May 11

“Lost Marbles”: Living with “Depression & Bipolar”

This is the book that medical students should read, not the DSM. Jim Phelps, MD, reviewing Lost Marbles: Insights into My Life with Depression & Bipolar

Part memoir, part self-help, Natasha Tracy‘s Lost Marbles: Insights into My Life with Depression & Bipolar, is a collection of articles she’s written that have previously been posted at Bipolar Burble and Breaking Bipolar over the course of several years.

Quotes excerpted from an interview Leslie Lindsay conducted with the author:

One of my strengths, I feel, is to write about mental illness in a way that is real, honest, gritty and not sugar-coated. I say the things that people with mental illness think but don’t have the words to express. This is why people identify with my work so strongly.

I don’t believe in the concept of “stigma” per se. What I believe in fighting is prejudice and the inevitable discrimination that follows it. I believe that by making people with mental illness three-dimensional people with real emotions and real struggles, we actually start to sound just like everyone else – just amplified.

[If diagnosed with bipolar disorder]…(I)t’s important to know that the world is not ending, there will be a tomorrow and there is an innate you that will not disappear. That said, the world, the tomorrows and even you, will change in response to the illness. Again, this is normal and natural. Most people never get back to a pre-bipolar state.

There are many things a newly-diagnosed person can do. Firstly, it’s important to get the best bipolar specialist psychiatrist and therapist one can find and create a treatment plan that makes sense for the individual. Then the treatment plan must be followed. It’s also important to lean on loved ones during this time as they will connect a person to who he or she really is.

It’s an unfortunate truth that for many in the United States the cost of medication is very high. That said, the drugs, while laden with issues like side effects, save lives every day. Many people would have taken their lives without these medications. Yes, there is no doubt that they are expensive and have other associated issues, but when it comes down to life or death, a functional life or a life spent in psychosis, there is no doubt that they are still worth it.

Some helpful resources suggested by Tracy in the interview:

If you want a sampling of Tracy’s writing before getting Lost Marbles, here are just a few good choices:

For further info go to Tracy’s YouTube page.

Apr 25

Mental Health Stigma Arises from Language

One of the clues to mental health stigma is in our language. Why do many, for example, talk in hushed tones about the “mentally ill” but are not so judgy or secretive when reporting about the “physically ill?”

More specifically, why do we say someone “is” his or her diagnosis, e.g., he or she IS schizophrenic, versus saying that person “HAS schizophrenia”? Do we ever say so and so “IS cancer”? Or “IS a broken leg”?

Mental health stigma is definitely at play. Another language example comes from researchers at Ohio State University. They reported (Science Daily) that when participants heard about “the mentally ill” they showed less tolerance than when they heard about “people with mental illness.”

What is “mental illness” anyway? A few definitions:

  • American Psychiatric Association“…health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”
  • National Alliance on Mental Illness: “…a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis.”
  • Mental Health America“…a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.”

Psychiatrist Thomas Szasz (1920-2012), on the other hand, famously proclaimed “the myth of mental illness” in his “Manifesto” :

Mental illness is a metaphor (metaphorical disease). The word disease denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term mental illness refers to the undesirable thoughts, feelings, and behaviors of persons.

Likewise, David Oaks, a “psychiatric survivor” and founder of MindFreedom International, has proposed that “‘mentally ill’ reflects a medical model that’s too narrow. If you’re okay using this model about yourself, that’s one thing, he adds, but it shouldn’t be the only way of looking at things. Thus he goes further:

…Let’s stop legitimating the use of words and phrases like ‘patient’ and ‘chemical imbalance’ and ‘biologically-based’ and ‘symptom’ and ‘brain disease’ and ‘relapse’ and all the rest of the medical terminology when we are speaking about those of us who have been labeled with a psychiatric disability.

What kind of language might serve us better?

Are we supposed to go the way of insurance company lingo, I wonder, and try to view issues as “behavioral health” versus “mental health”? Less about your brain or having an illness, more about what you do? Even though they simultaneously require billing codes that label people with mental disorders in order for them to qualify for coverage?

Anne Cooke, PhD, proposes the following to psychiatrist Allen Frances in a Psychology Today post on a related topic: .”..Why not just use people’s own language? That way we enable people to define their own experiences and avoid imposing our own ideas on them.” (This advice would be more applicable to everyday or clinical usage than helping clients use their insurance coverage, I need to add.)

But what about, asks Frances, the more severe issues that actually require proper diagnosis or labeling in order to have an understanding of how to resolve them? Back to an earlier analogy, a broken leg can’t be properly fixed if we don’t diagnose it correctly in the first place.

No easy answers, but a combination of knowledge and sensitivity will at least guide our communication toward some better places.

Dec 21

Asking For Help: Why So Hard For So Many?

I think the number one reason why people don’t ask for help is simply fear. Fear that others will judge them for seeking help, fear that others will see them as weak or damaged. This fear is the same kind of fear that holds many people back in their lives. John Grohol, Psych Central

Why is asking for help—of any kind, not just the therapy kind—often so hard?

Peggy Collins, author of Help is Not a Four-Letter Word (2006), thinks many of us suffer from “Self-Sufficiency Syndrome,” which is “characterized by an inability and unwillingness to ask for help or delegate because of the belief that no one can do it as well as you can.”

Jeana Lee Tankh (Huffington Post) lists some other aspects of this syndrome:

There are short-term payoffs that self-sufficient people experience such as singular control, approval from others, career enhancement and self-confidence, all of which act as a catalyst for the behavior. Yet, when self-sufficiency is taken to the extreme, the burden of too much responsibility can cause stress, unrealistic expectations, lack of self acceptance and no acknowledgment of personal needs.

When writer Alina Tugend (The New York Times) also researched why we don’t ask for help, she cited  both M. Nora Klaver‘s May Day! Asking For Help in Times of Need and Garret Keizer‘s Help: The Original Human Dilemma. Some of the various reasons include, said Tugend, “not wanting to seem weak, needy or incompetent,” fear of “surrendering all control,” fear of obligation and indebtedness, and lacking the skills to do it effectively.

Dr. Deborah Serani can remedy that last one. But first she cites (in a blog post) some myths that can prevent us from asking for help:

  • It makes us look vulnerable.
  • Holding things in and keeping personal issues under wraps keeps us secure.
  • It bothers others.
  • Highly successful people never ask for help.
  • I am a giver. I don’t like when others help me.

The truths, in a nutshell, are that help-seeking is empowering, connects us with others, helps other people feel needed, and aids success. Plus, as with the last one, our resistances are just plain worth getting over.

How to increase one’s ability to ask for help? HELP, Serani says:

  • Have realistic expectations for the kind of help you are seeking
  • Express your needs simply and clearly
  • Let others know you are there to help them as well
  • Praise your pals for their assistance and pat yourself for asking for help

What about asking for help from a therapist—what specific factors hold people back?

Dr. John Grohol, Psych Central, cites researchers Clement et al. (2014, Psychological Medicine) who back the idea that self-sufficiency is one of them. Others include, but are not limited to, mental health stigma, financial barriers, lack of local availability of therapy, being unable to get an appointment soon enough, and prejudice and discrimination.

Some of these are very real for some people, some are untested internalized beliefs. Most can be overcome, partly by researching the various available alternatives—online therapy, for example, versus in-office therapy, just to name one intervention that could be effective for those in certain circumstances. But in order to even look into such things, many people need a bit of assistance.

And now…? Aren’t we back to square one?

Oct 07

Patrick Kennedy Portrays “A Common Struggle” In His New Book

Former U.S. Congressman Patrick Kennedy (RI-DEM) is probably best known and appreciated professionally for what he’s done for mental health parity—as he says, making “the scope of mental health coverage the same as all the rest of physical health care coverage.”

And he hasn’t stopped there. Since leaving the House of Representatives in 2011, he founded the Kennedy Forum, an organization that supports various mental health initiatives, and co-founded One Mind for Research, which studies brain disorders. One common thread among his different pursuits is his desire to eliminate mental health stigma.

Patrick Kennedy is probably at least as well known both for being the son of Joan and Ted Kennedy and for having well-publicized though not necessarily publicly understood personal problems.

Believing in the 12-step program maxim “You’re only as sick as your secrets,” Kennedy has come out in recent years about the specific nature of his long-term battles with substance abuse and mental health issues. He has also finally, after repeated efforts throughout his lifetime, made his sobriety stick—four-plus years worth, he says.

In his new book A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addictionco-authored with journalist Stephen Fried, Patrick Kennedy expands not only on his own story but also on that of his famous family—thereby breaking what he calls “the Kennedy code of silence.”

A code, by the way, that extends to psychotherapy, in case the “psychiatrist” breaks confidentiality.

This past Sunday, the evening before the book’s publication, Kennedy was interviewed by 60 Minutes anchor Lesley Stahl. He expressed his awareness that many of his family members will not be happy with his revelations and/or perspectives.

“It’s a conspiracy of silence,” he notes, “not only for the person who is suffering, but for everyone else who’s forced to interact with that person. That’s why they call this a family disease.”

Although he writes mainly about his own issues, Patrick Kennedy also addresses certain family secrets—examples include the extent of the alcohol problems of both parents, the probable PTSD of his father (related to the tragic assassinations of brothers JFK and RFK), and the effects of no one discussing or processing these incidents as well as others, e.g., Chappaquiddick.

Stahl: “You actually say that because nobody talked about these things in the family, you were all kind of like zombies…”

Kennedy: “Well, we were living in a limbo land where all of this chaos, this emotional turmoil, was happening. And we were expected just to live through it.”

Somehow he has lived through it, and now he’s also managed to turn himself around. Currently he does what he can to maintain his sobriety, which includes daily 12-step meetings, and to treat his bipolar disorder, which includes taking appropriate medication.

So far, notably, it seems that news about A Common Struggle has focused more on the family’s negative reactions to it and less on reporting or reviewing its actual contents. The Boston Globe, however, calls the book “strikingly raw and emotional,” while other readers have applauded this Kennedy’s courage and openness.

Apr 27

“Shrinks” and “Madness,” (History) and Future: Two New Books

If you have an interest in the history of mental health treatment, two new books may be for you: Shrinks by Jeffrey A. Lieberman and Madness in Civilization by Andrew Scull. But if you’re anything like me, you’ll skip ahead to sections on the present and future.

I. Jeffrey A. Lieberman, Shrinks: The Untold Story of Psychiatry

Natalie Angier, New York Times, sums up today’s psychiatric care:

Ultimately, though, the real secret to psychiatry’s success is drugs…He glides over the very real problem of side effects, and the fact that psychiatric drugs don’t always work or stop working over time. Still, for all the hand-wringing in some quarters that we are an overmedicated society, psychiatric drugs give patients what no rubber hose or hectoring daddy can: peace of mind, a piece of sky, a life.

Drugs aren’t the only answer, though, Lieberman tells Scott Simon, NPR: “The cornerstone of the healing profession and the physician is the patient relationship…So medications were extraordinarily important — they were miraculous developments — but medications alone can’t do it.”

The author’s take on the DSM (also from the New York Times):

Lieberman hails the advent of the ­Diagnostic and Statistical Manual of Mental Disorders…He recounts, at rather too much length, the infighting that erupted over different editions of the manual, including the latest version, published during his tenure as president of the A.P.A., but he makes a convincing case that its format has given the field a precision and reliability it lacked in the past…

On what’s currently working, Julia M. Klein, Boston Globe: “For Lieberman, talk therapy — especially scientifically-validated modalities such as Aaron Beck’s cognitive-behavioral therapy — retains a role: Psychiatry, he writes, must ’embrace the mind and the brain simultaneously’ and ‘touch upon fundamental questions about our identity, purpose, and potential.’ But promising research at the frontiers of neuroscience, biological medicine, and genetics clearly excites him more.”

Who uses the available treatments offered by shrinks? Publishers Weekly: “While people are ‘more likely to need services from psychiatry than any other medical specialty,’ the stigma attached to mental illness means that most sufferers consciously avoid the very treatments now proven to relieve their symptoms’.”

II. Andrew Scull, Madness in Civilization: A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine 

Kirkus Reviews: “Scull is sharp on every point, but some of his best moments come when he explains the introduction of psychoanalysis into pop culture in the postwar period, thanks in good part to Hollywood, and when he takes a sidelong look at both the drug-dependent psychiatry of today and its discontents, such as Scientology…Often brilliant and always luminous and rewarding.”

Scull explains (Psychology Today) his choice of the term “madness”:

So I have chosen to speak of madness, a term that even now few people have difficulty understanding. Using that age-old word has the further advantage that it throws into relief another highly significant feature of our subject that a purely medical focus neglects. Madness has much broader salience for the social order and the cultures we form part of, and has resonance in the world of literature and art and of religious belief, as well as in the scientific domain. And it implies stigma, and stigma has been and continues to be, a lamentable aspect of what it means to be mad. If we are to grasp madness in all its dimensions, these are some of the subjects with which we must engage.

Regarding the deficiencies of both the DSM and mental health treatment overall:

…(T)he DSM remains enmeshed in controversy, even at the highest reaches of the profession itself…After all, despite the plethora of claims that mental illness is rooted in faulty brain biochemistry, deficiencies or surpluses of this or that neurotransmitter, the product of genetics and one day perhaps traceable to biological markers, the etiology of many mental illnesses remains obscure, and its treatments largely symptomatic and generally of limited efficacy. Those who suffer from serious psychoses make up one of the few segments of our societies whose life expectancy has declined over the past quarter century – a reflection in part of the generally poorer overall health of psychiatric patients, but also one telling measure of the gap between psychiatry’s pretensions and its performance…

Another intriguing critique, via a book excerpt posted by Scientific American:

Like the poor folks waiting for Godot (who, as it happens, were quite possibly waiting for a madman), we are still waiting for those mysterious and long-rumored neuropathological causes of mental illness to surface. It has been a long wait, and on more than one level a misguided one, I think, if the expectation is that the ultimate explanation of madness lies here and only here.

Why is that? It makes no sense to regard the brain (as biological reductionists do) as an asocial or a pre-social organ, because in important respects its very structure and functioning are a product of the social environment…