Archive | August, 2013

“Conspiracy of Silence: When the Psychiatrist Has BP” by Sara Solovitch

26 Aug
From bp Magazine (www.bphope.com):

One morning when she was 27, Suzanne Vogel-Scibilia, MD, went to work, a young, up-and-coming resident psychiatrist at a major Pittsburgh hospital and left, hours later, as a person with bipolar disorder.

The diagnosis—her own and later confirmed—took place as she was routinely questioning a distraught patient who, after spraying her neighbor with a hose, had been brought into the emergency room by police.

How much sleep had the woman been getting, Dr. Vogel-Scibilia asked. “Not much,” she answered. “Maybe a couple hours a night.”

And I’m thinking, me too.

How about food? Was she eating? “Oh, I had some dinner last night,” the woman responded. “I wasn’t very hungry.”

And I’m thinking, that’s interesting. Same as me.

Was she under stress? “Sure,” the woman said. “But you know what’s really annoying me? They’re talking about me on the PA system.”

And at that moment, I could hear the PA system and they’re not talking about her. They’re talking about me. And I’m not hearing a damn word this woman is saying. I’m just thinking, ‘What diagnosis does this woman have? Bipolar?’ Oh my god! Suzanne, you’ve got bipolar disorder!

Dr. Vogel-Scibilia was convinced that her diagnosis—which she now traces back to age 15, the first time she attempted suicide—would mark the end of her career.

The medical profession doesn’t look kindly on mental illness within its ranks. Michael Myers, MD, clinical professor of psychiatry at the University of British Columbia, Vancouver, British Columbia, and former president of the Canadian Psychiatric Association, argues that the stigma attached to mental illness is greater in medicine than anywhere else. Worst of all, he says, are psychiatrists who suffer from “internalized stigma.”

“Just because we’ve trained in psychiatry doesn’t mean we’ve purged ourselves of out-dated and discriminatory attitudes,” says Dr. Myers.

“I’ve looked after psychiatrists who feel dreadful—-some actually say they feel fraudulent—that they are taking care of depressed people when they themselves are on antidepressants. I say, ‘Hold on a minute, I’m sure there’s an endocrinologist out there who has diabetes.’”

Research shows that doctors in general are at greater risk of depression, mood disorders, and suicide than other professionals. “Psychiatrists commit suicide at rates about twice” the rate of other physicians, according to a 1980 study by the American Psychiatric Association, which found that “the occurrence of suicide by psychiatrists is quite constant year-to-year, indicating a relatively stable oversupply of depressed psychiatrists.”

“It’s an oversimplification to say it’s all due to the stress and strain of practicing medicine,” cautions Dr. Myers, a specialist in physician mental health. “It’s more to do with who we are: Many of us in medicine are wounded healers. We’re interested in practicing medicine precisely because we come from families with problems.”

Higher rates of family dysfunction, parental alcoholism, sexual and physical abuse, parental death, and psychiatric hospitalization were reported among female psychotherapists than in other women professionals in a 1993 study in the journal Professional Psychology, confirming the image of wounded healers.

Continues Dr. Myers: “Coupled with that, there are certain personality traits among people who become doctors. We’re perfectionistic; you have to be if you want to practice proper medicine. And people who are that way are hard on themselves.”

Yet the stigma of mental health continues to create what he and others have called “a conspiracy of silence” among doctors—psychiatrists in particular.

Disclosure

By her last year of college, Beth Baxter, MD, “knew” there was “something wrong” with her brain; during the previous four years, the top student and class president had routinely slept only four hours a night. She would enter the cafeteria only during off-hours, eating peanut butter sandwiches day after day, just to avoid running into her classmates. She fought suicidal urges and had already made several half-hearted attempts.

In her second year of medical school at Vanderbilt University, she became convinced that the songs being played on the radio were carrying messages to her. Her grades began to slip for the first time, so she took a break and visited her grandparents’ cattle ranch in Texas. While there, she went missing. She left on an imagined meeting with friends and followed some “messages” on the radio. Found wandering a day later, she was picked up by police on the side of a highway.

So began Dr. Baxter’s first hospitalization when she was diagnosed as having bipolar disorder. She managed to return and graduate from medical school, hiring a tutor to talk through all of her class notes.

She was accepted into an internship in internal medicine in Memphis, Tennessee. “They accepted me before they knew I had bipolar disorder,” she recalls. “The dean of students told them I’d had counseling, but it wasn’t fully explained, and they were kind of angry when they found out.” A year later when she transferred to Rochester, New York, she changed specialties. “Because,” she says, “I knew how much good a psychiatrist could do and I wanted to do that for somebody else.”

After her residency, her symptoms worsened: she became increasingly depressed and suicidal; she tried to slash her neck and had to return to her hometown of Nashville, Tennessee, where she was hospitalized for a year and the doctors told her parents that the most she could expect was to work on an assembly line. And the diagnosis had now changed to schizophrenic affective disorder.

“I was a pretty sorry sight,” she recalls. “I’d lost 70 pounds and I had a movement disorder—jerky hands and feet.”

By this time, however, her parents had become active in the local chapter of NAMI (National Alliance on Mental Illness). When the local NAMI officers learned that a doctor was hospitalized in Nashville, they approached her with a request: would she write an educational training program for people who have mental illnesses? Baxter completed the project while she was still on suicide watch.

Little by little she began to come back. “A psychiatrist there had a lot of hope in me,” she says, “and that hope was really important.”

Dr. Baxter is still on medication; the last time she was hospitalized was in 2000, when a prescription change failed to work. But today, she runs a large private practice in Nashville, where—just as in medical school, when she hired a tutor—she now retains an older and more experienced psychiatrist “to help me talk through my cases and review how they’re going.”

She talks about her experiences openly, addressing NAMI workshops around the country, speaking at physician conferences, and often sharing her story with patients—“to show that you can recover from serious problems in your life.”

She is famous around town for giving away little clay turtles from Guatemala: she sees turtles as a symbol of perseverance and determination, and has hundreds of clay, plastic, and ceramic turtles throughout her house.

Openness, for Dr. Baxter, was hardly a matter of choice: her medical history made disclosure an all too obvious decision. “But I still think it’s good when people know,” she says. “Then, when I got sick and bad things happened, they were more compassionate.”

Dealing with bp in practice

Mental Health Awareness Week in Canada features an annual campaign called the Four Faces of Mental Health. It’s a way of putting a human face on conditions, such as bipolar disorder, schizophrenia, and depression. For the first time last year, one of the four faces was a doctor.

“I had to convince myself to do it,” concedes Michael Paré, MD, a Toronto, Ontario, general practice psychotherapist. “I’m always telling my depressed patients that they don’t have to feel ashamed: They’re not bad; they’re not crazy; they’re not weak. But doctors—while we’re taught to say that—are not actually following through and admitting it. If it [mental illness] isn’t our fault, then why is it so bad to stand up and be counted?”

After a “very, very difficult childhood,” Dr. Paré sunk into a major depression in his mid 20s. “Literally, every day was like a terror, like being alive was the worst possible thing,” he says. “It’s impossible for me to remember the feeling, but I do remember my knowledge of it. Like when I opened my eyes in the morning, it was like, ‘Oh no, I’m still alive.’”

He swallowed a lot of pills one day and fell into a coma for a week, recovering only after undergoing a lumbar puncture, or spinal tap.

A few years ago, Dr. Paré was invited to address a large group of psychiatrists on the subject of depression. It was a professional talk, but at the end, he impulsively made mention of his own experience.

“I said, ‘Interestingly enough, I’ve suffered from major depression.’ And there was no reaction. No one came up to me after the talk. I thought I was dropping a bomb, but not one person acknowledged it. And these were psychiatrists who work with depression every day.”

Despite his own candor, Dr. Paré typically counsels young doctors against disclosing any history of mental illness at the beginning of their careers.

Most young doctors don’t need to be told. Consider the case of M., a 24-year-old California woman diagnosed as having bipolar disorder during her second year of medical school in Lebanon. She is so fearful of one day being denied a medical license that she refuses to see a psychiatrist now that she is back in the U.S.

Instead, she orders her medications online. They cost $400 a month and they’re generic, but they have one overriding advantage: they arrive unmarked from India and Australia.

“I’d go to any lengths to have my medication,” she says. “If I go to a psychiatrist here, my whole future is ruined—everything I worked for. There are always questions on the residency or licensing applications—do you have a medical condition? That’s why it’s so important to keep it to myself.”

That fear is widespread. A 2001 survey of Michigan psychiatrists found that half of them would rather self-treat than risk having a history of mental illness on their health insurance record.

And with good reason, according to psychiatrists who point to the widely publicized case of Steven Miles, MD, whose own bipolar disclosure turned into a cause célèbre.

In 1994, Dr. Miles, a well-respected gerontologist and professor of biomedical ethics at the University of Minnesota Medical School, had sought help for depression from a psychiatrist who diagnosed bipolar disorder II. After a few weeks on medication—and with no interruption in his teaching or clinical work—Miles began to recover.

But several months later, on filling out the annual renewal form for his state medical license, he answered the questionnaire affirmatively when asked if he had ever been diagnosed with or treated for manic depression, schizophrenia, compulsive gambling, or other psychiatric conditions.

Though he had never been the subject of a patient’s complaint, and though his name appeared regularly on lists of the state’s “Top 100 doctors,” the Minnesota Board of Medical Practice began an investigation, demanding a letter from his psychiatrist and full access to the records of his psychotherapy sessions.

Dr. Miles refused, and for the next four years he fought the board, arguing that its policy was overly invasive and served to deter physicians from seeking help for mental health disorders. After a protracted standoff and threats of legal action, the licensing board eventually changed its policy.

Today, many state licensing boards have adopted similar changes, but there is no consistent state-to-state policy. Nor is there any specific system for physician health care in the U.S.; the only health programs aimed at doctors are those restricted to drug and alcohol treatment.

In Canada, a physician wellness program has been set up in every province; its directors have joined to create a federal network, Canadian Physician Health Network, to share information and strategies. Under this system, a doctor who has bipolar disorder, for example, can be assisted and will be monitored at least three to five years, after which—if he or she is deemed stable—the monitoring is decreased or even removed.

Here’s how it works for one Toronto doctor, a 41-year-old resident psychiatrist who last year was diagnosed as having bipolar disorder. A., as he asked to be identified, was someone who didn’t “do” just residency. He simultaneously created a banking project for residents, invested $8,000 of his own money into a biotech company, organized a charitable organization for autism, conducted research into schizophrenia, and juggled a series of home renovation projects.

“I always have to self-monitor to slow down,” he explains ruefully, “because the rest of the world doesn’t operate as fast as my world does.”

Then last year, everything crashed. “A secretary made a note saying I was speaking too fast, had taken time off from work, and that I’d asked for a referral to a psychiatrist. And suddenly, there’s this note going around saying I have bipolar disorder—and no one had even diagnosed me at the time.”

After a letter was sent off to the Ontario College of Physicians and Surgeons, the self-regulating body for the province’s medical profession, A.’s first instinct was to fight.

“I don’t want to be labeled just because I’m outside the box,” he says. “No way in hell was I going to have a label like that. I didn’t want someone labeling my enthusiasm—even though I realized some of my experiences were perhaps bizarre.”

His psychiatrist reassured him, however, that he was not alone, that other physicians had similar problems, and that the system’s checks and balances would allow him to continue in his career.

“I thought that was a bunch of hogwash,” A. says. “All my faculties are based on my judgment and if that’s taken away from me how can I practice when people’s lives are dependent on my judgment?”

That insight doesn’t always mitigate the irritating presence of the system’s checks and balances. To A. they feel like an albatross, like he’s being “policed.”

“I have to inform my program director that I have an illness,” says A., checking off the list. And everything I say to my psychiatrist becomes open to the College of Physicians and Surgeons. They want me to see a mood disorder specialist. I have a case manager to keep an eye on me and make sure I’m functioning on all cylinders.

“I also have the people who ‘supervise’ me at work,” A. continues. “So all these eyes are on me. It feels like I’m being policed even though I’m not being policed.”

The choice is no longer his. His behavior had become so erratic that he could no longer deny his problems by working harder and plugging in the answers that he knew would get him off the hook with his fellow psychiatrists.

“With our specialized training we may be able to rationalize or deny our symptoms,” says Mamta Gautam, MD, an Ottawa, Ontario, psychiatrist who restricts her practice to physicians.

“And, a doctor’s ability to function at work is often the very last thing to go. In fact, you see that most people don’t have any idea that a colleague is struggling, because if anything they’re more productive than before. When, really, it’s just a mechanism—to keep working and stay with what’s known rather than stop and reflect.”

Coping and reaching out

Long before Dr. Vogel-Scibilia examined the patient who had bipolar and saw herself reflected back, she had figured out ways of adapting to her seasonal mood swings. Anticipating depression in winter, she scheduled her most challenging coursework for the fall.

“I’d do the research, pick the cards, and do the bibliography,” she says, “so if I had to write the paper I’d just have to write the text out. I would try to compensate for things, study stuff in advance.”

Now a practicing clinical psychiatrist in Beaver, Pennsylvania, she operates an independent mental health clinic and serves as clinical assistant professor at Western Psychiatric Institute, the same hospital where she did her residency and diagnosed herself.

Today, she is president of NAMI at the national level and a consultant for psychopharmacology projects at the National Institute of Mental Health and is a grant reviewer for the federal government.

But at least once a week, she gets a call from a young medical student or resident doctor—usually, she says, it’s a psychiatric resident secretly struggling with mental illness. Some of them offer to fly or drive long distances for a consultation.

“I have this theory,” she says. “If you were a patient before you were a doctor you don’t have so much trouble being in a patient role. But if you’ve been the doctor first and then you get sick, you have a hell of a hard time being a patient.

“You could do a study [about physicians having mental illnesses], but there’d be no sample, because nobody would agree to be interviewed. Actually I could just poll my friends. The trouble is it wouldn’t be a random sample. It would be the friends of Suzanne.”

http://www.bphope.com/Item.aspx/102/conspiracy-of-silence-when-the-psychiatrist-has-bp

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SAMHSA’s 8 Dimensions of Wellness

20 Aug

From samhsa.gov:

A Holistic Guide to Whole-Person Wellness

For people with mental health and substance use conditions, wellness is not the absence of disease, illness or stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.

Wellness means overall well-being. It incorporates the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person’s life. Each aspect of wellness can affect overall quality of life, so it is important to consider all aspects of health. This is especially important for people with mental health and substance use conditions because wellness directly relates to the quality and longevity of your life.

That’s why SAMHSA’s Wellness Initiative encourages you to incorporate the Eight Dimensions of Wellness in your life:

Emotional—Coping effectively with life and creating satisfying relationships

Environmental—Good health by occupying pleasant, stimulating environments that support well-being

Financial–Satisfaction with current and future financial situations

Intellectual—Recognizing creative abilities and finding ways to expand knowledge and skills

Occupational—Personal satisfaction and enrichment from one’s work

Physical—Recognizing the need for physical activity, healthy foods and sleep

Social—Developing a sense of connection, belonging, and a well-developed support system

Spiritual—Expanding our sense of purpose and meaning in life

 

8dimensions2

 

 

“Top Ten Mental Health Apps” by Sandra Kiume

17 Aug

From Psych Central:

With so many apps on the market, it’s hard to know which are useful.

Many are designed by software developers instead of psychologists, without scientific testing. They range from beneficial, to harmless but useless, to bordering on fraudulent.

The apps selected for this list make no hucksterish claims and are based on established treatments. Progressive Muscle Relaxation, for example, has been used for a century and is likely just as effective in this new medium. Knowledge from Cognitive Behavioral Therapy and Dialectical Behavior Therapy enrich two apps on this list. Others mix solid information with ingenuity.

Don’t forget to download the free PsychCentral app to keep up with the latest mental health information.

1. BellyBio

Free app that teaches a deep breathing technique useful in fighting anxiety and stress. A simple interface uses biofeedback to monitor your breathing. Sounds cascade with the movements of your belly, in rhythms reminiscent of waves on a beach. Charts also let you know how you’re doing. A great tool when you need to slow down and breathe.

2. Operation Reach Out

Literally a lifesaving app, this free intervention tool helps people who are having suicidal thoughts to reassess their thinking and get help. Recommended by followers of @unsuicide, who report that this app has helped in suicidal crises. Developed by the military, but useful to all. Worth a download even if you’re not suicidal. You never know if you might need it.

3. eCBT Calm

Provides a set of tools to help you evaluate personal stress and anxiety, challenge distorted thoughts, and learn relaxation skills that have been scientifically validated in research on Cognitive Behavioral Therapy (CBT). Lots of background and useful information along with step-by-step guides.

4. Deep Sleep with Andrew Johnson

Getting enough sleep is one of the foundations of mental health. A personal favorite I listen to all the time, this straightforward app features a warm, gentle voice guiding listeners through a Progressive Muscle Relaxation (PMR) session and into sleep. Features long or short induction options, and an alarm.

5. WhatsMyM3

A three minute depression and anxiety screen. Validated questionnaires assess symptoms of depression, anxiety, bipolar disorder, and PTSD, and combine into a score that indicates whether or not your life is impacted significantly by a mood disorder, recommending a course of action. The app keeps a history of test results, to help you track your progress.

6. DBT Diary Card and Skills Coach

Based on Dialectical Behavior Therapy (DBT) developed by psychologist Marsha Linehan, this app is a rich resource of self-help skills, reminders of the therapy principles, and coaching tools for coping. Created by a therapist with years of experience in the practice, this app is not intended to replace a professional but helps people reinforce their treatment.

7. Optimism

Track your moods, keep a journal, and chart your recovery progress with this comprehensive tool for depression, bipolar disorder, and anxiety disorders. One of the most popular mood tracking apps available, with plenty of features. Free.

8. iSleepEasy

A calm female voice helps you quell anxieties and take the time to relax and sleep, in an array of guided meditations. Separately controlled voice and music tracks, flexible lengths, and an alarm. Includes a special wee hours rescue track, and tips for falling asleep. Developed by Meditation Oasis, who offer an great line of relaxation apps.

9. Magic Window – Living Pictures

Not technically a mental health app, it makes no miraculous claims about curbing anxiety. However, there is independent research indicating that taking breaks and getting exposure to nature, even in videos, can reduce stress. This app offers an assortment of peaceful, ambient nature scenes from beautiful spots around the world.

10. Relax Melodies

A popular free relaxation sound and music app. Mix and match nature sounds with new age music; it’s lovely to listen to birds in the rain while a piano softly plays.

 

http://psychcentral.com/blog/archives/2013/01/16/top-10-mental-health-apps/

Natasha Tracy’s Bipolar Burble: Fantastic Blog

15 Aug

Natasha Tracy is a tech geek turned award-winning mental health writer. Her blog covers a wide variety of issues relating to bipolar disorder including breakthroughs in medical research, navigating the relationship between bipolar disorder and self, and the perennially raging debate of how we define and label mental illness.

Tracy fully endorses the biomedical model: she argues against nonadherence to medication and reports on developments in neuroimaging and gene mapping. Even if you disagree with her on that, I urge you to check out her blog. Her research is thorough, her writing is fresh, and she’s compiled a wealth of online resources about bipolar disorder, including research developments and treatment options. The comment sections are also edifying, in part because she mediates them thoroughly (the tech geek thing probably helps). This is easily one of the best bipolar blogs the Web has to offer.

http://natashatracy.com/topic/bipolar-blog/

Eleanor Longden: The Voices in My Head (TED Talk)

10 Aug


From an interview with Jon Ronson in The Guardian:

“Owing to a series of childhood traumas, I was a very anxious and unhappy teenager, and the voice’s methodical observations started to feel like a reminder that in the midst of crushing unhappiness and self-doubt, I was still carrying on with my life and responsibilities. I even wondered whether other people had similar commentaries but just never talked about it.”

“I…started making links between my emotions and the voice, and by putting this theory to the test, had achieved some positive results. In this instance, I’d stood up to another student in a particular seminar group who used to put me down a lot – usually, if I tolerated it, the voice would sound irritated, but when I was assertive and defended myself, it returned to its normal, calm tone.”

“[W]hat what research suggests is that voice-hearing (and other unusual experiences, including so-called delusional beliefs) are surprisingly common in the general population. This recognition has led to the popularity of ‘continuum models’ of mental health, which suggests different traits and experiences are all part of human variation – not strictly categorical in terms of ‘us and them,’ ‘sane and insane,’ ‘normal and abnormal.’ However, I do think life events play a vital role in determining who becomes distressed and overwhelmed and who doesn’t. This might include experiences of abuse, trauma, inequality, powerlessness and so on, but it can also include the immediate reactions of the people around you. If you don’t have people who will accommodate your experiences, support you, and help you make sense of what’s happening, then you’re probably much more likely to struggle.”

“For me personally, an analogy for all this is ‘a psychic civil war’. You start taking a blaming, negative stance towards your own mind. And the more I began to become fearful and resistant towards the voices (shouting at them, trying to drown them out, being abusive towards them) the more persistent, intrusive, and aggressive they became. I explore this concept in a lot more detail in the TED Book, but it has been neatly summarized by Marius Romme, co-founder of the Hearing Voices Movement: voices are messengers that carry important messages about genuine problems in the person’s life. Therefore it simply does not make sense to ‘shoot the messenger’ and deny the content of the message. My voices embodied all my (considerable) emotional problems.”

“Our society is given extraordinarily pessimistic messages about ‘schizophrenia’ (even though, as I discuss in my TED Book, the concept of schizophrenia as a valid entity is very problematic and contested) and in turn it can fill people with an overwhelming amount of hopelessness about themselves. Of course, everyone’s recovery story is unique and different, just as our experiences are. But I think a crucial part is providing hope, information, and choice. And being given opportunities to make sense of what’s happening to you, and what can be done about it: if passive drugging, sedation, and silencing is the cure response, then an active understanding, exploration, and integration of the emotional and social meaning of the person’s experience is the recovery response. But my own feeling is that things would never have got as bad as they did if I’d had someone available from the beginning to help de-escalate this crisis in a more positive way.”

“In my own case, I believe the reason I began hearing voices had to do with traumatic life events, and this was a separate issue that certainly needed to be dealt with. But what actually happened was that I ended up on the Schizophrenia Scrapheap – diagnosed, drugged, discarded, and with all the problems that had driven me mad in the first place still unprocessed and unresolved. Plus a whole burden of new difficulties, in terms of stigma, discrimination, medication side-effects, and a crippling sense of hopelessness, humiliation and despair about myself.”

“It was a complex process and happened gradually – and some voices took longer to change than others. But primarily it was when I stopped attacking and arguing with them, and began to try and understand them, and relate to them more peacefully. It was about putting an end to the internal civil war I mentioned earlier, because each of them was part of a whole – me! I would thank them for drawing my attention to conflicts I needed to deal with. I remember one very powerful moment, several years down the line, when I said something like, ‘You represent awful things that have happened to me, and have carried all the memories and emotion because I couldn’t bear to acknowledge them myself. All I’ve done in return is criticize and attack you. It must have been really hard to be so vilified and misunderstood.’ There was an immensely long pause before one of them finally responded: ‘Yes. Thank you.'”

http://www.theguardian.com/technology/2013/aug/08/ted-talk-eleanor-longden-schizophrenia

Hypergraphia: How Not to Write

10 Aug

One of the reasons I don’t usually write creative or personal pieces is that I don’t like looking too closely at my past experiences. It requires a facility with mood regulation that I have yet to achieve. I keep so much back, all the time, fighting with memories and emotional currents. I need to put them in boxes, not channel them.

T.S. Eliot once said that he wrote to escape from his emotions. I think that’s bullshit. We are driven by our emotions. There is no escaping them (especially not in writing). But mine overwhelm me if I’m not careful. I’ve finally internalized the fact that I can’t run from them, but I endeavor to keep them at a safe distance. 

I stopped performing for much the same reason as I stopped writing, even though I loved it and exhibited some potential. There were also the overlapping issues of hypomania and sleep hygiene. Performing makes me speedy and it often involves being “on” at night. Then I can’t sleep and things spin out of control.

I’m predisposed to being on at night. I used to start writing around 8 or 9 PM and go for hours until I passed out. This practice began when I turned twelve and the shit hit the fan.

A few years ago, I stumbled upon a box full of my old notebooks. It was pure hypergraphia. Some of the pages had holes where the pressure of my pen had pushed through. Many were so covered in ink that hardly any white showed.  When I reached the end of a page, I sometimes spun the book ninety degrees and continued writing so I wouldn’t have to stop.

Those notebooks horrified me. They chronicled the onset and development of my illness. So, over my mother’s bewildered protestations, I threw them out. 

Franz Kafka wrote his short story “The Judgment” in one night during a bout of hypergraphia. His family tearfully intervened in the morning, begging him to stop, and he collapsed. 

Kafka’s world was one of trauma. His hometown of Prague had a lengthy history of Anti-Semitic pogroms, the most notorious of which occurred on Easter Sunday in 1389 when a mob massacred 3000 men, women, and children and burned the Jewish quarter to the ground. The history of the pogroms was recent enough that the generation before his remembered them. Within this context, his Jewish family bore its own wounds. His two younger brothers died in infancy when he was six years old, and he had an exceedingly complicated and painful relationship with his father.

He confronted all of this pain in his writing, channeling it to create inimitable works of art. And he died in his thirties of tuberculosis after years of ill health, anorexia, and suicidal ideation.

I know that you don’t have to suffer to write well, but given my history, I don’t see how I could write effectively without examining my own pain. I’m afraid to do that because it could unleash my illness, which means I don’t write honestly. Without honesty, the writing falls flat.

So many of the writers I admire embraced their crazy. They looked unflinching at the world. They held nothing back. And almost all of them died early from suicide or substance abuse or lack of self-care.

Maybe I should just learn to play the violin instead.

“Posttraumatic Stress Disorder in Patients with Bipolar Disorder: A Review of Prevalence, Correlates, and Treatment Strategies” by Michael W. Otto et al

9 Aug
From PubMed:

 

Abstract

OBJECTIVES:

In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.

METHODS:

We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.

RESULTS:

Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.

CONCLUSIONS:

These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.

 

http://www.ncbi.nlm.nih.gov/pubmed/15541062

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