Bipolar Me

By Chris / adobestock.com

I went to a very good university. I learned nothing about bipolar disorder from the curriculum. I didn’t take any classes in psychology, though at that time (the 70s), I’m not sure they would have taught that much about the disorder – almost certainly not that there were two versions of it.

I could have taken psychology. There was a requirement that all students had to take two classes outside their major – there were called distribution requirements and were intended to make us more well-rounded individuals. My major was English and I took History of Science and Astronomy (also Beekeeping, but that’s a story for another time).

It had not escaped everyone’s notice that I had psychological problems by that point. My high school had recommended to my parents that I be taken to the school district’s psychologist. They left the choice up to me and I declined, as I thought it would look bad on my permanent record. (It never occurred to me how the behavior leading to that recommendation looked.)

So, I toddled off to college undiagnosed and untreated, but surely in the throes of bipolar disorder. Gradually, I became aware that my mental state was, to say the least, unsteady. I had insomnia – I would spend some nights sitting in the hallway, staring at a poster. I had mental confusion – I changed my major from Linguistics to English based on an irrational assumption about the job possibilities. And I took a year off because I was too depressed to continue. (I went back after a year of working in a restaurant.)

There are certainly things I regret. I regret that I missed so much that was educational, enlightening, or entertaining. I regret that in a fit of hypomania I joined a sorority and tried to fit in while living there. I regret the cutting. And, perhaps most of all, I regret that, once, a fellow depression sufferer asked me to meet her one evening in the student union building to talk – and I didn’t go. I was too involved in my own pain to be open to hers.

As the years went on, I got worse. I had physical problems due to anxiety. I had disastrous relationships. Once or twice, friends became so worried about me that they insisted I go to the school infirmary because they were afraid I might be suicidal. I stayed a couple of days, denied suicidal ideation, and went back to my regular college life.

I did try to get help. At one point I joined a therapy group. One of the exercises that we had to do was to start and maintain a brief conversation with someone else in the group. “I can do that,” I said. I had learned to do that in the sorority, and besides, I was able to fake normal for that length of time. The therapy group never addressed my real problem and so did me no good.

If I knew more about bipolar disorder at that time in my life, I still might not have gotten help for it – there wasn’t that much help available at the time. But I might have understood myself better, done better academically, enjoyed more of the varied experiences that the university and the town had to offer, and been ready to accept help when it finally appeared (in the form of Prozac).

When I finally did get help, it was because I drove past a building with the sign “South Community Mental Health.” I thought, “I don’t know what I’m feeling, but whatever it is, it’s not mentally healthy.” So I began the journey that brought me to where I am today – still bipolar, of course, but diagnosed, treated with medication and therapy, and living a pretty good life. I even went back to college and got a Master’s degree.

I do still think about those years of struggle. I’m glad they’re over, but I still have those regrets. I don’t regret the university experience, though. It did broaden my horizons, introduced me to some people who are still dear friends, and taught me that I needed to keep searching for help with my problems. And that was a valuable thing to learn.

Romolo Tavani from adobestock.com

There has been a furor lately in the psychiatric community and among psychiatric patients about the causes of depression and other mental disorders, as well as the appropriate treatment and the appropriate name for them. Among the issues are whether neurotransmitters in the brain cause these illnesses and whether biopharmaceuticals will help relieve them.

One of the main arguments against the neurotransmitter theory is that we do not really know whether depressed persons (most of the arguments use depressed persons as the easiest example) really have lower levels of seratonin, norepinephrine, or other brain chemicals than the general population. What is known is that increasing the amount (or decreasing the deficiency) of those chemicals helps many people recover from their condition, at least partly.

No, seratonin et al. are not “magic bullets” for depression. They don’t work for everyone. They can become less effective as time goes on. And no one quite knows how they work. But in many cases, including mine, they were the first – and at the time only – thing that helped. The explanation was sufficient for me, even when my doctors added new drugs to the “cocktail.” Advances in biochemistry, ya know.

Now, however, various scientists, psychiatrists, patients, and reporters talk about “debunking” the biochemical theory. Instead, they say, depression and other disorders are caused by traumatic events and stressors that change the way our brains react to stimuli – that the environment influences the brain in ways that lead to psychiatric illness.

But, it seems to me, we have a chicken-and-egg question going on here. Am I more susceptible to depression (or bipolar) because of the traumas and stresses in my life (especially my youth)? Or has my brain chemistry made me more susceptible to the traumas and stresses?

How, anyway, are we going to prove either theory?

Part of the difficulty seems to me to be the backlash against the pharmaceutical industry, which has surely done some sketchy things of late. Biopharmacy and drug treatment of various illnesses have become less popular as people question whether we really know what’s going on in the brain and whether we really know what those chemicals do.

Psychiatry itself follows the arc of a pendulum. At one time psychotherapy – the “talking cure” – was all that it had to offer. Later, with the advent of Haldol and Thorazine and Prozac and their cousins, it seemed that physical causes were more likely to be responsible for mental illness than unresolved childhood issues. This threatened to put psychotherapists out of business.

(I have always been helped by talk therapy, whether or not I was medicated for bipolar disorder. It has helped me through crises, taught me about healthy coping mechanisms, provided a reality check on my feelings, and so much more. I would never have made it as far as I have without both pharmaceutical help and psychotherapy.)

Now the biochemical theories are questioned and psychotherapy is in the ascendance again. Rather than treating our brains, we are to be treating our memories, uncovering the traumas that are said to have made epigenetic changes in our brains that manifest as depression, anxiety, or whatever. (I don’t think schizophrenia is included. There are just too many factors tying schizophrenia to genetics and the brain.)

It’s true that I had traumas in my young life, though never to the extent that many others experience. Were they brain-changing events? I wouldn’t have thought so. I took biopharmaceuticals and they helped. Was I mistaken about the causation (post hoc ergo propter hoc)?

If all this dissension leads to better ways to help sufferers of mental illness, then good. Plain and simple. But if it causes patients to abandon treatments that are working for them, I am less sanguine. In our pill-shaming, homeopathic culture, it just may be possible that the pendulum has not swung as far as all that.  I’m not giving up my psychiatric drugs based on a theory, when they have helped me so much. And need I point out that the “latest” treatments for depression and bipolar also target the brain and not the traumas they may have endured? Ketamine, ECT, and TMS all affect the brain directly. 

Also, let us consider that part of the objection to the “chemical imbalance” theory is the idea that it more likely promotes stigma to say a person has a “brain illness” than a “psychosocial difficulty.” That’s all well and wonderful, but I would argue that it calls for more education rather than a change in how we treat. “Neurodiversity” may be a less stigma-laden term, but so far it shows little sign of catching on outside the ASD community. (Ask the person-on-the-street what “neurodiversity” means. Then ask what “mental illness” means. Neither answer will be helpful.)

If this remains a debate about what we should call mental illness, then I suppose there is little harm done. But if it affects the way we treat mental illness, that’s another matter entirely.

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I recently spotted a headline that made me stop and read the story. It was from iflscience and the article was “People with Depression Use Language Differently.  Here’s How to Spot It.” Those of you who know of my abiding interest in mental illness, science, and language (I once studied to be a linguist) can imaging how my virtual ears perked up. The article also referenced technology and how it was being used to analyze people’s language.

But before we get to the article, a little background on computers, language, and therapy.

As early as 1950, computer scientist Alan Turing devised a test (now named after him) that challenged computer programmers to create a device that could produce language indistinguishable from actual human communication. This was in the days before computers could speak, so all the interactions were text only. Pairs of computer-and-human partners carried on a conversation, and an observer had to evaluate which of each pair was the machine. If the machine produced language that the evaluator could not distinguish from human speech, the computer was said to have passed the Turing Test. It was an early achievement in machine learning and artificial intelligence. (Only one computer is said to have ever passed the Turing Test, and even that achievement is in doubt.)

In the mid-1960s, another computer program called ELIZA was developed by Joseph Weizenbaum. ELIZA used “scripts” to reply to human communication. One of the most successful scripts was “DOCTOR,” which was based on therapy developed by psychologist Carl Rogers, who was known for repeating non-directional versions of what a client had said back to him or her. (“I’m mad at my mother.” “Why does your mother make you feel mad?”) Surprisingly, many users felt that the program displayed human-like feelings and it was believed that ELIZA could be helpful as an adjunct to psychotherapy – a very early version of a psychological chatbot, in other words.

Now we get to the iflscience article (which was previously published in Clinical Psychological Science and The Conversation). It divided the language that the computers analyzed into content and style. Not surprisingly, the content of the writings of depressed persons contained more words like “lonely,” “sad,” and “miserable.” But the computers noticed that in the realm of style, the depressed subjects were more likely to use first-person pronouns (“I,” “me,” “mine”) than third-person pronouns (“she,” “he,” “him,” “they”). Researchers theorized that people with depression were more focused on themselves than on other people and that pronouns are a more reliable marker of depression than content words.

On mental health forums that were analyzed, “absolutist” words such as “absolutely,” “nothing,” and “completely” were even better markers of depression than content words or pronouns, especially in anxiety and depression forums, and particularly in suicidal ideation forums.

What does this all mean? Researchers are using the knowledge gained from the studies to analyze natural language specimens such as blog posts, with results that sometimes outperform those of therapists. And because of machine learning efforts, the computers are only expected to get better at identifying not just depression and anxiety, but other conditions such as self-esteem problems.

At the moment, computers can analyze only written samples of language produced by those suspected of having psychological problems – blogs, poems, letters. This, of course, might be perfect for use with those chatbots that rely on text-only interactions. And psychologists might be trained to listen for language cues in the conversations they have with clients.

Will the depressive language experiments prove more successful than the Turing Test in mimicking human interaction and more functional than ELIZA in providing helpful feedback to those suffering?

Personally, I hope that the experiments continue, and continue to show promise. Although computers are not likely to take the place of human therapists, they may be able to help identify people who need the most immediate help, or even assist in filling the gap for populations with no easy access to psychological services.

Reference

https://www.iflscience.com/health-and-medicine/people-with-depression-use-language-differently-heres-how-to-spot-it/all/