Showing posts with label depression. Show all posts
Showing posts with label depression. Show all posts

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.

Interpersonal Social Rhythms Therapy: Good, Bad, and Ugly (Mostly Good)

Following #bipolar on Twitter for the last few years, I am often dismayed. So many people seem to spend so much time struggling with their medications and so little time focused on anything else that could help.

Don't get me wrong. Medication is an important tool for managing bipolar disorder. But it can't do the whole job. Education and life style changes are crucial for getting off the roller coaster of constant med adjustments to address the episode du jour.

I decided it was time to revisit my 2011 review of Ellen Frank's Treating Bipolar DisorderIt was a four-part review. The last three posts describe the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.

Part I laid the educational foundation, describing the relationship between circadian rhythms (our interior physiological clocks) and mood disorders.

Part II outlined Frank's Social Zeitgeber Theory and the treatment that proceeds logically from it, a process of establishing regular daily rhythms that set our interior clocks and keep them running on time. (Zeitgeber means timekeeper.)

Part III explained how work on interpersonal issues helps people reduce stressors and prevent disruptions to their social rhythms.

This last post will pull together my appreciation, my reservations and my hopes for future directions.

Social Zeitgeber Theory


How Does Interpersonal Therapy Help People with Bipolar Disorder?

Ellen Frank - Treating Bipolar Disorder, Part 3

Lately I have been reposting my 2011 review of Treating Bipolar Disorder by Ellen Frank. It was originally recommended to me by a friend who was researching hypomania. Part I described the basis of Interpersonal Social Rhythms Therapy (IPSRT) in circadian rhythms that control the many physiological symptoms of mood disorders. Part II outlined the Social Zeitgeber Theory and described the early stages of the therapy process, history taking and stabilizing social rhythms. Today I pick up with the later stages, interpersonal therapy and maintenance.


Interpersonal Social Rhythms Therapy came to Ellen Frank in an epiphany on her birthday, July 14, 1990. Personally, I like that. I especially like that it was the day that she participated in a conference for people with bipolar, and listened to them.

Frank and her colleagues were already using interpersonal therapy for people with recurrent unipolar depression. Their theory was that certain life events, particularly losses could result in lost social zeitgebers, (timekeepers), with subsequent disruption of circadian rhythms, leading to eventual relapse into another episode of depression.

IPSRT took up from there as an adaptation specifically for people with bipolar disorder, integrating the work on issues (as in, you've got issues) with greater focus on behavioral changes to achieve and maintain daily rhythms, time of rising, time of first human contact, work, main meal, etc. The purpose of IPSRT is to help people achieve stability and then to avoid relapses into either depression or mania/hypomania.

Why Do People Relapse?

How the Social Zeitgeber Theory Works, for Good or Ill - IPSRT

This -- this system is the gift I wish I could give to the people I meet on Twitter who struggle with their bipolar, who are in endless rounds of medication adjustments and medication failures and medication despair. Medication isn't the only thing you can do. I'm not saying quit your meds. I'm saying, add social rhythms therapy. Originally posted in 2011:

Ellen Frank - Treating Bipolar Disorder, Part 2

So you have bipolar. You know you have bipolar. You are way past the denial stage. You are into the pulling out your hair, screaming with frustration stage. Or maybe moved on to despair stage. Because:


  1. The medication sucks.
  2. You keep getting sick again anyway.

But contrary to what everybody has been telling you, medication is not the only thing that works. It may be essential to your recovery and continued functioning. But you can do better if you do more. From my last post:

IPSRT [Interpersonal Social Rhythms Therapy] is one of three psychotherapies tested by the National Institute on Mental Health in its recent major study of best practices for treatment of bipolar disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder, STEP-BD discovered that Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy.

Do I have your attention? Today we continue with Ellen Frank's Treating Bipolar Disorderin which she describes this therapy of her invention.

What Happens In IPSRT

Do Your Meds Work? There's More You Can Do to Treat Bipolar

Ellen Frank: Treating Bipolar Disorder - A Review

Ellen Frank changed my life. When I was diagnosed on the bipolar spectrum, and hadn't found a medication regime that I could tolerate, her Interpersonal and Social Rhythms Therapy gave me a way to get a handle on my wildly fluctuating condition.

She and I corresponded in 2011, as I was writing a four-part review of her book and her therapy. I published with her assurance that I got it right.

I was over the moon when she agreed to endorse Prozac Monologues: A Voice from the Edge. She wrote:

Brilliantly written, engaging from the first page, Prozac Monologues is a bit like a great evening at a first-rate comedy club…except that it is deadly serious.  Goodfellow’s painful and all too common journey to finding the right treatment for her bipolar disorder points her to the ultimate realization that doing well with this illness requires the right medication, the right psychotherapy, and the specific lifestyle modifications that support wellness.

Ellen Frank, Ph.D.Distinguished Professor Emeritus of Psychiatry, 

University of Pittsburg School of Medicine

Pretty cool, huh! She even wrote privately to her listserv to recommend it.

So many people I read on Twitter struggle to manage their bipolar disorder. I figure it's time to bring this four part series out again. So here is Part 1 - from April 4, 2011.

Medication And Mental Illness


Medication for mental illness is just like medication for anything else. It works better when you don't ask it to do all the work itself.

In the case of bipolar, once lithium and the chemical imbalance theory came along, the thinking was that medication was the only thing that worked. Therapy by itself certainly didn't. I wonder if therapists, worn out by their bipolar patients, were simply relieved to believe that medication was the only thing that worked. I wonder if therapists today, worn out by their recurrent depression patients, are secretly relieved to terminate when the diagnosis changes to bipolar, because medication is the only thing that works.

Frankly, there is a lot of wishful thinking out there in pharmacotherapy land. If only our brains were a chemical stew and the illnesses of the brain could be treated by adjusting the recipe. If only.

But people with mental illness, especially people with bipolar, can't afford the wishful thinking behind the better living through chemistry fantasy. Sometimes the medications do work. But not as well nor as often as your doctor would like to think.

I have a friend who is a psychiatrist. He challenges his colleagues who keep trying to solve this noncompliance issue, to get their patients to comply. He reminds them, if the medication (antidepressants, in this example) worked for 40% of those who took it in the trial, and the placebo worked for 30%, that means only one out of ten people benefit from the medication itself. So what's the big deal about nine who quit?

He says they just look at him funny.

Treating Bipolar Disorder by Ellen Frank


This same friend, God bless him, loaned me a book about a psychotherapy designed specifically for bipolar disorder titled, appropriately enough, Treating Bipolar Disorder. The author Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic, and her colleagues invented Interpersonal Social Rhythms Therapy (IPSRT), a kind of mash-up between talk therapy and regulating circadian rhythms.  It gets my next few posts.

In A Nutshell... 


IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.

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.

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.

Gratitude - The Prozac Monologues Publication Edition

Fifteen years! From the hypomanic first draft of Prozac Monologues on a yellow legal notepad to a published book, and the nail file that inspired it all.

The book was officially released into the wild this week and will be celebrated in two launches, one sponsored by Paulina Springs Books in Sisters, OR, and the other sponsored by Prairie Lights in Iowa City, IA.

It's a good time to talk about gratitude. Forgive my self-indulgence. It is a day to reflect.

First, people have asked whether it was hard to write about such dark times in my life, if it retriggered some of those emotions. Occasionally, it did. Occasionally I would have a sleepless night remembering, in particular, difficult encounters in treatment. One can forgive sincerely. One can forgive over and over. Still, the brain remembers. I don't harbor resentments, but I can't always hop off the time travel machine that is my brain, how it repeats the tracks laid down by past traumas.

Is It Time to Call a Therapist?

There is a difference between feeling depressed and having depression, which makes it hard to figure out what we need right now when - doesn't everybody feel like crap?

What you are feeling right now might be the entirely normal reaction to this currently abnormal world. Here is what's happening: everybody is experiencing trauma at the same time. Exhaustion, trouble concentrating, insomnia, hopelessness, these are common physical, emotional, and cognitive reactions to trauma. They are also symptoms of a depressive episode. And depression, the illness of depression can lead to serious complications, substance abuse, relationship problems, suicide. Not to mention that it simply sucks the joy out of living. Depression, the illness needs to be treated.
So do you need to see a doctor? It depends. A recent New York Times article can help you sort it out.

What People with Depression Need to Hear

Depression is one tough condition. Contrary to those cheery ads on tv and friends who want you to get over it, it is not easy to recover. Doctors also, in their eagerness to get you to do something that will help, sometimes oversell their solutions.

Chris Aiken's recent article in Psychiatric Times presents a more helpful picture.

Five Things to Say to People with Depression

You can expect, and do deserve, a full recovery. Aiken's point is that people with depression have a hard time believing we will ever feel any differently. (This is true. Boy, is this true.) Nevertheless, chances are, we will feel better. There is a rub here however. Most people get to full recovery, not all. As a patient, I'd like to hear up front that even if it comes back, chances are that things will get better again. So many of us feel like failures when depression recurs, when actually both remission and recurrence are part of the natural course of the illness.

Misconceptions about Antidepressants

What do you think are the most common misconceptions about antidepressants?


Prozac Monologues: A Voice from the Edge is at the press kit stage with Q&A in development. My publicist wants me to answer questions that interviewers might ask. My responses should be in the three to seven sentence range, she says.

Three to seven sentences are not my forte. I am doing my best and taking comfort that in an interview format, there might be a follow-up when I can say more.

They are good questions and worth a blog series, I think, where I can expand to three to seven paragraphs. Mostly seven. Maybe more. Plus, you know, pictures. So that's what you get for a few weeks.

No, antidepressants are not happy pills

The End of Miracles - A Review

What is it like to have depression with psychotic features?

What is a day like inside a psych ward?

What is the psychiatrist thinking?

Sometimes the best way to explore questions like these is in a story. So here is Prozac Monologues' first review of a novel.

Monica Starkman is a psychiatrist at the University of Michigan whose expertise includes psychosomatic disorders, stress, and women's issues around fertility, miscarriage, and obstetrics. In her debut novel, The End of Miracles, she turns her clinical experience to the story of one woman, Margo Kerber, a long-infertile woman who finally conceives, tragically miscarries, and then... unravels.

Mental Health Care as our Institutions Fail

There are twelve psychiatrists in Zimbabwe for a population of 16 million people. When Dixon Chibanda, one of the twelve lost a patient to suicide because she could not afford the $15 bus fare to get to her appointment, he did not blame her for breaking the appointment. He came up with another system to deliver mental health care. He trained grandmothers.



Six Ways to Heal the Holes in Your Head


Do you ever feel like you have holes in your head? Actually, you do. Ventricles are the spaces between the grey matter (brain cells) and white matter (wiring that connects the brain cells) in your brain. Depressive episodes, manic episodes, and psychosis all burn up brain tissue, leading to bigger ventricles. (Image: Effects of Western diet on the brain. See companion image, Effects of Mediterranean diet below.)

This loss of brain cells hits the hippocampus (in charge of memory and emotion regulation) particularly hard. In the early years after my last mental health crisis, I talked about my “Swiss cheese brain.” At my worst, I lost bills, I lost words, I lost everything my wife said to me on the way out the door in the morning. She took to writing down what I said I would do before she got home, never more than two items.

I lost the list.

New Year's Resolution - Eat Chocolate! Or Maybe Not...

Long time readers may know of my over-a-decade-long effort to get the sugar monkey off my back. I can report that I am reasonably  successful. I don't know if it has made an ongoing difference to my mood. But a shared dessert at a restaurant will get my arthritic shoulder burning. So I keep it up.

Or maybe I have taken it too far. It's all about costs and benefits, you know. And recent research suggests maybe I should lighten up, or rather, darken up.

Chris Aiken of Bipolar Not So Much fame, also Wake Forest University School of Medicine and The Carlat Psychiatry Report, says to my sugar fast, Not so fast. At least as far as dark chocolate goes.

Holiday Shopping for Your Diagnosed Someone

Black Friday, the traditional start of the Christmas, Hanukkah and Kwanzaa shopping season has left us in the dust. Are you still wondering what to get for your neuro-diverse friend or relation? Here is Prozac Monologues' attempt ever to be helpful to my dear readers.  As my therapist said, Virgo -- your destiny is service.  Get used to it.  (I once had a therapist who said stuff like that.) The following is a holiday shopping list to guide neuro-typicals who want to please their loved ones.

This is a repost from ten years ago. So the pricetags have probably changed. But the links have been checked.

Crazy Meds can be your one stop shopping for Straight Jacket T-shirts, when you're crazy enough to let your medication do the talking, with a range of messages for any diagnosis, medication or level of in your face. The lettering is made by arranging real medication capsules for that homemade, from the heart touch. If you are shopping for me, medium size, long-sleeved, and black, of course.  My favorite message: Bat Shit Crazy.  In three years nobody ever took the hint, so I finally bought it myself.  If you are shopping for me, today I'll go with Mentally Interesting.  I'm still into black, and still refusing antipsychotics, so still a medium.

The following gift suggestions are targeted to differential diagnoses.

Giving Thanks for Ellen Frank

If you can manage one, just one self-care exercise for bipolar, make it a regular sleep schedule. This week I am thankful I found Ellen Frank and IPSRT, Interpersonal Social Rhythms Therapy.

IPSRT in a nutshell: people with bipolar have a wonky internal clock. The hormones that regulate everything from when we are alert to when we are hungry to when we are cold are governed by an internal clock. When that clock sproings a spring, so do we. Bipolar is like jet lag on a daily basis.

There are a number of events that set and reset the clock throughout the day. If you have a wonky clock, you can reduce the damage it does by making sure these events happen the same time every day. That is the Social Rhythms part. The Interpersonal part is plain old therapy, focussing on whatever issues prevent you from protecting your clock.

Keeping this clock set correctly is the single most effective strategy for maintaining good sleep patterns. And sleep patterns are almost the whole show. Disruptions cause cascading effects: increased inflammation, cognitive difficulties, irritability, emotional lability, depression, hypomania, mania, all three, weight gain... Somebody has probably written the book. I will write the testimonial, that when my sleep is in order, so am I. Ellen Frank focussed my attention on that #1 strategy. When the meds didn't work, she saved my butt.

Several years ago, I wrote the more detailed version of IPSRT in a review of Frank's Treating Bipolar Disorder, three posts to explain the theory and one summary review. So here it is reposted, with links to the earlier posts within it. 

Treating Bipolar Disorder Part IV -- Summing Up
May 4, 2011

Intending to review Ellen Frank's Treating Bipolar Disorder,  I spent most of April describing the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.

Part I laid the foundation in work done on the relationship between circadian rhythms (our interior physiological clocks) and mood disorders.

Part II outlined Frank's Social Zeitgeber Theory and the treatment that proceeds logically from it, a process of establishing regular daily rhythms that set our interior clocks and keep them running on time.  (Zeitgeber means timekeeper.)

Part III explained how work on interpersonal issues helps people reduce stressors and prevent disruptions to their social rhythms.

This last post will pull together my appreciation, my reservations and my hopes for future directions.

Social Zeitgeber Theory

Frank builds IPSRT on the theory that people with bipolar are more vulnerable than others to disruptions in our circadian rhythms.  When our interior clocks get screwed up, we do, too.  Daily events, like getting up at a certain time, seeing people, going to work, set our circadian rhythms.  The core of the therapy is to help keep our rhythms regular.

The best brilliant part of Treating Bipolar Disorder is this theory.

A good theory accounts for as much of the data as possible, and then provides a way to solve problems.

The old theory is bipolar is a chemical imbalance in the brain.  The advantages of the old theory is that it is simple, it suggests a way to solve the problem, and it is earning the pharmaceutical companies billions and billions of dollars.  The disadvantages are that decades after it was first offered, it has offered false hope and subsequent despair to millions of sufferers, focused blame on those who won't take the drugs that make them sick and/or don't work, and for a majority of people who receive the best pharmacotherapy possible, simply failed to fix the problem.  It also neglects a lot of data.

The chemical imbalance theory comes from the data of clinical experiments -- that symptoms go away when you change the chemical stew.  Or at least, they go away enough to get FDA approval for marketing claims.  It does explain a piece of the puzzle.

But another set of data has to do with what was going on before the symptoms developed.  Frank and company turn to circadian rhythms to account for how the chemical imbalance developed.  And here there is a wealth of data.  For example, study of circadian rhythms reveals that lack of sleep causes depression as often as it is caused by depression.  This suggests a whole other way to solve problems.

Treating Bipolar Disorder documents this evidence in support of the theory.  Most of the book then describes the therapy that derives from the theory.

People With Bipolar Who Are Doing Well

The Social Zeitgeber Theory accounts for the data of those with bipolar disorder who are managing their symptoms, working, thriving over the long haul.  There are almost no studies done from this angle -- what people are doing to stay well.  John McManamy reports on two of these studies at mcmanweb.com.  Healthy lifestyle is the top strategy for these people, particularly maintaining good sleep.  Most, 85% take medication, but do not make medication the center of their self-care.  None rely entirely on medication to stay healthy.

Medication, Medication, Medication

My chief reservation about the book has to do with its assumptions about medication.

Let me put it this way.  It is a bold move to list the uses of specific medications in a hard copy printed published book.  Chances are that such a book will report positively on a medication for which the manufacturer then settles a class action suit in the same year as publication.  Zyprexa/olazapine is just one example of how quickly the chapter's information became debatable and/or dated.

Frank assumes that IPSRT is an add-on to pharmacotherapy.  She notes that lithium, the miracle drug that was supposed to have solved the problem of bipolar has turned out not to have done so in near as many cases as people think.  She acknowledges that there are problems with side effects and efficacy for anything that is currently in use.  But just barely.

Unfortunately, it is only a minority of patients with bipolar disorder who can comfortably take the medications that seem to control the symptoms of the illness and who are willing to submit to this control.  Especially early in the course of the illness, before it has wrought complete havoc in the patient's life, there is denial that there is anything permanently wrong and a longing for the highs that the medications take away.

Yup.  There it is.  Ellen Frank, too.  They miss their highs.  I won't go there right now.  It's just too tiresome.  But stay tuned...

Frank continues the clinicians' tradition of oversell.  She considers whether a clinician should refuse to work with a person who has bipolar I and does not take medication.  Her recommendation is that the work might proceed anyway, with the goal of revisiting the issue at every opportunity until the patient finally does take meds,and holding open the possibility that treatment may be terminated if the clinician concludes that he/she cannot accept responsibility for somebody who is not on meds.

Okay, on a positive note, Frank pays more attention to side effects than other clinicians, repeatedly urging that the therapist and prescribing clinician work in partnership, and that medication problems be addressed.

On a very positive note, Frank spends a lot of ink on the issue that people with bipolar I or II spend way more time depressed than manic and hypomanic.  And our depressions are far and away the part of the illness that disables us.

Can We Ever Crack This Medication Nut?

This medication debate never seems to get anywhere.  Like abortion or the Palestinian issue in US politics, nuance is not allowed.  You're either pro-med or anti-psychiatry.  And I can feel myself drawn into the blogosphere's quicksand.  So let me do the down and dirty on Frank's position and get out of here.

Frank's assumption that everybody who has bipolar I and not on meds is a trainwreck waiting to happen -- maybe that is a necessary evil to maintain her professional credibility; maybe more of the usual professional wishful thinking: I call it disappointing.


Frank's repetition of the old they miss their highs thing: I call it tiresome.



Frank's concern to take side effects seriously and her criticism of the standard practice of medicating people with bipolar into a permanent state of mild depression, treating anything approaching a normal feel-good state as a danger sign of impending mania: I call that refreshing. 

Clinical Language Alert

I have spent the last several years reading books and articles written not for me, but about me.  It is a perilous business.  Prozac Monologue readers occasionally are on the receiving end of my efforts to manage the consequences of this endeavor.  It is getting less perilous, as I learn some skills, the first of which is simply to acknowledge the intended audience.  So...

Treating Bipolar Disorder is written for clinicians and about people with bipolar.  I am not a clinician; I am a person with bipolar.  Therefore, Treating Bipolar Disorder is not for me; it is about me.

If you are like me, you need to take this into account when reading this book.

Having said that, this book is less perilous than others.

Yes, there are a couple bumps in the road: the bipolar temperament, the attitude of entitlement and they miss their highs.  For the record, Frank never uses those exact words.  Her exact words are above.

On the other hand, this book is exceptional in its tone of respect and genuine partnership between clinician and patient.  Absolutely exceptional.  Props to Ellen Frank.

The Future Of IPSRT

Like I said, this book was written for clinicians, who are addressed directly.  It was not written for people who have bipolar disorder, nor for a general audience.  There is no book, no pamphlet, no article, no website, no youtube that describes IPSRT for a general audience.  Prozac Monologues is as close as you get.  Not enough for a do-it-yourself-er.  But a start.

At this point, getting access to this therapy would be a trick.  If you use one of those Find a Therapist websites and actually do find one in your area whose interests include bipolar, you are still likely to get the response I got, The way to treat bipolar is with medication.

Frank and company keep track of those they have trained.  She says maybe she should develop a website.  A lot of people think maybe they should develop a website.  Most of them have many other things to do.  I wouldn't hold my breath.  I would write her directly and ask.  And then come up with a do-it-yourself strategy.  I have one outlined below.

Frank has the support of NIMH's STEP-BD study giving IPSRT the magic label of evidence-based.  So she has a therapy, a book, a training.  And 5,700,000 people who could benefit from this treatment.  She needs to develop the market for her training the same way pharmaceutical companies develop their markets -- go directly to us 5,700,000 people with bipolar.

There's a whole world of people out here who get our mental health care from Facebook friends and [Name Your Diagnosis and/or Treatment] for Dummies.  We need an IPSRT for Dummies.  We need a workbook.  Once we get started, we'll ask for help, and our care providers might get interested.

Here is my story: The meds don't work.  I have been stalled in Cognitive Therapy for some co-morbid trauma issues.  I don't have the capacity to interview a bunch of therapists who might deal with my bipolar, even if I could find them.  I lose my voice when I talk with therapists -- back to those trauma issues.  So I went back to my CBT therapist.  We are renegotiating to do more interpersonal work and I am experimenting on my own SRT/Mood Chart.  I will do the SRT part on my own.  My therapist and I can talk about my grief for the formerly healthy self.

You have to really have it together to do therapy this way.  I am not starting from a position of crisis.  I have good insurance and a lot of resources.  My wife tells me, if I have lost half of my cognitive functioning, that still makes me smarter than 80% of the people in the room.

So this might work for me and maybe another 100,000 high functioners out there.  5,600,000 more to go.

On July 14, 1990 Ellen Frank knew with absolute certainty that [she] needed to dedicate the next decade of [her] life to doing better by these patients and family members.  It was a decade well spent.  And then another.  I hope she keeps going into the third.

Last Words

If you are a person living with bipolar disorder, cut the author a break for the inevitable mental health provider mentality.  The medication issue is a minor, minor piece of an otherwise helpful, hopeful book.

Treating Bipolar Disorder offers hope.  Read it.  Talk to your therapist about it.  Get yourself a schedule that includes enough sleep at a regular time each day.  Talk with your therapist about whatever keeps you from doing that.

If you are a therapist, read this book.  Give its techniques a try.  If they help somebody, don't you need some CEU's?

If you are a doctor, read this book.  Stop promising more from meds than meds can deliver.  There is more help out there for your patients.  Help us find it.

If you are Ellen Frank, get this stuff out to those of us who can't find or afford a therapist whom you have trained.  And God bless you.

photo of clockworks by HNH and used under the Creative CommonsAttribution-Share Alike 3.0 Unported license
flair from facebook
caution sign by RTCNCA and used under the GNU Free Documentation License,

Giving Thanks for John Moe

Is depression funny?

John Moe begins every broadcast of The Hilarious World of Depression with that question. Then he and the comedian/musician/celebrity of the week talk.


My therapist told me about Hilarious World. I was preparing to do a seminar, OK2Talk about Mental Illness, eight hours total, five segments.  The third would be on humor. It is, after all, part of the Prozac Monologues brand.

Describing Negative Emotions and Depression


Negative emotion differentiation (NED) refers to the ability to identify and label discrete negative emotions.

Are you the mom who says to your tantruming toddler, Use your words? That's good parenting in so many ways. Well actually, I found it quicker to turn the critter over and hold him up by his ankles, so he could ponder his universe from a different perspective. You could call that reframing. But that technique is more difficult to execute on a teenager.

Here is the latest reason why Use your words is good for your kid: the folk who get paid to come up with new things to research have discovered a relationship between teenagers and words. The more words they have to describe precisely their negative emotions, the less risk they have to develop depression in the face of high stress. And conversely:

Results suggest that low NED is primarily depressogenic in the context of high stress exposure.

That's from "The perils of murky emotions: Emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression,"  by Star, Hershenberg, Shaw, Li, and Santee.

That's what I'm here for. I find cool stuff in the scientific research world and translate it into English for you, dear reader. The more words you have for negative emotions = the less depression you get when stressed.

I'm all over this. I use words like my sister uses broken bits of tile, to turn loss into beauty. There's a bit of Mama's good china that hit the floor in this photo of the tabletop coming together in my sister's workshop:


So one of the things that pleases me about this research study is that I have discovered a new word, depressogenic: causing or tending to cause depression.

Google doesn't recognize euthymigenic. I made it up: creating or sustaining a normal, tranquil mental state or mood. In a sentence: Turning the broken bits of our lives, turning our losses into beauty is euthymigenic. My sister does this with tile. I do it with words. 

Here's an excerpt from Prozac Monologues: What If It's More Than Depression?

The DSM has its checklists. People with depression have poetry. 

People with diabetes discuss about their diet, their feet, their retinas. They check glucose levels. Put two diabetics at a table, they compare numbers.

People with depression talk in metaphor. We talk about the cloud, the curtain, the weight, the darkness. When it goes away, we say, “It lifted!” That lift is a physical sensation, actually, of lightness or elevation...

If I could just find the right words, maybe I could break the spell...

See, I always knew that increasing my vocabulary would help me. Turns out increasing my kid's will help him, too.

cartoon from memedroid.com
photos from the Pato Loco, Coco, Costa Rica by the author

Making Music to Build Your Brain

Manic episodes burn up brain cells. So do depressive episodes. So do panic attacks. Cortisol run amuck leaves you with potholes in your head. Not to worry -- the brain has a built-in repair system, Brain Derived Neurotrophic Factor, BDNF.

They've been trying forever to reverse engineer antidepressants. If they can figure out how they work, they figure they will know what causes depression in the first place. At first they thought it was low serotonin levels, the proverbial "chemical imbalance." A more recent thought is that a low serotonin level is not the cause, after all; it's the effect. Fix the problem farther upstream by stimulating BDNF to repair the brain damage, and the serotonin level sorts itself out.

But the natural thing that gets this hormone humming to patch your potholes is learning! There's this big deal about seniors doing Sudoku to ward off dementia. But it only works until you get good at it. You have to keep doing new stuff that you don't already know how to do.

And what better than learning to play a musical instrument? You have no talent? You tried it as a kid and you were lousy? Hear me out. If you were good at it, it wouldn't build your brain. Seriously, it's like exercise. If you don't feel the struggle, you're not building the muscle. Making music turns out to be a full body/brain workout.


So go get yourself a ukelele! Your brain will be glad you did.
photo of pothole in public doman
photo of road repair taken by US Air Force and in public domain

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