I Really Hate February (Groundhog Day Ruminations)

Okay, I lie. Two and a bit years ago, I moved to southern California from New Jersey. Now I love February, I indulge in February, I get a sun tan in February.

But, back when I was living on the east coast, I hated February. I mean, really really hated it. Really, seriously, hate hate hate February.

Typically, by the time February rolls around, I have been a prisoner in my own home for the better part of two months, with no hope of parole. Think of Bill Murray stuck in Groundhog Day forever. That's me in February.

Just the thought of February makes me want to punch the crap out of a snow man.

I'm going to cut this blog short. The sky out my window is brilliant cobalt blue. The temperature is in the 60s. I'm going to take a walk. Breathe in the pure mountain air. Commune with nature. Believe me, my change of venue has done wonders for my mental health.

For the rest of you, I advise clicking on Therese Borchard's video classic, "The Most Crappiest Time of the Year." Also check out her piece on beating winter depression.

In a while, Crocodile ...




From mcmanweb:

Seasonal Affective Disorder

As the darkness settled in, I could feel the whole city turning against me. It was as if everyone in the phone directory had entered into a secret pact to make my life miserable.

Have Our Treatments and Therapies Failed Us?

"What best describes your condition in the past 30 days?" I asked my visitors, here at "Knowledge is Necessity." Nearly 200 people replied over late Dec and Jan. The results were not exactly encouraging:

Nearly one in four (24 percent) replied they were in crisis or close to crisis. Four in ten (42 percent) reported that they were stable but not well. Thus, a full six in ten of those who responded to my poll indicated that they are in pretty bad shape.

Contrast these results to the mere 14 percent who were evenly divided in being back where they wanted to be or better than they ever could have imagined.

In the middle, one in five (18 percent) reported they were on the way to recovery. Hopeful or false hope? Who knows? Perhaps we can split the difference.

No matter which way you parse the totals, the results are not encouraging. Granted, the poll is unscientific. Granted, the results could be totally skewed. But even accounting for all the distortions in the world we have clear evidence that our treatments are failing us, our therapies are failing us, and - let's apportion blame responsibly, here - we are failing us.

One advantage of this simple poll over far more sophisticated surveys is that those who responded were the judges of their condition. Patients, themselves, defined success or failure by their own criteria. In clinical trials and other studies, doctors typically fill out a symptom checklist (with patient input) and interpret the results. Having few illness symptoms typically means you are well, even though you may not feel well.

The world we live in is far different. For a lot of us, we have other things to deal with besides just our illness symptoms. On the flip side, a lot of us have learned to lead very enviable lives, despite a huge panoply of symptoms.

"Well" is how we define well, not how others define it for us. Even accounting for the fact that people who go online to find out more about their illness may be worse off than those who don't, we are dealing with an astronomical 86 percent who reported feeling well short of well.

Something is clearly wrong.

Illness or Personality?

I answer questions as an "Expert Patient" at BipolarConnect. Two days ago, Dark Angel asked, "Why does bipolar seem like your personality?"

The question goes right to the heart of how we see ourselves, and is central to every issue we discuss here at "Knowledge is Necessity."

"Welcome to a lifelong quest for self-knowledge," I began. Okay, let's see if we can figure this out:

The experts distinguish between "state" and "trait." A state equates to an illness episode whereas a trait is part of your personality. Let's use hypomania as an example:

People tend to pair "exuberant" with "personality." Exuberant is seen as beneficial, and, most important, people see YOU as in control.

In hypomania, for the purposes of this conversation, we are talking about over-exuberance. Not only that, hypomania is often a sign that we are really about to lose control of our brain, or that we have already lost it.

I would contend that for many of us hypomania is a normal part of our personality, only in this case we're mixing bad with good. For some, it may be a rational choice to accept the bad with the good. Others understandably want no part of hypomania.

The DSM sheds some interesting light on the topic. According to the DSM, we are in hypomania when we experience "unequivocal change in functioning that is uncharacteristic ... "

In other words, we are talking about a "state" that is not a true part of our personality.

I would argue that for many of us this is not necessarily the case. Nevertheless, the DSM is making a valid point. Keep cranking up the volume, and, at a certain point, we are definitely not ourselves. We are not in control of our brains.

Think of two individuals who are "up." They are thinking alike, they are acting alike. But one is behaving rationally and in character while the other is not. Same behavior, yet a profound difference. One may be on his game, the other may need meds. On and on it goes.

Hypomania is just one example. We need to apply this ruthless self-examination to all our behaviors, as well. This includes our depressions and anxieties, as well as a range of personality quirks.

For many people, our illness is fully integrated into our personality. Others rightfully view their illness as an interloper. Well-meaning experts, including friends and family, are not hesitant to proffer advice, but, in the end, you are the only expert in knowing where you stand. But this kind of wisdom only results from responsible self-enquiry. Welcome to "Knowledge is Necessity."

Are Bipolars Smarter than Everyone Else?

A study published in January's American Journal of Psychiatry found a strong correlation between people with lower childhood IQ scores and an adult diagnosis of mental illness.

The study was performed on the "Dunedin Cohort," a thousand-strong group of New Zealanders who have been tracked since their births in 1972-73. It was from this population that we got the first strong evidence involving the link between genetic vulnerability to stress and depression, which has led to a lot of re-thinking into cause and effect across the whole panoply of mental illness.

The current study involved a lot of the same researchers as the stress-depression study. The cohort was administered IQ tests at ages 7,9, and 11. Psychiatric evaluations were made at ages 18, 21, 26, and 32. The researchers found that "lower childhood IQ was associated with increased risk of developing schizophrenia spectrum disorder, adult depression, and adult anxiety."

Intriguingly, "higher childhood IQ predicted increased risk of adult mania." The authors of the study do caution, however, that this particular finding may represent a statistical anomaly.

Back in the 70's, Nancy Andreasen MD, PhD of the University of Iowa spotted a measurable bipolar-creativity link, and Kay Jamison's "Touched with Fire" of 1996 put the issue out in front of the public. But she also noted that:

"Thinking can range from florid psychosis, or madness, to patterns of unusually clear, fast, and creative associations, to retardation so profound that no meaningful activity can occur."

Indeed, the psychiatric literature is full of studies pointing to serious cognitive flaws in bipolar patients. In a study published in 2004, for instance, Deborah Yurgelun-Todd PhD of Harvard and her colleagues scanned the brains of 11 stable bipolar patients while performing a mental processing task, and found significant delays in their ability to respond with correct answers compared to 10 healthy controls.

The study also found decreased activation of the brain region responsible for processing the task compared to the controls.

That same year, at the APA annual meeting, I heard Dr Yurgelun-Todd propose that cognitive deficits should be regarded as a core feature of bipolar disorder.

In the current study, the authors point out that "lower childhood IQ may be a marker of neuroanatomical deficits that increase vulnerability to certain mental disorders." They also note the debilitating effects of stress and trauma.

What to make of all this? Some days our brains are running on rocket fuel; other days, molasses. Neither state is solely good or bad. Our best work often occurs at either pole. So do our worst moments.

Technically speaking, if our brains were manufactured goods, there would have been a product recall ages ago. But, here's the rub: Knowing that's the case, are you ready to turn yours in?

Further reading from mcmanweb: The Thought Spectrum

These days, my internal operating system is far and away the worst aspect of my illness I have to contend with. Moods, shmoods – I actually follow some of the advice in my book, "Living Well with Depression and Bipolar Disorder." But when my brain unexpectedly cuts out on me, what am I to do? These are no mere senior moments. The software simply isn’t loading right. When it happens, I know it and the people around me know it. This has been going on for as long as I can remember.

If you don’t think this is any big deal, then ask yourself: Knowing what you now know about me, how safe would you feel with me as an air traffic controller?

Happy Birthday, Jackson Pollock

Today, Google reminded me it's Jackson Pollock's birthday.

"Fuck Picasso!" Eddie Harris as Pollock shouts in a alcoholic stupor one minute into the film, "Pollock."

Seems Pollock had an attitude.

Pollock was the great abstract expressionist artist, part of the vibrant post-war New York bohemian scene that totally changed how we view the world and relate to it. His breakthrough moment in the movie shows Pollock laboring in the barn that is his studio in the Hamptons (back when Long Island's Hamptons was a cheap place to live). His wife Lee Krasner (played by Marcia Gay Harden) looks approvingly at her husband's canvas - lustrous Zen drips - and remarks:

"You've cracked it wide open."

Don't ask me why, but I instantly connected to those drips. Even as a kid, those drips spoke to me.

A couple of years ago, I experienced the joy of touring New York's MOMA with my grown daughter from New Zealand. We stood in front of a Pollock. I watched her face, resisting, quizzical. Suddenly her expression changed, she lit up. She "got it."

Pollock was a notorious alcoholic, and a strong case can be made that he was self-medicating his undiagnosed bipolar. He would have been 97 today. Instead, one summer night in 1956, in a drunken stupor, he drove his car off the road killing himself and a woman passenger. He hadn't done a painting in two years.

Further reading from mcmanweb:

"The paintings are like a reverse Rorschach test, where nothing bears the faintest semblance to anything we can see, yet each drip, each splatter, individually or as a grouping or as a whole, seems to act as the perfect register to how we think and feel."

Another Trick Question

You are depressed. The DSM checklist reveals you have nine depression symptoms out of nine. Question: Is your condition diagnosable as a depressive episode?

Not necessarily. "Checklist psychiatry" tends to influence how we view ourselves, but beneath the symptom menu to every Axis I DSM entry we find other qualifying criteria, such as a time period (two weeks for a major depressive episode). Also, before a diagnosis can be made, other possible causes (such as bereavement or a general medical condition) need to be ruled out.

The most intriguing qualifier, though, concerns functionality. With regard to depression, the episode must be severe enough to cause "significant distress or impairment in social, occupational, or other important areas of functioning."

Virtually identical wording appears across the Axis I panoply of episodes and disorders, including mania, anxiety, and schizophrenia. The prominent exception is hypomania.

So, in theory, it is possible to walk into a psychiatrist's office looking like a DSM basket case and yet obtain a clean bill of health. In practice, this is unlikely to happen. But suppose, just suppose, that we could have depression and not be depressed, that we could have a panic attack and not panic. And so on and so on.

Wait! I know what you are about to say. But before you call me crazy, I ask you to indulge me for a moment or two. Just suppose ...

Imagine.

Is Bipolar Cool?

Something major has happened in the ten years since I've been diagnosed with bipolar. Back then, it was an illness you concealed. It was a shame you hid. Friends, family, and colleagues had a way of only seeing the diagnosis, and what they chose to see was not good.

To disclose your diagnosis was to risk everything: friends, relationships, livelihood.

Then something started to change. Over time, bipolar morphed into something that could be "cool" to have. Mind you, those struggling mightily with their illness saw nothing cool about it. Neither did their suffering families. But the flip side was the stigma was diminishing, and this had to be good news.

Part of the trend had to do with the recent recognition of bipolar II and various forms of "soft" bipolar. In other words, bipolar wasn't an all-or-nothing disease. You could be a "little bit" bipolar. And a little bit was cool. Even the way-out-there bipolars could make a claim to cool.

Van Gogh, Hemingway, Woolf - how cool was that? Okay, they all killed themselves. But maybe if they were alive today - the thinking goes - that wouldn't have happened.

Over the years, I have urged individuals to embrace their entire illness - the good as well as the bad. If we simply viewed ourselves as patients who suffered, I kept saying, we would always wind up stuck well short of recovery.

Last night, I went to Facebook and searched under "bipolar." If the word appeared anywhere on a profile page that a member created, Facebook would find it for me.

My results revealed "more than 500" finds. I suspect many thousands. There were a great many examples to choose from, but let's go with three:

First, there were those whose lives seemed part of a weird Andy Warhol movie. These weren't exactly people you would be seeking out as Facebook friends. Then again, their bipolar credentials carried an air of exclusivity, as if to challenge the world. In the past, these people would have been shamed for failing to meet the standards of society. Now, there was an air of pride and defiance. They weren't about to please you. You had to please them. Too bad if you weren't good enough.

Then there were young hotties who advertised themselves as a bit on the wild side. Most of them, I suspect, had never seen a psychiatrist. But they proudly proclaimed themselves as "semi-bipolar" or "must be bipolar." Forget for the time being the dangers of romanticizing one of the worst illnesses on the planet. Instead, focus on the fact that these young women - part of a new generation - view bipolar as something positive, as a credential they can use (and misuse) to make new friends.

Finally, there were those I like to call bipolar role models. The image that stuck with me is that of a very attractive woman in her thirties or forties. She is in a smart pants suit, in stylish heels, posing in front of her Cadillac Escalade. I'm bipolar, is the underlying message, and not only am I making it in your world, I'm really kicking ass.

These are just some of the new faces of bipolar. They are a reflection of a changing world, a world that they (we) are changing. It is the face of a new bipolar cool.

A new generation - the Facebook Generation - is out there, in your face. They are not hiding in the closet. For good or bad, they are wearing their bipolar as if it were something to be embraced and envied rather than an entity to be feared and despised.

The rest of society is likely to embrace this change, as well, but possibly at the expense of being indifferent to our pain.

In the meantime, we are looking at tons of upside. Here's hoping ...

The Bipolar Time Warp

This is the most popular video from my YouTube Collection. The reason may have to do more with Rocky Horror fans searching "Time Warp" than the video's intrinsic worth. But viewer feedback to both the video and the mcmanweb article on which the video was based indicates I that I may have struck a chord.

I wrote the article sometime in 2000. I shot my video in early summer last year. It was my first venture into "acting," rather than simply narrating. It was also the first video where I started using studio lights - actually cheap work lights I picked up at the hardware store. For some reason, I thought lighting only applied to Hollywood. Then my orange face from my previous video forced me to rethink that notion.

Enjoy ...

From my mcmanweb article:

Bipolar is the equivalent of being stuck in bumper to bumper traffic in a race car. The world is simply too slow and people too dull-witted to accommodate you. The initial advantage over one's fellow man inevitably gives way to frustration and occasional rage. Sure, at first you experience the exuberation of weaving in and out of traffic as you leave the world behind in your rearview mirror, but now there are more cars, all closer together, backed up for miles on end. Your engine is revving hard, but you find yourself banging your head against the dash in utter despair because you are desperate to pop the clutch and floor it, but all you can do is hopelessly idle and suck other people's fumes.

Ooh-Boy Ruminations

Francesco writes: "My thinking had and continues to be shaped a great deal, by the writings of Thomas Szasz."

Ooh-boy.

Francesco's comments to a recent blog post here were very thoughtful and much appreciated, and I hope he continues to post. As for the S-name, one look at the photo above and you see why every neuron in my limbic system lit up like a Christmas tree.

Thomas Szasz is a giant in the mental health movement, a deep thinker, and an uncompromising champion of our cause. The catch is that these days I hear his name invoked in the context of various nihilist anti-science, anti-intellectual agendas.

Believe me, I hate these people.

Dr Szasz was a catalyst for the reforms of the 60s and 70s that put an end to institutions and their concomitant abuses, and for this alone he deserves our undying gratitude. Dr Szasz also recognizes that psychiatric imprisonment isn't just about walls and restraints. It can be a subtle state of coercion that gets us buying into the idea that unapproved behavior needs to be medicated out of us.

It's a complex argument, but trust me, Dr Szasz has a point. Too often, we simply assign values to symptoms with no thought to context. Yes, depression is a bitch, but it can also be a time of healing, of recouping and regrouping. I know - I have experienced this.

But Dr Szasz and his followers would have us believe that we actually choose to have depression - or psychosis or a panic attack. It's as if the brain were nothing more than undifferentiated tofu. It's one thing to take psychiatry to task for imposing a particular set of values on us. It's another to deny, as Dr Szasz does, that there is no biological component to our behavior.

Dr Szasz's influence has fallen by the wayside in the face of scientific discovery. But psychiatry may suffer a similar fate. Psychiatry shows every sign of embracing science, but to what end? As long as they fail to address the basic question - What is good? What is bad? - then Dr Szasz will remain relevant.

Perhaps science can offer an insight. In behavioral genetics, there is neither a good gene nor a bad gene. Depending on context, the same gene variation may be an asset or a liability. Can the same be said of symptoms? For instance, hypomanic behavior may yield bad results. But what if we learned to control the hypomania?

These are issues that go to the core of our beings, to what we experience, to what we want out of life. This is a conversation we need to have, that we need to own. Antipsychiatry would love to crash this party. So would psychiatry.

From mcmanweb:

The Two Toms

My totally surreal encounter with the Bizarro World parallel psychiatric universe of Tom Cruise and Thomas Szasz and how it didn't change my life.

Name One Good Thing About Depression. Okay ...

My friend Tom Wootton has published a book called The Depression Advantage.

Whoa! I hear you saying. What can possibly be advantageous about depression?

Mania? The creativity, the productivity, the good times. You can make a pretty good case for some kind of mania advantage. Indeed, Mr Wootton's earlier book is called "The Bipolar Advantage."

But depression?

In my own case, depression has left me for dead more times than I can count. "Finish the job, yourself," Fred (my name for my depression) keeps mocking me. Fred has left me alone, washed up on a strange shore, lost, disoriented, isolated. He has stolen time from me, years of it, lost years, years I will never get back.

As for the years I have remaining, Fred says nothing, just gives me that look.

So, again, what can possibly be advantageous about depression?

Believe it or not, I have two concrete case studies from my own life. Case study number one:

My first marriage broke up in the 1980s. Because of a precious young daughter, the break-up was especially rough on all of us. This occurred several months into a new job. I was one year out of law school. It was my first management position. It involved a discipline (journalism) I had no training for, working in a field (finance) I had no inkling of.

In short, I was an impostor. I had no hope of keeping the charade going. Any second, I was going to call attention to my total incompetence and lack of experience. Any second, someone was going to lower the boom. Since the economy was in a severe recession, losing my job would amount to the equivalent of being pushed from a plane without a parachute.

The stress was getting to me. My behavior was bordering on unpredictable.

Then came my marriage break-up. Once I got over the initial shock, a numbing thudding depression settled in. Oddly enough, a protective depression. In my slowed-down state of mind, the rest of the world no longer seemed so threatening. Likewise, my equally slowed-down behavior brought me into sync with the people around me, allowed me to fit in, settle down, buy precious time.

Make no mistake. I was alone, unhappy, miserable. But my depression acted as vital mental ballast that steadied me, allowed me to keep my cool, to buckle down and learn on the job. I made it through my first year, then my second. After three years - with my reputation firmly established - I was able to move on to greener pastures.

Don't get me wrong. I hate depression. I wish I never had it. I wish no one ever had to experience it. Ever. But if you were to challenge me to name one good thing about depression, well, I just did.

Lots more on this in future blogs ...