Sergeant John Russell

Sergeant John Russell was convicted April 22, 2013, for second-degree murder of five military men at the Mental Health Clinic at Camp Liberty in Iraq. He will probably spend the rest of his life in a military jail. Sergeant Russell is seriously mentally ill. He wanted to kill himself, but after the horrible treatment he received from the Army’s mental system he, in a fit of rage, murdered three enlisted men and two officers. One of these officers was Navy Commander Charles “Keith” Springle, a 52-year-old with a doctorate in social work. He was the only person in the Army’s mental health system that showed Sergeant Russell any compassion, but not being a doctor, he referred Russell to a psychiatrist.  In my opinion, the psychiatrist, Lieutenant Colonel Michael Jones, should be indicted for second-degree murderer as a co-conspirator in Sergeant Russell’s crime.  He seriously is guilty of misconduct and misbehavior in his treatment of Russell.

What I propose is not without precedent. In France, as reported by the Psychiatric Times, psychiatrist Daniele Canarelli was convicted of multiple practitioner failures after her patient of four years Joel Gaillard murdered a man.  The jury found Dr. Canarelli guilty of numerous and repeated lapses in judgment and stated that the doctor’s attitude “resembled blindness.”  Patient Gaillard, while he was in treatment, perpetrated a succession of acts of aggression, each of increasing severity, which culminated in his act of murder.  Dr. Jones similarly was “blind” to the growing rage and desire to kill himself that Sergeant Russell evidenced.

As reported by the Los Angeles Times, Dr. Jones treated his patient with what can only be described as gross incompetence and near egomaniacal belief in his own healing powers. Sergeant Russell stated to the psychiatrist that “he needed to either legitimately help me or send me back to my unit so could kill myself.”  Dr. Jones, as reported by Sergeant Russell, “leaned over very close to me, put his hands on either side of my face, and declared, “You’re fixed.”  This is totally unprofessional behavior. It is unbelievable that this doctor should be practicing in the Army. This is a doctor, who as reported in the Bloomberg News, six months prior to his treatment of Russell, was standing before a judge in Michigan to be tried on a DUI charge, his second offense. The judge sentenced him to a two-day jail term after Jones agreed to enter a program to help doctors overcome chemical dependencies and substance abuse.  Jones’s medical license was renewed despite his substance abuse issue because he had committed to the program.  It is not stated if Jones completed this program or if his deployment to Iraq allowed him to slide.

What is clear is that Russell was so enraged, harboring a rage that had been growing for a long time related to PTSD and workplace issues, that he returned to his unit grabbed a fellow serviceman’s weapon — his own weapon’s bullets had been removed by his unit commander due to Russell’s suicidal state of mind — and returned to the clinic. Through an open window he saw, Army Major Mathew Houseseal, the clinic’s lead psychiatrist, and shot him in the head. Entering the clinic, Russell found Navy Commander Springle in his office standing with his back to the doorway. He shot him twice in the back and once in the head. In a sleep therapy class, Russell gunned down three enlisted men. He followed one of these men, Yates, out the front door and put a bullet through his chin. Russell was a soldier seriously pissed off by the mental health treatment he received. Russell didn’t get Jones. Jones escaped by leaping out a window, but Jones should not escape punishment for his part in this tragedy.

This is a disaster that should not have taken place. If Russell had been diagnosed properly and given adequate treatment, five people would be alive today, and Russell would not be facing many many years in prison.  After the incident, a Walter Reed Medical Center team diagnosed Sergeant Russell with chronic post-traumatic stress and a major depressive disorder with psychotic features.”  Sergeant Russell, a dyslexic person, who never graduated from high school, found a home in the Army for 15 years. In Iraq he was on his third deployment, when he went berserk. Russell spent almost five years in war zones. In Bosnia and Kosovo in the 1990s he was “in firefights and inventoried a truckload of mutilated bodies.” On his second Iraq tour, Russell was in Ramadi during 2005 and 2006. He described “scraping my friend” off radio equipment after an improvised-explosive device was detonated in a tent.  Russell nightmares were so intense that a barracks mate videotaped them.  This soldier deserved better than the treatment he was given the Army’s mental health system, which was poor when he first contacted the system and culminated in the absurd treatment he was given by psychiatrist Dr. Michael Jones.  It is time to hold these professionals responsible.  Dr. Jones should be indicted. Maybe that will force the Army in particular to deal seriously with the problem of its mentally ill soldiers, and the psychiatric profession as a whole to deal with incompetent practitioners.

Jared Loughner  (Phoenix), Adam Lanza (Sandy Hook), James Holmes (Aurora, Colorado), Seung-Hui Cho (Virginia Tech), Dylan Klebold (Columbine), Kipland Kinkel (Springfield, Oregon)

These young men are the poster boys for most of American society’s attitude toward the mentally ill: mentally ill people are dangerous; give them a gun and they will kill you.  The attitude is deeply imbedded in the psyche of the normal population.  I just finished reading a book by the author Kathy Reichs called “Devil Bones,” in which in the end the killer is revealed to be a manic-depressive who wasn’t taking his medications.  Idiot, writing I thought. She’s picking the easy mark. Not a day goes by without some news story or police drama that doesn’t finger a mentally ill person as the culprit.  After the Sandy Hook tragedy, we have the NRA deflecting the issue of the right to own semi-automatic weapons and assault rifles by proposing draconian measures to take away the civil rights of people with mental illness.  We have state legislators demanding that the mentally ill be deprived of the right to own a weapon as if that is going to solve a problem where there are more guns floating around than people and where violence is a national addiction.

I am for gun control. I see no need to have semi-automatic weapons and assault rifles in anybody’s hands other than the military and law enforcement.  All the mentally ill mass killers pictured above had these weapons.  I am for background checks. I am for outlawing semi-automatic pistols in private hands in cities over 50,000 people. I am for the all-out ban of assault weapons. If a person has a criminal record or has run afoul of the law because of some incident related to a mental illness, the right to own a weapon should be restricted.  What I don’t like is the potential exposure of medical records to gun dealers, politicians, and law enforcement. Medical records should remain private, but I fear in this age of easy access through computer technology that this barrier will be breached if it already hasn’t been.  The civil rights of persons who have or have had a mental illness will be totally compromised.  A person with mental illness becomes someone apart from society. We become lepers. It was John Nash, the schizophrenic Nobel laureate, who coined the phrase, “We are the new lepers.”

At a recent one-day conference in Pasadena, California, called “Facing the Crisis: Mental Illness and Gun Violence” sponsored by NAMI San Gabriel Valley, All Saints Episcopal Church in Pasadena, and the Fuller Theological Seminary, Fredrick Frese, Ph.D., a schizophrenic unashamed of his mental condition, and a professor of psychiatry at Northeastern Ohio Universities, brought up John Nash’s remark. The conference, which had some wonderful and highly regarded speakers, was lightly attended and wasn’t even reported upon by any of the area’s news organizations. I concluded that most of society cares little about the positive information to be gleaned about the relationship of mental illness to gun violence.  Those social elements: the gun lovers, the outraged politicians, the media, and those who are unwilling and too lazy to see the truth, want the madmen and women controlled.  They shrink in fear from the mentally ill.  It’s us versus them. From the way they look at the problem, the madmen are winning.

But it is not us versus them! As Frederick Frese, his voice growing louder and his lip tic becoming even more distinct, pointed out, we are not separate, but an essential part of the human family. “It’s in the gene pool,” he said. “It is not defects but differences. We think out of the box. For us there is no box.” I have always felt that way. I think differently. It is the way my brain is wired. That wiring causes me difficulty, like my tendency to severe downs and super-exhilarating ups.  Mental illness is a difficulty not a defect. Look at all the people with mental difficulties, who have contributed to our culture. At the beginning of the conference each participant was handed a bookmarker with the heading “People with mental illness enrich our lives” The list started with Abraham Lincoln; and included Beethoven, Leo Tolstoy, Isaac Newton, Sylvia Plath, Vivian Leigh, Jimmy Piersall; and ended with John Nash.

Yes, a small percentage of the mentally ill are dangerous, but compare them against the normal Americans who are prone to violence.  Their number way far surpasses the number of violence-prone mentally ill people.  Keris Myrick, Ph.D.c, an articulate woman with a mental illness, National president of NAMI, and President/CEO of Project Return stated, “Conjoining mental illness and gun violence is wrong. The mentally ill are more likely to be victims of violence than the perpetrators.”  Increasing the stigmatization of mental illness by separating this faction from the whole and attributing the issue of gun violence to the lack of restriction of their rights is “binary thinking” according to the Reverend Edwin Bacon, Rector of All Saints Church.  Rector Bacon, who spoke of his own clinical depression, expressed the view that mental health and gun violence are embraced in an overall  “toxic narrative” that condones violence and a violent response to violence.

Dr. Michael Walsh, Director of Pasadena’s Department of Public Health, stated that violence is a public health issue.  With the passion of a pastor, Dr. Walsh noted that even those who were engaged in noble violence by being members of the American military “leave something behind” after they have engaged in killing.  As we witness the enormous number of suicides and the recent killing of a former Navy Seal by a man suffering from PTSD, we know the price these individuals have paid to be killers.  We can’t just divide them off from the community and make them lepers.

The question is not how to stop mentally ill madmen from shooting up our towns, but how to stop the mentality of violence. Eric Sahakian, from the Pasadena School District, said that 58% of students with emotional issues drop out of school and 75% of them are arrested within two years.  The school system is trying to reduce the risk of violence by teaching appropriate methods for dealing with feelings of anger.  This is yet another example that proper treatment and available treatment goes a long way toward helping reduce both mental illness and violence.  However the mentality of violence goes much deeper. It resides in the computer games people play, the movies and television programs they watch, the books they read, the news they hear and see, and even in athletic contests people play and view.

I have no prescription for treating this mentality.  What I do believe will mitigate this negative mentality is when, as Rev. Bacon stated, we recognize we live in a “network of mutuality.”  There is no “them.” We are not binary. We are all one. Everyone is somehow connected to mental illness and violence. It’s in our families, present with our friends, lives our neighborhoods, cities; and is in our universe.  It’s in the gene pool extrapolating on the words of Dr. Frese.  Looking at the six young men who murdered so many innocent people, I don’t see any one who appears much different from most of humanity. There isn’t a woman or an African American among these six, but if I looked further into the records I’m sure I could find a stand-in. Perhaps if these persons, the Adam Lanzas of the world, had felt their connection to the human community they might not have done what they did. Perhaps if all humans recognized the truth that we are part of one world community we wouldn’t resort to violence because it is ultimately against ourselves.

Norman Bates from Hitchcock’s movie Psycho

I believe that anyone, given particular circumstances, could “go psycho.”  Not everyone agrees with my assertion.  My psychiatrist thinks I am wrong, but did not elucidate why.  Thus I still think it’s true that anyone can “go psycho.” By this I mean anyone can have a psychotic break no matter if they are already suffering from a mental illness or not. While those with mental issues are perhaps more likely to go “psycho,” any normal person could have a psychotic break given compelling circumstances. In war some soldiers go bonkers.  There are those workers whom we referred to as “Going Postal.” There are those women and children who have finally had enough abuse from churlish husbands who hack the old man to death. There are those young men for who stress and mental illness pushes them over the line and they go out and kill their lovers, their families, and untold number of innocents.  Was not the Newtown gunman one of these, who went so far over the edge that he could in cold blood massacre school children?

I once had my hands around my ex-wife’s neck in a fit of rage and would have strangled her had I not heard her desperate call for me to stop.  I was a millisecond from going over the edge.  I pulled back and released my grip. but what if she had done something else, mocked me or perhaps attacked me I could have lost it and done her in?  I was astounded and ashamed of my behavior. This was the only time in my life I came that close to a violent act.  My wife, unable to deal with my rage, divorced me. I understood her feelings. I do not fear that I will “go psycho” anymore — counseling and treatment have blunted that fearful edge, but I know in my heart that I am capable of “going psycho.”

I believe each of us has another side.  Like coins we have two sides.  There is heads, my good side, my rational side; and there is tails my evil side, my unreasonable side.  I work hard to avoid coming up tails.  Occasionally I have fits of temper when I know I have flipped. It is then that I must apply all that I know and believe in to overcome this negative irrational side.  Yet it lurks unseen, but not unrecognized as part of my nature. A capacity for violence lies in the core of this negative nature.  Does our society not condone and even admire violence?  Americans watch violent movies and play violent games.  The question is how far can one go with violence, before it trips into mayhem.  The answer is that mayhem lies just beyond rim of violence, and too often people fall over that edge.  It is an illness of our society, which all the hand wringing and shouts to control weapons will not mend.

This was the situation with a friend of mine. He and his wife were in a bitter contest over the custody of their children.  After his refusal to accept her bargain on joint custody, she attacked him with a knife so he relates, cutting him on his arm. The newspaper didn’t report this. They portrayed him as an abusive husband.  In a fury, in a disassociated state he judges, he responded, and stabbed the woman 29 times.  Today he resides in the dungeon, as he calls it, serving 16 years to life.  He did not fight the judgment, he says, out of remorse for his act, and his desire not to sully the reputation of his wife

My friend, whom I have known since 1968 when he, a student at Oxford, and I, a student at the University of London, met each other on an overnight ship from Athens to Crete.  There was one deck chair left to sleep in and he and I found it simultaneously.  We had a spirited argument on who got to the chair first. Neither of us would relinquish our claim.  He being a law student thought he could outtalk me, but I, stubborn to the maximum, did not give in.  We spent the night talking on either side of the disputed deck chair.  We talked philosophy – he was a fervent reader of Ludwig Wittgenstein; I was a pragmatist who liked Jeremy Bentham, the founder of the University of London.  We talked politics, (the generals propped up by the American military were in charge in Greece), the Vietnam War (both of us were very strongly opposed), art, music, and architecture (he liked Gropius and the Bauhaus; I liked Robert Venturi and the anti-international style). This night sealed our friendship.

I saw my friend often over the ensuing years.  He was a person who worked for his beliefs helping the disadvantaged and suing the corporate bosses, who manipulated rates and laws for their favor.  He was and still is a bombastic person full of opinion and often seized with outbursts of outsized laughter. Is he mentally ill? I never saw him that way. He had I thought a larger than life personality.  I attended his wedding, and watched, as he became a doting father.  Then somehow it all came unglued.  The family moved to a new city where the wife got a university position, and my friend went with her.  The wife lost her job, and the marriage deteriorated.  Until that fateful evening when my friend “went psycho.”  How could anyone stab another person 29 times? He stated to me that his “losing it” came about from his wife’s attack on him, but newspaper reports stated he attacked her in bed.  No matter the circumstances my friend went “psycho.” I have visited him once in prison and I could not conclude he is mentally ill.  He is, as I have always known him to be, a funny, intelligent, rational, and generally caring person.  How could he have crossed civilized boundaries and become a killer?

My friend related to me a conversation he overheard while in the jail before his trial, when two inmates wishing to taunt him had this brief conversation.

“Hey! Hitchcock’s Psycho is on TV tonight.”

“Yeah. But we have our own psycho right here.  He stabbed her more times than Norman Bates stabbed the woman in the movie.”

What went on in his mind that he could do this act?   My friend and his wife were educated and articulate people.  Yet tragedy struck.  The judge in sentencing my friend to a life term stated, “this horrible event could happen to anybody.”  I believe him.

Today my friend sends me letters.  We don’t talk on the telephone. The prison system of telephone access is unfathomable to me, and I won’t do it. We must be the last people who still send letters. In the age of email no one does this anymore, but for someone in prison without a computer, letters, and the telephone are the only ways to communicate.  He sends me many letters.  I asked him if he really were full of remorse for the murder of his wife.  He has convinced me that he is. I have asked him what happened on that fateful night.  What was the experience of “going psycho?” He has yet to answer this fundamental question. Perhaps he can’t remember.  Does some wicked force take over our minds obliterating all other consciousness?  Does this wicked force then allows our savage animal instinct to attack furiously?  Do we kill without regard for the consequences? Do we lose hold so completely to our good side that it no longer exists for a period of time?  These are the questions I would like my friend to answer.

If he can dredge up this moment of time, it would be of great value to our understanding of what happens to humans who “go psycho” My friend said for long time he has no memory of what happened. I told him he has had a long time to think about this event, and perhaps now he can articulate the “killing, as he refers to the murder.  I have encouraged him to do this, and we have contemplated writing a book about this mystery.

When I started reading this autobiography by artist/author, Carlton Davis, I thought it would be a gruelling read. It’s not nice reading about people with severe mental illness and self-destructive tendencies, right? Actually, Davis has such a great grip on life, the universe and everything that he expresses the reality of schizophrenia with more wit than anyone I have ever encountered in print. The story is in his own words a roller-coaster and the device of narrative is to have an ongoing conversation with his alter-ego, Carlotta the tranny. Both are engaging, by the way and there’s something very Henry Milleresque in the structure of the story, particularly in the boots-and-all sex trawling scenes, drug use and other gritty encounters. Davis is indeed a writer of note, has a beautiful, strong sense of place and time and the only missing star was due to some repetition in the story that I believe to be unnecessary. Others may find the repeated info clarifying though. It’s not a book you will want to leave unfinished. His story of survival and even of using his condition productively (eventually) is amazing. The man should be dead a hundred times over but has lived through his (understandable) death wish to document his condition in a non-preachy, super-useful way. Bi-Polar Disorder is like Cancer. No two conditions are exactly alike. However, for people who suffer, for their families and workmates, this is a must-read. He is featured in a recent documentary ‘Of Two Minds’ and watching this (as well as reading the book) is illuminating. Long may he live and may happiness bless him so that he has many more years of outstanding creativity.

Bridge Jumper Suicide

“To see suicide simply as an individual mental illness and homicide as a similarly individual moral failing is to ignore the degree to which both are caused in part, by societal, economic forces.”

James Gilligan from “Why Some Politicians Are More Dangerous Than Others”

To see suicide- all suicides- as caused in part by societal and economic forces makes them a political act to my mind. This is a very intriguing idea.  To see suicide bombers and self-immolating priests as making political acts is easy to fathom.  Both forms of suicide are strikes against a perceived enemy.  To see a depressed and withdrawn individual taking his or her life as a political action requires more consideration.

James Gilligan sees suicide in a larger framework of statistics- a framework where any violent act whether self inflicted or directed against others can be considered a political act by total numbers.  He sites statistics in his book that suicide and violence increase to epidemic portions under Republican Presidencies and decline under Democratic Administrations. He shows that this statistic is true from the days of Teddy Roosevelt to our time of Barack Obama.  This fact he attributes to the basic tenets of each party.  The Republican Party supports the idea that in a free market system all men are not created equal. Some men/women are more superior and more important than others.  Society they believe should not bind by rules and regulations people in the exercise of their superiority. The Democratic Party believes all men are created equal and that it is the role of government to regulate the power of superiority (generally exercised as a function of wealth) such that the relationships between all men/women are balanced.

I have simplified Gilligan argument based on his comparison of violent death statistics and the succession of Democratic and Republican Presidents, but I believe I have captured the essence of his position.  Gilligan goes on to state that unemployment is always greater under Republican presidents except for Dwight Eisenhower who governed from the middle and was often accused of being a Democrat in Republican robes and under Jimmy Carter where unemployment was as high as his Republican predecessor. He was accused of being a Republican in Democratic garments.  How does this all relate to the issue of suicide? To understand Gilligan thinking we must go one-step further.

What interests me here is less the argument about the whether Republicans cause epidemics of violent behavior – although if Gilligan is right the revelation is startling and deeply disturbing- but the underlying issues around unemployment and feeling of negative self worth which lead to suicide and violence against others. Unemployment breeds low self-esteem, and a feelings of worthlessness and despair.  Unemployment breeds anger which can be directed inward to suicide or outward to murder.  These same feelings of low self esteem, worthlessness, despair and anger can be attributed to suicide not associated with unemployment.  Gilligan declares that these feelings arise out of two opposite value systems, and that those value systems create divergent paths to deal with the feelings aroused.  These two value systems are: Shame ethics and Guilt ethics.  He writes:

“Shame ethics is a moral value system in which the greatest evil is shame and humiliation, i.e. dishonor and disrespect, and the highest good is the opposite of shame, namely, pride and honor (respect). Guilt ethics is a moral value system in which the greatest evil is quilt (also called sin), and the highest good is the opposite of guilt, namely, innocence. But these two value systems are opposites. For example, in the guilt ethic of Christianity, the worst evil, the deadliest of the seven deadly sins, is pride, which is the highest good in a shame ethic. Thus quilt ethics supports egalitarianism, so that nobody can experience the pride of being superior to others (and no one will be shamed or humiliated by being considered inferior others),………”

In our society and other societies where suicide is prevalent, shame arises out of feelings of worthlessness and inability to complete with others. That shame creates the conditions where suicide is perceived as the only way out. The egoists and the confident don’t commit suicide. They see themselves as superior and capable of handling the many situation life presents. The suicidal person sees him or herself as inferior and unable to handle life’s demands.  Self–inflicted violence is an ultimate statement of anger against the society that allows suicide to happen.

I think back on my own first attempt at suicide when I was in college. I was failing in all my courses due to the fact I could find nothing I was good at doing. All my friends were academic standouts. I was a baseball player with an injured arm who could no longer play the game that gave me identity. I was ashamed that I had no other strengths. I could see no role for myself in society. Thus I wanted my life to end. I wanted to end the embarrassment of who I was not (a successful student headed for a successful life). I wanted to end the feelings of worthlessness that trailed after me everywhere I went.  I never thought of my suicide attempt as anything other than a personal statement of surrender to inferiority, however as I look back on this attempt I can see how my death would be an indictment of my own culture.  American culture lionizes competition and individual achievement. If you can’t compete and you can’t achieve you are at odds with the prevailing valves of your society. Thus it could be said my act was political.

Just recently a famous film director, Tony Scott, threw himself off a bridge in San Pedro, California.  Why he killed himself is disputed.  Some say he had an incurable case of brain cancer, and no longer wished to live.  Others say this is not true. His death, while a personal tragedy and indicative of an unstable frame of mind, is certainly a negative statement.  In killing himself he indicts (although he may not have been aware of it) the society in which he lived.  His death states that he can no longer value himself in a society that only validates winners, and in general turns it face from negative, be that terminally illness or personal disposition.  Thus Scott hurled himself from the highest bridge in Southern California creating a media sensation, which gave the dying man one last blip of recognition and caused many statements of incomprehension. Why would a famous director do this?  Why would he not? In a celebrity-oriented culture, he thus becomes a loser. Self-inflicted violence rocks the foundations of our culture. It shames the perpetrator, and at the same time shames the culture from which this shame arose.

Consider a person who is unemployed. Not a difficult thing to do in an age, the beginning of the second decade of the 21^st Century, when so many have been put out of work, or are young and can’t find work.  Unemployment breeds depression and despair. The unemployed person feels worthless and loses self-esteem.  If the unemployment lasts long enough, a person will feel there is no future for them and if there is no future, suicide is a viable option.  I don’t think an unemployed person who commits suicide is thinking in political terms, but his or her death makes a statement about the inability of our society to create work for worthy people. Thus the death has a political component, which indicts the society from which it arose as uncaring and unable to fulfill the needs of its citizens.

Thus I think that every suicide from the sick killer who guns down innocent people and then commit suicide by cop or their own hand to the sad young person who ingests 100’s of pills to free themselves from their lives are committing political acts.  These political acts hold a mirror up to a culture that values pride and success, showing the other unbeautiful failed side.  Suicide then is too often an unwitting political action. It is the ultimate statement of criticism to a society that makes some worthless and others glorious.

Carl Davis drawing in film OF TWO MINDS

I am one of the four featured persons in the film OF TWO MINDS. I feel very honored to be in this film by Doug Blush and Lisa Klein.  The honor comes from the fact that as Alice Boyce Ph.D. says in her blog review of the film on Psychology Today (http://www.psychologytoday.com/blog/in-practice/201208/two-minds-new-documentary-film-explores-life-bipolar-disorder) the film is a great conversation starter.  People who hear about the film are very curious and surprised that I, who appear today as a fairly rational and sane individual, have been afflicted with Bipolar Disorder, which has been increasingly stigmatized by the many violent people who have killed others and have been labeled bipolar.  The hidden pronouncement is that bipolar people are likely at any time to go insane and hurt others.  The film shows that we people are not unlike everybody else in most respects. We work. We make dinner. We have relationships. We have our own particular pain in our lives, but everybody has some kind of pain, too.

Five million or more citizens of the United States have this condition. Only a few are criminally violent.  Most carry on as best they can. Some fall to suicide, the self- inflicted violence that is more likely to be the fate of a bipolar person than that he or she hurt others; and some prosper.  I am one who has prospered, turning lemons into lemonade after decades of personal failure. The lemonade is the film and the book “bipolar bare” that I wrote about my mental illness.  I have become someone whom others, generally those with the disorder or those affected by the disorder, want to talk to. They want me to hear their stories and to reassure them that they are valuable human beings.  Each of these interactions is a conversation among peers that exchanges valuable information.  I learn from them; they learn from me.

Some of the best conversations have come about through the Q and A sessions after a screening of the film.  Six times I have stood before the audience after the screening of OF TWO MINDS with the filmmakers and the other cast members, heard the universal praise of this film, and fielded numerous questions.  The film is praised by the audience members, who clap vigorously at the end of each screening, as an accessible film.

They state how they see part of themselves or a family member or friend in characters revealed.  The audience can relate to the cast and their families and see the humor that flows beneath the condition.  They ask the filmmakers about the humor in the film. Doug or Lisa answer that the humor is essential to making a film that deals with the tragedy of suicide and severe mental pain by balancing it with other side of the condition, which can be comic. Comedy, the inverse of tragedy, exposes the human element in those afflicted with Bipolar Disorder.  I get a lot of laughs in the film, especially when I say it would be fun to cross dress again. My wife quickly says that she hopes I won’t do it. I respond that I would only if I lost 100 lbs. I can be a big ham.

Another question often asked is: Do we who have bipolar disorder experience times of mood balance? I am able to answer that I did. There were periods of time, some lasting months at a stretch, when I experienced no major mood swings.  What follows on from that question is: how did I cope with the major mood swings? I can answer that by saying that I self-medicated with illegal drugs.  This leads to the question: how often is the condition one of dual diagnosis?  The answer to this is very often.  What I find from these questions is that there still exists, in spite of all the information available on Bipolar Disorder, a huge lack of knowledge about it and a prevailing fear by those with it , those around people with the condition,  and the general public.

This brings up the subject of stigma.  People are afraid to admit they have the disorder for the consequences it will have on their lives. Doug and Lisa field many questions about how they selected the four featured characters in the film. They answer that they interviewed many people before settling on Cheri, Petey, Liz, and me.  They speak how they had wanted to use a Wall Street banker, but he was afraid that exposing himself in the film would affect his career.  The audience then notes that all the people in the film are creative. I answer that I too have noticed that many bipolar people are creative, but not all.  There are no reliable statistics that prove Bipolar Disorder is associated with creativity.  Creativity, I add, is not limited just to the arts. Bankers, doctors, and dentists can be creative forces in their fields, but revealing mental illness is another matter. I note that in the arts being a little crazy is acceptable.  How many people however would go to a crazy dentist, but they have and will buy art from a crazy painter?  Yet the main reason that I say that I expose myself in this film is desire not to shrink before my condition.  The stigma attacted to Bipolar Disorder must be smashed.

OF TWO MINDS creates a different picture of the bipolar condition — one that is not wrapped in medical or psychiatric jargon. It is a portrait that shows us who have the condition in full spectrum from the nature of our illness to the dimension of our lives, which are lived in and beyond the confines of our illness.  This portrait is one that provides understanding for everyone.  It is a gentle yet effective description. OF TWO MINDS is helping to smash the stigma associated Bipolar Disorder, and that makes me feel good that I am contributing to this effort.  The film also makes me feel more normal, since the portrait of me doesn’t simply focus on my illness. It shows the many dimensions of my life. Lastly I relish the fact that this film is helping others cope with and understand the bipolar condition. I spent a lot of time in my life feeling bad and thinking negative thoughts. Participating in OF TWO MINDS continued my education on the illness and liberated me from fear and self-loathing.  My self-esteem has risen another notch because of my part in making this film a reality. The conversation started by this film will help bipolar people feel better about themselves, and friends, family, and interested others know there is nothing to fear from the majority of bipolar people. To be part of this film is one of the highlights of my life.

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When this sharp and pounding ache appears, I am in for what I call the “Attack of the Black Brain.”  Nothing is good. Everything is negative. Suicidal thoughts consume me. Why, I ask, am I afflicted like this? All I want is to be left alone in a dark space (light is painful to see) that is dead silent (sound, too, is painful to my ears). Until this mood and this pain passes all I can do is hibernate.  I crawl into bed, lower the curtains, turn off all the lights, and dampen my ears with a pillow.  I feel like a vampire, dead in life and wishing life to be dead.  Luckily this time of extremes doesn’t last long.  The headache comes at the onset of a depression and usually catches me by surprise.  I will be feeling down, but not too down, when suddenly the blast of pain bursts through my left temple. I look at the calendar and realize it’s that time of year again. In mid- to late January I can count on an attack, or in mid-September it always comes.  Occasionally another off-schedule attack will happen.   I retreat to my dark and silent place to wait it out. But the time of suffering continues until the pain abates. After a day, maybe two and sometimes three, the ache will fade away and gradually I will resume normal functioning.  This is a migraine headache. My research on the web confirms it.

Here is a description from the web that makes sense to me. A migraine headache is a form of headache involving the blood vessels on one side of the brain.  The blood vessel (I think it must be an artery) enlarges, which tightens and pressurizes the nerve fibers wrapped around the blood vessel which causes the nerves to release biochemicals, and this in turn causes inflammation, pain, and further enlargement of the artery.  As the artery enlargement increases and the nerves are stimulated the pain increases. Looking at circulatory system, the artery that becomes inflamed must be the common carotid artery.  There are two such arteries on either side of the head. These two arteries further divide into an internal and external carotid artery. The internal artery is buried deep in the brain, while external branch is closer to the surface. In my experience it appears that it is this external artery that evokes the migraine headache.

Arteries and Migraines

I can find no satisfactory explanation of why these migraines occur, but I have found some interesting information. 28 million Americans suffer from migraine headaches. More women than men experience migraine headaches. The percentage breakdown is 75% women and 25% men. In women the occurrence of migraines may be related to their menstrual cycle. Those afflicted with migraines can have them occur as frequently as multiple times a month or at a minimum of only a few in a life time.  Most migraines alternate between on side of the brain to the other, but about a third of the time pain can be bilateral. Nausea, vomiting, and diarrhea are often associated with migraines.  20% of migraine headaches are associated with aura.  An aura is seeing flashing, brightly colored lights spreading out from visual field.

My migraines never alternate from side to side. They only occur on left side of my head. I do not get nauseated nor do I see auras. My migraines are associated with tiredness and extreme mood change.  I have bipolar migraines, and a recent study found that people with Bipolar Disorder are at a higher risk for migraine headaches. Lawrence Robbins, M.D., at Rush Medical College in Chicago did this study. He concluded those with migraine headaches and bipolar disorder were twice the number statistically classified as having Bipolar Disorder in the general population. Another study revealed that one in five patients with Bipolar Disorder I had migraine headaches while more than one in three patients with Bipolar II had comorbid migraines.

It is now believed that migraine is an organic disorder with a clear genetic background even if environmental factors are involved.  Migraine has a basis in the nerve system, although the carotid artery is also involved.  The doctors researching the link between Bipolar Disorder and migraines believe that certain aspects of brain chemistry are same for both conditions.  So that is the good news. The bad news is that none of the researchers know how this brain chemistry works.  They know that certain medicines block the symptoms, but they have no idea of a cure.

They have no way yet of separating migraine chemistry from bipolar chemistry. They have no idea why some persons suffer monthly from the problem of migraines yet aren’t bipolar.  They have no idea why I would get migraines only a couple of times a year and be Bipolar I.  It’s all a great mystery. Our witch doctors have sophisticated chemical tools, but just like the shamans of old they can’t tell you why a certain root prevents or heals an illness.  The brain and its function remain an incompletely explored continent perused by medicine men with tools as rudimentary as a saber-tooth tiger’s jaw.  Yet somewhere out there or in the future will come a scientist who will light the way like the aura some see.

Since I already take the medication that’s an inexplicable miracle for my bipolar condition, I am loath to add more for the migraines. It’s more cost and unlikely to end my twice-yearly cataclysmic downs.  The medication I already take hasn’t ended them. It has only dampened the attacks for which I am very thankful. The migraines I would rather wait them out.  Until there is a solution I will deal with pain in my brain in the darkened room with the pillow earplugs with the knowledge they will end soon enough.

Still from "OF TWO MINDS" Carl drawing

Can I who am featured in the film“OF TWO MINDS” write a review of the film?  I can’t write a typical review because my viewpoint is colored by my closeness with the film. My plan is not to so much to rate the film –although I believe it to be extraordinary-, but to speak of its origins and how it has affected me.

“OF TWO MINDS” premiered at the Cleveland International Film Festival on March 24^th, 2012.  Doug Blush and Lisa Klein, the filmmakers for this documentary film of 90 minutes about Bipolar Disorder, dedicated the film to Lisa’s sister, who died of alcohol poisoning under mysterious circumstances after long suffering with Bipolar Disorder.  Doug and Lisa invited me and the three other people featured in the film: Liz, Cheri, and Petey, to the premiere.  At the Cleveland International Film Festival was the second time I saw the film. The first was a private screening, which left me in a state of shock.

I was overwhelmed with emotion by the film. It is one thing to write about yourself as I have in my book, Bipolar Bare. It is a very different and visceral experience to see yourself on film. A photographic image records the real. I saw myself in my madness and recovery. The effects of bipolar disorder are written on my face. Unlike writing nothing is left to the imagination. In one disturbing image my pallid and somewhat bloated face captured me at my most addicted and sick state.  My first view of the film left me depressed. I have bipolar disorder and it won’t go away. I wasn’t sure I had done the right thing to allow myself to be featured in this documentary.

Doug and Lisa discovered me at a NAMI event where I was promoting my book. For almost four years Doug and Lisa followed the others and me around, filming us in various locales. They collected old photographs of us and interviewed those close to us.  They edited all this material into a powerful and evocative portrait of each person that is supported by the remarks of others with the illness, psychiatrists, a vignette about the suicide of a young woman in Michigan, and the pain that event has caused for her mother and sister, and a wonderful sidelight of Psycho Donuts in Campbell, California, where the waitress addresses the criticism of the store by mental health advocates with a witty remark. I was one of those who protested against Psycho Donuts. I wrote a blog trashing the shop; maybe I was being a bit too serious. Bipolar Disorder is a serious illness, yet Doug and Lisa have created a film that explains the condition without psychiatric bias, one that reveals the spectrum of Bipolar Disorder.

I could not see this after I first saw the film. I had to wait for the shock to wear off. When I saw the film “OF TWO MINDS” two more times in Cleveland I could grasp how the film shed light on the condition that is very insightful and poetic without being a psychological dissection of the illness.  The audience gets to see four people with mania and depression as humans not as patients. This is the film’s great strength. It is about four people coping with the illness.  It is not about how horrible the illness is, what people with the illness should do, or how society should treat the illness.  Doug and Lisa have created a portrait of the condition as it is lived by people who still function in the world. The portraits of the featured four show how different each person responds to their illness and how they have developed strategies for living a full life.  The film establishes a nuanced array of scenes that reveal each character in the context of family, friends and lovers.

The film, which goes back and forth between the four-featured people, starts with Cheri, a Los Angeles makeup artist, dancing by herself in a state of what she calls mania. She is in constant motion, swaying her arms and hips rhythmically. The unending movement captures Cheri’s transient soul.   We are introduced to her boyfriend Petey, a musician and artist.  He is intrigued by Cheri’s moods, then later finds out he too has the condition. Petey’s and Cheri’s struggle is followed throughout the film. Cheri and Petey represent young people.

I get introduced next in the film with the image of a wire screen from a freeway bridge. This mesh separating the audience from a reality beyond becomes the marker for my story. Each person in the film has a marker. For Cheri it is walking. For me it is the transparent screen.  My story begins with me recounting the events of my childhood as old photographs show my mother and me, my father and stepmother and me, and me as a college student. Seeing these old photos enlarged on the screen was very unsettling. My whole life gets laid out in photographs from youth, my checkered career, to my present advanced age. I talk about my own suicide attempt, and my erratic behavior. By my wayward career and Cheri’s constant moves, two symptoms of the disorder are powerfully illustrated.  I am the old person in the film.

We are then introduced to Liz, who tells the story that set off her bipolar behavior, and caused a later self-admittance to a mental hospital in Texas. In a haunting image of a patient standing alone in a hospital corridor, Liz recounts her history of hospitalizations. Liz’s story is revealed in relationship to her parents and specifically to her mother, an archetypal Jewish mom.  Liz’s marker is her family. Liz reads from a suicide letter in one of the many comic moments in this film.  The film’s interplay between comic and tragic situations underscores the film’s complex composition.  Liz is the middle-aged person in the film

The story of these people and me is woven into a full dimensional portrait of the illness from multiple segments about each person. I mention a few of the many engaging scenes. In one delightful short sequence we see Cheri drinking a vile looking brown Chinese herbal drink; then with a wry smile she wipes her pursed lips as if savoring the liquid. Cheri is a woman with plunk. In one very visual sequence, which reminded me of Magritte, Petey is moving through a doorway with the artwork of a 1500 razor blade-outlined man on the wall next to the passageway. Petey is a man of mystery. In one memorable sequence Liz’s mother asks Liz, who says she is ninety percent gay, how marginalized she wants to make herself.  She understood Liz’s bipolar nature because she is bipolar herself, then sums up her support for her daughter with a very humorous remark. Liz laughs. She has a sense of humor about herself. She is someone you can love. The filmmakers skillfully recorded scenes that speak eloquently of each person’s individuality. The film is a visual tour-de-force capturing images that are like narrative paintings.

To my great pleasure, I was shown as an artist. An image of my Diaphane #1 flashed on the screen.  This see-through sculpture related to the screen of the freeway bridge.  It simultaneously spoke to the transparency of reality and the two-sided nature of all things. I was revealed as a formerly crazy cross-dresser with two selves. I talk about how I reached a bottom and was going to throw myself off a freeway bridge.  The wire fence of the freeway bridge appeared again with vehicles zooming past below. The film in its dialogue, strong visual images, and interrelationship of characters creates a dramatic tension.

“OF TWO MINDS” is a full spectrum film full of humor, moments of exquisite pain, and rare insight. Doug and Lisa have created a film that humanizes a serious illness in a way that is visually rich, dialogue intense, and full of metaphors.  The filmmakers have captured in a new way the nature, both good and bad, of Bipolar Disorder.  Having overcome my initial shock, I am very pleased to be a part of this documentary.  I believe it will be meaningful and DE stigmatizing for all people. “OF TWO MINDS is an important film.

The film will be shown at the Newport Beach Film Festival on April 28^th, The Los Angeles Union Film Festival on April 29^th, and the New York Union Film Festival May 14^th, 2012. Later this year the film will become available on DVD. Look for it on the web at: http://www.oftwomindsmovie.com

Carl Davis

Laura’s Law and Kendra’s Law are, for anyone who has, has had, or appears to have a mental illness, scary legislations. These two laws inCalifornia and New York and copied by other states require a person to have psychiatric treatment when ordered by a judge after assessment by a mental health official. This is coercion and, I believe, an abridgement of fundamental human rights as established by the United States Constitution. Both these laws legislate treatment in an outpatient program and both purport not to require the taking of medication, but the underlying threat of non- compliance is involuntary treatment in a hospital and the imposition of unwanted medication.

I am extremely sensitive about this issue of coercion. I had my civil rights abused because I have a history of mental illness. I was in the hospital for another health issue and dressing discharged to go home.  A nurse apparently heard me make a threat. I do not remember the statement. Immediately I was surrounded by hospital police and escorted down to the psychiatric unit. I demanded they tell me why this was happening. No one would. I was now surrounded by more orderlies and hospital police. When I made a move to walk away, I was pounced upon, dragged into a room and strapped down to a slab. It took me eight hours to talk my way out of this incarceration. I felt dehumanized, violated psychically, and very angry at the power of institutions to abridge my civil rights based on a previous history of mental illness

Shackled in Hospital

I researched these laws after hearing a presentation by Brian Jacobs, a former president of NAMI California. When I asked him if these laws were coercive, he replied “yes, but coercion is a good thing.” He meant that Laura’s Law, which he was asking the NAMI San Gabriel chapter to support in the drive for it to be fully implemented inLos AngelesCounty, created a context that saves lives of the severely mentally ill by overruling their resistance to treatment.  InCaliforniathis law, first passed in 2002, has only been fully implemented in Nevada County, and inLos Angeles County it has only been partially implemented. Mr. Jacobs did not relate in what way the law has only been partly implemented. The law was made optional for eachCalifornia County to implement.

Laura’s Law is named after Laura Wilcox, who was shot and killed by a man with untreated mental illness at a mental health clinic in Nevada County,California. The law is based on a similar law, Kendra’s law, passed in New York State in 1999; this law is named after Kendra Webdale, who was pushed to her death from a subway platform by a schizophrenic man off his medications. Kendra’s law grants a judge the authority to issue orders requiring people who meet certain criteria to undergo Involuntary Outpatient Commitment (IOC). Failure to comply can result in commitment to a mental hospital. Laura’s law specifies a similar circumstance: a judge can order Assisted Outpatient Therapy (AOT), a change of words that Kendra Law also now utilizes to attempt to communicate a more positive intent to the law. Laura’s Law may differ in how the judge is authorized from Kendra’s Law. In California the county mental health director or his/her designee files the petition with the court. The county medical director is probably requested to do the petition by family members or mental health providers.

Both laws have a number of criteria associated with them that can trigger the court order including a history of mental illness, the substantial deterioration of the individual, their inability to survive on their own, a refusal to comply with treatment, and the risk to themselves and others. All of the criteria seem reasonable when viewed from the lenses of psychiatric practitioners and distressed family members. Family members who witness the suffering of loved ones and suffer themselves from the mental illness of a loved one see these laws as a life saver. My friend Marty, whose daughter is schizophrenic, sees this law as away to avoid forced commitment in mental hospitals. She writes:

“My daughter… She was living in a storage unit covered with ants, lice, and standing in a catatonic state for days, her feet swollen like melons, dehydrated and starving. When I called the police department, they refused to take her to the hospital. It took me over an hour to persuade them. The frightening experience of being placed in handcuffs, forced into a locked ward, kept there and forcibly medicated for five weeks, started her on a horrible odyssey to resist and flee from treatment. Over the course of six years, she was picked up by law enforcement and hospitalized in nearly every county in California only treated for a few days and released. She spent a year in a locked facility, and then ran away when she was out. I believe she cost the taxpayers over $300,000 in revolving door hospitalizations. I believe that if Laura’s Law had been in effect, she would have had a good chance to be treated before this sad saga began. She would have been made to feel like a participant in choosing her own treatment. I think the current situation, where people are free to die on the streets is inhumane and amounts to slow suicide. I am satisfied that Laura’s Law protects peoples rights and gets them help early enough to prevent tragedies such as the Gabrielle Gifford’s shooting and the Kelly Thomas killing.”

The Kelly Thomas killing inSan Diego, where a young man with mental illness was beaten to death by the police and the subsequent push by advocates of Laura’s Law in San Diego Countyto implement the legislation were covered in a story by Time Magazine. The author cited the compelling evidence that the law “would help mentally ill people like Thomas off the street and out of danger by making it easier for others to give them treatment. That is sorely needed because an estimated one-third of the nation’s homeless have untreated mental illness.”

The case for these laws is compelling, and advocates of the law have many statistics to support their point of view. They cite a study made by the New York State Psychiatric Institute and Columbia University that says those in the AOT program have 74% fewer experiences of homelessness, 77% fewer psychiatric hospitalizations, 83% fewer arrests, 87% fewer incarcerations, 55% fewer suicides, and 47% fewer cases of harm to others. These are impressive numbers, and they support the assertion that Laura’s Law and Kendra’s Law save the taxpayer money. It is hard to speak against these figures, but I must.

Our mental health system is broken, but I do not believe Kendra’s Law and Laura’s Law are the answer. I have many reasons. First and primary is the civil rights issue. These laws violate the fundamental freedoms of all people with mental illness by forcing competent, non-dangerous persons with psychiatric disabilities into coerced programs of treatment. If we allow certain designated persons the right to abridge the rights of others, we are at the will of people who views and positions can be in arbitrary and falsely founded.  This is the path that can lead to laws like the Nazi-era laws incarcerating not only the Jews, but the mentally ill. The New York Civil Liberties Union in its dissent against the passage of Kendra’s Law cited court cases noted “that the modern trend in legal and psychiatric fields is to give even those inpatients suffering from psychological disabilities an increasing amount of control over their treatment decisions — including what medication regimes he or she follows, what therapy sessions he or she attends and what other mental health programs he or she participates in.”

This law may not work. Statistics can be manipulated. The success cited for the Kendra’s law program is based on the number of people who agreed to the program. How many disagreed? The statistics do not tell. A study done by Bellevue Hospital found that court ordered treatment did not lead to increased  compliance with treatment, fewer hospitalizations, or lower arrest rates and violence. What forced treatment does is remove patient trust. What patients distrust most is imposed medication. While neither program requires forced medication, most programs I know of supply medication and insist one take it. The view of many people with mental disorders is summed up in an email I received from a man named Doug. He says:

“I was on Lamictal and Ritalin. My life was falling apart and I didn’t even think it could be the drugs, until I researched some stuff online. I quit everything cold-turkey in November of 2009. It has now been 26 months and I am still recovering. My vision got miserable and my coordination got horrible and I didn’t have normal emotions anymore. One of my best friends weighs 375 and takes Adderall during the day to stay awake and Seroquel at night to sleep. He is ALREADY diabetic!!! His life is a nightmare because he feels like he can’t quit the Seroquel at all. Like millions of other people in the world, he hates psych drugs, knows they are shortening his life span and making him feel like a zombie, but the withdrawal symptoms are so horrible he stays on them. I hate all of them and think they are pretty much the old testament definition of sorcery.”

The imposition of drug treatment is the established way to treat mental illness. Laura’s law may say that drugs are not imposed, but the truth of most mental health programs is that they are. Kendra’s law is vague on the issue. To many the drugs are helpful – they were for me — but there is a large segment of the mental illness community who feel as Doug does. Should they be coerced to follow a program that they believe will impose this requirement on them? I think not. Are drugs the best ways to stabilize the mentally ill? Not necessarily. There are a significant number of mental health practitioners who do not believe in drug therapy and a large number of mental health care recipients opposed not only to drugs but to psychiatry. Some mental health practitioners are too close to the pharmaceutical companies that sell the drugs. This relationship distorts the mental health care system along with the budgetary constraints that limit alternative care.

Our distorted system looks for legalistic answers, since it appears to be the only way to wring value for mental health. Our country is starved for services and adequate monitoring. We need more programs more easily accessible to those in need. What is not needed is enforcement on a limited supply, which only overburdens the supply and makes it more dependent on quick fixes. Drugs are the quick fix and anyone who has to deal with publically funded programs knows this. The mentally ill know this.

One last point about violence, which is what the general population fears most about the mentally ill: Are we going to kill you or not? I think neither Kendra’s law nor Laura’s law will diminish the occurrence of insane violence.  I note the cited statistic that 47% were less violent after a Kendra’s Law compliance program. This means that 53% were still likely to be violent, if they are given to violence. Most mentally ill people are not violent. They more likely to be treated with violence than to be violent. Kelly Thomas might have been saved from state violence if police officers were better trained. Marty’s daughter might have not been so distrustful of help if her first contact had not been to be shackled by handcuffs and hauled off to an institution.

The answer to the problem of violently mentally ill, the homeless, the high suicide rate, the high rate of severe depression, does not lie in legislation, but rather it lies in a shift of our cultural priorities. Laura’s law and Kendra’s law are bandages on a system of mental health care, which is in critical condition. They represent bondage for people who may be ill, but have not committed a crime. In our society we don’t force people with cancer to take treatment. We should not force treatment on the mentally ill. They have to be freely willing to accept treatment. Force begets resistance. Resistance overpowered is slavery.

From Unhinged, The Trouble with Psychiatry — A Doctor’s Revelations about a Profession in Crisis, by Daniel J. Carlat, M.D.

Depakote, Seroquel, Trileptal, Klonopin, Inderal (Propranolol), Lamictal (Lamorgine), Abilify, Roxerem, Neurontin, Lithium, Resperdal, Lunesta, Lexapro, Effexor, Cymbalta, Trazadone, Ritalin, Nuvigil, Provigil, Topomax, Artane, Primidone and Carbidopa/Levodopa are all drugs I have taken at one time or another  for the pathophysiology of my mental illness and the side effects of these drugs. Those side effects have been weight gain, anhedonia (the inability to find pleasure from activities previously found enjoyable), and tremors. From reading Dr.Carlat’s book and Robert Whitaker’s “Anatomy of an Epidemic” it is evident that the medical profession has no clear idea how these drugs work or how they work together. They are shooting in the dark based on spotty clinical evidence. It is only we the users who can verify if these drugs work. Sometimes they do, and sometimes they don’t. It all depends on the individuals and the knowledge of the medical professionals handing out the prescriptions.

The Scream by Edvard Munch 1893

I am in dismay and almost unhinged by this revelation and all the corollary issues that this essential fact raises. These facts make me wonder about the efficacy of psychopharmacology altogether.  I bought into the chemical imbalance theory, which states that a person with mental illness is suffering from a biochemical imbalance in the brain. Now I find out that this is just a convenient metaphor, which destigmatizes the condition and makes mental illness not the sufferer’s fault. I learned from a quote by Dr. Hyman of Harvard University sited in the “Anatomy of an Epidemic.” that:

“The chronic administration of the drug(s) then causes substantial and long-lasting alterations in the neural function.” As part of this long-term adaptation process, there are changes in intracellular signaling pathways and gene expression.  After a few weeks, the person’s brain is functioning in a manner that is qualitatively as well as quantitatively different from the normal state.”

In other words, psychotropic and anti-depressant drugs don’t make the brain normal, they muck it up. Robert Whitaker asserts this view. He also asserts that prescription of these drugs for schizophrenia, bipolar disorder, and depression may be altogether unnecessary. He cites evidence from the past and European mental hospitals that the recovery rate for un-medicated patients is better that for medicated patients. I do not support that view – perhaps I can’t because of my commitment to using these drugs — but Whitaker has raised an issue that bears further analysis.

I have been taking these drugs now for over ten years, and I must say that the modest cocktail of medications I take seems to work for me just fine. However, I did take other ones in the beginning and they really screwed me up. From Depakote and Seroquel I had massive side effects. These were the first drugs I was given upon hospitalization, and I was on them for a long period of time, until I was able to say no longer would I take Depakote that made me gain 100 lbs, nor would I take Seroquel that made me feel like a zombie. I was lethargic and in a kind of mental haze. (To be fair I must say there are other patients who did not have the same reaction that I did.)  Neurontin was given to me at some point and now I find out from my reading that this drug developed for epilepsy was foisted on the medical community by the drug company working with the FDA even when it was found this drug had little or no effect on bipolar disorder. Trileptal (Oxcarbazepine), Klonopin (Clonazepam) are two drugs also first developed to treat epilepsy. Why don’t we hear more about the relationship of epilepsy to mental illness?  Rozerem (Ramelteon), Artane (Trihexyphenidyl), Lithium, and Risperdal (Risperidone) are the drugs I have gone through to my latest concoction. I feel like a walking pharmaceutical advertisement.

Yet I am a success story. The medication Lamogrine, Abilify, Lunesta, Carbidopa/Levodopa, and Primidone, I take work for me. My current psychiatrist, who is much more than merely a psycho-pharmacologist, provides therapy, too. From what I hear from my fellow customers of psychiatry, my situation is not the usual. Those I know who go to an insurance-sanctioned practitioner or who must rely on public programs is universally confronted by pill pushers. If the drug is not working, they prescribe more. If the drug has too many side effects and the user balks at taking it, they prescribe something else. The cycle goes on until something is found that works for the patient.  If not, the patient usually gives up and goes un-medicated. Psychiatry is not a profession that leaves the client satisfied all the time.

Psychiatry as a medical profession is in crisis according to Dr. Carlat. First, it is not like the other medical specialties, which can correct real physical problems with an exact procedure. There is no brain operation, like a heart operation, that can cure mental illness. Maybe the closest it can come is Electro-shock Therapy (ECT), a medical last resort to break deep depression; but even this procedure is not like cutting out a tumor. It is more like giving the brain an external blast for which no one knows why or how it really works. Some Psychiatrists, in order to cloak themselves in the medical model, have come to depend on medication as the proof of effectiveness of their treatments. Because of this doctors have played into the hands of and become part of the pharmaceutical industry.

Both these books, “Unhinged” and “Anatomy of an Epidemic,” provide great insights into the origins of this state of affairs. They cite how psychiatrists acquired by law the sole right to prescribe medication blocking out pharmacists and psychologists. They cite the power of the DSM (The Diagnostic and Statistical Manual of Mental Illness), formulated by a committee of psychiatrists, that has over the years increased the number of types of mental illness almost to the point of over abundance, and that has became a vehicle for the drug companies to create drugs that responded to these many different kinds of diagnoses. One illustration of this move to excessive diagnosis is Dr. Carlat’s comments about the creation in DSM-IV of a condition called “social anxiety disorder,” which is a fear of social or performance situations resulting in distress. This condition, he says, was formerly called shyness. I am sure a drug will be invented to control this situation. Wait a minute — there is already a drug for this situation. It’s called alcohol.

Alcohol is not medically approved today, but as I remember from watching Westerns a drink of alcohol was the elixir given by a doctor prior to removing a bullet.  Maybe Seagram or Johnny Walker can get alcohol approved by the FDA for social anxiety disorder because it appears pharmaceutical companies have great success in approval for even the most dubious of drugs for mental conditions — Neurontin is a good example — or ones whose side effects are severe. Dr. Carlat mentions Paxil. Whitaker and Carlat claim the whole process of drug approval is polluted.  The kinds of results wanted can be fabricated by the way a drug company does its tests. Patients who might color the outcome, such as those with prior experience with a drug or are considered too old are eliminated from tests. Even a double blind test (one that uses a placebo as an alternate) can be manipulated to provide positive results. Since in our country the drug companies and not Federal Drug Administration (FDA) do the tests, we have a biased system for starters. There is no budget for the FDA to actually conduct the tests. Thus we rely on the drug companies and the universities for the testing. University testing is tainted too, since many of the doctors who carry out the tests are paid consultants to the drug companies. This issue of testing and approval is enough to make your hair stand on end.  Or mine anyway.

My hair stands on end when I think about the long-term effect of even those drugs that have worked (or at least I have thought they worked) for me. Robert Whitaker makes a cogent argument that these psychiatric drugs themselves create chronic mental illness and they are known to cause other medical conditions such as heart disease, liver failure, and diabetes. To keep from being chronically mentally ill, I have to keep taking these the drugs. If I stop, my Bipolar I Disorder may come back with vengeance. If I keep on taking the Lamoragine, Abilify, and Cymbalta, I run the risk of these heinous medical conditions. It’s Catch-22. I have decided for the time be to keep taking Lamoragine and Abilify because I decided I am willing to give up years at the end of my life to one of these illnesses in order to have good years now free from the mania and severe depression of Bipolar I Disorder, but I do so with trepidation and the hope that a severe medical condition won’t strike or if it does there will have been medical advancements sufficient to keep me alive.

The anti-depressant Cymbalta is a different matter. I have had a lot of experience with different anti-depressants. Lexapro didn’t work for me and Effexor, which I learned later from a San Francisco psychiatrist, after having been prescribed the drug by a medical doctor in Palm Springs, is not a good fit for someone who has mania. I dropped that drug and stayed off anti-depressants for a long time.  Much later I when I was depressed my psychiatrist prescribed Cymbalta and this drug seems to work. I am just one of the one in ten in America who uses anti-depressants.  Anti-depressants are the single most profitable drug for drug companies all around the world. In 2003 Cymbalta grossed $2.7 billion and sales grew at the rate of 60% annually. This is despite the fact that anti-depressants have been found to create a great relapse rate if the drug is withdrawn. Robert Whitaker writes:

“In the short span of 40 years, depression has been utterly transformed. Prior to the arrival of drugs, it had been a fairly rare disorder, and outcomes were good. Patients and their families could be reassured that it was unlikely that the emotional problem would turn chronic. It just took time — six to twelve months or so — for the patient to recover. Today the NIMH (National Institute of Mental Health) informs the public that depressive disorders afflict one in ten Americans every year that depression is ‘appearing earlier in life’ than it did in the past, and that the long-term outlook for those it strikes is glum.”

Could it be true that the administration of ant-depressants over the long term sentences one to depression for a lifetime?   I decided I did not want to find out. Working with my psychiatrist I am slowly weaning myself off the drug. We both agreed on this. I have been generally depression free for over a year, and given the long-term problem with these drugs, it was time to see if I can’t do without them. What if it doesn’t work and I become depressed again? I don’t know the answer to this question, but my inclination given my own tendency to suicidal ideation when I am down, I will probably return to taking a drug. I understand this is a big risk because reports say that a drug abandoned and then retaken may not work. Again I sense myself lucky in that I have a psychiatrist I believe in. She knows the good and bad of psychopharmaceuticals. I pay a high price for this expertise. I pay it out of my pocket. I don’t use insurance for this medical expense. At the present time I can afford to do this. But what if this situation changes – she retires or I can no longer afford the expense? I sense I will be in big trouble.

To go to another psychiatrist I do not know is not out of the question, but my prior experience with the profession until I found my current doctor was not reassuring. Most I met were solely psychopharmacologists and did not want for me to be a partner in the medication process. Most were motivated by the view that the doctor always knows best. I should shut up and do as told. I couldn’t in the past abide by this, and now that I know more about the profession and its weak medical link I can’t at all abide.

I have concluded that psychotherapy is as valuable as drug treatment, and finding the rare psychiatrist who does both is difficult. Much of my recovery has come through making peace with and understanding the past and with finding coping means to deal with present stress. Cognitive therapy works. Carlat makes the argument that most psychiatrists don’t want to provide psychotherapy because it would limit their income. A psych-pharmacologist can see many more patients a day, increasing his or her income more than if they provide therapy too; and therapy is generally not approved by the health insurance industry that drives the economics of the health care.  If I go to a psychologist — they are less expensive — I can get therapy, but I can’t get medication.

There is a real conundrum with our current methods of treating mental health conditions. Dr. Carlat makes a great suggestion that psychologists and psychiatric nurse practitioners be given the right to prescribe medication with appropriate training. This could greatly decrease psychiatric care costs. Apparently this is being done in several states over the vehement objections of the psychiatrists. This needs to be done across America. We also need to break the economic ties between psychiatrists and drug companies. Some universities – Harvard for example, after considerable scandal – no longer allow their psychiatric faculty to receive drug company payments for studies they are undertaking. Reform of the FDA and its relationship to the drug companies is essential.  If we can’t get the FDA to do the tests – for some this smacks of too much of socialism — then the drug companies must be forced to be more precise and less biased in making tests.  No more manipulation of placebo data. No more reducing the test pool to only those who will provide a positive outcome. If something isn’t done, not only I will be unhinged by the epidemic of mental illness in America, but all my fellow care receivers will be also. Please read “Unhinged” and “The Anatomy of an Epidemic” and you will be unhinged too!

Aerial view of California Men's Colony Prison

The California Men’s Colony is not a pleasant place to visit, and the authorities go out of their way to make you know it.  A visit has all the charm of a stopover in a dank toilet room, but this toilet is a difficult place to enter. It took me more than five hours to get in to see my old friend, who has been there a long while. It felt as if I was a criminal trying to see a criminal, and in that feeling I am sure I am not alone. There is no amenity for family or friend of the convicted. In every way the prison system throws barriers at you.  Prison visitation escalates emotional anxiety. I think it would be better to defuse the emotion than exacerbate it; however the system doesn’t appear to see it that way.

It starts when you first line up in the stream of cars at 7 a.m.  – The time the prison information said to arrive — to get into the prison by 9 a.m.  Nine is the time the official information states the institution will be open for visitors, but that time is not scrupulously adhered to. My wife and I joined the string of visitors in cars that formed a line on a dirt side road down the road from the entrance to the prison. There were no markers or signs stating that this was the place to wait, we learned when we drove onto the prison grounds and stopped to ask what we should do. A gruff uniformed man in a white truck labeled California Men’s Colony pointed to the side road about a half-mile away and said “Wait there until told you can enter.”  We backtracked and got into line. We were about the 12^th car in line, a line that gradually extended another 20 cars behind us. At about 8:15 the line of cars began to move out, drive down Route 1, and enter the main road leading to the prison.

We didn’t drive straight in toward the pale yellow complex in front of us. We turned left on a side road on the prison grounds, then turned right and formed another line that moved very slowly toward a group of prison officials who stopped and spoke to each car. After the stop the cars ahead of us either proceeded toward the large parking lot which fronted the prison or drove away and out of the prison. I wondered if they had been rejected for entry.  When our turn came, the prison officials handed us an entry sheet that stated what our number for entrance was. Being first in line does not mean you get to be first to enter the prison. Entry is by lottery. We were numbers 37 and 38 despite the fact that we were the 12^th car.  I asked what we should do now? The prison official stated we could go park or return at 9 when entry would begin. I then asked the official if it would be OK to enter with our bicycles, which I had locked up in the back of my truck. You may have the bicycles in your truck, the official said, but they have to be locked to your truck. Mine weren’t. They were merely locked together. Ginger and I sped off back to our hotel to unload the bicycles before returning a little before 9.  I wondered how prisoners were going to escape and steal locked up bikes. How much more protection would be afforded by the bikes being locked to the truck?  It didn’t seem logical, but nothing seemed logical as the morning progressed.

Inmate uniforms at the California Men's Colony

Nine a.m. saw us standing with all the other visitors outside the entry door across a road in an concrete island which had no shade, only one small bench to sit upon, nor any pleasant vegetation. Everyone milled about. We asked what happens now? An elderly African-American woman told us that you waited until your group was called so you could line up across the street to the left of the prison entry. Lineup went by tens. There were no signs that indicated procedure. Numbers 1-10 were lined up against the wall.  An official came out and told them they could enter. Once they disappeared inside, 11- 20 crossed the street and lined up in sequential number next to the pale yellow painted block wall. Twenty minutes later numbers 31- 40 were allowed to cross the street and form a queue. We dutifully lined up in positions 37 and 38.  Fifteen minutes later we entered the receiving room for visitors, an ugly small room with a few chairs and hand-lettered signs telling you to line up before another doorway. On the wall next to that doorway was a poster with images stating what you could wear while visiting a prisoner. You can’t wear blue shirts or blue denim pants because this color will too closely resemble the clothing of the prisoners. No white over shirts. You can’t have underwire in your bra. (Inmates can do prohibited things with the wire.)   You can’t wear green pants or tan shirts because these colors will too closely resemble the uniform of the guards. Now this was new.  We already had two instruction sheets about visiting, and they each had some contradictions, but we had chosen our clothing to be perfectly compliant so we thought.  I looked down at my pants. They were a greenish brown. The pants weren’t the same green as the prison guards’ pants so I thought I might be all right. My shirt was tan but had a bold tattersall design in blue, with wide crossing lines. Prison guard shirts were plain tan.  I thought I might be all right. When my turn came to go through the doorway, I approached the desk where one official was operating and looking over all visitation papers. I had to furnish my driver’s license and fill out the top of the entry paper. It was all good. I thought I had made it in. As I stepped away from the counter toward the next stop, the inspection station, a guard stopped me. He said could not enter the prison because my pants were green and my shirt tan. I tried to argue that my clothes were different than his. The green pants were not the same color. The shirt was tan but had a distinct blue pattern. The guard was unmoved. I had to change my clothes. What was I supposed to do I asked? I don’t have other clothes with me. You’re lucky, the guard said, there is an alternative. I could follow all the other folks rejected for non-complying clothing (there were many) to “the yellow house,” where I could find some clothes that passed prison standard. Where was this building? The guard pointed outside beyond the parking lot. It’s over there by the construction sheds, he said.  It wasn’t close. It was a fair distance away, back near the entry. I hastily returned to my truck and drove quickly to the yellow building near several construction trailers a quarter-mile away. I was beginning to fume.

The yellow house is a facility set up by “Friends Outside,” a non-profit group started to help family of prisoners. While I waited here for the changing room to become free, Ginger arrived having walked all the way to the yellow house after seeing me speed away.  She too had been rejected. She had on two layers of blouse, a no-no that had not been mentioned on the instruction sheets. I slipped into an ill-fitting pair of black pants with no belt and a black sweatshirt, both faded from many washings. Ginger put on a red knit shirt. Our clothes were locked in a closet until our return. We headed back.

The time was pushing 10 a.m. We joined a line much like the line at the airport to have our possessions scrutinized. Ginger went first. She took off her shoes and put them on a serving tray like you find in cafeterias, along with a $30 bag of quarters, which prison visitors are allowed to bring for use to buy lunch and snacks for themselves and the prisoner in the vending machines in the visiting area. (Another instruction sheet given us later said we could have brought in $50 apiece and that dollar bills were also acceptable.)  A guard inspected her shoes and handed them back. She was approved to move onto the next stage. I removed my shoes, placed my car key on the tray. My wallet I locked in the car. My loose pants nearly fell to my knees. Where is your driver’s license, the inspection guard asked? It’s in my car with my wallet, I replied. You’ve looked at all ready. What do I need it for now?  You have to have your license with you at all times, the guard stated. Where is that written I asked? The guard replied only you have to have your license with you at all times. This is 3 I mumbled to myself as I raced back to the truck to get my driver’s license. First the bicycles, second the clothes, and now the drivers license. These officials are really poor communicators, or they just don’t give a damn.

I rushed back with the license, and stood in the inspection line again with my shoes, my truck key, my entry form and my driver’s license on the inspection tray. Everything was approved and I moved up to the next desk where I lay my visitation paper with my number 38 on it along with my driver’s license. A guard had already reviewed Ginger’s paper and license and waved her through the metal detector portal. She was in. The guard departed and I stood there waiting while two guards carried on a long conversation. Finally one came and picked up my license and paper. He eyed it and told me to walk through the scanner. The scanner buzzed. Had I still some metal hidden on my person the guard asked? No I replied, and went through the metal detector again. It buzzed. I said I know what it is I have a pacemaker in my chest, but the pacemaker no longer works. The guard questioned me, where is your doctor’s certificate for the pacemaker? No I don’t have one I replied. This requirement is not listed in your instruction pamphlet. Well you can’t get into the prison unless you have one, the guard stated.  What was I supposed to do I asked? Come back another day with the doctor’s statement, or you could go to the medical clinic and get proof. Where is this clinic, I asked? Its back in San Louis Obispo at the second stop light on Meinecke Street, the guard said.  I headed out. I was really fuming now. This was number 4 hassle. What was an inmate going to do rip my chest open and pull out the pacemaker? This was ridiculous.

I headed back to my car.  We lowly visitors had to park at the far edge of the lot – employee parking is closest to the prison – and this was my third trip back to the vehicle.  I am 67 years old, so this was getting hard to do physically. I finally found the clinic after driving all the way back to the center of San Luis Obispo. Meinecke wasn’t at the second stop light in San Luis Obispo. It wasn’t a major street, but a small side street two streets beyond the first stop light at the edge of town.  Here I deduced that the medical clinic the guard had described was a family medical office. After parking badly as my temper was rising fast, I went in and joined the queue. I was told I would have a two-hour wait to see a doctor. Only one doctor was on duty on Saturday morning. I pleaded with them to see me sooner. In 40 minutes I was called and placed in a room where I nurse took my vital signs. I explained that all I needed was a doctor to write something that I have a non-operational pacemaker. The nurse said a doctor would be with me soon. I waited and I waited. I started to pace around the little examining room. From wall to wall I paced in three or four steps. My anxiety was growing steadily greater. I couldn’t take it in the closed door room. In my agitated state, the room felt like a prison cell I was sent to for being a bad visitor.  I opened the door and began pacing up and down a small corridor and in and out of the room. A nurse came and offered me refreshment. I said I didn’t need refreshment. I needed a piece of paper that says I have a pacemaker in my chest not a bomb. I waited again. The doctor finally came and made a cursory examination. Where is the pacemaker he asked?  I pointed to my upper left chest. He felt the site then dictated some information into his computer and filled out note on a prescription pad to say I have a pacemaker, and gave his telephone number. Two hours had passed.  I had my piece of paper.

In a fury I drove back to the prison and slammed down the prescription paper on the counter. My arms were shaking I was so angry after four trips. The guards looked at me suspiciously. I realized I had to hold my temper or I would never get into prison. I refrained from making a snide comment. I was silent and the guard waved me around the metal detector. It was now afternoon. It had taken me over five hours to enter the California Men’s Colony.

After going through two more sets of gates, the last under the watchful gaze of an officer in a guard tower, I made my way to the visitor’s room where Ginger and our friend sat at a low table. I pulled up a chair sized, it seem, like a kindergarten chair at a kindergarten high table — you don’t want the visitors to be too comfortable, as they might want to stay — and I was able to visit with my friend until quarter of three when all the visitors were shooed out.  Sixteen long years in prison had passed since I had last seen my friend in court.   He was in better spirits than I. He is looking forward to parole in a few years.  He says the California Men’s Colony is the best of prisons in the state. He has a single cell, and he is treated decently. He is healthy and has good medical and dental treatment. He hasn’t been raped.  I, on the other hand, was full of resentment against the establishment. The prison had treated me like nuisance. I felt like I needed medical treatment after dealing with their rules. I felt like I had been raped by their system.

It took me a day or more for the bile to dissipate. Could it be that prison was better for the imprisoned than for the relatives, friends, and loved ones of the incarcerated?  If you ask me, I would say my impression was true.  Visiting prison made me an emotional basket case. I don’t know if I could ever be prepared enough mentally to go to visit a prison again. That is the way prison officials want it, I am sure.

California Men's Colony

I recently watched a program on 60 Minutes, about a rewritten version of Mark Twain’s Huckleberry Finn has been created eliminating the word “Nigger,” which Twain uses often in the book in dialogue between Huck and Jim, his black slave friend. The editors of this changed version of Huckleberry Finn defend their actions as being sensitive to the feelings of African-Americans and not furthering the utilization of this word. An African-American writer said this was foolish, and an insult to the work of Twain. He said African-Americans need to get over their hostility to the word, and recognize it for what it was and is. In the past the word was used as label. It was uttered commonly in Mark Twain’s time and spoken frequently well into the 1960s.  It became a politically incorrect word – a slur — sometime during the awakening of Afro-American consciousness and black civil rights. Today it is hidden below the surface of white racism. It is shouted by African- American rap musicians as defiance and affront to the dominant culture.  Its euphemism, “the N word,” sensitive whites use with an embarrassed politeness, but everyone knows its sound and what it means. To be a nigger is to be less than a person who isn’t. To be any of those derogatory names is to be diminished. I was not called a nigger, but I was called a chink and it hurt. It traumatized me for many years when I was young.

Chinky and Mother

I was called Chinky by my family because I had drooped eyelids that made my family think I looked Chinese.  I was never Carl to my family. Maybe they couldn’t call me Carl because it was also my father’s name. So they had to come up with a nickname.  Nicknames were common in the Davis family. To his mother and father my dad was Carlie, not Carl or Carlton – his actual name and mine too.  Everyone else called him Carl. His mother, my grandmother, Phoebe, was called Nonnie and his father, my grandfather, Van Derveer was Yoya. They never explained why they had these names. From the days I can first remember I was called Chinky, my sister was Carolee even though her name was Carolyn, and my cousins were Dee and Dixie even though their names were Everett and Florence.  My mother, my stepmother, and my sisters, and all my relatives all called me Chinky. It was just a sound and a word without meaning. I didn’t know what it meant until that name followed me to school.

In elementary school I discovered how a name can make you miserable. I was taunted with Chinky said in a nasty pitch, and run after by students shouting “Stinky Chinky is a pinkie.” The bullies in the school would get in my face saying “Chinky, the Chinaman, are you a commie kid?” When I denied I was a Communist, these bigger boys would respond “Yeah, you’re a Chink and Chinks are commies” They would attack, push me to the ground yelling “Chink! Chink! Chink!” and pommel me; then laugh. I cried, which only made the taunts worse.  I hated going to school in Corning, New York, where I lived with my father and his new wife. We moved there from Rochester where I was born, and the name came with me.  This was the time of the Korean War, and the USA was engaged in armed conflict with Communist Chinese. Everything Chinese was a potential target of hate, much of it racial in character. America has had a long history of intolerance toward the Chinese. They were attacked when used a cheap laborers in the Western Territories in the 19^th Century. They, along with the Japanese, were subjected to exclusionary laws of immigration in 1882. The Asians were sly and inscrutable. Their language and writing was undecipherable. Their food was different. Their skin was a different color.  But I wasn’t Chinese; I was a white boy, and my skin wasn’t even vaguely yellow, yet I was a target.

I begged my father and my stepmother not to call me Chinky. They said it is only a fun nickname. It doesn’t mean anything.  Once when I came home from school and said to my parents that my friend Jimmy was a Wop and my friend Eddie was a Kike, my parents scolded me that I should be careful how I use these words.  They didn’t slap me.  They just warned me, but later they would use these same words in a conversation about who lived where in town and who was reliable or not.  The message is keep the words to yourself and only use them among your own kind. If I couldn’t say Wop in school, why would my family allow people to call me a Chink? It was confusing to a small boy.

My father was not sensitive to my distress. As I grew older and went to high school, I demanded that he stop calling me this name.  “What wrong with you that you can’t stand up to these stupid boys who mock your name?” he asked. “Be a man.  Punch them in the face, Chinky.”  “They gang up,” I said. I can’t beat up four or five kids!”

Dad had no response and, as he always did when confronted with an unpleasant situation, he disappeared into the basement to work in his woodshop. My father avoided confrontations outside the home, but at home or with his buddies he salted his speech with the derogatory words. He was a veteran of WWII, and Japanese people would always be Nips and Japs in his eyes.  He didn’t say Nigger, very often, probably because there were few in this town, but he did roll out the words Wop, Mick, and Polack with frequency. These people were Roman Catholics and different from us.  The Kike, my father said, weren’t to be trusted.  I learned most of the hateful names from my family, and the ones I didn’t know I learned in the schoolyard from other children, who got it from their parents.

The names were used as a spear in the high school. They made you easy prey if you weren’t part of a larger group or were caught without your group.  In Corning there were two groups: the farm kids and the townies. The farm kids all had common American last names: Jones, James, Miller, Smith Watson, Wilson, etc.   They disliked the townies, which were Italian, Irish, and Polish. The farm kids called the townies the names that would get them angry. The townies referred to themselves by slang names, but wouldn’t tolerate hearing it from a farm boy. To the townies, the farm boys were stupid pigs among many other epithets which usually involved the word “shit.” I was lumped in with the Jewish kids, of whom there were few, the other adolescents who didn’t fit in – too fat, too smart, too weird — or who had a funny name. The Chink was a good victim. Awkward, clumsy, nervous — I bit my finger nails; and with a mercurial disposition, I did not fit in with either group. The nickname pierced and deflated me like a balloon. I was reviled by a name. I was an outsider.

The boys, wearing the cloth jackets with leather arms and tight cuffs like their older friends in high school, confronted me outside the school at the bus stop.  “What’cha doin’, Chinky?” the leader of the group – his name was Butch — he was a farm kid with crew cut hair that stood up right on his head about an inch, snarled at me as he pushed his fingers in my chest and then in two quick moves up and down hit my nose and smashed my books from my arms.  The blood poured from my nose and my face turned crimson. “Look at this, The Chink is getting all pink. Shouldn’t you be yellow?” Butch mocked. He and the group of his four friends all laughed. Anger welled up in me, but I could not move my arms to punch Butch. They were paralyzed by fear at my sides.  His arm was still extended pointing at my face. Without thinking I opened my jaws, leaned forward, and chomped hard on his hand. Butch howled. I ran.  His buddies, surprised, didn’t move to grab me. As I ran I heard them yell, “Yellow Chink!” I ran all the way home. I didn’t want to go to school again, but my parents insisted I go.  The gang boys still taunted me at every opportunity, but they never again attacked me. I had crossed some invisible line when I bit Butch on the hand that made me crazy in their eyes, and they stayed a safe distance away as if I were some terrible cannibal. The Chink was safe.

My family moved. At home my family still used the name Chinky, and it made me want to defy them any way I could  At the new high school, a school full of  upper middle class adolescents who wanted to pleased their professor and professional parents, I wanted to be different from the good students.  I hung out with the group of outsiders and told my friends they could call me Chink, but never Chinky. Put the Y on the end and I would bite your head off.  I became proud of the Chinese reference.  The Chinks were revolutionary, and against the bourgeoisie, a term I didn’t really understand although I liked the sound.  The beatniks used the phrase to mock the American middle class, and I wanted to be a beatnik, so I was against the bourgeoisie. Under-age Chink and his outsider gang with ducktail haircuts, blue jeans, and white tee shirts, with cigarette packs rolled up in the short sleeves, went to strip joints in Scully Square, jazz and folk clubs in Cambridge, and convinced students to buy booze for us in Harvard Square.  Anything that my parents found objectionable, I wanted to do. I was your typical snotty teenager, but in exerting my independence from my parents and their values, I defeated the derogatory meaning of the word Chink. Gradually my friends stopped calling me Chink. “You’re not a Chink,” they said, “we’re going to call you Clink.”

I became Clink until I went to college. There I established my identity as Carl, and gradually I persuaded my parents to stop calling me Chinky. I told them they could call me Chink. I was proud to be associated with this noble race, but without the Y, they would not do it. I had finally defeated the nickname. What I realized was that I couldn’t go on using the term Chink either, or any other derogatory words. I could not be a person who diminished others by giving them a label. Now if I hear someone say any of these words, I tell them that it is offensive to me, and that it ultimately hurts the person using the word. If they persist, I have to walk away.  The funny thing is that being called a Chink has always made me interested in China. If I were called a Nigger, I think I would be interested in Africa. I’d want to go to Nigeria and travel up the Niger. I am finally getting to explore my interest when I go to China in a week to work as a volunteer teaching in a small town in Anhui Province.  I want to tell anyone subjected to an ethnic or racial slur be proud of that slur. The name you give me has no power over me.  It only reflects negatively on the person who used it. They are the dopes.

No one has described the state of mania better, or written about it in such a way that you feel the crazy high energy of this state of mind. Hornbacher writes at a forward-pushing staccato pace that blows you up like litter as the fire truck of her narrative sweeps past.

In one of my favorite passages she writes:

“I dash into the laundry room, leaping like a little frog, green pajamas flapping, and shout, “Just in time!” for I have flooded the basement. My bedspread is emerging out of the washer in an enormous coil, burbling over the edges like some kind of disgusting tongue, which I remind myself it is not, is not a tongue, “now don’t start with that shit, missy,” I snap, and tiptoe through the pool of soapy water that swirls all over the concrete floor. I grab the bedspread and try to wrestle it out of the washer, which takes this opportunity –“fuckers!”- to hemorrhage vast quantities of water; water is surging up and out of the washer and all over me, drenching me and twisting the coil of the bedspread ever higher so it looks like a cobra dancing out of the washer (though it doesn’t look in the traditional sense like a cobra, i.e., I do not really see a cobra, or anything other than a bedspread, which makes me meditate for a split second on the nature of simile and metaphor) “ah yes!” I bellow, “I have you now.” I climb up on the washer, barefoot, skidding a little, and seize the bedspread with all my strength and begin to drag it out of the “fucking bastard washing machine!” which I will think later (as I am giving myself a ‘calming’ bath), it does not occur to me to simply turn off, no, I hop down from the washer and, the soaking bedspread over my shoulder, lean forward with all my weight and begin a long, slow trudge across the basement, looking like Titian’s Sisyphus.”

What wonderful writing, such vivid images – the tongue, the soggy wet cobra of a bed spread, the author perched on top of the washing machine yanking at the cloth snake, and present tense narrative of dash, snap, grab, wrestle, hemorrhage, bellow, climb, drag, hop, and trudge, captures the whole mad scene, which is countered and deepened by the momentary thought of simile and metaphor and finally culminates in the art historical reference to Titian’s Sisyphus.

Sisyphus (1548-1549) by Titian, Prado Museum, Madrid

Are Bipolar Disorder and Sisyphus an unlikely pairing?  I think not. Hornbacher’s illusion to Sisyphus is not only a stunning image – I can imagine Mayra, grasping the heavy wet mass over her head and struggling across the basement and up the stairs while the dripping leviathan falls backward only to be gathered up and the steps remounted again and again – and it is a brilliant metaphor for the condition of Bipolar Disorder in a number of ways. Bipolar Disorder is a condition that never goes away. Like Sisyphus we carry the rock of our disorder with us all of our life. We carry it up the hill of experience thinking we can dump it over the crest and be done with it. But it slips out of our grasp, out of our control, and rolls back down to where we began, and we begin again to try and get rid of this terrible rock.  Hornbacher has dealt with this rock in so many ways, from an eating disorder, to cutting, and near suicide; and then the many bouts of mania that have plagued her life. She describes her attempt to escape this burden thus:

“And I know, I know that if I do that, I will drive myself off a cliff. At this moment, I understand with all my being why someone would commit suicide: there is no other way to get away from yourself, and I want nothing more than to finally escape the incessant shrieking of my mind, the crawling madness that has infested every part of me, body, and brain.”

I look at Titian’s painting that captures the madness swirling around Sisyphus, the raging sky and turbulent sea with its monsters nipping at the heels of the burdened man, and I hear the incessant shrieking of Sisyphus’s mind, Hornbacher’s mind, and my own mind, forever struggling up hill with the rock of our condition. There are times when I too can think only of suicide, perhaps as Sisyphus might have, when I think I have reached the point where I can dump this rock only to have it descend down the hill into the deepest depression.  Yet I climb down, pick up the rock again, and rush up the hill of my mania because I can do no other.

The rock is me, and not me.  The rock is another me conjoined with me in a never-ending labor to carry it away.  Marya Hornbacher has described eloquently her rock, her other self, her uninvited guest in this way:

“….no matter what you do, no matter how tightly you batten the hatches, madness can get in.

You wake up one morning and there it is, sitting in an old plaid bathrobe in your kitchen, unpleasant and unshaved. You look at it, heart sinking. Madness is a rotten guest. You can tell it to leave till you’re blue in the face. You follow it around the house, explaining that it’s come at a bad time, and could it come another day. Eventually you give up and go back to bed shutting the door.

But of course it barges in and demands to be entertained. Before you know it, it has strewn its stuff all over the house, and there are sticky plates in its bed, and it refuses to change the sheets.  Madness lounges all day in front of the TV……”

Dealing with the Bipolar Disorder is Sisyphean, a task that is endless and unavailing.  We carry the rock of our disorder up the mountain and down it tumbles. We carry it up again, and down it plummets, condemned forever to an affliction that is meaningless and absurd.  I wonder: why? I know in my heart of hearts that it is a biological condition, but then I think could be my own hubris, which, like Sisyphus’s insolence and cleverness, leads Zeus to condemn him to the rock, lead nature or God to give me this affliction. I rise from my depression with its feelings of worthlessness to the manic high where I think myself too clever for my own good.  I think myself to be grand, and I see that trait in others with the affliction. We have a distrust of authority, and tendency to be overly self-reliant. Marya Hornbacher describes the bias when she writes about medication:

“The habit of fucking with the dosages of your meds is common among bipolar people; since we don’t trust doctors, we figure our ideas are better than theirs, and so we add and subtract pills all the time. This rarely has good effects.”

For manic arrogance we are sentenced to the fall and the never-ending repetition of our errors.  There is an escape where the rock remains with us — perhaps the rock is eroded from boulder to stone, or cleft into a jewel like Marya Hornbacher has done with her writing — through acceptance.  Albert Camus related in his book the “Myth of Sisyphus” this concept. Camus, who saw the Sisyphean condition as a metaphor for modern man convicted to a life of ridiculous meaningless work, believed that when the hopelessness of this labor was accepted in all its futility that contentment could be found. Marya Hornbacher writes:

“Managing mental illness is mostly about acceptance — of the things you can’t do, and the things you must…… But there is hope too.  It’s been a long time since I’ve felt hope. I might have been mad, but in spite of it I did things, heard things, was inspired by things, wrote things, held conversations, worked, loved, even if I can’t remember it all.”

Looking at Titian’s painting of Sisyphus, I see a man with closed eyes grimly bearing his load. Surrounding him the wild sky rages full of storm clouds and intimations of fire. One small speck of blue sky appears near his knee. I see that patch of blue as hope. On one interminable trip Sisyphus will open his eyes and see the calm light, on that day like Camus’s Sisyphus, Titian’s Sisyphus will become happy because all is right in world. There is clear sky somewhere. The day of blue sky has come to me and to Marya Hornbacher.

Dyslexia and Deadly Skull

My wife and I have a joke with one another. She told me she was going to the county to get some information. She left to go and what I struggled with was why she was going to Downey to get some information. Downey is a town almost an hours drive from where we live. It didn’t make sense, but a lot of what I hear doesn’t make sense. Today she says she is going to Downey when ever she goes out on errands. I laugh and say “not again.” I am told this is a malfunction in my brain. The sound is heard correctly, but it is not translated properly by my brain. I liken it to target shooting, when the gun site is improperly adjusted the fired bullet will not hit the aimed at mark. The sounds I hear are like the bullets. They enter the ear and are loaded into my brain, but the adjustment is off kilter and the firing to the correct target is off the mark. “Weren’t we talking about cheese, not sleaze?” I ask a bewildered companion.  The words I hear are often not what they were intended to be. The condition produces extreme anxiety, and a determined effort to understand. I have to work a lot harder than most to make sense of my world.

Typing before the days of computers was a horror for me. In college typing was no end to frustration.  I have a favorite story about trying to type a paper in my freshman year at Yale University.  Late one night as I tried to type an English paper, I sat at my desk trying to type the word “The” which appears a lot in the English language. Each time I typed “the” it came out “hte.” I would get out the white-out and cover over my mistake and start again. No matter how slow or how hard I tried “the” ended up as “hte.” The white-out got thicker and thicker. The key got stuck in the goo. I would have to pick it out. I must have done this ten times, and the anxiety, the frustration, and the feeling of being stupid kept growing until I could stand it no more. I picked up the typewriter and tossed it out the 5^th story widow of the dormitory.  The typewriter- a present to me from my father to take away to college – sailed a long way out and crashed into the dirt of the central commons. I now felt even stupider. My temper always a bit on edge was high. I cussed at myself and descended the staircase to retrieve my possession. The typewriter was jammed into the earth and racked. I pulled it out, dusted off the damp earth, and tried to realign the typewriter body. I got it back into more or less a rectangular shape, and carried it back up to my room. I tried to type again, but the “W” won’t strike, and never would work again. I put the typewriter away and hand printed my English literature essay. I didn’t get a very good grade. The professor dinged me for the hand written words. From there after I knew I was doomed. I could not type due to the dyslexia and my carefully hand printed papers – they usually took me most of a night to transcribe- were always given lower marks. My dreams of being a writer were squashed. It was not until I was dismissed from college after a suicide attempt, and discovered art and drawing that I had any success. I returned to Yale College and majored in art and architecture where typing did not matter as much. I did very well and went on to graduate school in architecture.  Yet I felt something missing. I still felt stupid, and handicapped in a hidden but pervasive way.  Not until the use of computers and the miracle of spell check, could I realize my long sought desire to write. This tool that makes mistakes easy to correct has changed my life, but that didn’t happen until I was well into my forties.

In my thirties a psychologist, who recognized my distress had me enroll in a learning development center in Glendale, California where I tried to retrain myself to overcome some of my dyslexia. I recall that they showed me how my left eye tracked in front of my right eye such that I saw words in an inverted order. They had me doing exercised which attempted to pull my eyes together and be able to focus on one spot. They had me do a whole gamut of exercised one of which I remember vividly where I had to bounce on a small trampoline and say what was shown on my left, in front of me, and my right. There were pictures of a bear, a cow, and a chicken. I had to see the images and after I had memorized them I had to do the opposite. The instructor would rearrange the pictures. When jumping up and down seeing the bear, I had to say chicken, and seeing the chicken, I had to say bear. “Do the same, say the opposite,” was an exercise I found very difficult to do, especially when preoccupied by bouncing up and down trying to keep my balance. I would grow increasingly frustrated and would often yell out in anger.

These exercises reminded me of my youth when I was always being challenged by things I could only do with the greatest of concentration. I could only hold that concentration for a short period. I would become overwrought and go into temper tantrums. Teachers and my parents struggled with a screaming little boy flailing on the floor threatening to jab himself with a pencil. I have read of other young children to whom school presented similar challenges and who also tried to stab themselves with the hated pencil, which revealed all that one could not do like stay within the rule lines for writing, and keeping a relatively clean page. Mine were always a mess of blurs and smudges. I never followed the instructions – did I hear what other students heard? -, and to this day I have difficulty following instructions.

At the same time I was struggling to retrain myself, I was mentally falling apart. My bipolar disorder was raging. My mood swings were cataclysmic.  I had days when I was totally manic, super charged with energy, and retraining was relatively easy. I could say the same and do the opposite, if not with perfection, but with enough accuracy to get by. A dyslexic person learns strategies to get by, like pretending you didn’t hear and didn’t see.   In an up mood my dyslexia was something I could joke about. I would tell people who I was driving about town to point in the direction they wanted me to go because saying right or left made no sense to me. They would laugh and do as I requested.  In a down mood, I would be sullen, say nothing, and go left when I was requested to go right. I would become angry with the person who instructed. At the learning development center my disability would be much greater when I was depressed.  The frustration and anxiety would be so much that I would “fly off the handle.” I would accuse my instructor of trying to torture me.

Thus it is that I believe there is a relationship between Dyslexia and mental illness. Both are “disturbances of the brain” as one researcher called them. Dyslexia may not be mental illness, but the results of its reality can trigger mental illness.  Some of the characteristics of dyslexia are a lot like mental illness: self-esteem issues, temper impulses, phobias, strange reactions to external stimuli, obsessions, and mood dysfunctions.  Scientists have already made relationships between the brain chemistry of children with ADHD (Attention Deficits and Hyperactivity Disorder) and those of mental illness. ADHD is often co-morbid with dyslexia. I was definitely ADHD. Teachers would have to restrain me from literally climbing all over the walls. In one school – a summer school I was sent to improve my reading skills. I was behind my fellow classmates- I climbed all over the tables and chairs running about laughing as I tried to escape the pursuing teacher. They had me down as an emotionally disturbed child, who needed a strong mother to control my excess energy. No one talked about brain chemistry when I was a kid.

What we maybe talking about is a variation in brain chemistry which relates to the brain chemistry of those with mental illnesses like schizophrenia and bipolar disorder. While one set of reactions cause dyslexia, a similar reaction may cause mental illness. When the neurotransmitters fire haphazardly, perhaps one misfire leads to dyslexia and another depression. A person can have mental illness without dyslexia, but I would be surprised to see if there were persons with dyslexia who didn’t show some aspect of mental illness. Although I hate that word illness because I don’t see mental conditions through a medical model, it is the term used until we find a better way of describing depression, bipolar disorder and schizophrenia. Dyslexia may breed mental illness when the frustration of the disability becomes so great that another biochemical reaction takes place creating mental illness. My dyslexia must have some relationship to my bipolar disorder because dyslexia drives me crazy. After a particularly frustrating session of typing on my computer where the cursor flies all over the place because I hit a key I didn’t want and I do it again and again, my brain melts down. I have to exert every capacity for self control not the hurl the damned machine out my window. Even though I don’t do it, I think about killing myself. I think I am a stupid and inadequate person. Who would want to live with this terrible but hidden disability?

 And the political discourse is bent, too.  How can you deny that the Tucson shooter was influenced by the general atmosphere of violence created by the rhetoric and the images that portray Gabrielle Giffords as a target? Putting the crosshairs over her congressional district may be free speech, but it is the real crazy speech. We don’t call the Republicans who printed this excrement mad. I could call them more than just angry, I could call them mad, but they would deny it and call you mad if you called them that. Labels are undemanding and give an out. They allow the needed introspection to be shucked off. Once we labeled this individual as schizophrenic, the discussion seems to stop. The man is merely demented. He doesn’t represent a greater societal sickness that goes beyond the issues of mental health assistance, gun control, and harsh political rhetoric. We as a society need to dig deeper. There is a great malaise in our society that poisons the civilized environment represented by the uncivil conversation, computer games of death, destruction, and rape, television shows about unchecked lawlessness,  the disorder on our streets, and the fear of different. This great malaise of American culture creates stigma. This stigma is easily seen against the mentally ill.  Stigma is not facing our fears and the truth. .

 The truth is that we live in a society that glorifies violence, and the mentally ill are no more likely to resort to violence than the sane majority.  The truth is the mentally ill are castigated for their illness, mischaracterized as violent beyond the proportionate truth. They are constantly confronted by a society that would prefer to cast them aside as hopeless, rather than deal with the reality that mental illness is everywhere. One in five Americans will suffer some form of mental illness in their lifetime. Most of the 60 million Americans with mental illness will try to hide the fact. It’s too difficult to say “I’m nuts and I am proud.” It’s too difficult to say “You will not pigeonhole me into a special category; you will not prevent me from speaking out about the injustice of the moniker, or any other injustice in our society.” I am one who will.

Halloween II, The movie

I am nuts, but I will not be discounted. In my life I have been confronted with small-minded people who see me as a threat, as someone to be shunned. I have seen “normal people” cringe when I speak of my manic depression. I lost a job when I admitted I had the illness. If I had said I had cancer would I have been terminated? I think not. Once when I first realized I was bipolar, I was upfront and admitted I had a problem that I was dealing with. My reward, I was told “it would be better if I didn’t return to my position.” I thought of suing, but the firm was too small and cost of litigation would have been more than I could afford. So I let this architecture firm get away with discrimination. It was illegal, and I was livid, but I stuffed it and went on with my life. However, if I were to go out for a job interview, I would be wary and not admit to my condition because if I did, the chance of employment might be nil. Would I speak to the issue, if asked?  No, I would lie. I may be nuts, but I am not a fool. Admission is death in circumstances where you are the supplicant.

Admission of mental illness is difficult in any situation. Most with mental illness self-stigmatize. I am friends with folks who try to hide their condition at all costs. They will not speak of it outside the confines of a like-minded group: a NAMI, a DBSA, or a group therapy session.  Say mental illness outside the safe zones and they melt away.  They know the price you pay to say “I’m crazy, but I am dealing with it.” In the safe zone they will loudly protest the portrayal of the mentally ill: Hollywood’s and television’s exploitation of the illness for dramatic effect. It’s always a murderous mental patient who massacres. Isn’t “Halloween,” the horror movie of 1978 based on an escaped mental patient, Michael Myers, who wreaks mayhem on the cozy town of Haddonfield, Illinois?   Some critics have suggested this film encourages sadism and graphic violence. Where do you think the immature and alienated youth get their inspiration from?  In some youth cultures, Goths (today they call themselves Emos) — the ones dripping with death jewelry covered in black with streaks of magenta hair — are the only ones taking pride in their mental dysfunction.  Are they a model to be emulated?   Probably not, but 99% of them don’t go postal.

I am lucky. I can speak out about the discrimination faced by the bipolar, the schizophrenic, the constantly depressed, and the many others facing some mental disability. I have become a public speaker on the issue. I proclaim in front of all who will hear me. I have the condition, and I am not a threat to anyone. I will not resort to guns to get my way. I will not target the people who scare me or who are scared of me. I don’t represent anything alien. I am one with everyone. All people have a little madness in them. The irrational, overly emotional, the will to self destruction — a penchant for violence exists, however small, in all people. I think it is in the hardwiring of the brain and has been there since we climbed down the trees and began to be Homo sapiens. These aspects of ourselves are what make us human. Each person who holds a little madness should appreciate the gift. When the gift gets too burdensome, put it down and get some help until you can pick it up again, until you can appreciate all that you are. When you do that, all the madness that is called normal is merely something to ponder for its larger meanings. The Tucson murders and the striking down of a United States Representative should be looked at with a larger lens. There is something wrong with America when this kind of violence is so prevalent. It goes way beyond mental illness.

      The Scream by Edvard Munch

Just negotiating the names of the medication is enough to make you want to go postal. Citing a few of the many names: ziprasidone, quetiapine, fluoxetine, citlopram are the actual names of medication that is marketed by the Drug Companies as Geodan Zelox, Seroquel, Prozac, and Celexa respectively. The long titles generally ending in “one, tine, pram, pion or pam are the clinical names of these drugs. The drug companies have come up with their own name while they hold the patent on the drug. Clonazepam is Klonopin a trade name in the USA by Roche. The same drug is called Rivotril or Rivatril in the rest of the world. Klonopin is a benzopiaprene, which is a fusion of bezene and diazipine. Diazipine is a heterocyclic compound.  This all leads one down the chemical rabbit hole where I don’t want to go.

 It is enough to know that the clinical name for a drug is what will be used in studies especially those by academia, NIMH (National Institute of Mental Health), and other agencies. The trade names apply as long as the drug company owns the patent on the drug. After it becomes generic, and no longer a big money maker for company that brought the drug to market, the name changes and in some cases reverts to its actual scientific name. Lamictal by GlaxoSmithKline is lamotrigine, originally an anti-epileptic drug now widely used to treat bi-polar disorder. This drug can now be found as a generic under the lamotrigine name. Anyone taking a psycho-active drug should know the scientific name of the drugs they take for several reasons: because a generic drug using that name may be available, there may be scientific studies not publicized by the drug companies that contradict their findings, and the reason to take a drug should be based on the best available information.  

 Should you take these drugs at all?  This is a question that many answer by saying you shouldn’t. There are people with bi-polar disorder, schizophrenia, depression, anxiety, and autism, who believe the drugs poison them. They see alternate ways of healing through cognitive therapy (thought and habit changing) or psychodynamic therapy (working on the emotions), stress reduction by exercise and healthy eating, mind exercises including meditation, and herbs are often cited as means to resolution of mental disorder. Dr. Peter Breggin believes the use of psychoactive medications should be replaced by psychotherapy. He sees American culture as overly dependent on these drugs, which in his opinion have dubious merit. “Mad in America” is a book written by medical journalist Robert Whitaker that offers the idea that antipsychotic medicines have a 50-year record of doing more harm than good.

 I do not come down on this side of the issue. Drugs for various conditions have been with man, since the beginning of our consciousness. New understanding about the brain and how it operates have opened the door to preventative medicine. I am for science. I am for psychiatry. More power to the ones who decide against using medication for their treatment. For me I know the drugs I take work, but that doesn’t lessen many of my concerns.

 Do statistics show that medication works in relieving many symptoms of mental illness? I find lots of information about the percentage of people with mental illness, but little that relates to success. Is that because there is no mechanism for capturing these statistics? I don’t imagine doctors, clinicians, and psychiatrists calculate their percentage of success; nor do I see any national clearing house for assembling this information. What we do have is lots of survey information about the prevalence of mental illness. The National Health Interview Survey (NHIS) conducted by the US Census found that 11% of all Americans were sad (depressed) or hopeless for part or all of the 30 days before the survey. The National Institute for Mental Health (NIMH) using a survey conducted through SAMSA –these acronyms can make you loony- found that overall 4.5% of Americans suffer from severe mental illness. 2.2% have severe bipolar disorder. 2.6% of adults (non-institutionalized) suffered bipolar disorder for a12 month duration. Does this mean that 0.4 % recovered?  Hard to know for it is challenging to figure out what really these statistics mean.  The SAMSA survey was based on 3,600 interviewees in the big population states such as California, New York, and Texas, and only 900 interviewees in the small population states. I wonder if there isn’t a bias here, after all living out on the lonely range in South Dakota or living poor in the South might be more depressing than living amongst many people with plenty of money.

 With a US population of 308 million people, 11% are sad. That is 3.4 million depressed people. This number needs to be downward adjusted for the young, and significantly increased for the old because 32% of people over 65 are depressed. There are 4.5 % that are severely mentally ill. That is 1.380 million people – almost 1.5 million- crazy people. Understanding these statistics is a big effort because of the questions asked and who is answering. When the government asks if you are hopeless what does that mean? The statistics are different for different ages and ethnic groups. White men commit suicide between ages of 40 and 59 more than any other group. Women are generally more depressed than men.   What we do know is that mental health is a big market. It is in the interest of practitioners and pharmaceutical companies to serve our big population. Perhaps that is why more and more sad and hopeless people are diagnosed with mental problems. The means that the medical establishment most commonly chooses to treat mental illness is drugs. People were treated with anti-depressants 75.3% of the time in 2007, while it was only 73.8 % of the time in 1998. I am one of those diagnosed people, one of those mental health statistics. I am one who takes drugs.  

 Thus I take medication willfully, but the questions remain “How much to take and what to take.” I believe one should take as little as possible and as few different medications as possible.  These drugs are very powerful. They have many side effects and those effects depend on what you take and how much you take. Seroquel (quetiapine) by AstraZeneca made me disassociate with everything around me. I felt like a zombie on it. I had to stop taking Seroquel. Depacote (valproic acid or divalproex sodium) by Abbott Laboratories made me feel like I was boxed in. I felt like I wasn’t me. I was some being in a small container that allowed no room to feel up or down. I took this for a while before I had enough courage to say this drug is killing me as a person. It also has the side effect of weight gain. I gained 50 lbs taking this drug.  I also had unsteady balance on the drug, but I didn’t have dizziness, vomiting, fever, diarrhea, or hallucinations other common side effects of the drug. I now take lamotrigene and Abilify by Bristol- Myers Squibb. I take only small amounts. Of Abilify I take only 5mgs per day, a very low dose. Yet even these drugs concern me. I still have trouble with weight gain. Abilify’s manufacturer believes it doesn’t cause weight gain, yet other sources do not endorse this position. Lamotrigine and Abilify together make me have a tremor, which I now have to take another medication to relieve. This brings me to the issue of long term harm.

 The long term harm these drugs do is of great concern. Weight gain from the drugs leads to the possible advent of diabetes. The atypical antipsychotics (the atypicals are the newer medications as opposed to the old which were drugs like Thorazine) increase the risk of diabetes, some studies have suggested. The risk is highest for Geodon Zelox (ziprasidone) and Serolect or Serlect marketed by Abbott Laboratories and lowest for Seroquel (quetiapine) and Abilify (aripiprazole). However these studies also suggest that the risk varies depending on the user and the duration of use. I have been taking Abilify for many years. I continue to struggle with my weight and I worry about developing diabetes. This along with other such problems as liver or heart failure plagues my mind. I am glad that I haven’t gotten Stevens – Johnson syndrome, an incredible skin rash that inflames your mouth, feet and genitals. A man who shared a room with me when I was hospitalized had Stevens – Johnson syndrome.  When I look at this situation I am not sure what I am getting all the right information.  This leads me to my next topic “Who benefits.”

 First I believe the patient benefits from psychoactive drugs.  I know my bipolar disorder was and is controlled by the medication I take. However I also believe benefits abound to the clinical professions and the pharmaceutical companies. Psychiatrists have in a large measure abandoned talk therapy to medication therapy. This is not all practitioners – mine gives me both talk and medicine- but many especially those who work for HMO’s and those who see public assistance patients have become pill dispensers.  It is easier, cheaper, and faster to supply drugs than to listen to the hour long blathering of the sad, hopeless, and maniacal human beings. This is what I hear from people in NAMI and DBSA concerning most of the help they get. They take the drugs and put up with the side effects, but are unhappy doing this.

 The pharmaceutical companies benefit as long as they can hold the patent on their magic meds. Consider the money made on Abilify by Bristol Myers Squibb which costs in the 100s of dollar a month with out health insurance. With insurance Abilify costs me 60 dollars a month times 12 months that’s $720 a year. Abilify is being prescribed to more and more patients. Say of the people with severe mental illness half are prescribed a drug like Abilify. Using an estimate of $720 x .75 million people this means 540 million dollars a year.  (I bet my numbers are low.)  There is the cost to these companies of developing the drugs to be considered. Current figures estimate a cost of nearly $1.8 billion across 25 separate projects to successfully launch a new drug.  Therefore it can take up to four or five years before a pharmaceutical maker makes a profit. Citing the difficulty of creating new drugs two major pharmaceutical companies GlaxoSmithkline and AstraZeneca have announced they will terminate their psychiatric medication development programs. It is in the interest of the drug companies to get their medications on the market as soon as possible. Therein lays a problem.

 The Pharmaceutical companies test their own products because the NIMH does not have the money to do it.  Tests are costly. The tendency is to test drugs for a short time. Beneficial results in the short term do not show the long term effects of the drugs. This has been cited as an issue in relationship to certain depression relieving drugs. Millions were sold without clear long term evidence that they relieved depression. Thus the whole situation leaves me in a quandary. Making medication decisions on evidence that is not inclusive or exhaustive leaves me damn angry.  I proceed knowing that medication has worked for me in the past, but is it killing my future?  No one seems to know. My psychiatrist doesn’t know. The drug company’s literature can’t be relied upon as the absolute truth. To much of it is colored by profit making. The bottom line rules and the patient is the guinea pig. I could squeal, and leave behind what has proven so far to work for me, but if I do so I wonder if I won’t go mad in the mental sense. I won’t go there, but I will keep myself informed as much as possible. It behooves every client be in the know about what they ingest.

 Sexual excess is an essential element in the writings about bipolar disorder  I have read be they Carrie Fischer’s fictionalization of her own experience, Andy Behrman’s account of his own adventures in “Electro-boy,” or Jason Pegler’s account of his slavery to a domineering mistress in “A Can of Madness.”  We know that Vincent Van Gogh had a penchant for prostitutes as has been recounted in several books about the life of the artist. The manic- depressed individual is drawn to the flame of forbidden desires often fueled by drug usage. Van Gogh drank absinthe. Andy Behrman used cocaine. The loss of inhibition that comes with the illness and being drugged is a heady high.

 In “The Best Awful” by Carrie Fisher, Susan Vail is a promiscuous slut. She does after men with abandon. She is an alcoholic.  She goes after Dean, a Hollywood hedonist, who had “****ed the **** out of everyone.” Carrie Fisher writes: “Suzanne slid down in her seat an leaned into him (Dean), doing her best impression of being forward, suggestive, available – whatever the word was for ‘lets have sex now.’” This was Susan’s ecstatic state, “She was barely able to sit still, squirming with sunshine, this chaos of pleasure bubbling up in her, rendering her barely able to see.”  The sexual component of Bipolar Disorder is an electric state where what normal people do is forgotten, and anything goes to get the high or suppress the rage of the illness.

 In “Electro- boy” Andy Behrmann writes of: “The dichotomy of my smart yuppie lifestyle on the Upper West Side and my career stripping and getting jerked off in a seedy Times Square theater.” He adds: “The risk of hustling gets me high.” There are two things I take special note of in these words: the dichotomy and the risk.  There is this aspect of being another person at times of high mania. Andy Behrmann had a successful public relations business which called on him to dress normal and act normal. He did this in daylight hours. After dark he became the male prostitute living a life on the edge, where he was exposed to all kinds of deviant behavior. This is another retelling of the Dr. Jekyll and Mr. Hyde story- two different kinds of persons in the same body. These two persons are diametrically opposed to one another – the clean safe professional verses the sexual predator that lures lonely men as he dances. 

 Safety and risk define the two poles. Safety defines what is revealed in everyday life.  The bipolar person appears normal. He or she can operate like other people: hold down a job, have a place to live, even carry on what appears to be a normal relationship.   Risk, however, is the big attraction. The bipolar person is lured to that risk, which can be fulfilled easily in the night time.  To be outside the boundaries of society is trilling, and that trill is often sexual.  Isn’t this what we often find out about rapists and the pedophiliac?  They have ordinary lives laced with times of extreme behavior. Perhaps that is why so many sexual abusers are labeled bipolar.

 In my own case the sexual adventures, which I have recounted in vivid detail in my book, “Bipolar Bare”, were associated both with both mania and depression. A depressed rage would come over me, where I sought out high risk behavior in bathhouses. I wished to kill myself through contracting AIDS. I would go into periods where I thought my life worthless, and vile. The more I sought out sex in gay bathhouses the worse I felt about myself, but I hid this behind a façade of normality. I acted and dressed like a professional during the day, and at night during those times of extreme depression I would go out looking for sex. I didn’t do this when I was not depressed. I acted like a heterosexual male dating women and loving their company. But I could never get into a meaningful relationship because I had this secret life which occurred during my depressions. I was addicted to marijuana at this time. Stoned it was easy to overcome my inhibitions about homosexuality so that as my cyclical depressions arose I could operate on my hidden fantasies.  Gay sex was the behavior I loved and hated at the same time.

 Later after I had given up marijuana and became a Buddhist meditator, I abandoned this secret life for eight years. I still had depressions and manic episodes, but they were not as severe and I could handle them. I stopped hating life and frequenting bathhouses. I got married and embarked on a productive professional career as an architect, but this period of tranquility did not last.  After a few years the stresses in my life especially the problems of keeping an architectural practice flourishing lead me back into severe manic-depression and addiction. The drug I became addicted to was far more powerful than marijuana. I found crack cocaine and immediately began to abuse it. Crack is rocket fuel to mania. I loved this high, which at first and actually for a fairly long time diminished my depression. I was self-medicating. The drug however released all my inhibitions, and I found what I most wanted to do was cross-dress and seek out sex in clubs and bars. I did this secretly for a long time. I had a studio separate from my home, where I would go ostensibly to work on my art, which I did some of the time, but much of the time I spent getting dressed up as my alter-ego Carlotta. She would prowl the streets of downtown Los Angeles with the other transvestites looking for johns. She also carried in her purse and eight inch ice pick for protection –she said- but in reality she hoped to come across some poor smuck who would challenge her and she could skewer. Luckily this never happened. It was all about risk and dichotomy.

 The risk of this behavior was more than merely exciting, I was euphoric. Once I had a rough homeless man hanging onto my open car door as I tried to speed away from a drug deal gone bad. I was trying to push him off the door at the same time negotiating the steering wheel. He eventually let go and tumbled into the street. I should have been terrified by this event. I wasn’t. I was trilled. It was everything I wanted: the adrenalin rush, the exhibitionist behavior – I was dressed in full drag, and the act on the cusp of illegality. I could not get enough of this activity. I like Dr. Jekyll could not and did not want to stop becoming Mrs. Hyde.

 The dichotomy was a full expression of my manic self. There was Carl, the professional architect doing his job each day looking normal –at least normal at first, the more my addiction grew the less balance and reliable I became. People in my office later remarked to me that they did not know what Carl would show up on any given day. One day I would be cute and loving, the next I could be cutting and hateful.  Then there was Carlotta, black dressed bitch with orange red hair, who raced around town from transvestite bar to gay bar or walked the streets of skid row. These two selves were diametrically opposed to one another. One was the daytime loving husband and father; the other, the queen of the night.

                                                                                                                                                                                                                             I have recovered from my addiction and my cross-dressing with the help of therapy and medication. I have come to see my desire to become a woman as a manifestation of my illness that had its roots in childhood. When I was five or six before my young life was torn apart by the nasty divorce of my mother and father. My happiest days were dressing up in an attic closet with my older sister in our grandmother’s old clothes and shoes. We would put on slips- they dragged far behind us, high heels that were twice as big as our little feet, and wrap our necks with feather boas. These days with my sister that ended in our separation after the divorce stayed with me and influenced my future relationship to my sex.  Sex is deeply ingrained, be it be sexual identity or sexual proclivity. I believe it comes out in mental illness in some form or the other, perhaps influenced by personal history or just plain biology. Perversion of sex can be seen in many of the bipolar disordered.

 Tom Wootton is an engaging and provocative author and public speaker on the issue of Bipolar Disorder. I listened to him speak in Pasadena, California on September 15^, 2010. I found myself totally engaged by the theory he puts forward that Bipolar Disorder can be converted into “Bipolar –In- Order.”  This is a state, as I understand it, where self mastery has been achieved and where Bipolar Disorder is converted into a total plus, and the need for medication is eliminated.  It is akin to the Buddhist state of enlightenment, where the enormous swings in mood can be allowed without danger to others or oneself. I have found myself pondering the ideas he puts forward and while I find agreement with most of them, I have ultimately come to the conclusion that Tom Wootton’s premise is wrong’ or at least it is wrong for me. If it is wrong for me, I believe it could be wrong for many of the sufferers of the condition, who could be given false hope that life changing – life saving- medication can be abandoned.

Mr. Wootton shows a remarkable diagram, which is an an extension of diagrams by Dr. Allan N. Shore of UCLA, the eminent neuroscientist. (See diagrams attached.) Dr. Shore’s diagrams show the functions of mood as they related to a window of tolerance. In the first diagram fluctuations  of mood up and down are within the window of tolerance and represent to kind of swings that a healthy individual experiences. They are neither too high – above the window — nor too low – below the window. In the second diagram the cycle of mood way exceeds the window of tolerance. The ups spike way above this hypothetical window and the lows spike way below.  This is the diagram of an unhealthy person, a person with Bipolar Disorder. What the window of tolerance is exactly is not defined. Could this be the zone in which society accepts an individual’s mood swings? Or is it the zone that an individual can experience mood swings without acting out in unacceptable ways?  I will posit that this is the zone in which society accepts manic or depressed behavior. 

Mr. Wootton takes this second diagram – up and down peaking outside the window of tolerance — and extends it.  (See diagram attached.)  He extrapolates other states beginning with Crisis – the unbounded state of mood swings — and adds five more states: Managed, Recovery, Freedom, Stability, and Self-mastery. In the Managed, state extreme mood swings have been ameliorated by lower mood swings. They still are outside the window of tolerance. (What is interesting here that Wootton’s diagram does not identify the two lines indicating a zone in the middle of the mood swings).  I am going to assume he is referring to the same window of tolerance that was indicated on the Shore Diagrams.) Let us assume that this state is state where intervention has occurred and treatment begun, including the administration of drugs.  The managed state is followed by recovery where the mood swings of a bipolar person have been controlled and fall within the limits of tolerance.

Wootton posits that this is an uncomfortable state for an individual suffering from Bipolar Disorder. He terms it the prison of recovery. I think he is right. I experienced the same dissatisfaction. I felt as if I were not myself anymore. Artificial boundaries had been established which I could not break out of.  I could no longer experience the high energy that manic person experiences, nor could I feel the sadness that makes us sensitive to life.

I was deadened and slack.  This is the feeling that many people with the disorder experience when they are put on medication. They may no longer be suicidal, nor dangerously psychotic, but they are sucked dry of the spark that comes with Bipolar Disorder. (This same feeling of living death can come to those who are depressed only. Discussion of the relationship between Depression and Bipolar Disorder I will leave for future writing.)   Given this feeling many persons with Bipolar Disorder decide that medication is not for them and that they should look for another route to resolution.  Tom Wootton is offering that route.

In Wootton’s diagram, the limits of toleration disappear in the state of freedom that follows recovery. Freedom from Bipolar Disorder, in Tom’s view, comes through following a program, which he offers in workshops.  He has an integrated approach, which starts with an assessment of an individual condition and follows with a life plan for one or two years, and culminates with  a treatment plan. This treatment plan is based on three principles: Introspection, Cognitive Recognition, and Meditation. Introspection is developed from mood charts. Mood charts have been used in therapy for a long time. This is nothing new in this approach. Mood charts make individuals aware of the cycle that all bipolar and depressed people experience. Each person’s cycle is different. In my own case I have a six-week cycle between manic and depressed, with two severe extremes each year. One is in September and the other in late January/early February.  Others cycle weekly, some daily, and in the case of a doctor I know yearly.  Awareness is good and is a good step on a treatment program.

Cognitive Recognition is also a good therapeutic tool. If an individual knows the triggers that can aggravate a cycle, he or she can take steps to avoid the triggers. Stress is one of those great triggers; and stress can be brought on by a whole host of life situations: traffic jams, employment problems, and interpersonal relationships to name but a few of the triggers. My worst trigger is frustration. Frustration constantly arises in my life. I am dyslexic.  Number and letter reversals plague me. When my cycle approaches the period of extremes these dyslexic frustrations worsen. Recognition of this frustration trigger does not change it. This problem is organic, but other triggers can be controlled or at least lessened by cognitive recognition and appropriate life style changes.  It is difficult to dampen the mood when in full argument with your wife or girlfriend, but it can be done. Exercising, eating right, and adequate sleep are known factors lessening stress. There is nothing new in this cognitive recognition, but it is sound therapy.

Meditation is increasingly understood to have a beneficial effect on mood disorders. Tom Wootton is offering something here that is not a standard part of the therapeutic treatment of mood disorders. He is correct in stating that meditation can lead to states of high focus and to places where the individual is unshaken  by life events. However this is where I begin to depart from Mr. Wootton prescription. Nowhere in this outlined treatment plan does he talk about the role of medication. If you are to believe his diagram, Stability and Self-mastery, the final two stages of his program for an individual to become “Bipolar In Order,” can be achieved without drug help. Now I would say this is a miracle, and not that miracles don’t happen, but they are rare. In my view Bipolar Disorder can’t be turned into something else through thinking, experiencing physical sensation – an aspect of meditation, and therapy alone. The problem is organic. The bio-chemical disposition of our brains doesn’t change by awareness or even by life style changes (although healthy eating and exercise help). Just as with my dyslexic condition, which all the awareness in the world won’t change, I am stuck with a brain that bio-chemically works differently.  I know this to be true. I feel different when I am manic or depressed. I become a different person. A  second self assumes control over my actions that I am powerless to stop. This is not multiple personality disorder – the second self does not obliterate the first  self-, nor is hallucinatory.  Organic reactions occur. I have deep pains in my brain that spread across my skull in the left hemisphere. No amount of meditation or cognitive recognition will make it go away. It passes in its own time. All I can do is diminish the severity, which I do with medication.

I posit a different diagram for the bipolar condition – I like to call it a condition not a disorder, which implies it, can be made orderly – because it is chronic. I live with it, like I would live if I had epilepsy. (See diagram.)  It does not mean I can’t live well, or I have to have a diminished expectation in the world. Here again I think Tom Wootton is absolutely correct. Depression and bipolar can be an advantage. We just have to learn how to moderate it and use it to our best advantage.

My Curve is more complex than Tom Wootton’s Diagram. I see more factors at play. I begin with the crisis situation, but I would have you understand that outside the limits of tolerance are states that grow increasingly worse as one becomes manic or depressed. There are, I believe, four states to mania. I am not sure my titles are the accepted titles – I am not a doctor and my understanding is not clinical. It is experiential. As manic people move out of the boundaries of tolerance, they become wildly happy then super energized. They then move into problem territory. They become angry and enraged and finally psychotic. At it highest point mania can lead to death, either the person’s death or someone else’s. Depression also has states connected with the decline. I call these: mildly unhappy, super sad, isolated and angry, and finally suicidal.  At its nadir the depressed person may die. These are severe sequences, not to be trifled with, nor allowed to re-emerge as the individual reaches Wootton’s Self-Mastery, where one could play with death because it supposedly holds no power for the enlightened individual. Buddha I believe would take medication for a chronic condition.

After the crisis of emotion, we move into the sequence of recovery. The moods are dampened and gradually fall within the limits of societal and personal tolerance. This is done with the typical medical response: drugs, psychotherapy, cognitive therapy, etc. Social recovery is an uncomfortable place for most bipolar people. Tom Wootton and I agree on this. It is here that individuals must make choices and advocate for themselves. One option is to end medication gradually and to choose to “ride a bicycle” of a different sort. Tom uses the bicycle analogy to show how one learned as a child to balance and move on two wheels with the assistance of a parent. The individual who follows Tom’s program is at first guided by the hypothetical parent, and then as he or she becomes more skilled can bicycle alone. The parent (coach) is still close by to assist against disaster, but finally the cyclist reaches self-mastery and the role of the coach diminishes or goes away .  Tom’s diagram ends the limits of tolerance altogether when the bipolar person declares freedom. He or she has gone beyond the effect of society’s boundaries into a new world few can attain. According to Tom, Gandhi attained this kind of freedom.

Here I disagree and agree with Wootton’s diagram. I agree with his assessment that a bipolar person is trapped in a prison in the typical treatment model. I disagree with him that society’s limits on social behavior can be abandoned or at least disregarded,  As bipolar people recover they need to break those psychic boundaries that hold them down within society’s level of tolerance. The swing of their moods will never be within the boundaries because they have too much feeling and too much energy. The feat is to find a medium that allows one to go higher – become a controlled hypomanic person – and go lower – experience sadness fully — without traveling up into the high reaches of anger and rage or sinking into suicidal ideation. This adjustment is best done with medication. Lowering dosages or changing types of medication can often do the deed. A bipolar person can feel 90% himself and happily abandon the extremes of behavior that characterized full blown mania or depression. I don’t believe one can go through any program which does not include a medicine element successfully. Relapse is too great a risk.

What I do believe is that with drug adjustments, and continuation of other rehabilitation factors, an individual can lead a full life and not feel diminished in any way. That is the situation I live with. My medication is adjusted as needed. I am lucky I have a psychiatrist who works with me as a team. If bipolar people are unhappy with the side effects of their medication, they need to self advocate. Fire the unresponsive medical expert and find one who is not just a pill pusher.  Tom Wootton seeks the same goals of a purposeful and meaningful life for himself and his clients, but, in my opinion, he appears to be disregarding society boundaries. They exist and they are hard to penetrate. The goal of a managed bipolar person (I say managed, not recovered, because I don’t believe there is recovery which end the bipolar condition) is to change society’s boundaries. Society will never tolerate the extremes of mood behavior, nor do I think it should, but acceptance of a greater diversity below the zenith and above the nadir of mood behavior I think is possible. In my diagram I show the limits of tolerance widened. This can only be done by showing the world what good and productive people are those with managed mood disorders.  This would present the eradication of STIGMA. This is when a bipolar person becomes “Bipolar In Order.”

Imagine a Teeter-totter with a person on both ends and combine it with a roller coaster. This is the experience of bipolar people. They ride up the escalator and plunge down the descent seesawing back and forth.  At the summit they rise up very high – higher than in the coaster car alone, higher than others go- then do a double descent rocking back and forth into the coaster valley where they go lower than anyone typically does. Bipolar people take this ride not alone but with a second self.  The person is the being on both ends of the seesaw. To me this duality is a characteristic of the bipolar experience. At the manic high end of the seesaw a one feels a different self than the self at the low end of seesaw. The situation is unstable because the individual is always changing. Once one becomes the manic self, he or she descends into the different depressed self. A shift up or down begins and the two trade places through out this ride. When one is up, the other is down. When I am A; the other is B. When I am B; the other is A. My A and B coexist with each other- often very aware of the other.

When I was a young man, I attempted suicide. I took 150 aspirin tablets and drank a bottle of scotch while listening to a second self urge me on to death.  The voice was silent, but insistent. It spoke to me about how life was not worth living. I struggled with the voice, trying to convince it and myself that I had reason to live on. I was isolated and failing in my courses at college.  The future looked bleak to me. Drunk and gradually more tired of the persistent urging, I swallowed the aspirins in large handfuls. I became nauseated and lay down thinking death would come with welcome sleep, but I did not sleep. A terrible ringing began in my ears. A ringing so bad I could neither think nor hear my second self. A barely audible voice told me I had screwed up, and begged me not to give in to death. I somehow staggered to the telephone and got help. The campus police came. I was rushed off to the hospital. My stomach was pumped. I lay in the critical ward all night. listening to the ringing in my ears and the voices compete for my life. The orator for death said gives it up. The narrator for life said hang on. The debate went on while I heard a third noise. The man in the neighboring bed was dying. I heard his death rattles, as he fought and finally gave in to death.  His death gave the final victory to the voice for life. I survived my attempt, but the voice for death stayed with me especially when I was in the deep valley of my roller coaster in severe depression.  Only my other voice that loved life kept me from doing the death ride again.

The concept of two minds directing behavior is not new. The psychologist Robert Firestone has spoken eloquently about this link between suicide and an inner voice. The inner voice drives suicidal tendencies deceptively convincing people that it is better to end their lives than to find an alternate solution to their suffering. There are many others who have studied this concept of two minds. Perhaps not specifically linking it to the behavior of suicide as Dr. Firestone had done, they have looked more generally at the concept of two minds – or brains -determining that it is a basic condition of our biology.

The brain has two hemispheres. The left hemisphere controls the right hand and right eye and has been shown to be the locus of analytical thought and verbal communication. The right hemisphere controls the left hand and left eye and is the center of emotional   and non-verbal communication.  These two brains work together in a complex crisscrossing relationship between rational and emotional, verbal and non- verbal communication. What if this cross wiring is different or abnormal? I have always thought I thought differently than my compatriots. Where they thought A; I thought B. Where they reacted one way; I responded the opposite. I posited once that the biochemical electro-circuitry of my minds was connected in untypical fashion. Could this be wiring of the unusual person? Could this be the underlying structure of the bipolar condition?

 A lot of study has gone on in the past ten years, the so called “Decade of the Brain” into the nature and interaction of our two brains. Dr’s Allan Schore and Daniel Siegal of UCLA and Pat Ogden of the Sensorimotor Psychotherapy Institute in Boulder, Colorado lead the way in terms of how our brains work in the relationship to neuroscience and psychiatry. They talk about the development of the brain. They study young children who develop their right brains first in non-verbal and emotional ways. They found that kids before they acquire language skills react non-verbally and emotionally out of the right brain. The left brain develops after the child is three. But what if two brains don’t develop at the typical pace?  What if one brain grows faster or less fast than the other, or if one is more sensitive to biochemical stimulation, than the other, what would be the result?  This could cause in a fundamental difference in kind and quality of thought and action.

The conclusion of these researchers and others have reached is that emotional trauma and thus neurotic conditions is largely centered in the right brain. This could be true. I have found that in my worst states of great depression the right side of my head hurts. I suffered from deep aches inside my skull on the right side. I had trouble thinking, and moving. My arms were heavy. My legs don’t want to operate. My body became stiff. They do of course ultimately work. I can eat walk and do things, after considerable exertion.  I feel as is I am not wired up properly. Somehow the neurotransmitters get hooked up to the wrong receptors and there is not enough juice flowing through the connectors.  However, in mania I felt no such pain or discomfort. Everything is working perfectly – better than perfectly. I can think fast. My mind is going at top speed as if it were the fastest microprocessor in the world. I have all kinds of energy to do psychical things. I want to do everything. My wiring is in super shape. Every neurotransmitter is properly connected and the biochemicals are flowing without impedance. Something biological was obviously going on as I seesawed back and forth between my super highs and my catastrophic lows.

An Eskimo Seesaw

On every seesaw there is a point of equilibrium when both ends of the balance beam are even and the seesaw can stop teetering. Everything is level and equal before a force throws one end of the seesaw up or down. I would feel this way regularly somewhere between my manic highs and my depressed lows. As I see it here the biochemical balance is even and neurotransmitters are functioning smoothly.  The system is without excessive electric force or too little electric force flowing through it.  This is the point where one in two wishes to be. Here two can become one. The person is neither one way nor the other.

He or she has reached wholeness. I have reached that point through a whole gamut of resources. I have a support system of psychiatrist, family, and fellow riders on the bipolar coaster. I meditate. I take medication. I still totter a little this way and that. Everyone does, I consider myself enlightened if I didn’t.  I don’t ride the Bipolar Coaster anymore burning up synapses and alternately starved for fuel or gagged by it. I no longer go up and down in my up and down.  No longer does one side of my seesaw scream “give it up and die,” while the other yells, “life is good and live.”

 I listened in rapt fascination and horror as he explained how he drove. This bipolar young man with the fresh face and red hair sat up right in his chair at the meeting and with a giddy smile on his face spoke about how he bore down on slower moving vehicles. He liked to go ninety miles per hour when ever he could get away with it he said.  He would charge up behind a car in front and break fast slowing up just quickly enough not to crash. He liked he said the look of terror on the drivers face when he would then dash out from behind, speed by the shaken driver, and zip into their lane.  “You’re a crammer,” she said. The older woman looked over at the young man with disgust. “That what I call people like you, who drive so aggressively. You must have a will to death.” The young man smiled knowingly. I thought he did since not only was the young man bipolar; he was also diabetic at a young age. There was a certain angry edge to all his speech.

He reminded me of myself in the past, when I would drive like this in states of high anger. Once I discovered I left a prized book at the airport. I got off the freeway on my way home, turned around, and sped back onto the I-10 toward the airport. My wife and my daughter were in the car with me. I had just picked up my daughter from a flight from San Francisco. I charged onto the freeway without regard for coming traffic. I weaved in and out between the many cars traveling west, cursing at each driver who impeded my way. I accelerated and broke with increasing violence. Nothing was going to stop me from getting back to the airport quickly and pick up the book from a stand where I knew I had left it. I  swerved into the inside lane where traffic was not supposed to go, then rushed back into the snarl of traffic, blasting across three lanes in a fury of expletives. My wife and daughter were terrified. They begged me to calm down, but I could not. The lost of the book encapsulated all that was wrong with my life.

I had not just lost a book. I was confronted with my own inadequacies and failures too numerous to count. The book was my life. The book was a daily diary where I recorded all my events, responsibilities, desires, and thoughts.  I had to retrieve it. I could not stand the thought of so precious a document to end up in foreign hands, or cast off-handedly in the trash. Too lose it, would only brand my life so carefully constructed to have meaning in spite of life’s meaninglessness as worthless. I could not let that happen.

I raced on, pushed through traffic that ordinarily would have me stalled and waiting in silent frustration. I nearly nicked a hundred cars as I pulled out around them headless of the vehicles in the lanes beside me. If horns blared, I only sat on my own horn, and flipped them the finger. I crunched through the gears not careful to fully disengage the clutch as I downshifted. I ground the gears and swore as I up shifted. My wife and my daughter cowered in the backseat.  I was a madman focused on only one thing. Get my book back!

I screamed into the airport parking garage, nearly hitting a pillar. I parked abruptly, jumped out of the car and raced to the concourse. I ran from place to place where I knew I had been: the newsstand- The sales lady had not seen the red diary, the coffee stand- it was not on the counter nor had they picked it up, the toilet room – the counter was empty except for wads of hand drying paper. I looked in the trash cans there and all along the concourse from where I had passed to meet the plane. This was in the day before nine-eleven when you still could meet an airplane at its gate. I didn’t find my book. I was totally deflated. Tremendous fatigue gripped me. A great sadness overwhelmed me. I wandered back to my car where my daughter and wife berated my behavior. I told them to shut up. We drove home in silence and I drove defensively.

This was me on one occasion, mad as mad angry hatter, but as I sat in the meeting and heard the young man recall his own mad behavior, and remembered my own, I also thought how often I have encountered mad drivers on the road. Madness on the roadway is not the province of the mad only. Normal people drive crazy too. They swerve; they race; they cram, all in the pursuit of some personal need. Some no doubt motoring madly to some destination to which they are late or lost, but some – the most I imagine- seem bent on using their heavy armature as a weapon to strike out against the world. The world ignores them; they ignore the rules of road courtesy. They challenge other drivers to test their courage and their resolve. The car is like a sword cutting through the hesitation and concern of others. With rapier speed they zip through the traffic parrying any move with a move more aggressive and more determined to get ahead to that nowhere ahead. Most attacked hold back their aggravation. But what if they didn’t? Our roads would be a massacre of tangled cars and bloody bodies. Few would survive the demolition derby of egos.

So I thanked the many drivers who controlled their own madness on the roadway and let the few who are mad race on. I know however that everyone is capable of road rage, and has probably exercised it more than once. It is too easy to use the heavy club of an automobile to get our way, when all you have to do is press down on a small lever, and watch in glee as you propel yourself beyond the wretched heard. I know madness can come to anyone, and there is nowhere it is more evident than on the highway.

Carlton Davis finds the way to recovery in ‘Bipolar Bare’

By Carl Kozlowski 08/05/2010

http://www.examiner.com/x-5892-LA-Books-Examiner~y2010m7d12-Five-favorite-books-by-artist-and-author-Carlton-Davis

Ninety year old Thomas Szasz, controversial psychiatrist and author of the Myth of Mental illness, was the keynote speaker at the INPP (International Network of  Philosophy and Psychiatry) Conference in Manchester, UK, June 28-30, 2010. I attended and spoke at this Conference. When the conference ended I found my basic beliefs had been shaken to the core. I questioned the concepts of my own presentation.

Szasz is as notorious today as he was in the 1960’s, when I first came across his work. The Myth of Mental Illness questioned the medical model for and the support system of mental health. Szasz can be considered the instigator of the closing of most mental asylums in America and the creator of the thousands of homeless mentally ill people who populate America’s cities. I was an architecture student then looking for a social role for architecture. I dealt with the ideas of Szasz as we strove to make a better architecture for the mentally maladjusted.  I was interested because already at 21 I had experienced a mental hospital, The Tompkins One Ward of Yale New Haven Hospital. I didn’t like it and I didn’t think it had helped me.

Asylums were to be replaced with community centers, where the mentally ill could be close to their families and receive modern medical treatment. No more electro shock treatments, ice baths, and strap downs. These ideals never came to pass as the unable were dumped wholesale on city streets without any help or infrastructure.  In Manchester, fifty years later Szasz was still Szasz.  He had the leftist’s up in arms when he declared that people with mental disabilities are not entitled to state support. The editor of Asylum magazine jumped from his seat to challenge the old man stating that government owed the mentally disabled financial support. Another man from ENUSP gave a passionate plea for state support at the same time declaring that the mentally disabled needed and deserved basic human rights. Szasz chuckled at the men stating they were proposing the same old answers and standing on the same old positions of years ago. But has anything much changed since the state supported mental asylums were closed down? To hear Szasz and other you would think not.

The Medical model of mental disability that treats conditions as diseases of the brain still flourishes and with the use of brain scans that can detect depression, schizophrenia, and a whole host of other ailments has reinforced that position. Philosophy it seems takes issue with the medical model. The philosophers I heard questioned whether or not psychiatry could rely on it scientific basis to describe situations of human difficulty. The specifics of the argument were lost to me, but I did understand that philosophy believes the human condition can’t be limited to only scientific explanations. The issues are larger, and more universal.

I was amazed and remained amazed as I listened to the statements and positions declared at this conference. Szasz’ arguments which I had long forgotten came to me as fresh ideas. Other positions were alien to me in their challenge to the medical model of psychiatry that is so dominant in the USA. Many of the arguments as promulgated by members of ENUSP (European Network of (ex-) Users and Survivors of Psychiatry) seemed to go directly against the medical model. These folks who are articulate and passionate about their positions reject the disease model for mental conditions. They see themselves involved in a civil rights struggle. They demand that they have civil rights not to be forced into treatment by the medical establishment and that any therapy done be done with their consent. They see themselves as merely different, a difference which can be a disability; and as a disability should have the same respect and civil protections as other disabilities. ENUSP is engaged in a human rights struggle against a medical profession that takes away their voice and defines who they are. ENUSP is engaged in political battle to change the way society looks at the mentally different.

What a difference this is to the situation in America, which generally seems to accept the medical model without question. Concern is mainly leveled at the question of proper diagnosis. Am I bipolar one or hypo manic? Am I depressed or manic depressed? Am I schizophrenic or schizo-affective? No one seems to question the root of these definitions. The disease model is taken for granted. It is a question of what disease you have, not if you have one at all.  No one seems interested in the basic question of human rights. Does the state or a psychiatrist have the right to deprive one of their basic freedoms to be and to do as they want? I found myself challenged by these ideas as the disease model for my mental condition has never felt adequate or proper and my experiences with coercion have left a bad taste.

Even though I was attracted to the ideas I heard expressed, I had grave reservations. In one talk I listened to a woman who was involved in self harm, explained how forced hospitalization made her situation worse because all the emphasis was on preventing self harm, and this emphasis led the woman to an increased desire to harm herself. She stated that self harm was not necessarily a suicide act, but rather a compulsion with other roots. This woman and her sister set up a support group called Harm Minimization. They worked with people with the compulsion not to stop the self harm, but to minimize its effect. This to me was really pushing the boundaries of acceptability. How could a doctor or society stand by and let someone harm themselves without intervening. This woman was absolutely convinced that her approach was more effective in ending the behavior than the typical hospital regime. I for one was not convinced.

After my suicide attempt I was placed in a hospital against my will. I wonder if it did any good. My experience was so bad that I kept me from therapy for many years because I thought all psychiatrists were madder than their patients. In this hospital I was assigned a psychiatrist, who it turned out was a compulsive thief of electric typewriters. He was caught with an apartment full of the machines. One day he was gone from the hospital and I was given a replacement without explanation. Only when I read of this doctor’s exploits in the college newspaper did I know what happened. The doctor was sent away to the state mental hospital. This is when I decided that sanity was a game you played. If you acted sane and played by the rules you got out of the hospital. I played and I was released.

The INPP Conference brought up these issues for me. I am grateful for that. I am now rethinking some of my fundamental beliefs. I think users of mental health services do have civil rights issues they should be pursuing. I wonder about mental health drugs. They are pushed as a resolution to a disease, but are they? Aren’t they just drugs that influence the way we think? Thinking about drugs in a new way may change how we use them and what we expect from them. Psychiatrists may not be helping many people. Most have become licensed drug pushers. They don’t offer real therapy. I consider myself lucky. I am not in a forced relationship with my psychiatrist. I go to her because I want to and I get something out of it. It is a relationship of equals. This is not what I see many others have. For them it is an unequal relationship where power is in someone else’s hands. They need t o take the power back. Power to the Crazy that’s my new slogan.  I believe Thomas Szasz would approve.

 After a fit like this I have to rest and recover. Sometimes I don’t recover not for many days.  If certain things happen, I know that this is the beginning of an attack of the black brain. I sit or lie down in the dark. I hate lights being on. I want total silence. No TV. No answering the telephone or responding to door bells. If it is daytime I seek the darkest room or close all the shades. Light bothers my eyes. Brightness is painful. All sound is bothersome like scratching on a black board. These are the first things I notice in a string of psychical responses.                                                        

I am afraid sketch

 I notice how my body becomes stiff and sore. Every movement is hard to take. It is as if all my muscles were in a state of semi-cramp. I am slow and get slower as the attack deepens.  Food tastes bland and unpleasant like eating cardboard. I really don’t want to eat, but I eat anyway. Hunger gets no satisfaction. Always a nail bitter, I pick at my fingers even more, ripping the nail down to the quick compulsively going from one digit to the next. Last my brain hurts. The right side of my brain develops a dull ache above the eyebrow. I wonder if I am having some form of epileptic fit.

 All my thoughts turn negative. All is sorrow or pain. All I can think about is how I would be better dead. Life is not worth living. Plans for suicide crowd my head. I could drive off a bridge, slam into an overpass, or run into a tree. Hang myself. Immolate myself. Poison myself. Each plan is mulled over in my head. How quick would it be? How gruesome would the suicide scene be?  The more gruesome it is the better is the bitter image. Would I be a messy pulp, a decapitated corpse, or just a dead body surrounded by a halo of blood, excrement and piss?

 Poison is the alternative I least like, but it always gets consideration. Since my first actual suicide attempt was to poison myself with 150 aspirin tablets, I know what it is like to ingest a potentially poisonous potion. I can relive the nausea and the disorientation tasting the bitter memory. Yet usually I reject poison because I recall the trauma of my stomach being pumped and the sad hospitalization of my survival. No something more violent is called for. Blowing my brains out would be a good way to go. I would place the gun in my mouth and fire up splattering my mind all over the wall in a veil of red blood and white particulate. The body would slump to the floor in some awkward position. The gun would slip from my lifeless fingers. The corpse would lie there until the blood dried and the nauseating smell of putrid flesh pervaded the room of my execution.

 Once the decision was made and the trigger pulled, there is no undoing. There are no seconds for remorse. Death is immediate and irreversible. I wallow in this sour soup of suicide savoring each aspect of my demise: the color and character of each move, the feeling of resolve, and the last glimpse of life. 

 When all this transpires all I can do is go to bed and sleep. If anyone disturbs me I am rude and abrupt. I used to say to anyone who came into my sleeping area and ask me to do something. I would mutter “I prefer not” recalling Melville’s phrase from his story “The Scrivener.” I preferred the isolation, soundlessness, and darkness of my nest. Here I would ponder my evil thoughts, dream violent and frightening dreams. Tidal waves drown me. Earthquakes crush me under tons of fallen concrete. Bombs obliterate me. Often my dreams were about spiders and snakes, crawling and wriggling over my inert form before they bite me with their lethal venom.

 In one of the worst attacks I ever had, I dreamed a giant black widow spider crawled over a wall to get me. The red dot on its underside showed like a ruby. A long hairy leg reached out to explore my face. This went on while hundreds of baby black widows scuttled around my bed and body. They were tickling me with all their legs, but I could not react. I was paralyzed. I could not force my arms or legs to move. I would strain at the effort. Nothing would happen. All I could do was turn my head toward the approaching monstrous black widow, which stung me on my nose. The big red dot covered my eyes as the black widow struck. Poison flowed through my veins. I could feel it spread slowly down my nose and around my eyes and mouth. It was cold and viscous. I imagined it a gelatinous green, which froze every particle of my body as it spread. I tried to scream, but no sound would come out. The freeze was fast approaching my brain and vocal chords. I knew I would be dead if it made it to my mind. In one last herculean effort, I broke the spell and yelled “My God save me!” jerking up out of my orange starred quilt. I was covered by sweat and all bedcovers were damp. I leap out of bed and trashed around looking for insects. There were none.

 This was break in that cycle of the black brain, which always happened after a culminating bad dream. It was as if I pass through some bleak portal and emerge into the sunshine.  I arose next day feeling fine and sharp. My body felt good and my mind awake and super aware. My sense of humor was restored. I wanted to be in the light, listen to sound, and be around people.  The attack had lasted seven days. That attack was the longest I ever remember. Most of these periods of withdrawal last just a day, or two or three at most. They all end with me returning to normal feeling refreshed and restored. The attack of the black brain is my body demanding an overhaul. Depression is beaten back once more.  The bout of self hatred survived until it comes again as it always does.