Thursday, March 30, 2017

Preaching World Bipolar Day

It was not that this man sinned, nor his parents, but that the works of God might be made manifest in him. John 9:3, Revised Standard Version.

Or as The Message puts it: You're asking the wrong question. You're looking for someone to blame. There is no cause and effect here. Look instead for what God can do.

That was Sunday's text. It grabbed me last week and insisted that I post for World Bipolar Day.


In the Gospel, Jesus heals a man born blind. Presumably what God can do is manifest by that healing. So, okay, Jesus, what about me?

What about me? How many people, with how many disabilities, wonder, especially those of us surrounded by others who wonder, Who sinned, this one or the parents?

Isn't that what is behind those well-intentioned advisors -- You just need to... decide to be happy... get over it... get out more... exercise... take this herbal remedy... have you tried...  In other words, it's your own damn fault.

My mother worried, and it took until near the end of her life before she could say it out loud, Is there anything I could have done differently? Was it my fault?

So, props to Jesus, You're asking the wrong question. Look instead for what God can do.

That's the question for World Bipolar Day, What is God doing with my Bipolar?

It's right there in the diagnostic criteria: flight of ideas. And I have already preached that sermon. So here it is again, from February 21, 2013:


Flight of Ideas


Pride of lions
Fleet of ships
Host of angels...

Flight of ideas.

It's a lovely phrase.  Isn't that what ideas do -- fly?

I think so.  But evidently, not everybody.


A Visit from the Goon Squad

I was looking to meet new people in my new home town, and went to the library's book club.  The selection for my second meeting was Jennifer Egan's A Visit from the Goon Squad.  Sex, drugs, rock and roll, and, oh yes, suicide -- these characters were my tribe!  No, I haven't lived their lives.  More to the point, I have asked their questions.

I wasn't sure how Egan's characters would be received in this group of middle-aged and older women.  I didn't know the book club members yet, but they seemed pretty respectable.  Then again, I can seem pretty respectable, too.  I expected a lively discussion.

Nope.  No lively discussion.  No discussion at all.  They were so dismayed, they were speechless.  The librarian resorted to reading reviews.

I thought I'd open things up by framing a potential talking point.  I said, the theme is about the changes one makes across a lifetime.  How did I get from Point A to Point B?  I said that is a live question for me lately. [ I thought they could say something about that, us all being of the age when we look back and reflect on choices made, that sort of thing.]

Nope.  Silence.  The librarian went on to the author's bio.

Granted, the characters in the Goon Squad went from Point A to Point Q or X.  It was too much of a stretch.

One person, a psychiatrist did have something to say.  (How did I end up in a book club with a psychiatrist?  This could be interesting...)

The book reminded me of some of my patients, who have this symptom called flight of ideas.

She didn't mean it in a good way.  Everybody knew she didn't mean it in a good way.  They nodded, instinctively knowing what flight of ideas is and how it explains why they detested the book.

Oh, what the hell.  I said, Maybe that's why I liked it so much.

Flight of Ideas Defined

Psychcentral.com's encyclopedia defines flight of ideas as a characteristic of mania, rapid speech with frequent shifts of topic (the changes are generally based on cogent associations.)

BehaveNet.com goes with rapid movement through a succession of logically associated ideas.

In other words, my essential writing style.

But Mosby's Medical Dictionary has a different take on it, a continuous stream of talk in which the patient switches rapidly from one topic to another and each subject is incoherent and unrelated to the preceding one or is stimulated by some environmental circumstance.

Dictionaries vary by whether they acknowledge that the ideas in flight are indeed connected.  Some just call it disorganized and incoherent.

The thing is, disorganized and incoherent to whom?

To the psychiatrist, of course.

Diagnostic Criteria of Bipolar Reframed

Flight of ideas is a symptom of the manic phase of bipolar.  That is what the DSM says.

What would people with bipolar say?  Flight of ideas is our ability to find more associations, connect more dots than our psychiatrists can.

Actually, this is a chronic bipolar condition, or again, the way we would put it, the source of our art.  They think it is part of mania simply because, when we are manic or hypomanic, we forget to rein it in.  We speak as quickly as we think, instead of as slowly as the people around us think.

I had no trouble following the multiple story lines of A Visit from the Goon Squad, and recommend it to anyone who is willing to go along for the ride.  I love how the author weaves its many strands into a coherent narrative around her one central theme, a theme to which any reflective reader could relate, even if it is presented by characters to whom the reader cannot relate.  The reader just might grow in his/her capacity to find connection to and compassion for people of different life experience.  I think that is one of the great gifts of a great story, that it leaves us bigger, more connected to the universe than we were before we read it.

I am reminded of a story John McManamy tells, of when he was asked to speak at some psychiatric association meeting.  He said to a hall filled with psychiatrists

a pod of psychiatrists?
a posse of psychiatrists?
a crock of psychiatrists?

-- What you need to understand is, we don't want to be like you.  I mean, to me, you all look like you have flat affect.


It depends on who is doing the diagnosing, don't you think?

So now go look in the right hand column for the music video. Enjoy the bouncing balls -- whether you can follow them or not!

choir of angels in heaven, 19th cent., in the public domain
book cover from Amazon.com
photo of Royal Terns  by Debivort, used under GNU Free Documentation license
illustration of butterflies from In Fairyland by Richard Doyle, in the public domain
portrait of Ludwig von Beethoven by Joseph Karl Stieler, 1819 or 1820, in the public domain
portrait of  Virginia Woolf by George Charles Beresford, in the public domain
photo of faculty alumni forum at Princeton by  Andreas Praefcke, used under GNU Free Documentation license



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.