Me Again, with a Report on My Intensive Outpatient Program

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.


The Perversity of Depression, Neat Odds and Ends from Cool Blogs, Yet Another Drug to Ask Your Doctor About

Sprouting plant
Here I go again, hoping away.
The author of If You’re Going Through Hell Keep Going is on to something in this short post about the comfort of depression. At the end of a hard day — or, really, any day at all — there’s nothing I like more than snuggling under the quilt my mom made me and playing rain noises on my iPhone. My bed is a lovely place to be. My head, not so much.

Gretchen Rubin has compiled a list of the top 10 myths about happiness on her blog about The Happiness Project.

Doesn’t the word “happiness” start to look strange if you study it?

Another thing: I find it hard to read the excellent blog The Secret Life of a Manic Depressive because the author is so damn perceptive. Here she publishes two pieces that weren’t originally intended as blog entries. In the first, she reflects on the difficulties of being on the “other side of the bedside divide” — that is, on being a mourner or comforter rather than a sufferer. She gives some personal history in the second short essay, and muses on the significance of getting a diagnosis after years of considering herself “mental” (a nice British word) rather than mentally ill. The life she’s living is not at all the life she imagined for herself.

A year or so ago, yoga played a huge role in my life. My home practice was almost bizarrely advanced, and I dreamed of becoming a certified yoga instructor so that I could bring the delights of a regular practice to my sedentary colleagues. One bright morning, though, I stopped, probably because I was working 12 hours a day and spending my remaining waking hours in the company of a boyfriend whom I loved deeply.

Of course, it’s not unusual to give up important disciplines when working this hard. This time around, though, my avoidance of a deeply satisfying process gradually blossomed into a bitter and totally irrational conviction that I couldn’t do yoga no matter how much I might enjoy it. I would consider going to a class or simply starting out with a sun salutation or six, and I would feel, not my usual laziness, but a perverse certainty that yoga was now somehow beyond my power; I’ve noticed this problem in connection with other pastimes that bring me happiness, and I’m not sure what to make of it. I’ve puzzled and puzzled, but I can’t figure out why I began to think, not that I didn’t want to do yoga, but that I literally could not do it. The thought made me sad, but I really had become certain that a beloved activity was beyond my power. That’s the perversity of depression, folks, and it’s discouraging as hell.

Naturally I always knew that I could do it if someone held a gun to my head, and I did recently overcome this bizarre reluctance, mostly because I’d developed a chronic backache that contributed to my crappy mood. The minute I unrolled my yoga mat and dropped into a forward fold my body yelped, Good Lord, this feels wonderful! Painful, but wonderful! My whole body ached for three days after I performed the mildest of routines, but I broke through my mental block effortlessly and became hooked on yoga euphoria again.

This depressive perversity has taken over other aspects of my life — praying the Liturgy of the Hours comes to mind — and I have no idea where it comes from or how to counter it. It may be that understanding is the booby prize; despite what they teach you in therapy, merely having insight into a problem does not much help me to change. Insight is always very nice, but it’s no substitute for judgment, and I return to William Styron’s all-too-accurate observation: When you’re depressed, you wouldn’t creep three steps to pick a pill that might cure you entirely. This drives me and others batshit — it’s insidious, dangerous, and true without a doubt. In consequence, my capacity for suffering far outweighs my ability to help myself.

Is this another one of those entirely normal aspects of the human condition that seems unprecedented to me? Please do comment.

Another sign of hope returning: My admittedly silly fantasy of learning Latin. Talk about perverse — I’m more or less accomplished in three languages besides my native tongue, but nothing will do for me but to read Ovid and Augustine in the original. I’ve hired a tutor and bought armloads of textbooks even though I know that it’s unlikely that I will follow through. So, another truism about the human condition: As Alexander Pope observed, hope springs eternal in the human breast. (The brilliant literary critic Murray Krieger (he of the hilarious and touching baby blue polyester suits) used to tell us that just about every threadbare English expression can be traced back to one of those three sources. I would add a more recent fourth: Winston Churchill.) A part of me knows that I’m almost certain to disappoint myself again, but, darn it, I’m driven to try.

Another one of those almost entirely irrelevant observations that I’m sure you’ve all come to love: The Eyes of Stanley Pain is the best album in the entire world, and today I feel compelled to share it. I especially recommend “Suni C” and “Base Metal.” The lyrics to the former both frighten and move me — they seem strengely manic-y. Here’s the matching video:

And here’s the video for “Base Metal”:

This song makes me profoundly happy, perhaps because of the looped background sound of rain.

One last note: Alarmingly, the new shrink I tried had stocked his waiting room with brochures hyping Concerta, a drug intended to “manage the challenges of ADHD.” Get a load of these quiz questions:

1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

2. How often do you have difficulty getting things in order when you have to do a task that requires organization?

3. How often do you have trouble remembering appointments or obligations?

4. When you have a task that requires a lot of thought, how long do you avoid or delay getting started

And so forth. For the whole quiz in all of its delicious absurdity, click here. I’ve created a shorter version:

1. Do you have a pulse?

2. Do you have health insurance?

You’d better ask your doctor about ADHD quick, before you fall behind in the competitive global marketplace. Never mind the following black box warning: “Concerta should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence, with varying degrees of abnormal behavior.” What do you want to bet that bored lab monkeys self-administer this drug?

That’s enough for now. This is one of two draft posts that I’ve been avoiding for days, and I’m looking forward to hitting “Publish” though the writing continues to suck.

Love to all.

In Which I Pass on Gossip about a Few Famous People Who May Be Mentally Ill

Mental Illness Image
Just one of the many sensitive portrayals of mental illness on
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’s Forty 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.

The New York Times Considers What Will Happen If We Don’t Pass Health Care Reform

United States Capital
I love my country, but fear for our democracy.
This article in the Sunday Times considers what will happen if health care reform doesn’t pass. “Grim” is an understatement. Already health care costs are breaking the bank for individuals, employers, and Federal and state budgets; if current trends continue, premiums are likely to double in the next 10 years, and wages will certainly not keep pace. So, yeah, put your elected officials’ feet to the fire.

I’ve long suspected that we’ll have to stop throwing money at increasingly expensive drugs, devices, and surgery. I’m suitably grateful for the pace of technological advancement in medicine, but it’s clear to me that we need to ration care. If we do, it will be a damn sight cheaper to pay for preventative care than to cover, say, organ transplants.

Which brings us to another point that seems obvious to me, but that commentators rarely mention: In the U.S., we kill ourselves with food. Obesity has reached epidemic proportions, and young people seem to be leading the crowd. Video games, cable TV and the Internet have largely replaced my favorite childhood pastimes, which included scampering around the neighborhood pretending to be a horse, making horrid-smelling “perfumes” and “meals,” and jousting with sticks. I don’t advocate that children follow my example and fiddle with dead birds or use WD-40, Lysol and hairspray to create improvised flamethrowers. I’d probably show them how, though, if that would draw them away from shopping and gazing at screens.

Note to my parents: I’ve never set fire to anything. Never. Though I must say that I found Dad’s demonstration of how to use a magnifying glass to start a fire, um, compelling.

OK, I’ve wandered far off topic, and it’s time to pry myself from the screen.

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.

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.