Here’s a free 14-minute film that examines our failure to help individuals with serious mental illnesses and a sample from a new e-book by an investigative journalist with lived experience.
The film is The Realities of Serious Mental Illness by Dr. David Pickar, an Adjunct Professor of Psychiatry at Johns Hopkins University School of Medicine and at the Uniformed Services University of Health Sciences. The self-published book is entitled Not Just Up and Down: Understanding Mood in Bipolar Disorder by John McManamy.
The Realities of Serious Mental Illness begins with interviews with experts, consumers and families explaining schizophrenia and what it feels like to have a serious mental illness. The focus of Dr. Pickar’s film then shifts to advocacy when he interviews Rep. Tim Murphy (R-Pa.) about his Helping Families In Mental Health Crisis Act and praises Assisted Outpatient Treatment as an important recovery tool.
Because Dr. Pickar’s film endorses Murphy’s bill and AOT, the National Institute of Mental Health and the National Alliance on Mental Illness, have not been promoting it — even though former NIH Director Tom Insel is interviewed in the film and Dr. Pickar heaps praise on NAMI. But Dr. Pickar felt as a psychiatrist that he needed to speak out frankly about both Murphy’s bill and AOT and he didn’t back down from making his case for supporting both in his informative film.
The Realities of Serious Mental Illness a film by David Pickar from David Pickar, MD on Vimeo.
Not Just Up and Down: Understanding Mood in Bipolar Disorder is the first in a series of ebooks coming from John McManamy.
I first met John after my son became sick and spotted his book, Living Well with Depression and Bipolar Disorder. I was drawn to it because John is an “expert patient” — a combination of a journalist doggedly investigating mental illness and a patient undergoing treatment. Not surprisingly, some psychiatrists didn’t appreciate a “mentally ill” writer peppering them with pesky questions but that didn’t deter him.
I soon became a regular reader of John’s website, McMan’s Depression and Bipolar Web, and was impressed with his wit, his ability to dig for answers, and his straightforward and impartial reporting. His background helped. John’s first job out of law school involved writing summaries of high court decisions for a legal publishing company, distilling 50 pages of mind-numbing gobbledygook into understandable prose.
John said this about his new book in a recent email to me.
We are dealing with an illness that takes no prisoners, which demands taking our understanding to a deeper level. The issues may be complex, but I have made every attempt to walk readers through every step of the way, complete with diagrams, humor, personal anecdotes, accounts of historical figures, and personal stories. Basically, I’m relating what I have learned through the eyes of someone who faces the daily challenges of living with a disabling illness, one who is trying to make sense of both his illness and his life. This is one version of what all patients and loved ones engage in. We are all trying to frame some kind of coherent narrative that will somehow help us come to terms with a world that often makes no sense. No one has all the answers, but we’re all in this together.
John is always asking ‘why’ and we are better because he does.
A sample from John’s book.
When “Normal” Goes Wrong: Borderline Personality Disorder
By John McManamy
In 2005, back when I was active in a local DBSA in New Jersey, I joined the board of a state DBSA we were trying to form. There, I came across behavior from hell—extremely abusive verbal attacks, explosive meltdowns, public outbursts, poison pen emails, delusional self-centeredness, love and light one minute, fire and brimstone the next.
For my own self-preservation, I got the hell out. Was this bipolar? Or was it something else? Borderline personality disorder? I needed to find out. The first stop in my journey was the 2006 APA annual meeting in Toronto. Unexpectedly, the first borderline discussion there occurred during question time at a packed luncheon symposium on bipolar II.
Drs Goodwin, Akiskal, and Ghaemi were the featured speakers, along with Terrence Ketter of Stanford. I showed up early to make sure I got a good seat. Dr Ketter said that as opposed to bipolar disorder, which is about MOOD lability (volatility), borderline personality disorder is about EMOTIONAL lability. As soon as they develop an emotion stabilizer (analogous to a mood stabilizer), he said, borderline personality disorder would become an Axis I disorder rather than Axis II.
A little history: The DSM-III of 1980 introduced the axis system to mental disorders (since done away with in 2013 by the DSM-5). In general, illnesses that could be treated by meds (that by implication had a biological component) were accorded Axis I status. The personality disorders, including borderline, were assigned to Axis II. As biological psychiatry gained in influence, Axis II came to be seen as the last refuge of Freud.
What Dr Ketter was saying, in a diplomatic way, was that borderline had a way to go before it picked up respect.
Dr Ghaemi referred to borderline as a “clinical condition” rather than a disease, one best treated by psychotherapy. In a 2013 journal article, he fully elaborated. The DSM-III, he wrote, erred mightily when it classified all its diagnostic entries as “disorders,” as if bipolar were not to be taken seriously as a medical illness.
Basically, bipolar is from Kraepelin, borderline from Freud. Two different world views, but could there be a reconciliation?
Dr Goodwin, who was running the proceedings, turned to Dr Akiskal, and in a friendly way goaded him: “Come now,” he said, “what do you do with the patients you don’t like?” Words to that effect.
Nothing could have prepared me for what came next. “I like all my patients!” Dr Akiskal thundered. Then: “I don’t have any use for the borderline diagnosis.”
Hold off on that reconciliation.
It didn’t take me long to discover that Dr Akiskal had been waging war against borderline for decades. A 1985 article he co-authored had this title: “Borderline: An Adjective in Search of a Noun.”
The next day found me in a largely vacant hall listening to Joel Paris of McGill University deliver an award lecture on personality disorders. Significantly, he was not about to let Dr Akiskal go unanswered. Referring to Dr Akiskal’s long-standing hostility to borderline, Dr Paris let it be known, “I would say that is wrong.”
In true Axis I depression, Dr Paris explained, when patients come out of a depression, they are nice people again. Individuals with personality disorders, by contrast, can come out of a depression and still have problems with life. Unfortunately, clinicians prefer not to want to hear about personality. It means trouble. They would rather throw more meds at the problem.
In the five years I had been attending APA meetings to that point, you would scarcely know there was such a thing as personality disorders. But that would change three years hence. The 2009 APA annual meeting in San Francisco had nearly as many presentations devoted to personality disorders and related issues as to mood disorders. Moreover, its experts were speaking to packed rooms. A major sea change had occurred. Personality disorders were gaining respect.
Copyright John McManamy (2015) used with permission.
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