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.

May 05

What’s Special About Women and Depression?

Women and depression: we are twice as likely to be diagnosed than men. However, it’s not necessarily clear why or whether this statistic really reflects reality. As the Harvard Mental Health Letter stated in 2011:

Some experts believe that both genders are affected by depression in equal numbers, but women are more likely to be diagnosed with this disorder, in part because men are less likely to talk about feelings and seek help for mood problems. It also may be that depression shows up in different ways in men — for example, as substance abuse or violent behavior.

Others theorize that while both genders are biologically vulnerable to developing depression, women may be more susceptible to harm from life stresses and other environmental factors.

Neel Burton, MD, Psychology Today, proposes the following reasons for women’s more frequent presentation of depression, noting that the factors involved are biological, psychological, and sociocultural.

  1. Compared to men, women may have a stronger genetic predisposition to developing depression.
  2. Compared to men, women are much more subjected to fluctuating hormone levels…
  3. Women are more ruminative than men, that is, they tend to think about things more—which, though a very good thing, may also predispose them to developing depression. In contrast, men are more likely to react to difficult times with stoicism, anger, or substance misuse.
  4. Women are generally more invested in relationships than men. Relationship problems are likely to affect them more, and so they are more likely to develop depression.
  5. Women come under more stress than men. Not only do they have to go work just like men, but they may also be expected to bear the brunt of maintaining a home, bringing up children, caring for older relatives, and putting up with all the sexism!
  6. Women live longer than men. Extreme old age is often associated with bereavement, loneliness, poor physical health, and precarity—and so with depression.
  7. Women are more likely to seek out a diagnosis of depression. They are more likely to consult a physician and more likely to discuss their feelings with the physician. Conversely, physicians (whether male or female) may be more likely to make a diagnosis of depression in a woman.

Regardless of the possible causation, how can women heal from depression? Few resources focus specifically on women and depression, but a currently top-selling book on this topic is Dr. Kelly Brogan‘s 2016 A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives.

Antidepressant medication isn’t the best way to treat it, she believes, nor is there any proof for the theory that depression indicates a chemical imbalance in the brain. This is also the stance of such experts as Irving Kirsch, Andrew Weil, and James Davies. (Links will lead to my previous posts on their opinions.)

“Depression is an opportunity,” says Brogan. “It is a sign for us to stop and figure out what’s causing our imbalance.” Possible sources could be “your food, your gut, your thyroid, or even your go-to pain reliever.”

Nutrition is often the key to relieving depression, says Brogan. A free ebook obtainable by giving your email address at this link offers some of her basic prescriptions in this regard.

From reading the ebook as well as editorial and consumer reviews, it seems that Brogan’s approach is better suited to someone who can get totally on board with a holistic, the-food-you-eat-is-medicine-but-not-necessarily-fun-to-eat approach—something many resist.

Moreover, many do still believe that, for whatever unknown reason—placebo effect or otherwise— antidepressant medication not only works but also has saved lives. I’ve seen this too often myself to neglect to mention it here.

And don ‘t forget therapy, of course, as well as physical exercise—both proven to be effective.

May 01

Conversion Therapy Must Be Banned Nationwide–Here’s How

 Reparative therapy may be a lie, but the lie begins not with the idea that we can change from gay to straight, but with the belief that we are who the culture tells us we are…And no one, no matter what age, is safe from that. Peter Gajdics, The Inheritance of Shame: A Memoir (2017), about conversion therapy

Conversion therapy has to go—and I mean nationwide. Representative Ted Lieu (D-Calif.) agrees. Both Senators Patty Murray (D-Wash.) and Corey Booker (D-NJ), moreover, have joined Lieu in introducing the Therapeutic Fraud Prevention Act of 2017, aimed at having the Federal Trade Commission call conversion therapy what it is: a fraudulent practice.

States Lieu (Washington Post) regarding the Act: “It says it is fraud if you treat someone for a condition that doesn’t exist and there’s no medical condition known as being gay. LGBTQ people were born perfect; there is nothing to treat them for. And by calling this what it should be, which is fraud, it would effectively shut down most of the organizations.”

For a comprehensive list, by the way, of anti-conversion-therapy position statements issued over the years by mental health and medical professional associations, see this Human Rights Campaign (HRC) link.

It should be noted that some states already ban conversion therapy and its practitioners: California, New Jersey, Oregon, Illinois, Vermont, and New Mexico. Also the District of Columbia—and kinda New York in that they have something in place that serves the same purpose.

Several recent memoirs have chronicled the dire effects of being forced into conversion therapy in one’s youth. (See my post “Three Memoirs About Surviving Conversion Therapy.”) But as Steven Susoyev, a reviewer for LambdaLiterary.org, points out, it’s not always about outright coercion or being a minor:

Less common in the popular imagination is the story of a young gay person who voluntarily submits to psychological mutilation. In The Inheritance of Shame, Peter Gajdics, now in his early fifties, takes us into the heart and mind of his 24-year-old self, a desperate young man who believed everything his family and church told him about who he was, and who resolved to become an entirely different person, at any cost.

The Inheritance of Shame will be published in a couple weeks. An early review from author Daniel Zomparelli: “In Peter Gajdics’ memoir, we’re taken into a real-life horror film of malpractice and corrupt psychotherapy, hoping at every turn of the page that our narrator escapes. A shocking, crystal-clear, unsettling book. The Inheritance of Shame is both a necessary and devastating memoir about the trauma of conversion therapy and the homophobia that persists to this day.”

Guess who else recently tried to educate his audience about the weirdness of therapy to change someone’s sexual orientation? Bill Nye the Science Guy. As seen on his Netflix series Bill Nye Saves the World, he uses different flavors of ice cream to parallel various sexual orientations:

Apr 27

“Split” Adds to Dissociative Identity Disorder Stigma

This movie makes people with DID the next in a long line of cultural scapegoats. Audiences will sit through it, shivering delightfully in the dark and be reassured once again that all the evil in the world can be blamed on “the crazies.” lain C, TheMighty.com, who lives with Dissociative Identity Disorder (DID), about Split

Split, now available to rent, is M. Night Shyamalan‘s latest movie and one that unfortunately contributes to stigma regarding dissociative identity disorder.

A brief synopsis from IMDB: “Three girls are kidnapped by a man with a diagnosed 23 distinct personalities, [and] they must try to escape before the apparent emergence of a frightful new 24th.” James McAvoy plays Kevin, the man with DID.

Watch a trailer for Split below:

One problem: movies such as Split tend to give a grossly inaccurate impression regarding DID and a propensity for violence. The International Society for the Study of Trauma and Dissociation (ISSTD) has refuted this myth citing recent research statistics: “…3 percent were charged with an offense, 1.8 percent were fined, and less than 1 percent were in jail over a six-month span. No convictions or probations were reported in that time period” (Kristen Fischer, Healthline).

Moreover, ISSTD extends its objections to Split beyond the scope of DID:

With respect to Mr. Shyamalan’s ability to write and direct truly frightening movies, depicting individuals with this, or any other mental disorder, does a disservice to his artistic ability and to the over 20 percent of the population who, at some time or another, struggle with some form of mental illness. It acts to further marginalize those who already struggle on a daily basis with the weight of stigma.

Not that Shyamalan didn’t receive appropriate consultation. Bethany Brand, a clinical psychologist and professor, responded to his request and offered (free) advice, including that she’d help connect him with individuals who actually live with DID, something Shyamalan never took her up on. He also failed to follow through on a pledge to work on raising public awareness about the reality of the condition (CNN).

Another controversial aspect of Shyamalan’s depiction is explained by Charles Bramesco, The Verge. Dr. Karen Fletcher (Betty Buckley), Kevin’s psychiatrist, “repeatedly spells out her controversial theory that DID grants sufferers extraordinary control of their bodies, citing such examples as a blind woman with a personality capable of vision, or a strongman personality spontaneously developing extraordinary strength.” Research does show that different alters can display different capabilities—But…and the following contains movie spoilers…

Shyamalan extends the concept to a cartoonish extreme when he introduces Kevin’s personality ‘the Beast,’ which has superhuman abilities and a monstrous appearance. By the end of the film, Kevin is exhibiting abilities that amount to superpowers, somehow derived from what professional consensus indicates is his brain’s extreme coping mechanism to a fleetingly shown childhood of abuse…The act of other-ing Kevin as a patient of DID isn’t even incidental; it’s the whole point. It’s hard to imagine a more squarely on-the-nose example of demonizing mental illness than portraying a mentally ill man as a literal demon.

In closing, here’s powerful personal testimony from the writer of this post’s opening quote (TheMighty.com):

What if someone made a movie about you – only you were the villain? Not a brilliant, super-villain who is kind of cool, but someone horrifyingly bizarre and dangerous…
…Once again, people with deep psychological wounds get mis-cast as the perpetrators instead of, more realistically, victims of violence. Along the way, it lowers the odds of us having friends, finding love, working at terrific jobs and getting care. At the same time it ups the odds of abandonment, rejection and someone protecting themselves against us with misguided force. In fact, while people with DID are organized differently inside…we’re no more likely to hurt people than anyone else…

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.