Author Archives: JoelS

Does Mania Reveal Our True Selves?

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I am antisemitic when I am in mania. I warn all my friends about it, ask them to note it as a symptom, and let my wife know that I am spinning into the fire cloud. I am also sexually inappropriate. I enjoy arguments. I quote scripture when I argue even though I am an agnostic.

There’s a theory flying about, mostly held by the sane, that I am revealing my true self in my manic state. This stems from psychoanalytic theory and the notion that there is this subconscious running our affairs from behind the scenes. Supposedly, when I am stable, I am still an antisemitic rat. I’m just able to control it. But this theory crashes because these thoughts do not even enter my consciousness when I am stable or depressed except, in the latter case, in the context of reproving myself for having had them in mania. Nor do I dream about them except when I am running hot.

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Should We Lock Up the Sane?

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A new study — the MacArthur Violence Risk Assessment Study — found that those living with classic mental illness — schizophrenia, bipolar disorder, and depression — alone are not likely to use guns when they commit acts of violence:

“For the small group of people with mental illness who are at risk of committing gun violence, improved collaborations with the criminal justice system are clearly indicated,” the researchers stated. “However, directly targeting mental illness as the major driver of gun violence is misguided. … Prior violence, substance use, and early trauma are more likely to contribute to subsequent violence than is mental illness per se. In this regard, the politically inspired haste to focus gun control efforts on people being treated for a mental illness, rather than on people with demonstrated indicators of violence risk, such as restraining orders related to domestic violence, seems particularly misdirected.”

This contradicts the latest psychophobic reign of error that comes upon the shooting in Charleston, South Carolina. It isn’t the mentally ill who shoot people, but those who have no psychiatric diagnosis. So what are we going to do about them?

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Charleston AME Shooting

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As I write this, I can only begin to imagine the number of people who have jumped to the conclusion that the shooter at the Charleston AME Church was mentally ill. By this time tomorrow, even if the shooter has not been caught, we will hear the pundits debating what kind of disability afflicted the shooter. Undoubtedly there will be more calls for Forced Outpatient Treatment.

There are a few things to keep in mind before we turn Charleston into our reason-to-support-Murphy’s-Law-of-the-day:

  • We have no idea who the shooter is at this point, except that he is white and in his twenties or thirties.
  • South Carolina has “Assisted” Outpatient Treatment. So even if he was mentally ill, the much ballyhooed program sure as hell didn’t prevent anything here.
  • The man had a gun that let him kill a lot of people including a state senator.
  • White supremacist activity has been on the rise.

Rest assured that the NRA — which backs the Helping Families in Mental Health Crisis Act — will blame this on mental illness at the earliest possible press conference. We’re the scapegoat for this kind of thing every time it happens.

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Buzzfeed Petition

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I am deeply disturbed by the recent quiz on Playbuzz that purports to inform its takers whether or not they are bipolar. For this reason I have composed the following petition on change.org which I ask you to sign and circulate among your friends:

Buzzfeed calls itself the largest humor site on Facebook. It reaches nearly 500,000 people, many of whom are impressionable teenagers and young adults.

Recently, it published quizzes purporting to identify whether the test taker was bipolar or OCD. There were many problems with these quizzes.

The first was that many of the questions — especially on the Bipolar quiz — had nothing to do with the disease itself. People with bipolar disorder who have taken the test have been told that they don’t have the disease. Others who don’t have it, have been told that they have.

Second, they make light of syndromes that wreck the lives of those who struggle with them.

Third, the results may give the people the illusion that they have the disease when they don’t or don’t have it when they do. This can lead people to unwisely abandon their treatment or eat up valuable time at the psychiatrist assuaging their fears that they have the illness when they do not.

Fourth, the test has no medical disclaimers to the effect that it is no substitute for accurate diagnosis by a medical professional.

Fifth, the staff at Buzzfeed has been disingenuous about these harms and refuses to remove the tests from their site on the grounds that they are “just entertainment”.

We who live with mental illness live with the hardship of stigma. We are treated like children. We are told that we are faking our symptoms or that they “really aren’t that bad”. Buzzfeed’s arrant insensitivity must end.

Please sign the petition at the site.

On Refusing to Take Medication

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I avoided medications of all varieties for much of my adult life. When I was 36, I had had too much of my depression and opted to start taking Prozac under the care of a psychiatrist at Redwood City Kaiser. I stayed on anti-depressants alone until I was 47 when I finally acknowledged my bipolar disorder after a suicide attempt and added mood stabilizers to the list of drugs that I was taking. Why did I go so long before I sought relief? Mostly because of a prejudice that had been drummed into my head by my mother, a registered nurse, who believed that medications should be avoided at all costs and that my depression and manic swings were character flaws. When I stopped listening to her, the quality of my life improved and I was able to be the person who I always knew that I was.

Many people feel that people who refuse to take medications should be forced to take them. They cite incidents such as a New York City man who went off his meds and started hitting people with a hammer or a schizophrenic woman who killed her baby in a fast food restaurant’s bathroom. The recitation of such litanies by certain advocates who favor forced medication is stigmatizing because the vast majority of people who go unmedicated don’t commit such crimes. Their struggles are worse than those of us who don’t take them, but it is important to understand their reasons for refusing.

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Grandiosity, Branding, and the Purposeless Driven Life

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>Any inclination of mine to become a famous bipolar author — the kind that writes a best-selling book, gets invited to national conventions, gets coverage in the national magazines, etc. –is curbed by one reality: that I live with bipolar disorder and one of my symptoms is grandiosity. Grandiosity — for you outsiders — is different from narcissism in that the latter is strictly an extreme self-love while the former is a beyond-passionate-conviction in a crusade and the belief that one is ordained to be the leader of that crusade. It is a thing that easily falls into a shambles as people are scared away by our hyper-exuberance. As we ramp up into psychosis, we may style ourselves as prophets or even God him/herself. I have been there — once I talked a Quaker Meeting into sponsoring me for a trip to former Yugoslavia in the middle of the 1992 war when I had no clue why it was important for me to be there, other than it being important for me to be there.

Oh, I developed a rationale for my spiritual mission, and I did interesting things such as become one of the first non-journalists to report first-hand on a crisis using the Net. The governments over there didn’t like me much but that is to be expected when you know the Truth and report it through that warped, half-melted lens. The incident leaves me with several doubts about myself — where was this belief that the Spirit was calling me to do this really coming from? and Should I repay those who financed me now that I am disabused myself of the sacredness of my mission? I believe some people — quite a few — tell you that I did good and maybe I did. Others grew to hate me. Since my diagnosis, I am wary of any motivation which suggests that I alone possess a message that should be heard.

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The Merry Month of Self-Murder

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The sky was open to Space and the world was green. The sun shone on the grass as only it can in January. But despite the pleasant weather, my brain filled with pessimism. For many years, I had answered the question “Are you thinking of killing yourself” with “Not the fast way. The slow way.” What I meant was I propelled myself towards death by eating badly and refusing to exercise. Eventually I would suffer a major heart attack and that would be the end of it. But on that January day I texted my last will and testament to my wife, sat down on a log, and began to study the veins in my wrist.

I bucked the statistics by my choice of time. The media gets it wrong; the holidays and the winters that follow are not the time when hospitals see an increase in the number of suicides: it is May. Scientists have not hit upon why self-murder spikes at this time of year, but they have made some observations:

Doctors first observed in the 1820s that suicide rates spike during late spring. Researchers have since postulated and tested all sorts of explanations for the global phenomenon, making this one of the most studied questions in psychiatry. There’s still no consensus, but evidence suggests it has to do with so-called sociodemographic factors. During the winter, many people go into semihibernation: They work less, see fewer people, and are exposed to less frustration and conflict. That all changes in the spring, when increased interaction with others and the stress of work may trigger suicidal thoughts. The theory is based on a couple of observations. First, the spring suicide peak is more pronounced among people employed on farms or in factories who experience greater seasonal variation in the intensity of work and social interactions. In addition, developing countries with a higher proportion of agricultural workers see more seasonal change in the suicide rate than do developed countries. The magnitude of seasonal changes in the suicide rate is more than 10 times higher in Uruguay, for example, than in Belgium. Researchers have also detected a smoothing out of the seasonal variation in suicides in recent decades as more people move from farm to office. (There are smaller peaks in other parts of the year. Cubicle workers are more likely to commit suicide in the fall than in the spring, as are mothers who send their children off to school in September.)

I am not so sure of this theory or of some of the others. Some link the suicide rate to the weather. The amount of sunshine in the day, pollen counts, and air pollution have all been indicted. But one thing that I think affects me heavily by the time May rolls around hasn’t been investigated: Daylight Savings Time.

Why? Because Daylight Savings Time interferes with our inner clock. It makes us wake up an hour earlier than we are used to waking up. It hits us like a hammer in March and continues its drumming through the Spring. The ones who are worst affected are those who are most susceptible to bipolar disorder: night owls.

Owls aren’t early risers like larks. A Lark doesn’t feel the shift much if he has to wake up an hour earlier, but for an owl — who already has a hard time getting up early in the morning — the moving forward of the clock is catastrophic. Six o’clock is taken over by five a.m. A whole hour is stolen and it is not given back until the fall. I have met few people with bipolar disorder who like Daylight Savings Time. It’s proponents, in fact, are few. But big industry — especially retail — like it because people are more likely to leave the house to buy during daylight hours than during darkness. Oil companies like it because people do more driving and more driving requires more gasoline. Despite the health risks, we keep this destructive institution for the profit of a few.

I know that my sleep is sucky at this time of year. When my alarm goes off, it wakes me out of a deep sleep that my body has made no plans to end for another hour. I am dizzy and depressed on many mornings. A gray malaise overcomes me. This darkening of the mood affects my thoughts and those thoughts turn increasingly to negativity and the belief that I am a burden to others. Wouldn’t the world be better off without me?

The cheap fixes I employ are to adjust my medications if the depression gets too deep and to seek out the help of my therapist more often. I stick to my clock, however. Millions of others are in the same boat. So why do we persist in this? Well, our country puts corporate interest over people. What is my life to them? I am collateral damage.

For Further Reading:

  • The Suicide Rate Doesn’t Peak During the Holidays. Why Does It Peak in Spring?

    • Review: Rethinking Positive Thinking

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    Rethinking Positive Thinking: Inside the New Science of Motivation by Gabriele Oettingen

    I don’t know how many times I have listened to people in support groups declare that they have decided to apply positive thinking to their lives and then watched them crash and burn. People declare all kinds of objectives for their affirmations. They will lose weight. They will master their drug problem. They will control their anger. They will grow rich. Money will come to them without effort. They will find a millionaire and marry him. They will find a fabulous new job and leave all the cares of the old one behind them. Some goals are realistic. Others are simply fantastic.

    Studies show that plain old positive thinking drags people into a depressive rut. Oettingen cites the example of her work examining the attitudes of East Germans versus West Germans. East Germans spend a lot of time thinking positively. They see themselves as rich, as coming into opportunities of a lifetime which change their life situation for the better. But they still end up at bars trying to drink their melancholy away, and they never get anywhere with these plans. West Germans set reasonable objectives, put in the work, and succeed. Even though their goals are less grandiose, they are happier than their former Communist counterparts.

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    We Should Stop Using Mass Murderers as Our Poster Children for Change

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    It’s going to happen again with the same reaction by the media. Maybe we will wake up tomorrow morning and see the report in our morning newspaper; maybe we will hear about it from a coworker at lunchtime; or it will be the lead story of the evening news. Mass murder. Mentally Ill Man. The words will be slung together and dished out to a public which has been bred to believe that mental illness and violence are strongly correlated. Politicians, doctors, family members, and activists will devise plans to cope with the problem. It happened with the Virginia Tech shootings, it happened with the recent Germanwings crash. Autism, bipolar disorder, depression, and schizophrenia have all been implicated at one time or another. The mentally ill cannot be trusted, goes the drumbeat. Schizophrenics and bipolars are killers.

    Statistics show that about 3% of the mentally ill are violent. We are ten times more likely to be the victims of violent crime than perpetrators. Yet when we are portrayed on television or the movies, sixty percent of the depictions commit crimes, especially violence. So coupled with the way news outlets spin stories about mass murder, the general public believes that we are ax murderers and serial killers.

    Some reformers use this fear to drive some very specific agendas, namely destruction of our rights to privacy, forced medication, and the resurrection of mental hospitals. The objective is to control the mentally ill. They might argue that this is the best we can get in a society with our values, but that is a weak defense of some very problematic and questionable policy changes.

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    What I Did to Stay Out of the Hospital

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    Today marks the beginning of Mental Health Awareness Month.

    I committed myself for five days at South Coast Medical Center (now Mission Laguna Beach) when I was 47 years old and then attended their partial (out-patient) program for another six months. One thing that negatively impressed me were those people for whom hospitalization was a revolving door: they visited several times and probably have been back since. I resolved not to be one of these, so I made a plan for staying out. I have followed and improved upon that plan ever since. That episode in 2005 was the only time I went in, so far. These are the things that I did:

    I faithfully reported to my psychiatrist as we arranged.

    I kept every one of my appointments.

    Coping with bipolar disorder demanded that I manage the symptoms of my illness. They changed from week to week, at first, so dosages and types of medication needed to be adjusted. My psychiatrist also assured me that things would get better which encouraged me to stick to the treatment.

    I had not been honest with her or with my two previous psychiatrists about my condition. I had symptoms such as irritability, paranoia, grandiosity, religiosity, and suicidal ideation — among others — which would have changed my diagnosis. Believing that I could handle these on my own, I kept silent about them. Deep down I did not want my diagnosis to change. I am not sure whether this was due to dread of stigma or the different drugs I would have to take. My anti-depressants were enough, I thought, and through what those didn’t erase, I believed I could boot-strap my way. When the hospital psychiatrist finally presented me with a different take on the strange constellation of indicators that betrayed my bizarre state of mind, I actually felt relief.

    One of the first things I did was thank my regular psychiatrist for convincing me to check myself into the psych ward. She had saved my life. And she would do it again.

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