I first encountered Gary Shteyngart’s horrifyingly funny America in the not-to-distant-future in the New Yorker’s 2010 annual fiction edition. “Lenny Hearts Eunice” (I think it was called that, and I’m too lazy to look it up) was an excerpt of the remarkable novel that’s resting just to the left of my Mac, tilted for convenient cover-reference. Though jealousy and demographics cut through my adoration of Super Sad True Love Story, I’m going to give a wholehearted “Buy” recommendation. If you don’t see our sad, battered land in Shteyngart’s America, then your perceptions are so very different from mine that I suspect you are not merely deluded, but perhaps an alien of the science fiction sort, brought here to snap up our devalued assets.
First the good. Before I took my M.A. and moved off into the happy land of philosophical concepts of rape, I spent a brief spell writing on corporate culture in late 20th Century dystopian fiction. I dutifully Thomas Pynchon, and took on Martin Amis and Will Self with real enjoyment. If doubts remain about my ability to write a substantial work of criticism on a novel that warrants, at best, tepid approval, I can still steer skpetics to my M.A. thesis on Don DeLillo’s The Names. (“Substantial” may be the wrong word here. I’ve always been one for brevity in critical work, and my thesis set new records for anorectic length — a paper on Madonna that one of my cohort submitted that year was precisely three times as long. Come on, though — you can’t tell me that late-career Europeans educated at Oxford and Konstanz sit down to a 75-page effusion on an American pop star with anything other than clenched jaws and held noses. Damn blogs for lacking footnotes! This so clearly is one.) So while I admit to vast shoals of ignorance about contemporary fiction, I do know something about the tide pool Shteyngart wades in. And he’s easily the best going.
First, last and always — damn him — he’s a master of his craft. The novel is a blend of diary and epistolary, and he’s hit off each of his characters beautifully. When he writes in the voices of the less-literate, he captures their pathos without sinking into the monotony that plagues your average student paper or Facebook blathering. The novel’s core, the diary of the bookish Lenny Abramov, is charming, funny, original, sad, and deeply infused with the history that his younger characters hate and fear.
The surface of his prose is just part of the picture, though. Super Sad True Love Story is beautifully structured — the epistolary form is integral to the book’s functioning — and plotted. Like his beloved Kundera, Shteyngart depicts love, death and war; like Kundera, Shteyngart avoids cheap resolution and irritating ambiguity. Rather. like most of us, his characters reach a series of contradictory epiphanies, and are alternately vindicated and punished by events. Amazing. Subtle. And very, very funny.
There’s so much to admire here that my criticism really must result from irreconcilable differences. His portrayal of middle-aged male angst moved me — a tough assignment, since “pathetic older man finds love and redemption with an innocent younger woman” is at best a crowded genre. And here’s where demographics interfered with my enjoyment. As a middle-aged woman — one who redeemed her share of jaded older men during her 20s and 30s — I do find it hard to take that women my age appear in Shteyngart’s world as bitter, sexless harridans. As much as Shteyngart lampoons a culture that values women entirely for their “fuckability,” the entire structure and subject of his novel adds to a voluminous literature that worships dewy feminine youth and asks the reader to identify with the solid, lovable guys who who want to bang and protect what innocence they can command with their receding hairlines and shrinking bank accounts. That’s depressing. At the same time, I suppose that leaves an opening for my rejoinder to Super Sad True Love Story written from the point of view of an educated, sexy femme d’une certain age.
I’ve been so obsessed with Robert Whittaker’s work that I’ve lost track of how Ethan Watters’ excellent book, Crazy Like Us, has fared recently. I got a very flattering invitation to participate in this PRI forum on America’s most profitable non-defense export: mental illness. I’ve already posted once, and I’ll probably return before the forum closes on May 31.
Many of the people writing in have not read Watters’ book, and as a result he’s been answering some of the most obvious questions and objections, which may be more valuable to the average reader than a detailed engagement with the nuts and bold of his argument. In any case, check it out.
I’ve had all sort of wacky symptoms since I cut out the meds a month or so ago. It’s a cheaper and less time-consuming madness than what I’ve had for the last several years, though, so I’m trying to ride it out.
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.
Just one of the many sensitive portrayals of mental illness on iStockphoto.com.Over my Christmas break I read with interest Nicholson Baker’s provocative history of World War II, Human Smoke, in which the author assembles an impressive pile of evidence suggesting, among other things, that British Prime Minister Winston Churchill ordered the bombing of German civilians for three months before Hitler began his air raids — in fact, there’s a good deal of evidence that the British government used both explosives and chemical weapons on native populations as a sort of dry run for the forthcoming World War. This runs counter to conventional wisdom, to say the least; Churchill is revered partly for his prescient insistence on Hitler’s intransigence. In Baker’s book, he comes across, um, poorly, looking essentially like a bellicose nutjob. Indeed, even his most admiring biographers acknowledge that Churchill relished war and probably wouldn’t have flourished if he’s been named Prime Minister in peacetime.
Baker’s book set off a fascination with Churchill that I’ve just began to explore. My first stop was Gretchen Rubin’sForty Ways to Look at Winston Churchill, since I thought her recent book The Happiness Project was downright genius. Here’s my thoroughly idiosyncratic take: though Rubin’s biography doesn’t investigate the issue, it provides a good deal of evidence that this British wartime leader was at least as bipolar as I am.
In fact, if Churchill wasn’t manic-depressive, I’ll eat my hat. He suffered from black periods of depression (which Rubin does discuss), and when he wasn’t depressed he seems to have lived a life of mild mania. For example: He was a spendthrift; he drank like a fish; he was grandiose from childhood forward; he had poor impulse control; he couldn’t shut up, and lectured his associates and fellow world leaders for hours at a time (a tendency that he shared with Hitler). I’m not the first to have put two and two together — a Google search on “winston churchill bipolar disorder” draws a whole series of provocative hits.
(By the way, Rubin’s book promises both to introduce the reader to Churchill and to comment through its form on the genre of biography. The latter is the sort of enterprise that might well annoy me, but Rubin’s lack of pretension combined with genuine erudition save the day, and it’s an excellent book.)
So, yes, Winston Churchill, for whom I still feel an irrational admiration.
Once I Googled Churchill in connection with bipolar, I felt moved to check on Peter Gabriel as well. He’s got a new album out, and I’ve long had a vague idea that he has some sort of mood disorder, since years ago he wrote the deceptively simple “Lead a Normal Life,” a moving song about psychiatric hospitalization, of all things. In fact, the untitled album that fans call Melt contains sympathetic interior monologues from a set of thoroughly mad characters — perhaps the best is “Family Snapshot,” which dramatizes an assassination attempt. (I know, I know, that sounds like a misguided subject for a song. That’s what I think every time I start to listen to it. It wins me over every time.) Sure enough, many commentators have suggested that Gabriel is manic-depressive. Ha-ha, I say — we are poised to take over the universe.
By now you may be asking yourself, What on earth is she driving at? Um, nothing really. Churchill and Gabriel have been on my mind lately, that’s all. Naturally Adam Ant is always on my mind, since he’s openly mentally ill and probably as queer as a three-dollar bill (and, no, I don’t mean gay). I’ve played “Friend or Foe” countless times and thought, “Yes, that’s it exactly! I am Adam Ant!” (I am also Marilyn Manson, but that’s another story.)
In other news, The American Psychiatric Association has posted a draft of changes to its Diagnostic and Statistical Manual (DSM-V) on the APA home page. Readers can comment on these changes through April 20. The diagnoses in the DSM drive insurance reimbursement, among other things, so they are, of course, tremendously controversial. Over the last several days, John McManamy for Knowledge Is Necessity has been issuing a multi-part report card for the sections of the DSM that address depression and bipolar disorder. His analysis is polemic, to say the least. Given the current public debate concerning treating kids with powerful psych meds, yesterday’s polemic post on pediatric bipolar in particular will ruffle feathers. Whether or not you ultimately agree with McManamy’s analyses, he bases his comments on years of reporting on mood disorders, and his undeniable expertise shines through.
I resisted Ethan Watters’ Crazy Like Us long before I picked it up. In essence, he argues that mental illness is socially constructed, and for the last 20 years, Big Pharma and mental health professionals have evangelized for a pernicious and peculiarly American flavor of madness. Oh, Lord, I thought, another author earnestly “undermining discourse” by pushing a bastardized version of Foucault and postcolonial theory. Ho-hum. When rigorously supported, arguments based on social construction can be illuminating. However, the ideas behind it have become so pervasive that few authors feel the need to support them — instead, they rely on shared assumptions about causality to make the argument for them.
Since Crazy Like Us does, indeed, take social construction as a given, I’d like to begin with a brief overview the concept. I’m not going to prose on and on (I hope), but understanding what Watters means may head off some of the more obvious objections to his claims. This should help us to predict the book’s strengths and weaknesses alike.
Many people bristle at the phrase “social construction” because it seems like a trendy equivalent of its baggier sibling, nurture. Laypeople assume that socially constructed traits stem from individual neuroses, and that, through psychoanalysis, we can control them to some extent. Or, more absurdly, even sociologists may assume that groups choose how they mold members. (To my disgust, the entry in Wikipedia on social construction engages in just such oversimplification.) However, in its strict sense, “socially constructed” does not equal faked or chosen, whether by the individual or a group.
The concept of social construction offers two powerful theoretical advantages: it offers an alternative to deterministic arguments for genetics and allows thinkers to avoid the American sin of psychologizing, and thus pathologizing, individual expressions of, say, gender. Theoreticians (I’m thinking here of Judith Butler’s early work here) do this by arguing that social construction begins from the cradle and involves attributes that people experience as fixed. In fact, genetics may be more mutable, since all but a few traits that people regard as “biological” or “hard-wired” amount to strong tendencies rather than fate. Twin studies bear this out in the case of mental illness; the greatest concordance I’ve read about for even manic depression and schizophrenia is roughly 60 percent.
Further, the concept of social construction pushes philosophers to consider systemic causes rather than falling back on stigmatizing and scapegoating individuals who deviate from the norm. I’m big on systemic causes, particularly economic ones, so I tend to favor anything that jars us out of our national obsession with the individual.
One important objection to vulgar genetics also applies to social construction. In many people’s hands, the latter seems as deterministic as the former, and determinism raises both practical and philosophical objections. For one thing, some people, myself included, feel that they have molded their gender or sexuality through their actions. If the culture is generally homophobic, it seems unlikely that it would routinely construct lesbians and gay men any more than our genes would lead us in that direction. Finally, for many thinkers social construction becomes an unquestioned premise; whole communities of academic tend to take it as gospel and use it as a handy explanation for every behavior that call out for an explanation.
Oh, Lord. I just spent 30 seconds battling the conviction that “explanation” can’t possibly be a word. This is far from perfect, but I’ll run with it. More later.
Gretchen Rubin's The Happiness ProjectIt’s funny how the book that I pick up — or that comes in the mail from Amazon.com — is so often precisely what I need to read. That was certainly the case with Gretchen Rubin’s brand-spanking-new The Happiness Project.
Rubin’s book belongs to a favorite new genre of mine, blog stunt books. Like Judith Levine’s Not Buying It and Colin Beavan’s No Impact Man, The Happiness Project, chronicles a year spent carrying out a particular challenge — in Rubin’s case, the mission of becoming happier. Each month she works on a different aspect of happiness, from organization to spirituality.
In the beginning, Rubin seems a bit defensive about her project, wondering if it’s a self-indulgent reflection of pure privilege. The longer she works on becoming happy, the more confident she becomes of her enterprise, until, by the end, she’s a Happiness Evangelist, barely restraining herself from waxing pedantic about the pleasures of happiness.
I admit that a part of me was skeptical for the first chapter or two. Who is this woman to tell us about happiness, I thought, when she’s got the ideal life? She’s married to a guy who sounds great, she has two lovely daughters, and she’s self-employed as a professional writer. She took a law degree from Yale and lives in New York, for Christ’s sake. Anyone could become happy under those circumstances. What’s more, she admits that she’s never been depressed. What does she have to say to the exquisitely miserable?
Plenty, as it turns out. I enjoyed her book tremendously, and, more importantly, discovered several principles and practices that will help me with my own enterprise of becoming The Perfect Mental Patient.
Before she launches her project, Rubin reads and digests innumerable books on happiness and misery, from Aristotle to contemporary catastrophe memoirs like Joan Didion’s The Year of Magical Thinking. Now, here’s a woman I can relate to — her response to a challenge is to research it. She also comes up with 12 Commandments, a list of reminders which, she explains, are tailored to her own situation and psychological needs; she encourages readers to write their own. I particularly liked the First Commandment, “Be Gretchen,” which encourages her to follow her own tastes and passions. She often pushes herself out of her comfort zone, but again and again she returns to pursuits that she knows make her happy, such as reading, and turns away from pursuits that she feels she ought to enjoy but doesn’t, like listening to jazz.
What really won me over was Rubin’s modesty, humor, and eye for the details of family life. She admits that she is often snappish and sarcastic. She bickers with her husband and yells at her kids, worries incessantly about her career, and shies away from tackling straightforward technical tasks out of a misplaced sense of pride. Her kids throw tantrums that remind me of my own whiny childhood. Her husband can be neglectful and distant, but is also tremendously sweet and considerate. Throughout, she maintains respect for the complexity of her subject matter and her own aptitude for unhappiness.
Though my circumstances differ from Rubin’s (to say the least), I identified with her ultra-normal and largely happy family. Though a part of me grumbled throughout (“She has so many friends — I don’t have any friends!”), I could really see how her maxims and observations apply to just about any situation. her First Splendid Truth is particularly impressive: “To be happy, I need to think about feeling good, feeling bad, and feeling right, in an atmosphere of growth.” In other words, she strives to add sources of pleasure, remove guilt and anxiety, and do the right thing. Her aim in all of this is not simply hedonistic — she hopes to become a better person in every regard; this, too, resonates with me.
I especially like the growth part of the First Splendid Truth, since it acknowledges that long-term happiness often involves short-term difficulties. For example, when she takes a drawing class so as to advance beyond the stick-figure level, Rubin suffers from intense self-consciousness and frustration — in the end, though, she gains some mastery, and her pride more than outweighs her initial unhappiness. She works hard to conquer fear, and often does so; since I struggle with fear, I found her example inspiring. Her sheer imperfection makes it easy for even a grouch like me to think, “I could do that!”
Rubin’s conclusions are encouraging. She ends the year a much-improved and happier person, and I came away from her book with strengthened resolve for my own project. I may struggle more with depression as the year goes on, but I feel much more confident that I really can become The Perfect Mental Patient.
Rubin has a web site (who doesn’t?) that offers various tools for setting up your own Happiness Project. Since I’d already launched my project when I read her book, I don’t think I’ll be using these resources. I can see how they would be useful, however, and I would heartily recommend them to others.
I’ll end by emphasizing that The Happiness Project is both fun to read and a practical guide. It’s not a typical self-help book, and Rubin is not your average cheer guru. She studies her subject intensely, lives her principles day to day, and derives her ideas from her own successes and failures, which she chronicles in detail. I’m sure I’ll be returning to this book again as the year continues.
The cover of Erin Rooney Doland's excellent book on organizing.In case you hadn’t guessed, I am a huge believer in being organized, and in self-improvement in general. Nothing jazzes me quite like a complicated project that promises me a bright, shiny new life of simplicity and ease. On a more practical level, I believe that bipolar folk need to have good systems in place to keep us functioning when depression strikes.
Imagine my delight, then, when I read a review recommending Unclutter Your Life in One Week, a summary of wisdom from Erin Rooney Doland’s Unclutterer blog. I ordered it immediately, even though I thought I didn’t really have a tremendous amount of clutter in my home. How could I? I moved into my lovely new condo at the beginning of May, and purged crap madly before packing.
Of course, I do, indeed, have a good deal of clutter at home and at work. Why, my excess beauty supplies would keep a small village clean and preened for a month; my file drawers at work are crammed with outdated papers and office supplies that past data managers have bequeathed upon me, including, to my dismay, transparencies for overheads (which demonstrate that people bored each other well before PowerPoint) and printable labels for floppy disks.
Once I realized how dire the situation had become, I plunged into Doland’s program, and found her advice to be excellent. I would give one caveat: the agenda for each day is crazily ambitious. Unless you want to bog down and get discouraged, I suggest that you set aside two or three weeks for the dramatic cleanup that she recommends. I’m also a believer in incremental rather than dramatic habit change, if only because I’ve committed to so many radical new plans only to discard or simply forget them in the hustle of daily life. Again, I recommend that you allow several months to implement all of Doland’s cool systems.
The book is divided into separate chapters for each day of the week, each one focusing on a different area of the home and office. She begins by telling you how to clean, simplify and organize the area, then gives a system for maintaining your progress and streamlining the activities associated with the area. So, for example, Monday is devoted to tackling your wardrobe at home and your desk at work, and to setting up a “reception station” by your front door that will give you a transitional zone that will keep you from bringing clutter like loose change and unopened mail into your home.
I tackled the wardrobe project on Sunday, and am still working on it sporadically along with my bathroom. It’s Friday and I haven’t even touched the kitchen or living room. Of course, my wardrobe situation had become pretty grim. I love clothes and shoes, and tend to accumulate them willy-nilly without much regard for fit or function. Following her instructions, though, I managed to pare down my holdings and tidy the floor and storage bins. I haven’t yet established a routine for getting dressed, partly because that entails purchasing at least one big item — a full-length mirror. Also, Doland’s goal with getting dressed is to save time — she believes that it should take no more than five minutes — while I actually enjoy putting together the day’s stunning outfit. So I’m modifying her plan to make dressing fun and sensual rather than simply fast.
Doland provides examples of several wardrobe systems that could work, and encourages you to adopt one that you will actually maintain. This is a real advantage over programs like Getting Things Done that tend to seem elaborate, rigid, and overwhelming to us mentally ill folk. Again and again, Doland emphasizes that the goal is productivity, not maintaining a system for the sheer pleasure of being hyper-organized and precise. This is crucial, since I tend to use things like to do lists to procrastinate and engage in obsessive-compulsive checking behavior rather than as productivity tools.
All in all, though there are plenty of other systems out there (many of which I’ve tried), hers ranks in the 90th percentile, certainly. The same is true of her advice on emailing, filing, and running meetings — her systems are certainly not the only ones, and perhaps not the absolute best, but they are an excellent starting point if certain areas of your life have drifted out of control. Doland’s book rises above the competition because she breaks each project down into tiny steps and shows you exactly where to start on what could otherwise be an overwhelming project.
There are two odd omissions: there’s no advice on organizing storage closets (mine is quickly descending into chaos) or junk drawers (ditto). I can happily turn elsewhere for these, though, so it’s no big loss.
Overall, Doland’s book is a valuable organizing tool. Even if I only follow one-seventh of her advice, my quality of life will improve, and I’m all about quality of life. Too, this book showed up in the mail at just the right time: when I was digging out from a depressive episode and becoming discouraged by the disorder around me. I’m ready for some good old-fashioned goal-directed behavior, and Doland’s book has provided structure and encouragement. So buy it and jump in, or store it until you’re neck-deep in clutter and desperate for a cure.
I admit that I'm fascinated by images of crucifixion, not because I'm morbid or sadistic (no, really), but because I believe they represent the demanding nature of Christianity.This has always puzzled me a bit, and struck me as a bit fatuous:
God is faithful, and he will not let you be tested beyond your strength, but with the testing he will also provide the way out so that you might be able to endure it.
I feel that I’ve been tested beyond my strength often and often. Surely some of my darker thoughts prove that I’ve gone beyond my strength. Is that really the case, though? As I was typing this out, I thought that just because God provides the way out doesn’t mean we have to take it. It’s the whole bit about free will and sin. If sin is turning away from God and towards one’s own will, then perhaps — just perhaps — my darkest days came when I was turning away from God and relying on my own will.
Now I want to make it absolutely clear that I gain nothing by wallowing in the fact that I’ve sinned. As you all know, Christian or not, Christianity holds that none of us can avoid sin, since we’re fallen creatures and live in a fallen world. So meditation on this quote need not remind me of my vile sinning nature. Rather, it should serve as motivation to discern God’s will and turn myself over to it.
This is incredibly difficult, as any Christian will tell you. I’m still very much where St. Augustine was when he was tormented by his ability to discern God’s will and his inability to follow it. Sin is multifarious, is delightful at times, and holds us with chains that we’ve forged link by link over a lifetime. Turning towards God’s will presents us with challenges in just about every aspect of our lives, from our finances to our resistance to tithing to our shyness and distaste when it comes to engaging with the poor. It can often seem overwhelming to imagine striving to live a truly Christian life.
So, yes, following God’s will. If I could just do so, perhaps I could find that elusive way out of at least some of my suffering.
To be honest, I’m a little intimidated. McManamy is the author of McMan’s Depression and Bipolar Web, an encyclopedic site of the sort that makes me wonder what aspects of this disease haven’t already been hashed over on the internet in some detail. I highly recommend both the book and the site; I’ll discuss the former today, and the latter tomorrow — or when I get to it, whichever comes last.
The book is divided into four parts: “Diagnosis,” “Brain Science 101,” “Roads to Recovery,” and “Special Populations.” We’ll travel through the book by sections.
It is, perhaps, unfortunate that McManamy begins the book with such a lengthy and, well, depressing discussion of the two diseases. Unlike so many books and sites, he doesn’t pull any punches. He makes it clear that mood disorders are brutal, and that it will take plenty of hard work and all of your ingenuity to avoid suicide and live a decent life. While most books candy-coat the diagnosis, merely saying that you have a “broken brain” that can be made right with meds, McManamy argues that existing meds are at best crude tools, and that for most people, a diagnosis is the beginning of a long — perhaps lifelong — carousel of medications and side effects both trivial and crippling. The first section, then, on diagnosis, is a downer, and it’s a bit of a struggle to get from there to more hopeful sections on recovery.
I don’t blame McManamy for his approach, however. Too often, as David Karp points out in The Burden of Sympathy, health care providers both oversimplify the impact of the disease, and, at the same time, tend to give up on patients, essentially telling them that they will never live a normal life. While the latter may be true, the first two are inexcusable, and though McManamy’s approach may sadden you, it is realistic. After all, either disease can prove fatal, either through suicide or comorbidities, and existing medical therapies are partial at best.
In this first section, McManamy gives an excellent phenomenological sense of mood disorders — that is, he describes the feeling of having them from the inside. He also presents an argument that he will stick to though the next 300 pages: he considers depression and manic depression to be two faces of the same illness, bipolar spectrum disorder. In essence, he believes that many depressed people are just one bad antidepressant trip away from a diagnosis of bipolar disorder, and, as he points out, bipolar people spend most of their time depressed, and with a diagnosis of major depression. In his opinion, then, a firm distinction between the two is a false one. Though both diseases take many, many forms, and we can draw some distinctions between bipolar and unipolar depression, the two are intertwined, both in the experience of sufferers and in treatment.
In this first section, McManamy describes and analyzes the most terrifying and discouraging aspects of both diseases, and lays out clearly their ability to destroy the lives of patients and the people around them. He provides an unflinching picture of the isolating effect of depression, and lays out how common co-occurring conditions such as substance abuse and anxiety are. Neither disease is to be taken lightly, he writes; both require tremendous determination and resources if sufferers hope to live with dignity and some enjoyment.
The second section, “Brain Science 101,” should probably be titled, “Brain Science 401” — rather than the same old outdated and oversimplified description of how neurotransmitters work, McManamy explores cutting-edge research that suggests that therapies directed at boosting neurotransmitter availability may be crude at best compared to the subtle processes of the brain.
McManamy also provides a nuanced account of the current confused state of genetic research into bipolar spectrum disorders. Again, he moves beyond even the more subtle discussions one typically finds — the ones that talk about a combination of genetic vulnerability combined with triggering events — to explore the complexities of how genes turn on and off production of various proteins, and how these proteins appear to work in the brain and elsewhere. I learned more from this section than even the most sophisticated extant textbook, Goodwin and Jamison’s tome Manic Depressive Illness, which does, after all, date back to 1990. His discussion of depression, in particular, goes well beyond what is available elsewhere.
Once the reader has negotiated these two formidable sections, she finally gets some useful, if limited, good news. It is possible, of course, to combat the diseases on several fronts, from nutrition to exercise to mindfulness meditation and yoga, and that’s what McManamy recommends. He states unequivocally that it is never enough simply to pop a pill, or even a half-dozen pills, and to expect to recover. His refreshing decision to deal with complimentary treatments before turning to meds places the emphasis on what you can do — must do — to combat either malady with some success. Only then does he move on to a thoughtful and detailed dissection of available medical treatments and talk therapy.
Though there is, in his words, “No Magic Bullet,” it is, he argues, our right to expect remission and normal functioning. This is a remarkably optimistic stance given the litany of horrors that take up the first two sections. Even so, I find myself totally agreeing with him. If your doctor writes you off and suggests that you’re incapable of working or sustaining a relationship, in my opinion, you need to find doctor who will work tirelessly with you to find a combination of medical and alternative treatments that will help you to achieve the highest level of functioning of which you are capable — which is probably higher than either you or your doctor may expect upon initial diagnosis.
From here, McManamy moves on to discuss “Special Populations” — children and the elderly — and to consider the special challenges facing each of the sexes, from postpartum psychosis to “Why Psychiatry Fails Men.” He even weighs the question of whether we should have children, given the severity of the two diseases, concluding that the chances of raising a normal child outweigh the odds of passing on either disease.
Each part of the book contains many more intriguing details than I can possibly convey here. A few tidbits that caught my attention:
His assertion that “We may hate our illness, but we can hardly hate what our illness has made of us,” which goes hand-in-hand with his claim — true, I believe — that our courage is incredible even when our outcomes and behavior are less than stellar;
A large study that indicates that “symptomatic individuals [are] only half as likely to marry and twice as likely to separate or divorce,” a finding that has been borne out in my own life and the lives of many of my bipolar friends;
A spirited debate on whether we are special and sensitive, or simply cursed
The excellent suggestion that “[t]hose who are unable to work … do a day or two a week of volunteer work” to lend structure to their lives and gain the feeling that they contribute to society;
Advice that you enjoy “the serotonin benefits of a pet”;
And the recommendation, when it comes to reaching goals, you “start anywhere” rather than getting bogged down in calculating the perfect place to begin;
Finally, he concludes with a truly compelling statement:
Writing is what helped to bring me back from the dead. For me, it is a healing activity. If I were a basketball player, I would be shooting hoops; if I were a gardener, I would be out with the petunias. Healing is about finding something that makes you feel alive and doing it.
So true. I keep telling you that here because I believe it. As with anyone, the more you pursue your passions, the more likely you are to succeed in all areas of life, and to become a person you’d like to meet. He ends, then, on a surprisingly upbeat note: It’s a bloody struggle, but it is possible to survive and thrive. I couldn’t agree more.
It should be clear by now that I give this book the highest possible recommendation. Combined with more specific works that will help you to implement his suggestions for wellness, it may bring you a good deal of relief. Certainly it will reward you with a tremendous store of knowledge with which to make informed decisions about your treatment.
If you're happy, you may not be living according to a provocative post by Jonathan MeadAvoid comfort — that’s the provocative advice that Jonathan Mead of Illuminated Mind is handing out this morning. Essentially, he’s arguing that if you feel comfortable and satisfied in life, you’re not pushing yourself and pursuing your dreams. The art of pursuing your dreams is intrinsically uncomfortable, he writes, so you should be anxious, even afraid, a good amount of the time.
I’m drawn to this suggestion, since I know that I get a heck of a lot more done when I’m dissatisfied and pushing myself. Witness this blog, which came about as a direct result of leaving a happy but complacent state and moving into a state of perpetual restless desire. And I often do feel anxious and unhappy when I’m socializing, for example, or engaging in other activities that I need to do but dread.
On the other hand, when you spend a lot of your time fighting the grinding misery of depression, it’s tough to get all excited about seeking out more unpleasant emotions. I think that for me, and perhaps for most bipolar and depressive folks, Mead’s advice applies only when we’re at our most healthy. I do believe that I need to push myself constantly in order to accomplish anything; it’s just that what I accomplish — keeping a job, having a friend or two, seeking a stable relationship — may look a lot more basic from the outside. I wanted to be a superstar for many years. Now I would settle for that “normal” life, simply since it seems to be out of reach for me. Perhaps achieving what looks like complacent normalcy is hard enough for some of us.
On the subject of happiness, JD at Get Rich Slowly, reviews Happier by Tal Ben-Shahar, a book that I bought when it came out and still haven’t gotten around to reading. It sounds worth the time, though — the mental wellness techniques that JD singles out from the book are things that I’ve always advocated and tried to practice. Keeping a gratitude list, in particular, has benefited me recently; I intend to write more about it soon.
I came across Farewell Prozac via Furious Seasons, which supplies so many excellent links. The author of Farewell Prozac is struggling with quitting SSRIs (the family of drugs that began with Prozac and has given us such commonly prescribed drugs as Zoloft and Paxil). Going off of SSRIs is no party; there’s evidence that SSRI withdrawal may be significantly worse than going off of benzodiazapines, which are notoriously habit-forming. Certainly when I’ve run out of my SSRI accidentally, I’ve felt like fried shit. It will be interesting, then, to follow the travails and, I hope, triumph, of this excellent writer.
I took a long break from The Simple Dollar because I felt like he frequently ignored or even insulted single people without kids, and that’s a sore spot with me when it comes to personal finance bloggers. He’s tempted me back, though, and I’m glad, if only for this post on spending and mood. The author has noticed that he spends more money in the fall simply because his wife and kids are out of the house more; he believes on some level that this spending will make him miss them less. Like so many of us, though, he’s a recovering spendthrift, and he quickly realizes that buying a board game actually makes him less happy, though he subconsciously believed as he bought it that it would somehow help him to share more good times with his family.
As I’ve remarked before in this space, I often wonder how much of my struggle with overspending has to do with depression and mania, and how much is simply normal in this cancerous consumer culture. This post helped me to see that my spending isn’t that unusual, and, if I become more conscious of my motives, I can almost certainly control it.
So those are the links for the day; many aren’t specifically related to bipolar disorder, but all of them got me thinking more about aspects of my illness.
Revolt and Resignation 