And Richard Cory, one calm summer night, Went home and put a bullet through his head.

I learned just yesterday that one of my college housemates died last year. I remember “Richard” as an outgoing young anthropology major, with plenty of friends, and interesting stories of life among the Mbuti pygmies. A mutual friend and fellow housemate told me yesterday that he had died.

I Googled his name (with appropriate accompanying words to distinguish him from all the other men with the same name), and found his obituary, and some other things that people had written, before and after his death. There I found hints at what looked like an upper middle class childhood, note duly made of Richard’s Stanford degree, two books that he had written (I’m impressed, as I have written zero books, unless you count the novel in a drawer and the screenplay in a drawer), and stories of his woodsman skills and the meals he cooked for his friends.

I could see, perhaps, a few things lacking: the obituary listed no spouse or lover or children to mourn him, only parents and siblings and nephews and nieces. And one brother had died before him (ten years before him, of a heart attack, I found in another obituary helpfully supplied by Google). An article from a couple of years ago said that his small business was struggling a bit.

But nothing in these bits and pieces, or in my memories, prepared me for the closing paragraph of the warmest blog post of memories.

One summer day last year, Richard hung himself.


Review: Infinitely Polar Bear

I identified with the wife and mother. Partly because she was, like me, the wife of a man with bipolar disorder. But also because she was the kind of person I think of myself as being, a bright, competent woman who pulls things together to be the provider for her family. Any time I doubt my other wifely abilities, I can tell myself that, after all, I’ve done pretty well for us as the family breadwinner.

For the mother (played by Zoe Saldana) in Infinitely Polar Bear, though, providing for her family means trusting her chaotic, bipolar husband (“totally polar bear,” as his younger daughter describes him) can pull it together to care for their two daughters while she relocates from Boston to NYC to get the education she’ll need to provide a better life for her family.

As that bipolar husband, Mark Ruffalo shines, displaying an entirely believable mix of chaos, love, and hard work as a father pulled toward sanity by the need to keep it together (take the Lithium, put away the booze) for his two daughters. His enthusiasms and his battle with household clutter did remind me of my husband.

But this is a movie that focuses, not on the journey of the patient, but that of the whole family. You can see the wife, on her last reserve of patience as she gets her husband’s ecstatic 3am phone call announcing that he has completed a costume for his daughter, and realizes that he is manic again. And you can see her in warmer moments when she remembers why she loved him in the first place. And you can see his daughters’ loving but often embarrassed relationship with their father, as the film honors the way he pulls himself together to be the best father he possibly can without sugarcoating the experience of being the child who wonders, if I move away from dad, will he still take his Lithium?

On the whole, it’s an upbeat story, one in which love does triumph and dad does come through when he’s needed. And one I’d definitely recommend.


Meeting of the Minds, 2015

Two weeks ago, I attended Meeting of the Minds. This is a conference that is held every year in Orange County, CA, for mental health professionals, first responders, patients (whom the conference calls “consumers,” but that term always sounds odd to me) and family members. These are the sessions I attended:

Accessing Mental Health Services in Orange County: This is the third year in a row that I have attended a session that had something to do with available county services. Why, when I could pick a different topic each year? Mainly because I wanted to see what might be changing in the wake of the Affordable Care Act. Two years ago, the session I attended was all about what we could expect from the Affordable Care Act, and, above all, how to get the word out to people who would be eligible for subsidies and get them to sign up. Last year, it was all about what was new with the Affordable Care Act, which mainly boiled down to people on Medicaid (called Medical in California) being able to get mental health services before they are in dire crisis (plus, since California isn’t one of the states that rejected the Medicaid expansion, more people can get Medical). This year was different; the changes from the Affordable Care Act have already happened, and the focus was not so much on what has changed as on what the services are, going forward. There were two sections to the session, one on Caloptima (the provider for everyone on Medical in Orange County – this varies from county to county), and one on the OC Links information and referral line.

As of March 31, 2015, Caloptima in Orange County had 730k members, up from less than 500k before the Affordable Care Act. There’s also a behavioral treatment program for autism spectrum disorder that’s new as of September, 2014. Otherwise, the mental health services available are, as they were last year, individual and group therapy, psychological testing, outpatient monitoring of drug therapy, psychiatric consultation, and Screening, Brief Intervention, and Referral to Treatment (SBIRT), a program where primary care physicians screen their patients for alcohol abuse.

OC Links is a phone number to call for all kinds of referrals related to mental health (855-OC-LINKS). It differs from 211 in being specifically focused on mental health.

OC CAT and PERT: This session covered two things. CAT is for Centralized Assessment Team, a team that you can call to come to wherever you are and do an assessment as to whether someone is a danger to self or others, and might need to be committed on a 5150. They can get anywhere in the county usually within 30 minutes (in an immediately life threatening situation they advise calling 911 instead). What you get are mental health professionals who work closely with the police; cops will come with them, but it will be mental health professionals who do the evaluation. PERT is related in that it also involves mental health professionals riding with police and helping them learn to better handle people in their area who have mental illness. A trained clinician rides with a patrol 1 to 5 days a week, and the city involved develops a team of police officers with additional training related to working with people who are mentally ill. We heard from police officers in Newport Beach and in Anaheim, and the mental health professionals who rode with them.

Keynote speech at lunch: This was about the treatment of PTSD in veterans. The speaker clearly knew his topic well, and had some of the most compelling information of any keynote speech I’ve heard at the several Meeting of the Minds conferences I attended. That was the good part. The bad part was that, in the part of the room where I was sitting, he was not very audible at all. It took constant concentration to hear what he was saying, and this situation got worse as people around me gave up on hearing the talk and began talking about other things. Maybe the mic needed adjusting? What I did get out of the talk was that perhaps 16% of veterans have PTSD, and as many as 30% of those wounded, and that while only a very small percentage recover on their own, around two thirds can get better with proper treatment. The treatment was multi-faceted, and I wish I could have heard all of it, but I gathered that it included yoga, meditation, cognitive behavioral therapy for insomnia, and prolonged exposure with breathing.

New Diagnostic Test and Treatments for Depression: This session discussed three things. The MDD Score is a simple blood test for biomarkers associated with depression. It includes neuroendocrine, metabolic, neurotropic, inflammatory, etc. biomarkers, for an overall score that says whether you’re likely depressed. The GeneSight Psychotropic Test looks at genes that may affect your body’s response to and metabolism of different psychotropic drugs, to help in selecting which drug to give you. And Transcranial Magnetic Stimulation is a treatment for depression, where you sit in a chair and get a magnetic pulse sent through your brain. It’s still not covered by Medicare in California (though it is in some states), but is covered by some insurance plans.

I have more notes on the talks, but that’s the gist of what they were about.



What is that song you sing for the dead

I bought the album Carrie and Lowell because I had read that it was about Sufjan Stevens’ relationship with his mentally ill mother. Carrie, Stevens’ mother, suffered from bipolar disorder and schizophrenia. After she died, he wrote songs about his grief for her and his complicated relationship with her.

When I was three, three maybe four
She left us at that video store

I had a vague impression that Stevens was a Christian singer/songwriter. This is true in the sense that he’s both a singer/songwriter and a Christian, but turns out not to describe his songs (nor does he describe himself this way). While they contain religious imagery, it’s more the kind of religious imagery that you’d get from Leonard Cohen – tangled with varied emotions and accounts of his life – than the kind that’s straightforward worship and praise. The songs have a folk rock sound, with complex lyrics and simple, gentle tunes. The song with the most explicit religious allusions, “No Shade in the Shadow of the Cross,” combines that cross reference with lines like “There’s blood on that blade, fuck me, I’m falling apart,” just as it combines the memory of his mother with reference to some newer romantic love. Emotions range from forgiveness to despair, and allusions are classical as well as Christian.

the only thing that keeps me from driving this car
half light jacknife into the canyon at night
signs and wonders, perseus aligned with a skull
slaying medusa, pegasus alight from us all

Am I right in seeing a reference to Oedipus in “Should I tear my eyes out now?”


On Victor Frankl, and logotherapy

We who have come back, by the aid of many lucky chances or miracles – whatever one may choose to call them – we know: the best of us did not return.

I have just finished reading Man’s Search for Meaning by Victor E. Frankl. The book is written in two parts. The first part is an account of Victor Frankl’s experiences in several concentration camps, during WWII. The second is an account of Frankl’s system of therapy, called logotherapy, a humanistic variety of psychotherapy centered around the importance of finding meaning in your life. As Frankl says, in the first part, quoting Nietzsche,

He who has a why to live for can bear almost any how.

What ties the two parts together is the fact that, in relating his concentration camp experiences, Frankl focuses, beyond the bare fact of the abuses to which he and other Jews were subjected in the camps (those few who did somehow survive), on the psychology of being a concentration camp prisoner, both for worse (the decline, from constant hunger and weakness as much as anything, into numbness and apathy) and for better (where did prisoners find the resilience to keep going in the face of that horror). These sources of resilience include relishing brief moments of respite (a stolen potato or the chance to remove lice) or beauty (a sunset or a song), the memory of particular lines of literature and philosophy that speak to Frankl (Nietzsche, Lessing, Dostoevsky), hanging onto memories of the past (for Frankl, especially, the image of his wife, who would eventually prove to have died in another camp), humor, and seeking sources of meaning (for Frankl, an attempt to reconstruct, on scraps in shorthand, a manuscript that had been taken from him at Auschwitz, and a fantasy of a future Frankl, having survived, giving a lecture on the psychology of prisoners in concentration camps). That and a sheet of paper with the Shema Yisrael, received in the coat pocket of one who had already died, in place of the manuscript that had been taken from Frankl. When Frankl titles a postscript after his second part “The Case for a Tragic Optimism,” the fact that he has surely earned the “tragic” part of that case makes me trust the “optimism” part more.

Logotherapy, the school of psychotherapy that Frankl founded, and which he describes in the second part of his book, is a third school of Viennese psychotherapy, after Freud’s psychoanalysis and Adler’s individual therapy. In contrast to Freud’s will to pleasure, or Adler’s will to power, Frankl centers his psychotherapy on a will to meaning.
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Introducing myself

Hi. I promised Joel that I’d blog here at least once a month. It probably won’t be much more than that, between my job and my volunteer work and miscellaneous other things. But I do have a book review that I want to get up within the next couple of days.

I have been married for nearly half my life to someone who lives with bipolar disorder. I myself am mostly neurotypical; I went through some episodes of depression (with definite provoking incidents) when I was much younger, and was even briefly hospitalized, once, very long ago, but some people do manage to recover from depression and stay stable without medication, and I have been lucky enough to be one of them. Cognitive therapy helped some there, and I may write about that later.

In college I majored in psychology at a school whose psychology department was strong in experimental psychology, with the clinical classes in the department having a cognitive behavioral orientation. I didn’t continue in that field, though. Instead, I’ve held various computer jobs: system administration, technical support, software development, and software quality assurance. At this point, I can tell you a lot more about computers than I can about psychology, but computers aren’t the topic of this blog, so you probably won’t hear computer stuff from me here.