Unravelling man

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Unravelling man

Illustration by Matt Murphy

Bipolar disorder can rage through life like a hurricane. So why does the US healthcare system leave us to cope alone?

Kristin Ohlson is a freelance writer whose work has appeared in The New York Times, Salon, and New Scientist, among others. Her latest book is The Soil Will Save Us (2014). She lives in Portland, Oregon.

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I used to have a twangy guitar riff as the ringtone for Hank, a holdover from the days when we were lovers and he delighted me with music and a soft, southern-inflected singing voice. We didn’t talk often since I’d distanced myself from him after he returned to the kind of heavy drinking that had landed him in rehab shortly before I met him in 1993. More than just emotional distance: I had let loose my life in Cleveland and moved to Portland, Oregon, a return to the delicious proximity of family and the coast where I was born. But Hank and I were still friendly, so my only qualm about answering when my phone suddenly twanged on Southeast Belmont was that talking on your phone while driving is illegal here. So I put my phone on speaker and held it to my chest, out of sight.

He was down south visiting his family for his birthday. He had gone fishing that day with his old friend Reggie, and they’d had a wonderful time. ‘I’m having the most wonderful time of my life!’ he told me, his exuberance vibrating against my breastbone. ‘Reggie was wonderful and the fishing was wonderful and everything – everything was just wonderful!’

‘Really?’ I said. ‘That good?’

‘Wonderful! And you, I’ve been meaning to tell you. You’re wonderful, too. You really are.’

It was a surprising and suspicious pile-up of wonderfulness, so I pulled over to text his sister and ask how he was doing. She and I had become conjoined worriers, keeping each other posted on how he sounded over the phone, cataloguing the twisted ankles and scraped elbows and shattered headlights that suggested daily drinking, even when he claimed otherwise. ‘Let me call you later,’ she texted back.

It turned out that his visit had been about as destructive as one of the hurricanes that periodically rages through their city. He trashed his stepmother’s house with dirty clothes and dirty dishes and his dishevelled self, passed out in a chair. He smoked inside her house – an infraction almost as shocking as taking a piss in one of the neighbourhood churches. When the family gathered for his birthday, he cursed and argued at the table and was so unlike himself that everyone reeled away from him in dismay. And he announced that he might not leave for a few weeks, even though he was due back at work on Tuesday. He was having a good time and work be damned! This from a man who loved his job, showing up with Clydesdale diligence even during his worst drinking days, hiding his red eyes behind sunglasses.

That was the first signal that he was unravelling, seized by a mania that would shatter every mooring to the life he had built over 58 years. Within six months, he would lose his job and blow his retirement savings on fancy guitars, $400 shirts from Saks (no more 75-per-cent-off sales at Macy’s!), and catering for parties no one attended. He would alienate friends and agitate neighbours and, battered by the storm in his brain, sway on the precipice of homelessness.

It was the worst natural disaster I’d ever witnessed, an act of God, but with no Federal Emergency Management Agency and no clear path to help. Everyone who loves someone with mental illness seems to chart a solitary course, navigating the outback and dragging the afflicted along. We pray someone will help us, but discover laws and a health care system impeding meaningful treatment. The care we find is too sparse to make a difference, too slow to keep them from destroying their lives. Only love binds us to their crisis because pulling someone back from a psychiatric death spiral could mean dropping your plans – your own work, your own friends, your own life – to stand vigilant watch and advocate on their behalf.

On the day of my daughter’s wedding seven years ago, a Hank of a different hue rose before dawn to fish. He was there when my daughter arrived at the end of a dock near the house where we were staying. She wanted to write a toast to her new husband as she watched the sunlight tip over the mountains and across the lake. They kept an easy silence as the waves and swallows and occasional fish – far from his eager hook – went about their quiet business. She told me later that it was hard to think of anyone who would have been a better companion than Hank at that moment. Sweet, calm, kind, reliably at peace with the sunrise and the water and other simple things. We counted on him for this.

I met Hank when I was still bruised from the end of a marriage to a very different kind of man. Not a bad guy at all – we’re still very friendly – but marriages don’t end in the midst of good times, and I was nearly incapacitated by grief at the end of ours. I met my husband when I was 18 and, amid all the other glorious attractions, I fell in love with his family. They were a vivid and volatile crowd that loved to argue politics. Their constant roar of opinion was an exciting contrast to my family of origin, of whom a rather caustic elderly neighbour once said, when several of us paid her a visit years after we moved away: ‘Ah, the Ohlsons. Always so nice! Always so polite! Always saying the right thing!’ My 18-year-old self thought that niceness was terribly boring, but my marriage racked up so many years of conflict that I lost enthusiasm for sparring. I didn’t quite realise that I wanted a man as peaceful and sweet as my father, but I found someone like that, in Hank.

A friend who worked with him introduced us. She warned me in advance that Hank had just gone through his own ‘marital carnage’ (my phrase, not hers, one of my favourites from the play Hurlyburly) and had recently emerged from three inpatient weeks of treatment for alcoholism, but that he was a really, really nice man. According to Alcoholics Anonymous – he was attending AA meetings daily when we met – he shouldn’t have got into a serious relationship with anyone until after a year of sobriety, but we dismissed that as needless orthodoxy and fell in love.

I look back and wonder if those falling-in-love brain chemicals cloaked the darker Hank that would emerge

I remember my own brain state back then. How driving across town to Hank’s apartment seemed like a mythic journey. How fevered I was, even just sitting together at the shoe store to try on sneakers, our arms brushing as we bent to tie the laces, whispering while the salesman went off to search for sizes. We were amazed that we could feel this way again, and I actually began to long for a time when I’d be able to think about something else. Now I look back and wonder if those falling-in-love brain chemicals cloaked the darker Hank that would emerge.

I recently asked my friend Ceci McDonnell about this. She’s a therapist back in Cleveland whom I emailed after that first phone call, asking for help figuring out what was going on and how to get Hank services. I called her again to get some help thinking through this piece. ‘Yeah, the chemistry of falling in love is not unlike mania,’ she said. ‘There’s the same urgency and intensity and that might have postponed his depression.’ If someone is on the bipolar spectrum, alternating cycles of mania and depression wrack the body and brain. ‘We know they can throw themselves into something to prevent crashing. But there’s an inevitability to the cycles.’

At first, I had no idea that Hank was on any sort of spectrum. For the first four years, he was a sunny presence. During my marriage, I had kept my own moods strictly policed. My husband was moody and spectacular – he had played a role in a local production of Hurlyburly – and I became the dull rock that kept the moving pieces of our family life from flying away. But Hank was ever calm, ever positive. He glowed with a golden optimism. Because of him, I took new risks with my career, and my life grew bigger. My own moods began to leap in more magnanimous arcs. And when I arced into darkness, Hank was a great comfort. This is a little creepy, but I sometimes had this image of myself tucked safely inside his chest, foetus-sized, next to his big heart.

I wonder sometimes if I was too greedy with that comfort.

Then he started to struggle with depression. There were some disturbing things going on in his life – cutbacks at work, family problems – and he seemed to lose what I thought of as his effortless effervescence. He was always a big TV watcher – a source of some strife between us – and became someone who spent all his non-work hours on a couch with a clicker in his hand. It seemed obvious that this ceaseless electronic parade was a drug of some kind, and it wasn’t an effective one. I made the kind of irritating noises that people make when they don’t understand another’s depression. Take a walk! Take a class! Let’s do something fun!

He became hypomanic, although I didn’t use such an alarming clinical term to describe it. Annoying is the word I used

The bleakness improved and then it got bad again and then it improved and then it got bad again – it’s hard to remember now how many cycles there were and how he emerged again with his sunniness restored. Difficult as his depressions were, none were life-destroying, as the mania has been. I probably would have described them as funks. So when I look back now, I search for examples of irrational exuberance that might have foreshadowed the mania. All I can remember is the month he took an antidepressant that was being frequently advertised and prescribed as a tool to help people quit smoking. He became hypomanic, although I didn’t use such an alarming clinical term to describe it. Annoying is the word I used. He was chipmunk cheerful, talking fast and zipping from one project to another and so free with happy bromides that I couldn’t be in the same room with him. When we went to our couples book club, everyone gaped as he yakked on and on about the book, the meal, his day at work, the weather, whatever. I was relieved when he tossed the pills in the trash. But not long after that – or was it before? – he began taking antidepressants regularly.

When Hank had his manic break – when it became obvious that something alarming and new was happening – it was hard for other people to realise that it was a manic break. They hadn’t been privy to his depressions, as I had, and whoever heard of someone becoming bipolar in their late 50s? It’s an unusual presentation, said people such as my therapist friend McDonnell and others, since most people present with bipolar when they’re in their teens or 20s. But it can happen, especially when someone has a close relative with bipolar disease. And Hank did.

One therapist suggested (asking me not to quote her, since she hadn’t met Hank and this was just conjecture) that Hank had perhaps flipped into mania because of the antidepressants. She said that when someone has an underlying and undiagnosed bipolar condition, medicating just the depressions can have that effect. Wow, I thought. A few weeks later, I was sitting at breakfast with a new OkCupid date, a scientist and a sweet guy who told me – over two buttermilk pancakes and three strips of bacon – that he lost his lab and job and marriage because of a similar late-onset mania. His doctors weren’t sure why it had happened, but one theory was that antidepressants had flipped him over. ‘I can tell by the look on your face that this is a deal-breaker,’ he sighed.

Yet the connection between antidepressant use and mania is less clear than he’d suggested. According to Gary Sachs, the founding director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, studies have associated a slightly higher flip rate with only one antidepressant, Effexor. As for the others, he told me: ‘There may well be a small risk.’

For reasons unknown, Hank and the OkCupid guy are medical outliers, with the shitty luck of being interesting cases. While I don’t wish a lifetime of bipolar illness on anyone, I wonder if the people who develop this illness young are better equipped to deal with it. The onset often comes when they’re still within their family’s grip, when they are surrounded by people who consider it their job to watch over them, and they have years to become scholars of this flaw in their brain. As they mature and make new connections, the people who love them are alert for symptoms and quick with intervention. Sachs told me that some people suspect Mark Twain might have had an undiagnosed bipolar illness. He and his wife developed an elaborate signalling system for those times when his moods veered dangerously out of control, for instance at a dinner party. One signal to shut up, another to get up and leave the room – and he heeded them, because he had spent decades with the disease.

‘She was like the tail on his kite,’ Sachs told me. ‘People with these conditions are always looking at the world through their current mood. But if they have good supports, they can do extremely well.’

Hank never got the chance to build up the kind of supports he needed in his crisis. It took all of us too long to figure out what was going on and where to turn.

A few days after that first phone call, Hank flew back to Cleveland. I begged him to call one of the therapists or doctors that he’d seen in the past few years. He had met with most of them only once or twice, but there was a psychiatric nurse with whom he had something approaching a therapeutic relationship: she knew him from the outpatient alcoholism programme he’d attended when he and I were still together, and I think he had been in touch with her after he was hospitalised for a series of panic attacks.

But he wouldn’t call her. He wouldn’t go to the hospital. He was fine. He was better than he had ever been in his life! Why hadn’t he ever realised how good life could be! He agreed that he needed to sleep – he hadn’t slept in days – and promised he would nap immediately, as soon as he hung up the phone. When I called later that day and he didn’t answer, I hoped he was still sleeping. Instead, he was off at the Apple store, buying laptops and iPads and accessories for his TV. He spent $10,000 in an hour or two, a lot for a man with a modest income and, aside from his retirement account, no savings.

Hank sauntered out of police headquarters in the exquisite coat and hat a stylish French banker might wear

That was the first time we – my daughter and I in Portland, friends back in Cleveland, Hank’s mostly far-flung family – noticed the crazy spending, although it had begun before. He went to Pottery Barn and bought new dishes and wine glasses and linens and piles of artful baubles to entertain the many guests he was sure were going to come to his parties. He paid the tab for rooms full of strangers at restaurants and offered to take a neighbour’s children shopping and let them pick out whatever they wanted. He emptied out Home Depot’s woodworking department and piled up boxes in his basement for a new career making fancy garden trellises. He bought high-end guitars and displayed them on stands in his living room, poised like a choir ready to sing. He decided his real career opportunity lay in starting a band and opening a recording studio in his apartment, so he started inviting other musicians to join in and left the woodworking equipment to moulder in his basement. He called a drummer friend, who said he didn’t want to drag his drums up the stairs to Hank’s apartment to rehearse, so Hank added a $10,000 drum kit to the collection. He displayed a heretofore unnoticed fine eye for clothing and filled his closet with couture.

Months later, he called a mutual friend in the middle of the night to come pick him up at jail, where he’d been held after the umpteenth noise complaint from his neighbours. What most stunned our friend was the sight of Hank sauntering out of police headquarters in the kind of exquisite coat and hat that a very stylish French banker might wear. The afternoon he was released from one of the many psychiatric hospitals or psych units or detox centres that held him from one to 10 days in the six months that followed that first phone call – never long enough for him to stabilise – he bought a fully loaded Toyota Avalon.

How did he pay for this stuff? He was on disability leave for a few months, receiving some sort of paycheck and building up debt. When he lost his job, he drained his 401k. When he ran out of cash, he sold some of his new stuff to buy cigarettes and food.

I chastised him for all this spending, but I was a carping Cassandra to his whirligig Bacchus. He was incredulous that none of us understood how wonderful his life was. When he called to regale me with the details of his Pottery Barn purchases, I dutifully began to tell him how deluded this was, but he interrupted me. ‘Darling, stop worrying! I have plenty of money! I have all the money I need.’

‘I guess you must have won the lottery,’ I said.

‘That’s right!’ he answered, jubilant that I finally got it. ‘I won the fucking lottery!’

I was, in fact, a tiny bit... jealous isn’t quite the word – but I could see how much fun it would be to blow all my retirement savings on everything I wanted, right now. When pulled to the surface, that unconscious thought disturbed me because I had done something like that when I moved from Cleveland to Portland. Aside from a few pieces of furniture inherited from my mother-in-law and an illuminated globe that had been in my parents’ house when I was a kid, I wanted my Portland domesticity to look completely different from my Cleveland life. I sold or gave away all my old stuff and prowled eBay for earthenware plates and brightly hued Swedish cookware and barware with images of fanciful chickens, all from the 1950s and ’60s. I hired a contractor to fix up my new little house in Portland and a landscaper to make a stone patio and garden. I didn’t spend all my retirement savings, but I spent more than is probably wise and must now be more careful about money than I ever have been. At the time, all that spending felt… wonderful.

Yet my spending was different from Hank’s. People with bipolar disorder, said Hilary Blumberg, director of the Mood Disorders Research Program at the Yale School of Medicine, lack balance in the prefrontal cortex, the part of the brain right behind our foreheads that, among other things, regulates emotions and impulses. That part of the brain works a bit like a see-saw, with positive emotions generated on the left and negative emotions on the right – resembling the cartoon images of someone pelted with opposing advice from the angel on one shoulder and the devil on the other. In a manic state, the positive emotions from the left side of the prefrontal cortex exhort ‘Do it, do it, do it!’ and overwhelm the right side’s ‘Bad idea! Bad idea!’ Or, as Blumberg put it more carefully: ‘If there is less activity in the right hemisphere, the positive emotions of the left hemisphere may become more prominent relative to negative emotions.’

Hank’s left prefrontal cortex was king of the mountain for six months. His family and friends and I fretted and conferred after that first alarming weekend down south. Finally, one of his children called the police and a friend convinced the cops that he might be suicidal and they took him to the emergency room. And truly, we were worried about this, because how could flying this high not trigger a dizzying fall? How could sweet, mild, taciturn Hank abide the loud and extravagant Hank who had taken over? But he was held only for a day that first time. Then another day the next time. Then 72 hours. Then five days. Then a week. Then 10 days. Each time, a social worker or nurse would call me – he always gave them my phone number – and promise they’d get him sorted out. Then I’d hear he had been released, long before the three or more weeks that it takes for the medications to work, when I knew from his phone calls that he was still manic and delusional. I called one of the social workers after he had been released, which was pointless – it’s not as if she was going to hunt him down and bring him back. And anyway, he was off buying a car.

Who knew what to do? The new Hank was social, out and about, always at a table or bar, wandering the streets knocking on doors, walking into friends’ homes unannounced. It was clear that this Hank was different – brightly aggressive, clueless to their discomfort, unfurling skeins of wild talk that they didn’t know how to take. Was his band really going to perform at Playhouse Square, and was he really talking about a contract with Tommy Emmanuel’s manager? Had he really bought that great house which had been empty so long and was he really building a recording studio inside? His delusions were so convincing it was hard for his friends to understand what was real.

And since he was still drinking, it was hard for them to figure out if what they were seeing was extreme alcoholism or something else. I was sure from that first phone call that it was something else, a manifestation of brain sickness distinct from alcoholism, and I felt a spray of fury every time someone said that he would eventually hit bottom and realise he had to take responsibility for his behaviour – as if this was something a 12-step programme could cure.

‘That’s an old-time Alcoholics Anonymous idea,’ Ceci McDonnell told me. ‘And I get it: most people need discomfort before they want to change. But when you have bipolar illness, there is no bottom because the illness is so distorting. If someone is delusional — meaning they have fixed irrational beliefs – the intensity of those beliefs remains strong even as things keep getting worse.’

some of the same brain areas affected by bipolar disorder are also affected by substance abuse

Some of us thought Hank’s excessive drinking caused the mania, but many experts now think it’s the other way around: that people with bipolar illness drink to self-medicate against the fearsome swings of their psyche. In any case, there is a connection between the two afflictions. In one study, the US National Comorbidity Survey found that people with mania were up to nine times more likely than the general population to have an additional lifetime disorder of drug or alcohol dependence. Blumberg tells me that some of the same brain areas affected by bipolar disorder are also affected by substance abuse: ‘It is possible that there are genes that are involved in the development of the prefrontal cortex that lead to vulnerability for both bipolar disorder and substance abuse, and that that is why the two co-occur for some individuals.’

No matter the cause, getting someone treatment for mental illness is agonisingly tough in a health care system where long-term, therapeutic relationships have been trashed. ‘To help someone with these disorders, a therapist must know them well and have an ongoing connection, and that rarely happens any more,’ McDonnell told me. In addition, privacy laws passed in the mid-1990s are often so rigidly interpreted by health care institutions that families aren’t told what’s going on. When families aren’t sure what the diagnosis or treatment plan is, it’s hard for them to help, try as they will.

Patient rights laws have also placed the burden for making medical decisions on the person least capable of making them – the person with the mental illness. If you have a problem with your heart or your kidney, you yourself are highly motivated to take care of it. I have several loved ones who didn’t want to become experts in breast cancer, but became crack researchers and advocates for their own care after they were diagnosed. Hank didn’t think he needed treatment. He thought he was wonderful! And because of patient rights laws, no one could force treatment on him without a court order. ‘These patients have the legal right to refuse treatment, but they’re not in their right minds,’ McDonnell said.

Not so fast, the Virginia psychologist Russ Federman told me when I complained to him about patient rights. ‘Just because someone is delusional doesn’t mean they are dangerous or can’t manage themselves on a day-to-day basis,’ he said. ‘They may not be able to live very effectively in society, but the distance between being moderately symptomatic and being manic or even psychotic is not very far. Protecting the rights of individuals and protecting individuals from the adverse impact of their psychopathology is a delicate balancing act.’

Imagine, Federman said, someone else who feels like spending all his money. This imaginary person is not mentally ill, but has accumulated assets and lived prudently and suddenly decides that he’s tired of being prudent. ‘That person has the right to spend all his money. From a legal perspective, it’s not easy to differentiate between your friend and that hypothetical person.’

But I could differentiate. I sometimes felt the only moral response was for me to get on a plane and go back to Cleveland and hunker down among the empty boxes in his apartment and make sure he got treatment – to bang on doors and stand in hallways and make someone take care of him. Or set him up in my spare bedroom in Portland and watch over him. I blurted this out to my daughter one day and she said: ‘Are you sure you want to do that, Mom? That would be a huge responsibility.’ And the answer was no. I wasn’t willing to give up my life for him, and that’s what it would have meant.

‘you need at least 50 beds for a population of 100,000. In 2008, England had 62 beds per 100,000. The US only had 14 beds per 100,000’

Even if we could revise the patient rights and other well-intentioned laws to be more helpful to people with mental illness, there is still a fundamental flaw in the system. There are not enough hospital beds for the mentally ill and especially not enough public hospital beds, since people with mental illness have often blown through their resources and can’t get private care. ‘The rule of thumb is that you need at least 50 beds for a population of 100,000 people,’ said Doris Fuller, the executive director of the Treatment Advocacy Center in Arlington, Virginia. ‘In 2008, England had 62 beds per 100,000 people. The United States only had 14 beds per 100,000. And that’s the same number of beds that America had in 1850, which is when we decided to treat mental illness as a disease.’

Instead of funding our hospital system to care for mentally ill patients, we let our police and jails take care of them. As Nicholas Kristof illustrated in his New York Times column on 8 February this year, America’s largest mental health facility is a Chicago jail. And it’s not as if Chicago is special. ‘Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals,’ Kristof wrote.

In the sixth month of Hank’s mania, despair began to knife through. He’d call me weeping, asking why I had not come to his party, asking why no one ever came to his parties. He started to panic about money, because even though he was working on three lawsuits that were sure to make him a multimillionaire – and me, too, and my daughter, all of us would be millionaires! – he needed money right now. He was furious when I wouldn’t come to Cleveland and deposit some funds into his checking account. His calls finally became so frequent and angry that I turned off my phone. He was in what’s called a ‘mixed state’, in which mania and depression flicker in rapid succession. This is when the risk of suicide peaks.

That’s when he got lucky; the system kicked in. My daughter found a county mental health crisis centre, and I called them over and over. They went to his apartment twice, then told me they were working on a plan – not that they could tell me what it was, because of privacy laws, but it was a relief to hear. Next thing we knew, he had been court-ordered into treatment for three weeks.

He called me often from the phone in the hallway. After about two weeks, he began to sound like himself again – no rage or elation. But he was surprised anyone thought he belonged there. Group therapy was minimal. He wanted to feel the weather. He wanted to go outside.

It wasn’t the suite of healing therapies I wished for him. I know people with money go to places with gardens and unharried staff and healthy food. But at least he wasn’t alone in his apartment, his delusions blooming and then exploding, the hunks of cheese marbleising on the table and the wine uncorked.

‘I’m starting from scratch. I have no job, I have no money, I have nowhere to live, and I’m a fucking idiot’

And then suddenly, he was out before the three weeks were over. He sounded dazed and sombre, and everyone around the country who had been following his progress rejoiced. His kindest of landlords planned to delay eviction and let him move out at a less-frantic pace. His children planned to help him sort through and sell his purchases. Other relatives were helping him with funds, though he worried a paycheck wouldn’t come soon enough to prevent his car from being repossessed. ‘I have nothing,’ he told me. ‘I’m starting from scratch. I have no job, I have no money, I have nowhere to live, and I’m a fucking idiot.’

I assured him that he wasn’t an idiot, he had just been sick in his brain and had made some terrible decisions. I tried to shine up some optimism, but really, if I were in his place I’d drink myself senseless to block out the terror of this piper he would soon have to pay. I had wanted to reach through the phone and shake the people at the many treatment centres who told me they were releasing him because he wasn’t a danger to himself. Wasn’t the wreck he’d made of his life dangerous enough?

Within hours of his release, he was drinking. Within a week, he had called the suicide hotline and was admitted to another psychiatric unit. This time, Hank didn’t hector the staff to let him go. Finally, he had seen the bleak landscape carved by his mania, knew this was now his country, and wanted the help of many steadying hands before trying to make his way.

Note: Hank’s name and some identifying details have been changed to protect his privacy.

Read more essays on illness & disease, memoir, personality and psychiatry & psychotherapy


  • G

    From the time I've spent with a couple of close friends who have or had bipolar disorder, it's clear that the present clinical descriptions and theories of bipolar disorder are at minimum incomplete.

    It is not so simple as 'mania, depression, and mixed-moods that rapidly cycle.'

    There are two interacting variables that produce four distinct states.

    One is 'mood.' The other comes close to what's known in the general psych literature as 'arousal level' and in the vernacular as 'energy level,' as in 'I have a lot of energy today' or 'I have very little energy today.' (This is _not_ the same thing as the New Age usage of 'energy' as a term for vaguely-defined characteristics of the (hypothetical) soul.)

    The four distinct states are:

    1) High mood, high energy. In people who are highly talented whether in the sciences, technology, or the arts, this is what I call the 'Creative-God phase,' where someone has genius-level creative and intellectual capacity and can accomplish much in very little time (e.g. compose an album's worth of songs overnight). More often, this is the 'wild spender' state where personal savings get flushed down the drain in a consumer binge that ends with a crash.

    2) High mood, low energy. This is what I call the 'happy-go-lucky stoner' phase, where the person seems perfectly content and upbeat, but lays about and accomplishes relatively little. Behaviourally it appears very similar to what you see in people who chronically smoke too much marijuana. (This is one element of what is conventionally referred to as a 'mixed-mood state.')

    3) Low mood, high energy. This is what I call the 'raging arsehaul phase,' and you can adjust the middle word in that phrase to the more common vulgar slang term. This phase is characterised by behaviour such as argumentativeness combined with frequent use of insults, daring others to fight, coming on obnoxious, trying to pick fights with constables, etc. In some individuals it can produce a high risk of overt violence. It can also lead to 'suicide by cop.' It's the #1 major danger of bipolar disorder to the lives of those who have it, and to the emotional wellbeing (and potentially the physical safety) of those who are close to them. (This is the other element of what's conventionally referred to as a 'mixed-mood state,' and the difference between this and the preceding one supports my scepticism of the completeness of present medical hypotheses.)

    4) Low mood, low energy. This is what I call the 'classic depression phase,' where the person has little to no motivation, feels miserable about themselves, can't be bothered to do the routine things to take care of themselves, etc. It's the #2 risk for suicide among the four phases of bipolar disorder, in the same manner as when depression occurs as a sole diagnosis.

    I also believe the present 'prefrontal cortex' hypothesis of causation, as the author describes, is incomplete. There is more to it than simple positive/negative mood: there is also arousal/'energy' level, and there are complexities of the interactions of moods with personal interests and life history that strongly suggest state-specific memory is part of the condition. The reward pathways that are involved appear to differ with phase, and with the content of ideation. And the degree to which individuals can slam from one phase into another suggests 'punctuated equilibrium' as described by chaos theory: a hypersensitive mechanism that runs on a hair-trigger and self-reinforcing feedback loops.

    At least two people I have known who have this, have reported that marijuana substantially reduces the severity of the mood/energy swings, particularly the high-energy phases. However marijuana may make the low-energy phases worse, though that's less risky to self & others than the uncontrolled 'low mood / high energy' phase.

    The key to reducing the risks of bipolar disorder is a) a sufficient degree of insight to know when one should 'quarantine' oneself from risky activities such as spending money or interacting with authority figures, plus b) the ability to run one's daily routines 'on autopilot' whilst ignoring or setting aside one's own emotional state. I would hypothesise that these capabilities can be strengthened to some degree by persistent practice of a) mindfulness meditation (to learn to recognise one's internal states) and b) concentrative meditation (to learn to maintain focus and set aside subjective or emotional distractions).

    Any successful pharmacological approach to bipolar disorder is going to have to work by reducing the hair-trigger and feedback loops that hypothetically produce the extremeness of mood/energy swings. It's going to have to work without dulling intellect (that is a no-compromise issue), and it's going to have to produce a sufficiently pleasant subjective state as to encourage patients to take it regularly.

    Almost all of us 'have our moods,' and have mild versions of all four of the phases of bipolar disorder. But the difference between normal and bipolar is the difference between 'you having your moods' and 'your moods having you.'

    Lastly, it appears that some individuals naturally 'outgrow' bipolar disorder, as a result of changes in the brain as they get older. This element may be of substantial interest in developing a viable theory and viable medications.

    • bleh

      You cannot understand a psycho, stop trying to make them seem logical, they are not.

      • G

        That's not true. First of all, 'psycho' is a useless pejorative and arguably is objectionable in the manner of racial or religious slurs.

        Second, medical science has made significant advances in understanding and treating depression, anxiety disorders, and obsessive/compulsive disorder (OCD). OCD was once a medical mystery but, serendipitously, it turned out to be treatable with the same SSRI meds (Prozac etc.) as are used to treat depression.

        Third, minds live in brains, brains are built by nature, and nature is understandable through science. Science uses empirical experiments and logical reasoning to understand nature.

        As friends & family members of people with psychiatric illnesses, it may be difficult for us to understand them 'logically,' but that is not the same thing as saying that science won't be able to come to viable theories and develop treatments that work. You and I may have at best a layperson's understanding of relativity and quantum physics, but that doesn't stop us using GPS and CD/DVD drives respectively. Meanwhile Professor Higgs understood physics deeply enough to predict the scalar boson fifty years before experiments confirmed it.

        The same can be said for understanding why people fall in (and out) of love, why they enjoy certain foods, music, art, films, etc., but not others, and why they believe as they do about political, religious and philosophical matters. You and your best friend might argue about politics, and consider each others' politics 'illogical,' but that has nothing to do with what science may discover about how our brain activity relates to various emotions that influence political beliefs.

        Lastly, a little empathy for those who are living with bipolar disorder, goes a long way toward understanding them better. If someone you know has bipolar disorder, one of the best things you can do for them is seek to understand them, and be a stable person in their lives.

        • JenJen10

          Are you a medical expert in psychiatry?

        • DietrichB

          So called "bipolar disorder" is 100% fraud per Dr. Fred Baughman, Neurologist, and author of ADHD Fraud. Dr. Thomas Insel, Director of the National Institute of Mental Health, has finally admitted what those like me who have done tons of research have known for decades: that the psychiatric "bible," the DSM, is totally INVALID without a spec of scientific, medical or any other evidence to back it up. Rather, the 300+ so called disorders in psychiatry's junk science billing bible were VOTED IN by consensus by a group of corrupt KOL psychiatrists who sold out to Big Pharma to create the fraudulent biobiobio toxic drug, ECT and other brain damaging lobotomy pushing we have today. This is not treatment, but torture as defined by the U.N. and disgusting totalitarian human rights violations. Citizens should do their homework rather than posting ignorant drivel that helps destroy others lives and human rights in the guise of "mental health" that has made billions for Big Pharma and corrupt psychiatrists, politicians, government, drug company front groups like NAMI and others feeding at this lucrative gravy train as they help destroy others including family members with impunity for greed, profit, power and sadism.
          Wake up! You could be next!

      • Nancy Rubenstein

        That is nothing but hate speech.

        • DietrichB

          Agreed! Here is another excellent, recent book exposing the horrific fraud of biopsychiatry's bogus DSM bible and stigmas, toxic drugs and coercion with the latter the only "enduring treatment" by the mental death profession.

          Dr. Thomas Szasz also exposed this fraudulent robbery of human rights in the guise of medicine in his many great books, The Myth of Mental Illness, The Therapeutic State and many others exposing that psychiatry is the new state religion on witch hunts and inquisitions to destroy the lives of anyone challenging or dissenting from those with more power just as dissidents in Stalinist Russia and Nazi Germany were "treated."

    • brokeninside

      This comment is spot on. Thank you for telling it like it is!

    • anne

      Thanks for this - the problem with the article above is using a single person's life experience as a model for all people with bipolar disorder. The medical model is incomplete and flawed. This comment is a lot closer to getting at the complexity of what needs to change to get better treatment for people with mood disorders.

      • jaxative

        The article itself isn't about bipolar as much as it is about American society's response to it.

    • tarry2020

      As a front-line Medic working in a resource constrained environment, I find your characterization of the four states of bipolar disease quite enlightening. I have often wondered what exists between the extreme poles of mania and depression, and which of these states is more acceptable than the two extremes. But describing and defining the situation does not solve the problem, rather its utility lies in identifying the phases where 'active maintenance therapy' should take place rather than waiting for the trigger points as it is traditionally the case.

    • George

      "the ability to run one's daily routines 'on autopilot' whilst ignoring or setting aside one's own emotional state."

      This, I think, may be vital. There is a tendency to interfere with one's natural 'doing', to force it along, push or 'end-gain' - whilst other people are a bit more detached and unfold at a moment-by-moment pace. This hypers-you-up; your focus gets narrower and narrower; perspective dissolves; you're pushing a pendulum to a higher level until it pushes back on you.

      Bipolar people are always in a rush... until they aren't. I think it is behavioural rather than chemical, although it impacts all.

  • Tom

    Really fantastic piece. Thanks so much for sharing this story and for making us all more aware of this awful disease.

  • Jane Phillips

    I was in a similar situation as your friend Hank, having my first manic episode at age 38- no alcohol abuse though. After struggling badly for 2 years, I found EMPower Plus, a nutritional supplement. With this, I have been in remission for 4 years, with occasional problems if I miss the supplement.

    It does not work for everyone, but if it helps anyone struggling with Bipolar Disorder, as it did me, I would be happy about it.

  • Robert M

    As someone who has bipolar disorder and recently went through a manic state, this piece is dangerously sure of the usage of psychiatric facilities for treatment. Being put in one of these places is similar to jail and, depending on health insurance and the state involved, extremely costly. Even my spending binge was slight in comparison to what I would've been charged for staying in a facility for just three days if I did not have health insurance through my job.

    Since this was my first (and hopefully last) severe manic state, the psychiatric facility was profoundly disorienting and, I believe, made my mania worse by creating a severely constrictive situation I had no previous experience with, resulting in the only real thought of suicide I've had in my life and some visual hallucinations that partially resulted from my inability to understand my surroundings. Being around other people who are in a psychotic state also doesn't help matters.

    Care from the family and having a therapist to poke through the irrationality is by far the best option, but the family has to understand what's going on. And, unfortunately, therapists are incredibly expensive.

    In the end, due to the extreme commercialism in the culture and how health services are set up in the US, this is a terrible place to be bipolar. The system is arranged in such a way to take everything from you. Psychiatry also, as G mentioned, does not have a complete enough understanding of how it works (his description gets closer) and does not necessarily train its practitioners well to deal with people who have the disorder.

    • JenJen10

      You attribute your hallucinations & thoughts of suicide to the "severely constricting situation" in the facility itself. This is your first extreme manic experience.

      Be careful in attributing blame. It's possible you would've been the same no matter where you were located. Hallucinations are common in extreme mania, so is suicidal behavior. You're lucky you were not in a place where you could follow through on your thoughts.

      • DietrichB

        And what are your credentials or what expert sources are you citing as you dictate to everyone here?

    • DietrichB

      The so called manic symptoms could have been brought on by SSRI's or stimulants, lack of sleep, and a variety of other stressors. Bipolar is a bogus fad fraud and doesn't exist! It was invented to push the latest lethal second generation neuroleptics on patent to make billions for Big Pharma and corrupt politicians, government, psychiatrists and family members on the dole via NAMI and other drug company front groups.

  • Pattie Kettle

    Thank you for shining a light on a tremendous burden on our national system (i.e. jail time for mental health patients). We need enlightenment on what mental illness is and isn't and how to promote mental health effectively.

    • Nancy Rubenstein

      The burden on our society is the massive manufacturing of "mental illness" by the drugs purported to treat it. 250 children a day go on ssdi for "Childhood Bipolar Disorder" which was invented by Joseph Lieberman of Harvard. Children are literally being drugged for temper tantrums when they are toddlers.

      • DietrichB

        Exactly! Joseph Biederman created both the child ADHD and bipolar epidemics as a paid shill of Johnson & Johnson exposed by Senator Grassley. During his deposition Biederman compared himself to God. The real horror is he got his hand slapped for destroying millions of children's lives as with the death of toddler Rebecca Riley on his recommended lethal drug cocktail and is still highly regarded by the biopsychiatry/Big Pharma industrial complex much like the horrific deadly military complex death machine! They will stop at nothing for their sadistic greed, power hunger mania, status and acting as the dictators of the world.

  • Holz

    I wish there was more honest writing about real people like this in the mainstream media. Thank-you for writing.

  • Richard Hung

    I watched a mentally ill tenant destroy her own life, and trash my house in the process. There's a reason the government doesn't get involved. To do so is a complete violation of the bill of rights. The police were at that house a number of times. She got a DUI. She hoarded animals. She lost her driver's license. She spent 11 days in the hospital ICU and emerged with half a mind, and she STILL persisted in exercising her rights.

    These people destroy their own lives, then destroy those of everyone who will permit contact. Unfortunately they have every right to destroy their own lives, and enjoy getting "help" the same way a hunter enjoys shooting prey.

    All you can really do is protect yourself. He won't come out of his swoon, the constitution will respect his rights to destroy himself, and when his life is in complete shambles he will magically reach out for more charity to "help".

    He'll be using that compelling sympathy siren as his meal ticket for the rest of his life, because being crazy means never having to provide for yourself ever again. And they're oh so grateful until the money runs out - then they're ANGRY and everything you did to help means nothing because there's no more help coming - the well is dry.

    For the insane, Reality World consists of wonderful people who empty their pockets to help, and evil nefarious villians who refuse to be dragged down into the depths.

    I can't afford to be "helpful" anymore, so I'm now automatically a villain - one with an intact retirement plan, for now, anyway.

    • xplif

      I'd like every single human being to be robbed of their mind for a few months, experiencing phases where you think you're the Messiah and phases where even the simple act of talking to your relatives seems so daunting. People can be so judgmental, it makes me sick.

    • G

      In the US, we have Alcoholics Anonymous for peer support among recovering alcoholics, and we have Al-Anon for peer support among their families, friends, coworkers, and so on. Perhaps you have both of those in the UK as well. But in any case we need something similar to Al-Anon for people who are associated with someone who has a serious psychiatric illness.

      Psychiatric illness, like alcoholism, is hell on those who are associated with the person who has the illness. All of us who have known people with these conditions have stories to tell about how hellish it can get. But merely putting down the person who has the illness solves nothing. Seeking organised peer support from others with similar circumstances, or getting one-on-one psychological counseling to help understand their illness and develop ways to deal with it, are much more productive.

      • notmike64

        NAMI is good source for peer support

        • notmike64

          D7 stole my thunder

        • Nancy Rubenstein

          NAMI is a good source of misinformation. Since it was founded by the drug company Phizer, and over 80% funded by Big Pharma.......what a surprise!

        • DietrichB

          What a farce. NAMI is a Big Pharma front group like others pretending to help those they have made basket cases they call mentally ill. NAMI is the no fault group that blames all their narcissistic and psychopathic abuse of others on their diseased brains. That's part of the great manipulation biopsychiatry/Big Pharma used to prey on such blind, evil people traumatizing others so they could blame the victims and pump their grandiose selves up all the more by pretending to help those they destroy with impunity. What a despicable farce.
          Real experts in family dysfunction knew in the past that the one being brought for treatment was called the "identified patient" representing all the sickness of the entire family mostly created by the so called adults.
          See Dr. M. Scott Peck's great book, The People of the Lie, about evil people who always scapegoat and destroy others to keep their false lie and delusions of perfection intact as the cost of others' lives since they destroy life and liveness their victims. This is also described in great books like Stalking the Soul.

      • JenJen10

        Al-Anon is for anyone who is having trouble with an alcoholic. Not just family.

    • JenJen10

      You are right that every person must first look out for their own self. It is wrong to let anyone else ruin your life.

      But your attitude is very negative; you are demonizing all mentally ill people. They can't help how they are made.

      You are in a bad place. You have been hurt & you are lashing out at the person who hurt you. You need some objective distance between what happened & how it affected you emotionally.

      Be grateful that you stopped yourself from being ruined financially in time. But don't demonize the sick person. Like this article shows, the mentally ill don't even know what's happening to them, and even if you explain they won't understand. Their minds are in a different world.

    • asher2789

      both myself and my ex gf suffer from mental illnesses.

      i understand where you are coming from, considering how dependent my ex was and how she relied on me to help her, and essentially emotionally abused me with her narcissism. she a absolutely, 110% relies on other peoples kindness to get by in life, and then when they realize its all a ruse and leave her, she gets even CRAZIER. she blamed her suicide attempt on me, and then called me the emotionally abusive one. right.

      at the same time though, you should have to live with mental illness and not be able to hold down a job because of it, and then reread those words. mental illness is just like physical illness, it is disabling. do we shame those with cancer for relying on others because they cannot work? do we shame the blind? the deaf? the amputees? no. so why the hell are you shaming the mentally ill? because you think our illness is fake?

      you are a villain. not because you refuse to give a "handout" but because you fail to recognize the mentally ill as what they are: ill.

  • http://daviddobbs.net/ David Dobbs

    Beautiful, beautifully sad piece, Kristin. It's horrific, how badly we fail the sick in this country. Thanks for writing this, though. It's a triumph of empathy, honesty, insight, and superb writing.

    • MaggieMae

      What insight does this 'superb' (ha) piece offer? Just a bunch of quotes strung together in too-long sentences with a dose of first-world whining.

  • BipolarEx

    Bipolar people should be put to death. Not only are they selfish, leaching animals but they have no remorse for their actions. I dealt with bipolar exes, coworkers etc. Always the same. They mess something up, create drama and make sure they are the focus of attention. Kill them all.

  • Skanik

    Mention should be made of the compulsive/obsessive nature of Bi-Polar.

    Even though you may know that it is ridiculous to buy a new car or fly to
    Moscow and set Putin straight about Crimea...the thought just won't go away
    and the elation brought on by thinking about it and the future feeling that
    what (a) wonderful feelings/person it will make you just overwhelms whatever
    common sense you may have saying this is just asking too much.

    The laws should be re-written to give Family Members more scope and leeway
    to help their beloved children/siblings.

    • JenJen10

      I agree that family should have more power over the mentally ill. In most cases. The laws were created to prevent abuse. Remember the not-too-distant past when husbands could lock up their wives as punishment for refusing sex, or their children for refusing to obey them. I don't want a return to that.

      As this article so aptly illustrates, the mental health system in this country is incredibly inadequate & fragmented. People need long-term help, not sporadic pills. This man's problem is long-term, so should the solution be. Family are usually the ones who see the problem the clearest because they're the only ones around long-term, and that's why it's so frustrating to them. This man needed drugs for bipolar, and the family couldn't get them for him, only doctors can.

      The system has to change.

      • Nancy Rubenstein

        Family are usually the ones who create the problems that lead to a family member being diagnosed with so-called mental illness. The people we never see in psychiatrists' offices are narcissists. Everyone around them winds up with a diagnosis. This country is supposed to be based on rule of law. People should not lose their civil rights because someone says they are crazy. And no one "needs drugs" for "bipolar". The drugs are nothing but horse tranquilizers and stimulants. They treat nothing.

        • JenJen10

          I agree that the drugs in many cases do not "treat", they simply anesthetize, I have unfortunately seen a close friend being overmedicated. I tried to intervene with her "therapist", and her family told me they were very worried about her. She was the only person who didn't seem able to see what was happening to herself. The way society treats the mentally ill today is unfortunately to dope them up & push them out the door.

          But in many cases of extremely out-of-touch behavior, people cannot function at all in society. Schizophrenia for instance cannot be cured, but a schizophrenic can take medicine to dampen down the malfunction in their brain, at least enough to function on some level. I used to know a schizophrenic who was afraid to tell people he was schizophrenic, but he told us he believed in "angels" because he had heard them talking. He tried to say it did not happen any more, but I could see he was afraid that if he admitted that he still heard voices no one else heard, people would run away from him. He had a very high IQ & was able to find a place where he could make a living, but it was doing a job that his IQ overqualified him for. If his disability had not been present, I am sure he could've achieved more in life.

          That's the real shame in mental illness, it keeps people from being successful, happy, productive.

          One thing about drugs; any 'normal' person who takes drugs risks becoming an 'abnormal' person. Drugs can mess up your mind as well as help your mind, it all depends on what your mind is already like, & what drug you take. I take the position now that no one should take a drug unless they're in dire straits. My elderly mother was given a drug for her arthritis, it made her hallucinate, she started talking about the hands on a portrait of her great-grandmother moving. When I told the doctor, they told me immediately to take her off that pill. She had only been given this medicine because her insurance company had stopped paying for the other one she was taking. They didn't warn us that hallucinations were a common side-effect. It also seemed that the effect did not end when the drug was stopped, she still talked about the hands on the portrait moving, but with her age & mental condition, I'm not sure if she still thought they were moving or if she was just remembering what she thought she saw. Hers is not the only case I've heard of with an elderly person having mental problems because of drugs, my sister knew of another woman who for 2 1/2 yrs was diagnosed with mental problems, until a new doctor removed her from some of her drugs, then her mind cleared up.

          But unlike you, I don't think families create all mental problems. Schizophrenia is a case of nobody creating it, it's a miswiring of the brain that runs in families. It's nobody's fault. Bipolar is another problem that runs in families, it runs in my mother's family. It often skips generations.

          • DietrichB

            Bipolar does not exist. It's a junk science stigma VOTED INTO THE DSM in the 1980's into DSM III with narcissist Robert Spitzer, the editor. It's another garbage can stigma for trauma and other stress related abuse, bullying and mobbing symptoms to discredit and treat the victims with the latest lethal neuroleptics on patent to make a literal killing.
            Many given the equally bogus schizophrenia stigma for hearing voices often due to past family trauma recover if they avoid or escape the toxic drugs and the mental death profession like the plague it is!

          • JenJen10

            You say "bullying" & other forms of family trauma cause all mental illnesses, but in people I've seen that is not true. I'm sure it is in some cases. But I think there is pretty much proof for some brain miswiring that could be caused by environmental causes, such as viruses, a difficult birth. Or could be inherited.

            Personality is inherited. I think there is a strong case to be made for some types of personalities being more prone to types of problems, such as anxiety, which could be made worse by trauma.

            I also believe our diet can affect our moods very strongly. What I eat/drink has a very noticeable effect on me.

            But to say that all forms of mental illness are created by the drug companies & psychiatrists is pretty much too far away from the truth.

          • DietrichB

            I did not say that psychiatry or Big Pharma created the social or other environmental conditions that cause trauma, emotional distress, life crises, ups & downs or plain problems in living. What the mental death system DOES DO is to fraudulently MEDICALIZE these normal human problems in living or life stressors in a one size fits all bogus stigma with no evidence whatever to push the same few categories of toxic drugs, ECT or other brain disabling/damaging abuse they pretend are "treatments." Yes, there may be physical causes of some symptoms, but the mental death profession doesn't check for those; they just slap on a lucrative label like bipolar within about 10 to 15 minutes and dole out a prescription for lethal neuroleptics, so called mood stabilizers and may be other poisons for their deadly cocktails. Now that second generation lethal neuroleptics are making billions they are being used for everything under the sun off label for even toddlers and the elderly no less at huge risk and harm.
            The DSM 5 has even medicalized grieving over a loved one for over 2 weeks that should be treated with bogus, useless SSRI antidepressants with dangerous side effects for so called depression. The grief exclusion in DSM IV was removed in DSM 5. It's all total fraud, get it?
            They aren't interested in anyone's unique physical, environmental or other problems, but rather, just slapping on bogus DSM life destroying stigmas to push their lethal drugs, ECT and other tortures in the guise of medicine for maximum profits with Big Pharma.

          • JenJen10

            You have a very down attitude toward all mental health professionals. I have seen egregious misdiagnoses & overmedication, I've experienced overmedication by doctors in many situations, so much so that I've started telling people up front that I do not believe drugs are the answer to most problems. I agree that all doctors in general are too eager to prescribe. Our rising rate of overdoses & deaths by prescription drugs are proof of this.

            But I'm afraid I differ from you in that I do not believe the mental health community is solely to fault for this.

            We are a quick-fix country. We expect too much from medicines. And doctors.

            How many people go to a doctor today without the expectation that he will fix whatever problem they present in one visit? That's unrealistic.

        • DietrichB

          Nancy, I am grateful and proud of you for stating the facts despite the brainwashed biopsyciatry/Big Pharma/NAMI/corrupt government and other hacks cartel pushing the latest fad fraud of bipolar disorder on just about everyone on the planet to push the latest lethal drugs on patent per Dr. David Healy's excellent book, Mania. And this article is totally wrong in its false claim that toxic, useless drugs like SSRI's (AKA the misnomer of antidepressants) and kiddie cocaine like Ritalin for bogus ADHD don't cause iatrogenic harm that is fraudulently stigmatized as bipolar in millions of cases per Robert Whitaker in his great book, Anatomy of An Epidemic, and many articles now even acknowledged by renowned psychiatrists like Dr. Sandra Steingard and Dr. Thomas Insel, Head of NIMH, who now admits all DSM stigmas including bipolar are totally invalid and lack any scientific, medical, biological, genetic or any other evidence behind them despite psychiatry's lies to the contrary for decades.
          Great work of drama queen fiction here though in this article!

          • DietrichB

            Robert Whitaker, author of Anatomy of An Epidemic, and many other articles about the fraud of biopsychiatry has demonstrated in his book and many articles and expert studies that all psychiatric drugs are toxic and may provide very short term relief to a limited number of people, but cause way more harm than if left untreated in the long run. Dr. Thomas Insel, Head of NIMH, has admitted that this is true and that not only is biopsychiatry's bogus bible of voted in stigmas in collusion with Big Pharma for power, money and status, the DSM, totally invalid and lacking any science or evidence, but also its toxic treatments leave much to be desired as well. Thus, Dr. Insel has said that the NIMH will no longer be guided by the junk science DSM or book of insults/stigma of fraudulent disorders.
            Many experts have exposed how bipolar disorder became an evil, fraudulent epidemic driven by greed, power, Big Pharma and human evil/dishonesty fueled by the KOL's at the top of psychiatry in the American Psychiatric Association who sold out to Big Pharma while preying on mostly normal people suffering life problems, crises, abuse, trauma, losses and other all too typical NORMAL challenges to medicalize and profit from others' problems/suffering. The predation on children and toddlers no less thanks to "Dr." Joseph Biederman single handedly creating child ADHD and bipolar epidemics to make millions from J&J under the table exposed by Senator Grassley is well documented in the media. His horrific ADHD/Bipolar child epidemic to push lethal neuroleptics on toddlers no less resulted in the infamous death of Rebecca Riley.
            Please do your homework as the victims of this monstrosity have had to do to save loved ones from this evil debacle that Dr. Fred Baughman, Child Neurologist and author of ADHD Fraud, calls the worst medical crimes ever perpetrated against humanity since such DSM stigmas like ADHD and Bipolar are 100% fraud.
            If you do your homework, you will see that there are many highly acclaimed books, articles and experts exposing the fraud of biopsychiatry, so the Big Pharma front group NAMI mantra won't con so many suckers these days.
            And dysfunctional families do cause extreme emotional distress and before the no fault bogus DSM, the acting out child was seen as the "identified patient" or the scapegoat for the dysfunction of the family and mostly the so called adults.

    • DietrichB

      If you read family systems therapy it is the so called family driving their "identified patient" or scapegoat crazy with their double binds, narcissistic abuse, bullying and other toxic patterns. Many victims of such family, school, work and other bullying and mobbing have trauma symptoms deliberately misdiagnosed as bipolar and other fraud, voted in DSM stigmas to push the latest toxic neuroleptics and bogus "mood stabilizers" on patent to make more billions. Family systems expert Murray Bowen wrote about family systems that could get very toxic which led to the term "identified patient" when the whole family was really the patient and just scapegoating and blaming one member often the most healthy one who could see through their narcissistic posturing and abuse.

  • D7

    this article is important (but a bit long for me to share with bipolar 20 ish son) also a bit depressing, but glad you put it out there. NAMI is great organization for family-to-family (including close friends/ex partners/etc) education groups. VERY helpful info but "the system" is definitely not so helpful with inadequate insurance coverage to "stabilize" beyond a few days or so. Also jail is unfortunately the defacto alternative to hosp. Need better help in America. Living communities to support folks who struggle these ways...

    • Nancy Rubenstein

      D7, I pray for your son's sake that you read the book "Anatomy of an Epidemic" by Robert Whitaker before you condemn your son to a life of social death based on greed and fraud. Bob watches people WEEP over what they have done to their children because they believed these so-called doctors. I wish you the very best, and if I can be of any service, please contact me. My job is Director of Public Education for The Law Project for Psychiatric Rights (PsychRights.org). I can be reached at Ladyheartwork@hotmail.com. Here is a link to one of Whitaker's talks.https://www.youtube.com/watch?v=A7pcO1fnuxA

  • Manoj

    It is spot on. I have a relation who has been on a v similar map. I can just hope something or someone helps him from total destruction.

  • http://www.livinginthehereandnow.co.za/ beachcomber

    It's interesting how these case histories are all so similar and so, though this was a well written piece, it's not anything most of us haven't heard of before and tends to border on self-indulgence .

    A few thousand words less would have had made more of an impression.

    • Howard Yalkieto

      actually it's was not a well-written piece...rambling...slapped together...

  • JenJen10

    This article reminded me of the recent Ft Hood shooting. I'm wondering if Lopez was manic when he shot up the base. He was said by his family & friends to have been quiet & non-violent all his life. When he asked the base for help dealing with something (his mother had recently died), they gave him drugs, and then he suddenly went off the deep end & ended up killing himself? That is classic mania. One of his family was quoted as saying that in the last month he had changed drastically.

    I would really like to know which drugs he was put on, and when, and for how long, and if he was off his meds & for how long. (In my experience, coming down off certain meds can be more dangerous than the original symptoms). If he was bipolar, the antidepressants could easily have triggered his disease.

    It worries me that the media never listed which antidepressants Cho was on at Virginia Tech. They said they were asked not to release the info. It's not right to keep information on negative results of drugs from the public.

    • Nancy Rubenstein

      The comment above reflects the popular myth sold by the drug companies that people in emotional distress or existential crisis have a disease. There is no disease called Bipolar that is triggered by any drug. Antidepressants do, however, trigger many autoimmune conditions like fibromyalgia and since they are toxic compounds they affect every organ system in the body. JenJen10 I am so sorry you have been so misled, and I understand because I could have written the comment above while I was still drinking the Koolaid up until 2008.Please be very careful. Psychiatrists have never bothered to study drug withdrawal (they were more than happy to tell people to stay on drugs "for the rest of their lives" that never saw the outside of six week clinical trials ). The website "Beyond Meds" is very comprehensive on withdrawal. FRIENDS DON"T LET FRIENDS COLD TURKEY. When people read the research, learn about the drugs and how they were developed, and focus on outcomes ......people want out immediately. When people realize their doctors have lied to them about physiology and about the drugs they have been sold, often they go cold turkey, or they follow the same doctor's advice on getting off. Bad Idea.People become disabled for years from antidepressant, neuroleptic or benzo withdrawal. Done safely and very, very slowly with nutritional support and support from people who have been through it, on the other side of psychiatry there is new life.

      • JenJen10

        Nancy, you are right. People do need to research these drugs extensively. I did so after I had a bad reaction, it took years out of my life to recover somewhat from them, but I'm still not 'right'. I have been focusing on nutrition and foregoing drugs completely, I even got off caffeine (which made me feel like I was going insane temporarily). I feel better now, but the effects are not gone.

        I don't think this issue is being given the press it deserves. Based on what happened to me, these drugs are dangerous and severely overused.

        I think the drug companies pushed these drugs on doctors. I think doctors took what the drug companies told them at face value. I don't think the doctors who prescribed these to me were bad people, I think they believed they might help me. That's what's so terrible about this situation. And doctors need to stop.

        I don't know if I'll ever be 'normal' again. It's been years since I took the last drug. They hurt me for so long that it affected my overall health, I stopped exercising for years. That kind of change takes a toll. Frankly, if I could sue the drug companies, I would, and I'm not a litigious person. I think they lied to doctors. I think the drug companies published drug trials that made the drugs seem like miracle drugs. I remember the doctor telling me in the 1980's that the results of the drug trials were quite amazing. He was not an emotional man, but I could see the results surprised him. It's the old adage that if it seems too-good-to-be-true, it usually is.

        What you've said here made me look up your history of comments, quite frankly your ideas shocked me, but then I realized what you were saying mostly fits with my own experience, though I wouldn't go quite so far as to disavow that mental illness does exist. Yours is a more extreme view than I espoused of mental illness in general. I am not convinced that some people's brains are not messed up to begin with and that those people were never mentally ill. I have seen children with problems, in fact my sister married a man with brain damage from doctors using forceps on his head at birth, and according to his family his behavior was never good. His family took him to a doctor when he was 4 yrs old & told the doctor to do something because they couldn't control him. The doctor put him on Ritalin for 10 yrs. His family said that helped, but as soon as he went off Ritalin he went back to being out of control again. He's been having problems with his behavior all his life, he's been in multiple marriages, he's technically a sexual predator, he's also selfish, narcissistic, a compulsive buyer. There are definitely issues of self-control. In cases like these, perhaps sometimes a drug might help him get some control over his life, thought they cannot 'cure' the damage to his brain.

        I think many people are afraid to say drugs have hurt them, especially mental drugs. I've heard people whisper about having a bad experience, but people rarely admit they take drugs for mental issues. I can remember the shock & withdrawal of a boss at work in the 1980's when I told him I was taking one, it was like I had admitted I was insane, he literally drew back physically away from me & he never treated me the same again. It's a typical reaction in the US, we're taught to fear the mentally ill. But we were also taught to trust doctors, and we're also taught to trust the drug companies. That's beginning to change. After what happened to me, I can see the drug companies lied to everyone. I think the social stigma against mental illness is what led everyone to cover up the mistakes we made, and that's also caused us to perpetuate the problem. I will never again take what a doctor tells me at face value. Doctors are no more infallible than anyone else.

        • Nancy Rubenstein

          Dear JenJen 10, Thank you most sincerely for doing some looking into what I've written. Without question, existential distress and emotional crises are real experiences. And you are right that brain injury can profoundly affect people, their behavior, and their relationships. Psychiatric drugs injure the brain. Ritalin taken longterm shrinks the frontal lobe. All the drugs do. Once a chemical imbalance is created in the brain by drugs, there is no point in explaining anything away as an endogenous issue. Impulse control is an executive function of the frontal lobe. It's true that so-called mental illness has become the boogie man. But, in fact, it always was that way. Now, as more and more people are diagnosed by the medical/pharmaceutical industry the discrimination becomes more visible. Learning about the history of psychiatry is an eye-opener. And learning about the fact that in one region of Finland (The Western Laplands) there has been an 80% full recovery rate for so-called schizophrenia without drugs for over two decades now really changes one's perspective as well. There they use a psycho-social community approach called Open Dialogue. My radical view is not that people don't suffer. It is that these are not diseases. People don't recover from diabetes just because everyone in their life learns how to communicate. Thanks so much, Jen Jen10. Here is a documentary about the history of psychiatry sent to me by an activist in a group I moderate called "Interface; Beyond The Medical Model";https://www.youtube.com/watch?v=YmvuYTH5nU0

    • Nancy Rubenstein

      No, that is not classic mania. It is classic "Akathesia" and this is the feeling that drives people to kill themselves and others. Akathesia is caused by many drugs including some antibiotics.

  • GaelicCraic

    things have gone badly downhill relating to numbers of beds for people with mental health conditions in England since 2008. With all the cutbacks we now too have the police having to resort to detaining mentally ill people in holding cells when they need to be in hospital.

  • Nancy Rubenstein

    This is a most disturbing article. As much as people may want to believe that Bipolar Disorder is a real medical entity, there is not one shred of medical evidence to support this. For this reason the federal govt is embarking on an ambitious multi billion dollar research program. None of the diagnoses in the DSM are being considered for research because they are not valid. You did not read what I just wrote wrong; the NIMH will no longer fund "Bipolar" research because it is not deemed valid. They will only fund research with no diagnostic categories because- I repeat- they are not valid. Here you can read Dr. Insel's announcement;http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. The statement that troubles me most in this article is the old "an adverse reaction to an antidepressant unmasks an underlying disorder". This is absolute and unmitigated fraud and people who are told this have every right to sue (although good luck). The theory of the chemical imbalance has been disproven by over thirty years of drug company research. Hundreds of thousands of people have been diagnosed with "Bipolar Disorder" (which has not one iota of physical evidence to support its' existence) because they had a "Hypomanic reaction" to an antidepressant. So let's use science here to consider why that is. #1 Antidepressants function to increase serotonin on the premise that serotonin is involved in depression........except that serotonin turns out to be statistically insignificant in depression. #2 What we DO know about serotonin is that if you inject it into a rat, that rat will kill anything in sight. SO, we know that too much serotonin causes agitation. Just like caffeine will induce a "hypomanic reaction", so will an antidepressant in many people. Does someone who drinks too much coffee get diagnosed with "Bipolar Disorder"?? Yes, indeed. Psychiatrists don't get paid if they don't diagnose.There is no disease called "bipolar". There is no disease called "Schizophrenia". The federal government knows this. The federal government is not lying about this. Psychiatry is the source of the lies. I know not only because of the research I have done, or because I work as Director of Public Education for The Law Project for Psychiatric Rights, but also because I was sold these lies myself and believed them for over ten years. I lost everything because of adverse drug effects that were explained to me as symptoms of a chronic organic brain disease that does not exist. Anyone can have a manic episode. Take steroids, don't sleep for long enough, take an antidepressant, stop an antidepressant,.........mania can happen to anyone. There is absolutely no disease involved. Just a whole lot of money at stake in supporting these myths about so-called "mental illness"

  • Margaret Costello

    There is no such thing as a "bipolar disorder". Yes, people experience mania and depression but it's not due to some mythical "chemical imbalance" that drops out of nowhere into our brains...which there is NO test to prove happens, by the way. Mania and depression are symptoms of toxicity in the brain and body due to chemicals in the food supply, nutrient deficiencies, hormonal/sugar/thyroid issues or viral/bacterial infections. Our bodies don't have a "psych drug" deficiency...they have issues with what is lacking in the body i.e. vitamins, minerals etc. Heal the gut via the GAPS diet...stop eating toxic food and taking toxic drugs that our medical establishment thinks is "harmless"...not. I had cycles every 50 days...suicidal depression mixed with homicidal rage...what stopped it COMPLETELY was a powerful multi-vitamin called Empower by True Hope. Psychiatry is a huge lie. The damage they have done is a crime against humanity. Wake up, America and the world, and realize you've been lied to and that the FDA/Pharma/APA have been slowly killing you/making you into dependent drug addicts without you having a clue. I was told years ago I would have to take these drugs for the rest of my life...that I was like a diabetic who needed insulin...well, I've been OFF these poisons for 5.8 years now. Please, please, please wake up. Use that frontal lobe God gave you. Fight back against being chemically lobotomized by psychiatry. If you're on the drugs, educate yourself to the truth, find one of the COUNTLESS support groups online/FB of people walking the brutal road to freedom and health. Taper Sloooowly, read the Ashton Manual, seek truth and find it. Here is a great website in the UK, set up by the Earl of Sandwich's son whose life was destroyed by the lie of psychiatry. We who are survivors of this holocaust are fighting back: http://cepuk.org/ God bless~

  • wbw

    As someone who lives with type two Bi-Polar it is hard to see people claim that there is no such thing as bi-polar. I suffer from prolonged periods of depression followed by short periods of hypo-mania (a lesser form of mania). Even though science may not have a complete solution or understanding of Bi-Polar it cannot discredit the condition. I was lucky enough to have a supportive family when I became suicidal that I was able to see a psychiatrist and was prescribed medication that has greatly decreased the depression and eliminated the periods of hypo-mania. Yes I do agree with those that argue that being medicated is not enough as one needs to work through there issues not just take them down in two tabs and a glass of water but these things are a good point to start and have helped me more than I ever could have imagined.

    I found this to be one of the best pieces of expository writing I have read. It truly does shed light on the life of those suffering from such a hard to understand condition and for me it has made me grateful for the support I have received.

    • Nancy Rubenstein

      Hi wbw, I hope you don't misread my comments as a denial of your experience. And I am sorry if you did. You are very fortunate to have such a supportive family and I pray for you that they will be as supportive when they learn the truth. The book I would recommend is "Anatomy of an Epidemic" by Robert Whitaker, Pulitzer nominated medical investigative journalist. Unfortunately, everything I have written is true. I believed I had "bipolar Disorder" and took the drugs for over ten years. Then I read Peter Breggin's book, "Your Drug May Be Your Problem". When I began researching and found that there is not one shred of medical evidence implicating even a single biomarker for "Bipolar Disorder" and that since the introduction of prozac, the disability rate in 2010 from "Bipolar Disorder" was up 4,000 %........I began to understand that "Something is rotten in Denmark" (Hamlet). I work now as Educational Director for The Law Project for Psychiatric Rights (PsychRights.org) and I can be reached at Ladyheartwork@hotmail.com.

  • SaintMarx

    Too much anecdote and biography, too little substance. No conclusions can be drawn from single cases.

  • DietrichB

    This article is a great ad for the biopsychiatry/Big Pharma. cartel so well described by Dr. David Healy in his eye opening book, Mania: A Short History of Bipolar Disorder, Dr. Joanna Moncrieff's The Bitterest Pill, Dr. Irving Kirsch's The Emperor's New Drugs: Exploding the Antidepressant Myth, Dr. Grace Jackson's Rethinking Psychiatry, Dr. Peter Breggin's Toxic Psychiatry and Your Drug May Be Your Problem, 2nd ed., Dr. Timothy Scott's America Fooled, Robert Whitaker's great enlightening books, Mad in America and Anatomy of an Epidemic and countless others exposing the horrific fraud and menace of biopsychiatry. Dr. Fred Baughman calls biopsychiatry's ADHD, bipolar and other bogus DSM stigmas and drugging 100% fraud and the worst medical crimes ever perpetrated against humanity. These and tons of other books and articles describe the despicable invention of the bogus bipolar disorder stigma VOTED IN by the KOL's of psychiatry when they sold out to Big Pharma to give themselves the fraudulent pretense of being real medical doctors when Freudian analysis waned and they were a laughing stock. With the power of Big Pharma money and billions made from their dancing with the devil in each other, they pushed the bogus theories that normal human emotions, suffering, crises, abuse, bullying, trauma were/are "mental illnesses" to be "treated" with life destroying stigmas like bipolar to push the latest lethal drugs on patents. Bipolar is the latest fraud fad epidemic of the biopsychiatry cartel after the bogus anxiety, ADHD and depression agendas to push toxic drugs known to cause mania, suicide, aggression, permanent depression and a ton of other iatrogenic horrific effects then fraudulently misdiagnosed as bipolar to push an even more brain/body destroying cocktail of neuroleptic drugs and so called mood stabilizers or epilepsy drugs based on bogus theories to create chemical lobotomies in their victims guaranteed to create real brain dysfunction, psychosis, mania and other destruction along with early death by 25 years on average.

    The minute I read that this poor man took an SSRI antidepressant, I didn't have to read any more of this vile, self serving, ignorant, disease mongering article since this author is simply regurgitating the vile, Big Pharma spin for the spurious, voted in bipolar disorder this has now been used to create a child bipolar epidemic by evil psychiatrists making millions under the table from Big Pharma as those who created the adult bipolar epidemic and others before them.
    Even Dr. Thomas Insel, Head of the National Institute of Mental Health, has been forced to admit the all the voted in DSM stigmas to sell toxic drugs with Big Pharma for their mutual evil and greed are totally invalid since they lack any medical, scientific, genetic, biological, chemical or other evidence though psychiatry has been lying to pretend the opposite for decades. Dr. Insel has also admitted that biopsychiatry's current "treatments" often cause far more harm than good. Of course, he realizes that he and his cohorts must invent a new scam since too many have caught on that the emperors of the mental death profession are wearing no clothes. See the great book, Pseudoscience in Biological Psychiatry by Dr. Colin Ross and Dr. Alvin Pam.

    It would be nice if the author of this junk science Big Pharma spin would do some homework from the many more objective sources like the books above and the huge, growing number of critics of the biopsychiatry death trap.

    • DietrichB

      Oh and by the way, the junk science DSM IV warned to RULE OUT bipolar disorder when alcohol abuse or iatrogenic mania from SSRI antidepressants are involved, so that's just more evidence of the huge ignorance of the author of this article. The new DSM 5 has been subjected to outrage within this bogus profession now that is has even medicalized grief over a loved one's death if the grief goes over two weeks. The 300 plus bogus, voted in disorders by biopsychiatry to medicalize every normal human feeling, reaction or stressor while lying and denying the real causes of said suffering for evil power, profit and status as fake medical doctors is so evil and pernicious it boggles the mind.

      Also, Alcoholics Anonymous, and its bogus DSM disease theory has been totally debunked by many experts such as Dr. Stanton Peele, Dr .Lance Dodes, Dr. Colin Ross and many, many others. But, the mental death profession has made this part of human suffering another blame the victims, stigmating/vilifying agenda to push its multibillion bogus rehab "treatment" enterprise also shown to be much more harmful than helpful.
      Again, anyone having done any research on the mental death profession, the addiction BUSINESS and other frauds perpetrated by the power elite could never written the above slanderous article about those given bogus DSM stigmas to silence, discredit, disempower and destroy countless people while robbing them of all human rights and their social standing.

  • daqu

    Wow, I am blown away by the power of this writing!

  • rlhailssrpe

    The comments ring home. The misdiagnosis, mistreatment, the loss of hope, the non existent social network are all real. But there have been break throughs based on fundamental science which is rewriting the book. I am retired, not current, in a technical volcano and offer new facts and a lot of hope.

    The most misunderstood complexity known to man is the brain. Until only a few years ago, he could only consider the symptoms, relative information. But there is a new technology, functional Magnetic Resonant Imaging, fMRI (and today subsets). It is now possible to image, measure, the brain as it functions and make a detailed electronic "movie". It is revealing many unknown relationships, complex cascading, interacting brain sectors which control thinking, memory, mood, etc. Scientists can "prove" BP is real, but it is different from what we "knew". We can, attempt to can, medicate through the blood - brain barrier and measure the effects. A complex, "cut and try" hard reality is emerging. One major science center boss called fMRI the
    greatest medical advance since the discovery of anesthesia. One BP electronic genius.has sworn to conquer his devil with millions of research funding. We can measure; we can medicate, test, ergo we will win. It is science.

    We need new laws, based on hard evidence about meds. Compulsion, freedom, secrecy, disclosure, and medical costs will be defined by this science.

    Another factoid from personal experience, the drug day care center. It is common that patients respond to meds, get better, feel they are cured, stop taking the meds due to side effects and go back into the madness. In some locales, once stabilized, they can, must, stop by a nurses' station and ingest in his/her presence the needed meds, then go about their day. There are real control and cost savings with this

    The mental health world, including BP, is getting better.