Trip the Light

I have noticed, people who are buying more guns seem to be more scared than the rest of us.  It is about pattern formation, the anterior cingulate cortex.  It can be your friend, or it can be your enemy.  Come on, people.  Have you forgotten Christmas so soon?  We can do better.  Like Matt here --



If all the days that come to pass
Are behind these walls
I'll be left at the end of things
In a world kept small

Travel far from what I know
I'll be swept away
I need to know
I can be lost and not afraid

Ring The Bells That Still Can Ring

Liturgical Christians, Catholics, Lutherans, Episcopalians keep a season called Advent, four weeks before Christmas.  It is a difficult practice, because it calls us to be thoughtful.  Thoughtful?!  You mean making a list and checking it twice?  No.  Advent is a time to acknowledge the truth that we hide from, behind our shopping lists and party schedules, the truth of emptiness and brokenness, in ourselves and in the world.  We are surrounded by Ho Ho Ho.  Advent says Hmm.

Advent says, Yes we will rejoice, because the baby, The Baby is born.  And yet.  And yet...

This has been a hard week.  Our defenses against the darkness have been found wanting.  And yet.  And yet...



Prozac Monologues Goes to the Movies

This is not a regular post.  It is a call for your help to create a future post.

Periodically, Prozac Monologues goes to the movies.  This time, I want to do a piece on spirituality at the movies.  It will feature half a dozen titles, each with a short descriptive blurb and a couple prompts for pondering and/or discussion.  Maybe your support group or book club or Bible study could use the suggestions to mix it up a bit?

Here is an example:

Groundhog Day: Self-centered weather caster, played by Bill Murray gets caught in a time warp, reliving one day over and over and over and over.  The only thing he can change is himself.  What is the life worth living?  How do we get stuck in a life that isn't?  Where do we find the power to change?

Power, grace, forgiveness, redemption, hope, dignity, the meaning of life, the universe and everything -- What are the stories that help you think about these things?

Put your suggestion in the comments.  Whether it is included will depend on the number of suggestions received, whether I understand it, and whether it fits what goes on at Prozac Monologues.  Looniness is appreciated, though not required.  Deadline for inclusion: December 31, 2012.

Thanks!
image of popcorn from FreeDigitalPhotos.net
dvd cover from Amazon.com

More on Mood Charts

This is my personalized mood chart.


You can find a larger and clearer image here. It was inspired by the one my mental health insurance provider sent me when I began taking mood stabilizers. Last week I described how their chart works and how people with mood disorders benefit from using any of the great variety out there.

Cigna's chart primarily tracks mood. Using theirs, I learned that lamotrigine made a difference to the course of my symptoms. After years of inappropriate prescriptions of antidepressants, I had moved to rapid cycling. No, rapid cycling means several cycles in a year. More like, I was spinning, from the depths of depression to raging agitation within each week, week after week. Lamotrigine did modify that pattern. It stretched the cycles, down from four to two a month. By recording the pattern, eventually I concluded, and I had the evidence to support it to my doctor, that the costs of the medication (dizziness, fourteen hours of sleep and grogginess a day, losing words) outweighed the benefits.

More Than Mood

But Cigna's chart was missing vital information. Mood dysregulation was only part of my experience. It was the agitation, sense of urgency, poor concentration, lack of sleep that put me on the disability roles. And, I began to suspect, these disturbances in energy levels were driving my suicidal thoughts as much as my depression was.

Mood Charts Revisited

Mood chart is one of the top search terms that bring people to Prozac Monologues. I wrote about mood charts in July, 2010, first as a recovery tool and later as a way to illustrate the differences between various mood disorders. Both posts promised sequels, promises that remained unfulfillable until now that I have spent several months doing cognitive remediation at Lumosity.com. Maybe cognitive remediation is worth another post -- later.

Following last week's tale of misdiagnosis and mistreatment, this week's long delayed return to mood charts seems timely.

What is a Mood Chart

Anniversary - Prozac Monologues

Do you take antidepressants for depression and you are not getting better?  Do they make you agitated, anxious, insomniac?  Have you heard it often takes a while to find the right med, so you keep trying, you brave little soldier, you?

My friend, today you tapped your ruby slippers together, and Google brought you here.  Maybe not to your home, but to mine.  What follows is the back story to Prozac Monologues.  But first things first:

Stop.  Stop trying.  Go no further until you have taken the MDQ, Mood Disorder Questionnaire, right here at this link, and have asked a friend or housemate who knows you really well and loves you enough to tell the truth to fill it out for you, as well.

Holiday Shopping for Your Favorite Loony

Personally, I would rather stick a hot poker in my eye than go out on Black Friday.  But at reader request, I am reposting the following from 2009 -- reformatted, since I started using more images some time back, and updated in random places.

For all you who want to be part of the madding crowd, and even those who will be waiting for the dust to settle, start here for your mentally interesting friends and relations:

Holiday Shopping for Your Favorite Loony -- November 24, 2009

The Day after Thanksgiving, traditional start of the Christmas, Hanukkah and Kwanzaa shopping season is upon us.  You Hanukkah people better start cracking!  It is Prozac Monologues' attempt to be ever helpful to my dear readers.  As my therapist says, Virgo -- your destiny is service.  Get used to it.  (I have a therapist who says stuff like that.  The following is a holiday shopping list to guide normals who want to please their loony loved ones.

Holiday Survival Tips for Loonies


People are already googling prozac and holidays and bipolar and holidays.  This is excellent.  You are following your therapists' advice to reduce your anxiety by thinking through your triggers and how you will handle them.

So as a public service to my readers, I repost a slightly editted Holiday Survival Tips for Loonies from November 20, 2010:


Ah, the holidays!  Time when far flung family members travel home and grow close around the turkey table.  Time to renew friendships in a round of parties and frivolity.  Time to go crazy?

No Pink Ribbons - On Truth-Telling

I don't do the pink ribbon thing.

I was sitting at a sushi bar, watching a football game last month, and noticed the pink shoes and towels sported by both teams.  I mentioned that October was Breast Cancer Awareness Month.  Our server said he didn't know that, but pink is his signature color.


Okay, I think the Man Enough to Wear Pink phenomenon in football and Tough Enough in rodeo's version is way cool.  And a sweet young man in Idaho who owns that pink is his signature color would have to be More Man and More Tough than most.

But as a movement to define the struggle against breast cancer -- I couldn't put my finger on it, but something always seemed a little off.

Elections and Mental Health

Full disclosure: I am a Christian.  Every baptism I attend, I renew my vow to follow and obey Jesus Christ as my Lord and Savior.  When I was ordained a priest, I made another vow, to pattern my life in accordance with the teachings of Christ.  So that I don't just make it up as I go along, I also vowed to be diligent in the reading and study of the Holy Scriptures.

I'm telling you -- I'm serious about this.

Just so you understand -- that means I am a Christian first, an American second.

When I vote, my faith determines my vote.

In my reading of the Holy Scriptures -- and I read it a lot, and I read the whole thing, and keep reading it to catch things I missed the first and second and twentieth time round -- it is very clear.  According to Jesus and the prophets, a nation will be judged not by the private morality of its citizens, but on how the nation itself treats the most vulnerable in its midst.

When I vote, I am voting for policies that determine how my nation will be judged, because I believe this nation will be judged.  Since this is a democracy, as a citizen, I also bear some responsibility for what happens in this nation, and expect to share in its judgment.  So I am voting for people whose first priorities will be the hungry, thirsty, alien, poor, sick and those in prison.  Because those are the priorities on which we will be judged.  Matthew 25.  Got that?

So I am voting for mental health.  We throw around a lot of words, but behind these words are real people.  I know some of them.  Even if I didn't. I am commanded, by somebody I have vowed to obey, to do for them what I would have done for me.

Medicaid, veterans, parity, research, access to health care, including sufficient professionals to provide mental health services -- there is a lot at stake in this election.  Follow the link to NAMI's What's at Stake in the 2012 elections? for the details.  Then decide who you think has the same priorities as Jesus and the prophets.  I am not assuming anything here, just telling you where I stand.  Maybe you share these priorities, maybe you don't.  But figure it out.

And be honest about it.

Then go vote yourself.

clip art from Microsoft.com
icon of Christ Pantokrator, 6th c. St. Catherine's Monastery, Mount Sinai, in public domain

Pinky and the Brain

While I catch up on laundry from vacation, here's something to keep you little squirts happy.



And if you want the full tutorial, here is a new resource.  But no Pinky.

Hope for a Cure? Or Not?

But we have to keep hoping for a cure, don't we?

I spent six months preparing a power point presentation on stages of recovery and fifty minutes delivering it.  My co-presenters and I described the misery of the Chemistry Experiment, and the hope offered by other interventions that harness the brain's capacity to heal itself.  Medicine is a piece of the answer, but just not inadequate to carry the whole load of healing.

But DNA operates even deeper in an organization than in an individual.  NAMI was born out of the medical model, when parents who had been wrongly accused of causing their children's illness pushed back and insisted on their innocence.  Mental illness is not caused by distant fathers and overprotective mothers.  Mental illness is a physical illness.

Yes it is.  Whether it arises from chemistry, wiring or structure, it is an illness in the brain, a physical organ, inside a body.

Well, it was a short jump from that insight to the search for a cure, a medical cure.  Because that is what medicine does, it cures physical illness, right?

So there was that question, the NAMI parent's quest for a cure, in response to all our elegant talk about Recovery, the NAMI peer's quest for a life worth living.  Forget Recovery. Don't we have to keep hoping for a cure?

Neuroscience of Meaningful Work

Fourteen years ago, I was offered a new job, Missioner for Ministry Development.  What's that?  Sometimes I said, I consult with organizations undergoing paradigm shift.  Other times I said, I do what Paul did.  Depended on the audience.

The details don't matter.  What does matter is that I got up every single morning rejoicing at what I felt privileged to do that day.  I considered it the job I was born to do.


Well, yes and no.  It combined my burning passion for advocacy, my deep appreciation of small congregations, and my abiding love for the highways and byways of Iowa, Beautiful Land, as the native inhabitants called it.

On the other hand, it gave me intense fourteen hour work days, conflict with long time friends, people across the state who piled their hopes, dreams and desperations on my back and the resistance of those who value certain aspects of an institution that others can no longer afford.  When we mixed all that with second generation antidepressants -- Keep trying, the doctors and my therapist said -- my bipolar II went into hyperdrive.  I was both madly productive and plain old mad.  It was beautiful.  It was ugly.  It didn't last.

Ellen Frank says that people with bipolar need to deal with grief for the lost healthy self.  It's one of the interpersonal issues that sabotage our adherence to the regimen required to maintain recovery.

Stages of Recovery - AKA Hope

It gets better.  It really does.

People who get tired of the Chemistry Experiment go off their meds.  Why?  Because the meds don't work.  Or they make us sick.  And the doctor doesn't hear us, because the doctor has one tool in his/her toolbox.  [Hint: It's not an ear.]  And he/she thinks that the solution to our problem is compliance, because there isn't time for listening and problem solving.

When you walk into a hammer store, they will try to sell you a hammer.  Fair enough.  If you are trying to rebuild the life that your illness took from you, chances are you will need a hammer.  Chances are you will need some other tools, as well.

The doctor doesn't have those other tools.  But they are out there.  And so is the map.

You are angry that the meds promised what they could not deliver.  Get over it.  Pull out the map.  Or the toolbox.  Mixed metaphor.  Whatever.  Get over it.  Get to work on your recovery.

The Recovery Map

Recovery - From What?

Recovery is the individual lived experience of moving through and then beyond the limitations imposed by the disorder, by the world around us, and even by the treatment itself.

Huh?

Okay, the deal is, unless you know where you are going, it's tough to get there.

Recovery Defined as Escape from the Symptom Silo

The docs know where they want to go.  They want to get rid of your symptoms.  Your illness is defined by a list of symptoms, found in the DSM and measured by survey instruments, and when you score in the normal range, then you have recovered.

Which is sort of like saying that if you don't have chest pain or shortness of breath, then you have recovered from heart disease.  Cardiologists don't think that way.  They want to know the condition of your heart, not just your symptoms.

Recovery Redefined

 The Medical Model Failed

We got sick.  Well, we were already sick.  We sat in the doctor's office, while the doctor quizzed us about our behavior, sorting out where we belonged in the DSM's symptom silo.

Next the doctor enrolled us in The Chemistry Experiment, prescribed the chemicals that were supposed to reduce those behaviors.  Not fix our brains, mind you.  Nobody has been testing whether these chemicals fix our brains, just whether they change our behaviors.

Recovery - The Medical Model Continued

Last week I began scavenging my upcoming Mental Illness Awareness Week presentation Recovery: Rewiring the Brain for a series of blog posts.  I left you in the middle of the Medical Model.  The graphic is on the left.  The narrative left off as the person with the broken brain was reading the patient information sheet, gulped at that list of side effects, remembered the doctor said she should weigh her costs and benefits, and then discovered that, according to the patient information sheet, the doctor had already done the weighing for her, and all she had to so was swallow the damn pill.

The Chemistry Experiment

The way it actually happened was this.  The sixth antidepressant my doctor wanted to try, she said, I get really good results with this medication.

So I wanted to know, remembering the results I got from her last brilliant idea, or rather, from the samples she had just received from the last sales rep, What kind of results will I get?

Recovery - The Medical Model

My Latest Obsession Begins

It was a talk intended for a general audience.  Well, what was assumed to be a general audience.  Not many doctors attend the monthly meeting of NAMI Johnson County.  But some people in the room know a lot more about the brain, what goes wrong, why, what can be done and what really works than the average viewer of those Zoloft ads on TV.  We have to.  We have come to understand that our lives depend on it.

So when the new director of the psychiatry department explained it all, some of us caught the nuances, and squirmed in our seats.

What Is Recovery?

Seventeen Keys to Recovery

Margalea Warner is one of my partners, along with Carol Porch, for a Mental Illness Awareness Week presentation in October, Recovery: Rewiring the Brain.  Margalea is active in the Mennonite Church in Iowa City.  They have been supportive on her journey in recovery.  She says there were some years when she was hospitalized so often she bankrupted their flower fund!

This week I am reposting her recent contribution to ADNET, Anabaptist Disabilities Network.  Margalea's story is one of those lights I hold up when things get dark.  I hope it shines for you, as well.

Keys to Wellness and Friendship -- by Margalea Warner

On August 12, 2012, a group of my friends gathered at the home of my friend Becky for a celebration of two major life milestones.  My friend Sherry had achieved twenty-two years of being clean and sober.  I had reached the milestone of seventeen years outside the locked psych ward.

Is Recovery Possible? - Kayla Harrison Continued

A few weeks ago I published a video interview with Kayla Harrison, USA's first gold medalist in judo.  The story was dated before her win, and showed her determination: if not London, then Rio...  (The source is the Boston Globe.  Kayla didn't make NBC's radar screen until after she won.)

Lots of shots in the gym.  A young lady you wouldn't want to mess with.

Except, her former judo coach did, starting when she was twelve years old and for three years.

Today, her former coach is in jail, and she has her gold.

Well, of course we love this story.  It follows the USA's favorite narrative arc: misery, struggle, justice, triumph.  We will listen to this story, read this book, watch this movie every night of the week.

Some of us will ponder it a little longer than others.  I expect Kayla is one.

Get Over It, Already

The Positive Power of Being Strange


It's just too easy [in Iowa] to avoid the weirdos in our life.

First, the TED talk from one of those people who, whenever they have something to say, you want to pay attention to it. I am pleased to call Mike Wagner a friend, so I get regular doses. Here he doesn't use the language, but he's talking about the power of my favorite brain part, the anterior cingulate cortex.

Mike's shingle hangs at White Rabbit Group. The name itself tells you something. He calls it a brand altering experience.



Next, the Prozac Monologues take on the matter, a rerun from September 23, 2011

Differently Abled - More, Please

It's like he is in a world of his own. The first grade teacher, old school, same worksheets for the last thirty years, did not mean it as a complement.

Curiosity on Mars

And now for something completely different, the true origin of Curiosity's name?



Marvin the Martian looks at us, and observes, There is a growing tendency to think of Man as a rational, thinking being, which is absurd.  There is simply no evidence of any intelligence on the Earth.

Meanwhile, in case you missed it, NASA has landed a rover named Curiosity on Mars.  If you did miss it, then you might be curious about what called Marvin to my mind.  Curiosity has yet to meet Marvin.  It is, however, meeting a lot of rocks.  It doesn't seem to be enjoying the rocks.

Follow the twitter feed from the Martian Rover here.  (Keep scrolling to the bottom to find the beginning.)  I think Curiosity works better on Prozac Monologues than Bugs -- different chapters from the DSM, you know.  Three days, and it's already into isolation and suicidal ideation...

But if you must, here is NASA's version of events.  Obviously not yet hearing its pain.


Kayla Harrison Survives Her Way to Gold

She's calling me out of sabbatical.  Damn!  She's calling for a series.  I'll have more next week.



Note added on 01/02/13 -- Links to other posts in this series are below:

Is Recovery Possible? - Kayla Harrison Continued August 25, 2012 -- The judo champ's story introduces the concept of recovery.
Seventeen Keys to Recovery August 30, 2012 -- Guest blogger Margalea Warner describes her journey in recovery in schizophrenia.
Recovery - The Medical Model September 7, 2012 -- Introduces the doctor's agenda, covers the first half of the story.
Recovery - The Medical Model Continued September 14, 2012 -- It was a great idea.  If only it worked.
Recovery Redefined September 21, 2012 -- People with a mental illness have our own definition of recovery.
Recovery - From What? October 1, 2012 -- You have to know where you are going if you want to get there.
Stages of Recovery - AKA Hope October 5, 2012 -- We recover in stages, and need different tools for each stage.
Neuroscience of Meaningful Work October 10, 2012 -- Oh goodie!  Here come the dendrites!
Hope for a Cure? Or Not? October 18, 2012 -- We finish the series with questions left unanswered, like, What is a cure worth?

The Garden of Your Mind

Mr. Rogers does with the mind what last week's post with Carl Sagan, Jill Bolte Taylor, et al did with the brain...



Ode to the Brain

Something about this seems sacred to me.



Purple Heart for PTSD

I am pleased to have scooped NAMI and Fox News on this one by two years.

Some people say we have dumbed down PTSD, and that we dishonor the suffering of soldiers when we give the diagnosis of PTSD to people who have the same symptoms and same brain dysfunction of PTSD, but whose traumas were of a lesser severity.  In other medical departments, a broken leg is a broken leg, whether the person fell three feet or thirty.

Back in May, 2010 I proposed that the way to honor soldiers whose PTSD is the result of war injury is the way we honor any soldier wounded in war -- the Purple Heart.

Better yet, let's honor their sacrifice by preventing their trauma in the first place.  No more!

Meanwhile, check out Guitars for Vets.

Those Who Have Eyes, Let Them See

Yes, I said I was on sabbatical.  But I do have to write.  Like, I do have to breathe.  My facebook page this morning, somebody posted an Ernest Hemingway quote, There is nothing to writing.  All you do is sit down at a typewriter and bleed.  I have learned there is more than one way to bleed.  Teresa of Avila's stigmata, by the way, were interior.  Mine (writing) seems better than other alternatives.

So yes, I am on sabbatical.  That means I don't have to post.  I might anyway.  Oh well.

NAMI National Convention 2012

It started with Shepherd.  He stood straight tall.  Life has taken a lot out of him, including a lot of teeth.  But he stood straight tall.  I remember him as a black man, with piercing light blue eyes.  I know that's possible, a black man with blue eyes.  Maybe it isn't true in this case.  My brain really isn't that dependable anymore.  But the piercing part is the most important.  I am so glad I wasn't afraid to look in his eyes.

Sabbatical -- Summer Reading

Well, dang.  Regular readers know that every once in a while my brain goes on strike.  I can't imagine how I used to preach week after week after week.  Usually, I do a re-run or fill with some video.  But after posting something every week since April 2009, the time has come to take an intentional break, a sabbatical.

I hate to do this in the middle of a series.  I have one more post in me on apology.  But I need more than a week's recovery time this time.  So that series will have to wait until October or so.  I'll still stick up an occasional youtube.  I've got one in the file featuring Mister Rogers...

Meanwhile, I have some suggestions to broaden your blog-reading horizons.  Most are not about mental health issues.  They are the random reading that feed my mind and soul, a selection from my blog role.  Consider this my annual Summer Reading post.

First up, of course, Knowledge is Necessity.  John McManamy gave me a leg up in the blogging business, when he introduced me to his readers, as the only other blogger he knows who writes about the anterior cingulate cortex.  I think of us as blogmates.

Knowledge is Necessity is as close as you will get to your weekly Prozac Monologues fix.  The way John puts it, from God to neurons.  Not that you could mistake one of us for the other in a crowd.  For one, he's a lousy dancer.  Kinda scary, actually.  But his writing -- you'll snort milk out of your nose.  Here is my review of his new book Raccoons Respect My Piss, as well.  I am reading it a second time right now.

Second, Untangled by Dr. Kelly Flanagan.  Notwithstanding the fact that I write a mental health blog, I don't actually read many, especially not the inspirational ones.  I don't respond well to people who give me advice, even good advice.  Especially good advice.  Just ask my therapist.  But Flanagan can tell a story.  He respects the knots we tie ourselves into in a way that helps us untangle them and find a bit of freedom.

Flanagan is relatively new to the blogging biz, and rather brave, I think, a psychotherapist who blogs about psychotherapy, exposing himself to his readers' triggers.  He has managed it well when he trips mine.  Responsive, but non-reactive -- I think that's what they call it in that language of theirs.  Me, I have to choose between reactive or silent.  So I admire how Flanagan can pull off that responsive but not-reactive thing and still tell a good story.

So that's it for the mental health blogs.


Cake Wrecks.  When I need a dose of something nuts to keep from going nuts, I look at the weird things that people do with cake and frosting.  The subtitle is When Professional Cakes Go Horribly, Hilariously Wrong.  This blog is a whole franchise by now, with books, tours and contests.  The photo above is of my own cake which I did not submit for consideration, because I am not a professional.  At the cake-biz, that is.  But it gives you an idea of what you might find at Cake Wrecks.  I made this one for a guerrilla party held in the lobby of a hospital where I would commit suicide rather than be hospitalized, to celebrate suicide prevention.

My arts and crafts piece here was handicapped by a dearth of materials.  In a  fit of good sense, I had turned over to my shrink my stash of old, ineffective or intolerable and dangerous meds.  (I had quite a collection.)  So I couldn't decorate the cake with pills, which had been my intent.  I had to substitute Mike and Ike's and Smarties.  Cake Wreck cakes go way beyond this effort.

Which leads me to Suicide Food.  Only this blog is not about suicide.  Well, not that kind of suicide.  It collects advertising images that depict animals acting as though they wish to be consumed.  You know, like instead of the Chick-Fil-A cows, encouraging you to eat more chicken, these are the little piggies inviting you to the barbecue.  There seem to be an inexhaustible supply of these scenes to which you may be completely oblivious (I was) until you read Suicide Food, where they are rated on a scale of one to five nooses for just how sick they really are.  The folks who bring you Suicide Food are also on sabbatical.  But they have five years' worth of shrimp lounging and waving to you from the cocktail glass for you to peruse.

Finally, you can tell Shell Shock - Nell's Big Walk is not a mental health blog, because it has a beginning, a middle and an end.  An end, what a concept.  Here's the deal.  Helen and I have been thinking about the Camino, a 500 mile walk across northern Spain, from the Pyrenees to Santiago de Compostela, a pilgrim route over 1000 years old, to the place where are buried the bones purported to be of Saint James, the brother of Jesus, washed up on the shore of northwestern Spain in a boat made of stone.  My kind of pilgrimage.


In our consideration of this enterprise, we had been reading others' accounts, which are, for the most part, filled with angst and/or stupidity, slathered with pain and misery.  I mean, I thought Paulo Coehlo's quest for his sword to be the most self-absorbed little boy obsession I have ever read.

But we kept reading.  Helen was researching boots when she came upon Nell Spillane, an Irish trainer and business coach.  Nell and Frances, childhood friends, celebrated their 50th birthdays by fulfilling a vow to do the pilgrimage when they got old, which they took to mean 50.  Nell's blog is a day by day account.  Helen and I spent Lent this year, reading one post a day.  Neither of us has had the heart to finish the last few days and be done with it.  Obviously, we could use a business coach.  I am stuck 20k short of Santiago.

Frances and Nell had fun!  There are spiritual moments.  All the piety that means something to us means something to them, going to the pilgrim masses, putting beads on the wayside statues of Mary.  But it's the comfortable sort, the Celtic thing/Teresa of Avila/feel free to cuss God out/don't take yourself and your precious insights so seriously sort.  Go ahead, eat that ham sandwich (after you dust it off).  Just wash it down with some more wine.

One thing has become clear.  We will not begin our Camino at the most typical starting point, St. Jean Pied de Port on the French side of the Pyrenees.  No, we will honor our Irish ancestors and begin where they would have, outside the Guinness Brewery St. James Gate, Dublin.

Thanks, Nell.


And thanks to all my readers.  Drop in now and then this summer.  You might find something new.  But for anything that requires the frontal cortex, see you next fall.

flair by Facebook.com
book jacket from amazon.com
photo of cake by Willa Goodfellow
photo of tomb of St. James by Le Galician, in public domain
photo of Guinness Brewery, St. James Gate, Dublin by Dubh Eire, in public domain

Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Frank goes on to explain how this attitude of entitlement plays out in the clinical setting.  Unlike the usually self-effacing patient with Major Depressive Disorder, grateful for any scrap of attention, people with bipolar get irritated at imagined slights, such as when the therapist cancels an appointment, or is late.  Sometimes, the only way the therapist can maintain the therapeutic relationship is to go ahead and apologize for these imagined slights.

Yup, stick that fork in the 220 volt socket again.

Apology?

So Robert Spitzer's Apology struck a nerve: apologies made or received, or not.  More like, Robert Spitzer's apology stuck a fork into a 220 volt socket, the nerve labeled Apology in the Clinical Setting, Or Not.

I have long been curious about this issue.  Fork in the 220 volt socket kind of curious.  I watched with wonderment as a therapist handled my complaint, which was, to me, about a life-threatening experience, steering the conversation away, time and again, from what I thought was the simplest, most natural direction, I'm sorry.

Now, I trusted this person.  Her avoidance of those words, her downright circumlocutions confused me.  My brain has long practice in making sense of the nonsensical behavior of people I trust.  So I decided there must be a rule, a therapy rule, that says a therapist shouldn't apologize, because it diverts attention from the real issue, which is about the client's mother, and not about the therapist at all.  Or something like that.

Robert Spitzer Apologizes

Robert Spitzer -- some people call him the Father of Modern Psychiatry.  In 1980 he took the DSM II, widely criticized for unreliability and lack of validity, and as editor of the DSM III, turned this obscure publication of the American Psychiatric Association into the standard reference work that defined every psychiatric disorder we've got.  It was research-based.  It listed objective criteria.  It was honkin' big, but it could be understood, not only by researchers, but also by practitioners.

Spitzer's acolyte, Allen Frances edited the DSM IV, which added a lot of information, but did not change Spitzer's basic framework for how these diseases are characterized.  Frances was a consultant for the DSM V, until he quit, basically because the new editors started to rethink things.  Frances now leads the charge against the DSM V, which has delayed its publication.  I won't develop that theme right now...

Robert Spitzer is the Man.

With Great Power Comes Great Responsibility

Relapse/Maintenance - Stages of Change

Michelle Obama likes pie.  Michelle Obama likes cheeseburgers and french fries, especially when followed by a hot fudge sundae covered with peanuts.

And her mission as First Lady of the United States of America is to address the epidemic of childhood obesity.

She began this effort when her children's pediatrician noticed they were developing some issues.  That brought her own food issues to her attention.  So she changed the way her family eats.  Less fast food.  More fruits and veggies.

It wasn't about looking like a model, getting into that dress for the big event.  It wasn't a diet.  It was, and is about change, for the sake of health.

She still eats pie.  Just, not all the time.

Hypomania Goes To A Blog Party


The American Psychological Association is throwing a blog party.  Today!!  Why didn't anybody tell me about it until today?!  Maybe because they have heard about me and parties?

I didn't know about me and parties.  I didn't figure it out until I discovered I have bipolar II.  -- Not bipolar I.  Everybody knows about that kind of crazy.  Bipolar II is -- well, you never know what you're going to get.  Sometimes what you get makes you the life of the party.  Sometimes in a good way.  Sometimes it makes you crazy productive and successful at work.  That is why it years and years to get a bipolar II diagnosis.  Nobody goes to the doctor because they feel great, are having fun, and are the apple of the boss's eye.

Sometimes the family member knows about the evil twin.  But chances are, the doctor doesn't ask the family member.


Raccoons Respect My Piss

I don't know that for a fact.  Actually, the piss in question is John McManamy's piss.  And he has the experience to back his claim.


Nor do I have any recollection of how I discovered McManamy's blog, Knowledge is Necessity, and from there, his enormous set of resources at McMan's Depression and Bipolar Web.  But as it happens, my entry into McMan World was Skunk -- the blog piece from August, 2009 that inspired his new book's title, Raccoons Respect My Piss, available in kindle format and now in paperback.


Since I asked John's permission to steal Skunk, which I guess means I didn't steal it, we have become what I call blogmates.  He most graciously gave me a leg up in this business, plugging Prozac Monologues in its infancy on his own blog.  Since then, we often find we are captured by the same curiosities at the same time -- as he puts it, God, neurons and everything between.

NAMI Camino - BDNF Meets 5K

Exercise and learning new things -- two of the most powerful tools in the Recovery Toolbox.  They came together in my NAMI Camino, April 28, 2012.

NAMI Walk/NAMI Camino gave you the set up.  NAMI Johnson County held its annual walk/fund-raiser last week, when I was in Costa Rica.  It would be my fourth and last time participating.  But I would be in Costa Rica!  Inspired by the San Diego Walk in 2010, when a battalion in Iraq ran while San Diego walked, I decided to do Johnson County's Walk long distance -- though I would not be running in full battle armor and in the heat of the day.  My extra effort was confined to carrying a laptop to record the event.

With the following results:


So what follows is a series of installments, stopping at each kilometer marker.  This series shows you what you can do with Photo Booth, Youtube, not much skill, and a willingness to experiment.  Everything is reversed, left and right, which won't confuse you unless you are trying to read t-shirts or street signs.

Preparation/Action - Reprogramming Your Brain for Healthy Eating

Some days Facebook just breaks my heart.

Last week a friend who is trying to change his eating habits because, well frankly, his life depends on it, posted a complaint about his breakfast smoothie.  He gave the recipe, and yes, it was nasty.  So one of his "friends" said she would bring over some donuts.


Another friend posted, I have the best husband! He brought me home an Oreo Blizzard.  Her life doesn't depend on it yet, because she is younger.  But it will.  She is on her way.  SAD, the Standard American Diet is an addiction and addictions are progressive.

Real Mental Health Advocacy - We Have Begun

Okay, so I just blew away this week's post.  Sigh.

Instead, I will honor the people in Chicago, who have tried every form of education, conversation and persuasion they could devise to convince Mayor Rahm Emanuel not to close six of the city's twelve mental health centers.  Finally, they staged an occupation.  For seven hours, they held the Woodlawn Mental Health Center, while Occupy Chicago gave support from outside the clinic.

They are my heroes.

Read the remarkable details here.  The videos seem to be missing from the text.  Here is the link to the story as recorded in stages on youtube.

NAMI Walk/NAMI Camino

I started a new project today, researching the route for my NAMI Camino.

I Walk For The Mind Of America

April 28 will be my fourth Walk to raise funds for NAMI (National Alliance on Mental Illness).  I have been most gratified by the support from friends who help me give back to this organization that has made such a difference in my life, and hundreds of thousands of others.

History Of NAMI

Since its founding in 1979, by a bunch of uppity Wisconsin women who said There is no such thing as a schizophrenic family; we did NOT cause our children to have this devastating BIOLOGICAL disease, NAMI has been a beacon of light, education, advocacy, and support first to families and then to persons living with mental illness.

My History With NAMI

In my case, Peer to Peer, a 10 week class helped me to understand, come to accept, and learn skills to live with my illness, whatever they think it is this week.


Project Implicit and the State of One's Soul

Remember, Dumbledore said to Harry, It is our choices that show what we truly are.

Project Implicit

So did you do the homework?  Did you try any of the Implicit Association Tests?  Do you still want to read my blog?

This is how they describe what they are doing:

Project Implicit represents a collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington. While the particular purposes of each study vary considerably, most studies available at Project Implicit examine thoughts and feelings that exist either outside of conscious awareness or outside of conscious control. The primary goals of Project Implicit are to provide a safe, secure, and well-designed virtual environment to investigate psychological issues and, at the same time, provide visitors and participants with an experience that is both educational and engaging.

The variety of topics include attitudes toward age, race, disability, ethnicity, mental illness and others.  The tests are constructed to bypass thought, commitment, decision.  They dive deeper into what is known as the lizard brain, the part that evolved before reason, and that simply reacts, by setting one to tasks that have to be accomplished faster than the thinking part of the brain thinks.

Project Implicit is well aware that we may not like what we find in the lizard brain. I don't care for what I find in mine.  But it is important information, for two reasons.

Trayvon Martin and Soul-Searching - Not Gonna Happen



Two things struck me about this message.

The first was the more widely quoted, If I had a son, he would look like Trayvon Martin.  There is a photoshopped poster circulating on Facebook, Trayvon included in the Obama family photo.  It brought to mind immediately the young men I know who look like Trayvon.  I don't want to write their names, fearing, like O-lan from The Good Earth, that to speak such praise as they deserve would tempt the jealous gods to do them harm.

Their mothers are among my closest friends.  I can hardly speak of Trayvon Martin in their midst.  What it must mean to be the mother of a fine young African American man.

The second was a minor note, a hidden note, one that will be forgotten, was forgotten as soon as it was said, All of us have to do some soul-searching.

We Do Not Search Our Souls

Of all the words that this shooting has birthed, all the pundits and opinions, soul-searching is not among them.

Dopamine - Can't Live Without It

Dopamine -- It's what gets the lab rat turn to left at the T, race down the hallway, make a flying leap at an 18" wall, snag the ledge with its little claws, and struggle over to fall to the other side and win those four food pellets.  If you artificially deplete the lab rat's dopamine, it will turn right at the T and settle for the two pellets lying on the floor.

Dopamine -- It's what got you out of bed this morning and to work on time.  Or if your dopamine levels are depleted, you pulled the covers over your head, while your spouse pleaded with you to go back to your therapist.

Dopamine -- It's what got you out of the house early to redeem that two-for-one mocha coupon at your favorite coffee shop on your way to work, and as long as you were there, might as well order that banana chocolate chip muffin.  Bananas are good for you, right?  Or if you just never got into the habit of that particular coffee shop, and it's not on the way to work, and you really like the French Roast you have at home anyway, then your dopamine never got you fired up, and the coupon went to waste.

Changing Food Habits - Contemplation and Preparation

Do you have any idea how complex the neuroscience of your food habits are?  Cinnabon, Chili's, General Mills, et al know way more about your brain than you do.  David Kessler, former FDA Commissioner, pediatrician and Dean of Yale and UC San Francisco Medical Schools, tells the story in The End of Overeating: Taking Control of the Insatiable American Appetite.

Neuroscientists know how the salt/sugar/fat triple whammy messes with the brain circuitry, taking offline the I have had enough now sensors and replacing them with More, please.  Reward centers, neurotransmitters, HPA axis, limbic system, operant conditioning -- they are messing with you.  Neither your meds nor an aluminum foil hat will protect you.

My Food Autobiography and the Stages of Change

This is not a post about dieting.  If you are looking for the quick fix for the upcoming wedding, reunion or beach vacation, move on to the next page on Google's list.

Before life so rudely interrupted, I was doing a New Year's series on the Stages of Change.  Since then I have rewritten my profile, reflecting on change as a theme.  I don't particularly care for change, but I am fascinated by how people manage to pull it off.  And I am astounded that at age 54 I changed a basic health practice, that being my eating habits, and have maintained that practice for six years.

Let me repeat.  This is not about dieting.  Who wants to DIE-t?  This is about changing the pathways inside your brain, retraining it, creating new synaptic connections that serve you better than the ruts (automatic reflexes) your thoughts and behaviors now travel.


Not in one leap.  One step at a time.

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