Northern Ireland's Health Minister yesterday announced funding for a series of help lines to address suicide in that part of Great Britain. I wish them luck.
The trouble is that we have the same kind of systems here in this country, many of them government-funded, along with a national goal of cutting suicide in half (to about 15,000 people a year) by 2010. Sadly, all the help lines, public services announcements, psych meds and good intentions in the world have not budged the rate of suicide much in this country in 50 years. And that's not good.
The problem is far bigger than current solutions advanced by various governments and non-profits. I don't pretend to know what the answer is, at least one that would work on a society-wide basis (what works for individuals is another story), but I have a hunch it won't be coming from the government.
Because if there is, I've got it. Which is to say that yet another study is out in which yet another group of researchers claim that they have found yet another gene associated with schizophrenia. I am a big fan of brain research and of chasing down each and every gene associated with each and every mental illness. The trouble is that the media will splash these revelations around the world, as they have with this one, as if someone has just found the Rosetta Stone. I think this breeds false hope in patients and their families.
I've been seeing announcements of this sort for a decade or more. Gene X is the cause of bipolar disorder, Gene Y is directly linked to schizophrenia, and so on. Has anyone seen any of these genes become the pathway to a cure, much less a safe and effective treatment for patients? I haven't.
The sad fact is that scizophrenia treatments haven't advanced much in 50 years. If Gene Y were truly the genetic source of this nasty disease, it would still be 10 to 20 years before it'd lead to a handy capsule one could pop into one's mouth. In the meantime, we do need to find another way to grapple with schizophrenia and other mental illnesses, as our current approaches simply are not working out too well.
So wake me when it's all over.
NOTE: Here's my standard disclaimer: No, I am not bashing researchers and arguing to forestall genetic research. I am a big fan of genetic research. Give the researchers all the money they say they need, and then double the amount. Seriously. But we do need to keep matters in a real-world perspective.
I have no idea how legitimate this supposed study is, but a Russian newspaper carries a report on research by Russian docs indicating that spanking is a good fix for addictions and depression. If Fuller Torrey catches wind of this, we'll all be signed up for mandatory meds and mandatory smackings.
This cannot be good. Here's a fresh study, reporting that in macaques given atypical antipsychotics long-term there was a reduction in brain volume. And here's a study from last year reporting pretty much the same thing in monkeys. Both studies found reductions of 10 percent to 20 percent in brain volume. Rhesus macaques are generally considered model systems, or proxies, of human biology. I think I will refrain from further comment.
Here's a small rundown of the situation with Jane, gleaned from talking with some sources yesterday.
NMHA was an innocent conduit in helping the people who wrote the advertorial get in touch with Jane. Whomever the person was who interviewed Jane worked for a PR company of sorts that pulls togetehr this kind of copy for big companies. But when she spoke with Jane's assistant, she apparently used the magic words "with the New York Times," an indication to anyone in the biz that she was a freelance writer working on assignment for the paper. Jane's life story and picture then ended up on the front and inside of an advertising supplement to the Times Sunday Magazine. And that's why Jane is pissed. She wants an apology from the Times, a company that is loathe to admit a typo, much less a problem of this sort. So Jane sued the paper because the one-year statute of limitations was about to expire, as the advert had appeared last fall.
And that's what I know.
America's reigning most-famous bipolar and former talk show host Jane Pauley is suing the New York Times. The complaint in her lawsuit is a bit tough to follow, but indicates that someone passed themselves off as a Times reporter and scored an interview with Jane, then the interview appeared in a paid advertising supplement (which is to say it was an advertorial. not reported copy) that appeared in the Times' magazine and carried ads for all kinds of psych meds, including ones from Eli Lilly (likely either Cymbalta or Zyprexa). Somehow, NMHA's name appears in all of this—and I have to wonder if the non-profit wasn't somehow used by the advertorial people as a conduit to contact Jane.
Man, I cannot wait to see how this one plays out.
Sorry for obsessing so much about Seroquel lately, but its maker, AstraZeneca, keeps making news. This time out, it's an article about how Seroquel has dramatically boosted the company's sales—the article is mute on how much exactly—due to its increased use in bipolar disorder and schizophrenia. But that's not enough for the pharma giant.
The company now has plans to expand Seroquel's use into generalized anxiety disorder. Seriously. See the article I linked to above.
So Seroquel is now so rocking that we can use it for psychosis in schizophrenia and bipolar disorder, depression in bipolar disorder (as approved by the FDA last week), and anxiety. And, oh yes, let's hand it out as a sleep aid for hypomania as well. I cannot wait to look into this further, but am currently over-burdened with the day job.
In the meantime, remember, Seroquel isn't just for breakfast anymore.
STANDARD SEROQUEL DISCLAIMER: I am supportive of the drug's short-term use, but not its long-term use. Seen too many bad effects and poor performance on that front and so have many other bipolars. But, hey, if it works for you and you are making a free-will choice in its use, and understand the risk-benefit ratio, then enjoy.
I looked up AstraZeneca's press release touting the recent FDA approval of Seroquel for bipolar depression (it's already approved for use in acute mania). The company states the following in the press release:
"Patients with bipolar disorder are symptomatic almost half of their lives, and approximately two-thirds of that time is spent in the depressed phase of the illness."
There is no footnote or attribution for this assertion, but this strikes me as complete BS. I cannot think of a single bipolar I know or have known who has been symptomatic for almost half their lives. This is out of hundreds of bipolars I've encountered. I wonder upon what study they are making this assertion and whether it's a finding that has ever been replicated. It's one of those assertions that makes me want to contact the company's press office and ask them for the details. I cannot wait for that conversation.
I traded comments and some email with Liz Spikol yesterday. I was a bit imprecise in my thoughts on Seroquel over the last couple of days—OK, I had neglected to add a bit of context—so let me address this.
My criticisms of Seroquel—and other atypicals used for bipolar disorder—are limited to its use as a long-term maintenance med in bipolar disorder (ie, not in its long-term use in schizophrenia). Of course, AstraZeneca is trying to build the case for its use as a long-term maintenance med in bipolar disorder, which they can then call a mood stabilizer. Regular readers know my what my problems are with Seroquel, used as long-term maintenance med. I won't bother repeating them here. (When it comes to schizophrenia, there are no better treatment options than an antipsychotic, sadly.)
I do, however, think that Seroquel and other atypicals can be valuable short-term tools in treating bipolar. They are much more a velvet hammer type of medication than the old antipsychotics ever could be, and are quite useful in treating acute mania and in nuking depression. Despite a rough ride for me using the med long-term, I still use it for a day or two perhaps twice a year to knock down bouts of depression that I'd prefer don't spiral out of control. I won't use it any longer because its side effects are awful—who else doesn't like feeling like they drank a fifth of whiskey the night before?—and depression is generally something I am willing to bulldog my way through without taking neutron bombs to get me through the day.
Besides, when I took Seroquel and other atypicals long-term, I still had bouts of depression, so my incentive to take these meds long-term is zero. And I had the same kind of breakthroughs on all the other anti-depressants I took back when (again, we're talking long-term use here). Prozac, Paxil, Zoloft, Luvox, Wellbutrin and Lexapro: none of those anti-depressants worked especially well at killing off my depression and Prozac damn near killed me. After all of those meds (plus atypicals later on), I decided I would rely on my own resources in dealing with depression. It's worked out pretty well (I have fewer depressions than when I was on all that other junk—just to be clear for newbies, I now take Lamictal alone), plus my approach is cheaper and has fewer side-effects.
All the same, I ought to come up with a standard disclaimer to use each time I talk about atypicals so that people will be aware of the distinction I make between short-term and long-term use of these meds. If I have to type it anew each time, I'll lose my mind.
Liz Spikol, bipolar blogger, passes along these thoughts on my post on Seroquel yesterday:
"I know what you're saying, but Seroquel has been working for my bipolar disorder for eight years now with minimal side effects. It would be stupid for them to market it as a mood stabilizer like Lithium, but it seems reasonable to suggest that it could work for bipolar psychosis or mania. Will it be marketed as a mood stabilizer for sure?"
I'm glad it works well for someone in treating mania, but when it comes to bipolar depression, I have my doubts. After all, Spikol herself has wrestled with serious bouts of depression, as have I, throughout her adult life. She's blogged about this at length and I encourage you to read her work.
Seroquel sure didn't do shit for my depression.
I am confident that AstraZeneca will market it as a mood stabilizer in the near future. There's money to be made. In fact, the company recently launched a new website called Recognize Bipolar Disorder (cute name, no?!), which comes with a screening tool, geared towards the busy GP and internist, for docs to use with patients. I found it linked on the website of the largest TV station in the Pacific Northwest. Call me skeptical, but I don't trust these guys, especially given how unimpressive the results were from the studies that AZ submitted in getting the med approved for bipolar depression. The studies showed that it worked, meaning full or half-symptom reduction, about half the time during a short term study. I don't consider that impressive.
A reader passed along a University of Florida study, just in the recruitment phase, that will both try to measure increased agitation and suicidality in kids and teens (ages 7 to 17) taking Zoloft for obsessive-compulsive disorder, and create a behavioral model to scientifically assess agitation and suicidality in such patients.
Zoloft is one of the SSRIs that carries a black box warning for the risk of increased suicidality in adults and youngsters. Its only approved use in people younger than 18 is for OCD. It is not approved for use in treating depression and such in this population.
So, if a drug is linked with suicides and suicidal ideation in youth, then why would you even need to test what problems it might present with youth who are not depressed? Isn't this just courting disaster?
If there's one thing I have learned about researchers over the years, and not simply psych researchers, is that they will study literally every possible question around literally every substance on earth and how it interacts with humans. That's good in some ways. Scientific inquiry should be encouraged. But sometimes it leads to plenty of studies where we already have a pretty decent idea what the answer will be. Researchers can always make the case that even though an answer is known, it is not known with scientific precision (or at least not the kind researchers prefer) and therefore it must be studied. Besides, they can get grant money for the research. And if you are a researcher who's under pressure to drum up research dollars for your university, then you'll chase the money. Or be out of a job. Seriously, academic science is cut throat like that these days.
I think that's what we have going on with this study. But it still makes me uneasy. My hunch is that if this study shows that there is no connection between Zoloft and suicidality, etc. in the young OCD study group, then we will see headlines and media mentions that "Zoloft doesn't cause suicide after all, researchers at the University of Florida announced today." What the articles won't mention is that this is a study group of about 140 youth and that the larger population upon which all the bad news was predicated involved hundreds of thousands of people. Maybe I am weird, but I consider that more solid evidence than whatever you might get from a 140 patient study group.
Stay tuned.
NOTE: The study's principal investigator, Wayne Goodman, recently showed up in a "New York Times article about conflict of interest (ie, getting pharma money) amongst researchers who advise government agencies about drug approvals. Dr. Goodman, a major player on the FDA advisory committee on psych meds, appears to be one of those whose hands are clean. Which is good.
Last week, I wrote a post attacking docs for trying to use antipsychotics to prevent psychosis in teens in advance of an episode of psychosis in the patients. I am opposed to such research on ethical grounds and this particular study showed that this approach wasn't effective at all. Nonetheless, docs want to study this approach some more. Because pateients are clearly guinea pigs. And we've got to create an environment for pharma companies to go around and proclaim that X percent of the American public should take antipsychotics because people are deemed to be at-risk of psychosis.
The study researchers defended their approach, claiming that it was analagous to given a person cholesterol-reducing drugs before they have a heart attack. That's bullshit. Anyway, John McManamy happened to be at a NAMI fundraiser in Washington, D.C. last week. Guess what he ran into?
"Funny you should bring this up. Last night, I was at a gala NAMI fundraiser in DC. BMS was picking up the tab. The Pres or VP of BMS Neuroscience [Bristol Myers Squibb] got up to say his perfunctory two or three words, which turned out to be a shameless promotion for Abilify. Among other things, he mentioned psychiatric meds in the context of prevention. He specifically used as an example of patients who have never had a heart attack taking heart meds. One guess what he was driving at?If we were talking about an illness we actually knew something about, in a population with a very high risk probability of onset, with drugs that were predictably effective and tolerable then the conversation would be a lot different."
On Friday, the FDA approved AstraZeneca's application to have Seroquel approved for treating bipolar depression. The drug is already approved for acute treatment of mania. This will now allow the company to go marching around and tell docs that this drug is a mood stabilizer a la Lithium. I am so opposed to that kind of marketing that I cannot even get into it. I look forward to dissecting the study at a later date.
Interestingly, thre was recent exchange of letters among doctors in a medical journal questioning and defending the evidence for Zyprexa's effects as a mood stabilizer. I'll post those tomorrow.
Earlier this year, some researchers published an article in AJP in which they reported on an attempt to prevent teens identified by the docs as being at risk of experiencing psychosis by giving them Zyprexa. Another group of patients at similar risk were given a placebo. (Set aside for a moment how the docs think they know who is "at-risk.") I wrote about the study earlier here.
The basic story is that Zyprexa didn't do jack to prevent psychosis and also that many of the patients the docs identified as being at-risk never experienced psychosis after the study ended and they came off Zyprexa or the placebo.
Now, a psychiatrist in Portland, Oregon is challenging the ethics of the study in a letter to AJP:
"To the Editor: I am concerned that the article entitled "Randomized, Double-Blind Trial of Olanzapine Versus Placebo in Patients Prodromally Symptomatic for Psychosis" (1) lacked discussion regarding the ethics of treating young (average age=18.2 years) and nonpsychotic patients with the neuroleptic olanzapine for 1 year.The authors anticipated this problem, and, as they point out, in prior studies 46%–80% of those labeled "prodromal" never develop schizophrenia after up to 2 years of observation and were probably false positives (p. 797). In their study, 16 of 29 participants (55%) in the placebo group never became psychotic after 2 years. We should, therefore, expect that approximately 17 of the 31 (55%) subjects who were given olanzapine were also false positives. More than one-half of the patients who were prescribed olanzapine were exposed to it unnecessarily—at doses ranging from 5 to 15 mg/day.
In addition to the patients’ average weight gain of 19 lbs, I am concerned with what other biopsychosocial repercussions there were for these young men and women after they were placed on the neuroleptic, without a clear indication, for a year. Isn’t our first and foremost obligation to "do no harm"?"
Here, one of the original study's authors defends their work (full letter here):
"Prevention is a new concept to psychiatry. We are used to functioning as post hoc diagnosticians and interventionists. Prevention interventions are common in other medical specialties and, by definition, they involve prescribing active treatments to a mixture of true positive and false positive persons. The clearest example is cholesterol lowering pharmacotherapy. As prevention, the strategy treats risk (high cholesterol) not disorder (coronary heart disease), and the vast majority of those treated are false positives.We do agree with Dr. Block’s air of caution insofar as we feel that prevention treatment in schizophrenia, especially pharmacotherapy, belongs in the experimental domain for now. At this stage, our field possesses insufficient data to articulate specific treatment guidelines for those prodromally at risk beyond careful longitudinal monitoring and support (3). More research is needed to address this novel situation."
Are these docs behind the original study on drugs themselves? Or are they just arrogant? How many times do they plan to test their hypothesis? I cannot even begin to get into how much it angers me to hear these clowns compare slamming teens with 15 mgs. of Zyprexa with given cholesterol-lowing drugs to prevent heart disease. Perhaps these docs ought to take Zyprexa themselves and see how they feel about this ethical swamp before lining up people to take it who aren't even symptomatic.
More research isn't needed. These types of studies are unethical and must stop.
John McManamy's new book, Living Well with Depression and Bipolar Disorder, is being officially released today. As regular readers know, I am damn enthusiastic about the book—not only is it thorough and informative about how we live with the dread shit we've got, it's the first book of its kind written by a fellow patient. One of our own stepping into what's considered the exlusive preserve of docs and therapists. Congratulations to John.
It's available, online at least, at amazon.com, barnesandnoble.com and so on. It's about $11 on amazon.com. Order it. I did.
Wow. Let me just quote from the lede to the New York Times article on this:
"The drugs most commonly used to soothe agitation and aggression in people with Alzheimer’s disease are no more effective than placebos for most patients, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms."
Here's a quote from the study's conclusion:
"Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis, aggression, or agitation in patients with Alzheimer's disease."
The drugs in question were Zyprexa, Risperdal and Seroquel.
I know that I have made myself unpopular in the mental health community for saying harsh things about atypicals over the last year and that some psych researchers are pissed at me over this article in which I lashed out at docs for so aggressively pushing atypicals on bipolars. But, in that same time period, we now have three major studies establishing that atypicals are not nearly as benign as the psych world has been saying for the last decade—they called them the silver bullet for schizophrenia.
First, there was the CATIE study. Then the recent British study showing that the atypicals are no better for schizophrenia, in a clinical sense, than older antipsychotics, same as the CATIE study asserted (I haven't written about this one yet because I have been juggling too many other things, but will get to it soon and especially NAMI's bizarre response to the study). And, now, we have this new study on their inability to perform better than placebo in treating much the same symptoms they are used for in bipolar disorder (agitation and rage) in elderly patients with Alzheimer's—plus they have unacceptable side effects as well. In addition, there are numerous other studies establishing that these newer, very costly antipsychotics aren't very effective at all.
So, it looks like I was right to be banging on these meds.
Nonetheless, the FDA just approved Risperdal for use in children with autism. And it's an open secret that atypicals are being used aggressively in children diagnosed with bipolar disorder. Plenty of teenagers and adults take them as well—even more as a matter of fact.
I wonder how far away are the journal studies establishing that Risperdal has intolerable side effects for autistic kiddos? Then again, why are we waiting?
I made the assertion in my article "The Drugging of the American Mind" (my editor picked that headline) that doctors were side-stepping their ethical responsibilities in so aggressively prescribing these meds to patients. I cringed when I write those words last November because I found it difficult to say such a thing about a profession I respect plus I knew I was way out on a limb, a voice of one in the wilderness if you will. Now, I must call into question the ethics of using these drugs on a long-term basis (ie, every day, forever) in patients of every stripe. They are costly (10 times the price of an older antipsych), have miserable/dangerous side effects and don't perform better than older meds (which are no party themselves when used long term). I can no longer see the justification of prescribing these meds to patients outside of short-term crisis use with the exception of their use in schizophrenia (tragically, there are no other options there except the older antipsychs).
It is time for the medical profession to do some soul searching and grow a pair of balls. Also, it is time for the pharma companies to dramatically slash the price of these meds for the schizophrenics who need them since they work no better than the older, cheaper drugs. Fair is fair.
Too bad patients don't have more market power. But doctors have tons of market power and it's time that the thought leaders in the psych field stood up for their patients, boldly and publicly, and attempted to stem the tide. They did it against the tobacco companies, so why not here?
This is an especially crucial time for such a rethink, since the FDA is on the verge of approving Seroquel for use in bipolar depression, which would allow the company to actively market the drug as a "mood stabilizer" a la Lithium. Zyprexa is already approved that way—and we know just how much that has helped patients.
Our minds and brains and bodies are being fucked with here people. It's time to hold the psych profession and the pharma companies and the FDA and the mental health advocacy groups accountable. And, just to be clear, that statemnt comes from someone who embraces psychiatry as a whole, respects the mental health advocacy groups and knows that the pharma companies are not supposed to be moral actors in any way. I ain't no Scientologist or anti-psychiatry advocate. I just feel like one in light of news like today's.
I finished reading John McManamy's new book, Living Well with Depression and Bipolar Disorder, last night. I stand by everything I said in yesterday's post on the book. It's damn good and I hope people buy it. How he managed to pull off all the brain science he describes in the book is beyond me, but it's well done. All in all, though, it's a real world book, maybe not a life manual per se, but pretty damn close. It is more of a user's manual and an excellent resource, one that has 10 times the validity of the doctor-authored books out there because it was written by one of us.
At one point, John notes that psychiatry is still much more of an art than a science. True. And if it is an art, then we are still at the fingerpainting stage.
BTW, I noted on this blog last December (shit, I've been at this long enough to have a history with myself) that many in the mental health advocacy and patient world long for the one great voice on mental illness. My sense then, and now, is that we'll actually end up with many voices, principally because experiences with mental illnesses and mental illnesses are so diverse. There is no one Truth out there, the way there is in the cancer patient world. But John is definetely one of our voices. Now go pre-order his book before it comes out next week.
I'm not sure whether to call this a blow for patient rights and the anti-psychiatry movement, a defeat for the forces of forced medication, or what, but the Alaska State Supreme Court ruled in June (no idea why I just found out about it now) that patients in that state's state hospital—ie, long-term inpatient commitment—cannot be forced to take psych meds, especially the very hardcore ones, without "first proving it's in the patients best interests" and without establishing that less-restrictive alternatives aren't available or won't work.
I happened to interview the winning attorney, Jim Gottstein, a couple of years ago and we talked at length about this case, Myers v. Alaska Psychiatric Institute. I well understood his point that forced drugging—making non-compliant patients take meds through force or coercion—violated civil liberties principles. But I have my doubs as to how far-reaching this decision will be, although the counterpunch.org author seems to think, as does Gottstein, that this ruling will have huge implications for Big Pharma and that they won't like having their revenue stream screwed with. I only wish it were so.
The med at the center of the case was Zyprexa.
But Alaska is a small state, the ruling only applies there (it can be introduced in other jurisdictions but it's not binding) and I'd be shocked if psych med sales to state hospitals around the country (we're talking about 50,000 patients there worth, at the most, $500 million in annual sales in a $40 billion a year industry) were much impacted. What's significant is that this is the first ruling of its kind in, like, forever as the tide of legal precedents has turned very much towards forced outpatient commitment in recent years. I'm not sure that it will have quite the imp[act of the Olmstead decision by the US Supreme Court in 1999, but it is always nice to see individual rights and liberties being recognized especially in how they apply to the most vulnerable of our citizens. (I wish I had time to read the actual ruling. Sigh.)
How this will be implemented in the real world is beyond me. Stay tuned.
An interview with a leading psychoanalyst who questions why some in his end of the therapy field are more focused on getting to self-awareness as opposed to symptom-free lives, among other things. Another fine piece from Ben Carey at the New York Times.
Keep in mind that this type of analysis was pretty much the dominant paradigm in pscyhiatry and psychology until the 1980s, when the great shift to biological psychiatry took place. Are we better off? I don't think so. Does psychoanalysis suck? Oh, yes. And, also, note that psychoanalysis isn't the saem as the various behavioral therapies, especially CBT. This is old-school Freudian shit.
I began reading, as opposed to skimming, John McManamy's forthcoming book on bipolar disorder and depression. It comes out next week and is entitled Living Well with Depression and Bipolar Disorder. Here is a passage that aligns so well with the reality I know as patient who writes about these dandy illnesses as well as with the intellectual framework with which I have tried to treat my illnesses and have tried to think about them that I swear it's like John and I are channeling one another:
"Blind faith is your worst enemy. Whether it's the pharmaceutical industry, the psychiatric and talking therapy professions, or natural health advocates, all are guilty of overselling their products and services and downplaying their own failings. The negative campaigning that goes on would put a politician to shame.Yes, we need to listen to the professionals who treat us, but they also need to listen to us. They are the ones with the specialist knowledge, but we are the ones living in our own skins with access to the complete picture. It is my fervent belief that learning about our illness equates to better outcomes.
'Knowledge is necessity,' has been my mission since Day One of my Newsletter and Website, and it applies with equal force to this book. The more we know, the better we will understand our illness and the smarter the choices we will make in its management, in partnership with our treating professionals. Patients who are motivated to build partnerships with their doctors have a better chance of achieving a successful outcome. An editorial in the March 27, 2004 British Medical Journal reports that two Stanford University studies found that so-called "expert patients" with chronic diseases felt better and had 42 to 44 percent fewer doctor visits than the other patients in the studies."
I am going to let this speak for itself and go back to reading the book. More to come. Oh you can buy the book at Amazon.com and such places. I hope to God that John's publisher pushes the hell out of his book. As I have mentioned before, it is huge that a patient has taken on what is generally forbidden turf—the doctor's world of treating us.
I woke yesterday morning and there it was—that ugly empty in the stomach world is falling and I want to fall with it feeling. Which is to say, depression. This has been a great summer and fall for me, mood-wise, but I knew the black dog would come for its visit. So I sat there and ate some breakfast and took a walk in the sun. I was going into the office late, because of an interview I was doing at noon over at the UW campus.
I caught a bus over to campus, feeling as though I were dragging myself through the process. It was the Monday press conference by the UW football coach and there were six television cameras and like 30 reporters. I could've just sat there like a lump and let everyone else ask questions and taken notes on what Coach said. But, as almost almost happens for me in a work situation, I rallied, began asking questions of my own, although sports is hardly my expertise as a reporter. I hung around afterwards, asked Coach some questions in semi-private, took notes, felt better.
Then I took a bus downtown to the office, where I proceeded to soon feel like shit. I could feel that heaviness to my body and that weird agitated flutter to my stomach that signals the beginning of something. As it always has. I tried to keep busy until 5 p.m. There were screaming gay teenagers on the bus ride home and it took everything I had not to stand up and scream at them to shut the fuck up. But I got home and took a 90-minute nap from which I awoke feeling unrestored.
It's with me. It's on me. There was nothing to trigger it. It just is—and every so often jumps up and demands that I pay my respects, my tribute. I hope it follows its usual pattern and doesn't hassle me for more than a week. I can survive this shit, walk right through it the way you would a bad snow storm. Hope that works this time out.
Researchers in the UK want to ditch the term schziophrenia—they say it's scientifically invalid—and replace it with something else. They say the name is too stigmatizing. And the new term they suggest? Dopamine disregulation disorder, or the Triple-D. Which makes sense if they can prove that dopamine alone is the root cause of all those lovely delvusions, hallucinations and so on. Makes me wonder what they'll want to call bipolar disorder.
I'm not sure I buy this name switchery, but we'll see. No matter what you call it, however, schziophrenia will always carry a nasty stigma with it, so I am not sure where this act of political correctness might lead us and what it will gain anyone.
Today is National Depression Screening Day and bipolar disorder screening is being tossed in as well, all of it brought to you by NAMI and Screening for Mental Health, Inc. The latter is run by a bunch of psych docs at Harvard. NAMI takes gobs of money from pharma companies. Just putting some perspective on all this.
Perhaps, I am too much of a skeptic today, but there's something that concerns me about all the mental health screening going on. Maybe it's because I remember the dark old days of the early-90s, when depression and bipolar disroder were not publicly discussed, or if they were in whispered tones. Now, it's everywhere. If there's one constant in American culture, it's that when we go after something, when we buy into a paradigm, we go whole hog, sometimes to our detriment and sometimes to our benefit. I am not sure why that makes me skeptical, but there is a bit of the "mental illness is fashionable" business going on here that makes me go "Hmmm."
I guess it's because I was recently thinking through an experience a friend of mine had a couple of years ago. She's a single mom, raising two kids on a very limited income, as her ex is a dead beat dad. Her daughter, nine at the time, was having a bit of trouble at school—irritable, not paying attention, bored off her ass and so on. I also knew her to be a stunning artist—a natural—for someone so young. So her mom gets dragged into school for a parent-teacher conference. Short story: the teacher spends about half the conference trying to convince the mom that her kid is depressed, should be put on medication (we're talking about a nine-year-old for God's sake) and that mom is being a bad parent if she doesn't follow through. Teacher claims she'd screened the kid by asking her questions and so on.
Is anyone else bothered by that process? I cannot quite put my finger on why I am, but I am sure bothered by teachers playing diagnostician and then lecturing the parents. I have no problem with a teacher reporting obvious signs of mental illness or behavioral maladies to parents, nurses and so on. But it does seem to me that there a lot of ideologically-based diagnosing going on.
Well, two years later, kiddo is doing fine. No meds, no depression, just your typical 11-year-old behavior.
BTW, a handy little press release from NAMI on the screening stuff states that there are now 10 million bipolars in America. I don't question that number, but across that number of people there is a wide range of severities of the illness, something that often gets lost in discussions of mental health. The NAMI release stresses that 80 percent of diagnosed bipolars have "treatment success." That claim is oddly high, and is the same exact number that the fine folks at TAC cite. Guess it depends on how you define success.
Anyhow, all of this is just me engaging in early morning skepticism, nothing more.
Liz Spikol's blog is nearing its one year anniversary I believe and I really take my hat off to her. She does fine, fine work. And knows how to do YouTube posts!
In a separate milestone, John McManamy's book will be out in two weeks. It is huge that a fellow patient has the expertise, research skills and writing ability to write a book that is essentially a patient taking over a corner of the MDs' turf in the psych world. It's high time that happened.
I will write about his book sometime before its pub date.
And also because Liz Spikol does such a fine job digging up interesting things on her blog, I pass along this column from yesterday's Philly Inquirer bashing on America for what I'll call depression obsession syndrome. I don't disagree with the author, although I wish she'd gone after all these public health studies linking depression with everything under the sun and clouds—heart disease, diabetes, and every physical malady you can imagine. In other words, public health researchers are arguing that life is depressing and existence can be oppressive (all of it an argument for anyone with a physical ailemnt to take Prozac, I'm sure). Stop the fucking presses! And go read Jean-Paul Satre.
I wonder how public health and psych researchers feel about following the public health paradigm (every ailment is linked to something, study the link and eliminate the something by law or meds, no matter how benign) into such obvious minutiae and becoming tools, unwitting or not, of pharma companies and social control freaks. The media of course helps this along (especially, the AP and Reuters and your local television news) in ways that I will bang on another day. Keep in mind that researchers get paid big bucks for these studies and get to publish articles and advance their careers and make news. What America needs right now are a few more skeptical editors and news directors.
OK, I am not truly being lazy, but as some of you know, my attention is a bit divided these days by an outside project. Here's to hoping that my Burning Man neighbors decide to bust their respective nuts before 1 a.m.!
Swear to God, I hate that annual festival in the Nevada desert, which seems to breed the most self-possessed people on the planet who just think everything is "chill" 'cuz of their special post-hippie vibe and that everyone will be cool with exactly what they want 'cuz everyone should be down with their scene. And it wouldn't be cool to not be down with their scene.
Case in point: new neighbors moved in next to my apartment yesterday and I happened to meet them. "We met at Burning Man," they said. I shoulda known that was trouble. I told them that their bedroom was right next to my bedroom and that while I didn't mind noise at midnight or 1 am...well the hint was there to not wake me up after that.
Cut to an hour ago. I am awakened by the sound of these two folks fucking the hell out of each other coming through my bedroom walls. Nice. Now I cannot get back to sleep. Thanks Burning Man people! I look forward to leaving you the uncomfortable "I can hear you fucking at 3 am" note on their door later today. I hoep the Ecstacy wears off and you can actually read it.
A few weeks ago, I was over at a friend's house and her roommate comes home after a long drive from Burning Man. Wouldn't shut up about how cool it was, how all the food and booze is free and everyone loves one another and is down with free love and everything. Carried on like that for two hours. By all reports he was driving his friends nuts with the same talk for weeks on end.
Crap the Burning Man crowd is annoying.
I often dread October. For me, it is the roughest time of year when depression comes at me like a sledgehammer and life becomes difficult. That's OK. I know it's coming and I know I can get through it without slapping myself with gobs of meds. The last few years my autumnal depression has been beginning in September (last year was pretty rough for a couple of weeks), but so far this year it hasn't kicked in. Probably because I am too busy—several 60 hours weeks in a row—for my mind to become depressed. Well, that's just a guess about the dynamic, one that I will be able to test this month since I will be very busy once my brief vacation is over later this week.
Herb Perry, a journalist at the Portsmouth (NH) Herald, writes of his experiences with schizoaffective disorder and bipolar disorder. Read it. Send the man some email too.
Some of you know about the weird, fucked-up case of former King County Sheriff's Deputy Angela Holland, fired two years ago by her department for being bipolar, despite the fact that she done nothing wrong in a department where several male cops keep their jobs after being busted for doing openly crazy shit. Anyway, she writes to say:
" I would like to announce on this website since our very modest moderator has not mentioned it that Philip's article that he wrote about me "Good Cop, Sad Cop" was made into a documentary short. The documentry will be entered into a film contest this week.The film contest is for currents and the topic is intolerence. The filmmakers found Philip's article on the web, contacted him and it went from there.
They are hoping to get backing (funding) for a FULL FEATURE film based on our favorite writers work.
I have been waiting for Philip to say something about this but he is very modest, so I am going to say it for him.
Let's all hope that the film guys win the contest and can make their full feature.
So everyone give a shout out to Philip for his wonderful work!!!!
P.S. in case any of you are wondering, I have no future in acting."
By feature film, she actually means a full length documentary.