Bipolar 2 From Inside and Out

SMI in Higher Ed

July 7, 2024

I recently discovered a book written by Katie Rose Guest Pryal called Life of the Mind Interrupted: Essays on Mental Health and Disability in Higher Education. I was a little behind on reading the book—it came out in 2017. But I can’t imagine much in academia has changed since then.

In the book, Pryal presents short, readable essays about her experiences and those of other people who experience bipolar disorder, OCD, anxiety, ADD, and schizophrenia and must navigate the systems of working in academia. Pryal herself, now a law professor specializing in disability studies, says in the introduction that “academia isn’t an easy place to be if your brain isn’t quite right.” One interviewee remarked, “They hired you for your mind…Why would you volunteer that there’s something wrong with it?” The first chapter includes essays on disclosure.

If that were all the book covered, it would still be a revelation and an important work. But The Mind Interrupted is relevant to people with SMI in other areas of life as well. Just look at these essay titles: Disclosure Blues, Breaking the Mad Genius Myth, Working When Your Brain Isn’t, Handling Personal Tragedies Around You, How to Have the Accommodations Talk, Believe Your Colleagues With Disabilities, Trigger Warnings Are a Disability Issue, and more. These are issues that everyone with SMI has to deal with, whether they work in a burger joint, a business office, or aren’t employed at all. Given her circumstances, it’s understandable that Pryal focuses on higher education, but I feel that this is a valuable book for anyone living with SMI.

I’ve written before about how we refer to mental illness, SMI, brain illness, behavioral health, etc. Pryal uses a term that hadn’t occurred to me—psychiatric disability. It brought me up short. I have bipolar disorder. Is my condition a psychiatric disability? Ignoring the fact that I didn’t get disability when I applied for it, I would have to say it is. I have limitations that interfere with my ability to make a living. I have to deal with the question of whether to disclose my mental status whenever I apply for a job. I’m lucky that I now work independently from home and can basically make my own hours, an accommodation that likely would not have been available in the publishing companies where I used to work, even if I had asked for it.

When I was in academia as a grad student and teaching assistant, I hadn’t been diagnosed with bipolar, but I certainly had it. The stress was nearly incapacitating. I remember having a meltdown in a poetry class, which was ignored by the other students and the professor, aside from a few sidelong looks. I got one bad student review—scathing, really—and couldn’t bring myself to read any student reviews for the remaining three semesters. It’s similar to an experience that Pryal recounts in Life of the Mind Interrupted.

My experiences bear out what Pryal says in her book. As she explains, “This is a book about mental illness and academia. But this is also a book about so much more than that: it’s about grief, and friendship, and collegiality, and accessibility, and tragedy. It is about trying to get by in a world that fears you, that believes you are unfit for your job, that wants to take your children away….I’d spent my years in academia in hiding.” And so did the people Pryal interviewed for her book. As they were struggling to reach the safety of tenure, disclosure was not an option. Accommodations such as altered schedules were not requested or offered, even though people with mental illness are a protected class under ADA.

There’s so much more in Life of the Mind Interrupted: intersectionality, motherhood, creativity, language, students with disabilities, stigma, teaching, allies, privacy, and other essential topics. If you skip this book because you’re not in the institutions of higher education, you’re missing something truly important.

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Support Group Spam

June 30, 2024

I belong to a number of Facebook support groups for mental illness issues such as anxiety, depression, and bipolar disorder. I’m even a co-moderator for one of them, Hope for Troubled Minds.

What’s troubling my mind right now is the scammers and spammers who try to take advantage of the group members.

There are the typical posts of course about how much they admire your comments and think your profile picture is very appealing. They’ve tried to friend you, but it hasn’t worked. Then they beg for an “add.” I know that as soon as I friend them, they’ll DM me with a wonderful opportunity. I find these posts annoying, but since I simply hide and block them when they happen to me, I don’t worry too much about them.

The ones that really bother me are those that are targeted to support group members specifically. Here’s one I’ve seen in various groups:

[Product] on Instagram helped me overcome Osteoporosis, fibromyalgia, autoimmune disease, LUPUS rheumatoid arthritis, ptsd, Chronic gastritis, chronic-pain, joint pain, muscles spasms, intense sweating, Raynaud’s Syndrome, inflammation, diagnosis, Fibromyalgia, skin-itching, ADHD, arthritis, spasms, swollen, blotchy hands, shingles, numbness, Anxiety, Autism, feet nerves, and flare-up permanently after taking various meds that didn’t work, look him up.

I suppose I should find it amusing that diagnosis, feet nerves, and flare-up are among the many disorders that the product is supposed to relieve. And the idea that any one product can alleviate PTSD, anxiety, and autism along with all the other listed conditions, is ludicrous.

Another piece of spam along similar lines says:

Truly, natural remedies do work. If they didn’t, we wouldn’t have used them for thousands of years. And, pharmaceutical companies wouldn’t be studying plants, taking extracts of them, and patenting them as lupus drugs.this is not a claim or lies I was totally relieved from pains of lupus disease and CFS by [Person]. His remedy is surely the best. I suggest you try him out if you are having any health challenges and also get cured too, give him a try

This piece of spam is less hyperbolic than the previous one, but it still appeals to people seeking relief from difficult-to-treat conditions. But why post it in a support group that deals with mental illness? It doesn’t address them directly. Perhaps the poster thinks that, since SMI is not thoroughly understood, people who live with it are desperate for any treatment, however unlikely or unconventional.

It’s easier for me to understand how the next bit of spam might appeal to the distraught and lonely people who find that SMI has shattered their most significant relationships. But again, it offers false hope of a “love spell” and the opportunity to become a millionaire.

My appreciation goes to [Person] for restoring back my relationship with his powerful love spell to bring my boyfriend back and also for setting my son free from Courtcase and helping a friend whom I recommend with money spell that made her a proud millionaire are you having any issues that needs urgent attention kindly contact

Finally, we have one that might actually appeal to someone who’s been in an emotionally abusive relationship.

Living with a narcissist can be very difficult due to the gaslighting and lies. If you are interested in obtaining a basic analysis of what your partner does in secret, there is a resource called [product] can provide you with access to text messages, call logs, emails, games, and social media activity (including deleted messages) send a direct message

Never mind that it’s the gaslighter who is more likely to use apps like this to keep track of their victim and isolate them from friends and family.

When I see posts like these, I report them to the group admins. What they do about them, I don’t know. I do know that I haven’t seen people trying to post similar spam in the group that I co-moderate. Unless a person is well-known to us, they must submit a message before it’s posted. So far, no one has proposed a spam post to our group. Occasionally something a bit off-topic, but that’s about it.

I think the spammers intend to prey on people they see as weak and vulnerable. And while there are people who post about their trials and tribulations with brain illnesses, they’re far from weak and vulnerable. You have to be strong and determined to live with them.

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The King Baby and the Narcissist

June 23, 2024

Almost everyone knows a grown-up in their life who has to be right all the time, has to be catered to, and blames everyone else for failures or unpleasant events.

That person is a King Baby. (Not to be sexist. There is also a Queen Baby.) It’s someone who never grew up, at least not emotionally. King Baby expects everyone to love him, take care of him, and solve all his problems for him.

Reference.com says that a King Baby: “is typically selfish, rejects criticism, complains, is obsessed with money and belongings and doesn’t feel like rules should apply to him. In short, he is someone who refuses to mature.” Tom Cunningham wrote the book (well, the 28-page pamphlet) on King Baby Syndrome in 1986. It’s still available from Hazelden, which is good because King Babies haven’t gone away, nor are they likely to.

King Babies view the world as their plaything and other people as someone whose only function is to meet their needs. Physically they are adults, but emotionally they are still infants. Typical King Baby remarks are, “That’s not fair,” “This is what I want,” “That’s not how I do it,” “Do this for me,” and “I’m the best at everything.”

Needless to say, King Babies are very trying to be around.

I learned about King Baby syndrome from my husband. Not that he has King Baby syndrome. But he used to work as a counselor with various therapy groups. One thing he told me was that when someone was trying to pull King Baby shit, one of the others might call him on it by saying, “Wah!”

King Baby goes by other names as well. Probably best known is Peter Pan, from an 80s pop psych book, The Peter Pan Syndrome. Years before that hit the bookshelves, though, writer Aldous Huxley produced a novel called Island, which talks about “dangerous delinquents” and “power-loving troublemakers” who are “Peter Pans.” In addition, he said, they are “boys who can’t read, won’t learn, don’t get on with anyone, and finally turn to the more violent forms of delinquency.” Huxley cited Adolf Hitler as an example.

King Baby syndrome is not an actual psychological diagnosis. It is not covered in the DSM. But the DSM does include Narcissistic Personality Disorder, which sounds remarkably like a King Baby:

  • exaggeration of accomplishments
  • saying they have done things they haven’t really done
  • acting or feeling more important than others
  • believing they are special and unique
  • having a need to be admired all the time
  • expecting to be treated differently, with more status than others
  • exploiting others to get what they want or need
  • pretending concern towards others or lacking empathy
  • being jealous and competitive with others
  • thinking that others are jealous of them
  • acting arrogant and superior

Narcissistic Personality Disorder is, of course, an official diagnosis in the DSM. King Baby is only someone you perceive as narcissistic but who hasn’t gone through the process that leads to a diagnosis. I’d hesitate to call someone a narcissist who hasn’t even talked to a psychologist or psychiatrist. But I have no problem labeling someone a King Baby.

So what do you do with a King Baby? My advice is to avoid them if possible. You can, like the people in my husband’s therapy groups, call the person out for their behavior, though it’s not likely to do any good. Often it’s best just to cut the King Baby out of your life. If you do, though, expect anger, blaming, and recriminations.

If you do have to live with a King Baby, perhaps the best thing you can do is to recognize the behavior when you see it happening and not fall into the trap of trying to meet the King Baby’s every need. This won’t make any difference in the King Baby’s behavior, of course. You’ll have to deal with pouting, sulking, poor-me talk, and even retaliation.

Because just as vampires never grow older, King Babies never grow up. They can’t and they won’t.

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An Irrational Thought

June 16, 2024

I just bought a laptop because the air conditioner isn’t working. If that seems like an irrational thought I acted on, it is. It’s also a measure of my anxiety. And a consequence of my current mixed state.

Let me explain.

Our central air conditioner puts out a tiny bit of coolish air, but not enough to make the house comfortable. The weather has gotten up into the 80s, and the temp in the house is sometimes higher than that. And I know that July and August are coming, so temps over 100 degrees are likely. I’m afraid I’ll have heat stroke and die or at least have heat exhaustion and be incapacitated. I spend most of the day working at my desk, with fans on and cold beverages readily available, but still the heat gets to me. And I really need to do the work. We need the money, modest as my pay is.

So why (I hear you ask) don’t we call an AC repair service? My anxiety plus hoarding mean we don’t let people in the house. I suppose there’s a chance that they would only have to look at the outdoor unit, but I can’t count on that. There’s still a possible solution my husband can try. He’s going to get a tester and check the fuses. If that’s the problem, it’s easily fixable.

There’s the anxiety. What about the mixed state?

When I get hypomanic, one of my behaviors is online shopping. And there was just a sale at Best Buy on Apple computers that lasted three days. I ordered a laptop. I made sure it was a refurbished one to keep the price down, but I also bought the mouse, the subscription to Microsoft Office, and a carrying case. It was a tidy sum, money that we don’t have because of car repairs, but I put it on our Best Buy credit card. I also told myself that it was still cheaper than air conditioning repair. (A quick Google suggests that it’s likely a wash.)

How does this solve the air conditioning dilemma? If I have a laptop computer, I can take it to Panera, McDonald’s, or some other air-conditioned place and do my work while sipping on iced tea. (Panera has plugs and outlets conveniently located, I know.) Work accomplished. Body temperature regulated. Achievement unlocked.

Of course, I realize this is a slightly ridiculous plan. I know that my anxiety and hypomania are largely responsible. Ultimately, though, I’m responsible.

There’s still the chance that Dan can get the AC working again, if the fuses are the problem. If that happens, I can return the laptop (within 15 days after I receive it). So I have options, which I love.

I’m still left with confusing feelings. Maybe I’m too fearful of the heat or too dubious about being able to do my work in an overheated room. (I don’t think so, because I’m older and have had bad reactions to heat before. Computers also have bad reactions to heat.) Maybe I was too impulsive when I ordered a new laptop and all the fixings. Maybe even with the money I earn, the credit card expense will strain our finances further. I fortuitously just received a raise at work, so maybe that will help make up the difference.

I’m not asking for advice. I’ll work this out on my own somehow or at least with the help of my husband. He knows I’m in a mixed state, but the family finances are my responsibility and he usually goes with what I think we should do.

Things should be clearer by the time I post this.

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When You’re Threatened

June 9, 2024

We’ve all heard the phrase fight-or-flight and know generally what it means—the two basic reactions to threats. The fight-or-flight response to threats was a literal life-saver for our ancestors. If they were being attacked by a saber-tooth tiger, for example, their best bets were to try to kill it or to run away from it. It was a simple matter of survival.

Nowadays, however, we don’t find ourselves in that sort of situation very often, unless we encounter a bear or other dangerous animal. For most of us, the obvious response is to run away. There have been accounts of people who were able to fight off mountain lions, but most times, it’s just not realistic to fight unless there’s no other choice.

But when it comes to psychology, the fight-or-flight response often refers to a response to a verbal or emotional attack. When someone yells at you, you can either fight back by attacking them verbally too, or by running away, leaving the situation. Fighting back is usually counterproductive and fleeing is sometimes not physically possible or only a temporary solution. If you’ve been in a physically or emotionally abusive situation, you know what I mean.

There are other reactions to threats that are possible, and they’re not usually under your control. The first is to freeze. Of course, this would not be a very good reaction to a vicious animal unless you believe it won’t attack if you don’t move either toward or away from it. If the attack is already underway, freezing prevents you from trying any other, potentially better, reaction.

It’s not a very helpful response to a psychological threat, though. It can make the other person escalate their behavior. I’ve experienced this in the case of someone who was emotionally abusive. I froze and couldn’t respond to what he was saying. He responded by saying he wanted to kick me when I didn’t answer. We were on the phone, though, so he had no way to do it at the time. And by the time we were back home, he didn’t repeat the threatening remark, which I now realize was a verbal threat only, an expression of anger but not an actual threat of physical violence. At the time, though, it was frightening. If anything, I froze more.

The other potential reaction to a threat (and one that also begins with f) is to fawn or try to appease the threatening person. You give in to what they’re saying or promise to do better. You could retreat into people-pleasing mode and try to defuse the conflict that way. Or you could try to smooth over the situation with expressions of love and devotion.

This isn’t a very helpful response, either. Basically, it gives the threatening or abusive person what they want—compliance and “good behavior.” It may defuse the situation in the present moment, but it can set up a pattern in which you always respond with self-blame or praise for the abuser.

Fawning can be a tactic that you learned in your early childhood. If your parents or caregivers withheld praise or insisted on superior performance, you may have learned that you had to “perform” in order to receive love. That trait can persist in adulthood.

Another reaction that’s been suggested is “face.” This is proposed as the preferred reaction to verbal or emotional threats. It means standing firm when a threat of this kind happens. Admittedly, it seems to be the most mature option, a choice rather than an automatic reaction. And it could disarm the threatening person since you don’t react in an expected way to the threat. But the “face” reaction takes practice. It doesn’t come naturally to someone who feels truly threatened. And it can be read as defiance, which could escalate the situation.

Still, facing the threat preserves a person’s self-esteem and sense of agency. And for those reasons, it’s worth a try, if you feel it’s safe.

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Breach of Confidentiality

June 2, 2024

One of the things that people who see a therapist dread is a breach of confidentiality. Fortunately, it almost never happens. Therapists have client-therapist confidentiality that forbids it. It’s like the seal of the confessional for priests.

There’s an exception, however, and that’s the Tarasoff warning. Here’s how it came to be.

Way back in 1969, a young woman named Tatiana Tarasoff, a student at the University of California, Berkeley, was murdered. The killer was Prosenjit Poddar, also a student at the university. They knew each other and had gone on several dates. Unfortunately, as happens way too often, the couple had differing opinions on where the relationship should go.

Poddar became obsessed with Tarasoff. She was no longer interested. So he began stalking her. He had an emotional crisis and began seeing a therapist at the university medical center.

So far, it’s a pretty typical story of a relationship, a breakup, and an extreme emotional reaction. However, it soon became much more than that.

One day, Poddar admitted to his therapist that he wanted to kill Tarasoff. (He didn’t refer to her by name, but her identity was clear). The therapist said that, if Poddar kept issuing death threats, he would have to be hospitalized. Poddar stopped coming to therapy.

The therapist was left with a dilemma as to what he should do next.

The therapist and his supervisor decided to write a letter to campus police regarding the death threats. The police interviewed Poddar in the room he shared with Tarasoff’s brother. When Poddar denied everything and said he would stay away from Tatiana, the investigation was halted. The supervisor instructed the therapist to destroy all his case notes.

Of course, Poddar continued stalking Tarasoff and confronted her. When she tried to run away, he stabbed her with the knife he was carrying, killing her. He was arrested, tried, and convicted of first-degree murder (though he had tried to plea-bargain down to manslaughter). He served five years and was deported to his native India.

Tarasoff’s parents sued the university and the therapists on the grounds that they should have warned their daughter about the death threats. The therapists countered with the client-therapist confidentiality argument and won. Later, however, the case was retried and this time, in 1976, the Tarasoffs prevailed.

Since then, over half of US states have enacted “Tarasoff laws.” Others leave the decision up to the therapist. And Maine, North Carolina, North Dakota, and Nevada have specifically ruled that Tarasoff laws don’t apply there. The laws are still controversial. For one thing, the university therapists did call the campus police. For another, it leaves the burden of deciding whether a threat is credible solely on the therapist. And it left it up to the therapist whether to breach confidentiality. And there have been debates on whether Tarasoff warnings should be given regarding threats of physical violence that fall short of murder.

So, what’s a therapist to do? Warn clients that if they make threats, they’ll be reported? That can have the effect of causing the client to leave therapy. Guess—and it really is a guess—whether a threat is real or perhaps a fantasy? Err on the side of caution? Give priority to the confidentiality requirement? Risk a malpractice lawsuit brought by the client if the therapist does report the potential threat? A wrongful death suit for not acting in time?

Which prevails: the duty to warn a potential victim or the duty to preserve confidentiality? And is it a duty to warn or a duty to protect? (These distinctions have been made in some places.) We’ve become used to the phrase “harm to self or others” when it comes to involuntary treatment. But this question goes further. What does a therapist owe to a specific individual who may be killed? Sectioning the client? Reporting the threat to the police? Directly warning the potential victim?

It’s an awful lot to place on the shoulders of a therapist: determine the reality of a threat, make a prediction about future violent behavior, and determine an appropriate response. Weighing patient confidentiality and harm or death to another is a huge burden. But in the interests of there never being another Tarasoff-style murder, I’m coming down on the side of the duty to warn.

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Loneliness Reigns

May 26, 2024

For some of us, those with bipolar disorder, depression, agoraphobia, and anxiety, it’s like the COVID restrictions were never lifted. We remain at home as if we were still sheltering in place. We’ve lost touch with many of the people in our lives. The thin threads of social media aren’t enough to provide solid connections, though we’ve had practice during the pandemic.

There’s also the “reaching out” problem. We’re perpetually advised to reach out to others when we’re lonely or having difficulties. But of course, reaching out is too much to expect for many. Often, we’re not even able to make a connection when someone reaches in. Whether it’s a matter of not believing that we’re really worth someone else’s time or being submerged in misery, the loneliness of depression or anxiety does not allow us to respond.

Lately, though, there have been a lot of headlines and articles saying that America in general is experiencing an epidemic of loneliness. I don’t know about you, but for me, loneliness is nothing new. Depression does that to a person, even if loneliness is not one of the diagnostic criteria in the DSM.

Of course, the articles point out that the loneliness epidemic coincided with the COVID epidemic. People were sheltering in place, many working from home. We couldn’t get out and see our friends or go to school, church, or family gatherings. We missed weddings, birthdays, reunions, funerals. We missed seeing coworkers and friends. We even missed chatting with the people we encountered in our daily lives—nail technicians, servers, sales clerks, plumbers, and all the other people you don’t even think about missing until you miss them. Even our doctors and therapists took care of us online instead of in person.

But that’s largely over. What’s driving widespread loneliness now? Apparently, it’s a chicken-and-egg dilemma. Does loneliness come first? Do psychiatric illnesses? Recent research “suggests a correlation between loneliness and depressive symptoms, with one potentially leading to the other, although the causal direction remains unclear.”

The Journal of Clinical and Diagnostic Research has published a study that says there are three kinds of loneliness: situational, developmental, and internal. Situational loneliness involves environmental factors such as interpersonal conflicts, accidents, and disasters. Developmental loneliness appears with conditions including physical and psychological disabilities. Internal loneliness is associated with “personality factors, locus of control, mental distress, low self-esteem, guilt feeling, and poor coping strategies with situations.” Two other kinds of loneliness have been reported as well: emotional and social loneliness. It seems to me that those are the two that are behind the “loneliness epidemic” that headlines tout. Among the psychiatric and other disorders they say are associated with loneliness are depression, suicidal ideation, personality disorders as well as bereavement, Alzheimer’s, and physical illnesses.

The research is all well and good, but what’s to be done? The usual remedies don’t work very well. The report cited above recommends developing social skills, recognizing maladaptive social cognition, giving social support, and developing opportunities for social interaction. Not much help there. The last two rely on other people to provide intervention, which is obviously uncontrollable by the person experiencing loneliness. And the first two require therapy of one sort or another.

At any rate, the continued advice of the general public remains, “Cheer up,” “Get out more,” and variations on “Get over it,” as if the loneliness were the sufferer’s fault. Antidepressants may help but they don’t attack the root cause of social isolation. There are still social media, which help me a lot. But I interact with various people and groups, which not everyone is able to do. My husband gets me out of the house at times, usually with the lure of a restaurant meal. And that primarily connects me with the person I’m already most in contact with. He’s my social support. I have a high school reunion coming up, with a number of different events scheduled, but so far I’ve only talked myself into the most casual one.

Am I lonely? At times I am. But my loneliness is not the overwhelming sort that attacks many people. There are some ways to ameliorate the condition, but most of them require getting out of the house, which many lonely people are simply unable to do; having good friends who reach in (assuming that we have the wherewithal to reach back; and the long, slow slog of antidepressants and therapy, which may or may not “cure” the problem. Advertisements are beginning to address the problem of loneliness with advice to reach in and talk to friends and acquaintances who aren’t doing well, those these are minimal compared to all the ads for the latest drugs.

Obviously, there are other aspects of brain illnesses that the experts are working on more vigorously. But I, for one, hope that more research and interventions can be devoted to solving the problem, not just defining it.

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Girls and Their Monsters: A Review

May 19, 2024

Their names were Sarah, Edna, Wilma, and Helen Morlok, but they went down in psychiatric history as the Genain quads, Nora, Iris, Myra, and Hester, thanks to papers and books written about them at NIMH, where they lived for a while. NIMH was interested because all four girls developed schizophrenia.

Born in 1930 in Lansing, Michigan, the quads first became famous for the undeniable fact that they were four identical little girls. Their appeal was irresistible (at least until the Dionne quints came along in 1934). Unlike the five Dionne girls, the Morlok girls were not swept away to an institutional setting—at least not yet. They lived at home with their parents Sadie and Carl (who was appalled at their birth, comparing their mother to a “bitch dog”), under the scrutiny of the inquisitive, possessive townspeople around them. They wore identical outfits, of course, and performed tap dance and comedy onstage.

The girls seemed to provide evidence that schizophrenia was caused by a faulty gene or genes. Now, however, psychiatrists are exploring the effects of trauma in contributing to schizophrenia. And the Morlok girls had plenty of trauma. Nowadays, we would say they probably had C-PTSD. Their father was abusive to them and their mother. The youngest and smallest, Helen, came in for particular physical, emotional, and sexual abuse, along with her sister Wilma. Helen’s propensity for masturbation and sex play with Wilma led to both of them being tied to their beds at night and subjected to clitoridectomies.

The trauma continued into their schooling, when the girls were molested by a janitor and a teacher. Helen was considered slow and never graduated high school, but her three sisters did and went on to hold secretarial jobs. All were victims of attempted or actual sexual assault on the job, but were disbelieved or dismissed. Their schizophrenic tendencies may have begun in their teen years, but by the time they entered the world of work, they were having hallucinations and delusions, as well as the very real perceptions that they were still being abused.

The family members were all relocated to NIMH, the National Institute of Mental Health (part of the National Institutes of Health), where they lived, underwent extensive testing, and eventually were treated with Thorazine and other antipsychotics as they became available. Although the quads’ parents had raised them with an extreme fear of romantic relationships and sexuality, some of them found boyfriends at the facility. They were treated mostly by Dr. David Rosenthal, who formed a bond with the sisters and even visited them in Michigan after they left the institution.

One of the sisters, Sarah, was relieved of her symptoms to the extent that she was able to marry and have two sons. The other three lived at home, or independently at times and sometimes with one of their sisters. As of June 2023, Sara Morlok Cotton was still alive, living in an assisted living facility.

The book Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America by Audrey Clare Farley goes beyond the facts of the quads’ lives, however. It also explores the societal trends that affected the understanding of brain illnesses and trauma over the years. The book covers topics including structural racism and the civil rights movement. (Malcolm X’s mother, Louise Little, is featured in the book as a contrast to the Morloks. Little was institutionalized for 25 years when she was deemed incapable of caring alone for her eight children during the Depression.)

The gradual realization that incest and sexual abuse were rampant in society and their effects were decried in the book, as were the religiously repressive ideas of child discipline and the anti-feminist/anti-daycare agendas of the “Satanic Panic.” These societal developments as well as “recovered memories” were implicated in the treatment of those with brain illnesses. And, of course, John F. Kennedy’s legislation regarding community mental health and Ronald Reagan’s dismantling of it highlighted the lack of options for those with schizophrenia in particular.

Girls and Their Monsters also follows the development of psychiatry, from the days when schizophrenia was thought to have a biological origin to latter-day genetic theories that fueled the interest in the Morlok quads. The role of trauma in causing schizophrenia was also discussed. There was no treatment available until the advent of Thorazine, Compazine, and other powerful psychotropics. The role of psychotherapy is not mentioned, largely because of the predominately biological approaches to treatment.

The book covers a lot of territory in its brief pages. It makes for fascinating reading, even if there are no definitive answers. The sisters’ stories provide a mixture of tragedy and hope. Debilitated by their disorder, most of them managed to construct for themselves a life apart from the ravages of schizophrenia. None of them became homeless, and they were never permanently institutionalized. Their lives were difficult, but ultimately inspiring. The Morlok sisters’ struggles show the resilience of the human spirit, even while they lived with one of the most feared and misunderstood illnesses of their—and our—time.

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Anxiety and Big Life Stuff

May 12, 2024

Anxiety about health is a common phenomenon. It’s only natural to worry about the human body breaking down, especially as one ages. But how much anxiety is too much? How little is too little?

When anything goes awry with my body, I get panicky. I catastrophize, imagining the worst. I have anxiety disorder in addition to bipolar, so that’s not surprising.

Once, for example, I woke up in the middle of the night with something strange happening to my arm. There was a hard spot along the side of it the size and shape of a cuttlefish bone. Instantly, I got dressed and headed to the emergency room. They took x-rays (which were ambiguous) and sent me home. If I hadn’t been so panicky, I would have realized that the problem could easily have waited until the next morning or whenever I could get in to see my doctor. But I was frightened and anxious because it was something I had never heard of and couldn’t explain.

It turned out to be sarcoid, which was treated with steroids. (There was also a spot of it on my head, which my doctor biopsied, so I now have a divot on my forehead.) The sarcoid backed off, leaving me embarrassed at having reacted so strongly.

My husband, who doesn’t have anxiety, is just the opposite. He takes injuries and illnesses much more lightly. He’s a bit accident-prone, often cutting himself or otherwise mangling his fingers and hands cooking or doing repair work. I used to have to burst into tears to get him to go for treatment, stitches, or whatever was called for. He would wrap the injury in a paper towel and some duct tape, which I understand is a guy thing. (A heart attack that he almost waited too long to get help for changed his ways. Now I don’t have to cry. He goes to the ER as needed.)

Now, however, we’re facing more serious medical possibilities. I won’t go into Dan’s, since he’d prefer to keep that story private, but it’s Big Life Stuff.

I have plenty of anxiety to talk about. Over the past few years, my knees have been getting worse and worse. At first, it only affected my balance, which was enough to make me anxious right there, fearing that I would fall in public. I started using a cane. I did fall once, at a student union where my therapist’s office was located. A flock of young women (nursing students?) swooped in, picked me up, and offered me a hot beverage. Ever since, my anxiety about falling has increased, exacerbated by a couple of falls at home.

Now, however, I’m facing more serious anxiety. My knees have deteriorated to the point that I need steroid shots every six weeks and am afraid to walk. (The doctor’s words were “bone on bone.”) The steroids work for now but won’t last. Eventually, I’ll have to get both my knees replaced. And that ramps up my anxiety to new levels.

Today, I stumbled on the stairs and my left knee almost gave out. My right knee took up the slack, but I envisioned myself lying in a heap at the bottom of the stairs. Since then, my left knee has been twinging, and I’m doubting its ability to hold up until the next round of steroids.

The orthopedist says I could need the knee replacements anytime from six weeks to six years from now. So, of course, I’m anxious that it will be sooner rather than later. I’m catastrophizing, envisioning weeks lying immobile on the couch, taking pain pills, and unable to care for myself. I understand that the doctor said it might not happen for years, but I’m reacting as if it will be next month.

To me, this is Big Life Stuff, and not just because it’s a major operation (two actually, one for each knee). I fear losing control of my body. I worry that knee replacement won’t help. I anticipate going downhill rather than improving. It’s not that I don’t trust my doctors. I’m just consumed by anxiety. I’m looking at ads for mobility scooters and fold-out chair-beds for my study. I can’t envision a future in which things will be any better.

I’m being crippled with anxiety about being crippled. And no amount of reassurance, education, or time is lessening it.

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Mental Health

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Review: Bipolarized

May 5, 2024

My husband pointed out to me a movie available on one of our streaming services—Bipolarized: Rethinking Mental Illness, a 2014 documentary created by Ross McKenzie, a man who was diagnosed with bipolar disorder himself. In the film, he documented his journey to find treatments other than drugs for his condition. I watched it with interest and wanted to share my impressions with you. (IMDb gave it 5.7 out of 10 and said it “challenges conventional wisdom about mental illness and drug therapy through the raw personal journey of a man diagnosed as bipolar.”)

First, full disclosure: I take psychotropic medication (though not lithium, the villain of this piece) and am very satisfied with the results. However, I know that not everyone has the same experience and that there are people who are virulently against it. I’m not here to debate that today. I want to share what I learned from the movie.

The film follows McKenzie—not always in linear fashion—through his experiences with mental illness, psychotropic medications, and natural treatments. I’ll do my best here to unravel the chronology. The child of a seemingly perfect Canadian family (and more on that later), McKenzie experienced a psychotic break in 1993 when he gave away his money and clothes to street people in New York City and thought he could fly off the Empire State Building and land safely. His family convinced him to come home and were shocked at his manic behavior. At first, he was diagnosed as schizophrenic and hospitalized.

McKenzie escaped from the hospital, barged into a stranger’s house to use their phone, and ended up running down the street naked until he was subdued by police, taken back to the hospital, and put in a straightjacket in a padded room. (I didn’t know they still did that, even in 1993.) These scenes were recreated for the film.

At some point (I’m not too clear on this) his diagnosis was changed to bipolar disorder and he was given lithium. McKenzie became anhedonic, and the doctors told him this was it for the rest of his life—lithium and never accomplishing much of anything.

Determined to get his life back, McKenzie began a journey to heal himself through natural means. In 2010, he went through a lithium detox in Costa Rica. He notes that he had already tried to wean himself off lithium unsafely, making him debilitated and depressed. In Costa Rica, his detox included screaming headaches and vomiting, but was successful in getting him to kick lithium.

Next, McKenzie went to a naturopath who diagnosed him with lithium toxicity (two and a half years after he kicked it in Costa Rica) and prescribed a series of 30-40 chelation treatments to get the substance out of his system. The doctor measured his neurotransmitter levels, his bloodwork, and his kidney function for residual effects of the lithium. He also noted that McKenzie had high levels of lead and mercury (though those don’t come from lithium) and treated him for those as well.

McKenzie then traveled to Colombia, where he was treated by a shaman/psychic/psychic surgeon. It involved lying on a bed for two hours, covered in sheets of aluminum foil which were later bundled up and spit on, and meeting with his deceased father’s spirit. When back in the US, he also sampled cupping, acupuncture, and yoga, which he said helped ground him.

Other scenes in the movie include a parody commercial for “addictarin,” with McKenzie frolicking in a lawn sprinkler and sharing ice cream with a dog, before a crawl of “side effects” ran on and on, ending with death and halitosis. There was a visit with a former big pharma rep who had since denounced the system that she said was designed to addict people to psychotropics. There was footage of a protest outside an APA conference in Philadelphia which included marchers holding signs and chanting, “Hey, hey, APA! How many kids have you killed today?” McKenzie also interviewed debunker Robert Whitaker, author of Mad in America and Anatomy of an Epidemic.

At last, McKenzie saw Dr. Charles Whitfield, who said that half of patients with a psychiatric history of drugs and trauma actually have PTSD. Whitfield said McKenzie was never bipolar. Another practitioner, Peter Levine, a somatic therapist, worked with McKenzie in front of an audience to explore his family of origin and surface memories of his domineering, abusive father. One exercise involved imagining both himself and his father as seven-year-olds interacting.

The film, although it won awards, was not universally lauded. A review by H. Steven Moffic in Psychiatric Times titled “Warning: This Movie May Have Psychiatric Side Effects,” called the film a “movie selfie” and pointed out that there was no mention in it of conventional psychotherapy—only drug therapy. It also noted that no mention was made of McKenzie’s family’s evident privilege, which allowed him to travel to Costa Rica and Colombia for treatment. Most of the review, however, cited the film’s polarizing effect, pitting alternative treatments against mainstream ones, and said that he would be “very cautious” about recommending it to patients or the public. (I can’t imagine who else would be interested. Maybe psychologists?)

All in all, it was a difficult documentary to watch at times, and I thought some of the treatments seemed unlikely to help (especially the “psychic surgeon”). I’ve heard most of the debunking of psychotropic drugs before, but this was particularly vivid in the film. I think its major value lies in exposing the traumatic effects of McKenzie’s going on lithium in the first place.

Ross McKenzie now offers “mental health coaching services,” and, as stated in his 2024 blog, specializes in people “disempowered by labels” whose “perceptions were distorted by powerful psychotropics.”

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Mental Health

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