From the New York Times, July 16, 2008
"What is it like to have bipolar disorder? To be labeled 'crazy'? How do you balance the ups and downs? Here, in their own words, are the stories of nine men and women living with bipolar disorder." A series of audio clips of about 2 minutes each. Poignant, perceptive, illuminating, and very much worth a listen.
(Hat tip to Heather Soyka)
Saturday, July 18, 2009
Friday, July 17, 2009
Stones of Memory - Pt 1
Abridged and slightly revised from an account I wrote some years ago.
My early life was dominated by two events that occurred before I was born. I knew nothing of them until I was nine or ten years old. I know little about them even today. I suppose I could investigate, but the precise details don’t matter much. What matters is that these two events decisively, elementally shaped the battlefield on which my life has been fought, and they were all the more powerful for being glimpsed only intermittently. Strategists speak of a “fog of war.” Personal lives are subject to much the same thing.
The first event: In 1937 a foolish young man decided to make some easy cash by counterfeiting fifty cent pieces in his native eastern North Carolina town. He was caught, tried, sent to jail. His wife could not afford to keep their brood of children, so she farmed them out to friends and relatives. My father, then three years old, had been known to toddle behind a certain milkman on his daily rounds. The milkman and his wife had recently lost a child to illness and so decided to take my father in when the chance arose. (They did not formally adopt him until many years later) My father knew that in a material sense his life was better as a result, but he could never understand how his own mother could give him away like that. Particularly since within a few years his siblings were folded back into his biological family and he was not. I know this only second hand; I never heard him speak of it.
The second event: In 1958, a tortured wife and mother of five, once beautiful but slipping into middle age, bright and gifted but thwarted and unappreciated by a limited, sometimes abusive husband, put a revolver in her mouth and pulled the trigger. She did it during the day while the house was empty: her husband at work, her children at school. The husband usually came home for lunch and undoubtedly she expected that it would be he who discovered her body. Instead it was her youngest daughter, thirteen years old. She had forgotten her school lunch money and come home to retrieve it. The scream that filled the house that day never left it.
The woman who killed herself was my maternal grandmother. From the little I know of her I think she had bipolar disorder, though the young daughter, who grew up to be a registered nurse, thinks it was more likely schizophrenia.
My parents at that point had been married less than a year. They had met in January 1958 and were married four months later. They had little business sharing a cab, much less a marriage, but for better or worse they stayed together for almost twenty-five years.
Ten months later I came into the world. For the first five years of my life that world seemed warm and safe and happy, and my two parents seemed the best and most beautiful people in the world. In point of fact, they were good-looking. My father was slim, knew how to dress and carry himself, and had an infectious grin that managed simultaneously to be both boyish and masculine. My mother was a local belle who had once won a beauty pageant sponsored by a Norfolk television station. Among her prizes was an all-expenses paid trip to New York. A fashion photographer trailed around her, snapping pictures of a poised young woman who believed she had a great future ahead of her. I still have the photos. I almost never look at them.
Because her family had money and position in the rural North Carolina county in which she grew up, and because she had graduated second in her high school class, my mother went to college at Duke University. But her high school served a community of five hundred residents, her graduating class numbered exactly twelve, and she was not prepared for Duke. Overwhelmed, she left after a semester or two and went to a safer, less challenging school. Later in life she called that decision one of her greatest regrets. She went first to her mother’s alma mater, Guilford College, and then transferred to East Carolina College (now University) in Greenville. There she met my father.
My father hailed from New Bern, a town on the Neuse River not forty miles from Greenville, but he came to East Carolina by way of San Diego, Tokyo, and other ports of call on the Pacific rim. After graduating from high school in 1953 he had joined the U.S. Navy and served aboard a destroyer escort. He credited the experience with turning his life around. In high school he had not been a serious student. He ran with the popular crowd and played football but did not apply himself. It galled him, however, to take orders from ensigns just a few years older than himself. He once told a particularly obnoxious ensign, “The only difference between you and me is that you have a college degree and I don’t.” He began buying books to broaden himself, and when he got out of the Navy in 1957 he entered East Carolina.
My parents lived in Greenville until they graduated, then moved to a town not far away. Both became teachers: Mom taught Home Economics and Dad taught English. But they quit soon after my birth, she in order to be a full-time mother and he in order to take a better paying job. He found it working as an underwriter for an insurance company in Raleigh. He worked for that company for the rest of his life. He fell into the job almost by sheer chance; it was not something he chose to do. He spent most of every year working hard at a job he did not particularly like so that he could support his family. To reconcile himself to this fate, he convinced himself that when you’re an adult, your dreams have to die, and that maturity consists of accepting this hard reality.
My first memory is of my parents’ apartment in Raleigh and of my father riding me on his shoulders across a dirt road a few yards distant, so that I could see the excavators and tractors that were constructing the belt line around Raleigh. I can also remember our move to a modest ranch house in the suburbs. By then my brother had been born, followed three years later by my sister.
Shortly after my sister's birth, Mom had her first manic episode. It was really pretty florid, with delusions that her dead mother was Christ and that she herself was the Virgin Mary. Her doctors thought it was schizophrenia (in those days a common misdiagnosis). She was hospitalized for three months. During that time Dad sent my brother and me to stay with our paternal grandparents.
In June 1968 the family moved from the ranch house to a Cape Cod not far from the campus of North Carolina State University. Mom thought the move would revitalize our family life -- by which she meant her life -- because her marriage to Dad was getting pretty barren. We lived there less than a year. Then my father accepted a promotion and transfer to Lynchburg, Virginia. Shortly after we moved -- the boxes containing our belongings had not yet been unpacked -- Mom had a second manic episode. My father had to scramble to locate a hospital and a new psychiatrist for her. It was at this time -- I was then just shy of my tenth birthday -- that Dad decided to tell me that Mom had a mental illness. The point of telling me was to secure my help around the house and with my two younger siblings. From then on I functioned as a deputy parent, not continuously but more or less in accordance with my parents’ whim. I wasn't much good at it. Certainly my parents didn't think so.
If Dad dragooned me into functioning as a deputy parent, Mom roped me in as a kind of surrogate husband. I’ve heard this dynamic described as emotional incest. That began when I was about eleven and continued until I was fifteen.
In June 1971 I went off to a Boy Scout camp, and I recall that on the day I left Mom was manic, though not yet hospitalized. She pranced about the house, hugging a Bible and declaring in a sing song voice, "I'm going to read the Good Book! I'm going to read the Good Book!" On her face was a ghastly, unworldly grin.
Two months later she attempted suicide for the first time -- certainly the first time as far as I know. The rescue squad came and took her to the hospital, where she had her stomach pumped. She came home the next day. I remember standing in the carport, practicing semaphore for some Boy Scout merit badge, when Dad brought her home. She walked up the driveway and into the house. We kids did not know how to react, so we were pretty low-key. Evidently that distressed her, because Dad came out and asked us to go in and tell Mom how much we loved her. Actually it’s not quite correct to say we did not know how to react -- we’d been mirroring how Dad was handling it, and he was pretty much stone-faced. Had he been more demonstrative, we would have been.
It was after this episode that Mom got a new psychiatrist, Dr. Novak, who was one of the few psychiatrists in the country authorized to prescribe lithium, a then-new treatment for manic depression. (New, that is, in the United States. The efficacy of lithium had been recognized in the 1940s and in Europe by the 1960s it was a common treatment.) Mom improved a lot once she started taking it. She became a substitute teacher and was so good at it that when a regular teacher fell ill and would be out the rest of the school year, Mom was asked to take over the class. Within a couple of weeks, however, she had a third manic episode. I don’t know whether the lithium was ineffective, or whether she’d gone off her medication, or what exactly occurred to trigger the episode beyond the fact that she was having fun teaching and feeling energized and productive. But she had to be hospitalized and her days as a teacher ended, this time for good.
Part 1 - Part 2 (coming)
My early life was dominated by two events that occurred before I was born. I knew nothing of them until I was nine or ten years old. I know little about them even today. I suppose I could investigate, but the precise details don’t matter much. What matters is that these two events decisively, elementally shaped the battlefield on which my life has been fought, and they were all the more powerful for being glimpsed only intermittently. Strategists speak of a “fog of war.” Personal lives are subject to much the same thing.
The first event: In 1937 a foolish young man decided to make some easy cash by counterfeiting fifty cent pieces in his native eastern North Carolina town. He was caught, tried, sent to jail. His wife could not afford to keep their brood of children, so she farmed them out to friends and relatives. My father, then three years old, had been known to toddle behind a certain milkman on his daily rounds. The milkman and his wife had recently lost a child to illness and so decided to take my father in when the chance arose. (They did not formally adopt him until many years later) My father knew that in a material sense his life was better as a result, but he could never understand how his own mother could give him away like that. Particularly since within a few years his siblings were folded back into his biological family and he was not. I know this only second hand; I never heard him speak of it.
The second event: In 1958, a tortured wife and mother of five, once beautiful but slipping into middle age, bright and gifted but thwarted and unappreciated by a limited, sometimes abusive husband, put a revolver in her mouth and pulled the trigger. She did it during the day while the house was empty: her husband at work, her children at school. The husband usually came home for lunch and undoubtedly she expected that it would be he who discovered her body. Instead it was her youngest daughter, thirteen years old. She had forgotten her school lunch money and come home to retrieve it. The scream that filled the house that day never left it.
The woman who killed herself was my maternal grandmother. From the little I know of her I think she had bipolar disorder, though the young daughter, who grew up to be a registered nurse, thinks it was more likely schizophrenia.
My parents at that point had been married less than a year. They had met in January 1958 and were married four months later. They had little business sharing a cab, much less a marriage, but for better or worse they stayed together for almost twenty-five years.
Ten months later I came into the world. For the first five years of my life that world seemed warm and safe and happy, and my two parents seemed the best and most beautiful people in the world. In point of fact, they were good-looking. My father was slim, knew how to dress and carry himself, and had an infectious grin that managed simultaneously to be both boyish and masculine. My mother was a local belle who had once won a beauty pageant sponsored by a Norfolk television station. Among her prizes was an all-expenses paid trip to New York. A fashion photographer trailed around her, snapping pictures of a poised young woman who believed she had a great future ahead of her. I still have the photos. I almost never look at them.
Because her family had money and position in the rural North Carolina county in which she grew up, and because she had graduated second in her high school class, my mother went to college at Duke University. But her high school served a community of five hundred residents, her graduating class numbered exactly twelve, and she was not prepared for Duke. Overwhelmed, she left after a semester or two and went to a safer, less challenging school. Later in life she called that decision one of her greatest regrets. She went first to her mother’s alma mater, Guilford College, and then transferred to East Carolina College (now University) in Greenville. There she met my father.
My father hailed from New Bern, a town on the Neuse River not forty miles from Greenville, but he came to East Carolina by way of San Diego, Tokyo, and other ports of call on the Pacific rim. After graduating from high school in 1953 he had joined the U.S. Navy and served aboard a destroyer escort. He credited the experience with turning his life around. In high school he had not been a serious student. He ran with the popular crowd and played football but did not apply himself. It galled him, however, to take orders from ensigns just a few years older than himself. He once told a particularly obnoxious ensign, “The only difference between you and me is that you have a college degree and I don’t.” He began buying books to broaden himself, and when he got out of the Navy in 1957 he entered East Carolina.
My parents lived in Greenville until they graduated, then moved to a town not far away. Both became teachers: Mom taught Home Economics and Dad taught English. But they quit soon after my birth, she in order to be a full-time mother and he in order to take a better paying job. He found it working as an underwriter for an insurance company in Raleigh. He worked for that company for the rest of his life. He fell into the job almost by sheer chance; it was not something he chose to do. He spent most of every year working hard at a job he did not particularly like so that he could support his family. To reconcile himself to this fate, he convinced himself that when you’re an adult, your dreams have to die, and that maturity consists of accepting this hard reality.
My first memory is of my parents’ apartment in Raleigh and of my father riding me on his shoulders across a dirt road a few yards distant, so that I could see the excavators and tractors that were constructing the belt line around Raleigh. I can also remember our move to a modest ranch house in the suburbs. By then my brother had been born, followed three years later by my sister.
Shortly after my sister's birth, Mom had her first manic episode. It was really pretty florid, with delusions that her dead mother was Christ and that she herself was the Virgin Mary. Her doctors thought it was schizophrenia (in those days a common misdiagnosis). She was hospitalized for three months. During that time Dad sent my brother and me to stay with our paternal grandparents.
In June 1968 the family moved from the ranch house to a Cape Cod not far from the campus of North Carolina State University. Mom thought the move would revitalize our family life -- by which she meant her life -- because her marriage to Dad was getting pretty barren. We lived there less than a year. Then my father accepted a promotion and transfer to Lynchburg, Virginia. Shortly after we moved -- the boxes containing our belongings had not yet been unpacked -- Mom had a second manic episode. My father had to scramble to locate a hospital and a new psychiatrist for her. It was at this time -- I was then just shy of my tenth birthday -- that Dad decided to tell me that Mom had a mental illness. The point of telling me was to secure my help around the house and with my two younger siblings. From then on I functioned as a deputy parent, not continuously but more or less in accordance with my parents’ whim. I wasn't much good at it. Certainly my parents didn't think so.
If Dad dragooned me into functioning as a deputy parent, Mom roped me in as a kind of surrogate husband. I’ve heard this dynamic described as emotional incest. That began when I was about eleven and continued until I was fifteen.
In June 1971 I went off to a Boy Scout camp, and I recall that on the day I left Mom was manic, though not yet hospitalized. She pranced about the house, hugging a Bible and declaring in a sing song voice, "I'm going to read the Good Book! I'm going to read the Good Book!" On her face was a ghastly, unworldly grin.
Two months later she attempted suicide for the first time -- certainly the first time as far as I know. The rescue squad came and took her to the hospital, where she had her stomach pumped. She came home the next day. I remember standing in the carport, practicing semaphore for some Boy Scout merit badge, when Dad brought her home. She walked up the driveway and into the house. We kids did not know how to react, so we were pretty low-key. Evidently that distressed her, because Dad came out and asked us to go in and tell Mom how much we loved her. Actually it’s not quite correct to say we did not know how to react -- we’d been mirroring how Dad was handling it, and he was pretty much stone-faced. Had he been more demonstrative, we would have been.
It was after this episode that Mom got a new psychiatrist, Dr. Novak, who was one of the few psychiatrists in the country authorized to prescribe lithium, a then-new treatment for manic depression. (New, that is, in the United States. The efficacy of lithium had been recognized in the 1940s and in Europe by the 1960s it was a common treatment.) Mom improved a lot once she started taking it. She became a substitute teacher and was so good at it that when a regular teacher fell ill and would be out the rest of the school year, Mom was asked to take over the class. Within a couple of weeks, however, she had a third manic episode. I don’t know whether the lithium was ineffective, or whether she’d gone off her medication, or what exactly occurred to trigger the episode beyond the fact that she was having fun teaching and feeling energized and productive. But she had to be hospitalized and her days as a teacher ended, this time for good.
Part 1 - Part 2 (coming)
Thursday, July 16, 2009
A Bipolar Blogroll
You can't have a blog without a blogroll, so I've created one here. With the exception of Blog Them Out of the Stone Age (my military history blog), all of them deal primarily with bipolar disorder. I've encountered one or two of them before. The rest are drawn mainly, though not exclusively, from PsychCentral's list of the Top Ten Bipolar Blogs of 2008.
The selection is tentative. Whether they'll remain on my blogroll is going to be a function of time and utility. Time in the sense that so far I've scarcely done more than skim a few entries; utility in the sense that some of them will probably prove more useful for my purposes than others. Then too of course there are the considerations that apply to pretty much any blog. Is it well written? Does it have a voice? Does it stay generally on topic? Is it updated on a regular basis?
From what I've seen thus far, blogs about bipolar disorder tend to have three characteristics.
First, they are heavily didactic in tone. They seek to educate others about the illness and/or to help those with the disorder manage it better. Sometimes they critique the mental health establishment, particularly the prescription of psychotropic medications.
Second, many take a rather catastrophic view of the illness. For most of them it seems to be a huge struggle that dominates their lives, as in some cases it indisputably does . All in all, the effect is to create the impression that bipolar disorder is not something they have, but a major component of who they are.
Third, and perhaps as a corollary of the second characteristic, the authors commonly refer to themselves and others with the disorder as being bipolar or, in at least one case, terming persons like myself "bipolars," as if we were a unique subset of humanity.
People are entitled to view the disorder in any way that seems helpful to them. I mention these characteristics not to judge, but rather to say that while I find most of them interesting, I identify with few of them. That's because I conceptualize the illness as external to me and simply something to be managed.
Nonetheless, they do provide a window into the disorder, and probably as time goes by I'll discover other blogs more relevant to my own situation and perspective.
The selection is tentative. Whether they'll remain on my blogroll is going to be a function of time and utility. Time in the sense that so far I've scarcely done more than skim a few entries; utility in the sense that some of them will probably prove more useful for my purposes than others. Then too of course there are the considerations that apply to pretty much any blog. Is it well written? Does it have a voice? Does it stay generally on topic? Is it updated on a regular basis?
From what I've seen thus far, blogs about bipolar disorder tend to have three characteristics.
First, they are heavily didactic in tone. They seek to educate others about the illness and/or to help those with the disorder manage it better. Sometimes they critique the mental health establishment, particularly the prescription of psychotropic medications.
Second, many take a rather catastrophic view of the illness. For most of them it seems to be a huge struggle that dominates their lives, as in some cases it indisputably does . All in all, the effect is to create the impression that bipolar disorder is not something they have, but a major component of who they are.
Third, and perhaps as a corollary of the second characteristic, the authors commonly refer to themselves and others with the disorder as being bipolar or, in at least one case, terming persons like myself "bipolars," as if we were a unique subset of humanity.
People are entitled to view the disorder in any way that seems helpful to them. I mention these characteristics not to judge, but rather to say that while I find most of them interesting, I identify with few of them. That's because I conceptualize the illness as external to me and simply something to be managed.
Nonetheless, they do provide a window into the disorder, and probably as time goes by I'll discover other blogs more relevant to my own situation and perspective.
Wednesday, July 15, 2009
A Mood Watch Retrospective
On another blog, since discontinued, I had a category entitled "Mood Watch." In those posts I made an effort to track my moods, something that persons with bipolar disorder are often encouraged to do. I've decided to incorporate them here, using the dates of the original posts, so that they seem to antedate the beginnings of this blog. The first such post is here.
It took a while to transfer these posts, partly because there were rather a lot of them, and partly because I was careful to date stamp them precisely -- not just with the month, day, and year but also with the exact time of publication. The exact time can be useful because it usually provides a clue as to how well I was sleeping, and good sleep hygiene (which is to say going to bed and waking up at about the same time, getting sufficient sleep, etc.) is an important element in managing the disorder.
As I went through these old posts, two things stood out. The first was how few there were, considering that I had composed them over a period of about two years. It just isn't a lot of fun to keep track of one's moods. The second was how many encouraging comments the posts received. Without them I would probably have ceased the practice long before I did.
As to whether I'll resume these posts, I can't yet say. I probably will describe what the disorder feels like subjectively, particularly the depressions, which for me are much more frequent than the hypomanic episodes. Indeed, I haven't had a significant hypomanic episodes in years.
In fact, it's hard to know exactly what shape this blog will take. Like any writing project it eats time and it's not exactly a comfortable sensation to put so much of myself out there for people to read. Still, I regard it as a useful service; and if you find it worthwhile, I'd sure appreciate your leaving comments. They're likely to be one of the more important things that keeps me going.
It took a while to transfer these posts, partly because there were rather a lot of them, and partly because I was careful to date stamp them precisely -- not just with the month, day, and year but also with the exact time of publication. The exact time can be useful because it usually provides a clue as to how well I was sleeping, and good sleep hygiene (which is to say going to bed and waking up at about the same time, getting sufficient sleep, etc.) is an important element in managing the disorder.
As I went through these old posts, two things stood out. The first was how few there were, considering that I had composed them over a period of about two years. It just isn't a lot of fun to keep track of one's moods. The second was how many encouraging comments the posts received. Without them I would probably have ceased the practice long before I did.
As to whether I'll resume these posts, I can't yet say. I probably will describe what the disorder feels like subjectively, particularly the depressions, which for me are much more frequent than the hypomanic episodes. Indeed, I haven't had a significant hypomanic episodes in years.
In fact, it's hard to know exactly what shape this blog will take. Like any writing project it eats time and it's not exactly a comfortable sensation to put so much of myself out there for people to read. Still, I regard it as a useful service; and if you find it worthwhile, I'd sure appreciate your leaving comments. They're likely to be one of the more important things that keeps me going.
Tuesday, July 14, 2009
Twitter in Direct Support
Originally published in Blog Them Out of the Stone Age on July 9, 2009
If you scroll down on the sidebar of this blog, you'll find a section labeled "Twitter Updates," thanks to a widget I installed a few days ago. The question is, how does this relate to military history?
As long time readers of the blog are aware, I have bipolar disorder. The subject is covered in the category "Facing the Demon," along with battle stress injury -- not because I think the two are identical: one is an illness, the other an injury -- but because both require management and both carry a perceived stigma that requires a degree of courage to address. In my own case, I was diagnosed with bipolar disorder when I was twenty-six and have probably had it since the winter of my seventeenth year. It took a long time to come to grips with it. Until I was thirty-seven I didn't fully accept the reality of the disorder -- that it was something I had and would always have and that it needed to be managed precisely as one would manage any other chronic illness, such as diabetes, which in some respects it resembles. Both are abnormalities in one's biochemistry.
In the years since, I've gradually become conscious of the fact that in dealing with the illness I instinctively draw upon a number of concepts derived from a lifetime steeped in military history, strategic studies, and my own modest military experience. The most basic insight derives from Clausewitz: "In war, the best strategy is always to be very strong." This translates metaphorically into identifying as using as many tools to combat the illness as I can. Many of them are predicated on a crucial decision I made as soon as I received the diagnosis; namely that I would acknowledge it openly. As I've written elsewhere:
So where does Twitter come in?
I've decided to use this social utility as a way to discuss the illness, not abstractly, but as it affects my day to day life. (The updates, by the way, appear not just on the blog but are immediately cross-posted as a status update on Facebook.) Since I find the prospect of doing so a bit daunting -- it is one thing to state publicly that I have the disorder, quite another to state on a given day that I'm depressed -- I've begun with something reasonably safe: namely to keep public track of my workouts at the gym (and other forms of exercise). This has more to do with bipolar disorder than one might suppose. Coping with bipolar disorder involves more than taking medication. There are things one can actively do to manage the illness, among them getting enough sleep and getting enough exercise, which releases beneficial endorphins.
So announcing each trip to the gym is not based on vanity or the assumption that people are fascinated with the mundane details of my life. It's the early stage of what I expect will be a larger experiment in publicly sharing the experience of managing bipolar disorder, partly as a means to expand my network of support, but primarily to model in practical terms how one goes about it, and to treat the illness as one would any other: not something of which to be embarrassed or ashamed but a simple fact of existence.
If you scroll down on the sidebar of this blog, you'll find a section labeled "Twitter Updates," thanks to a widget I installed a few days ago. The question is, how does this relate to military history?
As long time readers of the blog are aware, I have bipolar disorder. The subject is covered in the category "Facing the Demon," along with battle stress injury -- not because I think the two are identical: one is an illness, the other an injury -- but because both require management and both carry a perceived stigma that requires a degree of courage to address. In my own case, I was diagnosed with bipolar disorder when I was twenty-six and have probably had it since the winter of my seventeenth year. It took a long time to come to grips with it. Until I was thirty-seven I didn't fully accept the reality of the disorder -- that it was something I had and would always have and that it needed to be managed precisely as one would manage any other chronic illness, such as diabetes, which in some respects it resembles. Both are abnormalities in one's biochemistry.
In the years since, I've gradually become conscious of the fact that in dealing with the illness I instinctively draw upon a number of concepts derived from a lifetime steeped in military history, strategic studies, and my own modest military experience. The most basic insight derives from Clausewitz: "In war, the best strategy is always to be very strong." This translates metaphorically into identifying as using as many tools to combat the illness as I can. Many of them are predicated on a crucial decision I made as soon as I received the diagnosis; namely that I would acknowledge it openly. As I've written elsewhere:
People often think that because I’m so up front about having bipolar disorder, that being candid about the illness must be an easy thing for me to do. In fact, it scares me. I’m up front about it only because I’m convinced that candor is better than the alternative. Being open with my colleagues, for example, populates the department with observers who have a decent chance of identifying unusual behavior as an artifact of the illness rather than erroneously attributing it to something else: simple high spirits instead of hypomania, for example. It enables me to ask for help when necessary without having to explain the illness from scratch. And it gives me a chance to combat, in a small way, the stigma that still attaches to mental illness. If a professor protected by tenure cannot summon the modest courage required for such an act, I do not know who can.
So where does Twitter come in?
I've decided to use this social utility as a way to discuss the illness, not abstractly, but as it affects my day to day life. (The updates, by the way, appear not just on the blog but are immediately cross-posted as a status update on Facebook.) Since I find the prospect of doing so a bit daunting -- it is one thing to state publicly that I have the disorder, quite another to state on a given day that I'm depressed -- I've begun with something reasonably safe: namely to keep public track of my workouts at the gym (and other forms of exercise). This has more to do with bipolar disorder than one might suppose. Coping with bipolar disorder involves more than taking medication. There are things one can actively do to manage the illness, among them getting enough sleep and getting enough exercise, which releases beneficial endorphins.
So announcing each trip to the gym is not based on vanity or the assumption that people are fascinated with the mundane details of my life. It's the early stage of what I expect will be a larger experiment in publicly sharing the experience of managing bipolar disorder, partly as a means to expand my network of support, but primarily to model in practical terms how one goes about it, and to treat the illness as one would any other: not something of which to be embarrassed or ashamed but a simple fact of existence.
What If Churchill Hadn't Tamed His "Black Dog"?
Originally published in Blog Them Out of the Stone Age on May 22, 2009
Reprinted with permission of World War II Magazine
In March 2006 a statue of Winston Churchill went on display in Norwich, England. It might have attracted little attention but for one disquieting detail: it showed the prime minister in a straitjacket. The statue was part of a campaign by Rethink, the mental health advocacy group that commissioned it.
“We are trying to break down the stigma of mental illness,” explained a spokesman. “Churchill documented his depression and referred to it as his ‘black dog.’ Nowadays it would be described as bipolar disorder or manic depression. We all know that Churchill was a great leader and this statue is an illustration of what people with mental illness can achieve” —- that is, without the cruel caricatures that too often burden those with such illnesses.
Indeed, the controversy in the wake of the statue’s unveiling underscored the point Rethink was trying to make. Many Britons cried foul. “It’s not only insulting, it’s pathetic,” growled Nicholas Soames, grandson of the former prime minister. The outcry forced Rethink to remove the statue after only a few days. The organization had miscalculated the public’s receptivity to such a portrayal of a national icon. But had it been mistaken about Churchill’s illness itself?
Full article (PDF)
Reprinted with permission of World War II Magazine
In March 2006 a statue of Winston Churchill went on display in Norwich, England. It might have attracted little attention but for one disquieting detail: it showed the prime minister in a straitjacket. The statue was part of a campaign by Rethink, the mental health advocacy group that commissioned it.
“We are trying to break down the stigma of mental illness,” explained a spokesman. “Churchill documented his depression and referred to it as his ‘black dog.’ Nowadays it would be described as bipolar disorder or manic depression. We all know that Churchill was a great leader and this statue is an illustration of what people with mental illness can achieve” —- that is, without the cruel caricatures that too often burden those with such illnesses.
Indeed, the controversy in the wake of the statue’s unveiling underscored the point Rethink was trying to make. Many Britons cried foul. “It’s not only insulting, it’s pathetic,” growled Nicholas Soames, grandson of the former prime minister. The outcry forced Rethink to remove the statue after only a few days. The organization had miscalculated the public’s receptivity to such a portrayal of a national icon. But had it been mistaken about Churchill’s illness itself?
Full article (PDF)
Pharmaceuticals in Direct Support
Originally published in Blog Them Out of the Stone Age on June 9, 2008
The current Time magazine features a cover story entitled "A Medicated Army," discussing the practice of prescribing antidepressants and antianxiety meds to soldiers in combat environments:
As many readers know, I have bipolar disorder, and consequently have a long acquaintance with many of the meds being prescribed. At the moment, for instance, I take Lamictal on a daily basis and clonazepam (the generic equivalent of klonopin) as needed. The former operates as an antidepressant. It has mood stabilizing properties that make it a reasonably good prophylactic against mania -- in fact I've had no trouble with incipient "highs" since I began taking Lamictal about two years ago. The latter is a mood stabilizer and anti-anxiety med. The biochemical manifestations of bipolar disorder are more complex than most people suppose. I have had days when I felt neither up nor down, but had such an insistent sense of generalized anxiety that I had to cancel class because I felt too light-headed to responsibly drive down to campus. Once I grasped its beneficial properties, clonazepam has done a lot to alleviate that problem. I also take the generic form of Ambien on a fairly regular basis in order to make sure I get a good night's rest. Regular sleep -- what's known as "good sleep hygiene" -- is a bedrock element in managing the illness.
The situation of a college professor in the midwest is obviously dissimilar from that of a combat soldier in Iraq or Afghanistan, but I think my experience can contribute a degree of insight. To begin with, I think it's important to regard the meds as simply a tool to assist with the overall task of maintaining good health. There's a tendency for those who take them to regard them as a sort of query against their character: that if they were somehow stronger they wouldn't need to take the meds. That leads to problems. First, it reduces self-confidence and self-esteem. Second, it often creates a state of partial denial in which a person may take the med, but does not acquaint himself closely with the medication's properties. He may not follow the guidelines for taking the med responsibly and when he feels better may quit taking the meds entirely. (Medication noncompliance is the single biggest problem among those with bipolar disorder.)
Third, there can be a tendency to regard the meds as shouldering the whole burden of managing the problem, whereas I have found it helpful to take an active role in managing the disorder rather than just passively taking the pills. I monitor myself for symptoms, even subtle ones that no one around me would recognize. I try to exercise on a regular basis. I make use of as many other tools as I can gather to help with the job: a psychiatrist, a therapist, and also the support of friends. There's too much tendency to let fears of the stigma prevent a person from letting others know about one's situation. But I've found that for every jerk there are many people who welcome the opportunity to be of assistance.
Finally, I have made a personal commitment to be public about having bipolar disorder. In each course I teach, I find a topic that lends itself to disclosure that I have the illness (in the U.S. history survey, for instance, the work of 19th century reformer Dorothea Dix provides a good opportunity). In a class of 200 students, statistically two students have been or will be diagnosed with bipolar disorder. I have never yet disclosed the illness and not received subsequent contact from a student who has the same diagnosis. They express appreciation for my candor and particularly a sense of relief in realizing that they are not alone, and that someone they regard as highly functional can have the disorder and lead a reasonably normal life. I often wind up meeting with them to discuss the illness and how best to manage it. Students usually have a lot of concerns: What will their life be like? what degree of stigma will they face? Frequently they do not yet have in place a good support system for managing the disorder. I recently spoke with a student who has no psychiatrist and therapist; her prescriptions are written by a general practitioner. I've been able to assist with referrals to good psychiatrists and therapists within her health care network.
How does this relate to military personnel who take psychotropic meds? First, I wonder how many officers and NCOs self-disclose that they are taking the same meds. If they keep this info away from their soldiers, they send a double message: overtly it's OK for you to take these meds, but tacitly it's really not because I wouldn't be caught dead letting you know that I take them myself. It would require real moral courage, but an officer willing to talk matter of factly about taking these meds, and at the same time functioning effectively as an officer, would serve as a powerful role model. (I find that's the role I often play with my students.) Such an officer's example could not only reassure the soldiers who take the meds, but would also help shift the military culture toward one in which other soldiers would find it easier to trust and support their comrades in arms.
Second, I think it's important to de-mystify these drugs as much as possible, so that the fact of taking them does not, in its own way, add to the issues that soldiers must face. To repeat, taking a med to assist with a problem is not a confession of weakness or bad character. On the contrary, it takes strength and maturity to face up to a problem squarely and do what it takes to accomplish the mission -- whether that mission is to maintain one's health as a civilian or one's effectiveness as a soldier.
Third (and as a corollary), I have found it useful to apply, metaphorically, the warrior ethos to the task of managing the illness. I conceptualize bipolar disorder as an enemy that will never cease in its efforts to destroy me -- either outright or by destroying my quality of life -- and that consequently I have to work conscientiously and intelligently to keep it in check. I've found that my military training and my familiarity with strategic studies have come into play, in various, sometimes unexpected ways, to help me do this.
It would be wrong to create a sunny picture. Even in my safe suburban life, the task of managing bipolar disorder requires a lot of vigilance and is not without its setbacks. For obvious reasons the problem is compounded for those in combat zones, and the last thing I would ever want to suggest is some sort of situational equivalence. At the end of the day, shorter tours of duty and regular rotation into safe areas (such as they are) is a better solution to the problem. But until then, if the Army is going to pursue what I regard as a sensible 21st century policy -- to treat issues of depression, stress and anxiety as problems to be solved rather than defects to be scorned -- then it needs to shift the military culture to conform with the policy. I hope these insights from my own situation, however modest, may be of some help.
The current Time magazine features a cover story entitled "A Medicated Army," discussing the practice of prescribing antidepressants and antianxiety meds to soldiers in combat environments:For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.
As many readers know, I have bipolar disorder, and consequently have a long acquaintance with many of the meds being prescribed. At the moment, for instance, I take Lamictal on a daily basis and clonazepam (the generic equivalent of klonopin) as needed. The former operates as an antidepressant. It has mood stabilizing properties that make it a reasonably good prophylactic against mania -- in fact I've had no trouble with incipient "highs" since I began taking Lamictal about two years ago. The latter is a mood stabilizer and anti-anxiety med. The biochemical manifestations of bipolar disorder are more complex than most people suppose. I have had days when I felt neither up nor down, but had such an insistent sense of generalized anxiety that I had to cancel class because I felt too light-headed to responsibly drive down to campus. Once I grasped its beneficial properties, clonazepam has done a lot to alleviate that problem. I also take the generic form of Ambien on a fairly regular basis in order to make sure I get a good night's rest. Regular sleep -- what's known as "good sleep hygiene" -- is a bedrock element in managing the illness.
The situation of a college professor in the midwest is obviously dissimilar from that of a combat soldier in Iraq or Afghanistan, but I think my experience can contribute a degree of insight. To begin with, I think it's important to regard the meds as simply a tool to assist with the overall task of maintaining good health. There's a tendency for those who take them to regard them as a sort of query against their character: that if they were somehow stronger they wouldn't need to take the meds. That leads to problems. First, it reduces self-confidence and self-esteem. Second, it often creates a state of partial denial in which a person may take the med, but does not acquaint himself closely with the medication's properties. He may not follow the guidelines for taking the med responsibly and when he feels better may quit taking the meds entirely. (Medication noncompliance is the single biggest problem among those with bipolar disorder.)
Third, there can be a tendency to regard the meds as shouldering the whole burden of managing the problem, whereas I have found it helpful to take an active role in managing the disorder rather than just passively taking the pills. I monitor myself for symptoms, even subtle ones that no one around me would recognize. I try to exercise on a regular basis. I make use of as many other tools as I can gather to help with the job: a psychiatrist, a therapist, and also the support of friends. There's too much tendency to let fears of the stigma prevent a person from letting others know about one's situation. But I've found that for every jerk there are many people who welcome the opportunity to be of assistance.
Finally, I have made a personal commitment to be public about having bipolar disorder. In each course I teach, I find a topic that lends itself to disclosure that I have the illness (in the U.S. history survey, for instance, the work of 19th century reformer Dorothea Dix provides a good opportunity). In a class of 200 students, statistically two students have been or will be diagnosed with bipolar disorder. I have never yet disclosed the illness and not received subsequent contact from a student who has the same diagnosis. They express appreciation for my candor and particularly a sense of relief in realizing that they are not alone, and that someone they regard as highly functional can have the disorder and lead a reasonably normal life. I often wind up meeting with them to discuss the illness and how best to manage it. Students usually have a lot of concerns: What will their life be like? what degree of stigma will they face? Frequently they do not yet have in place a good support system for managing the disorder. I recently spoke with a student who has no psychiatrist and therapist; her prescriptions are written by a general practitioner. I've been able to assist with referrals to good psychiatrists and therapists within her health care network.
How does this relate to military personnel who take psychotropic meds? First, I wonder how many officers and NCOs self-disclose that they are taking the same meds. If they keep this info away from their soldiers, they send a double message: overtly it's OK for you to take these meds, but tacitly it's really not because I wouldn't be caught dead letting you know that I take them myself. It would require real moral courage, but an officer willing to talk matter of factly about taking these meds, and at the same time functioning effectively as an officer, would serve as a powerful role model. (I find that's the role I often play with my students.) Such an officer's example could not only reassure the soldiers who take the meds, but would also help shift the military culture toward one in which other soldiers would find it easier to trust and support their comrades in arms.
Second, I think it's important to de-mystify these drugs as much as possible, so that the fact of taking them does not, in its own way, add to the issues that soldiers must face. To repeat, taking a med to assist with a problem is not a confession of weakness or bad character. On the contrary, it takes strength and maturity to face up to a problem squarely and do what it takes to accomplish the mission -- whether that mission is to maintain one's health as a civilian or one's effectiveness as a soldier.
Third (and as a corollary), I have found it useful to apply, metaphorically, the warrior ethos to the task of managing the illness. I conceptualize bipolar disorder as an enemy that will never cease in its efforts to destroy me -- either outright or by destroying my quality of life -- and that consequently I have to work conscientiously and intelligently to keep it in check. I've found that my military training and my familiarity with strategic studies have come into play, in various, sometimes unexpected ways, to help me do this.
It would be wrong to create a sunny picture. Even in my safe suburban life, the task of managing bipolar disorder requires a lot of vigilance and is not without its setbacks. For obvious reasons the problem is compounded for those in combat zones, and the last thing I would ever want to suggest is some sort of situational equivalence. At the end of the day, shorter tours of duty and regular rotation into safe areas (such as they are) is a better solution to the problem. But until then, if the Army is going to pursue what I regard as a sensible 21st century policy -- to treat issues of depression, stress and anxiety as problems to be solved rather than defects to be scorned -- then it needs to shift the military culture to conform with the policy. I hope these insights from my own situation, however modest, may be of some help.
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