Bipolar 2 From Inside and Out

Remote Work: Help or Harm?

07 12 26

Many people recommend that people who are no longer able to work a full-time job in an office try working from home. (There are ads that say you can make $500 a day doing it, but these claims are dubious at best, scams at worst.) The COVID years demonstrated that it was possible for someone to work from home even at a 40-hour/week job. So what are the benefits and drawbacks of working from home if you have bipolar disorder or another mental illness?

Pros

The benefits of working from home are apparent. If your condition makes it difficult to deal with high-pressure situations with extended contact with other people, remote work is quite appealing. You gain independence, the ability to cut down on distressing social interactions, and time to spend with family members or doing other chores and projects. Working at your own pace without so many distractions may mean that you can complete what’s considered 40 hours of work in less than that. And Zoom meetings are generally more efficient and less stressful than the in-person kind.

When you decide to work from home, you have many more options open to you. You can work part-time, for example, or start your own business. You can even structure your days so that you work for a company part-time and for yourself the rest of the time. You can take on a job that involves no in-person contact with others, such as phone or computer-based customer service, telephone sales, or order-taking. Then there are jobs you can accomplish almost completely on your own, like transcription and other forms of keyboarding, writing articles for clients or instruction manuals for manufacturers, or formatting and editing résumés and other documents. Perhaps you could team with another person who does client contact. If so, you can make a business of graphic design, for example.

Cons

On the other hand, remote work has been blamed for increasing isolation and distress. A study reported in Science revealed that remote work “worsens mental health, particularly for those living alone. Although a large body of research finds that workers want to work remotely, our findings suggest that workers may not realize the costs of remote work for their well-being, which may take time to accumulate….Our estimates indicate that remote work explains a third of the deterioration in mental health between 2011 and 2024.”

It’s true that people who work at home generally have only sporadic contact with other people, except in emails, Zoom meetings, and phone calls. The Science study says that “84 percent of remote workers spend their workday entirely alone. Even when communicating online, people working from home receive less feedback from their co-workers and contact fewer people outside their immediate teams.”

They add, “Despite its advantages, remote work has significantly deepened Americans’ isolation and distress. Our research doesn’t suggest that work can occur only in the office. But it does mean that employees and companies should make a greater effort to prioritize face-to-face time with colleagues.” Any contact with other people seems to make the difference: “People who lived with their spouse and kids saw their mental health hold fairly steady, while those who lived alone experienced a 20 percent decrease in mental well-being.”

My Experience

I used to work full-time in offices, spending a full 17 years at one office job and some time at others. During that time, I struggled with isolation and detachment from my coworkers. I tried. But the corporate culture of “mandatory fun” such as company picnics and parties struck me as challenging and empty, and only a few coworkers included me in their lunch hours and casual conversation. I blame myself as much as anyone. My social skills have never been terrific, especially when it comes to small talk.

Before I was let go from the 17-year job, I increased my own isolation by keeping my office door closed. My job did entail some aspects that required close attention to detail without interruptions. But that was an excuse. I preferred privacy even when doing normal busy work. Although closing one’s door was not strictly forbidden, an open-door policy prevailed. My closed door meant cutting myself off from interaction.

Since leaving the corporate world, I have worked at home at a series of jobs—transcription, editing, ghostwriting, book reviewing, and the like. In most of these jobs, I set my own hours, but I am indeed alone most of the day. I get regular calls from my husband when he’s on his breaks at his outside, people-y job. It helps. And I keep up with remote friends via email, Facebook, phone, and occasional visits.

Has my mental health deteriorated? Not appreciably. I have work to do some of the time and my blogs to write, emails to respond to, books to read, and friends to chat with. I’m occasionally unfocused, and I do experience mild depression and hypomania, but the depression is not anything like the depths of it when I worked in an office.

I can’t imagine going back to office work at this time in my life. I’m happy and stable enough where I am. I don’t want to mess with that.

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Having Both a Child and a Mental Illness

07 05 26

The New York Times recently ran an article by Christina Caron saying that scientists have begun “to study how adults with challenging health conditions weigh parenthood.” Readers of the Times reported that “they were worried about the possibility of passing along mental illness to a child or maintaining their own well-being under the stresses of raising a family.” In one study, people who said they had poor mental health also said that they were less inclined to have children.

Here’s how this has played out in my life.

When I got married, I was in my 20s. My husband wanted children, and I figured if I had a baby, I should have it before I turned 30. Later on, I moved up that timetable. My father was terminally ill, and I thought it would be a good thing if he could see his grandchild before he died.

That was before I was diagnosed with bipolar disorder. After that, I began questioning the wisdom of having a child. My husband, Dan, not to mention his mother, still wanted one, and this became a point of contention. Dan felt the lost potential of a child for many years. When the recession hit, we didn’t have the money to have a child. (We could barely keep up with our own and our cats’ needs for food and health care.)

When my major depressive episode hit, it became apparent to me, at least, that I should not become a parent. I wasn’t able to cope well with my regular, child-free life. How could I possibly cope with the demands of being a mother? Would it be fair to be a mother who was so depressed she couldn’t care for a child properly? Would it be fair to Dan to ask him to do the majority of the many tasks associated with a child?

Even after I pulled out of that depression, I knew there was no guarantee that it wouldn’t happen again. I gave up on the idea of becoming a mother.

Why does mental illness prevent many people from considering parenthood?

There’s the problem of genetics. We know that anxiety and depression, as well as schizophrenia and other brain illnesses, run in families, leaving potential parents to worry that their child might have those diagnoses, too. If I had a child, would I be setting them up for a lifetime of mood swings and medication? Once Dan started on antidepressants, too, after an alarming spell of depression, passing along our disorders seemed even more possible.

Another question is about physical as well as mental health during pregnancy. Once I was diagnosed, I was put on a revolving regimen of multiple psychotropic drugs. Would it even be safe to take them while pregnant? Would they harm the fetus? Cause problems like too-high blood pressure for me? Make the chance of a miscarriage more likely?

And if I stopped taking the meds while pregnant, what would that do to me? Would my fluctuating hormones combine with my fluctuating moods to make my mental health even worse? And once I had the child, would I be more prone than the average mother to experience postpartum depression? Given my history of depression, it seemed a real possibility.

The Times article also discussed societal and family pressure to have a child.

This pressure can make a woman feel guilty or unnatural if she doesn’t want to have a child. There’s already stigma surrounding mental illness. Add the stigma regarding being child-free, and you’re doubling down on guilt, shame, and denial.

Fortunately, my parents didn’t pressure us, and Dan’s brother provided the Reily family with a suitable number of children and grandchildren. But we did get the usual inquiries: When are you going to have a baby? (Note: It was when, not if.) The young daughter of a friend asked why we didn’t have children. Her mother told her that not every couple does, and she seemed to accept that without further questioning. A couple of friends talked about how we had good genes and should pass them along.

Now I’m well past the age at which I have a choice to make. My same-age friends are revelling in their recent grandchildren, and I heartily celebrate their happiness with them.

The people interviewed for the Times article said they had no regrets about their choices.

Neither do I.

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Depression in Congress

07 01 26

Even though they might like to downplay it, our elected officials are human, too. They have family problems, career problems, financial problems, sexual problems, and other personal problems that they would rather keep out of the spotlight.

Sometimes they have mental problems, too, and they can’t always keep them out of the spotlight. Some fear the public gaze. Others accept it, and even find something positive to share because of their troubles.

This is the story of two men in Congress, each of whom looked into darkness and then the spotlight. How each handled it says something, not just about the men, but about what they faced and how anyone else might face it, too.

John Fetterman, a senator from Pennsylvania, has been open about his psychological problems (and his physical ones as well). In 2023, Fetterman suffered a stroke that impaired his auditory processing. In the wake of this, he developed clinical depression. His office told the public about his decision to seek treatment. Fetterman spent six weeks as an inpatient at Walter Reed Hospital getting treatment for the depression and then returned to Congress.

Tom Kean, a representative member of Congress from New Jersey, was missing from public view for 117 days this spring, missing 100 congressional votes during that period and time on the campaign trail. As time went on, the press and public, mystified by his absence, began to search for an explanation.

Just this June 30, Kean revealed that he had been an inpatient in a psychiatric facility being treated for clinical depression. He gave a brief speech in front of the House of Representatives regarding his unexplained disappearance from the political scene, but did not issue a press release or take questions. He said that he discovered that he was having a depressive condition as a result of a medical diagnosis, and that he had hoped to be released from inpatient treatment in just a few weeks. “I am grateful that I accepted help because today I stand before you healthier, stronger, and excited to return to the work that I love,” he stated. “I am a private person by nature,” Kean said. “Talking about myself has never come naturally, but I believe that I owe an explanation to the people of New Jersey’s 7th District, to my colleagues in this chamber and to the American people for my absence.”

Fetterman has since used his public platform to talk about depression, its symptoms and effects. In particular, he has spoken about men’s mental health and encouraged anyone experiencing depression symptoms to talk to pursue treatment, whether that be outpatient talk therapy or inpatient hospitalization. “I want everyone to know that depression is treatable, and treatment works,” Fetterman has said. “This isn’t about politics. Right now, there are people who are suffering with depression in red counties and blue counties. If you need help, please get help.”

Kean has been much less forthcoming, though it’s only fair to note that he was only recently released from the hospital. “I am a private person by nature,” Kean said. “I’ve spent most of my life talking about the people I represent, the issues facing our communities, and the work that needs to be done. Talking about myself has never come naturally.” During his absence, his office said only that he had a personal medical condition. Of course, it is Kean’s right to keep his medical problems out of the public eye, but his lengthy absence had sparked both speculation and concern.

But Kean’s reticence may also reflect the stigma that still accompanies treatment for depression and other mental illnesses. Fetterman’s openness, on the other hand, has had the effect of bringing psychological conditions and their treatment forward. We may hope that other people, and in particular other men, may find the courage to recognize their need for help and take the steps needed to confront and overcome depression or another mental illness.

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What Does the $700 Million of Funding Really Mean?

06 28 26

You may have heard about the $700 million that the U.S. government has allocated for funding “behavioral health programs.” A number of different programs are getting slices of that money, as announced by HHS Secretary Robert F. Kennedy, Jr. The Safety Through Recovery, Engagement and Evidence-based Treatment and Support (STREETS) Program, for example, will receive $96 million, while those other programs get to split up $612 million, all in service of President Trump’s Great American Recovery Initiative. Kennedy said that the money would address the “addiction and serious mental illness that fuel homelessness across America.”

Where Is The Money Coming From?

Mindsite News reports that behavioral health experts responded to the announcement by saying that the $700 million was really the release of funds that Congress had already authorized. The spending was already planned to be spent before Secretary Kennedy’s announcement seemed to promise new funding. Until now, the money had been held up rather than being distributed to state and local treatment organizations. The STREETS funds may be pulled from existing programs as well.

Where Is the Money Going?

That $700 million is intended to benefit “multi-agency, street-based behavioral health systems integrating government, healthcare, housing, law enforcement, and courts for people experiencing homelessness with SMI/SUD.” Interestingly, according to Medical Economics, the money will “exclude housing-first approaches and harm-reduction services, aligning awards with the Great American Recovery Initiative and shaping allowable evidence-based models for homelessness-related behavioral health care.”

In other words, if I’m reading this correctly, the funds are really designed mostly to combat homelessness (which the Secretary says will “move people from the streets into treatment and recovery, strengthen families, save lives, and make communities safer”). Getting unhoused people off the streets and out of the public gaze seems to be a more important goal than mental health or addiction services per se. And it ignores the fact that most people with addiction problems or mental illnesses are not unhoused. They could use funding, too.

Experts have suggested that, rather than trying to fund new programs, the money should be spent on what is already working within the treatment and recovery community, as well as on deficiencies in the current state of affairs regarding mental illness, addiction, and homelessness. Kennedy claimed that new, innovative programs would result from the money spent, but behavioral health advocate and political consultant Andrew Kessler points out that many existing problems, such as “a shorthanded workforce, poor reimbursement, and not enough resources to handle the challenges we face,” could be addressed with increased funding.

If that $96 million portion for STREETS doesn’t sound like it will make a dent in the problems nationwide, well, it won’t. It’s going to eight communities, which will each get up to $3 million per year for four years, “to develop multisector, state-of-the-art care systems for people who are homeless and have substance use disorders, serious mental illness, or co-occurring disorders.” Presumably, any success in those locations will be replicated in other communities, or at least other communities will be encouraged to replicate it, though it seems unlikely that they will get federal money to do so.

988 UPDATE

When I posted about the 988 helpline a couple of weeks ago, I promised that if I heard anything new regarding Option 3 of the helpline, which is designated to help people in the LGBTQ+ community, I would let you know. Here it is:

Mindsite News, citing a story in The Advocate, reports that Congress has directed the agency that administers the 988 helpline “to reactivate the [Option 3 for LGBTQ+ crisis calls] service, but says it must do so in accordance with Trump’s Executive Order 14168, which recognizes only two sexes and rejects federal recognition of trans and nonbinary gender identities.” Mindsite adds that “the administration hasn’t explained how the two mandates can coexist or whether transgender youth will be included at all in any restored program.” The administration expects Option 3 to be restored by the end of the year.

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The 988 Helpline and Option 3 UPDATE

06 25 26

Mindsite News, citing a story in The Advocate, reports that Congress has directed the agency that administers the 988 helpline “to reactivate the [Option 3 for LGBTQ+ crisis calls] service, but says it must do so in accordance with Trump’s Executive Order 14168, which recognizes only two sexes and rejects federal recognition of trans and nonbinary gender identities.” Mindsite adds that “the administration hasn’t explained how the two mandates can coexist or whether transgender youth will be included at all in any restored program.” The administration expects Option 3 to be restored by the end of the year.

The 988 crisis helpline has been in place since July 2022, and most people consider it a success. 988 specializes in behavioral health crises and offers crisis counseling and emotional de-escalation, unlike the older 911 hotline, which focuses on problems requiring police, fire, and EMS.

“Nearly 4,400 fewer U.S. teens and young adults died by suicide than projected in the first two-and-a-half years of the 988 mental health crisis hotline, a sign the program is working even as it faces long-term funding challenges,” according to the Associated Press.

Those “long-term funding challenges” arise from the way the helpline gets its money. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) provides primary funding for the overarching national network, and they administer the helpline’s operations. Then, the National Suicide Hotline Designation Act of 2020 allows states to pass legislation assessing a small, monthly surcharge on phone and VoIP lines to sustainably fund local crisis call centers. Dozens of states have adopted this model. In states without phone surcharges, local call centers rely on general state budget appropriations, mental health block grants, Medicaid billing, and private donations.

If that system sounds cobbled-together and potentially rickety, well, it is. Aside from the SAMHSA funding, how much your local helpline gets to stay in business is far from guaranteed.

Recently, there was a decision that could put an end to one of the important aspects of 988—Option 3. When callers select Option 3 from the menu, they are connected to a portion of the helpline specifically designed to handle LGBTQ+ callers. Because the LGBTQ+ community accounts for a significant number of suicides, cutting off this kind of help would have been a tragedy that would have led to other tragedies.

It almost happened.

On July 17, 2025, a press release reported, “Today, the 988 LGBTQ+ crisis support line is being shut down as previously ordered by the Trump Administration. In response, a bipartisan group of federal lawmakers and national mental health advocates spoke out against the harmful decision and called for its immediate reversal. Today’s event follows an earlier plea to U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr., urging his office to ‘scrap this ill-advised plan.'” The release continued, “Its closure comes at a time of growing need — just last year, nearly 40 percent of LGBTQ+ youth seriously considered suicide, according to national surveys.”

Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness (NAMI), speaking about the absence of Option 3, said that “we lost the trust of a lot of people who no longer saw themselves as being reflected in 988.”

SAMHSA tried to calm the situation: “Everyone who contacts the 988 Lifeline will continue to receive access to skilled, caring, culturally competent crisis counselors who can help with suicidal, substance misuse, or mental health crises, or any other kind of emotional distress.” And The Trevor Project tried to pick up the slack, though it has nowhere near the bandwidth to mount a thorough campaign and serve all those needing help.

Then, on April 24, 2026, a reprieve came. MedPage News reported, “Advocates for the LGBTQ+ community claimed a win this week after the Trump administration pledged to reinstate the 988 Suicide and Crisis Lifeline specialized support program tailored to their needs.”

The report continued, “During a Senate hearing earlier this week, HHS Secretary Robert F. Kennedy Jr. was asked whether he would commit to restoring the tailored line for LGBTQ+ callers to 988, as required by law, after the Trump administration removed it last summer.”

Kennedy, with no apparent sense of irony, was reported as saying, “We are working on getting it up now.”

Chase Anderson, MD, of the University of California, San Francisco, said that while reinstating the specialized 988 line option is a “nice step,” he remains skeptical due to the continued attacks on LGBTQ+ individuals, especially transgender people, by the Trump administration and the Supreme Court.

MedPage Today notes, “The fiscal year 2026 funding bill included $535 million for the 988 Suicide and Crisis Lifeline, including $33.1 million for the LGBTQ+ line. The legislation does not include a timeline for reinstating the program.”

If I hear any more about this issue, I’ll let you know.

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Book Roundup

06 21 26

I read a lot. I mean, a lot. Of course, my bipolar disorder has a thing or two to say about that. When I’m depressed, I don’t have the energy to read. And when I’m hypomanic, I don’t have the attention span to read. During my worst episode, which lasted over two years, I read practically nothing. Fortunately, I came through that and am now reading again, if not with the speed of consumption that I had when I was younger, at least with the same satisfaction.

I read my books on an e-reader so I can take 1,000+ books with me wherever I go. (I can also read on my phone, if necessary. I’m never without something to read close to hand.)

Among the books that fill my virtual shelves are many on psychological, psychiatric, and assorted mental health topics. I thought I’d share with you a list of what I have, and I invite you to share any others you know of with the readers of this blog. To be sure, I haven’t listed or read all of them. My TBR list is so long that, if it were made of physical books, I could easily be crushed if they toppled over on me. But here’s a look at an assortment of what’s available. Let’s start with Jenny Lawson, one of my favorite writers, and go on from there.

• Let’s Pretend This Never Happened: A Mostly True Memoir; Furiously Happy: A Funny Book About Horrible Things; Broken (in the Best Way Possible); How to Be Okay When Nothing Is Okay, by Jenny Lawson; Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, by Allie Brosh.

The four books drawn from Lawson’s chaotic life present astoundingly funny takes on depression, anxiety, and other illnesses and treatments. Her most recent, How to Be Okay, is a compendium of “tips and tricks” for fighting against these conditions, neatly packaged in chapters that each deal with one aspect of them. Also notable are Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, both by Allie Brosh, who gives very accurate accounts of depression, embellished with cartoon drawings. Other books attempt the same feat with less success: The Hilarious World of Depression, by John Moe; and Surviving Mental Illness through Humor, by Alyson Herzig and Jessica Azar.

• Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are – Investigative Journalism on Psychiatric Medication and Identity, by Katharine Sharpe. Prozac Nation, by Elizabeth Wurtzel. Prozac Monologues: A Voice From the Edge, by Willa Goodfellow. Prozac Diary, by Lauren Slater.

These books, taken together, give accounts of the lives lived and societal effects of the group of antidepressants that most people have heard of. From success stories to denunciations and questioning, together they provide an in-depth look at how Prozac and Zoloft have affected both patients and our society.

• Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, by Debbie Nathan; The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, by Susannah Cahalan; The Psychopath Test: A Journey Through the Madness Industry, by Jon Ronson.

Exposés of two of the most famous psychological narratives of our time, both shine a light on the narratives and point out serious flaws. Nathan‘s Sybil Exposed discusses the book Sybil: The Classic True Story of a Woman Possessed by Sixteen Personalities, by Flora Rheta Schreiber, and the flaws with that narrative and the dependence “Sybil” developed on her psychiatrist and the author. The Great Pretender is about the Rosenhan experiment, in which volunteers were admitted to psychiatric wards for minimal reasons, and examines their difficulty in being let out. Ronson‘s book is lighter, with interviews detailing when “a potential hoax being played on the world’s top neurologists takes him, unexpectedly, into the heart of the madness industry.”

• Switching Time: A Doctor’s Harrowing Story of Treating a Woman with 17 Personalities, by Richard Baer.

Switching Time is an account of a woman with Dissociative Identity Disorder (multiple personalities), written by the doctor who undertook her treatment.

• An Unquiet Mind and Touched With Fire, by Kay Redfield Jamison; Manic: A Memoir, by Terri Cheney; Madness: A Bipolar Life, by Marya Hornbacher.

Jamison‘s books are the gold standard for accounts of mania and mania’s association with creativity, respectively. Cheney‘s memoir focuses on her own experience with bipolar disorder. Hornbacher is also the author of Wasted: A Memoir of Anorexia and Bulimia. Her book on Type I rapid-cycling bipolar disorder illuminates her diagnoses.

• Darkness Visible: A Memoir of Madness, by William Styron; The Noonday Demon: An Atlas of Depression, by Andrew Solomon.

Literary greats Styron and Solomon discuss their experiences with depression and recovery in a pair of important books. Darkness Visible conveys “the full terror of depression’s psychic landscape.” The Noonday Demon is particularly thorough and “examines depression in personal, cultural, and scientific terms.”

• No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America, by Ron Powers; Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, by Lynn Nanos.

These two books are searing indictments of the societal response (or lack thereof) to mental health care in the United States. They’re important, and they lay bare the many difficulties that patients, families, and clinicians have within the “system.” Another book from a different era, Ten Days in a Mad-House, by Nellie Bly, is an exposé of conditions in a “lunatic asylum” in 1887. Her revelations led to reforms in the treatment of psychiatric patients in what was also a broken system of the time.

• The Bell Jar, by Sylvia Plath; Red Comet: The Short Life and Blazing Art of Sylvia Plath, by Heather Clark.

Confessional poet Sylvia Plath wrote with raw feeling about her psychological troubles, leaving a document that still resonates down the years. Clark‘s biography is a much-needed examination of Plath’s life and her marriage to poet Ted Hughes.

• Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America, by Audrey Clare Farley; Hidden Valley Road: Inside the Mind of an American Family, by Robert Kolker; Schizophrenia: A Brother Finds Answers in Biological Science, by Ronald Chase.

Both Girls and Their Monsters and Hidden Valley Road are about familial patterns of mental illness. Kolker‘s book, about schizophrenia, is particularly good. Schizophrenia approaches the disorder from the perspective of a brother who is a scientist wanting to discover answers.

• Tangentially Related

The Neuroscientist Who Lost Her Mind, by Barbara K. Whitaker; Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness, by Stephen P. Hinshaw; Life of the Mind Interrupted: Essays on Mental Health and Disability in Higher Education and Even If You’re Broken: Bodies, Boundaries and Mental Health, by Katie Rose Pryal; (Don’t) Call Me Crazy, by Kelly Jensen; The Woman They Could Not Silence: One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear, by Kate Moore; Rosemary: The Hidden Kennedy Daughter, by Kate Clifford Larson; My Lobotomy: A Memoir, by Howard Dully and Charles Fleming; Just Like Someone Without Mental Illness Only More So, by Mark Vonnegut; Girl, Interrupted, by Susanna Kaysen; The Man with the Electrified Brain: Adventures in Madness, by Simon Winchester.

Whitaker‘s book relates how her brain tumor mimicked schizophrenia. Hinshaw‘s is about his father’s recurring mental illness, but has a lot to say about stigma. Pryal’s two books talk about the difficulties of navigating higher education while living with a mental illness; and about sexual assault and mental illness. Jensen presents essays and other writers’ perspectives on mental illness. The Woman They Could Not Silence presents the life of Elizabeth Packard, committed to an asylum in 1860 by her husband, on flimsy grounds, and her decades-long struggle to escape and to shine a light on the abuses of the system. Rosemary tells the story of Rosemary Kennedy, who was “different” from a young age and kept out of the limelight. The book details her lobotomy and tragic life with its aftereffects. My Lobotomy recounts Dully‘s lobotomy at a very young age and his struggles to recover from it. Vonnegut, son of the famous writer, details his chaotic upbringing, manic episodes, and decision to become a pediatrician. The basis for the famous movie, Girl, Interrupted, recounts the author’s two years in a ward for teenage women and the other patients she meets there. Noted author Simon Winchester describes a series of several nine-day periods of psychosis or dissociative states, and how ECT allayed them or failed to.

• Books I Don’t Recommend

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, by Thomas S. Szasz; Committed: Dispatches from a Psychiatrist in Training, by Adam Stern; A Bipolar Life: 50 Years of Battling Manic-Depressive Illness Did Not Stop Me From Building a 60 Million Dollar Business, by Steve Millard; I Never Promised You a Rose Garden, by Hannah Green (Joanne Greenburg); Shrinks: The Untold Story of Psychiatry, by Jeffrey A. Lieberman; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker.

Szasz questions the whole notion of psychiatry. Stern presents a very superficial look at an intern’s experience on a psych ward. Millard barely acknowledges his disorder in his “you-too-can-succeed” narrative. Rose Garden was wildly popular in its day, but presents a now-discredited explanation of schizophrenia. Shrinks purports to tell the “‘astonishing’ story of psychiatry’s origins, demise, and redemption.” Anatomy of an Epidemic blames the rise of psychiatric disorders and medications on psychiatry.

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Men and Mental Health: Two Stories

06 07 26

There are so many Awareness Months these days that it’s hard to keep track of them all. June alone has Pride Month, Caribbean American Heritage Month, National Immigrant Heritage Month, Men’s Mental Health Month (which is also recognized in November), and National PTSD Awareness Month, as well as celebratory or awareness weeks and days.

The Verbate site, which keeps track of these awareness days and months, has this to say about Men’s Mental Health Month: “Men’s Mental Health Month raises awareness of the unique mental health challenges men face and the social stigma that often prevents them from seeking support. Research shows men are less likely to seek mental health care, despite experiencing higher rates of suicide and untreated mental health conditions. Cultural expectations around masculinity and self-reliance can deepen isolation. This observance encourages open conversation, early intervention, and inclusive definitions of well-being.”

They also offer suggestions on ways to celebrate the awareness month inclusively:

• Share mental health resources and benefits.

• Normalize help-seeking behaviors through leadership modeling.

• Highlight intersectional perspectives on masculinity.

• Encourage open, stigma-free conversations.

The statistics regarding men’s mental health are fairly well-known and easy enough to find, though they differ from source to source. Men’s rates of suicide, especially compared to women’s, are often mentioned. So too is the lower number of men seeking help for their mental health compared to women.

But statistics provide an arm’s-length look at the problems. While that’s valuable, so are men’s stories regarding the need for better care with mental health problems.

Owen’s Story

Owen worked for years in a highly responsible, high-stress job at a facility that required him to supervise a large number of men. The long hours contributed to his increasing inability to cope. His home life deteriorated, and he stopped pursuing his former interests and activities. His friendships fell by the wayside until he had only one close male friend.

Then Owen was fired from his job. He drove home, then sat in his car, unable to move. Before long, an ambulance pulled up. Owen’s coworkers had seen how distraught he was and called for a wellness check. The EMT squad took him to the emergency room for screening. Owen found it fairly easy to respond to the questions in ways that would not raise alarm bells and was sent home.

Over the following months, Owen realized that he needed emotional and mental help, rather than just a new job. He went to a therapist, who prescribed SSRIs and a course of talk therapy. Eventually, Owen was able to voice his feelings and move on to a lower-stress job that didn’t require him to supervise anyone. His mental health improved.

Franklin’s Story

Franklin was married with three young boys, and he had a temper. His wife, Leslie, had a progressively debilitating and ultimately fatal disorder, which meant that Franklin was increasingly responsible for the children. He shared his interest in trains with them and got them a pet tarantula. But the kids knew that when Daddy got mad, he blew up. Leslie joked with them that Franklin was like the Incredible Hulk; when he was angry, he turned into another person.

After Leslie died, there was no buffer between Franklin and his boys. As the kids grew up, they became more and more estranged from their father. Franklin had trouble keeping a job and, for a time, had to sleep in his car. Eventually, Franklin moved in with his aging mother and tried to care for her. But he reverted to his old habit of yelling at her when he was irritable or became angry. His physical health declined as he aged, too, and he never sought treatment for either his various ailments or his anger issues.

Seeking Help—Or Not

Owen’s and Franklin’s mental health suffered at various times over the years. Owen had less extreme bouts of depression besides the one when he lost his job. He lived off his retirement savings for a year. That relief from the pressures of the job, and the medication and therapy he received, turned his life around. He still experienced reactive depressive episodes, but not out of line with the extent of the everyday problems he encountered.

Franklin became an increasingly angry man. Family members wondered if he was treating his mother abusively, but never broached the subject with her because she had made it known that she was unwilling to accept any other living arrangement, such as assisted living.

Both Owen and Franklin would have benefited from a social structure that was more supportive of men receiving help with their mental health. Owen might have sought help before the long build-up to the end of his job and learned healthy ways to cope with the pressure. Franklin could have dealt with the death of his wife and caring for his aging mother while taming his temper and explosive interactions. Both would have been better off.

In this Men’s Mental Health Month, let’s try to reach out to friends, family members, and coworkers like Owen and Franklin before their situations become desperate. Help them get the help they need. They aren’t immune to psychological difficulties just because they’re men.

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“Deprescribing” Psych Meds

05 31 26

I saw my psychiatrist this week for a med check and asked him about RFK, Jr.’s crusade against antidepressants. He said a good number of his clients had asked him about it. He reassured them that he was not going to cut them off.

Then Dr. G. said, “They’ll pull up to your house in a black Suburban, with face masks on, and ring your doorbell.” (He was joking.) I replied, “I have a gun.” (I wasn’t.)

Still, the fear is real. I’m not sure if Kennedy has an actual plan to curb what he considers an overprescribing of antidepressants. But those of us who need them are genuinely afraid that he will find some way to take them away from us. Maybe he’ll try to cut down the supply coming from the drug companies. Maybe he’ll invent some system by which doctors will be penalized for writing “too many” prescriptions. Or maybe he’ll put in place his threatened “wellness farms,” where people with mental illness will supposedly be cured by fresh air, organic food, no medication, and hard outdoor labor, much as he has recommended for “reparenting” children on ADHD meds.

The psychiatric community is as alarmed as their clients. At this year’s meeting of the American Psychiatric Association, doctors expressed fears that if Kennedy’s recommendations are put in force—and maybe even if they’re not—people who currently take antidepressants or other meds may decide to quit cold turkey or taper off without their physician’s advice and supervision, both of which are dangerous. Physicians also fear that patients will refuse necessary medications and relapse without them.

Kennedy has particularly targeted SSRIs (Selective Serotonin Reuptake Inhibitors) such as Zoloft (sertraline), Prozac (fluoxetine), Lexapro (escitalopram), and Paxil (paroxetine). Other targeted medications include antipsychotic medications, mood stabilizers, stimulants, weight-loss drugs, ADHD medications like Adderall, and combinations of these drugs. All these, Kennedy says, add up to a “dependency crisis driven by overmedicalization.” He has described the people who take these medications as “addicts.”

Kennedy compared coming off SSRIs to his experiences with trying to curb his heroin addiction: “You just have to steel yourself for 72 bad hours.” (He said that he had tried to quit and gone through withdrawal “a hundred times.”) He has also said, without evidence, that SSRIs are partly responsible for the rise in school shootings and other mass shootings.

The New York Times reported that at the Mental Health and Overmedicalization Summit organized by the MAHA (Make America Healthy Again) Institute, speakers were discussing “a variety of steps to address the overprescription of psychiatric medications, such as phasing out school-based mental health screenings, requiring written informed consent before starting medications, and featuring prominent, cigarette-style warnings on packaging.” It’s also been proposed that clinicians be paid through government programs to “deprescribe” patients. Too, there were discussions about changes in insurance billing and an “expert panel” with the mission to “develop clinical guidelines for deprescribing.” “This summer,” the Department of Health and Human Services says, “The Substance Abuse and Mental Health Services Administration, or SAMHSA, will release training modules focusing on the risks of psychiatric medications and on tapering and deprescribing.”

The risks of coming off psychotropic meds went largely unaddressed. People who have tried to do so without proper medical supervision have reported “brain fog,” as well as “emotional blunting, loss of motivation, suicidal ideation, and difficulty in withdrawing.” Some have also reported “shocklike sensations, flu-like symptoms, insomnia, nausea, and restlessness.”

It’s true that many medications, including some psychiatric medications, have been overprescribed. But they’ve been judged safe enough to be prescribed by primary care physicians as well as psychiatrists. Targeting and demonizing SSRIs and ADHD medications will leave patients with few ways to get the treatment they need. NPR reports that Dr. Theresa Miskimen Rivera, president of the American Psychiatric Association, has said, “It really is an oversimplification. And it really ignores the larger reality, which is that too many patients really cannot access timely, comprehensive care that is much needed for our nation.”

Personally, I have been taking various combinations of these medications, including SSRIs, for decades. My psychiatrists have never recommended stopping them, and I have never wanted to. The medications and the dosages have changed over the years, as needed. Psychotropic medications have literally saved my life as well as my sanity, and allowed me to function well in my relationships, my career, and my other activities. I don’t consider them cure-alls; I still have occasional symptoms of depression and hypomania. But being told by a government agency to quit them, or even to taper off them, scares me. I hope Kennedy’s ideas are never instituted, but given all the other recommendations he has proposed, I’m far from sure that they won’t be.

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The Importance of Apologies

05 24 26

When my mother was a young woman, she had the chore of cleaning up her parents’ bedroom and emptying the trash. She came across a condom and asked her mother what it was. Grandma gave my mother an innocuous but wrong answer, claiming it was where Grandpa spit when he was chewing tobacco.

Later, of course, my mother learned about condoms and what they were really for. She told me this story much later in life and expressed disappointment and hurt that her mother hadn’t told her the truth.

When I was a tween, I asked my mother a question about my body and asked her not to tell anyone what I had asked. Minutes later, I heard her telling my sister, “She thought she was developing, but she’s not.” I was disappointed and hurt.

Neither my mother nor I said anything about these incidents at the time. My mother only told me her story when I was an adult. I don’t think I’ve told mine until just now, in this post. I’m sure both of us would have felt better if our mothers had apologized to us.

Neither of these incidents was earth-shattering. They were just that—lone incidents, not part of a pattern of untrustworthy behavior. We didn’t feel we had to break off all contact with our mothers. We still loved them. I know it just goes to show that they were human and therefore imperfect. But I know I was a bit let down, and suspect my mother was too.

The Guardian recently printed an article about Lindsay C. Gibson’s book Adult Children of Emotionally Immature Parents. The author of the article, Emline Saner, chose to highlight a story from that book in which a mother apologised to her child, then seven, for being too harsh while potty training her as a toddler. It let the child know that the child had done nothing wrong—that the mother was admitting that she had fallen short because of circumstances in her own life. In this instance, the daughter burst into relieved sobs.

I wouldn’t call my mother or my grandmother emotionally immature. Our parents were human. Both of them fell short in communicating about difficult subjects. Later on, we felt that we had deserved the respect of being told the truth and being listened to. We weren’t significantly harmed by their lapses. But they were something we remembered into adulthood.

Saner’s article says, “Gibson’s idea of emotional immaturity is not an official diagnosis. It has been criticised for being too broad, for shifting blame onto parents, and for tempting readers to pathologise fairly benign, if irritating, traits alongside more obviously abusive ones. But it has also clearly deeply resonated with people who recognise the deficiencies of their parents, the effect it had on them growing up, and the present struggles they are dealing with.”

No parent is perfect. They all do some things that upset their children, especially when the parent is stressed by circumstances outside of the child’s comprehension or control. But apologizing for those lapses takes a lot of self-knowledge, empathy—and yes, emotional maturity. It gives a child a role model, too. Children learn that parents aren’t perfect, that they can do things that upset the child without meaning to. They also learn that apologizing is the first step in making right something that was hurtful.

My husband (and many other former children) have had trouble apologizing because they’d been told, “Say you’re sorry,” when they didn’t feel sorry. Maybe having an adult who modeled apologizing to a child would have helped them feel more comfortable with making apologies when they were needed.

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Was My Family Dysfunctional?

05 17 26
Clockwise from left: my father, my sister, my mother, and me

Leo Tolstoy said, “All happy families are alike; each unhappy family is unhappy in its own way.” Nowadays, we don’t talk about happy and unhappy families. We talk about functional and dysfunctional ones.

If you ask, most people will say that all families are dysfunctional. They differ only in the degree of dysfunction and the ways that dysfunction presents.

But is that true? Is there really no such thing as a functional family?

First, we need to look at some definitions.

What Is a Dysfunctional Family?

According to certain stats, 70% to 80% of families are dysfunctional. But what does that mean?

Fortunately, the term “broken home” has been retired, and single-parent families are no longer considered automatically dysfunctional. In fact, a dysfunctional family can result in a separation or divorce that makes the remaining family structure much more functional.

In addition to dysfunctional families, we talk of “toxic” families, “traumatic” families, and “estranged” families. (There’s obviously considerable overlap.)

But are those the only kinds of dysfunctional families?

A 2024 article by Kaytee Gillis in Psychology Today says, “Having one or two unhealthy behaviors crop up occasionally is usually not cause for concern. Traumatic dysfunction involves patterns of behavior that are harmful and pervasive, such as emotional or physical abuse, neglect, or extreme manipulation that occurs over a long period of time. This type of dysfunction creates an environment of fear, instability, and ongoing emotional pain, leading to significant psychological scars and lasting trauma that likely impacts you today.”

In a 2023 article, also in Psychology Today, Gillis identified five different kinds of dysfunctional families.

• The family that believes they have no problems because they project them all onto other people.

• The family that worries about what others think of them and carefully controls appearances.

• The family with one “scapegoat” member who is blamed for any and all problems.

• The unpredictable family that changes based on traumas like mental illness, addiction, or abuse. (This is what most people think of when they consider dysfunctional families.)

• The family that faces challenges from extreme conditions such as generational poverty or violence.

Nidra Nittle, in VeryWellMind, lists three kinds of dysfunctional families:

• The emotionally unavailable family.

• The family of addicts and enablers.

• High-conflict and abusive families.

Soulaima Gourani, writing in Forbes, says “subtle issues such as the inability to give unconditional love, … and poor boundaries contribute to dysfunction. Regardless of what the cause is, the outcome is the same. An unhealthy emotional connection can lead to the breakdown of the family unit and residual shame.” She adds, “I believe strongly that the concept of family is up for discussion. We can define family for ourselves and break the cycle of dysfunction. How we do this depends on our resolve to make a different choice.” Many people these days are creating new family structures that they hope will be less dysfunctional than the ones they grew up in. “Chosen family” is edging out “blood kin” as a preferred family pattern.

Was My Family Dysfunctional?

I didn’t grow up in a ’50s television family, though my parents took the roles of breadwinner and homemaker. They never had loud arguments or violent behavior. We had an alcoholic uncle and a “bad girl” cousin, but neither of them lived with us, so we weren’t exposed to their behavior much. My parents weren’t very outgoing, but my father did have some friends in the neighborhood and at his work. He was part of the gun culture, but deeply law-abiding and a stickler for safety. My mother was quiet but creative, exchanging crochet patterns with friends around the world. She also had a strength that most people never noticed. And we had at least one “chosen” family member, a friend of mine whose parents were divorced and who became an acknowledged sister to me.

All of that says that we were pretty darned functional. I can’t identify us as any one of Gillis’s five types or Nittles’s three types of dysfunctional families. But there was mental illness in the family (mine, undiagnosed at the time), which no one had any idea how to cope with, and some devastating health problems that directly or indirectly affected us all (cancers and a heart attack). My sister and I are now estranged (by my choice), so that likely indicates some dysfunction somewhere. I’m not in touch with uncles, aunts, or cousins either, and have surrounded myself with people I have chosen to be close to.

Put all that together, and I’m probably the closest thing my family had to a dysfunctional member. The family structure seems to have been as functional as anyone’s ever is.

All in all, I’ll take it.

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