Bipolar - Just Get a Little Self-Control

I posted something about bipolar the other day and was shocked to get back two of those "it's not real, they just need to pull themselves up by their bootstraps and get a little self-control responses. God help the people who said that. It's like telling someone with cancer to just grit their teeth and stop having cancer.

That attitude, all too common in the Christian community is just so entirely wrong that I can't find words to express how appalled I am at that attitude. I've worked for 40 years with people with mental illness and other disabilities. I have two immediate family members with bipolar disorder. 

And I'm here to tell you that bipolar is a physical disability. It affects the mind, but it has physical causes. Imagine, if you will that you lost control of your emotions. One minute you are depressed, another you are angry and another you are exhilarated and it has absolutely no relation to what's going on around you, other than that stress can trigger the onset of a new fresh emotional hell. Your mind searches for a reason for your anger, depression or exhilaration. The emotions are entirely a response to chemicals in your physical brain. 

The brain of a person with bipolar or schizophrenia or Asperger's for that matter, inexplicably shoots out neuro-transmitters that trigger often violent emotion, delusions or voices in your head if you're schizophrenic and YOU HAVE LITTLE OR NO CONTROL OVER IT. I have a child in prison because he felt "better" on his meds so he decided to stop taking them and then confessed to a crime he didn't commit because he thought he could save a child by manipulating the legal system and in his deluded state thought he could get away with it. My wife deals with the side effects of medications she has to take to keep from experiencing wildly fluctuating emotions that confuse her mind and impair her judgment.

Carrie Fisher made her struggle with
bipolar very public hoping to help
others escape the stigma of mental illness..

Just because you cannot see a wound or find a tumor on x-rays doesn't mean there's not something wrong. To say that people with bipolar should just pull themselves up by their bootstraps is simply ignorant. Humans do not possess a disconnected "soul". The soul resides in the organic machine that is the brain. When God made man he first made a body from the clay and then breathed life into it. Only then did man become a "living soul". If the machine is messed up, the soul is in trouble. That Psalmist said, "He knows our frame. He remembers that we are dust."*

Most people with mental illness no longer have any bootstraps to pull themselves up with. Some mental conditions CAN be treated with behavior change, abstinence from drugs or alcohol or talking therapy in the same way we can fix a computer by reinstalling the software or moving the magnet away from our hard drive. Medication is a crapshoot at best because what's going wrong in the brain varies from person to person and there are no X-rays, CT Scans, MRIs or PET Scans that can detect anything other than secondary level effects.  

For instance, with kids who have true Attention Deficit Hyperactivity Disorder (and there are other disease including bipolar which mimic ADHD), a PET scan reveals lowered levels of glucose in the attention centers of the forebrain. They don't know what causes this and the only treatment they have for it is to administer stimulants which logically should make it worse. It doesn't. Stimulants like Ritalin and Cylert re-energize the brains attention centers and help the person with ADHD to focus and from there to "have a little self-control".

Self-control, talking therapy and "good discipline" only work if the underlying hardware (the human brain) is functioning properly. It's like trying to install new software on a damaged computer. If the organic hardware that is the brain is not working properly, often the best you can do is try medication, therapy and other work-arounds to achieve the best quality of life possible under the circumstances. It's unlikely, however, that you're going to fix it. You can slap a patch on your leaky lifeboat while you are at sea, but don't expect it to be able to take a lot of pounding from the sea.

Even medications are not all that accurate in treating specific conditions because we cannot see inside the living brain to find out what bit of it is not working and we do not have the ability to fix the delicate mechanisms of the brain. The best we can do is cut out tumors, but there aren't any surgeries available to "fix" bipolar. You can only diagnose it by its symptoms. It's kind of like trying to fix your car's engine without opening the hood or taking the engine apart. 

Other attempts to mechanically cure mental illness through surgical means have resulted in some horrific solutions like lobotomies and electro-shock. These do violence to the mind. It's like using a hand grenade to clean out your closet. Such radical solutions may make the person more compliant or less violent, but the mind is irrevocably altered in the process.

With bipolar and other mental illness with a brain defect of some sort as the cause, all you can do is try different medications until you find one or a combination of meds that give the person some relief.  For example, if your computer has a defect on the motherboard, the software won't work properly however much you want it to. If you have a defect in the brain, no amount of gritting your teeth or efforts at "self-control" will work effectively to make it go away. The best we can do is create some sort of chemical workaround or some intense therapy that works around the problem. The defect doesn't go away, though. It remains there lurking in the background for the rest of a person's life. It's why addicts say they are never cured. They're only "in recovery". Addiction, however it's caused, makes physical changes to the brain that you will have to deal with the rest of your life. The brain is too complex for mere humans to dig around in it to fix the problems. The best you can do is to try to control the neuro-chemicals through medication and fix the damage through therapy. It's tough to do.

There's a reason Robin Williams played mentally ill people so well....
The landscape of mental illness was all too familiar to him.

The #1 side effect of uncontrolled bipolar is suicide. Bipolar isn't a made-up excuse for bad behavior. It's a real disorder. It can be traced genetically through multiple generations of families and you better pray to God you don't have the genetic marker for it yourself, because one day a physical or emotional trauma may trigger full blown bipolar disorder. Left untreated or left for the person to pull themselves up by their bootstraps, bipolar may drive you to the point that one day you find yourself sitting in a porta-jon on a California beach with a shotgun in your mouth like a former preacher/evangelist and good friend of mine did. He did not survive. My wife's uncle did not survive his final bout with bipolar. He went to bed, rolled over to face the wall and starved to death in that position. Her niece's life is a wreck because of her bipolar. We've been to the ER and mental hospitals five times with my wife's bipolar. She's not a bad person. She's just overwhelmed by it from time to time. 

A lot of famous people have successfully coped with bipolar and some not so successfully. A lot of them have lost or ruined their lives as the disease progressed. Earnest Hemingway killed himself. Mel Gibson's disastrous bipolar psychotic breaks are famous and nearly ruined his career. Robin Williams killed himself. People like Winston Churchill, Ben Stiller, Catherine Zeta-Jones, Richard Dreyfuss, and Jim Carrey have all struggled with bipolar. You can also add Vivien Leigh of "Gone With the Wind" fame, Carrie Fisher, whose youthful drug abuse has been tied directly to attempts by the actress to self-medicate her then undiagnosed bipolar, Jean Claude Van Damme, Linda Hamilton, Vincent Van Gogh, TV journalist Jane Pauley, Marilyn Monroe and Patty Duke all have struggled with bipolar disorder. The disease is often fatal if untreated and unmonitored.

So before you tell someone else that's sick to pick up their bed and walk, please make sure you are Jesus! And remember, Jesus first healed the demoniac's mind BEFORE he healed his soul.

© 2017 by Tom King
 *Psalms 103:14 

Psychiatry does NOT Kill: Stupid Internet Videos Kill

Not everyone who hangs out their shingle
on the Internet knows what they are
talking about.

Okay, can you tell I'm angry? I just saw a video entitled "Psychiatry Kills". The premise is that the medicines psychiatrist give are all bad and you should get off them. The trouble is, rather than trust a highly trained physician with years of study and research behind him, you're going to trust a lot of anecdotal "evidence" from a group of people that the video says, quit all their meds "cold-turkey".

EXACTLY WHAT THEIR DOCTORS WARN THEM NOT TO DO!

Here's what happens when you quit a psychotropic medication cold turkey.  First, you start going back into the depressed, panicked, schizophrenic or whatever state you were in that caused the medication to be prescribed in the first place. Second, the change in neurochemistry in the brain caused by the sudden stopping of your meds triggers all sorts of brain neuro-transmitters to either shut down or kick into overdrive giving you the equivalent of a very bad LSD trip.  So every story in this video (and no I'm not going to give you the link to some advice that can kill you, so don't ask), is based on someone doing what their doctor told them not to and in many cases probably because the person saw one of these scary videos about evil Big Pharma and decided some anonymous Internet video cares more about them than the physician you are paying to look out for your health.

Do psychotropic meds sometimes cause side effects?  YES.  You see, you can't peek inside the human skull when the patient is alive to see what's causing his mental problems. That would do more damage than good (remember lobotomies).  Diagnosing psychoses is a very much working in the dark process. We can only diagnose by observing behavior and listening to you tell what is wrong.

If you do a lousy job of telling the doctor what's going on in your head or if you spin the story to make it sound worse or sound not so bad, you will almost certainly get the wrong medication the first time out.  That's how psychiatry works. It's a partnership between patient and physician. He is not a magician. There are no magic words he can say nor magic pills he can give you, especially if he doesn't get good information from you. If you don't tell your physician what is going on, you probably are going to have a bad experience.

The truth is that the chances of the first medication you try working for you are pretty slim. That's because the causes of many mental disorders cause symptoms that look pretty much the same. One pill may work great for one kind of depression and be really bad for another kind of depression.

And yes, not every depression is exactly the same and cannot necessarily be cured by the same treatment.  I know people expect doctors to wave their magic prescription pad and cure their problems, but it's not that easy.

Think of the doctor/patient relationship as a collaborative research partnership.  Here's an example.  My grandmother's physician prescribed a powerful anti-biotic for an infection she had.  Just after she started taking it, she had a terrible panic attack. I was in grad school at the time and so the first thing I did was ask if she was taking any new medications. I'd never heard of an anti-biotic causing panic attacks, so I went down to the pharmacist to ask about side effects (this was pre-Internet).  Sure enough one of the side effects listed was panic attacks.

We called her general practitioner and he prescribed valium for her anxiety. It didn't work and the problem escalated. She was so freaked out, she was afraid to drink water. Fortunately, at school I had access to Medline and looked up some info on panic attack. A doctor in Shreveport had done some work on panic attacks and noted that anti-anxiety meds don't work on severe panic when used alone. He recommended pairing it with an anti-depressant and had shown good results with a combination treatment.  I went down to the doctor's office (his secretary wouldn't let me talk to him). I ambushed him as the office was closing, told him about my grandmother's problem and showed him the research I had found (he was not a psychiatrist, remember).  He said he'd take a look. He called me a couple of hours later and told me I was right. He prescribed an anti-depressant to go with the valium and once we convinced my grandmother to take it, she got better immediately and within two weeks, just like the research said, the panic attacks were totally gone and she was able to quit the meds as she should have.

Treating mental illness is a tricky process. There are no instant cures. If you are lucky and diligent to give the doctor good information, you may get the right treatment the first time, but don't count on it. If you have bad effects from the medicine, tell the doctor and he'll try something else. Trying a lot of different meds doesn't mean you've got a bad doctor. On the contrary it may be a sign that you have a very good doctor.

Here is some advice for those of you with mental illness who are taking or considering taking psychotropic meds like anti-depressants, anti-anxiety or anti-psychotic medications:

1. If you need psychotropic meds see a psychiatrist: If the problem is severe, you may need to see a psychologist too. A psychologist will test you to find out what's wrong. A psychiatrist handles medication.  Either may send you to a counselor for talking therapy if that's appropriate.
2. Trust your physician:  Take the meds as he or she tells you to. Don't fiddle around with the dosages or times you take them. Doing that can cause some side effects or mess up what the drug is supposed to do.
3. Choose a treatment partner:   Your spouse is the best or a parent or adult child who lives with you. That person needs to know what you are taking, why you are taking it and go along on doctor visits to provide a 3rd party report to the psychiatrist as to what your behavior is really like. They WILL see things from outside that you don't see from inside your rattled brain.
4. Trust your partner! Your partner will tell you when you are going off the rails. It's the hardest thing in the world to trust someone to tell you your behavior is erratic. You probably don't want to hear that and you may be so screwed up that you think your partner is out to get you. You need to know that this may happen. It's the illness, not necessarily the meds. It could be both if you have the wrong medication too.  Here's where you have to use cold rational thinking to overcome your feelings. If you are mentally ill, you cannot trust your feeling.
5. Don't self-medicate:  Pot may make you feel "mellow", but it may also have some nasty interactions with the stuff your doctor gave you. Illegal drugs are notoriously irregular in their strength and dosages and pushers are a real hazard to your health. My son wound up 3 days in a coma because he believed pot had no dosage limits and smoked his whole supply wrapped up in papers his helpful dealer had treated with PCP. It nearly killed him.  That's why you don't self-medicate.
6. Call the doctor if there is something wrong or give your partner permission to call on your behalf: When you are having an "episode", you cannot trust yourself to act in your own best interests. People who trust their own judgement when they are mentally ill are the ones who kill themselves or do something monumentally stupid that they wind up in jail or worse. You need someone who will get you to the help you need and you have to keep reminding yourself that you trust that person, no matter what you feel emotionally.
7. Don't switch doctors:   Too many people switch doctors the first time their medicines don't work and then complain because the new doctor gives them the same medication.  Each mental illness diagnosis has a protocol that doctors follow. You give Medicine A first and then Medicine B if that doesn't work and then Medicine C and so on. Change doctors and he's going to start down the same protocol list.  Stick with your doc till the two of you figure it out. If you find a physician that will listen to you when you tell him what's wrong, then stick with that doctor. You've found a jewel.
8. NEVER QUIT COLD TURKEY:  Every damned story in the "Psychiatry Kills" video was of someone who belonged to a group which quit their meds cold turkey and they all had suicidal ideation, homicidal thoughts and really twisted urges. No wonder. THEY QUIT COLD TURKEY. The warnings that come with the medicine say never to quit cold turkey. It can be fatal.
9. Don't believe everything you see on the Internet:  There are some wonderful resources there. Mayo Clinic, Johns Hopkins and other reputable information sources have a wealth of material about every disease imaginable. If you see some hysterical warning on Facebook, skip it. Search out the information for yourself. Avoid the independent websites. Hook up with social media groups to share stories and learn how other people handled their disease, but be careful of quack cures and hysteria. Your doctor studied all those years because she wanted to help people. Besides, killing your patients is not a very good way to make a living. Dead people don't pay for doctor visits.
10. Remember that you are unique:  No two people are alike and there is no "blood test" or X-ray for mental illness. Even MRIs and CAT scans can diagnose your mental illness on their own. It's a long and complex process.
11. Don't make big decisions when you're not thinking clearly:  If you or a loved one is struggling with mental illness, make it an agreed upon thing that you don't make big decisions when you're having an "episode". Always let your treatment partner be the one to be the final word on whether you are up to it or not. That's hard to do, but it's the best way to regain control of your world. By deciding not to make impulse decisions when you aren't at your best is very wise.

Finally, remember that fear, paranoia, sadness, elevated mood and rage are all components of various mental illnesses.  They come with the territory. Apologize in advance to your loved ones. You may say stupid things that you regret later, but which, at the time, seem like they simply must be said. Build around you a circle of loved ones who know what you are going through and who you trust to be on your side when you are in trouble. You want people who won't let you go to the casino when you're manic, because they know you'll bankrupt yourself if given a chance.  You want doctors who have enough experience with you to piece together a correct diagnosis and who trust you to tell them what's really going on in your head. Not every general practitioner is good with medications for your mental health. If you need medication support, go to a psychiatrist who is expert in treating mental illness and build a partnership with him or her in helping you reach stability.

AND FOR HEAVEN'S SAKE STOP WATCHING CRANK INTERNET VIDEOS.

Tom King
© 2016

Robin Williams Was A Hero

Robin in The Fisher King

The death of brilliant comedian, Robin Williams has shocked and saddened the nation this week. Everyone's asking how could a man, so rich, so talented and so well-loved end his own life like that. He seemingly had everything to live for.

The Internet's predictable leap to judgment by the usual set of self-proclaimed experts has got us all sorts of clever answers.

• He wasn't a Christian so he's gone straight to hell - don't be sorry for him.
• He just didn't read the right books.
• See, we told you wealth doesn't bring happiness.
• He was a liberal douchebag
• He chose to kill himself because he was a coward.

There are lots more, but this stuff sickens me and I don't want to repeat any more of it.

Suicide may indeed be a person's choice. I think of Saul who did not wish to die at the hands of the Philistines and others who took suicide as a way out of what they saw as an insoluble problem.

But the idea that suicide is always a clear personal choice is not true at all. There is evidence a-plenty that Robin Williams suffered from bipolar disorder or something closely akin to it. Bipolar is a cruel disease in which an underlying severe neurological condition causes maladaptive psychological responses. What that means is that at times your perception of the world becomes utterly distorted and things make perfect sense to you that make no sense at all to anyone else.

I have two family members who have made multiple suicide attempts over the past few years. They failed, not for lack of trying but  because family members were watching, praying and intervening when they lost contact with reality. In one case, I am certain angels intervened. Neither wanted to die, not really. It's just their perception was so distorted that it seemed the least selfish thing they could do. Later, when they weren't in the middle of a psychotic break, they could see that what they believed with all their hearts at the time was not true.

Many artists suffer from mental disorders. Many of them incorporate their illness into their art. Earnest Hemingway, Vincent Van Gogh, Mel Gibson, Catherine Zeta-Jones, John Nash, Brooke Shields, Carrie Fischer, Emma Thompson, Herschel Walker, Michael Phelps, Howard Hughes, Paula Deen, Elton John, Craig Ferguson, Margot Kidder, Sinead O'Conner and Kurt Cobain are just a few of the famous people who battled with neurologically-based mental disorders and often lost their lives to it.

Much of Robin Williams comedy was the result of his successful sublimation of his wild swings from mania to depression and back to mania. He worked it all into his comedy routines. It's little wonder he did so well playing lunatics as in The Fisher King and One Hour Photo. He'd been there, done that and bought the T-shirt franchise.  His portrayal of men on the brink of madness were heart-breakingly real for a reason. He'd been there. He was probably there at the time he played them.

I lost a good friend ten years ago to the ravages of bipolar. He was a brilliant preacher and Godly man and incredibly creative. Toward the end of his life his brain betrayed him. He began having blackouts, panic attacks and psychotic breaks and at the last and he became so isolated that no one was there when the madness overwhelmed him and he put a shotgun in his mouth and blew out his brains.

The truth is that Robin Williams death may have been inevitable - a consequence of his bipolar. What may be the real miracle is that he managed to hold off his own death for so long in the face of the unrelenting effort by his own brain to kill itself and stop the pain.

The number one outcome/side-effect of bipolar disorder is suicide. Those who love a person with bipolar need only miss the signs just once to lose their loved one. I know. I care for someone with bipolar. Most days are good, but once in a while it all goes to hell in a hand-basket and if I wasn't here, I could lose the person most dear to me in all the world.

Robin may have lost the fight in the end, but given the severity of the disease that eventually claimed him, his long and courageous fight against it deserves to be lauded for what it was - heroic. Like the defenders of the Alamo, Robin Williams held out as long as he could. You don't berate a soldier who died at his post.

So, Robin, go with God my friend. He sees the sparrow fall and notes its resting place. I suspect one day Robin will stand before the throne of Grace, look up into the face of God and say, "There you are." And God will say, "I have found you my child, come home with me."

© 2014 by Tom King

I Hate That #$@%$# Horse....

I spent a lot of years working with severely troubled kids. I started one of the first equestrian programs that worked specifically with emotionally disturbed children. The state didn't like it. Other people working in children's mental health said we were out of our mind to put "those kids" on horseback.  They predicted all sorts of dire results - kids galloping off into the woods, abusing horses and getting themselves kicked, stomped and bucked off.

Nothing of the kind happened.  In my two years in the saddle, spending some seven hours a day I think we had one child kicked.  He'd been banned from the stable for unsafe behavior for several weeks prior to the incident. The first think he did when he came back for his first session, was to run down a row of peacefully breakfasting horses, slapping them on the butt. My horse, Cinnamon was last in line and saw him coming.  She waited till he reached her and then smartly kicked him into a pile of horse manure.  He was never allowed to come back to the horse program again - the only kid ever permanently banned from riding.

The story I wanted to tell happened one summer day just after the last session.  I'd put up all the horses except Buck, a huge dun-colored and very muscular horse I was testing.  We'd only had him a few weeks and I wanted to run him through his paces to see what sort of temperament he had before I put kids on him. I had him tied by the gate to the horse pasture while I carried some paperwork to my office.

I heard a disturbance from the direction of the dorm.  As I looked that way as ten year old "J" (not his real name) burst out the door, and broke for the woods. Our therapy dog, a black and white border collie named Benji and a large and not terribly fit staff member in hot pursuit.  The staffer made it as far as the creek before pulling up winded.  J had a long history of running away for extended periods of time.  Not wanting to lose him again, I tossed my clipboard on the porch in front of my office and sprinted (I could still sprint back then) toward Buck. Reaching the gate, I untied the reins, pitched them over Buck's neck and swung up into the saddle (a surprising height for me as short-legged as I am).  I swung Buck around and gave him a nudge in the rips and shouted, "Hya!".  Buck needed little urging. He broke toward the woods like a starting gate had just opened.  I shouted, "I'll get him!"  as we galloped past his gasping counselor, He waved weakly at us as we tore past him.

I discovered several new things about Buck in the next few seconds.  First he was very fast. He hit full speed so fast I had to catch the saddle horn to keep from sliding off the back of the saddle.  Second, Buck is the only horse I've ever ridden with an automatic transmission.  As he took off toward the woods, he went through three distinct gear changes, shifting smoothly from walk to trot to lope to dead run - boom, boom, boom. Also, the horse is sprung like a Rolls Royce - smoothest gait I ever saw in a horse. At a trot, the ride was incredibly smooth. A full gallop was like floating along on a very fast cloud.

We galloped past "J" about fifty yards from the path that led into the woods.  I didn't intend to roar past the boy, but here I discovered something else about Buck.  He knew what we needed to do better than I did. From that point on, I was only partially in charge of the proceedings. Once we had passed "J" he wheeled around and planted himself in "J's" path.

"Where you going?" I asked "J" as kindly as I could muster from my perch way up on top of this huge horse.  "J" tried to break left to get around Buck.  Without warning, Buck broke in the same direction and again planted himself in "J's" path. Up top, I managed to retain my seat after nearly being tossed from the saddle. Buck looked back over his shoulder at me in disgust.

"J" broke right and this time I was ready, leaning into Buck's sudden matching lurch to again reblock "J's" path to the woods. The three of us repeated the dance two or three times.  I gave up trying to rein Buck. It confused him. I soon found myself using slight pressure from my knees to steer the old cutting horse. When they donated him to us, nobody had told me he was a former rodeo cutting horse.To Buck, "J" was a particularly stubborn calf and his pride as a cutter was up.  He didn't do anything dangerous, just patiently moved back and forth, keeping himself between "J" and the woods and gradually herded him back toward the main campus.  Benji the dog circled the scene excited by what he figured was a mighty interesting game of tag.

Finally, exhausted "J" gave it up.  He screwed up his face and planted his fists firmly his hips. He gave Buck a look of disgust. "I hate that @#$% horse!" he snapped.

I grinned and laughed out loud.  I couldn't help myself. "J" turned and stalked back toward the dorms.  I rode up beside him, leaned over the saddle horn and extended him my hand.  ""You goin' my way, Pal?" I asked.

He gave me a sheepish grin, shrugged and reached up to catch my hand.  I swung him up into the saddle behind me. Benji the collie, took off ahead of us to show us the way home. We talked a little about what a cutting horse was and how Buck had once been a rodeo horse.  We took the long way back.  "J" kind of thought it was funny that Buck had mistaken him for a loose calf. He finally told me what was wrong and by the time we got back home we had a plan for dealing with his troubles that didn't involve running away. "J's" brothers had once tried to set him on fire.  Later, he had come home from school to find that his family had moved away and left him behind. The police found him sleeping on an abandoned sofa in a vacant lot. I understood why he tended to run away from trouble.

I stopped to drop him off in front of the dorm and told him I had to put Buck away.  He asked me if  I needed any help.  I took him with me to the barn.  We brushed Buck down, fed him and turned him loose.  Before Buck took off to join the rest of the heard, "J" reached up and patted the big horse on the nose.  Old Buck lowered his head and nudged "J" in the ribs. As he turned away and headed toward the pasture. I reached for my big red bandana - allergies, you know. 

Stuff like that happened all the time at Odyssey Harbor.  I used to carry the bandana as part of my strategy to maintain my manly image.  Truth is - I'm a big tub of mush.

When I look back on a hundred little incidents like that, I am proud of the work we all did at Odyssey Harbor. The lives that were changed were not just those of the children.

Just One Man's Opinion

© 2013 by Tom King