the San Diego Zoo.

What has the world come to? I'm in denial. This is NOT snow. It CAN'T possibly be snow. No way.

Someone call my psychiatrist.

Wednesday, January 20, 2010

Is There Anything At All Possibly Good About Depression?

In a blog piece late last year, Therese Borchard (pictured here) of Beyond Blue wrote:

I spent my adolescence and teenage years obsessing about this question: Am I depressed or just deep?

When I was nine, I figured that I was a young Christian mystic because I related much more to the saints who lived centuries ago than to other nine-year-old girls who had crushes on boys. ... Now I look back with tenderness to the hurting girl I was and wished somebody had been able to recognize that I was very depressed.

In my own blog piece a day or two later, I reported that I very much identified with Therese:

I just know that had we been in the same class at grade school, while the other kids played ball during recess, Therese and I would have found a quiet spot to sit under a shade tree, sharing cookies our moms packed and discussing how Augustine of Hippo must have felt after Alaric the Visigoth sacked Rome in 410 AD.

But here’s the rub. Were Therese and I two sensitive souls waxing philosophical, or two depressives acting strange? In her piece, Therese cited Peter Kramer MD, author of "Against Depression" (from a NY Times piece) in support of the proposition that depression and thinking deep are clearly distinct. Says Dr Kramer:

"We idealize depression, associating it with perceptiveness, interpersonal sensitivity and other virtues. Like tuberculosis in its day, depression is a form of vulnerability that even contains a measure of erotic appeal." First the ancient Greeks, then Renaissance thinkers, and later the Romantic movement assigned spiritual and artistic and even heroic virtues to melancholy. Nonsense, Dr Kramer responds. "Depression is not a perspective. It is a disease."

Therese found comfort in the realization that her capacity to think deep, even at a young age, although unusual, was not pathological. Her personality was fine. Her depressions were another matter. Nevertheless, she was not prepared to go as far as Dr Kramer, noting that “some of my depth caused by depression is a good thing. Not on the days where I'm in excruciating pain, of course.”

The viewpoint I expressed was fairly similar to Therese’s, but with this overlay: I feel my depressions are both part of my illness and my temperament. The illness aspect is an alien invader that I would gladly kill off. The temperament aspect, on the other hand, is a true part of me that gives depth and meaning to my experiences.

In a blog piece from last week, Therese revisits Peter Kramer, but adds: “However, having said all that, I do hereby appreciate the gifts that this ugly and manipulative beast has laid upon my table.” Then, David Letterman style, she serves up a Top Ten list of good things about depression. Number Nine is too juicy not to quote in full:

I have fascinating conversations with strangers.

Here's how the majority of my first conversations/introductions go with people who I sit next to on the plane, train, or at my son's soccer games:

"So what do you do?"
"I write a mental health blog."
"Oh. That's interesting. How did you get into that?"
"I had a major nervous breakdown and wanted to kill myself for about two years. So one day I told God that if I ever woke up and wanted to be alive that I would dedicate the rest of my life to helping people who are trapped in the Black Hole. That morning came. And you, what do you do?"

On a more serious note, Number Five:

I am more outwardly focused.

Abraham Lincoln taught me this one. Poor thing did not have the benefit of medication. But my friend Joshua Wolf Shenk, author of "Lincoln's Melancholy," says the most important contributor to his climb out of the Black Hole was turning to a greater cause ... of transforming his melancholy into a vision for emancipation. I get that. I really do, because I feel like Beyond Blue and my outreach efforts on behalf of those cursed with brain chemistry inspire me with a mission worth getting out of bed for.

Therese also notes that, among other things, depression has: Made her a better writer (with “material oozing from my very heart and soul”); Given her perspective (“When you've lived on the fault line between death and life for years at a time, the little stuff doesn't matter as much.”); Honed her sense of humor (“Just like G. K. Chesterton once wrote, ‘Angels can fly because they take themselves lightly.’"); and made her more compassionate (“My mood disorder didn't just disrupt nerve cells in my brain, it also expanded my heart.”)

Therese’s post drew 47 comments, and to my considerable surprise they were overwhelmingly favorable. This, from Bill, is fairly representative:

I'm a better human being, man, counselor, writer, father, and potential catch (had to throw that in) thanks to my circumstances. Absolutely, my feelings often twist me up in knots, but at least I can feel...unlike so many hardened souls in this world. I am who I am. More so, I will be who I choose to be. I was dealt a hand, and I'll play it ...

And, from the dissenters:

“Nothing is really good about the actual depression - it is a monster, an evil entity living in our minds,” and, “from where I stand, depression has been an enemy and a robber of happiness.”

There is no right or wrong, of course. On one hand, there is no denying the malevolent nature of depression and what it has done to us. Similarly, society-at-large has absolutely no appreciation for the destructive nature of this illness and what we have to endure.

On the other hand, for all the hardship, horror, and humiliation I have faced as a result of my depressions, I know I am a much better person as a result. I may hate the illness, but over the years I have learned not to hate myself. Until I read the comments to Therese’s post, I thought she and I were in the minority. Sometimes it feels good to be wrong.


My favorite blogger Therese has a terrific book just out: Beyond Blue: Surviving Depression and Anxiety and Making the Most of Bad Genes, which you can purchase from Amazon by clicking the link.

Check out my first review ...

... and my second. 

Also, check out Therese in a live interview, Thursday, 1 PM EST, on Blog Radio.

Tuesday, January 19, 2010

Tiger, King David, and God

Someone else is always controlling the clicker when the TV goes weird on me. Here I was, minding my own business when two women came on the screen - one claiming to be a psychologist - carrying on with haughty disapproval about Tiger Woods’ sex life.

“Listen,” I found myself shouting back at the TV, “unless you have a dick, you need to stay out of this conversation!”

In a similar fashion, I believe those with no ovaries (or a history thereof) have no business speaking out against abortion. And while we’re off the topic, if you’re against gay marriage, then don’t have one and shut the hell up.

I swear I wasn’t going to write about this, but there was something about these idiots that got me going. Okay, I’m not approving Tiger’s behavior, but let’s restore a bit of perspective to the conversation:

The Bible tells us Solomon had 700 wives and 300 concubines. His more monkish father David, by contrast, made do with a mere eight wives that we know of and 10 concubines. God apparently had no problem with quantity, as we hear through the prophet Nathan: “ ... and if that had been too little, I would moreover have given unto thee such and such things."

We don’t need several branches of science to know what men are built for, but we have them anyway, and the ancient Hebrews had a practical insight into this. But there were limits, and a large part of what makes the Bible so fascinating is the constant tug of war between the way we are made and the way we need to behave. To return to David:

God apparently thought it was okay that David exercise his alpha male prerogatives. What upset the Lord was that David, not content with what he had, had to go pluck a forbidden fruit, Bathsheba (temptation deluxe, pictured here), wife of Uriah the Hittite. After that, David’s life was never the same.

“I will raise up evil against thee out of thine own house,” said God through Nathan.

Back to Tiger. Being the best golfer in the world sounds decidedly un-Biblical, but today’s highly successful athlete (or media star or politician or business person) would have been yesterday’s warrior. And as we know from the Bible, success in battle was catnip to the opposite sex:

“When David was returned from the slaughter of the Philistine, that the women came out of all cities of Israel, singing and dancing ...”

I have no insight into this. Had I lived in ancient Israel, I’m sure I would have settled into a routine of predictable domesticity. Which translates into no singing and dancing women every time I went into town to pick up a loaf of bread. Lord knows, in my modern existence I am not exactly fending off tall blonde women trying to hop into my 1992 Tercel.

“I can resist anything but temptation,” said Oscar Wilde. The fact that temptation rarely presents itself to me does not make me a moral person. Once in a blue moon during my marriages and relationships I have had occasion to choose smart over stupid. But the difference between my world and Tiger’s is the difference between politely turning away a Jehovah’s Witness at the door and fending off wave after wave of Kamikaze pilots. I’m trying to imagine all those tall blondes hanging out by my Tercel. Sorry, God. No chance in hell.

Tiger is currently in a Mississippi clinic, reportedly being treated for sex addiction. My guess is therapy would be helpful for Tiger, but for sex addiction? On which side of the equation does abnormal truly belong?

As the Bible says: “Judge not, lest ye be judged.”

Monday, January 18, 2010

We Still Have a Dream

Like anybody, I would like to live a long life. Longevity has its place. But I'm not concerned about that now. I just want to do God's will. And He's allowed me to go up to the mountain. And I've looked over. And I've seen the Promised Land. I may not get there with you. But I want you to know tonight, that we, as a people, will get to the promised land!

Sunday, January 17, 2010

Judi Chamberlin - Requiem for a Hero

I really believe that it's those of us who were considered the most ill, the most non-compliant, the most trouble, we're the ones who have the fastest track on getting better, because there's always that part of us saying, "No, no, no. I'm not going to take your vision of what my life is going to be. I'm going to stick to my own vision of what my life is going to be."

Judi Chamberlin belonged to a generation of antipsychiatrists who got in the face of psychiatry and changed it. Equally, she helped shake patients out of their fatalistic mindset to one of feeling empowered. In early Dec 2008, Judi established a blog, Life as a Hospice Patient. She was dying of COPD (she never smoked). Now she had a new cause to fight for - the right to die in accord with her simple wishes. But her fight was never her own fight. It was always our fight as well.

Judi’s initial activism focused on the rights of psychiatric inpatients, but, as hospitals closed, her focus shifted to the needs of outpatients, then she expanded her reach to those with physical disabilities. In 1992, she received the National Council on Disability's Distinguished Service Award of the President of the United States, and helped push a treaty on disability rights that the UN passed in 2006.

Hospice care imbued Judi with new insights. In one blog entry, she noted:

Again, I can't help contrasting this with the mental health system, where often what people want is very practical stuff, like finding a place to live, and instead they have to jump through all kinds of hoops because someone else decides what's most important. That approach makes the person feel even less in charge of his or her own life.

In another piece, she observed:

I don't believe in an afterlife; I think when I die it will just be a return to the same nothingness as before my birth. I believe that the only 'afterlife' is the way one lives on in people's memories, and it has been so gratifying to me to hear from so many people who appreciate the work I've done and the positive effect I've had on their lives. So I feel confident that I will live on in the memories of many, many people, and that thought gives me great comfort.

On Jan 12, she wrote:

Marty should be home soon, and he said he is bringing me all kinds of goodies from the Jewish deli and grocery store in Brookline, which is right near the hospital. I'm glad I have my appetite back! I've eaten soup and ice cream and cookies, and I'm eager to see what he's bringing me for dinner.

Those were Judi’s last public words. She died last night. She left behind a family and no end of friends and admirers. She was 65.

iPhone Photo of the Day - One Determined Acorn

No, your eyes are not playing tricks on you. You are looking at an oak tree growing out of a boulder. I caught this out of the corner of my eye as I was treating out-of-town visitors to a tour of the far reaches of San Diego County's back country, 60 miles east of downtown and a mile or two from the Mexican border.

I quickly backed up the car and we got out, scrambling for a closer look. Indeed, a massive tree was growing out of solid rock. Its trunk and root system were literally splitting the boulder apart - the oak was eating the boulder for lunch. Draw any lessons you want, but never underestimate the mighty acorn.

Saturday, January 16, 2010

How Old is Old Enough?

An article in Governing entitled, What is the Age of Responsibility?, observes:

In most respects, people are considered adults at 18. That’s when they can vote and enter into legal contracts—including the purchase, if not rental, of a car. But a 20-year-old Marine, just back from patrolling the streets of Baghdad, would have to turn 21 before he could join a local police force in most cities in the United States. A 20-year-old college junior, far more educated than the average American, cannot buy alcohol or enter a casino. In 10 states, a single 20-year-old cannot legally have sex with a 17-year old. But in nearly every state, a 16-year-old can marry—if he has his parents’ permission.

With regard to juvenile justice, "in most states, a 10-year-old charged with murder can be tried as an adult."

But now some serious rethinking is going on. According to Governing:

Legislatures and courts are hearing a very different argument from a group of people that haven’t traditionally testified before them: neuroscientists. Using advanced brain-scanning technology, scientists are getting a better view of how the human brain develops than ever before. And what they’ve found is that in most people, the prefrontal cortex and its links to other regions of the brain are not fully formed until age 25—much later than anyone had realized. These areas are the seat of “executive decision making”—the parts of the brain that allow people to think through the likely consequences of an action, weigh the risks and benefits and stop themselves from acting on impulse. In other words, the stuff that makes you a mature person.

I had the opportunity last year to talk with scientists first hand on brain development. Or, rather, I stumbled into it. This from a Knowledge is Necessity blog piece late March, 2009:

Another full day at the International Congress on Schizophrenia Research, here in San Diego. To recap:

Breakfast: Beatriz Luna of the University of Pittsburgh tells me she isn't a schizophrenia researcher. Rather, she's into something called "development." I'm thinking development, as in a child psychologist.

No, she tells me. This is about brain development, as in the child brain maturing into the adult brain. She will be one of the speakers at a two-hour symposium later in the morning. Curious, I check it out:

Think of research into normal brain development shedding valuable light on schizophrenia, and, by extension, all of mental illness. The first speaker, Patricio O'Donnell of the University of Maryland, talks about cortical microcircuits and the balance between excitation and inhibition. Dopamine, he says, plays a large role in the modulation of circuits in the prefrontal cortex. During adolescence, he explains, these circuits experience dramatic connecting changes.

For instance, "phasic dopamine" (firing in bursts) gets dialed in, with improved signal to noise ratios.

But suppose the brain doesn't mature? Are we then looking at an approximation of schizophrenia?

David Lewis of the University of Pittsburgh shows slides that highlight the neuron's "dendritic spines." These spines play a major role in brain cells talking to one another. We know that people with schizophrenia are not favorably endowed in this category, but what does it mean?

In normal brain development, he explains, there is an early dramatic increase in spine density followed by a dropping off in adolescence and leveling out in adulthood. But are we talking about a drop-off in "functionally mature" or "functionally immature" connections? In other words, when the brain experiences structural changes, are the right chemical messages crossing the dendritic divide or the wrong ones?

Early intervention, he says, might be directed at enhancing the normal development of these synapses.

Dr Luna informs the audience that adolescence involves major risk of mental illness. As she explained to me over breakfast, this is when the brain changes gears. But what if something goes wrong in the transition? Might this underlie the pathology of mental illness?

During adolescence, the brain undergoes "synaptic pruning," along with axonal "myelination." In essence, brain function becomes more equally distributed, with less reliance on impulses from the basal ganglia and other more primitive regions of the brain.

But what if something goes wrong? Normal child brain function is suddenly not so normal, not in an adult brain anyway. You can kind of see this with the current economic meltdown, Dr Luna explains. It's a new world. AIG and GM and the rest can't behave the way they used to. The failure in executive behavior in this new context, she concludes, now becomes obvious.

The article in Governing notes that lawmakers are not going to exactly change the age of majority to 25 across the board. But there is room for nuanced legislation, say for raising the age for treating minors as adults in the criminal justice system and for lowering the drinking age (to paradoxically discourage binge drinking).

“Graduated driver licensing” (GDL) places conditions on teens behind the wheel. Some form of GDL has been implemented in nearly all states, with corresponding reductions in youth road accidents, fatalities, and injuries.

Yesterday, I put my 19-year-old nephew on a plane back to Connecticut after five or six days here with me in southern CA. He was a delight to have, and very easy to talk with. At his age, I was probably ahead in the book knowledge department, but would have been no match for him in social skills and insights into human nature. This kid was way more perceptive than adults twice or three times his age, and we were able to constructively discuss sensitive family issues adult-to-adult.

At the same time, I was able to openly acknowledge the 19-year-old in both of us. I'm single. I'm male. I don't always think with my brain. With reference to my age-gender cohort, I told him, we're all basically 19-year-old frat boys. The only difference is men my age (60) are physically falling apart.

In regard to some areas of our lives, we never attain the age of 21. Thank God for that.

Friday, January 15, 2010

iPhone Photo of the Day - Gorilla

Yesterday, I took my out-of-town visitors to the San Diego Zoo and led them straight to the gorilla enclosure. These guys have to be my favorite animals.

Wednesday, January 13, 2010

iPhone Photo of the Day - The Taco Stand From Nowhere

I shot this close to the town of Campo, a few miles from the Mexican border, about 60 miles east of San Diego. That's a '38 Buick out front. My beef taco was delicious.

Emigration Ship

"The Star of India", in San Diego Harbor, is the oldest active sailing ship, christened in 1863. The other day, I bought a ticket and hopped aboard with my trusty iPhone.

For 25 years beginning in the 1870s, as "The Euterpe", the ship took emigrants from Great Britain around the Cape of Good Hope to New Zealand. A typical voyage lasted four months. These days an LA to NZ flight takes about 13 hours and I always bitch about it. I lived in New Zealand back when Carter and Reagan were President. My daughter was born there, and calls New Zealand home.

A second class cabin. Try not to imagine steerage.

A deckside view.

End of voyage. The Euterpe docked in Port Chalmers in the port of Dunedin on New Zealand's South Island. I once owned a house about three miles from here.

Tuesday, January 12, 2010

Interview: Therese Borchard on the Dark Side of Funny

Therese Borchard has come out with a terrific new memoir of depression, Beyond Blue: Surviving Depression and Anxiety and Making the Most of Bad Genes, that had me rolling in the aisles. That’s right, a book about depression that is funny. I decided to confront Therese on this ...

John: Listen, Therese. William Styron’s memoir of depression was bleak. Sylvia Plath’s The Bell Jar was heart-breaking. Yet, here you are, agony with a thousand punch lines. This has to be sacrilegious.

Therese: Funny you should ask the question that way. Gus Lloyd, who has a radio show on Sirius Satellite, confronted me with the same thing this morning. But he asked me, “How do you know when you are using humor and comedy to heal, and when it is perceived as offensive?” I responded, “I don’t. I guess that’s why a lot of people stay away from humor.” I typically offend 5 to 10 percent of my readers when I use sarcasm and wit in a post. So should I skip the attitude satire? Absolutely not. I hate to say this – it sounds cold and heartless – but I’d rather offend five listeners to allow 95 listeners a moment of healing laughter, than to stay boring and safe. It’s sort of the opposite philosophy of Jesus and the lost sheep. I’d rather lose one sheep in order to help out the 99 that are desperate for a laugh. Sorry, Jesus.

John: Uh, uh. I’m not letting you get away with that. By your own admission, you’re a self-confessed manic-depressive, alcoholic, stage-four people pleaser; ritual performing weirdo, hormonally imbalanced female, and Catholic. What could possibly be funny about that? Honey, you got some ‘splainin’ to do.

Therese: Here’s the deal, John. It goes back to the Seinfeld rule on humor. You remember that episode? When Jerry is telling dentist jokes and his dentist calls him an anti-dentite. And the dentist converts to Judaism so he can tell Jewish jokes safely? If someone came up to me and said, “Therese, you are one manic-depressive, alcoholic, people-pleasing, ritual-performing weirdo!” I would be offended if they A) were wearing ugly clothes, B) could not laugh at themselves too, C) could not check off anything in the DSM-IV, and D) had no sense of humor. I have earned the right to call myself all those things with levity because … for crying out loud … I’ve wanted to die for big chunks my life. Cut me some fricking slack! Now if a former co-worker of mine emails another co-worker and accidentally copies me on the email in which she says I’m looney (true story, actually), then yes, I have a right to be pissed. But can I call myself looney? ABSOLUTELY. I say let’s err on the side of recklessness.

John: Right, that’s your story and you’re sticking to it. Okay, let’s shift gears a bit. Some of our darkest thinkers in history also doubled as our greatest humorists. I’m thinking of Mark Twain, Kurt Vonnegut, and George Carlin. You can also throw in Shakespeare and Swift. What accounts for this? Were they as twisted as you are?

Therese: I believe in the theory of the rubber band. Your brain (sanity) is stretched, and stretched, and stretched, and stretched to where it … ZAP! … just snaps one day, and from that day on, everything in life is somewhat hysterical because you can’t believe how messed up the world is. You see everyone around you trying to walk straight while juggling five heavy suitcases of baggage … and for some reason, it’s funny, and you know you can’t take life so seriously. As G.K. Chesterston once said, “angels can fly because they take themselves lightly.”

Stephen Colbert was interviewed in Parade magazine a while back, and he explained the night to burst out of his shell of pretension and was able to fully be himself on stage. He said, "Something burst that night, and I finally let go of the pretension of not wanting to be a fool." I don’t know, John, something burst in the psych ward, where I sat eating rubber chicken with women wearing granny underwear for everyone to see and painting birdhouses with a teenage boy who wanted to hook up with me at the mall after we were discharged. Some people probably wouldn’t find the humor in it. But man, they do make great social hour stories (and especially since I don’t drink or use any illegal drugs).

John: Are you trying to tell me that had you been born “normal,” you’d be some shallow humorless stuck in the mud?

Therese: Yes. Absolutely. Haven’t you noticed that pattern? Those who’ve had rather uneventful lives don’t have as much to say at cocktail parties as the ones who have been cleaning up feces for a few decades. As much as I curse depression and bipolar disorder (and most of the DSM-IV that I’m diagnosed with … let’s be honest), it has brought me the blessings of humor, perspective, compassion, humility. Plus I write better! Because I no longer have to make stuff up anymore. There actually WAS a guy in my inpatient unit that tried killing himself by chugging down a gallon of Tide laundry detergent. And there WAS a psychotic woman who attacked an innocent 97 year old man one night because she said her spouse slept with the old man’s wife! Let me tell you, that group therapy session was interesting!

John: In all seriousness, Therese, you are a gift to humanity. Any concluding words?

Therese: Thank you, John. As I’ve said to you before, I have no idea how I am going to repay all your kindness and generosity. I think you should rename your blog as “Beyond Blue Promotion Site.” I suppose I must quote Kay Redfield Jamison here, because she gets credit for my philosophy on humor, and I live by her words every day. She says, “Tumultuousness, if coupled to discipline and a cool mind, is not such a bad sort of thing. That unless one wants to live a stunningly boring life, one ought to be on good terms with one’s darker side and one’s darker energies.” I guess I ran from my darker side for so many years. And that just made me more afraid. So now I try to look the beast in the eyes and ask him what he’s got for me, and, whenever possible, to “break his face” as Jerry Seinfeld says, to make him laugh.

Show your gratitude to someone who helped you in your time of need. Nominate your favorite mental health grunt for a free copy of Therese Borchard’s Beyond Blue. See: Calling All Mental Health Grunts.

Purchase Beyond Blue from Amazon

iPhone Photo of the Day - Point of View

Forbidding obstacles or opening to a limitless horizon? Depends on how you look at it. I shot this from the crest of Mount Laguna, 6,000 feet up, about 50 miles east of San Diego.

Monday, January 11, 2010

iPhone Photo of the Day - I Almost Saw a Whale

Instead, I got this great shot of Point Loma.

Sunday, January 10, 2010

Trolley Ride

What do you do when visitors from out of town arrive in town? You join them and become a tourist. Today we hopped on the Old Town Trolley, a hop-on/hop-off guided circumnavigation of San Diego's attractions. The trolley shot is stock footage. The rest were taken on my iPhone.

San Diego's Harbor through the rigging of the clipper, The Star of India. In the background is the supercarrier USS Ronald Reagan.

A drive-by palm tree shooting.

Downtown San Diego and Coronado Island from the Coronado Bridge, 200 feet up.

Hotel Del Coronado, which featured in "Some Like It Hot."

Balboa Park, one of my favorite spots.

This Time I'm Really Reviewing Therese Borchard's Terrific Book, Beyond Blue, and I Mean It

Okay, this time I’m really going to review Therese Borchard’s terrific new book, Beyond Blue: Surviving Depression and Anxiety and Making the Most of Bad Genes. As you will recall from a recent blog piece, I started out with the best of intentions, only to get diverted. You see, doing book reviews is kinda like handing in book reports - you cheat if you can get away with it.

You read a little bit of the intro and a few random page samples, then go to the keyboard and set your fingers to yada-yada-yada mode.

It’s easy. War and Peace, 40 minutes tops. Russian family drama, Napoleon loses. Nothing to it, really. Throw in the odd quote: “All happy families are alike; each unhappy family is unhappy in its own way ...” Oops! That’s from Anna Karenina. Not to worry, who’s going to notice?

Last time, I made the mistake of opening Therese’s book in search of something quotable, only to find myself actually reading the thing. Ha! Won’t make that mistake again. The book is safely out of reach on a top shelf. Wait! Batty, don’t go up there!

Oh crap! My crazy cat knocked the book to the floor. Hold on:

I have a magnet on my refrigerator that reads, “Jesus loves you, but everyone else thinks you’re an asshole.”

Stop reading! Stop reading! The prose is addictive. Can’t stop. (Must be an OCD thing):

Perfectionism is like an untreated person with OCD who gets stuck analyzing a lady bug on a blade of grass - struggling to determine what shade of brown its dots are instead of appreciating the view of a spectacular rose garden she’s in.

Quick, flip the page. “It’s Depression - Naming the Pain.” Good, anything with a title this depressing has to be as boring as the definitive text on dental fillings. Just one or two quick sentences and I can get on with it:

To my dorm room, where I hid. There, I’d bury my head in the writings of the Carmelite saints Teresa of Avila and Therese of Lisieux. Because their words made sense of my suffering. They had experienced their own inner torment and said it served a higher purpose. ...

Sorry, no book review today. If anyone asks, I’ve got Tiger Woods’ Blackberry right here and I’m speed-dialing all his female contacts. I can’t golf, but I make up for it by having no money. 

Show your gratitude to someone who helped you in your time of need. Nominate your favorite mental health grunt for a free copy of Therese Borchard’s Beyond Blue. See: Calling All Mental Health Grunts.

Purchase Beyond Blue from Amazon

Saturday, January 9, 2010

Ten Schizophrenia Myths Busted

Below is my Reader's Digest treatment from a very informative blog piece by Suzane Smith on X-Ray Technician Schools. Suzane dedicates her site to provide information to medical students. I strongly urge reading the full article. Now, to the myth-busting ...

1. Schizophrenia involves multiple personalities.

One of the most prevailing misconceptions regarding schizophrenia revolves around confusing it with Dissociative Identity Disorder (DID). DID requires the presence of at least two entirely unique personalities with easily distinguished behavior patterns, one of which must regularly assume control of the body over the other. 

Schizophrenia, by contrast, is classified under the psychotic disorder spectrum. It contains 5 different subtypes, each with varying symptoms and diagnostic requirements. Delusions, visual and/or auditory hallucinations, disorganized speech and thoughts, dramatically erratic or outright catatonic behavior patterns, avolition, alogia, and a deadening of emotional responses may all indicate the onset of a schizophrenic episode.

The confusion set in due to the Greek etymology of the word, which literally means “I split.”

2. Individuals with schizophrenia are inherently dangerous people.

In reality, those with schizophrenia and other psychotic disorders only comprise anywhere between 1% to 5% of violent crimes against other individuals. 10%, tragically, end up committing suicide – making those with schizophrenia more likely to stand as a danger to themselves rather than others. Many of them feel pushed to the brink of killing themselves due to extreme levels of marginalization and misunderstanding courtesy of mainstream society. In fact, people with schizophrenia are far more likely to end up as the victims of violent criminals rather than the perpetrators. 

3. There is no reason for individuals with schizophrenia to receive psychotherapeutic treatment – they’ll just keep relapsing.

Treatment for schizophrenia usually involves psychosocial therapy, cognitive behavioral therapy, self-help groups, family therapy, antipsychotic medications, or some combination thereof. By learning how to take control of their illness, people with schizophrenia may very well end up leading happy, productive lives once the proper blend of therapy and/or medication has been established. Unfortunately, due to stigmas regarding psychotherapy, many individuals suffering from schizophrenia shy away from pursuing it.

4. Individuals with schizophrenia are generally too far gone to work, and the ones who can rarely rise above the menial level.

In reality, those with schizophrenia run the gamut from a complete inability to work to highly functioning in an impressively accomplished career. Nobel Prize-winning mathematician John Forbes Nash, Jr. battles paranoid schizophrenia, as does bestselling author Robert M. Pirsig.

5. Schizophrenia is just a clinical term for a character defect.

Scientists have narrowed schizophrenia’s origins to genetics – possibly triggered by certain environmental factors – and a patient’s brain structure and chemical makeup.  Other research has revealed possible issues with the neurotransmitters glutamate and dopamine in addition to enlarged ventricles, irregular activity, cell distribution, and inadequate grey matter. 

6. Symptoms of schizophrenia are relatively homogeneous.

Because medical professionals recognize 5 different subtypes of the disorder (7 in Europe), the actual symptoms of schizophrenia remain far more diverse than many people think. All of them share at least 3 diagnostic criteria, with variances between the subtypes and some individuals. In order to be considered schizophrenic, a patient must display two or more of the following symptoms: auditory or visual hallucinations, delusions, a thought disorder, disorganized speech and behavior, catatonia, avolition, affective flattening, or alogia. He or she must also suffer from a social and/or career disruption, and all symptoms must persist for a minimum of 6 months.

7. Schizophrenia is an extremely rare disorder.

Approximately 1.1% of Americans over the age of 18 receive a diagnosis of schizophrenia every year. However, due to mainstream society shaming and stigmatizing the mentally ill and the psychotherapeutic avenues they need to get better, it is sadly possible that many more suffer from the disease and never seek out professional guidance. Symptoms generally begin their onset between the ages of 16 and 30, with males developing them earlier than females and delusions generally appearing first. Though rare, it is still possible for schizophrenia to manifest in a child.

8. The most defining characteristic of schizophrenia involves hearing voices in one’s head.

Not all cases of schizophrenia involve the clichéd voices in the head. Typically, those with paranoid schizophrenia suffer the most frequently and the most intensely from auditory hallucinations. Other types may experience them, though it is typically more sporadic and less severe. 

9. An individual with schizophrenia may only undergo rehabilitation upon attaining stability.

Once an individual has received a formal diagnosis of schizophrenia, rehabilitation must begin immediately in order to infuse him or her with all the tools necessary for the simultaneously most effective and swift method of treatment. Waiting too long for a patient to achieve stability prior to initiating the rehabilitation process may mean the difference between a recovery and merely doing better.

10. Individuals with schizophrenia have to be medicated the rest of their lives.

For schizophrenia patients who find a psychotherapy and medication regimen that efficiently quells their symptoms, the recovery rate remains startlingly high. Some professionals estimate between 25% and 50% of the schizophrenia population cease to display signs of the disorder upon responsible long-term cessation of their medications. However, whether or not they achieve a full recovery hinges on a number of different factors, such as a suitable combination of one or more types of therapy.

Full article ...

Also check out on Suzane's site:

Ten Common Myths About Suicide

Ten Myths About Domestic Violence

Friday, January 8, 2010

Baby Santa

 Little Teddy, three months

Thursday, January 7, 2010

I Was Supposed to Review Therese Borchard's Utterly Fantastic New Book, Beyond Blue, Today, But a Funny Thing Happened (and a Few Serious Ones, Too) ...

I thought I would have an easy time reviewing Therese Borchard’s terrific new book, Beyond Blue: Surviving Depression and Anxiety and Making the Most of Bad Genes. You see, I already read an advance copy several months ago, so it wasn’t like I had to start from scratch. Just skim a few pages to refresh my memory, then get crackin’.

So I opened to:

There is a saint for every neurosis: St. Joseph takes care of those prone to panic attacks while traveling. For twitching, Bartholomew the Apostle is the dude. Those roaming the house in their sleep can call on Dymphna. The venerable Matt Talbot is the patron saint to those struggling with alcoholism and drug addiction. And, of course, St Jude covers the hopeless causes. ...

Dang, this is interesting. Flick to something boring. No, wait ...

11 Ways You Know You’re an Addict: 1. You can recite the Serenity Prayer in three different languages. ... 6. When you look up dysfunctional in the dictionary, you find a portrait of your family of origin. ... 8. You accidentally feed your sobriety chip into a vending machine. ...

Crap, this is like potato chips. Can’t stop:

“Pretend that I am an editor with Ladies Home Journal,” my therapist said. “I walk up to you and say, ‘Hey, Therese! Good to see you? What have you been up to?’ What will you say?

“Oh. Nothing much. Just hanging out in the community room of a psych ward with Allen, an eighty-five-year-old who has slept with ninety-six women and wants to make it ninety-seven.”

“Try again,” she said. "You are still tutoring at the college, right?”

“Until the dean discovers a whackjob is teaching tomorrow’s leaders.”

Stop reading! You’re supposed to be doing a book review. Wait, you’ll enjoy this:

30 Ways Motherhood is Like a Mental Illness ... 6. Both feel like you’re being pecked to death by a bird. ...

But Therese also has a deadly earnest no-joke zone to her persona:

When Liz encouraged me to train my mind without drugs - to reach inside myself for the strength and discipline to do it without the crutch of medication - she spoke with no understanding of what it’s like to have your survival instinct completely dead, to have 99 percent of your energy going toward not pursuing one of five ways to kill yourself.

And ...

How can you possibly explain severe clinical depression to a four-year-old boy who wants a stable, cheery mom - one that can take him to the park without breaking into tears behind a tree, or miss his great karate achievement because she had to bolt to the restroom and let her body shake with anxiety like a woman with severe Parkinson’s.

Okay, it’s pretty obvious I’m not going to get to reviewing Therese’s book today. I’m otherwise engaged, so don’t bother emailing or phoning me, not even if you’re Angela Jolie telling me you’ve broken up with Brad and are lonely. You see, I’m re-reading a truly outstanding book.

Win a copy of Therese Borchard’s Beyond Blue. See: Calling All Mental Health Grunts.

Purchase Beyond Blue from Amazon

iPhone Photo of the Day - Tribute to the Sun

I shot this today on a walk in the mountains near my home in southern CA. I can't emphasize enough what these walks do for my recovery.