Photo by Leigh Cohen.
A Quality Paperback Book Club Selection
Excerpts From Living Well With Depression and Bipolar Disorder
Chapter One
I have an MD. It stands for manic depression. In January 1999, at age 49, following a series of severe depressions and a lifetime of denial, I was diagnosed with manic depression's successor label, bipolar disorder, so technically my MD is now BP, which pisses me off no end. After what this illness has done to me, I feel I have every right to call myself an MD.
Screw the medical profession. What do they have on me? Well, they were smart enough to save my life, so I take it back. ...
Chapter Two
The DSM was never meant to be regarded as cast in stone, though I came away with that impression when I found myself unexpectedly seated at a dinner symposium next to one of its principal architects at the 2003 American Psychiatric Association’s annual meeting. In fairness, no one ever told Harley Earl, the legendary auto designer, what to do with the shape of his fins.
The next edition of the DSM is scheduled for 2010 at the earliest, and there are bound to be changes based on what we have learned about depression since the DSM-IV came out in 1994, the revised edition of the DSM-III (DSM-III-R) which is very similar, which came out in 1987, and the ground-breaking DSM III of 1980 (the equivalent of the ‘55 Chevy) which influenced everything that came after.
But by nature, the DSM is a conservative document, so there will always be a certain disconnect between clinical reality and diagnostic formality. ...
Chapter Three
With the Duke study, we once again witness the spectrum phenomenon in action, this time from a different perspective, of depressive symptoms in mania, rather than manic symptoms in depression. As with novel depressions, the treatment implications are enormous.
If one thinks of either pure or mild mania as Duke Ellington and Louis Armstrong on a cool clear summer night, mixed mania is heavy metal and rap in a thunderstorm, the blast of jackhammers, the frizzle-frazzle of shorted out power lines, and the elbows on the black keys of every neuron in the brain vibrating to extinction.
In 1988, I woke up from a drunken stupor in a strange city in a strange country, jobless and friendless and nearly penniless, with my psyche playing host to the type of cold fusion nuclear reaction that demanded instant release. Rage, Goddess, sing the Rage - a line from Homer. My high had turned on me. I was now a non-person, a pariah.
I'M NORMAL! I wanted to shout. I've always been normal.
And just to prove it, I didn't seek help. It was by no means my first round of Russian roulette with my brain. Why I'm not dead is a mystery to me. ...
Chapter Eleven
In what can be regarded as an appalling oversight, these guidelines have nothing to say regarding lowered doses. Virtually all drug studies are based on treating severe mania in the acute phase, which is also the focus of most clinical training. The few maintenance phase studies have used high doses with alarmingly high drop-out rates.
In the old days, psychiatrists had the time to carefully work with hospitalized patients in finding the right dose on one or two meds. These days, clinicians are under pressure to get their patients out the door in a matter of days, if not the next day. Since these are psychiatric emergencies, there is sound rationale for pharmaceutical overkill. But there is a huge difference between medicating a person out of danger and medicating a person into recovery. ...
Copyright 2006 by John McManamy