The Year That Was: My 2011 Highlights and Lowlights

This is the time of the year for looking back, a la Time Magazine and CNN. Following is my personal (and highly idiosyncratic) view on how the year unfolded:

Person of the Year: The Three Stooges 

This was a no-brainer. Anytime I was stuck for a pictorial representation for a blog piece, these guys delivered. Need something to illustrate the fine points of personality? Moe, Larry, and Curly - and sometimes Shemp - were there. The intricacies if the human condition? Who better? The state of psychiatry today? I rest my case.


Historical Person of the Year: Adolf Hitler

Investigating historical figures sheds endless light on timeless behaviors and current conditions. This year’s crop included Lincoln (depressive realism), Ayn Rand (greed), Phil Ochs (depression and empathy), LBJ (bipolar grandiosity), and Chairman Mao (Machiavellianism). We even used President Obama to shed light on the unfortunate condition of chronically normal. And for pure evil - who best to illustrate the point? Wait, that’s not ...

Supreme Being of the Year: God

When I tell people this blog is about everything from God to neurons I really mean it. Okay, God and I have issues. In fact, earlier this year, in a post here, I reported that I fired God. No one owns the truth about God, but when we’re looking to explain life, the universe, and everything, who always turns up in the conversation? My own proof of God? Look at us - someone up there has to be laughing.

Neurotransmitter of the Year: Dopamine (of course)

From a PowerPoint slide presented by Nora Volkow, head of the National Institute on Drug Abuse, reported here earlier this year: “All drugs of abuse increase dopamine in the nucleus acumbens. But stress does, too.”

Or this, from a piece on deciding on a partner: “When all is said and done, it is the ventral tegmental area (VTA) that rules, not the parts of the brain we actually think with. The VTA is the dopamine-sensitive region in the midbrain that mediates pleasure and reward.” 

Trust me, compared to dopamine, serotonin is a wimp.

As I like to tell people, reported in another piece here: “If you think you are experiencing God - it’s probably dopamine. If you think you are experiencing love - it’s probably dopamine. That doesn’t mean God or love is not real, but we know dopamine is.”

Ah, the God to neurons thing again.

Psychiatrist of the Year: Emil Kraepelin (second year running)

As I reported last year: “Okay, he’s sort of dead - well, completely dead - which is a rather large technically. But even dead, this guy leaves the live psychiatrists for dead.”

This year, psychiatry excelled at playing dead. As those of you with at least two working neurons are aware, last year journalist Robert Whitaker published his eye-opening “Anatomy of an Epidemic,” which raised the startling proposition that mental illness is on the rise because of meds, not despite meds.

We waited for an intelligent response from psychiatry. And we waited - and waited. Except for a sicko hissy fit from psychiatry thought leader Andrew Nierenberg, psychiatry played dead. And continued to play dead.

This was like waiting for Godot. Last month, I had no choice but to conclude: “So, for right now, in the absence to date of any credible marshaling of the facts from psychiatry, Whitaker stands as the most authoritative voice on psychiatric treatment.”

Somehow, I cannot imagine Kraepelin - the father of diagnostic psychiatry who knew far more about manic-depression in 1921 than the failed proctologists who mindlessly dispense antidepressants today - sitting out this vitally important conversation.

Condition of the Year: Crazy

Crazy is not a dirty word. “Here’s to the crazy ones,” begins the classic 1997 Apple ad. “The misfits, the rebels, the troublemakers, the round pegs in the square holes ...  They push the human race forward, and while some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think that they can change the world, are the ones who do."

Here’s to you, Steve Jobs.

That was the year that was. 

Who knows what next year will bring? Whatever happens, we’re all in it together. Many thanks to all of you here who gave me a reason to get out of bed each morning.

The Year That Was - Almost Over, But Not Letting Go: Part II

My second (first here) idiosyncratic installment in looking back on how 2010 unfolded:

Old Movie of the Year: Groundhog Day

Updating the DSM is an exercise that affords us that rare opportunity to think mental illness afresh. The last time this happened was in the late seventies with the publication of the ground-breaking DSM-III of 1980. Think of the DSM-III as the old DOS operating system. Its successor editions (the last one was 1994) were essentially DOS updates. In Feb this year, the American Psychiatric Association unveiled its draft to DOS-5 - um DSM-5 - due for publication in 20013.

In sticking to DOS, as I reported here on numerous occasions, those responsible for the next DSM - which sets the scene for the next 20 years - are keeping us stuck in 1980 Groundhog Day forever.

If nothing else, a soul-searching discussion would have been useful. Hell, I would have settled for an instant message. An instant message where numerals pose as words, even. Is this asking too much? Yes, apparently.

Psychiatrist of the Year: Emil Kraepelin

Okay, he’s sort of dead - well, completely dead - which is a rather large technically. But even dead, this guy leaves the live psychiatrists for dead. (Wait, let me rephrase that.) Kraepelin, who was born the same year as Freud, coined the term, manic-depression, which - contrary to conventional thinking - is not synonymous with bipolar.

Kraepelin saw all forms of depression (even unipolar depression) in an obvious relationship with clear overlap. This translates into a lot of unipolar depressions behaving like bipolar, even if mania is not involved. This may also explain why antidepressants do not work for a good many people, and may indeed be harmful. The DSM-III of 1980 can be forgiven for getting this wrong. The DSM-5, due out in 2013, cannot.

No doubt about it: If we could somehow “undead” Kraepelin, he’d be saying take a match to the DSM and start over. Instant message: "G8 stuff, homey! All 4U! :) :)"

Person of the Year: You

That’s right, you - patients and loved ones. In April this year, I delivered a keynote to DBSA Kansas. As part of my talk, I asked my audience to come up with a one-sentence description of depression. The answers bore some relationship to the DSM, but were much more insightful and in touch with reality:

“Like having two doberman pinschers waiting for you to get out of bed in the morning.”

“You're on a raft, in the middle of a huge ocean, you can't see any land anywhere, on any horizon, and you're totally becalmed.”

“It's like trying to walk through mud up to your neck.”

These were just some of the responses, very much in line from what I have been hearing from fellow patients and loved ones for years. But then again, only we know what we have to live though. Too bad psychiatry isn’t interested in hearing from us. “Is that a better list than the DSM list?” I asked my audience. “Congratulations,” I concluded, “you guys have beat the best psychiatrists in the world. Give yourselves a round of applause.”

More to come ...

The Year That Was - Almost Over, But Not Letting Go

This is the time of the year for looking back, a la Time Magazine and CNN. Following is the first installment in my personal (and highly idiosyncratic) view on how the year unfolded:

Historical Person of the Year: Genghis Khan.

It turned out my first piece of the year just happened to mention this much-maligned conqueror. His name came up in the context of traditional societies, where people have far less mental illness and recover far more quickly than those forced to cope with the demands of modern living. We can debate forever about the hows and whys until the cows come home. We did just that over the course of the year.

Nevertheless, Genghis Khan reminds us that even people living back in simpler times had cause to be stressed, which kept the discussion honest.

Later in the year, I devoted an entire piece to the man who made Alexander the Great look like a pussy. In his wake, things were never the same, which offered an excellent object lesson on thinking outside the box and paradigm change - my other major theme of 2010. Clearly, the prevailing biological psychiatry paradigm of mental illness is under threat - from its own shortcomings, from new advances in brain science, and from a growing consumer-led recovery movement. New explanations are needed.

Bottom line: In two different thematic approaches to rethinking mental illness, Genghis Khan was there.

Historical Person of the Year, Runner-Up: JFK

“We enjoy the comfort of opinion without the discomfort of thought,” our 35th President said in 1962. He could have been talking about today. Is Republicanism the New Stupid? I questioned in one blog. (Short answer: Yes, but that doesn’t mean Democrats are smart.) In numerous pieces, JFK served as the pin that punctured the fallacy that our choices are based on reason. Whether we are voting for a political candidate or buying a product or choosing a mate, new research is revealing that the thinking parts of the brain cannot make a decision without input from the primitive limbic regions. Our highly-evolved cortical areas, too often, seem to serve no other purpose than to rationalize our emotional reactions.

Kennedy had an undeniable emotional appeal, but of all things the televised 1960 Presidential debates reveal the man’s appeal to our higher reason. “What piece of work is man?” Some surprising answers are revealed by gazing into that distant mirror.

No doubt about it, Kennedy is there.

Fictional Person of the Year: Hamlet

I have of late - but wherefore I know not - lost all my mirth, forgone all custom of exercises; and indeed it goes so heavily with my disposition that this goodly frame, the earth seems to me a sterile promontory …

What is depression, anyway? Feeling sad? Lack of motivation? Psychic numbing? Is it a “normal” reaction to abnormal events or an abnormal reaction to normal events? A loss of energy or a mammalian need to hibernate? A crisis of the soul? Perhaps it’s even a part of our normal personality. Hamlet did a lot of talking, but scholars still debate the true shade of his “nightly colour.”

Obviously, no two depressions are alike, which makes one wonder why psychiatry treats them as if they were. No wonder we don’t get better. All year, on Knowledge is Necessity, we asked the type of questions that psychiatry needs to be asking. Hopefully, one of these years, psychiatry will begin to do some asking of its own.

In the meantime, Ham-o-let is there.

Fictional Work of the Year: The Draft DSM-5

As those of you who read this blog are aware, the DSM-IV bears little semblance to clinical reality. The DSM-5, which is due to come out in 2013, proudly continues in that tradition. In February, the American Psychiatric Association unveiled its draft, which amounted to (with the notable exception of personality disorders) a reissue of the DSM-III of 1980, replete nearly word-for-word with its antiquated and highly misleading symptom checklists.

This definition of depression, vintage 1980: “Depressed mood most of the day.”

Huh?

I could go on and on. For most of the year, I did. But who listens to me?
 
The DSM, the DSM, there's nothing like the DSM
It’s a text in medical shape
An illusion of authority
You may read it in a by-street
You may consult it in the square
But when we need an answer, the DSM’s not there!

Much more to come ...