Thanksgiving Day is Coming: How to Avoid a Holiday Meltdown

Did anybody decompensate at last year's Thanksgiving Day feast, when there were no pearl onions in cream sauce, notwithstanding the fact that nobody has ever eaten a single pearl onion in cream sauce, since GreatGrandma Libby died forty-five years ago?


Was it you?

I think I figured it out. Unfortunately, this flash of brilliance came to me the morning before, during a hypomanic surge that got me ready for my stuffing/broth/cranberry sauce/pie-making marathon. But not in time to prevent the scene by preparing said onions.

Somebody's anterior cingulate cortex blew a fuse.

Of course, I don't know for sure. It is one more hypothesis that I would like to test in that Million Dollar fMRI machine that I have requested for years for Christmas. Some girls want a pony. I want an fMRI machine. I don't expect it this year either.
 
But here is the hypothesis:

The Anterior Cingulate Cortex and the Amygdala


The rising cost of that Thanksgiving feast, the family-splitting political debates, the impending government shutdown, the war in the Middle East, climate change -- your anterior cingulate cortex (ACC) is doing all that it can to calm your amygdala. That is one of its jobs. Partnered with the prefrontal cortex, it exercises executive function over your amygdala. 



Your amygdala is convinced you are about to die and is sending out
non-stop messages to your adrenal gland to keep pumping out those glucocorticoids. All those glucocorticoids are destroying your hippocampus, not to mention your heart. The amygdala must be brought under control!



So your ACC has plenty of work to do already, and needs for you to help it out by deep breathing. And yoga. And crystals.

The Anterior Cingulate Cortex and the Thanksgiving Table


But it also has another job, which is to detect abnormalities in patterns. You know those games where you are supposed to find five details that differ in two nearly identical pictures? That's a job for the ACC. But what with climate change and all that other stuff, or last year's version of all that stuff, when somebody's ACC detected a variation in the Thanksgiving Day feast table, i.e., the missing pearl onions, that was just one thing too many. And it blew a fuse, releasing the amygdala from its cage. And this time, the amygdala did not send out the message to freeze. It came out fighting.

Couldn't we all use a little peace this year? Just for one day? Here is what you can do:

If you are the cook, poll your guests about what food item they Have. To. Have. In my family, we serve three different types of cranberry sauce. Because we have to have each one.

If you are not the cook, do a bit of self reflection beforehand. What do you have to have? Then give the cook a break, so the cook doesn't have a meltdown. Bring your own damn pearl onions.

Racism is not a Mental Illness; Racism is a Sin

  • Racism is not a mental illness; racism is a sin.
  • White nationalism is not a mental illness; white nationalism is a sin.
  • Violence is not a mental illness; violence is a sin.
  • Hatred is not a mental illness; hatred is a sin.

Okay, the Christian in me is coming out here when I say sin. And even some Christians have trouble using that word these days. Which is fine. Don't use it if you can't sort out sin from all the baggage it carries.

But for the love of God and your neighbor, don't substitute mental illness to explain the appalling image of the latest white guy with his racist manifesto and his swastika painted on his semiautomatic weapon shooting up the Dollar General, or the supermarket, or the bible study.

Use the word wrong if you can't bring yourself to say sin. Wrong doesn't seem strong enough, I understand that. But explaining these events as mental illness is REALLY wrong on two levels.

Ignoring the Evidence about Mental Illness

First, mental illness does not correlate with violence.

Let me say it again for the people in the back of the room.

Mental illness does not correlate with violence.

Sure, journalists will go digging into the background of the latest shooter. And journalists will find that the shooter had some previous contact with mental health services. The American Journal of Public Health article by Sherry Glied and Richard G. Frank explains this phenomenon:

The journalist’s search for a mental illness explanation of aberrant acts will almost always succeed. Epidemiological research suggests that nearly half the population—whether or not involved in crime—experience some symptoms of mental illness over the course of their lifetimes. The most recent population estimate of the lifetime prevalence of major mental illnesses meeting diagnostic criteria among US adults is 46%, and 9% meet criteria for a personality disorder. Seeking mental health treatment is hardly less common: the literature suggests that about one fifth of the US population report seeking professional care for a mental health problem in a year and nearly one third do so over their lifetimes. 

The very high lifetime prevalence of illness and treatment seeking helps explain why virtually every story of a violent act can be linked to some clues of psychological abnormality or mental health treatment—even though the rate of violent behavior of any type among people who meet diagnostic criteria for mental illnesses is estimated to be only about twice as high as the rate among those who never experience a mental illness. Mental illness is simply not a very specific predictor of violence.

People with serious mental illness are only twice as likely to commit violence than the general population. Which means that they commit 4% of violent crime. 4%.

It is wrong, it is incorrect to explain violence by mental illness.

Why does the myth persist, contrary to the evidence? Because having rejected the concept of sin, we can't figure out why these things happen, unless something is wrong with their heads. But that explanation is wrong, as in incorrect.

Indeed, there is something wrong in their heads. But it is not mental illness.

  • Racism is not a mental illness.
  • White nationalism is not a mental illness.
  • Violence is not a mental illness.
  • Hatred is not a mental illness.
Which is why, when these guys are taken in for evaluation, they are released. Because they are not mentally ill.

Making Mental Illness Illegal

Blaming mental illness for violence is wrong in a second way. It is harmful, hateful, and dangerous.

Harmful, hateful, and dangerous.

Liberals repeat the myth of violence caused by mental illness to support funding for more services for the mentally ill (which never are forthcoming). Conservatives repeat the myth to push back against gun control (without allowing any restrictions, even for those they claim to be violent). Both liberals and conservatives, both liberals and conservatives create scapegoats of vulnerable people.

Here is what a candidate for president of the United States tweeted, repeating his answer to the violence question in the recent GOP debate:

Don’t remove guns from law-abiding citizens. Remove violent, psychiatrically deranged people from their communities and be willing to involuntarily commit them. Revive mental health institutions: less reliance on pharmaceuticals, more reliance on faith-based approaches that restore purpose to people’s lives. We know from the 1990s how to stop violent crime. The real question is if we have the spine to do it.

That this candidate has low polling numbers does not undo the damage he does by calling us violent and deranged. He makes such discourse seem reasonable.

On the other end of the political spectrum, both California and New York City politicians are endorsing forced institutionalization and treatment of people with serious mental illness, even for those who do not pose an immanent threat to themselves or others.

Forced institutionalization may look like compassion. It is a violation of civil liberties. It makes mental illness illegal.

Where will these forcibly institutionalized people be housed? The latest figures for all types of psychiatric inpatient settings are from 2014, when there were 170,000 beds available. However, that figure includes VA and private hospitals. State capacity, where those who are hospitalized by the state go, is 35,000 beds.

Where are the mentally ill really housed? According to a recently released federal Bureau of Justice Statistics (BJS) report, 1.25 million of them are in prison, where they do not fare well. According to this report:

Prisoners with mental illness find it more difficult to adhere to prison rules and to cope with the stresses of confinement, as evidenced by the new BJS statistics that 58 percent of state prisoners with mental problems have been charged with violating prison rules, compared to 43 percent without mental problems. An estimated 24 percent with a mental health problem have been charged with a physical or verbal assault on prison staff, compared to 14 percent of those without. One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without.

Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.

The Bigger Picture - Making Homelessness Illegal

“The man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team: These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered,” the mayor said.

...Mr. Adams has received criticism from some progressive members of his party for clearing homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor has defended his focus on public safety and has argued that many New Yorkers do not feel safe, particularly in Black and Latino neighborhoods.

Connect the dots. From homeless to mentally ill to dangerous to better off incarcerated, one way or the other.

The Myth Will Not Make You Safe

My friends, you can put another 1.25 million of us loonies in jail. That young man will still be stalking the streets who lives with his white middle class parents in their suburban home with an arsenal in the basement. You will have done nothing to protect our schools, our shopping centers, and our bible studies.

So stop it.

Racism is not a mental illness; racism is a sin.

Fear of People with Mental Illness Fades When We Know How to Help

Trends in the public marketplace of ideas:

  • There are more houseless people around us
  • Many churches, congregations, and volunteers of all sorts are trying to help
  • Some local governments are trying to restrict these efforts
  • Claims are made in support of these restrictions that people with mental illness are dangerous
The following post is a repeat from a few years ago. It seems time to repeat it. It does not address the mistaken notion about mental illness and violence, nor the scapegoating of people who are in need. It does address the issue of fear. I hope to provide resources for people who are exercising their constitutionally protected right to the free practice of their religion.

Mental Illness First Aid


We know how to do this. A car hits a light pole -- somebody, maybe you will call 911. Somebody is choking in a restaurant -- somebody else, maybe will leap up to do the Heimlich Maneuver.

It doesn't have to be an emergency. If a friend has a persistent cough, or mentions a bruise that won't go away, or complains about chest pains, we urge them to see a doctor. We have learned to recognize signs of cancer, heart disease, stroke. We get involved, we even get on their case when the people we care about need help.

Most of the time we do. Sometimes we turn away. Last week I kept having the same two 
conversations over and over. The first was about a man who dangled by a chain from the end of a crane. He reached out to catch a woman caught in the boil of a dam, to rescue her from drowning. The second was with friends who just didn't know what to do -- about a cousin who is irrational, a daughter who doesn't get out of bed, a godson who can't keep a job, each of them diagnosable with a serious mental illness, none of them getting treatment.

What To Do When A Friend Has A Mental Illness


Bad Mental Health Take on Autism - One More from Allen Frances

Before Mental Health Awareness Month draws to its nonconsequential end -- 

Allen Frances

New York Post has published a new interview with Allen Frances about how bad it is to receive a diagnosis, or as he puts it, become a mental patient.

Become a mental patient?

Some background: Allen Frances is a professor emeritus of psychiatry and behavioral sciences at Duke University. His fields of research were wide ranging, including personality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. [Note: not autism]. He served as the chair for the DSM (Diagnostic and Statistical Manual of Mental Disorders) task force, which published the DSM IV in 1994. He later became the chief critic of the DSM 5, which is a modest revision of his work.

In a nutshell--he didn't like any of the revisions.

As part of Frances's critique of the DSM 5, he wrote Saving Normal, subtitled An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. His book was published one week before the DSM-5. Since then he has continued the themes of the subtitle.

In addition to my review of his book linked above, I have commented a few times on Frances's statements. I appreciate his concerns about Big Pharma's influence in the treatment of mental illness and inappropriate use of medication, especially in the case of mild depression. His periodic attempts to save normal, not so much.

A couple quotes from his New York Post interview:

Dr. Allen Frances told The Post that he is “very sorry for helping to lower the diagnosis bar.”

Now, Frances said, he fears his work “contributed to the creation of diagnostic fads that resulted in the massive over-diagnosis of autistic disorders in children and adults.”

Stigma Against Mental Illness

One of the themes of Saving Normal is that diagnosis exposes people to stigma. So it would be worrisome to him that so many people are now mental patients, newly exposed to stigma.

I'll grant Francis this point. Prejudice against mental illness is alive and well - and particularly dangerous when it is expressed in the medical field.

There is scant evidence that Stamp Out Stigma campaigns have moved the needle, except on the issue of depression. Judging by news reports, prejudice against people with mental illness has been growing. 

  • Recently, an ex-Marine is lauded as a hero after putting Jordan Neely, a disturbed man on a New York subway, into a choke hold for fifteen minutes. In two days Daniel Penny raised over $1.5 million for his defense against a charge of second degree manslaughter.
  • As politicians regularly blame mass shootings on mental illness, they also routinely reduce funding to address it.


The thing is, prejudice against difference does not stem from diagnosis. It stems simply from difference itself.

A Diagnosis of Autism

In the case of autism, let me suggest an alternative to Francis's view.

From the anecdotal evidence of many people finally diagnosed in adulthood, the diagnosis brings not stigma but relief. They had already been stigmatized throughout childhood. Not by a psychiatric diagnosis, but by the schoolyard diagnosis weird and the classroom diagnosis behavior problem. They grew up being bullied and punished because they were not normal - to use Dr. Francis's favorite word.

People diagnosed with autism in adulthood often already have other diagnoses, most commonly depression and anxiety. They sometimes have experienced suicidal thoughts or attempts. These are the consequences not of their undisclosed diagnosis of autism, but of the way they have been treated by others - on the basis of their difference which it does not take a psychiatrist to notice. It only takes a psychiatrist to explain.

Hence their relief - finally to have an explanation.

The NYP quotes the statistic that rates of autism in the US have soared 500% over the last sixteen years. This is a bait and switch statistic. The DSM 5 changed the definition of autism, combining profound autism, childhood disintegrative disorder, pervasive developmental disorder, and what was once called Asperger syndrome under one umbrella diagnosis, autism spectrum.

Whether or not combining these conditions with different treatment needs under one label was a good idea is a separate discussion. But the change in rates was not as drastic as the statistic suggests. The numbers for three separate diagnoses have been added to the first.

But it is not the first time Dr. Francis has played fast and loose with statistics to claim over-diagnosis. The statistic does not support his thesis of over-diagnosis because the sample population has changed.

Underserved Children with Autism


The article misses the most significant part of the story, reported in the journal Pediatrics. There are significant disparities in rates of diagnosis between white and black children and between affluent and poor children:

Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas.

The consequence of under-diagnosis is that, while rich white kids get services, poor black kids get placed in the school to prison pipeline.

There are real life consequences to under-diagnosis. Poor black kids should not have to pay the cost for Allen Frances's hobby horse.

More Next Week


So clearly, I have thoughts. Lots of thoughts. It's time to sign off for this week and promise more to come. But you are welcome to join the conversation by commenting below!

Why Am I Still Sick? Mental Illness, Faith, and the Love of God

Rumor has it, I'm going to start preaching again. My brain functions a lot better than it used to. But it still functions slowly. So to give myself plenty of time, I have been looking ahead to the scriptures that are coming up in the lectionary.

[In the Episcopal Church, among others, we preachers don't pick and choose our favorite bits of the Bible. We get confronted by and have to deal with what is assigned.]

That's how I came across Matthew 9:18-26, one of the texts for early June. Jesus is on his way to heal a young girl when a woman with an issue of blood reaches out surreptitiously to touch him. He feels the power go out of him and turns to confront her. Then he says:

Take heart, daughter; your faith has made you well.

Ah, here it comes -- the faith question of every person with a chronic or fatal illness, every person who prays and has people praying for us.

Don't I have faith? Don't I have enough faith to get my healing?

Many years ago in one of my darkest times, I met a young woman. She was part of a mission group who had come from Mexico to Costa Rica. On behalf of a local church, she and others would be going door to door, sharing their witness.

She asked me what I was doing in Costa Rica. So I told her that I had depression and was writing a book about it.

Without missing a beat, she answered, If you give your life to Jesus, he will heal you, and you won't have depression anymore.

She described her life in her teens, a life of indulgence, as she put it. She was a smoker. But then she gave her life to Jesus and he turned her around. He took away her addiction to cigarettes

Oh, honey.

She and I had met at the church that was sponsoring the mission. The worship service had gone long. I was tired. And I didn't have enough Spanish to get into it with her.

So I didn't tell her that 

  • I fell in love with Jesus when I was eight and was baptized
  • I took Jesus as my Lord and Savior when I was eighteen at college
  • I gave my life to Jesus when I entered seminary at twenty-five
  • I vowed to . . . pattern my life in accordance with the teachings of Christ, so that I may be a wholesome example to my people when I was ordained a priest at twenty-nine
  • I . . . well, you get the idea.

The thing is, I have a brain that works differently, and sometimes not very well. Living a life in Christ has not protected me from the symptoms of bipolar disorder, nor even from feeling suicidal at its worst.

Bipolar disorder has been around for millennia. People had it before the coming of Christ. And people have had it since. Faith in Jesus really has nothing to do with it.

I am glad that Jesus took away her addiction to cigarettes. I am glad that Jesus healed the woman with an issue of blood, that he freed the Gerasene man who had been possessed, that he raised Lazarus from the dead.

But he hasn't healed me. At least, he hasn't taken away my bipolar.

Why not?

No, don't answer that question. I don't want an explanation. I especially don't want God to explain to me how He -- and I use that pronoun on purpose -- how He is using my suffering to some greater end. To help you, I suppose.

I don't want a God who manipulates people who are suffering, moves us around on some chessboard as part of His grand design.

For God's sake, don't tell me to have faith.

What a cruel notion that if you just believe hard enough you will be healed.

The first preaching I will do after an absence of a few years will be for a man who was one of the most faith-filled people I know. He died after waiting for years for a lung transplant, while people around the world prayed for him. As people have prayed for me.

Why am I still sick? I think that's the wrong question to address to God. I think that question posits the existence of the kind of God that we want, a God who will answer our questions and give us certainty and make us feel good.

A God that exists only in our desires and our imaginations.

Whoa! Did the preacher say that God doesn't exist? No, the preacher said that the God that does exist is not small enough to fit inside the box of our desires.

Who is the God who does exist? I am a very smart person. Nevertheless, that question is beyond my bandwidth. I have my own desires about God. But I no longer expect that God will satisfy them.

However, reading all those stories of healings year after year, over forty years of preaching on them, there is something that I have noticed. In almost every one of them, part of the healing is a return to community.

The woman who had had an issue of blood for fifteen years (endometriosis?) would have been unclean on that account. Nobody would have touched her. For fifteen years. Now she could take a neighbor's hand.

The Gerasene man who was possessed (schizophrenia?) lived in chains outside the city of Gerasa. When he was restored to his right mind, Jesus sent him home.

Lazarus -- dead and in the tomb. Jesus returned him to his sisters.

And me with my bipolar -- that is the kind of healing I have experienced. When I was newly disabled and not leaving my second floor condo except to go to the doctor, I joined NAMI -- National Alliance on Mental Illness. I went a Peer to Peer class, where people with mental illness teach other people with mental illness how to navigate our lives.

I discovered people who didn't care whether I had faith or not. They didn't need for me to be healed to confirm their own faith. They expected I wouldn't be. And they loved me. They invited me in. They were my new community.

Romans 8 -- that's what I believe. When I don't believe in God -- I really don't believe in the God who withholds healing based on my puny wounded capacity for faith -- I do believe this:

I am sure that neither death, nor life, [nor feeling suicidal], nor angels, nor principalities, [nor health insurance companies], nor height, nor depth, [nor the personal hell of side effects], nor anything else in all creation will be able to separate us from the love of God in Christ Jesus our Lord.

I am not healed. But I am loved.

That's a kind of healing. And it is enough.


photo by Nevit Dilman, used under the creative commons license.

This is an experiment


Oops. I didn't realize this was published. I'm trying to figure out how to get it into a powerpoint, with the byline - this is NOT what I mean by self care. Silly. But oh well, I'll leave it up for now.

But as long as you're here, check out the labels in the column to the right. Explore some topics of past posts.

World Bipolar Day: What the Heck Happened to my Brain?

Prozac Monologues is a book within a book. Its original form was a series of monologues written in an unrecognized hypomanic state. The rest of the story is what I learned about bipolar disorder after I learned that I have it.

In Balancing Act -- The Science Chapter, I answer the question, How did I get into this mess anyway? I compare it to another question, Why did the roof collapse? Both answers are to be found in a process that begins with something a little wonky and develops into a systemic mess.


The following excerpt skips the charming roof collapse explanation (inspired by true events during one Central Oregon snowmaggedon in 2017). Buy the book for that story! It goes straight to the science part. Let me know in the comments what you think.

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