Bipolar 2 From Inside and Out

Is TMS Right for You?

08 23 26

On Tuesday, when I went to my psychiatrist’s office, I noticed a large display of brochures for Transcranial Magnetic Stimulation (TMS). My husband, who was with me, asked about it, so I told him what little I knew about what it is and what it’s supposed to do. But I realized that I’ve never investigated it thoroughly. When I was considering ECT, TMS was rather new and not an option offered to me. Then a change in medication alleviated my treatment-resistant depression at last. When we got home from my appointment, I thought I’d look into TMS further.

What Is TMS?

TMS, sometimes called rTMS (for repetitive TMS), is a non-invasive treatment for long-term depression (and perhaps a few other conditions such as OCD, PTSD, migraines, epilepsy, and even nicotine addiction). It differs from vagus nerve stimulation and deep brain stimulation because it doesn’t require surgery or cutting the skin.

TMS involves placing electromagnetic coils on the patient’s scalp and moving them around until they have the desired effect. The procedure targets areas of the brain that show decreased activity in patients with depression and is thought to activate those areas.

Calibrating the magnetic coils and determining their placement happens at the initial appointment. For subsequent appointments, the coils are simply placed at the effective points already determined. TMS only affects areas of the brain that are close to the surface. Sessions are required five days per week for several weeks. Each session lasts approximately 20 minutes or sometimes less.

TMS doesn’t require anesthesia and can be performed as an outpatient procedure in a provider’s office or a clinic. You don’t have to have someone to drive you home afterward, though you may want to for your first session until you know how TMS will affect you. Symptom relief can occur after several weeks of treatment.

TMS is FDA-approved, and most insurance plans cover it if you meet certain criteria, like having no effect from several antidepressant medications. Many also cover repeated treatments if the effects wear off. Deep TMS, in which the electromagnetic pulse reaches deeper into the brain, is FDA-approved for OCD and nicotine addiction when standard treatments have failed, but is off-label for other conditions.

Outcomes

Approximately one-third of people who undergo TMS experience full remission of their depression. Fifty to sixty percent report improvement of their symptoms. Most patients, however, experience remission lasting for months after the treatment, with positive outcomes averaging somewhat more than a year. But the results are not permanent; there is a high rate of recurrence. Patients can engage in multiple rounds of treatment after the effects wear off. For patients who don’t respond to TMS, ECT is often considered.

Side Effects

One of the first things I learned about TMS was that I wouldn’t have been a good candidate for it. My illness is bipolar disorder, which has a mania component, and one of the possible side effects of TMS is mania. And I might not qualify for it now, as I have metal implants in my body, which is sometimes a contraindication. Although TMS is sometimes recommended for bipolar depression, I’m not sure I would like to risk it. I would have talked it over with my psychiatrist.

TMS has other potential side effects as well, though not the memory loss that can accompany ECT. In addition to possible mania, TMS carries the risk of seizures, as well as hearing loss if the ears aren’t properly protected. More common side effects include headaches, scalp pain, lightheadedness, and twitching facial muscles.

Pros and Cons

The relatively high success rate is certainly a selling point. Even better outcomes are expected for TMS guided by fMRI for more precise placement of the magnetic coils. Although seizures can occur, the rate is approximately 1 in 10,000 sessions. In addition to alleviating depression, TMS may also reduce suicidal ideation. If you’re taking medications for depression, they will not interact negatively with TMS. Many clinics offer the procedure.

On the other hand, TMS is not for everyone. The treatments can be time-consuming. And some practitioners don’t treat patients under the age of 18 or over 65. If you’re not insured, the procedure can cost $6,000 to $15,000. Advanced equipment and the costs of added therapies can boost the total to $30,000.

Only you and your doctor can determine whether TMS is worth trying. But if you have longstanding, treatment-resistant depression, you may want to explore the possibility.

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Mood Music

08 16 26

Last week, I got to go out and hear live music—the Stray Cats, one of my favorite bands, were having a reunion tour with some new music, and I had tickets for it. I looked forward to it with great excitement (and a little anxiety, which proved warranted when a violent thunderstorm started as we were driving home on the highway). Aside from the thunderstorm, however, the evening was magical.

And I needed it. I’ve felt myself sliding toward the depressive end of the scale lately.

My Music

When I’m depressed, I always forget the power that music has to restore me. I have plenty of music accessible to me, on my Mac, Pandora, Spotify, and other sources. I even have Pandora on my iPad and my phone, so I can have music with me at all times. But I don’t remember, and I don’t make use of this inestimable resource that is always at my fingertips.

Of course, there’s nothing to compare with live music when it comes to restorative power, and I’ve been sorely short on that. I remember times in years past when I went out to hear live music as often as several times a week. Later in life, it became a lot less common, only happening every month or so. Now, it’s so uncommon that it doesn’t happen even once a year.

Listening to music—and singing along, loudly, enthusiastically, and totally off-key—clears the cobwebs out of my brain. I return to the same music over and over, favorite singers and songwriters, bands that no longer exist, artists who are now dead. I don’t object to new music, but it doesn’t hold all the memories, the weight and history, of music that I already love.

Bibliotherapy and Music Therapy

The idea of bibliotherapy is pretty well known. Self-help books abound (for all the good they do), and therapists sometimes recommend books and articles to their clients. Music as a part of formal therapy might be much more difficult to make work, however. One person’s soul-touching music is simply background music even to others who know that person well.

No one but me can prescribe what music “works” best for me on any given day. Are what I need raucous tunes to lift me up or calm ones to settle me down? Do I crave hearing a particular artist or band? Should I search out songs by a favorite songwriter that have been covered by others? Or do I simply click shuffle and let my vast playlist decide for itself?

There’s some science behind the idea that music can be good for people with depression. Listening to music has been associated with increases in neurotransmitters like dopamine, and the lessening of the levels of the stress hormone cortisol. Emotional release is another way that music works, allowing you to access feelings that you can’t actively name. “Active engagement,” such as playing an instrument, writing lyrics, or “intentional listening,” is also said to be good for grounding. It certainly activates more areas of the brain.

Still, we’re talking about some awfully subjective findings. A study-of-studies found that TAU (Treatment As Usual) with added music therapy “was superior to TAU alone for anxiety and functioning,” but that the combination “was not more effective than TAU alone for improved quality of life.” Maybe it’s just me, but I’d think that an improvement in anxiety and functioning is an improvement in quality of life.

Formal Music Therapy

That meta-study was looking at formal music therapy, however. What does that entail? One site I visited described individual and group music therapy like this:

“In individual music therapy sessions, a therapist works one-on-one with a client to address their specific needs. This personalized approach allows the therapist to tailor interventions to the client’s preferences, whether it involves playing instruments, songwriting or listening to music. Group music therapy sessions provide a supportive environment where people can engage with others through music. These sessions may involve collaborative music-making, improvisation or group discussions about the music’s impact. Group sessions foster a sense of belonging and provide opportunities for social interaction.”

I’ve never had that kind of music therapy. I’ve had to create my own with Pandora listening sessions and tickets to the Stray Cats. But I hope that if I’m ever in need of the formal variety, there will be some place where it’s available to me. For now, I’ll enjoy the subjective improvement in anxiety and functioning that I can build on my own.

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New Science: Inflammation and Mental Health

08 09 26

Over the years, I’ve heard all kinds of definitions and supposed causes for depression, from anger turned inward to double-jointedness. Many of these turned out, like these two, to be either questionable or outright bogus.

Now there is new information about what may be a factor in causing depression, bipolar disorder, schizophrenia, and indeed any diagnosed psychiatric disorder: inflammation. And there’s some science behind this theory.

Some have called the link between inflammation and mental illnesses “undeniable.” Others aren’t willing to go quite that far, saying rather that it “seems to be” a factor. Statistics seem to back this up. Roughly a quarter of people with major depression show increases in immune molecules that are associated with chronic inflammation. That’s far from saying that all people with depression also experience inflammation, or vice versa, however.

Even more intriguing, though, is that researchers have found that inflammation occurs before the depression sets in. Even childhood trauma, chronic low-level stress, and infections that are associated with inflammation are also implicated in treatment-resistant depression. Of course, they’re also associated with depression in general.

Brain chemicals aren’t entirely out of the picture either. Inflammatory proteins can reduce the levels of serotonin and dopamine in the brain and disrupt activity in areas of the brain associated with reward mechanisms. There’s also the possibility that inflammation and depression form a “loop” in which depression may increase inflammation and inflammation may have some causal effect in depression and other mental disorders.

So, what should you do if you think that inflammation might be a factor in your depression, bipolar, or schizophrenia? One option is to see a medical professional who can run tests to see if a connection between the two conditions is likely. It won’t be cheap. It involves specialized tests and assessments, as well as a doctor who knows something about the subject.

On the other hand, you can treat the inflammation with remedies that are known to have some effect. These include a change in diet, eliminating sugary drinks and ultra-processed foods; reducing the stress in your life, which is known to be associated with both inflammation and mental health issues; lessening indoor smoke inhalation, such as that produced by air freshener dispersers, incense, and candles; limiting alcohol consumption; increasing physical activity; and getting enough good sleep, including dealing with problems such as sleep apnea.

There are still many unknowns on the subject of inflammation and mental disorders. The reporting on the topic includes words like “may,” “might,” “associated with,” and “implicated,” which indicate that the link is not entirely solid so far. One article got the headline right (“How Inflammation Can Threaten Your Mental Health”), but then had a subhead that went the other way (Important breakthroughs promise new understandings and treatments”). Others asked questions that at least had some ambiguity (“which came first?,” “is there a connection?,” and “Could lowering inflammation treat depression?”).

I hate to end this post with a wishy-washy “Time will tell,” but honestly, that’s about the most I’m willing to say. That and “Follow the science.”

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“Why Don’t They Just Take Their Meds?”

08 02 26

That’s maybe the most common reaction to hearing about the unhoused mentally ill. After all, there are medications that lessen the effects of schizophrenia, mania, and bipolar delusions. Why wouldn’t a person take advantage of them? Don’t they want to be mentally healthy? Why wouldn’t they do something that can alter their lives so dramatically?

Anosognosia is frequently the answer.

What Is Anosognosia?

If you look in the DSM-5, you won’t find anosognosia listed as a separate illness. Instead, it’s a symptom of another illness, often called “lack of insight.”

But anosognosia is so much more than that. It’s the reason that a sufferer doesn’t even realize that they have a disorder. They aren’t able to comprehend that there is anything wrong with them, that they have a serious mental illness that affects the choices they make and the way their brains work.

This is not mere denial. Someone in denial realizes on some level that they have a problem. They just keep pushing it away. A person with anosognosia does not understand that they have a disorder, that their mind is affected by it, and that their behavior is shaped by their condition. It might instead be called “brain-blindness.” The schizophrenia or other condition itself prevents the person from perceiving that there might be something wrong with their thinking, emotions, and behavior. As far as they’re concerned, they have no illness.

The Medication Question

Schizophrenia was once considered an untreatable illness. All that could be done with a person suffering from the disorder was to put them away—lock them up so they couldn’t harm anyone. After all, the diagnosis of schizophrenia at the time was synonymous with violence. In the minds of many people, it still is.

So, if their disease is so severe and there is a medication that will help, why don’t they just take it?

Let’s think about this. If you didn’t have a serious heart condition, would you agree to take Inderal or Plavix? Would you just mind your doctor and take it anyway? Or would you decide you didn’t need it and stop taking it?

What if you took the Inderal and you experienced unpleasant side effects? You should tell your doctor that it’s having side effects that you can’t tolerate, such as dizziness, stomach pain, sexual problems, or vivid nightmares, and ask for something else. But you might be tempted simply to stop taking it without your doctor’s knowledge or input.

It’s the same with medications for schizophrenia. Many of them have very troubling side effects, including uncontrollable muscle movements (tardive dyskinesia), which may not go away if you take the medication for a long time. Weight gain, sexual dysfunction, sedation, or dizziness are other possible side effects. Stopping the meds might seem very attractive, especially if you don’t believe you are ill.

The Blame Game

It used to be that when the public saw the unhoused, the sick and suffering, they might think “But for the grace of God, that could be me.” At some level, they recognized the people they saw as human beings and knew that they, too, might someday fall prey to illness, financial reverses, or other disasters. There was empathy, or at least sympathy.

Now, that reaction has turned to “othering”—denying their common humanity. The “unfortunate” are to blame for their circumstances. They “choose” to live on the streets. They make bad decisions that lead to their problems. And they don’t take their meds. It’s all their own fault. They’re not like us.

Empathy only comes when a problem touches a person directly. Unless they have a schizophrenic or unhoused family member, they don’t think about how people get into dire circumstances. They separate themselves and continue to believe “it will never happen to me.”

But as the population ages, many people must deal with older relatives who have dementia, who sometimes become combative or violent, who may resist taking their medication, and who don’t realize that they have a condition that makes them confused, less capable, and in need of specialized kinds of care.

Unfortunately, that understanding seldom reaches the schizophrenic people who experience many of the same difficulties. And anosognosia is a big reason. If you’re not aware you need help, you’re not likely to get it.

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Living With a Bipolar Family Member

07 26 26

Let’s start with this: A bipolar family is like any other family. They have good times and bad. They live with each other; they fight with each other; they care about one another. They deal with each other’s differences and problems. But they have the added stressor that one or more members of the family have bipolar disorder.

What does this mean for a family? It does mean that there are likely to be difficulties that other families don’t face. Depending on how severe the disorder is, whether the family supports their relative in getting treatment, and the resources available to them, their lives will look quite different.

My Family

My family was unprepared for me to develop bipolar disorder. They knew that I was different, and often didn’t know what to do with me, particularly when I went into depressive episodes and retreated from the world, crying hopelessly. I remember this happening in seventh grade in particular. I had been publicly humiliated at a birthday party and spent days curled up in a bean bag chair, sobbing uncontrollably. My parents knew that something was very wrong.

Nothing happened for quite a while. When I was in high school, my behavior had gotten so off-kilter that it was recommended I go see the district psychologist. My parents left the choice up to me, and I didn’t go, for reasons that now seem completely ridiculous. I should have taken the opportunity.

Later still, when I was diagnosed and medicated with Prozac, my family was encouraging, but had some issues. My mother, who got a lot of her information from TV talk shows, said she had heard that Prozac was a “ticking time bomb.” My father had no objection to my therapy as long as he didn’t have to go (which no one had ever mentioned). But they continued to give me love and emotional support throughout, though they never really understood my condition or what I was going through. I don’t think they ever did, but they never gave up on me.

Other Families

I think it’s vitally important for family members of someone with bipolar disorder to learn all they can about the disorder. This will require bravery and openness on their part. But learning all you can about bipolar disorder will help you help your family member in the best possible way.

Of course, the kind of support a person with bipolar needs will differ greatly depending on how severe their symptoms and their disorder are. If they are subject to mild to moderate depressive phases, don’t try to “cheer them up.” It won’t work. Instead, talk therapy and/or medication, or, if they’re in a more severe depressive phase, an alternative therapy like TMS or ECT may be called for. Hospitalization is definitely an option if the family member has suicidal ideation.

If they’re in a manic phase, don’t just tell them to “calm down.” That won’t work either. Instead, help them be more grounded and keep potentially harmful behaviors in check. How you do this will vary depending on how their mania manifests. If they are given to reckless driving, for example, you keep the car keys and drive them where they need to go. If they’re an overspender, keep the credit cards and PIN numbers out of reach.

Help your bipolar family member in specific ways. Encourage them to seek therapy. If needed, drive them to their therapist appointments. Pick up refills of their medications for them. Get them a pill caddy to make it easier to take their medications as prescribed.

If your family member is experiencing delusions or psychosis, don’t argue with them about hallucinations, which are very real to them. They may also be suffering from anosognosia, which means they don’t even recognize that they are ill. You may have to intervene more directly, whether that means taking them to the emergency room or admitting them to a psychiatric facility. Do all you can while keeping yourself and the rest of your family members safe. If you or your loved one is in immediate danger, don’t wait—take action!

Kinds of Support

It may seem that you are taking agency away from your family member, and that is to some extent true. But until they’re more stable and able to demonstrate agency over their own condition, helping them negotiate the practicalities of their illness is likely the best thing you can do. You can’t change your family member’s disorder or change them; in most cases, all you can do is support them.

Remember there’s help available. In addition to your local or county National Alliance on Mental Illness (NAMI) chapter, you can get in touch with Depression & Bipolar Support Alliance (DBSA), the Bipolar Caregivers website, or bphope.com, which has online support groups. That last link will take you to a page that lists other organizations and resources that may be available to help you.

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Wealth and Mental Health

07 19 26

It’s becoming more and more apparent that your socioeconomic status has a significant effect on your mental health. This is not to say that money buys happiness. It does mean that wealthy people can have mental health conditions related to their abundant resources, and that people who have mental disturbances often find their suffering to be greater if they are poor.

Little to No Money

It only makes sense that having severely limited funds can take a toll on a person. Finding money for rent, medical bills, childcare, retirement, or other recurring or one-time expenses can increase your worry and seriously affect emotional well-being. Financial hardship and mental distress often reinforce each other. These difficulties can be difficult—or even impossible—to escape.

But dealing with the problems of inadequate money can strengthen connections among family members and close friends. Shared hardships foster shared sacrifice, as well as negotiation and compromise skills. People with little money must work through problems and conflicts because they have few alternatives. This process can be distressing, but it also fosters trust, resilience, and intimacy. The Harvard Study of Adult Development has found that strong social bonds predict long, happy lives better than intelligence, genetics, or money.

Perhaps surprisingly, socioeconomic difficulties may also lead to alterations in the brain, particularly in children. This link seems to run through parts of the brain that keep a person awake and alert. The circuits change in children who get less sleep, face more stress, or spend lots of time on social media. All of these factors increase with lower economic, educational, and social opportunities. It’s been noted that preteens who grow up in areas with fewer monetary resources and less social support particularly show brain differences that are measurable on MRI scans. Researchers have voiced surprise at how strongly socioeconomic opportunity correlates with brain differences. Studies that link cognitive performance to brain differences without taking socioeconomics into account “may require reevaluation,” according to experts. “We need to find out how socioeconomics is becoming biologically embedded.”

Lots of Money

Many Americans believe that more money would improve their mental health. That can be true some of the time. Money can alleviate many of the problems that people on lower socioeconomic levels face. The wealthy don’t worry about where rent and food money will come from, how to get a job, or how to get to their job. They don’t have the problem of even a relatively minor illness or injury plunging them deep into medical debt.

When problems do arise, notes psychologist David H. Rosmarin of Harvard, the well-off assume that they can make problems (he gives as examples a son’s gambling losses or a daughter’s extreme depression) disappear via the application of money. “Parents with less resources would have no choice but to quickly confront the painful realities their children were facing,” Rosmarin observes.

Money can resolve most of those problems, providing stability and freedom. However, the ultra-wealthy can find themselves lacking hardship-developed strengths and descend into family conflict and emotional disconnection. Their relationships rely on control and expectations rather than shared bonding experiences.

Though they may have family, friends, coworkers, and even servants around them, the wealthy can easily feel isolated and alone. And loneliness has been shown to increase the risk of health problems such as cardiovascular disease, stroke, depression, and early death by roughly 30%, despite wealthy people’s broader access to top-quality health care.

My Experience

I grew up in a middle-class family, and local schools were among the best in the area. It seems that socioeconomic factors didn’t contribute much to the brain illness I began to develop as a child. The only time I experienced distress at a lack of money was when I was told that there wasn’t much money for higher education and that I should go to a community college. (I reacted to this with tears and distress at first, then applied for good schools and scholarships. Eventually, I went to an Ivy League school with multiple financial supports.)

When my husband and I got married, we were both out of work and on food stamps (as they were known back then). Later, we both got jobs that had good salaries attached to them. Rather than experiencing loneliness and disconnection, we had already built a basis of cooperation and negotiation as we worked through the hard times. We enjoyed each other and our families’ and friends’ love and support throughout. When we began to get ahead in our finances, we traveled, but felt the strain of not seeing each other often enough when we were home because of long hours working. All through this period, though, in bad times and good, I suffered from bipolar disorder. Money seemed to make little difference in that.

Now that I’m mentally more stable, I find that I am able to deal more effectively with financial crises, which, given the economy, arise fairly regularly. I do experience severe anxiety and worry at times, but have so far been able to work my way through them.

I’m not denying what the researchers say about brain differences in children from lower socioeconomic levels or that the wealthy have different sorts of emotional problems. But being aware of the possibilities of such problems and getting mental health assistance when necessary can make the difference between a distressed situation, whether well-funded or not, and a tolerable one.

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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?

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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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mental health

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