Tuesday, June 21, 2016

Mental Illness in the Bible

Something different here -- a sermon from the batshit crazy preacher --

[When I Googled mental illness in the bible, I was, frankly, appalled by what came to the top of the page. So I hope this banal title will make a better message easier to find. If you share this post, you can do that service.]

Now to the sermon:

1 Kings 19:1-15
Psalms 42&43
Luke 8:26-39

I don't often preach about mental illness. I'm not sure I have ever heard more than a mention of it by any other preacher. But today the lectionary asks us to tell stories that are not told.

Because we are no strangers to mental illness,and neither is the Bible. There's Saul, his bipolar episodes and his suicide. There's Job and Jeremiah, hardcore depressives. There's neurotic Paul himself, though that diagnosis has gone out of fashion. And Ezekiel, well, you'll have to read him and decide for yourselves.

Monday, February 1, 2016

Not Just Up and Down -- A New Map for Bipolar


Last week a friend told me she had just been diagnosed with bipolar.  I remember eight years ago when she told me she was finally getting treatment for depression.  I didn't say it at the time, but for the next several days my brain was screaming it: Really?  In 2016 people are still being misdiagnosed, and mis-treated, mistreated with meds that make them worse.  I mean, 


F*cking Really?!!

Lives are at stake here, people.  Careers, families, credit, and yes, lives. That is what people lose when their doctors get this call wrong.

Nancy Andreasen, world prominent researcher of schizophrenia and former editor of the American Journal of Psychiatry once wrote, Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual's problems and social context and that is enriched by a good general knowledge of psychopathology.

What replaced careful clinical evaluation were the damned symptom lists.  The DSM was supposed to make it easier for researchers to talk with each other and check each other’s work.  But when clinicians, the people who treat patients, got hold of the lists, they stopped listening to patients and started comparing us to what we were supposed to look like.  Count the symptoms; assess severity; assign the diagnostic code.

As a consequence, the lists, which were actually rough drafts until DSM-III carved them in stone, turned into circular arguments.  They could never be significantly improved, because when the researchers wanted to learn more about bipolar, they went out and got a bunch of people who already matched what they thought bipolar was.  Deviations were excluded from studies, and so were not able to provide better data.
Downstream from the lab, patents became chained to lists.  We have to learn the language of the DSM, because that is the only language our doctors speak.  Unless we report what matches the lists, our complaints are not heard and not treated; our suffering is not known, let alone addressed.

How many times have I reported to a doctor that my body doesn’t regulate temperature well?  That might illustrate a pattern of difficulty maintaining homeostatsis, like any number of disregulation issues related to bipolar.  But it’s not on the list, and they really aren’t interested.

Shortly before DSM-5 was published, Thomas Insel, director of NIMH declared that treatments for mental illness were just not good enough.  He announced that NIMH wasn’t going to fund research anymore that depended on the damned lists.  It’s time to stop reading the list of features pasted to the car window and start looking under the hood.

Up steps John McManamy to say:
       Look under my hood!

In Not Just Up andDown, John tells the story of how medicine got to such a distorted view of bipolar – the very name of the disorder confuses doctors, patients, and public alike as to the nature of the beast.  He provides his own careful clinical evaluation.  And he proposes a different map to follow to connect the dots.

He tears up the book, looks at the patient, and finds a new way to explain what is going on, exactly what Insel says we need to do.  Finally!  Here is somebody paying attention.

Monday, March 30, 2015

World Bipolar Day -- Happy Birthday, Vincent

Today is Vincent Van Gogh's birthday.  Some people give him a post-mortem diagnosis of bipolar disorder, and take the occasion to declare World Bipolar Day.  Healthcentral.com contributor John McManamy says for him, every day is bipolar day.

As for the world in World Bipolar Day, precisely which world are people talking about?  In my memoir, I note:

Maybe someday, aliens will kindly abduct me and return me to the planet of my birth.

In the meantime, I'm stuck on this one, not a planet of my own choosing, performing my own stunts, learning as I go along.  As I like to joke: We're peanut butter people stuck in a tofu world governed by Vulcans.

Wednesday, September 10, 2014

World Suicide Prevention Day - Keeping It Simple This Year


Two things I wish everybody knew:

No matter how you package it, shaming suicide does not prevent it, and

Understanding never pushed anybody over the edge.


photo of candles by Nevit Dilmen, used under the GNU license.

Friday, August 15, 2014

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

Friday, May 2, 2014

Antidepressants and Suicide: Defending Prozac

It amazes me how many research scientists seem to have flunked statistics.  Or ought to have.  Me, I majored in the liberal arts.  But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables.  No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression.  You give them all antidepressants.  It seems irresponsible not to, doesn't it.  Thirty of them get better.  Fifteen do not make a follow-up appointment.  You switch the fifty-five who are still trying to another antidepressant.  Another fifteen get better.  And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling.  You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea.  But you have fifty patients who think you saved their lives.  You feel pretty good about yourself, don't you.

Friday, April 18, 2014

Antidepressants and Suicide: A History

Do antidepressants prevent suicide, or do they cause it?

Yes.

Well, maybe.

It's a no-brainer, right?  People who commit suicide are depressed.  Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide.

So what's with the question?  Here is the story:

History of Antidepressants