Showing posts with label thanks. Show all posts
Showing posts with label thanks. Show all posts

Ritual, Stress, and Surviving a Pandemic Thanksgiving

Human beings are pattern-seeking creatures. Place us in an absurd situation, we feel stress. We respond by ritual behavior, or clinging to biases, or even inventing an explanation. Does this sound like anything happening around you for the last several months?

Some of these responses serve us better than others. Biases preserve energy by saving us the time it takes to make case by case evaluations. But they also can be mistaken and rob us of original insights.

Invented explanations are how we manage the terror of acknowledging any bad thing that is out of our understanding or control. Why did Daddy hit me--again? Who is to blame for all these fires lately? How could my candidate have lost? We tell ourselves a story that makes sense of the event, relieving the pain of uncertainty, and thus gaining control over our emotions.

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.

Prozac Monologues - A Book is Coming


The life of an author - this author anyway:

Mornings I work on finding my peeps. Twitter has been a revelation to me. I resisted it for years until I discovered what was possible. It's not all politicians and celebrities! I thought I was supposed to do Twitter because that's what you do when you want to sell books. That made me feel icky.

But then somebody reframed it for me:

There are people out there who have a question, a need, a pain point. Can I address their pain point? If so, how do they find me?

Giving thanks for Jerod Poore

Jerod Poore is the walking, talking, tweeting, posting wikipedia of all meds psychiatric and neurological. His manifesto: At Crazymeds [his original website] we make psychiatric and neurological conditions (AKA brain cooties) our bitches with evidence-based medicine and a healthy dose of gallows humor.

When I caught brain cooties fourteen years ago, Jerod was the first person I found who gave me genuine information. When the docs turned my brain into a chemistry experiment, Jerod told me what was happening to it.


That's the sketch I drew of my brain on drugs. Not the drugs they warn you about, but the drugs they scold you for refusing to take. Prozac, Celexa, Remeron, Cymbalta, Effexor.

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.

Giving Thanks for John McManamy

John McManamy was my introduction to the concept of expert patient, a mental illness educator with lived experience and serious chops, research-wise.

Our relationship began not long after Prozac Monologues, the blog began in 2009, with a skunk. How on earth did I find his tale of too-close-but-thankfully-not-the-worst-sort-of-too-close encounter with a skunk? Probably I googled amygdala. That tells who John is right there. You want to know about amygdala? John will tell you a story about a skunk.

Spiritual Practices for the Dark Night - Giving Thanks. Again.

This post transitions from a month dedicated to PsychiatricTimes.com  to a month dedicated to gratitude. In short, I am grateful for Psychiatric Times. When I needed to figure out what the hell happened to my brain and how do I fix it, this online magazine for psychiatrists and other mental health professionals began my slow, steady self-education with its research reports, book reviews, philosophical discussions and occasional rants.

Mmm, sort of like Prozac Monologues: information, provocation, entertainment, and an occasional rant. That's how Google describes this blog. What do you think?

In the month of November, I will write posts about other resources and people for whom I am grateful. Today I repeat a post from ten years ago, part of a series on Spiritual Practices for the Dark Night. Those were dark nights, indeed, for me. These days, I think they are dark nights for everybody. But I digress...

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?

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.

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

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.

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.


On The Road Again -- NAMIWalks 2011


It's that time of year again.  Across the country people with mental illness, our friends, family, care providers, even law enforcement officials are pulling on our walking shoes to raise money for NAMI -- National Alliance on Mental Illness.  Last year soldiers in Iraq pulled on their hiking boots and their 40 lb. packs and ran while NAMI San Diego walked.

So what is this all about?  Here, my friends, is my testimony.

A couple years ago, I wrote a post on holiday gift giving for your favorite normal.  I asked my spouse, What would be a good present for the family member of somebody with a mental illness?

She didn't even look up from her computer.  Without missing a beat, she said, A cure.

A cure.  I know that mental illness is a family illness.  The whole family lives with it.  But her words caught me.  What she wanted was for both of us, a cure.

It's something she can't give me.  I can't give her.  My doctor can't.  You can't give it to the person you love.

We can, however, learn to manage symptoms.  We can claim the very best lives we can live.  We can live in recovery. 

Peer To Peer Program

I learned about recovery from NAMI, from their Peer to Peer program.  P2P is a ten-week course taught by people with a mental illness for people with mental illness about what we do after the doctor hands us a diagnosis and a prescription.

P2P teaches us how to live.  It is why I bust my butt for this walk.  It's not a cure.  But it's a lot.

That first class, I heard that I am not alone.  The very first note I took said, More unites us (our experiences) than divides us (our diagnoses.)

Next P2P showed me the immense dignity of those who live with mental illness.  It made me proud to know and be known by and be in community with others who live with mental illness.

It supplied tools like dialectical thinking, mindfulness, relapse prevention planning, techniques for emotional regulation and getting a good night's sleep, strategies for staying safe and coping with hospitalization.

P2P gave me something to do when medication didn't give me a cure.

And it opened for me a path into my future.  It reminded me that I am an advocate.  That is who I am.  I still have an identity, after all

So I bust my butt for this walk.  It is how I give back.

NAMI Walks

Now, the first time I did a NAMI walk, to tell the truth, I was scared.  Would it be grim?  A protest and a wailing against what is not possible, what we have lost and what we have to face?

If you have walked for NAMI, you are laughing here.  You know a NAMI Walk is so -- not grim.  It's a party!  With balloons and babies and dogs, music, belly dancers, football players, great food.  In Johnson County, Iowa, the Old Capitol City Roller Girls lead off the walk.  In San Diego, you are likely to hear a didgeridoo.

Bottom line, a NAMI walk is a gift.  It's a public demonstration to our families, friends, politicians, our neighbors, coworkers, the people in our places of worship, the viewing public -- a public demonstration that we are here for each other.  We take a break from all that wailing.  And throw a whale of a party.

At the same time, we raise funds for the programs that help us help ourselves and one another, the things that nobody else will pay for, for people who have fallen off the bottom of the budget.  NAMI does the stuff that makes a difference the day after the doctor hands us a diagnosis and a prescription.

Team Prozac Monologues debuted last year, with results that were not too shabby.  We raised $2640.  Mazie's sponsors contributed $250 toward that total.  Helen is walking in her stead this year.  Sponsors can contribute in Mazie's memory here.

Why I Walk

Me, I am walking for everybody who used to be on a three month wait list for an intake interiew at the local community mental health center; but this year that became a six month wait list at the center the next county over.  I am walking for everybody who used to  be on a four year wait list for sheltered housing; but this year the shelter shut down.

I am walking for those who are not crazy enough to pull out a gun and get the sheriff to buy their meds; they're just crazy enough to sleep in the alley behind the homeless shelter after they have stayed their ninety-day limit.

I am walking for family members who go to work wondering what is happening at home with their loved ones, now that the day program is closed.

I am walking for the resident on call in the ER who has to send home the merely suicidal, while the flaming psychotic waits for 36 hours in the hallway for the next available bed.  And for the newly diagnosed and dazed person who just got released with not enough meds to make it through the weekend, to make room for the flaming psychotic.

I am walking for the young people I know whose brains are even now being damaged in a war that we got into for oil.

I am walking in gratitude for law enforcement personnel who are trying to figure out how to do this new job, and need new training, to take care of those who have been discarded so that the very richest people in the world can get a tax cut.  I am walking in prayer for those who get caught up in somebody's suicide by cop.

This would be the place to note that the co-chairs of Johnson County's NAMI Walk this year are Janet Lyness, County Attorney, and Lonnie Pulkrabek, County Sheriff.  Props to them and to the competition between their two teams!

I did say that the Walk would be a party.  So even while I am angry that so much suffering comes not from the illness, but from the neglect, I will nevertheless celebrate those who do what they can do.  (That sentence would be an example of dialectical thinking, by the way -- see above, the curriculum of Peer to Peer.)

I am walking in wonder and amazement at the strength of the human spirit.  I am walking in deep appreciation for those who have helped me personally, for peer teachers, support group members, care providers, friends and family.

I will be walking with tears in my eyes, that my son and daughter-in-law will travel from Madison to Iowa City to walk beside me.

I am walking on April 30, 2011 in Iowa City, Iowa for all these reasons.  And I am walking also for you, dear reader.  I ask you to support me in this walk.  Click here to make your tax deductible, safe and quick contribution to NAMIWalks Johnson County. 

Closing Shot

There are many versions of this song on Youtube.  I chose this one, despite the credits that run over it, because the ragged bunch of friends who sing it, some not sure of the words, illustrate the point.  We are a ragged bunch.  And pretty wonderful because of it.



The Scream by Edvard Munch in public domain
photo of Team Prozac Monologues by Judy Brickhaus
photo of homeless vet by Matthew Woitunski and used under the Creative Commons licencse
photo of New York City police officer by See-ming Lee, copyrighted and used by permission

NAMI Walks -- We All Win



This is my second year for the NAMI Walk Johnson County, Iowa.  It's how people across the United States raise money for the National Alliance on Mental Illness, an organization whose mission is support, education and advocacy with and on behalf of people with mental illness and their families.

National Alliance On Mental Illness

I became passionate about NAMI when I learned about its origins.  Once upon a time, not so long ago, the holy writ on schizophrenia was that it was caused by overprotective mothers and disinterested fathers.  Wow.  In 1979, a bunch of these mothers started to push back.  They organized and demanded better research, better treatments, better treatment.  Would there ever be any progress in the world if it weren't for uppity women?  A new documentary, When Medicine Got It Wrong tells the story, coming soon to a PBS station near you.

NAMI has grown into a national program, built on local chapters.  It fights stigma.  It advocates for funding of services, research and rights.  It provides information about mental illnesses and medications.  It offers a variety of educational programs and services.

Peer To Peer

Prozac Monologue followers read with some regularity what I have learned from NAMI's Peer to Peer program.  In Peer to Peer, those who have a mental illness and are in recovery help others learn about recovery, living to the fullest while managing a mental illness.  I drove (my wife drove -- my meds won't let me drive anymore) 120 miles round trip every week for nine Iowa winter nights so that I could attend this program.  It was worth every mile.

Make A Difference

So here's the deal.  Every year NAMI raises money through local Walks.  My local chapter will walk on May 8th, rain or shine.  Last year was my maiden voyage into NAMIWalks.  I went with some trepidation, wondering just how bleak and weird a walk for mental illness could be.  Instead, I discovered a registration process that reminded me of summer camp, belly dancers leading the warm up, pep talks from the Hawkeye football team, a balloon arch, kids, dogs, food, t-shirts and more t-shirts, displays that kept falling over in the breeze, and chalk drawings along the trail made by the Girl Scouts.  It was a party!

I did not do a shabby job raising funds my first time out.  I knew I would do well, because I know my friends.  This year I decided to co-chair a team called, wouldn't you know, Team Prozac Monologues!  And right there, on the name, is where you can go to support my team.  Giving online is safe, easy, fast and tax deductible.

Team Prozac Monologues is about halfway to our goal so far.  Any amount you can give is important.

And as Hoops and Yoyo say,

The Miracle of Gheel -- Humane Treatment for Mental Illness

It was seventh century Ireland.  The Queen died.  King Damon's grief was so deep that it moved into depression and then psychosis.  He thought his daughter Dymphna was his queen.  Rather than submit to his advances, Dymphna fled to Belgium, to the town of Gheel.  But her father followed.  When she again rebuffed him, he killed her, cut off her head.  Dymphna was buried in the local church.

Six centuries later, her coffin was found during renovations.  Signs on the coffin demonstrated her holiness.  She began to be venerated.  Cures of the sick were attributed to her.  She was canonized in 1247 as the patron saint of the mentally ill.

Okay, here the one last bit of unrecovered Catholic in me demands to be heard, to note Rome's fascination with girls who prefer death to rape.  Even as a nine year old, that made me uncomfortable.

Moving on.  People came to Gheel for healing.  Many brought family members who were mentally ill.  Sometimes they left them there.  The priest housed these abandoned ones next to the church.  When the job of caring for them became too much for him, townspeople started bringing in food.  They built a hospital in the 14th century.  When it was full, the real miracle of St. Dymphna occurred, or rather, began.  Townspeople took some of the patients into their own homes, reserving the hospital only for those most ill.

All across Europe, people with mental illness were thought to be possessed.  They were exorcised, tortured and burned at the stake.  But not in Gheel.

Imagine it!  A psychotic foreigner commits a terrible deed.  But the townspeople do not close the borders.  No, they open their homes.

And they still do.  Through plagues, wars, revolutions, recessions, depressions, during the Napoleonic "Reform," when all the mentally ill people in the country were ordered into one big hospital, during the Nazi occupation, with their "final solution" for mental illness, during the latest reform when the U.S. of A. was/is dumping all our mentally ill people out of the hospitals, onto our streets and into our jails, the people of Gheel developed and continue genuine community-based mental health care.

Today, there are 700 foster homes for 1000 people with mental illness.  A person will enter the hospital for evaluation and stabilization.  S/he meets the psychiatrist, psychologist, nurse, social worker and family practitioner who staff one of the five neighborhood community mental health centers.  Each of these staff people spends half a day each week in the hospital, so everybody gets to know everybody.  The potential foster family and patient meet at the hospital, then over tea at home, then over a meal, then over a weekend before placement.  Outpatient care, medication monitoring and therapy continue at the neighborhood center.  If possible, the biological family participates in the treatment plan.

Once part of the family, the person shares in family activities, chores and church.  The church doesn't have special bible studies, services or programs for the mentally ill.  They are fully integrated, regular readers, members of the choir, ushers, etc.

What if the person's symptoms flair?  "We say s/he is having a bad day."  Because the person lives in a family, not on the streets or alone in an apartment, problems are caught and addressed early, not after getting fired or evicted or arrested or in a bloody mess.  If needed, s/he can go back to the hospital for a while.  In fact, the hospital is not the place of last resort.  When the foster family has to go out of town, say, for a funeral, the person can stay at the hospital.  There is continuity of care.  There is care.

Three years ago I wrote a chapter for Deep Calling called, "If This Were Cancer."  I detailed all the ways that hospice patients receive the support of others, and that people who have suicidal depression do not.  "If this were cancer, there would be casseroles..."  I imagined the total collapse of care for the mentally ill, under the weight of our crazy health care system.  In fact, it's happening as I write.  I imagined that the Church would step in to meet a desperate need, to create hospice for the mentally ill, as the Church originally created hospice and hospitals.  I claimed that the Church has the resources to organize for such care on a local basis.  It has the faith to imagine such a thing, the love to cast out fear, and the values to demand it.  I will have to rewrite that chapter.  I didn't know it had already been/is already being done.

I am ever so grateful to Janet, whose last name I don't remember, who gave me Souls in the Hands of a Tender God: Stories of the Search for Healing and Home on the Streets by Craig Rennebohm, the source of this story.

Lord God, Who has graciously chosen Saint Dymphna to be the patroness of those afflicted with mental and nervous disorders, and has caused her to be an inspiration and a symbol of charity to the thousands who invoke her intercession, grant through the prayers of this pure, youthful martyr, relief and consolation to all who suffer from these disturbances, and especially to those for whom we now pray. (Here mention those for whom you wish to pray.)

We beg You to accept and grant the prayers of Saint Dymphna on our behalf. Grant to those we have particularly recommended patience in their sufferings and resignation to Your Divine Will. Fill them with hope and, if it is according to Your Divine Plan, bestow upon them the cure they so earnestly desire. Grant this through Christ Our Lord. Amen.
 

Dymphna's feast day is May 15.

Spiritual Practices for the Dark Night -- Tithing

Yes, I'm serious.  Tithing.

I knew about tithing because I am a Christian.  The concept comes from the Old Testament. I used to think it was interesting -- from a distance. Like fasting. Of course nobody except the legalists actually did it. Still, I suspected I was missing something.

Then two things happened within two months. I left the person to whom I had turned over all decisions that mattered. And I attended a conference about what was called the "Alabama Plan." We did bible studies about money, about tithing, about abundance and God's promises. And then we were asked, What is preventing you from claiming God's promises? I realized my answer was -- nothing. Nothing prevented me.

So I became a tither.

Now remember the context. Having just moved out on the chief money maker of the family, my household income had plummeted to 40% of what it had been. It occurred to me -- this was the perfect time to begin tithing. Instead of 10% of what I was used to living on, now it would cost me just 4%. The difference between living on 40% and living on 36% didn't seem like that bit a deal.

I was so excited by my new resolution that I decided to tithe for the previous two months as well. So I sat down with my checkbook. That's when the magic happened.

Suddenly, I had $300 to give to whatever cause I wanted.

I had never had $300 to give to whatever cause I wanted.  I was rich!

And I have never looked back. In the years since, I have purchased honey bees, rabbits, trees, a pig, a llama, a sheep, and this year a goat from the Heifer Project. I have purchased mosquito nets from UNICEF. I have fought hate crimes and taught tolerance through the Southern Poverty Law Project. I am helping secure marriage equality through the Lambda Legal Defense Fund.

My most satisfying sense of wealth was the opportunity to purchase four chlorinators for $300 a pop. They provide four villages in Swaziland with clean drinking water. The last time our diocese sent a team to partner with the Anglican Church there, they sent back word, "One elder welcomed us with great thanks. He said, 'Ever since you came, we have not buried a child.' It's a much bigger project than my contribution. Now the Swazis are making the chlorinators themselves.

And I have given lots of money to old churches in small towns. I make no apologies for paying heating bills of drafty old buildings. Hearts starve as well as bodies; Give us bread, but give us roses. In out of the way places, stained glass windows are the only art most people see. So I am glad to support the furnace repairs of my church home. We are family. Paying the bills is part of belonging.

I couldn't do all this if I hadn't made a commitment -- 10% on the first line item of my budget. If I had to decide each month whether I could afford it, well, of course there are other things I "need." But with that money already allotted, my only decision is where I get to spend it. Frankly, it's almost the only discretionary money I have. That there is so much of it makes me feel rich.

And what on earth does this have to do with Prozac Monologues: reflections and research on the mind, the brain, depression and society?  This:

Regarding depression: those of us with mental illness experience loss piled on loss, often including financial loss. We live in a world so programmed for consumption that it consumes us. We are surrounded by images of things we don't have. It hurts to feel poor.

Regarding society: the "Crazy Delusion" consumes all the rest of us, as well. Do you realize that of the almost 7,000,000,000 people on the planet, most of them do not have cable?

Regarding the mind: think of tithing as Cognitive Behavioral Therapy. First, pay attention to your feelings about money. Money is the quickest way into what we value. Examine the assumptions behind your feelings. Challenge your assumptions. Do they have a basis in reality? Explore and test options.

Nothing has ever matched the rush I got when I wrote those first checks. If you have to be careful about mania triggers, you might start slower. Figure out what you gave away last year. Calculate the percentage. Double it this year, and double it again next year, until you reach your goal. The trick is to make it a line item in your budget, as intentional as your light bill.

Tithing is a spiritual practice for the dark night, a way to push back your feelings of loss and your anxiety about the future. I am not going to promise that you will be rewarded by an unexpected windfall. Rather, it will occur to you that you already have enough.

So like thankfulness, tithing is a form of mindfulness, paying attention. The Torah has given us this great gift. Claim it. As Moses said, Choose life.

P.S.  I seem to have given a lot of advice lately. Too much.  There will be no third spiritual practice; the series ends here.

Spiritual Practices for the Dark Night -- Giving Thanks


I don't believe in New Year's resolutions. They tend to be such cliches. Quit smoking. Exercise. Lose weight. Well, if you are serious about losing weight, you gather information, you set goals, you plot a course, you prepare your house, you find a buddy (just like in AA), you plan each day, you think a lot and you practice. It's worth doing, and I did. The point of all of the above is to change the way you eat. Permanently. So I did all of the above and I feel great (at least about the way I eat). I wish you all the success in the world.

Christians get a second shot at the diet thing in Lent, which begins sometime in the middle of February. It doesn't fare any better than New Year's diets, because so few people want to change their life. They want a quick fix for that swimming suit or class reunion. That's why Lent. It's time limited, forty days, with Sundays not counting. Sundays are free days, for all the bad habits you resume once Lent is over.

Me, I am interested in changing my life. You may be, too, if you too have peered into the dark abyss and something still holds you back from the edge. We are tired of living on that edge. It's just too scary. It wears us out.

So I take advantage of whatever reflecting you might be doing on your life this time of year to introduce some spiritual practices that could change it.

Now don't get twitchy because I use the word "spiritual." Yes, I am a priest; and yes, I have a charge on my life; and yes, I do my best to follow Jesus. It causes me pain that many of you do not have access to that most powerful juju, because of how badly Jesus is represented by some people who have such strange ideas about how to follow him. And I ask him and you also to forgive me for how little I ever do about that.

But give me a hearing. I even changed the title for you. I could have called it "spiritual disciplines," which is how I think of them, and which connects these practices to their deep roots in my own and other religious traditions that have been around a lot longer than you or I, so that you might give them a chance to find out why they have stuck around so long.

Anyway, "practices" gives the sense that if you mess up one day, well, that's what people who are practicing do. Then they practice some more.

Having spent so much space on the title, I can't get to all three practices today. For which I am glad, because I do better when I don't have to figure out what I will write about, and now I know for three weeks, because I have just created another series. I hope I will remember the second practice, which I don't right this minute.

I try, I don't always succeed, but I try to start each day with three things for which I am thankful. I am not particularly profound, nor even moved.  I just notice three things. Today I am thankful that the sun came up. It didn't come out, but I can cut it slack some mornings. I haven't been out yet either. But it came up. That's a start, for which I am thankful.

I am thankful that I have a psychiatrist who listens to me. Let's not spend any time on the one who didn't. Let's focus on the present, for which I am thankful, because she listens to me.

I am thankful that my sweet Mazie is still alive. She has renal failure, and every day we notice more signs. It began with weight loss, then bad breath. Now she needs to go out several times a day, instead of three. I am the one who takes her for two long walks, and that gets me out, as well as up, whether the sun is joining us or not. Which is good for my mental health and for my heart, and so I am thankful.

Three things for which to give thanks makes me mindful, makes me pay attention to the present, which is a gift, which is why it is called the "present." For those of us who have peered into the dark abyss, the present is indeed a gift. Because we can imagine not receiving it.

Sometimes I forget to practice this practice. But I almost always give thanks at mealtime. That covers me three times a day. I give thanks for the food, for the hands that prepared it, and sometimes for those who grew it and picked it, and those who packed and delivered it. When appropriate to the menu, I might thank the chicken or the pig, and while I am at it, I apologize to them that I am not yet a vegetarian.

When I am in Central America, I hear my friends giving their thanks in quiet and rapid Spanish, so rapid that I can barely pick out a few words. But I hear them pray for those who do not have food, and for a world in which everyone will have food every day, like we pray in the Lord's Prayer: Thy will be done. Another word for this kind of prayer is mindfulness.

I was at a restaurant once on "A Day Without Mexicans," when lots of people from Central America stayed home from work to demonstrate how much the rest of us depend on them. I overheard a woman ranting at this demonstration, and how "they should go back to where they came from." All the while, she was eating a big beautiful salad.

Since that day, sometimes I pray, "Bless this food and the hands that prepared it. May it bless us or curse us, according to how we treat those who brought it to us." That is mindfulness, too.

I treat this practice gently. Once in a while I wonder who I am thanking, and that reminds me how mad I still am at God about this disease. I don't know how to give thanks for that yet. Part of my dark night is this alienation from God. Even alienation is a relationship. But it's not one I want to press too hard.

Don't press it too hard.  Thankfulness will do its work over time.  Treat it as an experiment, to find out what it will work in you.

Happy New Year.

Thank You For Being My Friends

Try this experiment on yourself.  Imagine that you are standing at the base of the hill.  What do you see, smell, hear?  Put yourself in this picture.  Are you with anybody?  If so, who is it?  What is your relationship like? 

Now, tell me. How steep is the hill?  Really steep?  Sort of steep?  Not so steep? 

Friends And The Perception Of Difficulty 

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