Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

Book Roundup

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Tangentially Related

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

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

• Books I Don’t Recommend

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

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

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Men and Mental Health: Two Stories

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

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

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

• Share mental health resources and benefits.

• Normalize help-seeking behaviors through leadership modeling.

• Highlight intersectional perspectives on masculinity.

• Encourage open, stigma-free conversations.

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

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

Owen’s Story

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

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

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

Franklin’s Story

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

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

Seeking Help—Or Not

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

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

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

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

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Was My Family Dysfunctional?

Clockwise from left: my father, my sister, my mother, and me

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

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

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

First, we need to look at some definitions.

What Is a Dysfunctional Family?

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

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

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

But are those the only kinds of dysfunctional families?

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

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

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

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

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

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

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

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

• The emotionally unavailable family.

• The family of addicts and enablers.

• High-conflict and abusive families.

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

Was My Family Dysfunctional?

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

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

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

All in all, I’ll take it.

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A New Addiction

You see a lot in the news these days about gambling addiction, particularly since there are booming sites for online gambling, prediction markets, and sports betting platforms.

Digital gambling can rise to the level of an addiction. And addiction, as the DSM tells us, is a disorder. You can have a narcotics abuse disorder or an alcohol abuse disorder. In both of those disorders, you use something—alcohol or drugs.

But gambling addiction is different. You aren’t consuming any substance. You’re performing a behavior—risking money on an outcome. It shares all the characteristics of gambling, however: risk, reward, and uncertainty.

How Digital Gambling Addicts You

Gambling addiction, and especially digital gambling addiction, works by using some of the same strategies that other addictions do, and some that are specific to technology. Here’s how apps that appeal to kids turn into digital casinos:

Solitude: Most often, it’s just you and the machine. The social cues that tell you to stop aren’t operative. This is particularly true of children, who often play gambling games online, alone in their bedrooms. That encourages, if not addiction, at least problematic usage,

Continuousness: Gambling apps provide endless content that plays automatically. The slot wheels keep turning, and the card games keep going. Other online games trap you with continuing levels and new, open-ended content. The player wants more and more stimulation and continues playing.

Speed: The faster you play slots, the longer you gamble. It’s a lot like other social media. Scrolling through new content makes it difficult for you to stop. Infinite scrolling accelerates the presentation of more content in a feedback loop.

AI: When you play against an AI system, it feeds you what you’re interested in and teases you with promises of more and new content. However, they don’t give you exactly what you want. Instead, they tease you with something close to what you want, and you keep playing to reach the reward.

Brain chemistry: When you do win, even a small amount, your brain receives a hit of dopamine, and you feel good. The sensation of winning just makes you want to play more.

Money: Online sports gambling, in particular, offers the possibility of winning actual money on the outcome of games or even plays within those games. It’s the same as the promise held out by the stock market. If you’re really quick and clever, you can reap rewards. And literally anything can be bet on. Recently, a man with insider information won $400,000 by predicting when a world leader would be toppled.

These factors combine to create a state in which a user is metaphorically glued to their device. You lose track of place and time in a kind of dissociative state that is difficult to break free from, especially for children.

The Companies That Run the Games

Online gambling really took off during the COVID pandemic, when people were sheltering at home with limited choices of amusement other than their computers and smart phones. And it has snowballed from there.

What to do about this “public health crisis,” as gambling addiction has been called? “You regulate the distribution, the speed, the type, the access to the product, because the product is what’s dangerous,” Harry Levant, director of gambling policy at the Public Health Advocacy Institute (PHAI), has said, calling for gambling to be treated like alcohol or tobacco. “The problem is the product, not the people.”

There are consequences for the players, but now there are starting to be consequences for the purveyors of online gambling and addictive digital pastimes. Both Meta and Google were tried and found liable for endangering children via their addictive products. They’re appealing, of course.

But the cases have put parents on notice that their children may not be doing homework alone in their darkened rooms. In addition to harassing classmates and posting nude pictures, they may be playing addictive games, either with points or money as the reward. If it’s money that gets exchanged, parents need to keep their credit card information secure. There have been cases in which children have lost thousands of dollars of their parents’ money playing online games. And the game companies have been notoriously indifferent to pleas for restitution. They claim that players have to be a certain age, and that they know they are spending or risking money in order to play.

Some of their “clients” have started as early as middle school. “If I had a bad day I’d gamble. If I had a good day I’d gamble,” one said. “Gambling was my best friend.”

What can be done about online gambling addiction? “If they come into the office, we do what we do for any other addictive disorder,” Dr. Timothy W. Fong, clinical professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, has said. “We do psychotherapy, we have Gamblers Anonymous, we have medication, and strategies to get people to work hard on their recovery, where their addiction can be contained.”


 

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What Is Intimacy?

The first thing you probably think of when I say “intimacy” is “sex.” That’s natural. Most people do. Sex is a particular kind of intimacy, but it’s not the only one. Others can be just as intoxicating, fascinating, and compelling. They can be a great way to bond with another person and provide fulfillment.

You may think that treatment for mental illness will take intimacy away from you. I’m here to tell you that you can still have intimacy with another person. It may or may not be sexual intimacy, but it’s valuable all the same.

Intimacy is a bond between two people. While it can be caused by sexual attraction, we all know how quickly a sexual bond can fade or disintegrate. Sometimes, a couple can have another form of intimacy once sexual intimacy is no longer possible. And, of course, there are couples who can maintain sexual intimacy until quite late in life.

Another way you can bond in a kind of intimacy is through shared trauma. As the saying goes, shared pain is halved and shared joy is doubled. The trauma doesn’t have to be a natural disaster, though that can certainly bond people who show kindness to each other. Once, I was sitting next to a man at a concert when a song touched a deep nerve and made him dissolve in tears. I reached for him and held him until the song was over. That started a deep friendship that has lasted for decades.

I’ve also found that shared symptoms can lead to a kind of intimacy. If both of you find your legs twitch when you’re not paying strict attention to stopping them, if you’re taking the same medications or have the same adverse reactions to them, or if you’ve both been gaslighted, you can find yourself exclaiming, “Hey! You too!” It helps to know that you’re not alone in your pain.

Humor, especially dark humor, is another way of sharing intimacy. It’s that shared joy principle. One way that’s worked for me and others is to use quotations from funny movies or songs—Young Frankenstein, Monty Python and the Holy Grail, Buckaroo Banzai, and Weird Al Yankovic are among my go-tos. Puns. Bad jokes. A good, shared belly laugh is a powerful bonding experience. It can lead to endless conversations that reveal lots about another person.

Some couples who have explored these alternative kinds of intimacy find they can live without traditional sex or can find sexual fulfillment solo. Those are valid choices, too. Even people who have sex with a partner can use sex toys and other aids from time to time. They’re easily available on the internet, so you don’t even have to go to a potentially embarrassing sex shop.

Of course, you might point out that these kinds of intimacy require meeting people, and going out may be something that frightens you. Fortunately, technology provides answers. With telephones, computers, and the internet, you don’t have to be in the same room with another person to develop intimacy. You can even turn off your computer’s camera so your new friend won’t see you. I’ve corresponded with a kindred soul via old-fashioned snail mail. And it’s something you can work on with your therapist if non-sexual intimacy is your goal.

If sexual intimacy is what you want, however, you can start with these techniques and work up to the big event. Having a solid foundation for touch, foreplay, and sex will make the process go more smoothly. Leaping into a sexual relationship without exploring other kinds of intimacy can leave you open to disappointment, a mismatch of sexual styles, and a devastating ending. Taking your time and finding a partner who doesn’t pressure you for sex will help you achieve sexual fulfillment when you are truly ready for it.

Intimacy with sex? That’s another topic for another week.

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Was My Ex a Narcissist? Maybe Not

I know I’ve said my ex was a narcissist. His pleasures and interests were the only ones that counted. If I said that I liked something, like a certain style of music or kind of food, he said, “Eat shit. Fifty million flies can’t be wrong.” He talked about how important his honor was. He invented something that I would collect, just so he could pre-select gifts for every occasion. To quote the song “My Baby Thinks He’s a Train,” “He dragged me ’round just like an old caboose.”

But was he a true narcissist or simply a self-centered asshole?

Well, he was never diagnosed as a narcissist. The only time he saw a therapist was when we went for couples counseling. He aligned himself with the therapist. He made it seem like I was the crazy one, and he was only there to help me because he loved me so much. (That was gaslighting, not narcissism.)

And that’s an important point. Only a psychiatrist can diagnose a true narcissist: someone who has narcissistic personality disorder.

What’s Narcissistic Personality Disorder?

The Diagnostic and Statistical Manual-V (DSM) has a list of criteria that add up to Narcissistic Personality Disorder. There may be changes in the DSM-VI, currently being written, but for now, in order to be diagnosed, a person has to exhibit:

A pervasive pattern of grandiosity, need for admiration, and lack of empathy, as well as five or more of the following behaviors or traits:

grandiose sense of accomplishment

My ex: Check. Always had to be the smartest person in the room, though he never completed his doctorate. Thought his middle name, Albert, was a reference to Einstein.

preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

My ex: Probably not. Content with a public service government job; bounced from relationship to relationship.

believes that he or she is “special” and unique and can only be understood by or should associate with other special or high-status people (or institutions)

My ex: Pretty much. Only associated with neighbors who could do something for him; felt others had lower status.

requires excessive admiration

My ex: Check. Wanted to be known as the smartest, funniest, most talented, skillful, and well-loved.

a sense of entitlement

My ex: Not sure. Regarding sex, intimacy, and attention, yes. In other ways, not so much.

interpersonally exploitative

My ex: Big check. Put people in “can’t-win” situations.

unwilling to recognize or identify with the feelings and needs of others

My ex: Check. See above.

envious of others or believes that others are envious of him

My ex: Not really, or didn’t say so.

arrogant, haughty behaviors and attitudes

My ex: Check. Corrected others’ pronunciation; got to define “quality” for others.

Explanations

By those criteria, my ex might qualify as being among the 1% or 2% of people who have a Narcissistic Personality Disorder—if diagnosed as such by a psychiatrist, not through the lens of only one person—me—who is not truly qualified to assess him. I can’t truly say that he had the Narcissistic Personality Disorder, only that he exhibited some narcissistic traits when I was with him.

There’s a possibility that we were simply incompatible, or that I exhibited unhealthy traits too, or that he was fine in relationships with others, or that he was simply a selfish asshole and nothing worse. If you were to believe social media, 30% to 40% of bad relationships were caused by a narcissistic partner.

There are different degrees of bad behavior. A person can be a gaslighter without being a clinical narcissist. They can be abusive. They can be cold and unforgiving. They can behave so badly that you think of them as abusive or narcissistic. None of those are good things. But calling someone a narcissist is giving them what is essentially a meaningless label, or at least one that says, “I suffered when I was with them.”

So, I did suffer. My ex treated me and others badly. But as for his being a real-life Narcissist, the jury remains out.

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Global Wins for Mental Health

Most of us know quite a bit about the U.S. mental health system, if it can be called that. We know about its successes and its failures, its help and its harm, and its practitioners and patients. But what about other countries? What large and small actions do they take to help people with psychiatric symptoms or disorders in their countries?

First, we know that approximately 78 countries around the world have socialized medicine or some form of universal health care that includes psychiatric services. Some have reported long wait times to get help, but others are easier to access. Most psychiatric drugs are subsidized. And the societies function in ways that foster mental health. Let’s look at a couple of programs that seem to be working.

Denmark

Denmark has a program designed to fight the stigma that accompanies mental disorders. It’s called One of Us.

Giuseppe Parlatore, who lives with paranoid schizophrenia, felt the stigma himself when a former teacher assumed—and said to him—that he must be either self-harming or violent and dangerous to others. He felt shame.

Parlatore, who was diagnosed in 2009, has worked hard to cope with his symptoms and carve out a life for himself. Now he is a leading mental health advocate, working with officials to lessen the stigma of mental disorders.

One of Us works with people called ambassadors, who have mental illnesses, to work with schools, police, and hospitals, sharing their stories and focusing on recovery. The emphasis on hospitals and police, they feel, is necessitated by the fact that personnel mainly see mental patients when they are in crisis rather than when they are coping better with their illnesses.

The Danish Health Authority also has a department of prevention and inequity. Anti-stigma campaigns are a part of the Ministry of Health. They hope to see lasting effects among the population, rather than just short-term upticks in awareness. The Danes see social contacts as more likely to change opinions than education alone.

Still, the battle against stigma requires persistence. Parlatore says that for him, it’s a “generational project.”

Japan

In Japan, there is a thing called kodokushi or “the lonely death.” The population of Japan is aging, and many older adults have little to no social contact. They can die alone and not be discovered for a long time. Social isolation leads to stress and loneliness. But a program designed to encourage physical health is having an effect on the elderly people’s mental health as well.

The “yogurt ladies” started as a way to promote health by selling yogurt to households. They were easily identifiable by their blue uniforms and bicycles. They succeeded very well in making people aware of gut health.

But gut health is also related to stress and chronic loneliness, two factors affecting mental health. Social isolation is, in turn, involved with gut microbiome diversity.

Loneliness is taken seriously in Japan. The government even includes a Ministry of Loneliness, as well as a task force on social isolation. The yogurt ladies provide weekly check-ins, a friendly face, and a chance to interact with someone. They see themselves as people who look out for others. Their services are a practical factor in maintaining gut health, but they perform an important function in reducing social isolation and preventing the “lonely deaths.” The lift they provide weekly is an important factor in maintaining mental health for the aging population of Japan.

Why don’t we have programs like this in the U.S.? I think you know the answer.

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Self-Care Definitions

It used to be that when you said “self-care,” you were talking about spa days, shopping sprees, mani-pedis, indulgent desserts, or wine tasting. Or, as Marge Simpson so eloquently put it while ensconced in a bubble bath, “a banana fudge sundae! With whipped cream! And some chocolate chip cheesecake! And a bottle of tequila!”

Pretty quickly, that definition of self-care was recognized as a bougie, upscale fantasy available only to a wealthy person. Not to say that it isn’t relaxing or restorative, but it’s clearly not for the majority of those overwhelmed, traumatized, or otherwise suffering psychologically. They need something more than a beauty regimen and a spending spree.

A Better Definition

The next definition of self-care adds up to basic physical health and hygiene. You know, all the things you’re supposed to do to lead a healthy life: eat right, hydrate, get enough sleep, take showers daily, walk daily. And the things we’re supposed to do for mental health and hygiene: get outdoors, reach out to friends and family, take your meds, exercise, go to therapy, journal, practice affirmations.

All those actions and activities can help your mental health, it’s true. But they work best if you’re already fairly stable. There have been times in my life when all I could do was eat Cocoa Puffs and take my meds. When you can’t even get out of bed, telling you to get out of bed isn’t likely to work. It can even make you feel worse because you know you should do those things, someone’s telling you to do those things, and you’re so deep in the hole that you can’t do those things. Then you beat yourself up for that.

The Self-Care Box

I think that when it comes to self-care, you should start small. When you do begin to see a ray of light, take note of the things around you: comfort objects, things that have distracted you and pulled you out of your misery for even an hour or two in the past. Surrounding yourself with these items or knowing where to find them is, to me, a valid form of self-care.

I’ve seen recommendations that you prepare a self-care shoebox containing the things that soothe your five senses: ones that you can touch, taste, hear, see, or smell. That’s a good idea, but the things that soothe me don’t fit in a box, especially my blue blanket, my cat (just try to put a cat in a box not of his own choosing), a DVD player, and discs of The Mikado, The Pirates of Penzance, and The Three (and Four) Musketeers. I could probably fit a bag of ginger snaps in a self-care sensory box.

Instead, I just make sure I know where these things are. They’re all in my study (except sometimes the cat), which is, in effect, a large sensory box itself. My husband knows my self-care regimen and steps in as needed to provide the items I don’t have. And, after I’ve restored myself a bit, he’ll try to coax me out of the house with the promise of lunch at a favorite restaurant. Or even Waffle House, which is very close by and doesn’t require much effort, like getting out of sweatpants and into a skirt.

If you don’t have a study, keep your comfort objects in one room of your house: bedroom, living room, basement, rec room, or wherever. The important thing is to know where to find them when you need them.

Today’s Self-Care

I do journal, or at least I write in my blogs and post them weekly. When I’m overwhelmed, my schedule keeps me tied to the world. I know I have to have something written by Sunday at 10:00 a.m. It motivates me to get out of bed and kick my brain into gear. It’s less random than journaling, which can easily fall by the wayside. And if I’m still depressed, anxious, or overwhelmed, I can write about that. Thanks to my bipolar disorder, I have a ready supply of topics.

Right now, today, I have my blue blanket and my word processing program. The cat is in the doorway and likely to curl up on my comfy chair or my lap and sleep. I have a bag of ginger snaps on my desk and more nutritious things like fruit within easy reach. I’ve taken my morning pills, which live in a bag that hangs on the doorknob near my bed. I’m set for the day. I don’t need cheesecake or tequila.

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AI and Mental Health Concerns

I read a lot of news and commentary regarding mental health and mental illness. There are sources I return to again and again because of the quality of their reporting and the consistency with which they address difficult topics. Two of my favorite sites for timely information are The New York Times and MindSite News.

Here’s a brief look at what they’ve published recently on the topic of AI and how it impacts mental health.

AI as Therapists

AI in general, and chatbots in particular, are being used to assist human therapists or even take their place. It’s true that therapy bots and chatbots are available whenever a person needs their services. There’s no waiting for an appointment.

But what is happening during those “sessions”? Many of the therapy bots use “generative AI,” which means that they can answer questions with output they have gleaned from thousands of input sources available throughout the internet. There is at least one therapy bot, however, that uses responses that have been vetted by actual human therapists. It’s designed to provide discussions of a problem or emotion between in-person appointments. The user gets a hybrid therapy experience that includes follow-up questions, affirmations, or short lessons.

General-purpose chatbots like ChatGPT can respond to sensitive questions about topics such as self-harm with responses that may encourage such behavior. Teens have found ways to avoid the safeguards that chatbots are supposed to have regarding these topics.

One thing that therapy bots cannot do is offer a diagnosis. They may be better used for persons with mild symptoms.

Chatbots as Friends

AI chatbots can also take the place of sympathetic friends who can provide connection and conversation. Paradoxically, however, this can lead to greater isolation for users whose human contacts are replaced by AI. You can’t share a meal with a chatbot, although you can chat virtually on your phone while you’re in a café. (Not that I recommend this.)

Some chatbots provide companionship as they have conversations with users who feel isolated. There are drawbacks, however, as some of the bots offer paid upgrades to the program or in-app purchases, including “gifts” for the online “friend.”

AI and “Brain Rot”

“Brain rot” has become a euphemism for over-reliance on technology, including computers, smartphones, video games, and especially social media. While most of the concern is focused on children and teens, adults can be afflicted with brain rot as well. After all, grown-ups spend time online for work, communication, recreation, research, news, and other purposes. The working definition of brain rot is a condition of “deterioration of a person’s mental or intellectual state,” or associated with “engaging with low-quality internet content,” without reference to age.

Media, especially short-form video, can reduce a person’s attention span and lower academic performance. Interaction with social media has also been associated with emotional conditions such as depression, anxiety, stress, and loneliness. Experts warn that, so far, they’re talking about correlation rather than causation. That is, they haven’t proven that absorbing short-form video causes the negative results regarding reading, memory, and language, but it is associated with them.

Other Hazards of AI

There have been reports that a few people who use chatbots begin to suffer from delusions. Where before, a person might have eccentric thoughts, using a chatbot can escalate the person to paranoia, for example, or psychosis, suicidal thoughts, or even violent crimes.

ChatGPT faces lawsuits related to harmful outcomes when people use it. While the percentage of people experiencing these ill effects is small, the sheer number of people who use ChatGPT means that the number of people experiencing psychosis or mania may be quite high.

Other, less dire effects are also possible. People who live with anxiety, depression, or OCD can find that the chatbot may provide validation for their symptoms rather than encouraging them to face their problems. A chatbot can also fuel grandiose thoughts by reinforcing them. Or a troubled user may come to rely on the chatbot to help them calm down, which is less healthy than addressing the source of the person’s anxieties.

Of course, chatbots have many positive uses, and not all interactions with them will lead to problems. But both children and adults should monitor their use of chatbots to make sure they aren’t going too far “down the rabbit hole.” A “digital detox” can be good for both adults and children.

If you’re interested in exploring topics like these, you might want to consider subscribing to MindSite News at mindsite.org.

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Unpaid Drug Reps

Eight years ago, I wrote a post about how I despise TV commercials for psychiatric drugs. The New York Times has caught up with me. On February 16th (updated on the 17th), they published a story titled “Should Drug Companies Be Advertising to Consumers?” The article concentrated on drugs advertised to seniors, but what they said holds true for psychotropic drugs as well.

The problems of drugs advertised directly to consumers started in 1997, when regulations covering drug ads were loosened. Until then, drugs had been advertised to doctors who were going to be prescribing them. Then, print ads appeared in magazines and journals targeted to prescribers. In addition, drug reps visited doctors’ offices, handing out drug samples and literature, along with tchotchkes decorated with the drugs’ names. The reps also often brought carry-in lunches for the whole office and sometimes wooed particularly influential doctors with golf outings and other gifts and junkets.

That system had its drawbacks, it’s true, but so does the new one. When it was first allowed, drug ads appeared in consumer magazines, often as multi-page fold-outs because so much information about dosages, effects, and side effects had to be included.

Before long, however, the drug companies started to take advantage of television and the internet. And take advantage they did. As the Times reported, last year, “total spending on direct-to-consumer advertising of prescription drugs topped $9 billion.” Only New Zealand and the U.S. permit direct-to-consumer advertising.

The result is that consumers have become drug reps. The TV ads say, “Ask your doctor if Drug X is right for you.” What happens instead is that patients come in to their doctor and say, “I want Drug X.” And if the doctor doesn’t comply, the patient moves on to another doctor who will provide the requested drug. Instead of investing in a flock of drug reps, the pharmaceutical companies are investing in advertising that replaces many reps with many consumers who know much less about the drugs. In effect, the patient has become the drug rep, trying to influence the doctor to use a particular medication.

TV drug ads are sophisticated. Even the psychotropics have songs and slogans and color palettes, just like the ads for other drugs or indeed, soft drinks or cruise lines. Even the much-touted antidepressant Caplyta, which has had some of the slickest, most attention-grabbing ads, uses the song “This Little Light of Mine,” with slightly altered lyrics. Austedo, for tardive dyskenisia, features the slogan “As You Go With Austedo.” Cobenfy ads, for schizophrenia, sing, “Imagine What You Could Be. Cobenfy.”

The commercials do have recitations of the possible side effects, which are accompanied by tiny type on the screen. Often, the side effects seem to contradict what the drug is for: a bone-strengthening pill has a side effect of “unexpected thigh-bone breaks”; depression and bipolar meds have side effects of suicidal thoughts; one for tardive dyskinesia warns of “body stiffness, drooling, trouble moving or walking, trouble keeping your balance, shaking (tremors), or falls.” And there are other warnings: potentially fatal skin rashes (most likely Stevens-Johnson Syndrome), for example, or harm to an unborn baby.

The manufacturers probably count on the consumers not reading the tiny warnings. (The voice-over sometimes says, “These are not all the possible side effects.”) An ad will say, “Weight gain is not often seen,” but the tiny type says how much weight gain in mathematical terms such as “<.27 percent” that can be confusing to a layperson. If you read the type, you can also find that, for example, other side effects are not mentioned in the lists of possible outcomes. (“You should ask your doctor about these and other possible side effects.”) Some of the studies they quote seem to have reported results after only five weeks–not that the public can be expected to know the scientific niceties. I’m aware that I don’t understand them all myself. There may be aspects I’m not catching.

At the end of a psychotropics commercial, the now-stable person/actor/model engages in a variety of pursuits: being outdoors, playing with children or grandchildren, playing guitar, or taking painting lessons. There’s no indication that the meds may not work without an additional drug or drugs, that they may take six weeks or more to begin working, or that they may have no effect at all. In short, the TV commercials build unrealistic expectations for wonder drugs.

Certainly, many people have found that a drug or “cocktail” of drugs has alleviated their symptoms, though not cured the underlying disorder. I’m one of those people. But my information about my medications came from my doctor, not an advertising agency.

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