What is God Doing on World Bipolar Day?

It was not that this man sinned, nor his parents, but that the works of God might be made manifest in him. John 9:3, Revised Standard Version.

Or as The Message puts it: You're asking the wrong question. You're looking for someone to blame. There is no cause and effect here. Look instead for what God can do.

There's the text for World Bipolar Day.

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

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

Five Good Books I Recommend for World Bipolar Day

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

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

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

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

It isn't offered often.

One More Reason to Ask About Suicide

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

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

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

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

The boat is pain.

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

What Happened When Meghan Markle Asked for Help?

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

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

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

They told her, No.

Are You Asking Your Meds to do All the Work?

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

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

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

Pills are not enough.

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

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

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

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

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

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

Can People With Mental Illness Become Saints?

 The day approaches - the start of Lent Madness.

What, any reasonable person might ask, is that?

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

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

Help! How Do I Talk to My Delusional Cousin?

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

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

Let's start with some clarification. The Diagnostic and Statistical Manual (DSM-5) defines delusions as fixed beliefs that are not amenable to change in light of conflicting evidence. Well, that sure sounds like what we are dealing with.

Delusions are taken as indicators of a mental or physical disorder. But before we go making armchair diagnoses, consider how powerfully our minds cling to ideas that are demonstratively false, the fear of spiders, the hope in lottery tickets, trickle down economics. Let's exercise some restraint and some humility here.

How Will You Get Through This Week?

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

    Therapist: What will you do for fun this week?

    Me:

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

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

What Happened to My Bipolar Brain and How Do I Fix It?

The most troublesome statement in Goodwin and Jamison's Manic Depressive Illness may be this: "Complete symptomatic remission does not ensure functional recovery." This is no small problem. For some 30% to 60% of patients with bipolar disorder, simply treating their mood symptoms is not enough to help them return to a full life.

There’s a third pole that needs to be addressed for that to happen: cognitive symptoms. These often persist even when patients are euthymic, and they range from problems with memory and attention to more subtle deficits such as picking up on social cues and making wise decisions. 

Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!

How Does the Mind Learn? The Neuroscience of the Way of Love

This month I have been posting at Batshit Crazy Preacher instead of Prozac Monologues. It's a series of daily reflections for Advent, the Christian season of preparation for Christmas. Watching and waiting, not so much shopping and decorating. Lots of people are posting images and reflections on social media for #AdventWord. But me, well, you could expect that mine would have a Prozac Monologues flavor, regardless of the venue.

So in case you don't follow both blogs, here is the link to one of my posts in which I explain the neuroscience behind a particular spiritual discipline. Not meditation, mindfulness, breath prayer, those typical crossover exercises that regulate cortisol. No, I'm talking about learning, at the cellular level, complete with my drawing of a neuron.

Blessings, all.

Prozac Monologues Moves to Batshit Crazy Preacher

Advent is the season of spiritual preparation for Christmas. The idea is to slow down, not speed up. Spend some quiet, reflective time. Remember the reason for the season... Honestly, I think about setting up an Advent wreath, that sort of thing. But our candle holders broke. They broke years ago. I guess I'm just not into the candle thing.

Most years, the closest I get to Advent wreaths, calendars, whatever, is a box of twenty-four wee drams of Scotch from Master of Malt. I know, I know, Scotch is not what your psychiatrist recommends for your recovery toolbox. At least it usually take me well past the twelve days of Christmas to finish the thing.

Anyway, this year I found a practice that does spark my imagination, #AdventWord. It is an international community of prayer that you can enter in whatever way appeals to you. There is a daily meditation to read, based on a different word every day. Advent Word, get it? The ones so far this year are tender, deliver, strengthen, earth, rebuild, fellowship, and glory. People post photos on Twitter or Facebook, or scripture passages, or songs inspired by the word. You can get a poster with spaces to color in each day. You can doodle, decorate the word, or draw whatever comes to you. When it's finished, it's supposed to remind you of a stained glass window. The whole project lets you do whatever prayer style works for you.

Gingerbread Houses and Cognitive Behavioral Therapy

Thanksgiving is one of my hypomanic seasons. I'm getting better at not taking on projects that worry my wife. In fact, I have given up gingerbread houses altogether. Which is not to discourage you, just to acknowledge that they were once my one great weakness. That woman in the fringed dress down there? - Each bit of fringe was an individually placed sprinkle, separated out from a container of red, green, and white sprinkles. See what I mean?

But I did learn some things from my hypomanic gingerbread houses. And learning is good for the brain. The following post is a repeat from ten years ago, when I was in the throes of it. It explored the relationship between gingerbread and cognitive behavioral therapy. I am one of many who have a love/hate relationship with CBT, which I freely acknowledged to my CBT therapist in our first session. Nevertheless, she persisted, and I persisted, and I do rely on it daily and have written about it from a variety of angles. So here it is again, for those of you who want to explore CBT and also for those of you who want to know how to make a nine patch quilt out of fruit rollups:

Cognitive Behavioral Therapy - Gingerbread Style, 11-25-2010

First Cognitive Therapy Technique -- Distraction

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.

Between Stimulus and Response

I went searching for a Viktor Frankl quote. Mental health pro-tip: When desperate, Google "Viktor Frankl quotes." I mean, how does even the most desperate, darkest depression argue with a Holocaust survivor?

Here is what I found:

Okay, I confess, when you put an inspirational quote on top of a beautiful peaceful scene, it loses its inspirational value for me. That's just the way my brain works.

So I'd make my own image if I were inclined to that sort of thing, like if I were having a hypomanic episode. It would be three boxes, left to right.

On the left would be a screenshot of a webpage saying something like, Cannot open page because search timed out. Maybe, Cannot find printer. I saw those images on my laptop a lot last week.

Sanity, the Serenity Prayer, and the Way of Love

Last week I just couldn't. Well, my laptop was dying. And then my printer wouldn't install. But all that within the context of everything that well, you know... So last week there was no new post.

This week, I still can't, not really. I can't find any new research that intrigues me. I can't bear the thought of yet another rant. I am determined not to spread any more pain.

But there's pain out there. There's pain in here. And this blog is about the things I can change. So this I will do.

I have a spiritual discipline that I am using to walk through these days. I am a Christian, and this is a Christian discipline, or series of ancient practices - though my guess is that nonChristians can find something of value here. I will do my best to do some translation.

It's called the Way of Love.

Confessions of the Good Suicide Survivor Story

I was suicidal. I nearly killed myself. I am glad I didn't do it. Because I got better.

Moral of the story: You will, too.

That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.

Some of it is true. It did get better. For me. For now.

For now.

There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.

And like I said, it's true, some of it. According to David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.

But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.

Bipolar Screening - People with Bipolar Know It When We See It

Psychiatrists and people with bipolar both have told me that my book captures what the manic experience is like.

Reviewers tend to say either, She must have written it when she was manic. Too bad her editor didn't fix it. One star. Or: She must have written it when she was manic. So glad her editor didn't fix it. Five stars.

Which gets me thinking: Doctors say bipolar is really hard to diagnose. But if people who have it know it when we see it, what if we wrote a screening tool? Bear with me here. I'm thinking something like this:

They say: A distinct period of abnormally and persistently elevated, expansive, or irritable mood.

What we hear is: Are you abnormal?

To which we answer: No. I mean, duh.

So what if they said: Has there ever been a time when everybody around you just didn't understand why the world was so great or why you felt so good? Or has there ever been a time when everybody around you was massively irritating?

Suicide is Not a Mystery - Get Beyond the Romance to Get to the Work

Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.

The following is an example, a post from a previous Suicide Prevention Month, edited with my more current thoughts on the matter.

This is Suicide Prevention Week - from September 8, 2011

When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?

If you want to know my take on suicide prevention, here is the link for those original posts. Among the Labels in the right-side column, you will find links to other posts tagged suicide, suicide prevention, and the like.

Looking back at these posts, I wish I had less to say about suicide. But having this much to say, and frankly, a lot more, I think it's best I go ahead and say it. That was my POV for The Suicide Monologue. And I'm sticking to it. I urge you to take the same approach. If you have something to say about suicide, go ahead and say it.

You know, all those years we never talked out loud about cancer, our silence never saved a single life.

Understanding Bipolar Disorder - A Review

On the one hand, bipolar disorder can sweep like a tornado through a family, disrupting every aspect of daily living and relationships.

On the other hand, family members can be one of the most significant resources for a person's recovery and stability.

In my own case, my wife is the one who described the symptoms that helped my psychiatrist recognize that I have bipolar, not major depression. But once that happened, what did she, as a family member, as the member of the team with day to day, hour to hour access, receive by way of help and guidance?

Nothing. Not a word. Butkus. Like, not even a pamphlet.

Really Nothing GIF from Really GIFs

Nope, nothing. She worried. She worked from home to protect me at my sickest. She shouldered every responsibility. She thought through and recommitted to and excelled at "for better for worse, for richer for poorer.

Eventually she got to Family to Family, NAMI's program for education and support of people whose family members have a mental illness. And that helped. It gave her a skill set. It let her know she was not alone. It was more than a brochure.

What she needed was Aimee Daramus's new book Understanding Bipolar Disorder: The Essential Family Guide. Daramus, a clinical psychologist with over twenty years of experience in mental health, from psych units to private practice, has written the definitive guide for family members of people with bipolar. She takes you by the hand and leads you from a chaotic landscape to a steady path.

World Suicide Prevention Day from a Different Perspective

Many people who are suicidal hate suicide prevention campaigns. We notice that they are not directed at us, but at would be heroes. They publish lists of risk factors, things to watch out for in those of us who would thwart their efforts. But we fail to see listed what drives us to suicide: poverty, bills, homelessness, rape, child abuse, bullying. Nor do we hear anything about addressing these issues that might actually reduce suicide rates.

What about helping parents understand their children's sexuality so that LBGTQ children don't end up on the streets? What about bully intervention programs in schools (designed to prevent bullying, not treat the victim)? What about universal health care and food security? What about a health care reimbursement structure that encourages doctors to go into psychiatry? What about treatment that isn't demeaning? What about...

Instead, we get posters of "head clutchers." Get a grip.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

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.

A Better Suicide Prevention Month

CW: Cynical Warning.

Anybody else cringe all through Suicide Prevention Day/Week/Month? Anybody else roll their eyes at the "Ask for Help" messages? Or search the lists of "Warning Signs" to make sure you're covering your tracks?

Are you a potential helper and confused by that paragraph? Did you design this poster? Let me explain it to you. The psychiatrist doesn't accept your insurance. The psychiatrist who does accept your insurance doesn't treat your issue. There isn't a psychiatrist. The therapist is available six weeks from now. Or later. What's the point of therapy anyway, the therapist isn't going to pay your rent, if you could make rent you could manage your mental illness just fine, thank you very much.

If you call a help line, what if the cops arrive to handcuff you in front of your neighbors to help you enjoy your free trip to the ER? That's the only thing that will be free. If you go to the ER, you may or may not be admitted. Either way, the bill will leave you homeless.

Circadian Rhythms and Fixing Bipolar's Wonky Clock

When nothing else worked, Social Rhythms Therapy got my bipolar under control. That's why Ellen Frank is my mental health hero. She invented it.

A few years ago, I spent four weeks summarizing Frank's book, Treating Bipolar Disorder: A Clinician's Guide to Interpersonal Social Rhythms Therapy. My goal was to create a patient's guide. Here is the link to Part Four. It includes links to the earlier posts.

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

Circadian rhythms are at the core of IPSRT. People with bipolar have difficulty maintaining the stability of our circadian rhythms, because our internal clocks, governing everything from sleep cycles to blood sugar levels to body temperature are, well, wonky.

Will This Trauma Never End?

I found this video while trying to survive the cluster f*ck of misdiagnosis, antidepressants, mixed episodes, and a psychiatrist and therapist who didn't know what they didn't know, so it must be me and maybe I had borderline personality disorder - the go to diagnosis for patients that the professionals are tired of.

OK Go - This Too Shall Pass. And in fact, it did. I survived to... today? I offer it to everybody who is trying to survive the current COVID cluster f*ck in the US.

To Write Love - Hope for Depression, Addiction, Self-Harm, and Suicide

There is power in a story. You tell me your story. You are seen, heard, affirmed. I tell you my story. You know that I am for real. We are not alone.

To Write Love on Her Arms (TWLOHA) harnesses the power of story to offer hope to people struggling with depression, addiction, self-harm, and suicide.

The organization itself began with a story, a young woman who was suicidal but could not be admitted into a treatment program because she was also addicted and they couldn't bear the liability of her detox.

Yes, if you think you're done after you tell your suicidal friend or family member to get help, read that sentence again. Trying to get treatment can be enough of a nightmare to push us over the edge.

But that was just the beginning. A group of friends took it upon themselves to create a safe place and treatment program for this young woman for the five days it took to detox. The treatment program was admittedly unorthodox. She stayed with friends. In rotating teams they supported her, kept her safe. They also took her to concerts, Starbucks, and church. They prayed. They smoked cigarettes. They were her hospital.

Mostly, they listened.

Mental Illness Podcasts: Teaching and Tickling the Mind

I have to move a lot to manage my anxiety disorder. So why did it take so long for me to discover podcasts? I can do research and fold laundry at the same time! Here are four of my favorites:

My therapist recommended The Hilarious World of Depression, hosted by John Moe, a few years ago. And I recommended it to you as part of my Giving Thanks series last November. A depressive himself, John interviews comedians, musicians, and other celebrities, asking the question, Is depression funny? Not everybody thinks so, but that's my brand. The show was recently cancelled. Sigh. But with five seasons, that's a lot of bingeable laughter to come your way. And you can often find Youtubes of the featured comics to extend your pleasure. So have at it.

I should mention that John has just published his memoir by the same name, for when you can sit still and read.

I discovered Beyond Well, hosted by Sheila Hamilton after reading her memoir about her husband's undiagnosed bipolar and subsequent suicide. It is the cautionary tale and not so funny version of my book. Well, she wrote hers first, but I don't want to say I wrote the funny version of hers. It's not always funny.

COVID Mask Resistance and the Death Wish

Why won't people wear masks? If their answers don't make sense, maybe we need to listen more deeply.

Truth be told, I want to respond with name-calling: selfish, anti-science, "drank-the-kool-aid"... I am tired of dodging the maskless in the street and the grocery aisle. I resent being confined to my home to protect myself from my fellow citizens. I grieve the slow, and now not so slow, decimation of the population of the United States, my native land, hurdling toward third world status as our health care system collapses, our food chain folds, and our future generations head toward long-term disability.

Side comment/serious question: There is such variation world-wide in leadership and results. Some countries have got this pandemic under control. Who benefits, who is the one who gains by our abysmal mismanagement and consequent destruction of the United States of America?

But 1) name calling is not helpful, 2) I actually care about some of these people, and in general, 3) I commit to the Way of Love. So I am stuck with listening more deeply.

Is It Time to Call a Therapist?

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

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

So do you need to see a doctor? It depends. A recent New York Times article can help you sort it out.

Pride Month Report: What Parents Can Do for Their Trans Daughters and Sons

1.8 million LBGTQ youth (13-24) in the US seriously consider suicide each year. The numbers for trans people in particular are even more staggering. According to the UCLA Williams Institute report, 81.7 percent of those surveyed by the National Center for Transgender Equality had seriously thought about killing themselves in their lifetimes, and 48.3 percent had done so in the last year. 40.4 percent of transgender people attempted suicide sometime in their lifetime.

Suicide happens when pain exceeds resources for coping with pain. This report adds evidence to that assertion. The following statistics are pulled directly and paraphrased or quoted from this report.

Mental Health Innovators Ponder the End of the COVID-19 Honeymoon

Dear Mental Health Innovators: The COVID-19 Honeymoon Is Almost Over.

The title of a recent PsychiatricTimes.com article caught my eye. Honeymoon? Then I realized it was dated May 19, so perhaps the authors could rewrite the title with the "Almost" removed.

The authors identify predictable stages of psychological response to our current pandemic. Unbeknownst to those whose education was really less education and more training for their future jobs (so things like history were deemed a waste of time), the human family has lived through past disasters, including multiple pandemics. There are patterns to these things.

Heroic Stage

Care of the Soul and COVID-19

Ronald W. Pies is a psychiatrist, bioethicist, and professor emeritus at SUNY and Tufts. His writings often tend to the philosophical, which keeps me reading his work and occasionally engaging with him in cross conversation between Prozac Monologues and PyschiatricTimes.com, where he served as editor-in-chief 2007-2010.

Pies' recent post is one such example where our respective disciplines come along side each other, Care of the Soul in the Time of COVID-19. He identifies five assaults on the soul made by the pandemic: impotence, grief, loneliness, mistrust, and displacement. While underlining that one solution will not work for all, he proposes cognitive therapy, gratitude, and the arts as strategies for healing.

Therapy and Spiritual Direction

As a physician, it is natural that Dr. Pies would write of problems and solutions. I too have been thinking about the larger implications of the COVID pandemic. However, I do less pastoral care these days. My thinking has been more in the realm of spiritual direction. Spiritual direction is as likely to trouble the mind as soothe it, raising questions to ponder rather than soothing manifestations of distress. So my care of the soul focuses on the questions that COVID raises about identity, values, and purpose. 

Identity

Misconceptions about Suicidal Thoughts

My publicist seems to think people have a lot of misconceptions about mental illness (she's right), because many of her questions go there. You are very open about discussing your own struggles with suicidal thoughts. What do you think are the biggest misconceptions about people going through similar experiences? So today's post will focus on suicidal thoughts or suicidality.

Suicide is not a choice

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

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

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

What People with Depression Need to Hear

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

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

Five Things to Say to People with Depression

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

Misconceptions about Therapy

Continuing the press kit-inspired series...

No, therapists aren't like friends that you pay

Therapists make you work. The work you do depends on the kind of therapist you see. Interpersonal therapists get you to examine your relationship patterns. Are they working for you? Are you sure? Social rhythm therapists make you track your schedule. For people with bipolar, an off kilter schedule results in an off kilter brain. (The chart I use is here.) Cognitive behavioral therapists even give you work sheets! Mostly this homework involves learning to examine your thoughts. Just because your brain tells you something doesn't mean it's true.

No, therapists don't give advice