Not Now — I am Hypnotizing the Chickens

April 27, 2010 at 3:44 am | Posted in Uncategorized | Leave a comment

Chickens.  Lots of chickens.

The poor things don't even have their own cubicles!

I kept cracking up as I read this New York Times piece on the use of PowerPoint in the military. Who knew that there was such an apt phrase for the act of dazzling and boring a credulous audience into submission?

On a slightly more serious note, if you’d like to start your day with the lash of indignation, you have only to read this exercise in arrogance by psychiatrist Daniel Carlat, who is proud that he now spends a few moments talking to his patients before whipping out his prescription pad even though doing so reduces his profits slightly. Be still my heart. I’m fascinated by how he pairs an unquestioning faith in the psychiatric Diagnostic and Statistical Manual with a cheerful willingness to slap a patient with fiercely addictive uppers and downers without apparently mentioning the substantial long-term risks. Even more interesting — and, frankly, discouraging — is how many of the comments praise him for for his insight. If this is an example of refreshing modesty, then our standards for psychiatrists must be very low indeed.

I have been considering what the heck to do with this blog now that I am apparently not bipolar. I don’t really see closing up shop, and he idea of launching a campaign against the psychiatric establishment makes me more weary than an hour of PowerPoint. I have a lot — a lot — to say about the evils of the 21st Century, so don’t be surprised if I hare off in that direction.

I’m Not the Only Mental Chick Off Her Meds

April 25, 2010 at 6:01 pm | Posted in Philosophical Problems | 1 Comment

I’m intrigued to note that the author of The Secret Life of a Manic Depressive has gone off of her meds, and is questioning a diagnosis for which she’d been treated since age 12. Hm. I sense a movement starting.

I must note with regret that I’ve lost five of the 10 pounds that I gained on Zyprexa and Remeron. I felt mighty cute at 109, and was almost giddy at the prospect of being able to buy clothes off the rack. Alas, I’m back to regarding food with mingled indifference and suspicion, and my uncannily tiny clothes are growing baggy once more.

In Which I Rise Like Lazarus

April 23, 2010 at 4:50 am | Posted in My Fascinating Mood, Philosophical Problems | Leave a comment

I’ve been off all medication for two weeks now, and I have the strange sensation of turning back into the mercurial 19-year-old that I’ve missed so. It’s as if I’ve come back to life and the burial cloth shrouding my senses is falling away. When you combine this with the evidence from Robert Whitaker’s Anatomy of an Epidemic, it looks very much like the past 20 years of crushing mental illness may have been iatrogenic.

You would think I’d be vibrating with horror at that possibility, and, indeed, a part of me feels very angry indeed. However, I’m mostly grateful to have escaped. I’m not entirely recovered, and it’s not realistic to expect to undo two decades of damage in weeks or months, or perhaps ever. I’m hardly perfect now — I do have this alarming temper, for example — but I’m so much better than I ever hoped to be. It really does take my breath away, and I feel profound and unforced gratitude.

There is a moral here, however: It rarely pays to be a good patient. The more conscientiously I followed medical advice, the worse my situation became. A more rebellious or skeptical soul might have stepped off the merry-go-round years ago. Until six months ago, with each downward turn I actually redoubled my commitment to the medical model. If I can just get the meds right, I can whip this, I would think. And the worse I got, the more I doubted my own perceptions. I knew I was getting the best possible treatment, so I blamed my slow disintegration on imagined deficiencies of character. I felt that I must be lazy, sloppy and downright ungrateful. The meds are so good, I thought, and I’ve certainly tried them all. I must be the weak link here. The truth, though, is a textbook example of irony (Dad take note): The more faithfully I followed orders, the worse I became. I felt so horrible precisely because I was so very, very accomplished at being “good.”

I’ve run out of writing time — I’m finding all of this very difficult to imagine and express — so I’ll close now and return later to what is, after all, the key question: Why was I so desperately obedient? And what drove me to this lifesaving rebellion?

Most profound love to all.

I Hate the 20th Century: Email Hack Edition

April 22, 2010 at 1:48 am | Posted in I Hate the 21st Century | Leave a comment

Here's the Archbishop Cranmer being burned at the stake in 1556. He seems to be taking it pretty well, all told.

During the Elizabethan era, the state executed unfortunates who were convicted of treason as follows:

1. Half-hanging (which I believe is an erotic practice in these degenerate times);

2. Disembowlment while conscious (not, to my knowledge, an erotic practice);

3. Burning at the stake.

If your friends felt sorry for you, they would pay to have a bag of gunpowder hung around your neck for the last step; it would decapitate you relatively painlessly as soon as the flames reached it.

An inventive bunch, the Elizabethans. But nothing they could dream up is too harsh for the jerk-off who hacked my email yesterday, thereby inconveniencing me at the end of an exhausting day of PowerPoint-driven meetings.

Speaking of the death penalty, when I am named dictator, I must dream up and enforce a grisly punishment for people who utter any variant of the following during a PowerPoint presentation: “I’m not going to read this whole chart to you….” To which I say, “No? Well bless you, since the wretched thing is written in single-spaced six-point type.”

Final note on the history of capital punishment: For the Elizabethans, murdering your husband was punished as treason, since, after all, your husband was your lord and master for legal purposes. I believe that murdering your wife drew a fleeting frown of disapproval from the bench before the court moved on to more serious matters, like sheep-rustling.

Final note generally: I’ll be cutting back to two sessions a week for my intensive outpatient program, so I should be able to creep back into this space.

Book Review: Robert Whitaker’s Anatomy of an Epidemic

April 21, 2010 at 5:31 am | Posted in Book Reviews | 2 Comments

If you’re taking psych meds or care about anyone who is, click here and order Robert Whitaker’s Anatomy of an Epidemic right this minute. Better yet, hie thee to your local big box bookstore, buy it today, and start it tonight. You’ll want an emergency appointment with your shrink the next day.

I am prone to exaggeration, I suspect, but I’m not indulging that sin when I tell you that this is the most important book I’ve read about psych meds. Whitaker argues that, far from fixing “broken brains” or relieving symptoms, psych meds — antipsychotics, antianxiolytics, antidepressants, and mood stabilizers — cause the very illnesses that they purport to cure.

I don’t want to believe Whitaker. I want to plug my ears and hum, put out my eyes rather than read the words on the page. The evidence is irrefutable, though, and it’s pulled from a staggering variety of unimpeachable sources.

A crude summary:

1. Clinical studies have shown again and again that antidepressants, for example, are no more effective than placebos in relieving depression. This is well-established, and has even been discussed in the general press, including my beloved New York Times. The few studies that do show efficacy do so because they were crudely manipulated by the sponsoring drug companies.

2. It’s also long been accepted that psych drugs do not work the way that conventional wisdom says that they do (I read about this debate most recently in The New York Review of Books, but if you’re interested in these things, again, this will not be news). That is, they do not supplement a serotonin deficiency. Whitaker takes this debate to its logical conclusion, demonstrating that powerful evidence exists that psych drugs actually damage the brain’s ability use the neurotransmitters available. The science is not based on speculation, and this is not a hypothesis. The mechanism of action of antidepressants is old news, and Whitaker’s argument simply presents long-available information in a lucid, step-by-step fashion.

3. But what about those hordes of crazy people who got their lives back when psych meds were introduced? Um, that didn’t happen. Depression, anxiety disorders, and manic-depression were all vanishingly rare in the centuries before the 1970s and 1980s. Systematic examination of the studies available shows that all three have reached epidemic levels in the last 30 years.

4. More horrifying still: Large-scale outcomes have deteriorated significantly significantly for all of the mental illnesses for which drug treatments are available. In the 1950s, about half of the few people who suffered a manic, psychotic or depressive episode remitted spontaneously. When patients did experience repeated episodes, they enjoyed long interim periods of stability and high functioning — they married, had children, held jobs, and lived largely normal lives. People who are diagnosed with a mental illness today are much more likely to be permanently disabled, and much less likely to function well enough to get an education, hold a job, marry, or care for any children they may have. By objective and subjective measures, their lives are a misery.

Have I mentioned that I am one of them, and that my life has sucked?

5. It’s always been acknowledged by enlightened practitioners that psych drugs are, at best, a bargain with the devil. When doctors weren’t just telling you to shut up and take your meds already — do you want to be a burden on society? — they were apologetically explaining that side effects ranging from humiliating to life-threatening are a small price to pay for the privilege of living a normal life. Psych drugs can kill you quickly, through, say, a serotonergic reaction or a fatal spike in blood pressure. They can kill you slowly by causing dangerous weight gain, diabetes, and metabolic syndrome. And, of course, they can render your life pointless by making you impotent, for example, or robbing you of your intellectual and artistic gifts.

That’s the quick-and-dirty version. There’s a lot more, including cogent responses to all of the objections that are bubbling up on your lips right now. Read it. I dare you.

A Fantastic Article on Mental Health and Finances from The Simple Dollar

April 11, 2010 at 9:07 am | Posted in Finances, Links | Leave a comment

I really recommend this brief article from Trent at The Simple Dollar. It’s so funny — I know intellectually that bipolar people face specific financial difficulties, but I experience tremendous shame and frustration about my relationship to money. I’ll take the time to write a full-length post about this later today. For now, I invite all of you to think about how mental illness — or even just normal emotional ups and downs — have affected your financial life.

Guest Post: The Health Care Bill Might Not Be As Trivial As I Thought

April 5, 2010 at 3:45 am | Posted in Uncategorized | Leave a comment

A lawyer friend recently sent me the following and gave me permission to publish it here as a guest post:

The health care bill is very, very complex. Wrapping one’s fingers around the health care costs of employers, the government costs of subsidies and tax breaks, the societal benefit of low-income citizens having access to health care, including the economic savings as a result of prevention, early detection, and quicker treatments that allows people to get back to work, the savings of hospitals who will have fewer patients who can’t pay, the additional revenue of new taxes, changes in medicaid, the potential changes in insurance premiums and costs, as well as the economic efficiency and new jobs created from allowing people to spend their money on homes and cars and vacations instead of health care- and comparing that to the cost of doing nothing- is next to impossible. I have a degree in economics, and I have no clue what the costs and trade-offs are going to be. But I do know it’s complex.

Who likes things complicated? Nobody. So Republicans, to their credit, have done a fantastic job of manipulating the debate. The “debate” became one about death panels, big government, socialized medicine, and huge tax increases. These things are easier to understand. As a result, people turned strongly against a health care bill that will benefit many of them. Republicans have scored major points by opposing and blocking anything and everything. Sadly, it seems likely that some Democrats may lose their seat in congress because they wanted their constituents to have better access to health care.

I am sending this to you, because you know more about health care than I do, and you have a blog. People who care about the welfare of others and favor health care need to share our thoughts with the world.

Here is HR-3950 in condensed version:

1. Tens of millions of Americans who didn’t have health insurance before will now have access to affordable coverage.

2. The biggest part of this program will be paid for by closing a tax loophole that only the super-rich could exploit, and by taxing the profits the super-rich reap by letting their wealth earn interest for them.

3. Insurance companies will no longer be allowed to massively raise premiums and co-payments while denying claims simply to boost their profits.

4. Families with good insurance will have an easier time keeping that insurance, even if they change jobs or even change states.

5. Because families will have more choices of insurance, they will be able to pick a plan that saves them money.

6. Most middle-class families will spend less of their money on health care, freeing them to spend it on houses, cars, vacations or big-screen TVs, giving a boost to the economy and creating new jobs.

Interesting. I guess I had lost perspective and come to think that (without seeing the new law) the reform that passed was no reform at all.

Love to all. I’ll be off for the next four days, but will take up my pen again on Friday.

You Have to Take Your Shots

April 3, 2010 at 3:22 am | Posted in Links | 1 Comment

I love this post from Knowledge Is Necessity, and not just because he uses basketball, a sport I adore, as a metaphor for life. He examines the playing style of Shane Battier, a small forward whose scoring stats are unimpressive, but whose defensive game is spot-on. Battier may not win every game, but his process guarantees that at least he can say he’s given it his best effort.

This is another way of getting at a truth that I’ve mentioned before in this space: you have to take your shots. Basketball players miss lots of shots — many more than they make. If they don’t accept and embrace failure, they will never taste success. Here’s how Michael Jordan puts it:

I have missed more than 9000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot…and missed. And I have failed over and over and over again in my life. And that is why… I succeed.

Another basketball quote I love, this one from Jerry West:

“You can’t get much done in life if you only work on the days when you feel good.”

Ain’t that the truth.

And Derek Jeter:

“There may be people that have more talent than you, but there’s no excuse for anyone to work harder than you do.”

Finally, Larry Bird:

You never make any of the shots you never take. 87% of the ones you do take, you’ll miss too.

All basketball quotes are from Great-Quotes.com, a fine resource.

Me Again, with a Report on My Intensive Outpatient Program

April 3, 2010 at 3:05 am | Posted in Dealing with Mania, My Fascinating Mood, Rage, The Heath Care System | Leave a comment

Wolverine

Like me, this guy may be subject to irrational frenzies, but he's still furry and wistful.

As I’ve noted, I’m now involved in an intensive outpatient program at a nearby hospital. It’s a huge commitment — nine hours a week — and it’s necessarily eating into my blogging time. I’ve given myself permission to write a good deal less, partly because of the IOP, and partly because I hate the trappings of the 21st Century (as you know).

As I was buzzing around the house cleaning obsessively (a new hypomanic symptom for me — I’ve spent much of my adult life living in squalor), I figured out a couple of things concerning my loathing of the mental health system.

As I’ve mentioned, two-thirds of our therapy sessions in the IOP are run by a gentleman whom I will call A, who is the best therapist I’ve ever worked with. I mean, this guy beats the godlike Dr. B who treated me when I was in graduate school (though Dr. B was dashing and handsome, and the IOP therapist is not especially attractive). Oddly, the remaining third of the program is run by a woman, V, whom I would cheerfully strangle. She easily ranks among my worst therapists, and I’ve endured sessions with counselors who were so incompetent that they presented a public health menace. I spend much of her hour disassociating, which I haven’t done since the last time I was hospitalized.

Why does she rile me so? For that matter, why does my soon-to-be-former shrink drive me nuts? I often puzzle over this as I drive home from evening sessions. I figured part of it out two nights ago, and more while organizing my junk drawer this morning.

First, V is a crappy listener. She spends her sessions with us pronouncing all-too-familiar 12-step and therapeutic truisms. “Take it one day at a time” is undeniably excellent advice, but we need concrete coping strategies, not general rules. A, on the other hand, asks questions, expresses empathy, and helps us to explore how to cope with our lives and illnesses. The contrast is striking.

What’s more, whenever I do speak V flatly contradicts me, essentially saying that my experience is uniformly wrong or mistaken. This enrages me so much that I snap my mouth shut for fear of snarling ugly imprecations. For example, V thinks my shrink walks on water, and I’ve reached the conclusion that said shrink is a quack. It’s not surprising that V should favor this doctor — they both recite irritating cliches instead of engaging with patients. The real horror is this: the arguments between me and V reproduce the tiresome and seemingly inescapable dialog in my head. No wonder I’m angry precisely one third of the time at my IOP — it’s like seeing my most misery-inducing interior monologues come to life.

Of course, some of you are probably thinking that I should be more grateful for the help I’m getting. I’m sure this is true. It burns my ass, though, when people who are not in a position to know suggest that I’m too cynical and negative about the health care system. I hate being told that I should be grateful for crappy care. I approach each new drug, shrink, and therapist with buoyant hope, and my anger is largely a product of intense disappointment.

It’s interesting that A and V subscribe to the same theoretical model. Many clinical studies have reached the conclusion that the form of therapy matters less than patients’ perception that their therapist genuinely cares whether or not their quality of life improves. I may be wrong in feeling that V is uncaring, but the mere semblance of arrogant indifference is profoundly disillusioning.

Enough. I actually am grateful for A’s help, and the handouts and techniques have proven valuable, not just in the group, but in everyday settings.

Love to all. I will likely write more this weekend.

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