Beyond the DSM: Three Ways to Manage Other Issues of Bipolar Disorder

Medication is approved for a mental illness if it reduces symptoms, the symptoms listed in the Diagnostic and Statistical Manual (DSM).

Did you know that there is more to bipolar disorder than: 

an episode of depression 

elevated or irritated mood, inflated self-esteem, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increase in goal-directed activity, psychomotor agitation, and excessive involvement in pleasurable or risky activities?

These are merely the outward and visible signs of what is happening inside the brain. These are how the doctor can tell that you have bipolar disorder.

But even after you suppress these symptoms, you still have a variety of neurological dysfunctions that affect your thinking, your energy metabolism, and your health.

Psych meds do not address all these other issues. They are a piece of treatment, an important piece. But suppressing symptoms, while it relieves the anxieties of those around you, does not fix your life.

What am I talking about, and how come you weren't told this stuff when the doctor wrote the script and your family member told you to take the damn pill already?

First, what I am talking about:

In a person with bipolar disorder, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to rebalance. And I don't mean just mood. It's not just up and down.

The list of these mis-timings and misalignments includes:

  • Dysregulation of hormones, neurotransmitters, and immune system
  • Irregularities in communication within and between brain cells
  • Disrupted wiring among the networks that connect the thinking, feeling, evaluating, and reacting parts of the brain.

A number of these issues persist beyond the individual episodes of depression and mania/hypomania that the medication is intended to reduce.

Here are three examples, and how to reduce the damage they do.

Dysregulation of hormones, neurotransmitters, and immune system

Let's look at cortisol, the get up and go hormone.

Cortisol fluctuates throughout the day. You can trace the fluctuations in a curve. In a healthy brain, a high level of cortisol gets you out of bed and out the door in the morning. Throughout the day, you get an extra boost in response to stress, when you need more energy to deal with whatever the issue is. In the evening, the level dials down so you can go to sleep.

In the bipolar brain, the curve is flattened. It has similar highs and lows, but not high enough in the morning, making for a sluggish start to the day, followed by too high at night, making for sleep difficulties.

These flattened cortisol curves persist even in remission.

Is there a pill to change this pattern? Your mood stabilizer or antipsychotic may make you sleepy at night. But what about the morning?

Here's an idea - live with it. Plan on it. Build the cortisol curve you have into your schedule. I get up at least an hour before my spouse does. She doesn't expect me to participate in meaningful conversation until I have been up for two hours.

At the other end of the day, I start signaling to my brain that it is time to dial down two hours before bedtime. Routine soothes the savage beast. No super-stimulating television, no news, no Facebook right before lights out. I treat my limbic system, the source of all that cortisol, gently.

Irregularities in communication within and between brain cells

Mitochondria are the little critters inside our cells in charge of energy production.

These little critters are not as efficient in bipolar brains as in non-bipolar brains. This is a problem particularly in the hippocampus, the part of the brain in charge of memory and mood regulation. Inefficient energy production in the hippocampus means that this part of the brain shrinks and cannot do its job as well as you would like.

How do mitochondria produce energy anyway? They use the fuel that we provide by what we eat. So what kind of fuel makes for happy, healthy, productive mitochondria? Can you guess?

Is it this?

Or is it this?

Hmm, I'm going to let you figure out that one yourself.

I'll just add that the wrong fuel produces waste products that poison the mitochondria, like burning "dirty coal."

Disrupted wiring among the networks that connect the thinking, feeling, evaluating, and reacting parts of the brain

One part of the brain really does need to hear from other parts of the brain on a regular basis to function well. For people with bipolar, there is static on the line between the prefrontal cortex (the thinking brain) and the limbic system (the reacting brain). The result can be a hasty judgment, an emotional upheaval, and an impulsive reaction when thought can't catch up in time to modulate a response.

Practice the pause.



And it does take practice, to pause after the stimulus to give the message from your intelligent self time to reach your self-protective self before you act.

Victor Frankl put it this way:

When I was writing my book and working with a developmental editor, every time she gave me feedback, every damn single time, my first reaction was She doesn't understand. Why am I paying this person who just doesn't get it?

I learned to say I'll think about that. Then I would breathe. Then I would remember that I was paying her to give me feedback. No, she wasn't being mean; she was using her own expertise. Then I would think about how to use her feedback. I seldom took her suggestion exactly. But I did figure out how to address her concern in a way that was true to my vision. And I made the book better.

Thanks, Brooke. Thanks, breath.

How come your doctor didn't tell you this stuff?

Ah, well. Just like the gap between your prefrontal cortex and your limbic system, there is a gap between what the research has been saying about bipolar disorder for decades and what is actually taught in medical school. Your doc didn't tell you, because nobody told your doc.

The focus on treatment of mental illness is still on addressing the crisis and reducing symptoms, not healing the brain.

Well, the symptoms are indeed problematic, sometimes life-wrecking. But once you get those under control, if you think things still aren't working for you the way you would like, you are not crazy. And the solution is not to tinker with your meds.

The solution lies in all the life-style measures that address all the other, out of sight dysfunctions of the brain. Regular schedule, healthy eating habits, exercise, self-awareness.

Oh, and education to learn what your doctor didn't tell you.

It's not easy. But when you start putting this stuff into place, it gets easier.

Remember, I'm rooting for you.

Graphic of corticosteroid-binding globulin in complex with cortisol from the Protein Data Bank, in public domain

Picture of mitochondrion by NIH, in public domain

Photo of donuts by lucianvenutian, used under Creative Commons license

Photo of fruits and vegetable at Pike Place Market by Eric Hunt licensed under GNU

"I Don't Believe in God Anymore. Just Don't Trust the Guy"

Job 42 - A sermon

Fourteen years ago, I wrote an essay titled, I don't believe in God anymore. It was a response to my grief about my mental illness, the loss of my self-image, my sense of confidence as a person who could rely on the state of my own mind.

I wasn't suicidal at the time. But I was acutely aware that chances are I would be again in the future, because I have a remitting, recurring condition. It appears, it gets better, it flairs again. And suicidal ideation is one of its symptoms, a particularly cruel symptom.

I felt betrayed. Betrayed by God.

I mean, I had given my life, my energy, my health to serving God. And all of those things had been taken away from me. Me!

Okay, I know that bad things happen to good people. Bad things happen even to saints. But, damn!

It wasn't about mental illness so much as it was about grief, grief for the loss of what I thought I knew about myself, what I thought I could count on, my brain, most of all.

And I thought I could count on God, too. So, I wrote, I don't believe in God anymore. Just don't trust the guy like I used to.

Job had a different response to his grief. He never said, I don't believe in God anymore. He continued to challenge God to be the God he thought he knew. But there are ways that the book resounds powerfully for me.

And maybe for you.

It is a book about grief, about loss, about a world that has been turned upside down, and taken so much that we held dear with it. And many of us have lost. Many of us grieve. Even if not as vocally, as vociferously, as Job.

A job, a career that meant the world that was taken from us. A love that ended. A beloved who has died. A child who went another way. A child who never was. A secret loss that is not spoken.

And of course, we are surrounded by global loss, nearly five million people dead now worldwide from this pandemic, even more millions who are permanently disabled, the underbelly of this pandemic that we have not yet explored. Inevitably, maybe more painfully, the millions become one and one and one, not numbers out there, but individuals, people we can name.

Collateral losses, a social fabric that is falling apart, families at odds with one another, a collapsing health care system, a government that is not able to fulfill one of its basic functions, because public health, public anything ultimately comes down to what Dr. Fauci said, I just don't know how to convince people that they ought to care about each other.

And I'll tell you, as a priest, it is embarrassing to be confronted so graphically with the failure of the Church's mission to teach people to follow Jesus.

It is embarrassing when the Church fails to speak, because somebody called it a political agenda, to care about each other, to give up something of ourselves, as Christ did, who did not count equality with God a thing to be grasped, but emptied himself, taking the form of a servant, for the sake of another.

And I could go on. But you get the picture. And you wonder why I am pushing it in your face, that we are experiencing devastating loss and incredible grief, both publicly and personally. We want to forget. We want so desperately to forget.

Our ministry development team process got cut short in the second unit, a foretaste of our grief to come. There are six units. The design is to read through the Bible, book at a time, considering the issues that each book raises for how the people of God live together. Job gets his turn in the third unit, pastoral care, where the process asks the participants to examine in themselves how very hard it is to listen to somebody else's pain when you can't fix it.

We don't read much of Job on Sunday mornings. Preachers dodge the book. It used to be, we didn't read the book on Sunday mornings at all. So many of us think of it as this problematic part of the Bible that starts out disturbing - this bizarre test of a righteous man, to find out just how much he can endure, the loss of his fortune, the deaths of every single one of his children, and then this miserable, miserable skin disease.

Then it turns depressing.

If you have ever tried to read it, you know that he goes on and on and on with his complaints. His friends did listen to him for two weeks. And they don't really get credit for that, that they sat with their friend in his anger and his terrible grief for two whole weeks.

But they did. They did their best with the pastoral care training they had. Until it just ran out and they started saying all those things that we say, trying to make the pain go away, if not Job's pain, then at least our own.

  • This is a test; God is testing you.
  • God has a plan; you just don't see it yet.
  • What could you have done differently?
  • Happiness is a choice, you know; just choose to be happy.
  • Or - this will make you stronger.

See, it is so hard to look into somebody else's abyss and not back away.

It is so hard to look into somebody else's abyss and say instead the truth, Damn! This is hard. I don't understand why this is happening to you. I want to make your pain go away and I can't. But I will not abandon you. I will not abandon you.

Job is not the only one in the Bible who grieves. Out of 150 psalms, forty-two are psalms of lament. They speak of grief, of loss, failure, betrayal.

The Israelites were not like Americans. They did not expect that they would always win, that they would leave the field victorious, happy. In their worship, they could speak of their sorrow.

That's not part of our culture in the United States. We can speak of our rage, but not our failure.

American culture presses to the ending of the book of Job. See, there are two parts to the book, this fable of a righteous man who was tested, who endured the test, and was rewarded by all those good things we heard at the end of the reading this morning.

Oh yeah, that's another thing that people say,

  • Don't fret; you can still have another child.

But somebody came along later, took that fable and said, Nonsense! Listen to Job! Let him have his say.

I mean, even Jesus got his say, hanging on the cross, My God, my God, why have you forsaken me?

Let Jesus, hanging on that cross, have his say, My God, why have you forsaken me?

And then have your own say.

That's what the book of Hebrews is about. Because he has been there, he has been here, he knows what is in our hearts. Consequently, he is able for all time to save those who approach God though him, since he always lives to make intercession for them.

There he is up on that cross, praying the words that we would pray, that we do pray, when we pray what is truly in our hearts.

You have forsaken me. I don't believe in you anymore. I can't trust you.

That's not part of our culture in the United States. We can speak of our rage, but not our failure. So I know that I break the taboo when I said, I don't believe in God anymore.

How do I end this? How do I resolve this unbearable tension?

How did the book of Job resolve it?

There are two endings. The last words we hear are from that ridiculous fable: It's okay. He got his fortune back. He had more kids. And gee, the next daughters were even prettier than the ones who died!

So - what? Pass the test and you'll get your happy ending, too?

The poet who wrote the bulk of the book, the big middle, went in another direction. For thirty-seven chapters, Job challenged God to be the God he thought he knew. The God he thought he knew. After thirty-seven chapters - and congratulations if you really do sit with Job and let him have his say - if you get through them all - in chapter thirty-eight, finally, God shows up.

And God says, Who is this that hides counsel without knowledge?

Like, Who do you think you are?

Where were you when I laid the foundation of the earth?

Have you commanded the morning since your days began?

Do you give the horse his might?

Is it by your wisdom that the hawk soars?

Well, that goes on for a while. God has God's say, and keeps saying it, until ultimately Job succumbs, I have uttered what I did not understand. . . I repent in dust and ashes.

I take two things from what God has to say.

First, I take comfort by putting myself in my place. Whatever my misery is, and it is great, at times it has nearly overwhelmed me, yet I am small. The universe is vast. And starting at chapter 38, that universe, and God's creation of it, is worth reading.

When I in awesome wonder consider all the worlds Thy hands have made, I see the stars, I hear the rolling thunder, Thy power throughout the universe displayed,

Then sings my soul, my Savior God to Thee! How great Thou art, how great Thou art!

This misery that surrounds me, that once blocked out every single person who loves me, and horse and hawk and mountain and Cliffs of Moher and stars around me, this misery is small. It is held, I am held, in something vast, something that turns out to be magnificent, and powerful.

And maybe, just maybe, what holds that vastness, and me in it, and you, and you, turns out to be love.


And the second thing that I take from the book of Job, and from that long dark night that Job traveled, that I have traveled, and perhaps you, too - 

I just don't know as much about God as I used to.

God says, Who is this that hides counsel without knowledge? Who do you think you are?

With Job I have to answer, I have uttered what I did not understand, things too wonderful for me, which I did not know.

And I still don't know. I don't know as much about God as I used to.

And I don't know how you feel about a priest who didn't wrap it all up in a bow for you, because I can't wrap it up in a bow for me.

I think love has something to do with it. So, all I can do is choose, as best I can, to follow the one who has gone the way of love.

I choose to follow Jesus.


Should Every Primary Care Patient Be Screened for Depression?

Depression affects about one person in five across their lifetimes. It is a significant source of disability, loss of productivity, and impaired relationships, and a major risk factor for suicide. A study from the 1990s revealed that, in the absence of routine screening, primary care providers at an HMO in Washington state missed the diagnosis in approximately 35% of patients who had depression.  

It seems common sense, doesn't it, that routine screening for depression would improve care by better diagnosis and follow-up treatment?

Actually, no. Despite more widespread practice of routine screening in primary care settings in the US in recent years, and despite subsequent increase in the use of antidepressants, the benefits have yet to show up.

Real Suicide Prevention or Self-Satisfied Nonsense?

It's Suicide Prevention Month/Week/Whatever again. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us? Some of the following came from an earlier post. It bears repeating, 'cuz evidently even some bright people have some strange ideas. Like:

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

Resisting COVID Depression, One Song at a Time

Who knew COVID would last this long? Did you, like me, feel a bit of hope last spring? We had the tools; we got the jab; the numbers started falling.

But . . . not everybody got the jab.

Then . . .

Now? Children are thrown into a virus laden cauldron while state legislatures pass laws prohibiting measures that would reduce the spread of a pandemic. Nurses are dropping like flies. A guy died in an emergency waiting room this week because there was no room for him in ICU.

And people with a high school diploma and an internet connection know better than the medical community. Instead of heeding the pleas of their doctors, they are taking horse-deworming medicine. Our local feed store has run out of it.

I guess next up--the horses start dying.

So, it looks like this thing is going to be with us for a while.

Prejudice, Not Stigma: How People with Mental Illness Get Crap Health Care

Eight years ago I published an article titled Doctors' Prejudice Against Mental Illness. It lays out the reasons why it is so damn hard for doctors to learn. Here is a paragraph from that original rant:

Similarly, people with other mental illnesses as well often do not receive routine standard of care for a whole host of conditions, including screens for infections, dental care, metabolic syndrome, even blood pressure checks, even while receiving medications that put them at risk for all of these health complications. As a consequence, the death rate gap between people with mental illness and the rest of the population is growing.

The link in the second paragraph is to a World Psychology article, a review of the literature documenting the crap health care that people with serious mental illness receive, with the consequence that we die an average of ten years sooner than people without mental illness.

The difference in lifespan is only slightly due to suicide. For the most part we die of the same things everybody else dies of, heart disease, cancer, that sort of thing. We just die sooner because our heart disease and cancers are not detected as early, nor treated as aggressively, as everybody else's.

Surviving Heat Waves with Bipolar Disorder

Did you know that more people are murdered at 92 degrees Fahrenheit than any other temperature? I read an article once. Lower temperatures, people are easy-going, over 92 and it's too hot to move, but just 92, people get irritable.

That's what the sheriff said in an opening scene of It Came from Outer Space. Set in Arizona -- even in black and white, you could feel the heat rolling off the sand. And throughout the movie, they attributed people's reports of strange sightings to heat-induced lunacy.

As I read that quote from 1953, I think -- 92, if only!

Everybody is irritable right now in -- how shall we put this? -- the coolest summer we will experience for the rest of our lives. Everybody is exhausted. But some of us more than others.


One Exciting Thing and One Ironic Thing About Prozac Monologues and Psychology Today

Last week Psychology Today posted Bipolar Disorder: How to Get Correctly Diagnosed, my interview with Monica Starkman, M.D. about Prozac Monologues: A Voice from the Edge. Its tag says, The average of seven years to receive accurate diagnosis is unacceptably high.

Damn straight it is! The article is about how to improve that rate, or at least to improve the odds for the people who follow its suggestions.

This popular journal chose to place the article in its Essential Reads section on its bipolar resource page. The article's key points include:

  • Bipolar disorder, particularly Type II, is often misdiagnosed.
  • People tend to spend much more time in a depressive state and often do not recognize mild or hypomanic symptoms.
  • The chance of getting properly diagnosed is increased by using online screening tools and bringing family/friends to doctor visits.

I spent a mere (!) five years misdiagnosed with major depression, two of them taking the antidepressants that threw me into mixed episodes and made me suicidal. A random conversation on an airplane led me to the Mood Disorder Questionnaire referenced in the Psychology Today article. Taking the MDQ was the first step to discovering my bipolar and, more importantly, getting on the road to recovery.

So the exciting thing is that this information will be accessible to a larger audience than those of us who go poking around medical journals. That is my mission. Contact me on my website if I can speak to your book club, church group, or fraternal organization about mental illness and recovery.

The ironic thing? -- The photo the magazine chose to accompany the article.

On the Road Again for NAMI: No Cougars Encountered

NAMI and I go way back. I don't even know when or how I heard of this organization, the nation's largest grass roots organization dedicated to building better lives for the millions of Americans affected by mental illness. But it has walked beside me for thirteen years now, as I have tried to build my own better life.

NAMI began in 1979, when some Wisconsin parents of people with schizophrenia pushed back against the prevailing theory of the day, that they had caused this terrible disease in their children. They aligned their new organization with the view that schizophrenia is an illness of the brain, and a commitment to support research into medical approaches to alleviate this and other mental illnesses.

NAMI provides advocacy, education, support and public awareness. My own life has been touched by NAMI through their Peer to Peer classes and support groups. My wife attended Family to Family classes. In the last ten years, these core programs have expanded to address other needs.

So most years, I have participated in their annual fund raiser, the NAMIWalk. For the first few years, I walked with NAMI Johnson County in Iowa City, with Team Prozac Monologues. It was a party affair, kicked off with balloons and Middle Eastern dancers and roller derby demonstrations. And t-shirts, always t-shirts.

This year we did it DIY. COVID cancelled the big events. We all walked our own routes.

Does Music Therapy Help People with Bipolar Disorder? Maybe Not

Non-pharmaceutical approaches to mental illnesses are great. I mean, who wouldn't like to pop a pill without the side effects?

I eagerly clicked on the link: Music therapy for bipolar disorder: Can it help? from the newsletter, Medical News Today, hoping to find the playlist that would soothe the savage beast. The article reported on two studies, both pretty small, N<30. I guess music therapy doesn't attract the big bucks in research land. Spoiler alert: I did not find the magic playlist.

The first study compared people with bipolar in a euthymic state (stable, not depressed, not manic) with healthy controls. They listened to music that typically produces wonder and joy. The healthy controls felt wonder and joy. The bipolar participants felt... tense. The researchers surmised that the negative emotions in bipolar participants has to do with difficulties in emotional regulation, part of the executive dysfunction.

The music disrupted an equilibrium, perhaps, which healthy controls found exhilarating, but bipolar people found simply disruptive? -- That's my conjecture.

How Far Have You Come? A Review of Trauma and Recovery

Judith Herman wrote the definitive work on Trauma and Recovery in her book by that title, with the subtitle: The Aftermath of Violence--From Domestic Abuse to Political Terror. You haven't heard from me in a month while I have been living with this book, preparing a presentation on the trauma of suicidal ideation.

It was a trip, that presentation, taking me through the dark corners of my life in the last fifteen years. With Herman as my guide, I also traveled through the progress I have made, considerable progress.

[It's still possible to register for The Healing Conference, now with two for one pricing. Recordings of the presentations will be available through 2021.]

The first half of the book begins the history of the concept, beginning with what was called shell shock in World War I through to Post-Traumatic Stress Disorder, PTSD in Viet Nam, along the way picking up other traumas, sexual violence and captivity.

Want a Sneak Peak to the Healing Trauma Conference?

The third annual Healing Trauma Conference: Come to the Table: Nourish your Body, Mind, and Spirit, Because No One Heals Alone takes place April 30-May 2, sponsored by Haelan House of Bend, OR -- Healing the Root Causes and Effects of Trauma.

My bit is Sunday morning's keynote address:

Suicidal Thoughts as Trauma:

Taking Charge of My Own Recovery.

Description: Trauma can be both the cause and the consequence of suicidal thoughts. Suicidal ideation is considered a symptom of a mental illness. The mental illness model (what's wrong with you? instead of what happened to you?) suggests that if the illness is treated, then the symptoms resolve. But often, while the thoughts themselves go away, the trauma can go unrecognized, untreated, and underground.

What is God Doing on 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.

There's the text for World Bipolar Day.

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

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

Five Good Books I Recommend for World Bipolar Day

Knowledge is the key to taming this beast we call bipolar disorder. The more you know about what is happening inside that beautiful brain of yours, the better you can avoid letting it bite you in the butt.

Alas, many people with bipolar think their doctors will tell them what they need to know. Most of the psychiatrists I have seen gave me an abbreviated (and sometimes disingenuous) description for potential side effects of the pills they prescribed. And that's it.

How do I actually live with this beast? Take my meds. What will it mean for my life? Not so much as a pamphlet.

Psychoeducation for bipolar disorder has been shown to reduce recurrence of depressive, manic, and mixed episodes, all three, and to reduce hospitalization, as well. It includes information about the biological roots of the disorder, the rationale for medication, other treatment options, early warning signs of episodes, and common triggers. It aims to improve adherence to treatment plans. It usually is offered in a group setting.

It isn't offered often.

One More Reason to Ask About Suicide

It's always dangerous to listen in when psychiatrists and therapists talk among themselves. I used to do a whole series, OMGThat'sWhatTheySaid, devoted to overhearing what they say about us. More than one post was devoted to their discourse about suicide.

There's been lots of opportunity to overhear in the last several days since the Meghan Markle interview. The clinicians weighed in on Stacey Freedenthal's New York Times article where she dared to repeat what some doctors and therapists have told her (an expert in the field of suicide and suicide prevention), that they fail to ask the question about suicide. There have been proclamations about professionalism, training, protocols, risk-assessment, and - God help us - malpractice.

I started to write a post reporting my own experience of risk-assessment and the failure of my doctor and therapist to ask, even as they told me they were concerned about me. Concerned about what exactly?

But I began to feel -- empty. Like the whole conversation, including my part in it, was missing the boat.

The boat is pain.

What is at stake is whether we have a safe place to talk about our most painful feelings.

What Happened When Meghan Markle Asked for Help?

Ask for help. That is the suicide prevention message. When you are in trouble, ask for help.

And I am not going to suggest otherwise. That's about the only way you will get help. The pain that you are in, the scary thoughts that you are having, there is a way out that is a way through, that leaves you alive on the other side. The way begins when you tell somebody, when you ask for help.

That, alas, is not the end of the story. This week we watched as a princess, a celebrity, somebody who lived in a multimillion dollar house in a multibillionaire family told her story of what happened when she asked for help.

They told her, No.

Are You Asking Your Meds to do All the Work?

Where is my magic pill? They say it takes a while to find the right medication, you just have to stick with it.

But for how long? How many chemistry experiments? When? WHEN will my bipolar get fixed?

This was me, resisting therapy, resisting exercise, resisting every other suggestion my doctor made. Alas, here are the pills that finally did the trick:

Pills are not enough.

Do You Really Want to Use Mental Illness as an Insult?

I am tired to death of hearing mental illness diagnoses used as pejoratives.

I am tired to death of hearing technical medical terms that apply to me and my friends hurled as insults at political figures, used to describe weather conditions, and employed as self-deprecating comments in the context of life's little challenges.

I am especially tired to death of hearing this language in the postings of Facebook friends and in the pulpit from educated people who should know better.

Especially after I have called them on it over and over and over.

So you can imagine that my eyes perked up at a thread that addresses this issue, posted on Twitter by somebody who goes by the handle @queerfox.

Can People With Mental Illness Become Saints?

 The day approaches - the start of Lent Madness.

What, any reasonable person might ask, is that?

Take March Madness. Mash this bracket-style competition with a list of saints, some well-known, some utterly obscure, chosen by Scott Gunn and Tim Schenk, the two members of the Supreme Executive Committee who answer to nobody. Despite years of campaigning, they still will not include Fred Rogers. But I digress...

Every weekday through Lent the reader is presented with two saints and asked to vote. Anybody with an internet connection can vote - only once - they will know. The saint with the greater number of votes advances to the next round.

Help! How Do I Talk to My Delusional Cousin?

Consensual reality has taken a real beating lately. Fake news, alt facts, conspiracy theories, Russian Facebook bots... Sure, we'd all like some civil discourse. But what do we do when we can't even agree on what is true?

Delusional is a big word to throw around, especially when you are trying to stay in some sort of relationship with friends or family whom you believe, frankly, to have gone over the deep end. Does it really apply to this situation? Or is the use of the word a lit match in a room full of gasoline?

Let's start with some clarification. The Diagnostic and Statistical Manual (DSM-5) defines delusions as
 fixed beliefs that are not amenable to change in light of conflicting evidence. Well, that sure sounds like what we are dealing with.
Delusions are taken as indicators of a mental or physical disorder. But before we go making armchair diagnoses, consider how powerfully our minds cling to ideas that are demonstratively false, the fear of spiders, the hope in lottery tickets, trickle down economics. Let's exercise some restraint and some humility here.

How Will You Get Through This Week?

Self care is not my best subject in the best of times. I can establish a routine, get up, eat breakfast, go to work, walk in the afternoon, and so on. I can hang on to good habits, eat a healthy diet, wear amber glasses at night. But that place in the list where I am supposed to do something for myself? Here is how that goes:

    Therapist: What will you do for fun this week?


Okay, so what will YOU do for fun this week? (Clearly, I could use some ideas.)

And now there is this insurrection. How did that word work its way into daily conversation?

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