Hats Off to Whitaker

Just a quick note that last week Robert Whitaker received the prestigious Investigative Reporters and Editors Award for his book, "Anatomy of an Epidemic." As regular readers of this blog are well aware, I have published at least 10 commentaries here based on his book, plus several more that used his book as a starting point for other topics. Some of my commentary was highly critical of Whitaker, but always in the context of acknowledging him as a welcome and vital voice and a breath of fresh air.

In singling out Whitaker, the IRE notes:

This eye-opening investigation of the pharmaceutical industry and its relationship with the medical system lays out troubling evidence that the very medications prescribed for mental illness may, in increasing measure, be part of the problem. Whitaker marshals evidence to suggest medications “increase the risk that a person will become disabled” permanently by disorders such as depression, bipolar illness and schizophrenia. This book provides an in-depth exploration of medical studies and science and intersperses compelling anecdotal examples. In the end, Whitaker punches holes in the conventional wisdom of treatment of mental illness with drugs.

Took the words right out of my mouth. Please-please-please, read his book. Warm congrats, Robert, from a sometimes critic but a very ardent supporter.  

I Invest in a New Chick Magnet (But Did I Make the Right Decision?)

When shopping for cars, most of us engage in months of careful research, only to drive off the lot in the first thing that appeals to our fancy. Last week I decided that it would be far more efficient, instead, to simply dispense with the research phase of the process.

“What the f... ?” I could only wonder, an hour later, as I sized up my new purchase in the parking space to my apartment complex.

Let’s see: I had neglected to ask about things like gas mileage and how to pop open the hood, much less what kind of engine was actually beneath the hood. Minor stuff. Okay, forgetting to scrutinize the cup-holder for possible design flaws, that was major, but better to err on the side of simplicity. Keep simple things simple.

According to Jonah Lehrer in “How We Decide,” the average American spends 35 hours comparing automotive models before making a decision. See? I’m a lot smarter than that. Let me explain:

On Tuesday, my trusty old beater - a 1992 Tercel (“The Chick Magnet,” pictured below) - died on me. Four years earlier, I went way over my budget in paying $800 for the thing. Then I made a five-dollar investment in a blanket to conceal the gashes in the back seat.

I know, I know. Excessive spending is a sign of mania, but I did get three good years out of the thing. (My first year, I didn’t drive it - minor technicality about not having driven in 30 years, but that’s another story.) Anyway, here I was, Tuesday of last week, with a dead Chick Magnet, and me living 30 miles out of town with no wheels.

No sense in panicking, I decided, once I got through with my obligatory Peter Finch in “Network” scene, the one where he fulminates, “I’m mad as hell and not going to take it anymore!” (bless you director Sidney Lumet, RIP). Thursday morning, I got hold of a cab driver and we negotiated a flat rate to go shopping for used cars. “They say it’s best to buy a Japanese car,” I opened. (Who said I didn’t do my research?)

The cab driver (who was incidentally driving a Lexus) enthusiastically concurred.

We pulled into the first car lot on my list. Five VWs with silver paint were lined up in a row. “Get the car with the silver paint!” the two-year-old part of my brain screamed at me. But I’m way too sophisticated for that.

“Uh, German is kind of like Japanese,” I said tentatively to the cab driver. Yes, he agreed. Good enough for me. After all, they both lost World War II. I zeroed in on the one with a $4,999 price tag. One dollar under my budget. I could blow the rest on a 99-cent taco. No shortage of taco stands in this part of town.

The cab driver and I got in for a test drive. What do they call this thing? I asked him. It sounded like he said Pasada. A 1999 VW Pasada. Bigger than a VW Jedi. Clearly, the vehicle met all my major criteria, namely: It had an engine that started when I twisted the key in the ignition. Okay, the fact that the engine didn’t sound like a re-enactment of Pearl Harbor was slightly unnerving, but I could get used to that.

Plus, it’s got silver paint!

I test-drove one more car with silver paint, just to make sure. My cab driver suggested I try some other car lots in the neighborhood, but there was no sense in over-thinking this. Silver paint job, kinda Japanese, engine included. Good enough for me.

I called up my brother as the dealer was completing the paperwork. What kind of car is it? he asked. A Pasada, I replied. I checked the piece of paper in my hand. A Passat, I corrected. It’s even got a radio that works.

Jonah Lehrer’s book cites a series of studies by Dutch psychologist Ap Dijksterhuis. The first study was simple and hypothetical: Subjects were presented with four different used cars based on four features, representing 16 pieces of information. One car, for instance, handled poorly but had lots of leg room. Then he gave his subjects a few minutes to contemplate their choices. More than half wound up picking the “best” car. Easy.

Then Dr Dijksterhuis distracted his second group of subjects, forcing them to make an unconscious or emotional decision. These hypothetical buyers made bad choices. Obvious, right?

Not so fast. This time, the buyers were provided with 12 features (such as cup holders and trunk space), totaling 48 pieces of information. Their brains couldn’t handle the overload, even when given time to think things through. Less than one-quarter chose the best car, worse than chance. But the group he distracted actually made the best choice 60 percent of the time. What gives?

Dijksterhuis followed up with real-world studies on all kinds of consumer products, plus further hypothetical exercises. The gist of his findings is that our brains are designed for choosing simple products such as toilet paper and vegetable peelers, where buyers can zero in on important things, such as price. Emotions can mess up your thinking, here, and lead to bad choices.

That all changes, though, when we’re buying a couch at IKEA. Will the couch, for instance, match the drapes? Will the cat scratch the leather? On and on, way too many things to think about. Inevitably - without input from our emotions - we are going to make the wrong decision.

Yes, we need to do our homework. Yes, we need to rationally sift through our options. But Dijksterhuis found an important qualification to this. When it’s a complex decision, we need to distract ourselves, let our thoughts marinate in our unconscious for awhile, then have faith in our feelings. According to Lehrer: “Complex problems ... require the the processing powers of the emotional brain, the supercomputer of the mind.”

Anyway, here I am stuck with a car that has defective cup-holder that doesn’t slide out. It’s also way too huge for me. But it handles beautifully and it’s a pleasure to drive (a totally alien experience to me), and I didn't exceed my budget. Plus, it just FEELS right.

Not to mention the silver paint job. My new Chick Magnet. Honestly, could I have made a better choice?

Why I Walk

 Following is a talk I gave six weeks ago at a NAMI San Diego Walk kick-off event. Our Walk takes place April 16 ...

I walk because I am haunted.

I am haunted by my childhood. By the strange looks from family members, from kids in school. They knew. I knew. Even way back then, I wasn’t normal.

I am haunted by my adulthood. A bright promise denied. They knew. I knew. I’m normal! I wanted to shout.

I’m haunted by what I encounter. A question by a father about his kid who refuses to acknowledge his illness - one I can’t answer. Queries I get from my readers - their loved one is acting strange, very strange. What is wrong? More questions - my doctor won’t listen, my insurance is running out. What the hell is wrong with me?

I’m haunted by a world that doesn’t give a damn. People who are supposed to be helping us who tell us that we have a highly treatable illness that at times is barely treatable, and then turn around and say we should be happy where we are - stuck in a miserable half-life, alone, left to fend for ourselves.

I’m haunted by the fact that everything I read or listen to bears no relation at all to my world, your world. Isn’t anyone paying attention? Doesn’t anyone give a damn?

I’m haunted, you’re haunted. Everyone in this room is haunted. That is why we come out in the rain on a Saturday. That is why we get on the phone. We make noise. That is why we show up at meetings. That is why seven weeks from now, rain or shine, we will show up. We will walk. A family, bound together by experiences that haunt us. We will walk. We will send the world a message.

So much to do, so few of us. A good deal of the time it seems hopeless. But we get involved, anyway. Anyway we can.

No one - absolutely no one - should have to endure one day of what we have been through. Not one day. We will walk.

I will conclude with this:

Back in 2004, when I was newly into my second marriage, 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.

Over the weeks, I couldn't help but be impressed by the way Kevin carried himself. He would walk up to newcomers and introduce himself and start up a conversation. In the group, he was a great listener, dispensing the wisdom of a sage, leavened by a keen sense of humor.

It was amazing to observe him with people much older. At once, he was deferential, compassionate, and exuding great authority. You simply forgot you were talking to someone much younger. You simply wanted to be around him, laugh with him, seek advice from him. 

He had his setbacks, his dark moments. Yet, over time - in group, over coffee, over sandwiches, hanging out - I watched him blossom. With his extraordinary people skills, the sky was the limit.



In late 2006, my marriage broke up. Kevin was the first to offer me support. He also reached out to Susan.

Suddenly, I had my life in seven or eight FedEx cartons and a one-way ticket to San Diego. I popped into the DBSA group one last time. Kevin was facilitating. He gave me a heartfelt tribute. I felt the goodness in the man. Goodness, true goodness. That was the last time I saw him alive.



He had so much to live for, so much to offer. Yet, on a miserable muggy New Jersey morning, his brain tricked him into believing otherwise. He was 28. Years later, Susan and I, plus all those he left behind, are still dealing with it.



I've been suicidal. So have most people with this illness. We fully understand, yet - we totally don't understand.



Kevin, you still shine a light on the world. Nothing - nothing - is ever going to extinguish it.

That is why I walk.

***

Our Walk takes place this Saturday - April 16 - in Balboa Park - 6th and Quince - at 8AM. Please come, if you live in the area, and bring your family. If you wish to support me in my walk, please go to my NAMI San Diego Walk page.

NAMI San Diego Walk - We Need Your Support

I put this together for NAMI San Diego. Our annual Walk is taking place this Saturday, 8 AM April 16 at Balboa Park (6th and Quince), and I urge you to attend if you're living in the area. You can register on site (beginning at 6:30 AM) or in advance on the NAMI San Diego website).

Also, if you are a fan of this blog, I urge you to support me in supporting NAMI San Diego by making a donation on my Walk Page.

I serve on the board of NAMI San Diego, and I put way too much time into it, which is nothing compared to the heroes who founded NAMI and gave those of us living with mental illness a voice, and more heroes who kept the vision alive and more heroes pushing the vision forward. I am inspired by these people and the great work they do, so please pay attention:

I provide Knowledge is Necessity as a free service, along with mcmanweb. This is the only time I hit readers up for money, and it's not even going to me. Any small gesture of support would be greatly appreciated. Thank you.

Depression-Proofing Your Home

This is a chopped version of an article I just uploaded on mcmanweb. It's amazing I've never written on this before. Better late than never ...

Let’s start with the proposition that people with mood disorders are extremely sensitive to their environments. You may be stuck where you are, but your entire well-being is riding on making the best of what you’ve got.

Atmosphere

Essential adjectives are vital: Cheery, bright, relaxing, calm. Your home is a key player in setting the right mood. If what comes to mind, instead, is, say, depressing, you are on the wrong adjective.

There is a direct connection between light and mood. If vast quantities of natural sunlight aren’t streaming into your place, then you need to buy stock in a lamp company and make yourself rich by purchasing their entire inventory. You may also want to consider a light box, normally used to treat seasonal affective disorder.

Meanwhile, fresh air (charged with negative ions) is linked to good health, both physical and mental. Cracking open a window is the obvious solution, but if you are you living in a sealed enclosure and inhaling central heating or air conditioning (charged with positive ions), you may need to consider investing in an ionizer.

You also need to be extremely mindful of breathing in anything toxic, from mold proliferating behind the wallboard to chemicals in the carpet to germs the central air-conditioning spits out.

The Bedroom

The basics: A comfortable bed that supports your back, good lighting (for bedtime winding down and for waking up), and as close as possible to absolute quiet.

The quiet aspect deserves special consideration. Many of us have hair-trigger stress responses that can be set off by loud noises. A lot of us also have great difficulty tuning out background noise (such as air-conditioning). These should not be regarded as inconveniences we have to get used to.

Family members: You will be doing both yourself and your entire family a favor by bending over backwards to accommodate the needs of your affected son or daughter (or other family member). If he or she sleeps peacefully, you all sleep peacefully. And daytime will be much easier on all of you, as well. Whatever it takes.

Your Own Special Room

Having your own hideaway is essential, whether in catching your breath or catching up. This is your special piece of the world. It needs to reflect you in all your quirky glory, from the First Folio Shakespeare in the bookcase to the neon Budweiser sign in the window.

However you choose to set up the room, it is giving You permission to be You, whether smoking cigars or meditating, building model airplanes or running a business.

The Kitchen

You are what you eat, but living with a mood disorder means you are often going to be too depressed to want to cook. Therefore, it’s vital to be well-stocked on healthy pre-prepared slap-together stuff. Bags of mixed greens, stir-fry, you get the picture.

The Bathroom

Think of all the stuff that goes on in this room besides the usual - uh - stuff. From looking in the mirror to all the rest of it, you are on display. The other you is evaluating, assessing, taking stock. Don’t like what you see? It’s going to be a rough day.

Likewise, there you are, in your inner sanctum, alone with your thoughts. Is the atmosphere conducive to a meditative experience, a breather, a pleasant time-out? Or is your decompression chamber a depression chamber?

Of all the rooms in the house, the bathroom is the one room where you need to walk out of it feeling much better than you went in. If this isn’t happening, you need to closely evaluate the situation - and treat it as a high priority.

Home Maintenance

Things can easily run away from us, even when we are not depressed. I know for a fact that if I go to bed with two dirty plates in the sink, I will wake up to a family of dirty little saucers. As for clothes on the floor, it’s like tumbleweed piling up against a fence. My theory on rubber bands is they morph into power cables for electronic devices that don’t exist. All my cables, incidentally, defy the law of entropy by self-organizing into gordian knots.

By now, you recognize that the front line in the battle against depression is played out literally on the home front, in our own homes. Make yourself at home and live well ...      

McMan's Dispensable Rules and Observations for Right Living

My grandson’s birth in Sept 2009 inspired me to come up with two posts along the lines of the clan elder (me) offering his sage advice to the newest member of the tribe. The piece below represents a reshuffle of my original two lists, plus some new stuff. I make no claim to originality (one of my aphorisms is a shameless rehash of Diogenes). My status as a dispenser of wisdom derives from an unparalleled lifetime streak of doing everything wrong. Enjoy ... 

Four Rules for Living with Perspective

1. Remember, Hannibal never won a battle with his elephants.
2. Caviar is fine, but peanut butter will always be your friend.
3. We elude happiness far more than happiness eludes us.
4. God has a sense of humor. Trust me, every day you will do something to make Him snort milk out His nose.

Four Rules for Making Wise Decisions

1. The Wise Man knows when to quit while he’s behind.
2. If you challenge Tiger Woods to a game - make sure it’s not golf.
3. Ration your hate. Don’t indulge.
4. When you reach into your pocket searching for a one dollar bill and all you can come up with is twenties - try not to express your disappointment.

Four Rules for Right Conduct

1. There is no excuse for dancing like a white man.
2. You are a book responsible for your own cover. Expect people to judge.
3. We are who we pretend to be. You can’t go wrong pretending to be JFK or Martin Luther King.
4. If you suck up to the rich and powerful, you won’t have to do your own laundry. If you do your own laundry, you won’t have to suck up to the rich and powerful.

Four Observations About Meaning

1. Friends are a way better investment than money.
2. A good poop is way better than mediocre sex.
3. Our purpose here on earth is to laugh at farts.
4. There is one constant in life: Ursula Andress will always be the all-time number one Bond Girl.

Four Observations About the Mysteries of Life

1. Thoreau danced to a different drummer, but he also died a virgin.
2. Napoleon lost an entire army in north Africa and an entire army in Russia. Still, he had no trouble recruiting volunteers for Waterloo. Go figure.
3. God has a funny way of treating people He loves most. Just ask Joan of Arc.
4. The oldest known redwood is 2,200 years old. An idiot with a chainsaw only needs one day.

Four Observations on Reality

1. If you think you are experiencing God - it’s probably dopamine.
2. If you think you are experiencing love - it’s probably dopamine.
3. That doesn’t mean God or love is not real ...
4. ... but we know dopamine is.

Where Does Hypomania End and Mania Begin?

As part of my overhaul to mcmanweb, I've scrapped most of my old articles on the diagnostic aspects of bipolar and replaced them with new pieces. The following is extracted from a much longer piece on hypomania. Enjoy ...

The DSM mandates that if psychosis is present, then it has to be mania, not hypomania. Otherwise the only separator is severity, and here the DSM is highly confusing and contradictory. On one hand the DSM reassures us:

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization ...

On the other, symptom number seven (a direct copy and paste from the mania symptom list) tells us:

Excessive involvement in pleasurable activities that have a high potential for painful consequences ...

So - wait! First, we're being informed that there is nothing to worry about. Next, we're being told to go to DEFCON One. Which one is it?

There are no easy answers, but one possible solution is to eliminate symptom seven in hypomania and make it mandatory (rather than merely optional) for mania. In other words, if the individual is entering the danger zone - putting his or her livelihood, relationships, and safety at risk - then it is mania, not hypomania.

Another piece of the puzzle is control. In my article on mania, I suggest my own diagnostic guide:

Behavior must be out of control to the point that subject can no longer responsibly manage his or her affairs or reasonably interact with others. ... Thinking must be out of control to the point where subject has a grossly distorted perception of him or herself and his or her surroundings, and is no longer capable of making realistic or responsible decisions.

Whereas with hypomania, it's more like this:

Subject may exhibit unusual or unexpected behavior, but is still capable of responsibly managing his or her affairs and interacting with others. ... Subject may have a mildly distorted perception of him or herself and his or her surroundings, but is still capable of making realistic and responsible decisions.

Finally, there is the matter of presentation. In euphoric states, I would contrast a "magnanimous larger than life presence" (mania) with a rather more diminutive "sociable charismatic presence" (hypomania). In dysphoric states, I would contrast a "hostile menacing presence" with an "unpleasant mildly threatening presence."

But nothing is ever that simple. In bipolar, our brains are always in perpetual motion, so even in a seemingly benign hypomania there is always room for worry.

***

New mcmanweb bipolar articles:

Bipolar Disorder - Really a Cycling Illness
Bipolar I and Mania
Bipolar II and Hypomania

Letter From an Asshole

Yesterday, I published two April Fools pieces on assholes (Imaging Studies Reveal Brains of Assholes, Psychiatry Come Up With New Diagnosis of Asshole). Naturally, I expected assholes to take offense, and sure enough ...

Dear Sir:

Speaking as an asshole, I take extreme umbrage to your posts. Just because we treat people like shit doesn't mean we're full of shit. We are people, too, and we expect you to treat us much differently than we would treat you.

Don't you realize? You and everyone else are mere outer planets in my universe. Not even a gas giant. Not even a moon rock. Not even a piece of Pluto that has been demoted to renegade asteroid status. No, more like a cosmic speck of dust, and the lowest order cosmic speck of dust at that. Sort of like a molecular splinter of a dirty space-floating chunk of ice.

For your information, I'll have you know, Assholes are very compassionate. Why just the other day, I suppressed the urge to jump the curb and run over a mother with her baby, fucking mewling screeching poop machine. The only thing they're good for is as the main ingredient on Iron Chef. Roast rack of baby with rosemary, now we're talking.

But do they ever put me on the short list for a Nobel Prize? Me, with all the abuse I have to put up with? Just yesterday, some diphthong-mangling, border-jumping, Obama-loving excuse of a waiter actually had the effrontery to serve me water in a wine glass.

How the hell was I supposed to react? Of course I made him rue the day he was born. You'd think the patrons in the restaurant would have supported me in my moment of need, but no, they were whispering and looking at me. ME!

As if I were the one who did something wrong. No, all they see is me summoning the manager and saying in a very loud voice that even the slop-ladlers in the kitchen can hear that I will call the health authorities and have them shut down their filthy cockroach-infested excuse of a Dairy Queen if he doesn't fire Gunga Din immediately.

What they didn't see was that I generously tipped the ungrateful wretch one dollar.

See, a regular Mother Teresa I am, and my therapist agrees with me. She better, the bitch. She's the third one I've had in three months and she can be replaced and she knows it. Christ! I've texted her eleven times in the last 20 minutes. Why isn't she responding?

Damn! I just noticed I forgot to put my ice cream back in the freezer. The price I paid for this yuppie shit named in honor of some over-rated dead rock star, the stuff shouldn't melt. Cherry Garcia, my ass. I'm going to file a class-action law suit.

Well, that completely shoots my day to hell. Should I call my reiki specialist to say I'm not coming in? No, not my problem.

Anyway, I trust you have an appreciation for what Assholes have to endure. Why I had to point this out to you is beyond my comprehension, but then again coming from a lowly piece of space junk like yourself, don't get me started.

Respectfully yours ...

Rerun: New Imaging Studies Reveal Brains of Assholes

In a study about to be published in "Nature," researchers at the NIMH reveal the first-ever fMRI scans of assholes at work.

Said lead researcher Y Mee MD, PhD, "We've always known an asshole when we see one, but it never occurred to us to actually scan their brains. I mean, seriously, who would want to?"

Nevertheless, the researchers overcame their strong revulsion and recruited 10 assholes plus 10 control subjects.

"I mean - crap - I was ready to quit my job in the first five minutes of the study," said co-author I Hadinoff PhD. First the assholes filled out their intake forms completely wrong, then abused the staff when they had to fill them out again. Next, they kept pushing and shoving to be the first one into the MRI machine. But once in, they couldn't stop complaining.

This posed a special difficulty because study protocol required that first the assholes' brains be scanned while in a resting state.

"So here we are," said Dr Hadinoff, "having to be nice to these fucking assholes. No sooner do I get one calmed down than another one gets started, and next thing they're all setting each other off like mousetraps going off in a room."

One asshole lady complained that her no-good son-in-law refused to finish cleaning the leaves out of her gutter, as he had promised. A world-class therapist had to be called in to remind the individual that her son-in-law had fallen off the ladder while she was shaking it and had cracked nine vertebrae and would be a quadriplegic the rest of his life.

"But I'm on a fixed income," the woman retorted. "How the hell am I going to find affordable help?"

Said Dr Hadinoff: "You know that show where that guy does all those shit jobs? I'm on the short list for the Nobel Prize, but, believe me, I was ready to throw it all in and go to work standing up to my ears in cow shit. Seriously, anything had to be better than dealing with this shit."

Eventually, the researchers got the assholes settled down and were able to get images of their brains at rest. On close inspection, the scans revealed certain structural abnormalities to the posterior corpus rumpus section of the brain. (See image above.)

"It's uncanny," said Dr Y Mee. "It's as if their brains had 'asshole' written all over them."

Then the assholes were made to perform certain tasks while their brains were being scanned. In one task, the subjects were asked to imagine lying on a beach on a tropical island.

"What? I'm just supposed to lie there in the hot sun with all the mosquitoes and sandflies and who knows what?" was the typical response. "Screw you, I did that for my second honeymoon, and let me tell you, it wound up to be our first divorce."

In other tasks, the assholes were asked to imagine something good about a member of their family, any accomplishment they could be proud of, a waitress they were nice to, and something that went wrong that they were willing to accept responsibility for. They failed every task spectacularly.

As their brains were thus engaged, a certain part of the posterior corpus rumpus, known as the temporal anal cortex, lit up like a Christmas tree. (See image below.)


















"It's amazing," said Dr Y Mee. "For the first time ever, we are looking into the mind of an asshole - and the last time, I can assure you. Believe me, after what we went through, no one in their right mind is going to want to try to replicate our findings."

The findings are expected to provide valuable insights into radio talk show hosts, Fox News commentators, and antipsychiatry bloggers.

Drs Y Mee and I Hadinoff are at present in intensive therapy. Their prognosis is poor to miserable.

A happy and meaningful April Fools ...

Rerun: Breaking News: Psychiatry Comes Up With New Diagnosis of Asshole

A Knowledge is Necessity exclusive.

In a surprise move expected to be announced shortly, the American Psychiatric Association's Task Force responsible for overseeing the revision of the DSM - psychiatry's diagnostic bible - has come up with the new diagnosis of "Asshole."

Unlike other disorders, episodes, types, and specifiers listed in the DSM, the diagnosis of Asshole fails to mention any symptoms. Nor does it offer a description of the illness.

"Let's put it this way," said Ru Dayborn MD, director of the Darwin Awards Treatment Center at Johns Hopkins and member of the working group that came up with the new diagnosis, "you know one when you see one."

The new diagnosis is the result of heated discussion throughout the Task Force's many working groups, in particular the one responsible for updating the bipolar diagnosis. According to I Gitswoureigh MD of the University of Northern South Dakota, speaking strictly off the record: "We were sick of hearing from our bipolar patients about the bad rap they were getting as a result of Assholes who had mistakenly been diagnosed as bipolar."

Leading bipolar patient advocate Phil Toogood was ecstatic over the news. "It's about time," he commented. "Since the dawn of history we've been putting up with their shit. Every time someone like Charlie Sheen does some asshole thing, people automatically assume the jerk must be bipolar. Maybe now the public won't confuse us."

It isn't just bipolars. Reports Charles Manson from his prison cell: "For years, assholes have been giving us sociopaths a bad name."

The illness is considered chronic and untreatable. When asked to give an example, Dr Dayborn commented, "That's easy. Rush Limbaugh. Say no more." Dr Dayborn did add that Assholes can go on to lead productive lives. "Look at all those idiot commentators on Fox News," he observed. "See, there is hope."

When advised that not every Asshole can aspire to a position on Fox News, Dr Dayborn replied: "No problem. They can always become antipsychiatry bloggers."

The new diagnosis of Asshole is expected to become official in 2013, when the American Psychiatric Association is scheduled to publish the fifth edition of the DSM.

A happy and meaningful April Fools ...