Ten years ago I retired on a mental illness disability. It was a relief. It was dreadful. It was a heartbreak. And I was pretty sick. Being a priest is a public job, and mine had been more public than most. So between retirement and the mental illness that led to it, I felt isolated and had a serious case of Who the hell am I, anyway?
But I sat down, signed up for a blog, wrote my first post, and there it was, my new life, Prozac Monologues: Reflections and Research on the Mind, the Brain, Mental Illness, and Society.
This is the place where I have recorded my learning about what happened to me: genetic variation, childhood trauma, wonky wiring, unhappy mitochondria, that broken internal clock... followed by misdiagnosis of Major Depressive Disorder, inappropriate antidepressant medication, a bit of psychiatric manipulation, a new diagnosis of Bipolar 2. And then recovery. Not cure, but recovery, as in the way I live the rest of my life. It is where I have puzzled through philosophical issues about mental illness and its treatment, political issues about society's response, stigma/prejudice, the use of language, how art can soothe the savage brain, how mental illness comedy can give voice to what cannot otherwise be said. It is where I have discovered psychiatrists and others whose work I admire: Ronald Pies, David Conroy, Hagop Akiskal, Jill Bolte Taylor, John McManamy, Nancy Andreasen, Nasser Ghaemi, and some others... not so much.
My readers have read my rants, my musings, and even my sermons. And some of you have made comments that told me I needed to keep going. Which I did. Thank you for that. To mark the occasion, Prozac Monologues, the blog has been given a facelift. There may be a few more tweaks in the days to come. Actually, I'll invite you to make suggestions. Broken links have been removed from the Mental Health Break list on the right. I could use some new ones. What are your favorite videos and sites that would fit the category? Click the link for comments at the bottom of the post. One more thing: Prozac Monologues: Are You Sure It's Just Depression -- promised so long ago in that first post will be coming to your local bookstore in September 2020! Published by She Writes Press, distributed by Ingram Publication Services, you can follow its progress on my author page. And Twitter, that thing into which authors are dragged kicking and screaming by their publicists (mine is JKS Communications), yes, I am on Twitter, too @WillaGoodfellow. Again, thank you for reading. That will be my dedication in the book: I wrote this for you.
Anosognosia. It means lack of insight. But from the mouth of Xavier Amador, it’s his ticket. He tells you he knows why your son or daughter won’t take meds. And you are desperate for the answer, aren’t you. Because schizophrenia is a terrible disease and your beloved child is sick and won’t take the meds. The meds would make everything alright. So you are desperate and Xavier Amador throws you a lifeline, a promise that once you understand this unpronounceable word, you can learn how to get your child to take the meds.
He must be right, right? Because he is a psychologist and he can pronounce it. And then the kicker, he also loved somebody with schizophrenia, and he says he got him to take the meds. So NAMI invites him to give the spotlight lecture, and for the rest of the convention, parents hear every other presentation through the filter of this new word that they cannot pronounce.
Here is how you pronounce it:
But really, why bother? It means lack of insight. But you have heard of lack of insight before. And you can pronounce lack of insight. So those words don’t have the power to claim you and get you to buy his book like anosognosia can.
Actually his advice is not bad, once you get past the power play. Stop fighting your sons and daughters, stop trying to convince them that they are sick. Instead, build a relationship.
Listen: reflectively with respect and without judgment
Empathize: strategically with emotions stemming from delusions and anosognosia
Agree: find areas of agreement - abandon the goal of agreeing the person is sick
Partner: on those things you can agree on -- not being ill
I like that advice and have given you a clip of the best part of the presentation.
Now if you will permit a word of advice about relationship-building from somebody who has a mental illness and occasionally does not recognize when her symptoms are showing - ask us why we don’t take our meds.
I met a new friend at last month's NAMI convention. I explained that I wasn't going to this presentation, I had heard it a number of years ago. Then I said, "Ask us why we don't take our meds." She said her son says they make him feel terrible. Bingo.
Now it's true, sometimes people with schizophrenia have delusions that make reality testing difficult. Sometimes people with bipolar in a psychotic or manic state do not recognize that state. I have on occasion rejected my spouse's concerns about my hypomania. And some of us do go off our meds in these temporary states.
But NAMI does a disservice to family members by giving them this fancy word that substitutes for believing what their loved ones tell them. These meds suck. They cause ballooning weight gain, leading to heart disease and metabolic disorders which shorten our poor pathetic lives by ten years on average. They evaporate our sex lives (not that parents want to hear about their children's sex lives.) They fog our brains and drain our energy, leaving us with lives that are not worth living.
Nobody talks about what Nancy Andreasen discovered after fourteen years worth of brain scans of people with schizophrenia -- the more antipsychotics you take, the more brain volume you lose. National Medal of Science recipient, one of the world's foremost experts on schizophrenia, yes, Dr. Andreasen remembered to control for things like severity of illness and alcohol/illicit substance use. Neither affected the results. It was level of dose and length of treatment. The more antipsychotics you take, the more brain volume you lose.
[Funny thing, soon after she published her preliminary results, her funding evaporated.]
A conversation about why we should take our meds anyway really has to include an acknowledgement of the fact that these meds suck. True acknowledgement, not some sort of mental crossing of fingers behind the back, with the all-knowing family members chanting Amador's magic power potion, anosognosia, under their breath.
Half the people who won't take their meds think they are not sick. Those are Amador's numbers and I won't dispute them. And if you don't already know that delusions are not the sort of thing that somebody can be talked out of, then I suppose he does a service to tell you that. But are you sure that's why your loved one doesn't take the meds? He's got a whole ballroom filled with people who now believe it, and who take any other protestation to the contrary as proof of anosognosia.
Okay, that's my first objection to NAMI's sponsorship of Xavier Amador's presentation at not one but two of the three NAMI conventions I have attended. Dammit. His half truths.
The second is that his presentation is a parlor trick. Really, two parlor tricks. The first is that unpronounceable word by which he's got you. He has established the power of his credentials over you. He is the expert.
The really disturbing parlor trick is his demonstration of what a delusion is. He gets a volunteer from the audience. Then they do a role play. The volunteer answers questions about his/her spouse. Then Amador does an "intervention." He tells the volunteer that s/he has been stalking said "spouse," who is not actually married to the volunteer after all. The marriage is a delusion. The volunteer has violated no-contact orders, and they are going to get the person help. There are people just outside the door who are going to take him/her to the hospital. This goes on for a while, demonstrating that Amador is indeed not able to convince the person that the so-called spouse is a delusion. Voila! Anosognosia.
Now one interesting thing about this demonstration is that we are to take it as a demonstration of the power of delusion. But in fact, the volunteer is not deluded. The volunteer genuinely is married to his/her spouse, and ends the demonstration still sure of the fact.
What Amador has actually demonstrated is called gaslighting. The volunteer does not fall under the spell, does not forget the spouse. But the audience does. The audience is convinced that this demonstration demonstrates something more than mental cruelty, that they have learned something about the power of delusion, which, again, never existed in the first place. And he knows that this parlor trick is harmful, because at its conclusion he gives the volunteer advice about how to recover from it.
But there are those who do not fall under the spell, those who have seen it before, in some other psychologist or psychiatrist's office during a professional visit. That's why one person left last month's demonstration sobbing, and why I spent an afternoon in concentrated self-care after my exposure to this presentation years ago.
Here is an example: I call my psychiatrist to get help for symptoms I am having from withdrawal from Effexor. She says I don't have withdrawal symptoms, because it is not possible to become addicted to Effexor in the short time that I took it. I persist, I am having the withdrawal symptoms described in the literature and need help. Now who do you believe? She, after all, has a PhD in psychopharmacology as well as her MD. And I am a self-confessed mental case who insists on stopping this medication that she thinks I should be taking.
I took my wife with me to my last appointment with that psychiatrist, so she could report what happened in the office to my therapist who had slapped a new diagnosis on me based on my own reports.
Amador is not that psychiatrist. He is the trigger for the reliving of that psychiatrist because he uses the same techniques:
1. Establish the extreme power differential, in one case her academic degrees over my addled mental state, in the other his five-syllable word over the uninformed audience who cannot wrap their tongues around it.
2. Take the moral high ground of compassion, trying to help, a position over the other.
3. Say whatever the hell you want.
4. Refer any protestation back to #1.
Yes, there is a kernel here. Stop fighting your loved one. Build the relationship. But the parlor tricks do real damage. Isn't it time to retire this presentation from its position as the major Friday night presentation at NAMI conventions?
Eight years ago I wrote "I don't believe in God anymore." It was the title of a book chapter, a book reflecting on suicide from a Christian perspective, though probably not the Christian perspective that you think about when I say that. More like what goes through the mind of a Christian who is suicidal and is bringing what is left of her theology to the experience and desperately trying to tell the truth about it. The truth. Not what we want the truth to be. Just the truth. It wasn't exactly a suicide note, though it might have been taken that way if that's the way it turned out. It didn't turn out that way. I recovered. "I don't believe in God anymore" anticipated that I would recover, but that wouldn't make the problem go away. Relapse was statistically probable. I might be in that darkest of places again. This chapter dealt with the problem of suffering. Oh, how tidily that phrase expresses the chaos of a believer's brain when looking into the abyss. But I wouldn't let the tidy answers stand, and I still won't. While I am not so bitter anymore about this remitting, recurring condition of mine, as far as God goes, well, I just don't know as much about God as I used to. Here is a piece of that chapter: Although my own soul is a dry desert, I have deep wells from which to draw. While I do not believe in God, so I cannot say the creed, I cannot set my heart on the One who has broken it, I still believe in the communion of saints. As a Christian, I have a big family, across space and time. For now, I ask the rest of my family to do my believing for me. The lament psalms persist in worship, and worship is how I persist. I listen to Gospel music. I sing along with those whose music it is. I do not have their faith. But I cannot dispute their testimony, what God has done for them, and the power they find in God to get through. I believe in them. I believe in the Brooklyn Tabernacle Choir.
Those whose ancestors survived the Middle Passage, survived slavery, survived Jim Crow, survived the Klan, who still survive today, I don't know how they survive. But they assure me, and I listen to them tell me over and over: Everything He said in His word, He will do it for you. Every prophecy he gave, every promise He made, He will do it for you. Eight years later, I am in remission, not depressed, not even a shadow for the last six months. An eternity! I have challenges. I manage my condition every single day. And my life is good. I work toward a publication date of September 2020. There will be something that comes out of that old hellhole, a book, a different book that offers help and hope to others who have been misdiagnosed and inappropriately treated as I was. And I am very proud of it, Prozac Monologues, the book.
I am not saying it was worth the price. I am not saying that my God issues have been resolved, that some promise was kept, and it's all okay because there was a happy ending. You can say that if you want. But it's a slippery slope, hanging your faith on the happy ending.
David Conroy wrote, Suicide is not chosen. It happens when pain exceeds resources for coping with pain. There is some truth for you. I have been blessed by enormous resources, and they have kept me alive through enormous pain. One of those resources is an unshakable experience of the communion of saints, those who have been there for me across the centuries, from Jeremiah to John of the Cross to the friend who said my prayers for me when I confessed I couldn't pray anymore to the Brooklyn Tabernacle Choir. I went to church on Sunday with a CD by The Brooklyn Tabernacle Choir. It reminded me of that chapter. And I thought it was time to say thanks. They carried me through.
photo of candle by anonymous, used under Creative Commons license
Spirituality has a troubled place in the psychiatrist's office. A recent PsychiatricTimes.com article explores the complex reasons. The discomfort starts in "the traditional psychoanalytic view of religion being almost a culturally sanctioned form of neurosis" and continues through the modern diagnostic schema, "it is not uncommon to have delusions with religious or spiritual elements." While the DSM, the manual that guides diagnosis of psychiatric ailments takes care not to label as delusional any thought that is part of the cultural framework of the patient, this fig leaf seems to beg the question - is the patient's culture built on delusion?
Neurotic or delusional - which would you rather?
Honor the physician
The issue is made thornier by the recent development in Christianity that pits faith against science. And I cannot stress enough - this is a recent (also North American) development. Alas, what was once a minority voice within American Christianity has gained political and cultural power and, in this country at least, threatens to drown out the traditional Jewish and Christian view, as expressed in the Book of Ecclesiasticus:
Honor the physician with the honor due him, according to your need of him, for the Lord created him; for healing comes from the Most High, and he will receive a gift from the king. The skill of the physician lifts up his head, and in the presence of great men he is admired. The Lord created medicines from the earth, and a sensible man will not despise them.
Again alas, not a lot of sensible around these days. I don't even want to give you the link to the page that headlines, Psychiatry is a vicious enemy of Christianity and the Bible. In bold type, no less. One can hardly blame doctors for suspecting those who make them choose between religion and the gifts that God gave them.
Now there are plenty of psychiatrists who recognize this choice to be nonsense, among them one of the psychiatrists interviewed in the article above. While president-elect of the American Psychiatric Association, Paul Summergrad "convened a gathering of clergy, other faith leaders, patients, and patient advocates with a group of distinguished psychiatric leaders. [Their] first goal... was to establish a dialogue and recognize common goals. [Their] work group developed a guide for faith-based leaders, which can be found and downloaded... from the APA website. "
A Guide for Faith-based Leaders
This guide has good stuff in it, and I commend it to faith leaders. But there is something about it that bugs me. It bugs me in most stuff that I have read written by people who approach spirituality from a scientific point of view. It is found in their description of wellness. Wellness means overall well-being. For people with mental health and substance use conditions, wellness is not simply the absence of disease, illness, or stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful. relationships, a healthy body and living environment, and happiness. It incorporates the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person's life. Each aspect of wellness can affect overall quality of life.
There is a graphic that demonstrates each of these aspects as separate items, presumably of equal weight, with Wellness at the center.
Well, what's wrong with that? I am just not sure that spirituality can be turned into an item among others. I am a priest. Spirituality is my life. But I can't figure out how to use it to promote my wellness. God uses me. I have no idea how to use God. And frankly, I suspect those who do.
Wellness vs. Wholeness
What would that graphic look like if theologians created it? For one, at least for this one, Wellness would not hold central position. Wholeness would. Not exactly the same thing. Wholeness is how to describe spiritual health. It is a translation of the Hebrew shalom or Arabic salaam. It means the kind of peace that comes from completeness and includes the completeness or justice of the community. It does not depend on financial, environmental, nor physical health. How one addresses either presence or lack of financial, environmental, and physical health is a measure of spiritual health.
Doctors are about the business of maximizing wellness. That is their job and, from a spiritual perspective, their calling. That's fine, and this wellness paradigm is fine. Except for the spirituality part. Spirituality is a different paradigm.
Well, I have only stated my starting point here. Perhaps this sounds like nonsense to you? Spirituality is peddled today as something to make you feel good. Okay, let me put it out there. Feeling good, as a life goal, is the goal of a spiritual peanut.
This blogpost will just have to become a book. I would like your help. What are the questions you would like to explore about spirituality and mental illness? Like, can you be whole and mentally ill? Does prayer really work, and how? Does it make a difference what you believe? Add a comment. Thanks.
cartoon from @lectrr
photo of St. Luke (patron of doctors) window by author
In Priests, Providers, and Protectors: The Three Faces of the Physician, Ron Pies proposes a third way to view physicians, not exalting them to the grandiose position of Priest nor demoting them to mere Provider. In the role I call the Protector, the physician's chief obligation is that of the safeguarding of the patient's physical, emotional, and spiritual well being.
This is a role that acknowledges the patient's autonomy, while recognizing the physician's expertise and the ethical imperative to use that expertise to express foundational principles of the medical field: beneficence, nonmaleficense, and justice. Do good, don't do harm, and I'm not sure what he means by justice, though I have some ideas. The examples below are mine, not his.
Several years ago I took Prozac for what was then thought to be Major Depression. The hypomanic episode it precipitated gave me a book. But before that, it gave me the runs. Since my first doctor thought the runs would go away on their own, but I was about to leave for Costa Rica and wanted them to go away faster, I sought a second opinion. The new patient form asked for my full history, and I told the truth about my depression, as well as the runs.
What follows is an excerpt from Prozac Monologues, the book to be published next year. It describes that appointment. I offer it as an example of a doctor functioning as priest. [See last week's commentary on Ron Pies' article, Priests, Providers, and Protectors: The Three Faces of the Physician.] Not the Father kind of priest, but the more ancient healer/witch/shaman kind. It's tricky to handle the power of the priesthood. But I want doctors to manage that power responsibly, not give it up on account of its ambiguity. It is the power of relationship. We need doctors to use every power at their disposal to heal. Priesthood is one of those powers.
The Look
...When the doctor looked at the piece of paper with all those words circled on it, she didn't smile at my weak attempt at humor. Oh well. What she was most concerned about for my trip to Costa Rica was how I would manage my depression as the Prozac was leaving my system -- which I could tell it was, because the dark suffocating cloud was coming back.
The kind of guy I'd love to meet for coffee and conversation, Pies added to my fascination an article reflecting on his role as a doctor, Priests, Providers, and Protectors: The Three Faces of the Physician. See, my senior thesis reflected on my own future role as priest, the ordained kind, Is the Holy Spirit an Equal Opportunity Employer? Both of us take on the notion of priest as Father.
"Yes, Father, I've been taking my medicine." A patient's slip of the tongue led Pies to recall the ancient connection between the roles of healer and holy person. It's a natural connection, if you consider the divine will to be for healing. It doesn't matter what faith tradition you examine. The two roles were originally one.
The Three Faces of the Physician is the subtitle of a recent article in Psychiatric Times by Ronald L. Pies, MD, Professor in Psychiatry at SUNY and Tufts, Editor in Chief Emeritus at said e-zine, bioethicist, and aspiring mensch. Dr. Pies and I have been allies on a certain DSM revision. We once butted heads over the nature of suicide. And he has provided valuable assistance in the science chapters of my soon to be published book Prozac Monologues: Are You Sure It's Just Depression? His (typically) thoughtful examination of the shifting role of physician calls for a response from the side of the relationship, the confessant, consumer, and cared for, aka patient. My (typically) thoughtful response will be in three parts, starting in the middle of this alliterative stew.
Pies has many problems with the title provider. It blurs the distinctions among the various health care team members, their roles, responsibilities, and contributions. It obscures the dignity of a highly educated, hard working and dedicated profession. It compromises the relationship with its counterpart, the consumer who comes to the exchange overvaluing what she has learned from her internet searches and trying to tell the doctor what to prescribe.
Consumer Movement
Pies traces the origins of the provider usage to two things, the consumer movement in medicine and the encouragement of the insurance industry. There are good things to be said about the consumer movement, he acknowledges. I will list a couple of them here.
Every once in a while, Prozac Monologues reaches into my Roman Catholic childhood's fascination with saints, especially the ones who today might be assigned a diagnostic code in the DSM. Twice, Lent Madness has introduced me to new ones that I share with you.
Today it's Margaret of Cortona. If you're a Lent Madness regular, you'd expect Margaret to be a shoe in for the first round of voting, where her competition is a stuffy old bishop/theologian, because Margaret became a Franciscan and, more significantly, her story features a dog. Lent Madness voters are suckers for dogs.
There are several parts, each playing its own position and fulfilling a particular function. Together they run plays that have been rehearsed and repeated over and over, many until nearly automatic. The behavior of the other team/environment requires adaptation of these plays, often in mid-play. And communication among the members is essential.
Here is how they line up on the brain field. Analysis is at the front, near the forehead. Memory and emotion hang out together. Coordination is at the back. Basic life functions are at the base of the skull. Communication runs through the middle, connecting them all to one another.
Misfirings and mis-timings of a number of systems affecting: hormones, neurotransmitters, and immune system cycles that go off-kilter; glitches in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain -- that's bipolar disorder in a nutshell. Okay, a very full nutshell. Last week I explored one example of hormone cycles gone off-kilter, cortisol.
This week, we go inside cells to discuss my favorite little critters, mitochondria. I first learned about mitochondria from Madeleine L'Engle, from the second of her Wrinkle in Time series, A Wind in the Door. Charles Wallace is sick, dying, because of a problem inside his cells. His mitochondria are not doing their job.
Mitochondria are organisms (technically, organelles) that crawled inside the cells of animals back when animals were being formed out of the ooze. It is a beautiful relationship. We are their hosts and meal ticket; they are the power plants that convert food into energy. If they don't work well, neither do we. Since the brain uses bucket loads of energy, a problem with energy production has serious consequences for anything the brain is supposed to do.
Y'all know about Bipolar as the mood disorder of Up and Down. You have seen the movies, watched the soap operas and dramas. The medications promise to reduce the number of trips around the loop de loop.
That's important, because what goes up must come down, and the fall can be mighty. But there is more to is that that.
In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to maintain balance. The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.
In other words,
Over the next few weeks, I will sample this list, especially the items that are true all the time, even when not on that roller coaster.
Dysregulation of cortisol is one of my favorites, to use the term loosely. Cortisol is the get-up-and-go hormone. It gets you out of bed in the morning and manages energy throughout the day in response to stress.
And the Prozac Monologues Tutorial on Bipolar Disorder continues, with installment #3.
Bipolar starts in the genes. But there is no smoking gun. There is no genetic defense. If you mortgaged the house, went to Vegas, lost the money, caught a disease, now you're in divorce court and maybe jail, nope.
Your genes did not make you do it.
The way the scientists put it, genes do not code for behavior. Okay, as last week's post says, it starts in your genes. But you are not doomed to end up in divorce court. You have just got some extra challenges to surmount.
Mental illnesses are developmental. They start with a brain that has certain vulnerabilities which come from genetic variations from the norm. These are vulnerabilities, not scripts.
Your genes — that’s where bipolar gets started. Of all the mental illnesses, bipolar is the most heritable. That means it has the strongest genetic connection. In studies of identical twins, if one twin has bipolar, so does the other in 75% of the pairs. That compares to 60% with depression and 35% with schizophrenia.
If one parent has bipolar, a child is 13 times more likely to develop bipolar than a child with parents who do not have the disorder. If both parents have it, the child is 36 times more likely to develop it.
So you go to your doc and present symptoms of depression. Your doc will ask, Does anyone in your family have bipolar? But that's not the question you will answer. When you say No, the question you are probably answering is, Has anybody in your family ever been diagnosed with bipolar — that you know about?
While Prozac Monologues the book is on its way to publicationđŸ˜²Prozac Monologues the blog is being revived. I start the revival with a preview/expansion series on the chapter called Balancing Act, aka, The Science Chapter.
A friend who happens to be an academic psychiatrist reviewed The Science Chapter. He wrote, Pathophysiology of BP is really tough, even for us "bigwigs", and I hope you have some success summarizing it for a non-professional audience.
So I said, Hold my beer. And here it is: In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to rebalance. The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain. Okay, that will take some unpacking, which I will do over the coming weeks. Meanwhile, it's like this:
The news story caught my ear. I don't usually follow celebrity news. But I had just read an article about Demi Lovato in a NAMI magazine. I listened for some report of who she is and what she represents. I wondered about a recent depression, a suicide attempt, perhaps.
Nope, not a word. Celebrity drug overdose. That's the story. I swear they wrote this story thirty years ago, periodically pull up the file, change the name, and post.
She deserves better. I'll just have to write my own post.
Lovato has long been open about her mental illnesses, bipolar, bulimia, self harm, drug abuse, and alcoholism. Her celebrity as a pop star is significant to the story in one way. It has given her a voice to advocate for those who have no voice.
Celebrity is not a risk factor for substance abuse. But an alcoholic father is. She has the genetic load to develop the condition.
Celebrity is not a risk factor for substance abuse. But childhood trauma is. She was bullied as a child, to the point of resorting to home schooling.
Celebrity is not a risk factor for bipolar, either. But substance abuse and bipolar do often go together. 56% of people with bipolar struggle with addiction. Why so many? There are three potential explanations:
Prozac Monologues -- the book -- is coming! It really is. Well, a chapter and a half still to go.
Here is a sneak peak that may answer the burning question,
Why are you wearing red on World Bipolar Day?
It's called:
Three
Have you ever noticed -- flight of ideas, distraction, talking fast/pressure to keep talking -- these are symptoms of a serious mental disorder (we're talking the manic phase of bipolar here) and also kind of -- fun.
It's Mental Health Month again. Out comes the stigma word, the pleas for understanding, the heart-warming whatever.
I am so done with stigma. Frankly, I am insulted that NAMI et al still use the word. Is Black Lives Matter about stigma? It's dangerous to be either in the US, and for the same reason. Prejudice, people. We are talking about prejudice. The following was first posted in July 2013. Alas, we are still trying to get our heads out of our asses. The Affordable Care Act made some progress, a little, toward mental health parity. Insurers had to get creative to deny us coverage. But this congressional session, it's all up for grabs again, whether our illness will get covered at all. And the prejudice of doctors -- don't get me started. So from July, 2013 --
************************* 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>.
I opened my curtain this morning, saw a brilliant blue sky, and remembered, "April is the cruelest month..." April is when suicide rates start to rise, to peak in June. Then, as is my habit, I said Morning Prayer, a spiritual discipline of prayers, psalms and bible readings. The assigned psalm for today is Psalm 20:
May the LORD answer you in the day of trouble,
the Name of the God of Jacob defend you;
Send you help from his holy place
and strengthen you out of Zion;
Remember all your offerings
and accept your burnt sacrifice;
Grant you your heart's desire
and prosper all your plans.
We will shout for joy at your victory
and triumph in the Name of our God;
May the LORD grant all your requests.
If April is the cruelest month for you, my friend, I prayed this prayer for you. Now, this sort of thing doesn't always help me. And no blame, God, no blame, if it doesn't help you. But if it does help you today, there it is. We will shout for joy, you and me and all of us who know what I am talking about, at your victory. And while I have anybody else's attention, suicide prevention is not usually a dramatic, last minute intervention. Suicide happens when pain exceeds resources for coping with pain. Let me repeat that. Suicide happens when pain exceeds resources for coping with pain. Every day, in any little way, you are a resource. Or not. Kindness. That's the ticket. Just pay attention to someone who may be struggling. And do something, anything kind. That's all.
[When I Googled mental illness in the bible, I was, frankly, appalled by what came to the top of the page. So I hope this banal title will make a better message easier to find. If you share this post, you can do that service.]
I don't often preach about mental illness. I'm not sure I have ever heard more than a mention of it by any other preacher. But today the lectionary asks us to tell stories that are not told.
Because we are no strangers to mental illness,and neither is the Bible. There's Saul, his bipolar episodes and his suicide. There's Job and Jeremiah, hardcore depressives. There's neurotic Paul himself, though that diagnosis has gone out of fashion. And Ezekiel, well, you'll have to read him and decide for yourselves.
Last week a friend told me she had just been diagnosed with bipolar. I remember eight years ago when she told me she was finally getting treatment for depression. I didn't say it at the time, but for the next several days my brain was screaming it: Really? In 2016 people are still being misdiagnosed, and mis-treated, mistreated with meds that make them worse. I mean,
F*cking Really?!!
Lives are at stake here, people. Careers, families, credit, and yes, lives. That is what people lose when their doctors get this call wrong.
Today is Vincent Van Gogh's birthday. Some people give him a post-mortem diagnosis of bipolar disorder, and take the occasion to declare World Bipolar Day. Healthcentral.com contributor John McManamy says for him, every day is bipolar day.
As for the world in World Bipolar Day, precisely which world are people talking about? In my memoir, I note: Maybe someday, aliens will kindly abduct me and return me to the planet of my birth. In the meantime, I'm stuck on this one, not a planet of my own choosing, performing my own stunts, learning as I go along. As I like to joke: We're peanut butter people stuck in a tofu world governed by Vulcans.
Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you. By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?
I have written reams on suicide and suicide prevention. Click on those two links and take your pick. But skip the Suicide Monologue, at least for another week. It is inappropriate for another week. And if you do go there, then mind the humor alert. I am serious -- about the humor alert, that is. Some of you won't find it funny. It wasn't written for you.
But before we abandon the suicide conversation in favor of the next thing, let's expand the frame. Here's the deal. Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.
I can't say we will think about suicide. Those of you who think about it in passing seem to think that the seriously suicidal think. There is lots going on inside our burning brains. But thinking doesn't really describe it.
It amazes me how many research scientists seem to have flunked statistics. Or ought to have. Me, I majored in the liberal arts. But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.
So the vocabulary terms for the week are observer bias and confounding variables. No worries -- lots of pictures. Clinical Experience in Defense of Prozac
Let's say you are a doctor treating 100 patients with severe depression. You give them all antidepressants. It seems irresponsible not to, doesn't it. Thirty of them get better. Fifteen do not make a follow-up appointment. You switch the fifty-five who are still trying to another antidepressant. Another fifteen get better. And another fifteen do not make a follow-up appointment.
Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling. You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea. But you have fifty patients who think you saved their lives. You feel pretty good about yourself, don't you.
Do antidepressants prevent suicide, or do they cause it? Yes. Well, maybe. It's a no-brainer, right? People who commit suicide are depressed. Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide. So what's with the question? Here is the story: History of Antidepressants
Richie had a fisherman's philosophy when it came to story telling. He inspired, or provoked, or was co-conspirator in many of the Bar Tales of Costa Rica. The following excerpt is my tribute to this cowboy/hippie/mystic who will be sorely missed.
Apology
There is one particular table at the Pato Loco where deals
get made over American breakfast.Mama,
who has overheard a lot of deals being made, said, “It gets so you can tell the
real ones from the ones who are all talk.Paul, he never talks about his deals.He’s one of the real ones.But
that Jerry who reneged on the house, you could tell he was all blow.”
Basil the Great vs. Christina the Astonishing – Lent Madness
begins.
Saints and Lent – is Prozac Monologues straying from its
mission, reflections and research on the mind, the brain, mental illness and
society?Hardly.First, note the Madness in Lent Madness.Then wait ‘til you see the saints.
Lent Madness
The forty days before Easter are traditionally a time to
focus on one’s spiritual growth.But there is a looniness built in from the start.Ash Wednesday to Holy Saturday – count them –
46 days.Oh yeah, Sundays don’t
count.Does that mean I can smoke and
eat chocolate on Sunday?Opinions vary.
And once you are debating whether you can smoke on Sunday
(does it depend on what you’re smoking?), you have already leaned in the
direction of madness.Leaning, leaning…
I peered over this very overpass on the Eisenhower Expressway. Years ago, there was no the fence along the top, just a rail. It was pie that brought me there. Yes, pie. It was Thanksgiving night, and the holiday was ending without pie.
Of course, it wasn't a reason to commit suicide. Of course, suicide is a permanent solution to a temporary problem. Don't treat me like an idiot with your clever lines.
No, pie brought me there, but that was not why I would jump. Pie was a match, a tiny little three letter match. My problem was a brain filled with gasoline. And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge. The shame of being powerless over one tiny match poured on more gasoline.
Guilty pleasure: Eavesdropping on psychiatrists talking with each other about us loonies. Like many guilty pleasures, it is not always good for my well-being. But I am endlessly curious. And it has yielded a number of blogposts in the OMGThat'sWhatTheySaid thread.
My go-to source for blog material is Psychiatric Times. It reports the latest news and research in Loony Land. It reflects on the practice of psychiatry. Sometimes it turns to mud wrestling. Oh, the good ol' DSM days!
I want to be Andrew Solomon when I grow up. Only briefer. And funny.
In the absence of blood tests, people with depression have words. And Solomon has a lot of them.
Solomon's book The Noonday Demon: An Atlas of Depressionsits by my bedside. I'll get through it someday soon, because I want to tell potential publishers that Prozac Monologues is Noonday Demon, only briefer. And funny.
Solomon went around the world to report how the world experiences depression. Yes, he found it everywhere.
Last week when I told my doctor I was going to Costa Rica, he asked if I would feel better there. You know what? People in Costa Rica get depression, too. Hard to imagine, I know. But it's true. They have psych wards and therapists and ECT and everything in Costa Rica. I have a card for a psychiatrist in San Jose, just in case.
