This and That

Here I am, as busy as a weasel.
I was hypomanic yesterday afternoon, and, boy, was it fun. My enjoyment was impaired only slightly by a suspicion that I was behaving a bit strangely. I had all the classic symptoms: I was unable to shut up in a meeting, my language became more convoluted, and I drove recklessly. I felt compelled to mention Zeno of Elea and the Duke of Wellington several times. I also entertained the following thoughts:

1. I am so clever!

2. Work is so fun and absorbing!

3. How I love test and software engineers! (This is particularly nutty — when I am in my right mind, I would like nothing more than to strangle the entire Mission Planning group because their work is invariably late and shoddy.)

4. How fun it is to think!

I’m betting this is connected to going off of my antianxiolytic. Ever since, I have the great pleasure of thinking much more clearly. Why, just yesterday I performed a minor but sweet mental feat without thinking: I looked up Alcibiades’ mother’s family name in a book I’m reading about the Peloponnesian war. Years and years ago, my mind effortlessly retained the general layout of most texts that I read. While I didn’t have the entire text of Middlemarch neatly arranged in my head (a trick of the late literary critic Northrup Frye), if I needed to find a particular passage, I could always recall its location on the page. I lost this capacity years ago, but apparently have regained it entirely.

This is big. For years I’d been mourning — mourning, I tell you! — the loss of a whole series of Stupid Brain Tricks, and even if others don’t notice or care, it’s distressing to shed brain functions wholesale. My moods are have been volatile, but it’s more than worth it. Strangely, I’m much less anxious, and am less prone to disappear into what I think of as my Dark Tunnel of Misery, a mental state that renders me unable to hear or see others.

In other Fascinating Mood News, I have been slacking on walking and meeting my social obligations. This weekend I intend to restore those habits, since the next phase of my quest to become The Perfect Mental Patient begins Monday.

Lately my mood has settled into a weekly cycle that I can’t shake. Sunday and Monday I am positively crippled by depression. My spirits begin to lift on Tuesday, and by Thursday I am as brisk as a bee in a bottle. On the bad days I struggle mightily to shift laundry from the washer to the dryer, and there seems to be no hope of folding it once dry. I spend Thursday mornings bustling around the house knocking out even the most repulsive tasks, and at work I crank widgets briskly.

I’m not sure how to handle the down times. A part of me refuses to accept periods of low productivity, so I castigate myself early in the week. Three days later, I am positively smug with accomplishment, resting secure in the knowledge that I am busy and therefore good. I’d like to treat myself with compassion, but my Inner Protestant can’t stop carping. I’ll have to devise a solution and share it.

One last thing. On If You’re Going Through Hell Keep Going, the author shares a list of things she’d like to do someday. Imagining future self visiting London, for example, helps her to survive brutal lows. I will have to try this on Sunday, provided I can move my hands.

Love to all.


A Couple of Political Notes, and the Virtue of Underreacting

Obama's Inauguration
A crowd shot from President Obama's inauguration. He called us to action on that day; let's unite to answer his call.
Here are the words that most struck me in President Obama’s State of the Union address:

Every day, Americans meet their responsibilities to their families and their employers. Time and again, they lend a hand to their neighbors and give back to their country. They take pride in their labor, and are generous in spirit. These aren’t Republican values or Democratic values that they’re living by; business values or labor values. They’re American values.

Yup. I’ve talked about the importance of a work ethic in this space before. So often, genuine. pressing work needs call me out my self-absorbed misery and into a common enterprise. I was pleased to see President Obama (how I love those words!) reaffirm those crucial American values.

Here’s another crucial point: “I never suggested that change would be easy, or that I could do it alone.” At every campaign stop, Obama the candidate drove home the point that citizens can’t just vote and sit back. I admit, I’ve been guilty of this approach. It’s been a tremendous relief to go to bed at night knowing that I won’t wake up to be deprived of another civil right, or shocked by the news that our economy is teetering on the brink of total destruction.

But I need to get on the stick. You need to get on the stick. No matter what our ideological beliefs, we all share a belief in decency and hard work. So let’s get to it. We need to insure health care for all Americans, whether by the government or by private efforts. So I challenge each and every one of you to work for the reform you support, and may the better man win.

Along those lines, kudos to the Chairman of the Republican National Committee, Michael Steele, who has the sense to oppose an ideological test that would determine whether the Republican Party could support a candidate financially. The mean-spirited side of me cheers at anything that would weaken the Republican Party, and believe me, this proposal would. But let’s face it: at this moment in history, we don’t need another divisive battle about ideological purity.

Back to bipolar news. Apropos of a post on Mentally Interesting, No Spam writes, “Lack of control sucks to cuz even when I’m doing it I know I’m gonna regret it.. yeah I have that insight but it does me no good, it just makes me feel more guilty.” I know exactly what he means. Most people do. It sucks to know that you’re exercising poor judgment, and unfortunately mental illness often leaves the bipolar among us in that position.

I really like how Gretchen Rubin on The Happiness Project urges us to Underreact to a Problem, which, as you might expect, is the opposite of overreacting. Underreacting — that is, not throwing a fit to which you are perfectly entitled to — allows you to evaluate a situation calmly and and assign tasks instead of blame. I highly recommend this approach when others have made a mistake and gotten you into a fix.

Here’s an example: I used to see a gentleman who was as intrepid a hiker and climber as I am. On one particularly ridiculous occasion, we got his truck stuck in the mud in an isolated spot. We had, of course, been off-roading, although his truck did not have four-wheel drive.

Now, there was plenty of blame to go around. I had navigated us down a series of unpaved roads. He had accepted my suggestions. Neither of us had thought to turn back when it started raining, or to load boards and shovels into the bed of his truck (something we remembered to do roughly half of the time when rain threatened). As usual, one or both of us had behaved in a foolhardy fashion or forgotten some key element of preparation. This raised alluring opportunities for tears and recriminations of the “You never,” “You always,” and “You promised” variety. Neither of us indulged. Instead, we deliberately underreacted, treating each absurdity as an adventure, evaluating our resources, devising a plan, and implementing it briskly. I’m still proud of having taking that approach in that particular relationship, and I intend to behave similarly in the future.

One last thing: A series in The New York Times on errors in radiation therapy demonstrates two things. First, you absolutely must take responsibility for and control of your own medical treatment. At the same time, medical technology has become so complicated that even doctors and technicians can make life-threatening errors. I hate living with this sort of bind, but I’m not sure there’s any way to put an end to it.

Love to all.

One Simple Piece of Advice About Rage

Artemis the Huntress
Artemis, the Greek goddess of the hunt. When Acteon accidentally caught a glimpse of her in her bath, she turned him into a stag and his own dogs ripped him limb from limb. Lately, that's been me.
Lately I’ve been fuming pretty much nonstop, to the point where I resolved to write an entry on “How To Defuse Anger.” I felt like I needed to research it, though, because I have no idea how. You see, I haven’t been angry for years. When I quit my antianxiolytic, I found myself getting more and more irritable. Since I quit it entirely, I’ve been brooding nonstop about real and imagined indignities.

This unsettles me. I have been a peaceable, easygoing creature for years. When I think back, I realize that I’ve been calm and sweet … since I started an antianxiolytic. Before then, when my rage-bomb went off, it was thermonuclear. Now it looks like I may have been drugged into sweetness for all these years. Uh-oh.

I did have one piece of advice: Do whatever it takes to restrain yourself from throwing a carpet-chewing fit. If you do, people will lose respect for you and busy themselves trying to thwart you. As usual, though, I can’t follow my own advice. Allow me to give an example.

In order to get to the office at 6:30 a.m., I have to leave home more or less in the middle of the night. Two days ago, as I was pulling out of the parking lot outside my condo, I saw a guy in a hoodie standing on the corner. I don’t know about you, but when I see a guy standing around idle, I figure he’s up to no good.

As I rounded the corner, I saw that this dude had his dick out and was yanking on it while glaring at me intently. “Well, there goes the neighborhood,” I thought. And as I drove off, the new Dr. RandR began to spin up into a hissy fit. I wasn’t shocked — while it didn’t impress me, it hardly struck fear into my heart. Rather, I felt boiling impatience. Great, now I have to worry about this stupid dickweed jumping me. I couldn’t remember if flashers are suppose to be dangerous or not. Damn it, I thought, this is a matter of property value. A lot of single women live here, and we don’t need random guys hanging around jerking their willies. I decided to go back and give him what-for.

I felt no fear. I knew that confronting this guy wasn’t sensible, but I persuaded myself that it was The Right Thing To Do. I wasn’t planning to get out of the car, but I was ready to give him the rough side of my tongue. I have a gift for invective, and I can reduce a roomful of rowdy 18-year-old guys to shocked silence by reeling off slang terms for acts they’ve never even seen on the Internet. Heck, I’ve drawn a carving knife on a woman-beater. (“Are you going to stab me?” he jeered, puffing out his chest. “Yeah,” I said flatly. And he ran like the coward he was.) So I was ready to rout this guy like the Romans at Cannae.

Of course, he was gone when I got there. I drove around, but was left impotently grumbling, “If I ever see that [adjective describing an obscure and terrible act][insulting noun] again, he’s going to be sorry he was born.”

I knew this was stupid as I was doing it, but white-hot outrage made me reckless. As I took off again for work I thought, whoa, I am dangerously pissed. I’m going to have to learn some anger management techniques. And irritability can be a symptom of hypomania. So is reckless driving, another sport I’ve taken up recently. So, off to my shrink. I’ll let you know when I’ve figured out constructive ways to defuse anger. As always, feel free to suggest things in the comments.

Love to all.

Mind Freedom International Distributes the National Council on Disability’s Provocative Report on Civil Rights for People with Mental Illnesses

I found this report, From Privileges to Rights: People Labeled with with Psychiatric Disabilities Speak for Themselves, both valuable and troubling. The NCD held hearings in which they specifically listened to consumers of mental health services, and drew the following 10 conclusions, discussed below.

My initial reaction, I admit, was impatience. I’m inherently suspicious of activist language such as “people labeled with with psychiatric disabilities,” partly because I come from a profession that displays a naive faith in the power of such phrases to erase stigma. I spent much of my 20s playing language police — insisting that people who have been raped be called “survivors” and not “victims,” for example, or that we use the inelegant phrase “people with disabilities” instead of “disabled people” — and experience teaches me that such insistence needlessly intimidates people with no direct experience of rape or a given disability. Instead of asking direct questions and learning about mental illnesses, people tend to lapse into tongue-tied silence out of fear of transgressing some linguistic boundary. I’d rather create an atmosphere that encourages people to ask questions, even if their phrasing is flawed.

I’m also uncomfortable with the notion that I’ve simply been “labeled.” Of course, diseases are partly socially constructed. The treatment offered varies wildly from culture to culture, and these treatments are unquestionably more or less effective. In fact, I agree with the recent article in The New York Times that suggested that American ways of understanding and treating mental illness may create more stigma and suffering than they erase.

At the same time, the most disabling mental illnesses — schizophrenia, manic-depression and major depression — have been observed in most extant cultures since before the birth of Christ. I don’t think that these sicknesses are simply biological, but neither are they mere labels that would disappear if we stopped applying them. The very title of the NCD report riled me, then.

Next, I read the Executive Summary and core recommendations. Again, I found myself in immediate disagreement. The first recommendation begins, “Laws that allow the use of involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with the principle of self-determination.” That’s a nice sentiment, I thought, but serious mental illnesses prey on judgment, will, and the ability to perceive reality. As I’ve said before in this space, the concept of self-determination may well not apply to us at all times.

Also, I worry that this insistence on self-determination feeds into the worst tendencies of American culture to offload citizens’ illnesses onto an already-weak family structure. David Karp’s The Burden of Sympathy, which I reviewed in this space, eloquently addresses the tragic consequences of this approach. We have, as a culture, abdicated responsibility for people who are ill, most notably by depriving them of quality, accessible medical care. This follows directly from our insistence on total independence and self-determination.

So, yeah, I found myself struggling with this report from the outset. Here’s the funny thing, though: When I read the actual testimony, I began to waver. Here are the words of one former patient:

The unit structure is based on privileges and punishments, which are referred to as consequences, since they maintain these are not punitive. [The structure] will not allow any kind of privacy whatsoever, and everything is a potential treatment issue, including nail-biting and not making one’s bed. They maintain control through humiliation and fear of humiliation.

Too true. These aspects of psychiatric hospitalization are undeniable, maddening and unnecessary. I’ve never been restrained or forcibly medicated, but I’ve often seen it happen in totally inappropriate circumstances, both in the snake pit of a public hospital and in exclusive private settings. Nurses and aides pathologize perfectly natural and even healthy behavior. A trivial example: a nurse once recorded the following in my chart: “Patient engaged in writing behavior.” God forbid you should express healthy, righteous anger. A less trivial example: When I refused to eat meat (I was a vegetarian), a nurse threatened to “ram a feeding tube up [my] nose.” In fact, when I’ve been subjected to forced treatment, it has never benefited me, and has often done significant harm.

Even so, a part of me thinks, “Yes, but some people refuse treatments that they need, and they are in no condition to give informed consent.” For instance, I remember a young woman in a public hospital who became floridly psychotic and posed a danger to other patients. I was grateful when they restrained and medicated her, and I think it was necessary.

Along these lines, I’ve noticed that no one who lands in a mental hospital thinks they belong there. Absurdly, each patient thinks that her case is an outrageous mistake, and that she doesn’t belong in the company of this pack of nuts. In other words, we can see each others’ pathology clearly, but we typically have very little insight into our own.

In the end, though, I return to the core of my own experience. Coerced treatment has never helped me, and I’m not sure that it benefits anyone else, either. I think back on my first hospitalization, which was at a swanky clinic for women with addictions and eating disorders. I had neither, but my shrink persuaded me that “they know how to feed people.” You could say that. The young anorexic who shared my room was very, very ill — she envied my weight, which was an unenviable 92 lbs at 5’6″. The staff’s approach? At each meal, a nurse was assigned to watch us and record what we ate. Patients were then forced to wait in public for two hours so that they wouldn’t purge. Can anyone seriously argue that someone with an eating disorder would benefit from this treatment? If anything, it was fiendishly designed to drive her deeper into rebellious self-starvation, and to reinforce her fear of food.

These musings lead me to the following conclusion: Forced treatment can be a good idea in principle, but in fact it rarely works as intended. Instead, it encourages nurses and aides to abuse the absolute power they enjoy over patients. Psych aides, in particular, are poorly paid and usually receive no special training. They act out of prejudice, fear, and, yes, a perfectly human desire to punish and control “bad” patients. Restraints, forced medication, and solitary confinement make their jobs easier, and prejudice allows then to justify mistreatment of patients.

(Incidentally, I do feel sympathy for psych aides — their working conditions suck, and despite this, some treat patients with genuinely healing compassion.)

Well, it’s time to get ready for work, and I’m still on the first recommendation. I’ll return to this report later.

Love to all.

News Flash: Life Is Hard and No One Gets Out Alive

In other news, it has recently come to my attention that life is hard and the human condition is no picnic.

I realized this over the Christmas break. Recently, a friend remarked, “You make it sound as if you’ve cornered the market on depression, when a lot of what you talk about in your blog is normal.” I was genuinely surprised. My feelings are normal? I was absurdly disappointed.

Of course, the more I thought about this, the more it made sense. Recent events have brought it to my attention that even the people that I admire most struggle. They are often lonely and sad, and find it difficult to communicate with their fellow creatures. Humbling, that.

It’s also strangely reassuring. I am not alone; I’m not even especially unique. When I first began this blog, it puzzled me that so many non-bipolar people identify with the emotions I describe. Lately I’ve been thinking that anyone in my circumstances would feel unhappy, lonely and sad. (Well, ungrateful wretches like me, in any case.) My behavior is sometimes strange — for instance, I have a morbid fear of smiling and meeting people’s eyes — but the emotions that drive that behavior are standard-issue human feelings.

I’ve always maintained that bipolar disorder is best understood as an intensification of normal life. Depression and mania may be quantitatively different from normal ups and downs, but they aren’t qualitatively different. I find this strangely reassuring. I often tend to think of myself as a tragic, hopeless case. In fact, the normal life I long for may be both closer and more difficult than I’m willing to admit.

That’s all for now. I also banged out the long post below, and I’m getting tired of staring at a computer screen. Without a doubt, the Internet is the television of my generation.

Love to all.

In the Absence of a Super-Majority, 10% Will Rule the Country

The headline says it all. According to The New York Times, Republican Scott Brown won the special election in Massachusetts, and will fill the late Senator Ted Kennedy’s seat. On the campaign trail, Brown promised to be the 41st vote that would block health care legislation by threatening a filibuster. As a result, 41 senators who represent 10% of the nation’s population will be able to derail health care reform.

Make no mistake: they will derail it, and do so loudly and righteously. The Republicans will hold ranks, and conservative Democrats will work tirelessly to lard any remaining bill with more pork and greater concessions. Ultimately, we won’t get a damn thing. By God, I’m sick of this. Citizens of the United States are dying by tens of thousands annually for lack of health care coverage. If you can remain placid in the face of that fact, consider this: The current system is a gigantic anchor to industrial progress. Countries with universal health care enjoy a huge competitive advantage in the “global marketplace” (a phrase I hate). So my industry in particular, one of the few areas of manufacturing remaining partly in the U.S., will see business go to European competitors.

Let me mention a few especially annoying points.

First, when the Times interviewed Brown supporters in Massachusetts, again and again they said that they didn’t want health care reform “rammed down [their] throats.” In what alternate universe has anything been rammed down anyone’s throat? The House and Senate bills in conference were, in the words of one Democratic senator, “the compromise of a compromise.” It’s not like they mandated universal, single-payer coverage for all; they didn’t even allow people 55 and older to buy into Medicare. Nope. The Senate version was a feeble, washed-out compromise more or less dictated by that smarmy turncoat, Joseph Lieberman. Its net effect would actually be a giveaway to insurance companies and Big Pharma. But even that wouldn’t be enough to satisfy conservatives, apparently.

Second, Massachusetts already has near-universal health care mandated at the state level. So 52 percent of the voters in a tiny state — one of 20 states with tiny populations — will deprive the rest of us of a shot at a decent, workable system.

And for some reason it really bugs me that Republican Senators don’t actually have to filibuster — that is, hole up on the Senate floor reading aloud from their home state’s phone book until the majority gives in out of sheer impatience. They can just threaten to do it, and if Democrats call their bluff, everyone will just take their marbles and go home. I want to hear the phone book, damn it.

Finally, the current procedural rules came into effect in the late 19th Century, so they weren’t exactly drafted by the Founding Fathers. They are protected primarily by Senate tradition, and of course jealously defended by The Minority That Rules.

I’m genuinely pissed off about this. What does it take to implement even the most feeble change in this country? Tea Baggers were already roaming the country promising to lynch President Obama at the prospect of adopting solidly centrist changes. The previous administration assembled a lawless Praetorian Guard, held people in preventative detention for years without bringing charges against them, and formally authorized torture. With the exception of that latter, these policies are still in place. Hell, they tap phones without judicial approval. What’s next?

Ironically, for all of my complaints about incipient fascism, recent events have destroyed my faith in democracy. It’s still the worst system of governance except all of the rest. We fancy ourselves leaders of the Free World and latter-day Athenians (those of us who remember Athens); in truth, we struggle to educate the next generation in basic scientific principles, let alone to produce the engineers we need to compete militarily. With the exception of material riches, we live in ignorance and squalor. We are the Athenians, folks — the Athenians at the end of the Peloponnesian War, when eternal wars with Sparta precipitated what historians call the Greek Dark Ages.

Grr. Okay. Back to our regularly scheduled programming.

Links: New FDA Website Answers Basic Questions about Regulation and Approval Processes

I’m liking the Food and Drug Administration’s new website, which offers information on how the FDA regulates everything from sunscreen to biotechnology. If you take psych medication, it’s essential that you understand both how the system is supposed to work and its very real weaknesses. Thanks to the Pharma Blog Review for pointing out this valuable resource.

The Carlat Psychiatry blog offers a brief but sensible assessment of the therapy-versus-drugs debate between psychiatrists and psychologists, and calls for more shrinks who are trained in proven therapy methods such as cognitive-behavioral therapy. Eminently sensible.

I fell off the wagon yesterday and drank a cup of coffee. It was delightful, but I was dragged-out and yawny later in the day. No walking and no smiling. I will get to it today. I’m also planning to sign up for classes in drawing and writing experimental poetry. Yay!

The Simple Dollar’s short article on important but not urgent tasks gave me a needed kick in the pants. The author makes an excellent point: Willingness to take on dull but crucial tasks often separates the sheep from the goats. Or, in his words, “It is the special person – the one on the path to success – who can put aside the countless “urgent but not important” things in life … and replace them with the “important but not urgent” things.