Prozac Monologues

Hearts Beat As One

It is common knowledge that we can slow our heart rate by slowing our breathing. Breathe is arguably the most important tool in the whole recovery toolbox for relieving stress and staying in the here and now. The folks in Sweden have taken this data a step further, into building community for common action.

Having taken a leave of absence just as DSM-5 was published, I have a backlog of posts on diagnosis to write. But let's break it up, shall we? This one gets filed under both recovery and political action.

It would take researchers from outside of the United States to think of examining the physiology of a group activity. Swedes, with their solid background in hymn singing, did just that, using group singing as a stand-in for group action.

One in four people in the United States meet the criteria for a diagnosable mental illness in any given year. About half will develop a mental illness sometime in their life. Allen Frances, editor in chief of DSM-IV wants fewer people, only those with the most serious illness, to be diagnosed to spare them the stigma of the diagnosis. The chief mechanism to achieve his goal would be to change the DSM criteria, so that fewer people qualify.

This series began by introducing Dr. Frances, whose work has inspired it. It continues to address the topic of stigma, what it means, where it comes from, how to respond. Last week I defined terms, adding one that expands our frame. Briefly, Merriam-Webster says that stigma is a mark of shame or discredit; while prejudice is injury or damage resulting from some judgment or action of another in disregard of one's rights.

I think it is important to distinguish between the two. To do so, one has to clarify the context. Stigma, when used by somebody who is the object of stigma, is the internalization of somebody else's prejudice. When it is used by somebody else, stigma is a mechanism of diversion that calls on the object of one's own prejudice to bear the responsibility of that prejudice.

So is Allen Frances trying to protect those whom he calls the worried well from being marked with shame or discredit? Or is he creating a diversion that calls on people who are suffering to bear the responsibility for somebody else's prejudice?

I don't use the s-word. I hate this title. I use it only because people who need this post will use it when they google.

I don't use the s-word. But here it is.

First from Google:

Definition of STIGMA

Noun

A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.

DSM-5 - Passé Before Published

Most of Allen Frances' ranting against DSM-5 bounces back to hit his own DSM-IV just as well. He acknowledges this in the preface of Saving Normal, which he says is part mea culpa. You could sum his argument against DSM-5 as It's DSM-IV, only more so! We could all find some consensus around that line.

So while I am not pleased with this man's rants [did you pick up on that last week?], I do not come to praise DSM. To keep us all on the same page, I am reposting my piece from November, 2011. What I wrote below referred to DSM-IV. Most of it applies to DSM-5, as well. The differences between the two do not a difference make in my own critique. The fatal flaw in DSM-5 is that it is DSM-IV's little brother. That's what Thomas Insel is talking about...

Allen Frances was the editor of the DSM-IV, first published in 1990. He is now the fiercest critic of its next major revision, the DSM-5. For over three years, he has been blogging weekly to this end at Psychology Today. This week I will summarize his steady drumbeat. I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries. The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles. I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion. The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.

Looking Under the Hood - A Better Depression Diagnosis?

Corrected July 7, 2013

Maybe my writer's block is an Ecclesiastes issue. There is nothing new under the sun.

But finally, there is. No, not the DSM. Keep reading.

The DSM. Sigh.

But regarding the DSM, and it makes no difference at all which edition, you have to wonder when somebody who is suicidal, losing weight, irritated at the drop of a hat and can't sleep gets the same diagnosis as somebody else who is immobile, gaining weight, couldn't be bothered about anything anymore and sleeps the night and day away. It's all depression -- the DSM's junk drawer.

Finally, somebody thought to sort the junk drawer, by looking inside the brains of these two sorrowful souls, both taking the same meds for God's sake.

PET Scans - Looking Under the Hood

Helen Mayberg and her team at Emory University School of Medicine used PET scans to look under the hood (to use John McManamy's favorite metaphor). PET scans use a radioactive tracer to determine where glucose is being used in the brain, i.e., what part of the brain is busy.

The Power of Apology

First, a nod to our excrutiatingly polite neighbors to the north, on the Power of Apology from Scott Stratton:

Next, inspired by Scott and in honor of Magna Carta Day - a rerun of last year's Entitled to an Apology?

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

Landfill Harmonic

I promised a series --

If the world sent you garbage, send back music.

Robert Gupta - Music as Medicine

This oughta be the start of a series...

Rx for Joy - Joanne Shortell

Joanne Shortell took me up on my call for guest bloggers. I am glad she did, as I learned of a blogger and mental health advocate I'd like to introduce to you. Joanne has three websites. Strongly Bipolar is a blog similar to Prozac Monologues. Maevetour.blogspot.com/ is the source of the following piece. And Servicepoodle.com gives more information about the issue it discusses.

Rx for Joy Can Be Written by any Therapist in the U.S.

My current therapist is a nurse practitioner who can prescribe psychiatric drugs. My previous therapist was an MSW who could not. Both, however, could write a prescription for an emotional support animal (ESA). A short, simple letter (see sample below) from a doctor (any medical doctor, not just a psychiatrist) or any therapist will allow a person with a psychiatric disability or a chronic pain condition to have pets in no-pets housing, to avoid any pet deposit or pet fee, and to avoid size limitations or species restrictions. The person with the disability gives this to their landlord or co-op/condo board as a request for a reasonable accommodation. (See link: How to Get an Emotional Support Animal.

Why should I prescribe ESAs?

And Now For Something Completely Different

Glad he cleared that up!

Thomas Insel - Toward a New Understanding of Mental Illness

Cutting this guy's budget is like telling Orville and Wilbur Wright to take the month off.

Jill Bolte Taylor's Stroke of Insight

Dr. Bolte Taylor's story is told in greater detail, both her stroke and her recovery in her book. You can link to it in the column to the left under Fabulous Books.

Calling All Guest Bloggers

That little box of words is empty. Day after day, replacements do not arrive. It is time for Prozac Monologues to go on sabbatical. I'm thinking -- two months might do it.

But I hate it! I can't do it! Help!

Calling all bloggers -- this space is vacant and available.

So here's the deal. I am open to publishing your poem, blog piece, article, ruminations, if:

It is on topic (reflections and/or research on the mind, the brain, mental illness and/or society);
It is educational and/or entertaining;
It is not hateful nor wildly inaccurate;
It strikes my fancy.

Oh, My Aching Neurons!

Having a hard year?

Fiscal Cliff, Sandy Hook, Sequester, you can take your Swiss Army knife on the plane with you, no you can't, North Korea, ricin -- not to mention your own life...

And then there was Boston.

If you are exhausted, you don't need to blame your meds. Your mind has been stretched to the limit.

How's your brain doing?

Minding My Mitochondria

I don't know if this is related, but it sure seems timely. One of my posts has gone viral - well, within the context of Prozac Monologues viral. I have been working up to over 100 hits a day. Nice progress -- thank you to all who have helped spread the word. Suddenly one day this week, my hits jumped to 530. Almost all of them were one post, a review of Terry Wahl's book, Minding My Mitochondria.

This post was already one of my most read, a cross-over hit with people who have multiple sclerosis. Last month it got mentioned in an MS chat group, which drove a spike in hits out of Poland. [The blogger.com software enables bloggers to track aggregate statistics. I can't tell who is reading, but I can tell how many, what country, and to a limited extent, how readers found my blog. This week's traffic seems to come from Facebook.]

Wahls' book is about brain cell health, and how what we eat sustains or starves our brain cells -- in particular, mitochondria, the little power plants inside our nuclei that turn what we eat into energy.

Hence, the relevance to your current state of exhaustion.

The article that inspired this post is titled Why the Rich Don't Give to Charity. But I figure, language has power, and why reinforce behavior that I would rather see changed?

Before you go off in a huff, let me tip my hand -- I acknowledge and will discuss both the exceptions and free will.

The short answer to any of these questions, why the poor give more, why the rich don't give, and why some rich do is -- mirror neurons. Three weeks ago I reported on these in Mirror Neurons - They Change Everything, along with a youtube featuring V.S. Ramachandran. Here is the promised expansion on the theme.

Statistics on Giving

Ken Stern reports in The Atlantic Magazine that the top 20% of Americans donate 1.3% of their income. The bottom 20% donate 3.2%. He asks, What's up with that?

Paul Piff - Higher Social Class Predicts Increased Unethical Behavior

Last week I was part of a group that was confronted with a psychiatric crisis in a visitor. This group had never been called upon in this way. But among our ranks we had enough experience of psychiatric crisis that:

1) We were determined we would help a stranger; and
2) We knew how to do it.

Part of the story was that inevitable series of telephone calls to offices in 24 hour institutions that were closed. When flesh and blood was finally located, the response was rude, ineffective and dismissive.

When I debriefed with my therapist, she expected my frustration at calls for help that did not yield help. That is one of my therapy themes -- a cognitive schema, as a former cognitive therapist called it. I surprised my new therapist and surprised myself with my response. No, I didn't expect help. We are on our own.

In the Beginning -- Four Years Out

Four years ago I had lost my voice. Literally.

How does a psych patient get help without a voice? Too many times shamed into silence, when I quit my therapist I went to a Chinese Practitioner who did energy work, so I wouldn't have to speak. When I had no choice but to find a new psychiatrist, I had to whisper.

How does a preacher preach without a voice? Too long in the dark night, I had nothing to say. When the pension fund required I not work at all for a year as a condition of disability, it was a relief.

How does a writer write when the words disappear? Again I had no choice but to return to the Chemistry Experiment, this time with Lamictal. -- They tell you all about this exceedingly rare rash. Sure it could kill you. But you just stop taking the med, the rash goes away. Meanwhile, they forget to mention the very common side effect -- your words disappear. I didn't complete a sentence for months, forgetting in the middle what I intended to say. Four books languished on my laptop.

Prozac Monologues

But I am a psych patient. I am a preacher. I am a writer. I need my voice. Enter http://prozacmonologues.blogspot.com/.

Mirror Neurons - They Change Everything

Blow your mind in the seven minutes and forty-four seconds:

You just watched V.S. Ramachandran, Director for the Center of Brain and Cognition at the University of California Sand Diego, cross the mind/brain barrier in his description of mirror neurons. These neurons, a subset of the command neurons in the frontal cortex, are the neurobiological basis for imitation, culture and empathy. What we see another do or feel causes mirror neurons in our own brains to fire, so that we understand or feel the same.

This week's blogpost is published late because I kept trying to explain what mirror neurons explain. They explain everything.

They explain why rich people are not as generous as poor people. (That may get its own post soon.) They explain why religious people give more than nonreligious people, more time, more money, more blood. (My source for that one is sociological, not neurobiological. So I may not blog it, though mirror neurons would explain it.) They explain why people who own guns are more afraid than people who do not, and why people who watch tv overestimate the crime rate. They explain pornography. They explain Congress.

Fabulous People With Schizophrenia

People With Schizophrenia Who Recover

My guess is you don't know people with schizophrenia who have jobs, own their homes, are married and join clubs and congregations. My guess is, even if you work in the field or volunteer in homeless shelters, you do not count among your friends, your real friends, the ones you invite to your house for dinner, anybody with schizophrenia.

My guess is you do not know that such a thing is possible.

Lionel Aldridge decided to change that. Lionel Aldridge played defense for the Green Bay Packers and won two Super Bowl rings. (Go Cheeseheads!) He lost them when schizophrenia took his life out of control. Literally, his ring fell off his hand; he couldn't find it in the gutter.

But he came back. He got treatment. He vowed that if he got better, he would not remain silent, so that other people with schizophrenia would know they are not alone, so they would know they could recover, and so you would know that, too. His story is in this link.

Inductive Research

Schizophrenia -- Taming the Dragon

Imagine you have a dragon in the house.

It has been there a long time. When it was little, you could hide it. You knew your parents didn't like it when you talked about it. So you guarded it as a secret for the longest time, even with its nasty habit of singeing your fingers. But when the couch caught fire, they knew, and insisted you get help.

They want you to get rid of the dragon. Some of them think you can. Others think you can tranquilize it, and the couch will never catch fire again, and nobody need ever know you have a dragon in the house.

Iron Rule #1: You cannot get rid of the dragon. It is here to stay.

I sat next to the young man as he told his story in Peer to Peer. Honestly, he scared me. I was new to the loony world. I was getting less scared of people like me (and through them, eventually less scared of me). But I was still scared of people with schizophrenia. And this one, especially. The others had a grip. My young man had missed a session or two, not yet stable, like, able to tolerate a large room with twenty people stretched around big tables.

He whispered. They asked him to speak up, but the longer he talked, stretching the three-minute limit to ten or fifteen, the softer his voice got. I strained to hear him. I was the only person in the room who could. The story rambled, hitchhiking around obstacles and through obscure events. If he hadn't whispered, if I hadn't strained so hard to hear the words, I would have missed it. I would have missed him.

It actually made sense. There was a flow. The connections were loose, granted. But if I got in the canoe with him, I could ride the river as he paddled through his quest to make sense of it.

That was my introduction to the inner world of schizophrenia. My life is richer for it. Yours could be, too.

Caveat -- Mental Illness is Real

Untangling Redemption

Kelly Flanagan is a psychotherapist who blogs. I think that is brave of him. Most mental health professionals keeps a decidedly low profile online. Boundaries, you know.

Flanagan not only blogs -- he puts it right out there.

[I have been sick as a dog this week, and will share him with you, instead of churning out my own stuff. Thanks, Kelly, for doing the heavy lifting.]

Flanagan's blog is called Untangled, and his theme is redemption: Tell a redemptive story with your life. Now.

Immediately, he is asking for trouble in this bizarre world where meanness has become the measure of ones Christianity, and all those Christian words are distorted to stand for the opposite of what they intend.

In this Orwellian world, (where entitlement means something to which you are not entitled) Redemption means that you have paid whatever price somebody else has decided you ought to pay in mental gymnastics and conformity to their way of life.

Pride of lions
Fleet of ships
Host of angels...

Flight of ideas.

It's a lovely phrase. Isn't that what ideas do -- fly?

I think so. But evidently, not everybody.

A Visit from the Goon Squad

I was looking to meet new people in my new home town, and went to the library's book club. The selection for my second meeting was Jennifer Egan's A Visit from the Goon Squad. Sex, drugs, rock and roll, and, oh yes, suicide -- these characters were my tribe! No, I haven't lived their lives. More to the point, I have asked their questions.

I wasn't sure how Egan's characters would be received in this group of middle-aged and older women. I didn't know the book club members yet, but they seemed pretty respectable. Then again, I can seem pretty respectable, too. I expected a lively discussion.

Nope. No lively discussion. No discussion at all. They were so dismayed, they were speechless. The librarian resorted to reading reviews.

Good mental health reporting takes research, careful analysis, nuance and a whole lot of work. And in the end, it doesn't sell newspapers. Which is why you see so much bad mental health reporting, even where you thought you'd find better.

[I like to think that opening sentence explains why I post no more often than once a week. I work to provide a quality product. But that is for you to judge.]

The long awaited publication of the Diagnostic and Statistical Manual, Edition V has generated a blizzard of easy-to-whip-off articles with sensationalist headlines, just the thing for you to share on Facebook on a boring weekday afternoon, and get a nice Ain't it awful rant going among your friends when, really, you should be doing your life.

The Spectre of the Butterfly Net

Most of these articles follow the same tired theme, Psychiatrists are out to diagnose half the population, turning normal human conditions into mental illnesses, because they are in cahoots with the pharmaceutical industry to put the nation on medication.

These articles write themselves. Pick any diagnosis that the DSM-V has dared to update from a work last revised nineteen years ago, add a quote from the disgruntled old man who was editor-in-chief of said nineteen-year-old document, which only barely tinkered with the 1980 edition anyway, plug in a statistic on drug sales, and there you have it.

Next, pick another diagnosis, substitute a humanistic psychologist for the disgruntled old man, and you are good to go with next week's article.

I, who love links, am not going to link to any of this trash.

Now I have my problems with the DSM. But I do have some sympathy for its revisers, caught in the middle of a sea change, trying to update a system that will be tossed into the deep within the decade, and would have been already, if we spent any halfway reasonable amount of money on research.

For now I will do my own op ed piece and offer for your consideration the following assertion, based on my own experience in the system and reports of friends who have been at this a whole lot longer:

There are no psychiatrists running around on the streets, chasing toddlers with temper tantrums, trolling funeral parlors for grieving widows, whipping up business. People! There are not enough psychiatrists to deal with the loonies already identified. They do not need you!

You don't get to see a psychiatrist and submit to trial by DSM until

denial
snapping out of it
hiding
behavioral modification
herbal remedies
and prayer

have not worked, and there is no choice but to go where you do not want to go, in the face of your drinking buddies who all tell you, You'd have to be crazy to see a psychiatrist.

Well, maybe you are. Maybe you are on the knife's edge. Be prepared to stay there a while longer. It will take three months to get an appointment. Longer, if you don't have insurance.

Seriously, they don't need you.

Diagnosis is Your Best Friend

Do you know anybody who has suffered for years with some unidentified illness, bouncing from doctor to doctor, treatment plan to treatment plan, feeling crazy and out of control, because there is no reasonable explanation for these vague, though debilitating symptoms that come and go, and your friend begins to think that you all think he/she is crazy and not really sick at all? Lyme Disease, Fibromyalgia, TBI, MS, ALS, Lewy Bodys...

The day that person receives a diagnosis, even a difficult one, is a day of rejoicing. Now he/she knows, can make plans, can learn about the illness, follow a course of treatment, maybe even find one that helps.

Diagnosis, if it is the right diagnosis, even if it is more serious than the previous diagnosis, even if you really, really don't like the diagnosis, is the first step toward recovery.

I mean, think about it. If you get out of breath climbing a flight of stairs, do you listen to your friends tell you to rest mid-flight? Or do you go to a doctor who might tell you that you have a blocked artery? Is the doctor drumming up business? Or is he/she saving your life?

Mental Illnesses are Made of Normal Experiences

Let's break out some dialectical thinking. I know, it's hard. That is why mental health reporters for USAToday and even the New York Times don't ask you to do it. Prozac Monologues does ask you to do it. But we can take it slow.

First, what is dialectical thinking? It is when you hold two truths that seem to contradict each other in your mind at the same time. Truth is not about either/or. It is mostly both/and.

So our first statement is this:

Mental illnesses are made of normal experiences. Everybody gets sad. Everybody gets angry. Everybody gets up in the morning sometimes and just can't get started on the day. Everybody who walks by a group of scary people thinks they are saying bad things. Everybody catches something out of the corner of the eye that isn't really there. Everybody throws something against the wall. Everybody persists in believing something that is false. Everybody has an occasional impulse to jump off the bridge.

The symptom lists of the DSM are filled with behaviors that everybody does.

News Flash: Us loonies inhabit the same planet as everybody else.

That is the first truth in our venture into dialectical thinking. And it is the source of all those headlines about how the DSM is turning normal behavior into mental illness. How is this for a thought -- mental illness really is not that weird after all.

The Suffering of Mental Illnesses is not Normal Suffering

But. Here is the other statement to hold in your mind while remembering the first one:

There is a difference. You get a diagnosis of some sort of mental illness when a whole lot of normal experiences and a whole lot of normal suffering pile up beyond your ability to function in a normal world.

That's it. If you are not at the end of your rope, you do not have a mental illness. Rather you are having a bad day, or week, or year. If you are functioning well in the world, you do not make an appointment with a psychiatrist, and do not receive a diagnosis. And the psychiatrist is just fine with that, because he/she doesn't have time to see you anyway. The DSM is not about you, and does not try to be about you. So leave it alone and let it help those of us who need its help.

When your loved one dies, you will not be diagnosed with depression just because you are going through a normal grieving process. A normal grieving process looks like depression, but only on the surface.

If what you have is Major Depressive Disorder, then you don't go through a normal grieving process. You don't think about your loved one; you don't remember the good times; you don't share those scandalously funny pokes in the ribs during the funeral; you don't cling to your sister; you don't even get mad at the person who deserted you by dying. You just sit under a black cloud and think about how miserable you are. So you do not get better, and -- get this -- you do not do normal grieving, until you get treated for your depression.

Grieving widows are in no danger from the DSM, if their grieving really is normal.

When your child throws a temper tantrum, you don't run out for a diagnosis of Disruptive Mood Dysregulation Disorder. A badly behaved child has good days and bad days. If the parents are consulting with school and other resources and genuinely working on the issue, things get better. When they have tried every recommendation in the book, when they fear for their lives, when the child is out of control and scared and miserable about his/her own behavior, and this has gone on for years...

then it is insulting, it is cruel and it is simply not helpful to tell these parents that there is nothing wrong with their child and that the doctor's attempts to figure it out are part of some grand conspiracy that threatens to medicalize normal behavior. If you don't know, if you have not walked in their shoes, then shut the hell up.

Naughty children are not diagnosed in the DSM, if they can get better without it.

Diagnosis of Mental Illness is Not Easy

The DSM V does not make diagnosis easier. Yeah, well -- diagnosis of any sort got more complicated when they threw over the four humours theory.

There is more to say in the DSM's defense. I will get to it. It will make me work and make you think. And I don't imagine you will share it on Facebook.

Oh well. My ad revenue never did pay the mortgage.

flair from Facebook.com

The Brain on Tetris

What happened to that hour? That other hour? The one after that? Where did they go?

My son's best friend from childhood, whom I haven't seen in ten years, sent me a message with this link to a BBC story, The Psychology of Tetris. When he saw it, did he remember that I used to ask my son to hide the Gameboy?

Compare states to states. Compare regions to regions. Compare states within regions to other states within the same region. Compare people of the same age group, in any age group, men to men and women to women. Compare unemployed people to unemployed people, working folk to working folk. Compare city dwellers to city dwellers, country folk to country folk.

Compare people with depression to other people with depression; people who are suicidal to other people who are suicidal; people who have a plan to other people who have a plan; people who have a past suicidal attempt to other people who have a past suicidal attempt, for God's sake!

More Guns = More Suicides.

Get it?

While I was researching this post, a Facebook friend posted this picture. I commented, giving information I discovered and found surprising. The stats are below, under domestic violence. A friend of my friend then commented, Dearest Willa......useless, worthless statistics. Lies, damn lies and statistics. Go back to class and learn forgiveness, and while you're at it....drop dead!

Well. That was disturbing. To my knowledge, I do not know the person who called me Dearest Willa, said I need to learn forgiveness, and then told me to drop dead. It occurs to me that facts have power, if they evoked this response.

My facts come from the Centers for Disease Control, Bureau of Justice and Federal Bureau of Investigation, from reports and data bases that count people who died and how they died. That is all these sources did -- they counted. They made no policy recommendations.

I make no policy recommendations in this series, either. I am reporting their numbers. I do hope they are not useless numbers. I offer them to you to help you weigh the costs and benefits of gun ownership.

How Many Killed Since Newtown?

Technical difficulties have delayed my research on homicide and firearms. I can't figure out how to make the story not tedious. So I will skip it. Maybe next week...

Until then, here is a resource to keep you up to date. Slate Magazine and the Twitter feed @GunDeaths are crowd sourcing data to answer the question:

How Many People Have Been Killed by Guns Since Newtown?

The answer is not easy to find. Coroners do not publish this information in real time. Perhaps you noticed that my statistics last week were from 2009 and 2010. The tally is collected only at the end of the year, and it is not official for some months after. Suicides, in particular, are underreported, even in official statistics. They get caught up in investigations that take months beyond the reporting date. Eventually the numbers for 2011 will be corrected, when these investigations are completed. Meanwhile, the smaller number has been published in places that will not be corrected and will nonetheless be repeated (including Prozac Monologues, if I try to publish the most current sources.)

I have a friend, a young mother of two toddlers, whose New Years resolution is to get her license to carry. This series is for her. Live long and prosper, dear one!

My Next Series -- Facts About Firearms

I have a plan. No, not that kind of plan. Well, yes, I do. But that is not the plan I mean right now. I plan to do a series about firearms. It is my intent to provide facts, just facts. There are a lot of facts out there about firearms. A lot of nonsense is disguised as facts. But genuine facts are available, and more useful than our impressions for making sound decisions.

I am not going to write about my opinions about firearms, because, well really, who cares about my opinions.

Keeping Track of How People Die

Firearms are a cause of death, which means that the US Centers for Disease Control keeps track of them. Wait, wait -- it doesn't keep track of the firearms, just the deaths.

Best of 2012 - Which Do You Choose?

Healthline.com is sponsoring a Best Health Blog of 2012 Contest, and Prozac Monologues is one of the contestants.

Click on Best of 2012 to vote Prozac Monologues the Best Health Blog of 2012! The list is long -- find Prozac Monologues alphabetically. You can vote every day until February 15th. The contest started on December 21, so I am behind on the multiple vote front. Tell your Facebook friends! Tell your neighbors! Tell the people using their SmartPhones at the coffee shop! I guess you have to use a Facebook or Twitter account to cast your vote.

Meanwhile, I went back to look over my own work for the year, and invite you to do the same. Click on the word comments at the bottom of the screen to weigh in on what you think of this body of work, or any particular piece of it.

Favorite Post

Judging by page views, the Popular Vote far and away goes to Dopamine - Can't Live Without It from March 23, 2012. Coming in the middle of a series on the Stages of Change approach to changing the way we eat, this post traces the brain circuits that brought you from your grandma's cocoa to your daily Starbuck's habit, or from The Cocoa That Ate Your Brain to Pimp My Cocoa.

Trip the Light

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

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

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

Ring The Bells That Still Can Ring

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

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

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

Prozac Monologues Goes to the Movies

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

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

Here is an example:

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

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

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

Thanks!

image of popcorn from FreeDigitalPhotos.net

dvd cover from Amazon.com

More on Mood Charts

This is my personalized mood chart.

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

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

More Than Mood

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

Mood Charts Revisited

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

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

What is a Mood Chart

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

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

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

Holiday Shopping for Your Favorite Loony

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

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

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

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

Holiday Survival Tips for Loonies

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

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

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

Definition of STIGMA

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