Saturday, December 21, 2013

Visions for the Future of Mental Health Care




Updated and partially re-written, July 2015

In the nineteen or so months since I first wrote this I have seen nothing to show me that the need for a facility of my vision has declined at all, in fact I just see more and more people slipping through the cracks of the mental health care system. 


I say mental health care but I don't really mean that. What I mean wouldn't fit neatly into a headline, though. What I mean by mental health care is advanced care for those specifically with schizophrenia, advanced bipolar disorder and major depressive disorder. You know, the hard cases. These are the people that the current system is failing so badly. The numbers speak for themselves. I won't get into them but research the numbers of suicides related to these three, research the numbers of people on the streets related to these three and research the numbers of people on permanent disability related to these three. Spend some time doing that - with a little old fashioned gumshoe street work thrown in to put faces to the numbers - and tell me how the current system is not failing these people. You can add my face to the numbers as well if you like - I am a textbook example of how the inept mental health "care" system - one based on drug therapy that's been proven in long term studies to not only be ineffective but also cause long term brain damage - has been utterly failing a very large number of people. 

There are other reasons people slip through the cracks that social scientists and those in the mental health care system simply do not understand.

Many of them will fit into two categories:

One, they will reject traditional diagnostic methods and drug treatment for their disorders. There are long reasons for this which I'll have to dedicate a separate post to but going on my own experience, the many people I have met in psychiatric hospitals and got to know as human beings (rather than "psych patients") and in talking to street people, these people become very hurt by and deeply mistrustful of the mental health care system, psychiatrists and drug therapy (which for them will be forced drug therapy). So they avoid the system even if at some level they know they need help.

Two, is that they tend to be very proud, independent people who want to be self-reliant and feel deep uncomfortable living on hand outs. They want mostly to take care of themselves in their own ways. This does NOT mean, as many mistakenly assume, that they "choose" the streets, it's just that all the alternatives are too difficult for them to bear and to negotiate. 

I have spoken to many of these people (and met them and got to know them) and they are at their core good, good people. But between mental health issues, the stigma and rejection of society and the cycle they become trapped in, they end up in untenable situations. 


My vision is for specialized long term treatment facilities for those disabled by one of these three disorders or those as I described above. The facility of my vision offers the best hope for people in this category of mental health problems. 

I can't even begin to tell you the mountains of research and reading I put into this, not to mention my not inconsiderable experience of being "on the inside" of the current mental health "care" system. 

This is what I want my true legacy to be - to see this vision realized. It would take massive efforts and real courage but it's doable. As government agencies are too closely tied to pharmacological and mainstream psychiatric models, it'd have to be privately run and funded. 

In the grand tradition of visions for the future, I bootstrap off of past or present successful models. They are as follows:

Soteria House:

Founded by Dr. Loren Mosher in the early 70s, Soteria House was a long term treatment facility for those diagnosed with schizophrenia. No medications, no doctors. NONE. And this was one of the most successful schizophrenia treatment programs in history. Patients lived there and interacted with each other and grad students (I believe ... not professionals at any rate) who received a bit of training. The patients could live in a low stress and embracing environment where they were free to talk out the workings of their inner minds in a non-judgmental environment. And patients by and large got better (which is defined by being able to return to work, raise a family and other basic societal norms). This is not the case with most people diagnosed with schizophrenia today. 


Hearing Voices Network:

I have personal experience working with a local chapter of the Hearing Voices Network. HVN provides a network of chapters that provide peer to peer counselling for those who, as their subheading reads, "hear voices, see visions or have other unusual perceptions" in a non-medical, non-judgmental setting. There is nothing, I can tell you, like peer to peer discussions about the mental phenomenon we experience for working through these issues and not be made to feel "wrong" or "broken" or "diseased" or otherwise judged. Unlike in talking with various "doctors" from the mental health care industry (psychiatrists, psychologists, medical doctors, and others), you talk with people who actually know what it feels like and who take a non-diseased approach to unusual mind phenomenon. My facility would provide a similar atmosphere and approach.  

Delancey Street Foundation:

Founded by Mimi Silbert in the 70s, Delancey Street Foundation has been doing the impossible for thousands of people for four decades. It takes the worst dregs of society - people labeled by "the establishment" as psychopaths, sociopaths and hopeless career criminals - and makes functioning human beings out of them that return to society. We're talking career prostitute drug addicts, pimps, gang members and all manner of "human garbage" that society seeks to lock away for ever then completely rehabilitating them and re-integrating them into society. Her success rate is vastly, vastly superior to the prison system. And get this - she does it alone. No staff, no doctors, no guards, no warden, no bars, no cells - nothing. She stands maybe 5' 1" and she handles about 1,500 of these career "scumbags" at a time by herself. No, I am not making this up. Mz Silbert and the Delancey Street Foundation is easily one of the most inspiring examples of what's possible for human recovery you could possibly find. 


Dr Dean Ornish's program:

Dr. Ornish also does the impossible - he turns around heart disease among those for whom triple or quadruple bypass surgery is the only option for living. Other than himself, there are no doctors, no hospital, no drugs, no surgery - nothing. It's all diet, meditation, yoga and a few other simple lifestyle changes. 

There are a few things that all of these have in common. One is that they are amazing examples of and inspiration for what is possible in human change and recovery. Two is that they are all long term residential facilities or programs. People stay in them for long periods under guided care. Ornish's is the shortest - about six weeks if memory serves - but it has long term follow up. Silbert's is the longest; a minimum of two years. The common theme is that the patients are in a structured environment tailored to their needs. I'll return to this in a moment. First I have to introduce:

Neuroplasticity: 

The brain is not set. It can and will change itself. It will rewire around horrifically damaged areas (like in stroke victims) or in the cases of blindness, it'll "remap" and restructure areas to boost other brain functions to compensate. It'll do this naturally on its own but that does not always lead to the desired results. It works best in structured environments (do you see where I'm going with this?). Neuroplasticity is a sexy popular term that gets thrown around a lot now. But the rub is that it needs structure and repetition - neurons that fire together wire together is how it essentially works. And it needs that "fire together" to happen repeatedly and in close time proximity, two things for which a structured environment and program work best. Hence the above three facilities. Silbert doesn't know this, but her program produces massive plastic change in the brains of her wards - that's how they change from sociopathic criminals into empathetic mainstream citizens. 

Edward Taub of the Edward Taub Clinic pioneered a unique therapy for stroke victims based on the principles of neuroplasticity and this too, I believe, serves as a good model. Again, the patients stay in the facility for extended periods receiving much personal help and encouragement. 

Now, my own thoughts. 

For people with major mental illnesses, the only course of hope is to move forward. But here's the rock and hard place catch-22: A) they cannot do it alone and B) their very brain conditions rob them of the mental faculties to move forward. In order to move forward, they need to be able to work and take care of themselves. Living normally like this is what true recovery is but they can't take care of themselves or work due to their mental conditions and society's view of them (which is not dissimilar to how society views the career criminals that Silbert turns around and enters into society) so they're stuck. 

The only way these people can truly be helped is in a long term facility that A) heals their minds, brains and souls and B) teaches them job and life skills that will help them return to functioning within society. I am not aware of any facility like this. Psychiatric wards certainly don't do this (ask anyone with one of the illnesses I listed who has spent time in one). Public mental health programs try to help with job skills but don't provide long term living and treatment facilities. It's a real crack in the system. When you hear of people "falling through the cracks of the system", this is the massive chasm into which they fall. 

The facility I envision would be the net at the bottom of that chasm. 

In the facility I envision people would get a highly specialized program designed to heal their minds through neuroplasticity, would have a safe, peer supported environment in which to recover from the rigors of life in a society that has rejected them and heal their ravaged souls, and they'd learn job skills that would help them build dignity and esteem and get truly back on their feet again. The program would involve specialized forms of yoga and meditation specifically designed to "build up" the brain regions that are misfunctioning or underfunctioning or, in the case of the ever overactive amygdala in the majority of people with difficult cases of mental illness, calm down brain regions. Jeffery M. Schwartz deals with OCD and other disorders very much in this way, using no medications. There would be much peer to peer group work and individualized therapy. 

The Delancey Street Foundation provides the financial model; aside from doing all this remarkable work by herself, Silbert's program is - get this - completely self funding. She gets no government grants, no private grants or funding - nothing. The program entirely pays for itself (which is why it works). 

The present dominant paradigm of mental health care as run by the alliance between the psychiatric and pharmaceutical industries are not making mental health problems better. Statistics bear out that things are instead getting far worse (and all predictions are for that trend to continue). It is time for widespread alternatives to psychiatric hospitals and forced drug therapy. My vision is an attempt to give an idea of what one alternative might look like. 

Additional notes added June, 2014

A great deal of the daily activities of the program I envision to help heal these people minds and to help their ravaged cells in their brains and bodies recover would revolve around the following:


  • Music therapy. There's just an enormous amount of evidence pouring in from the fields of neuroscience that show the kinds of benefits for the brain that come from regular and carefully directed music therapy
  • Dance therapy. Same benefits as music but with an additional physical component
  • Art therapy. Like music and dance, it opens up and stimulates vast areas of the brain that can help facilitate emotional, spiritual and physical recovery 
  • Yoga, meditation and qi-gong. All of these have been demonstrated for thousands of years (and now through more scientific research involving advanced brain scan techniques) to greatly ease and reverse the damage from chronic stress (which will be a major part of what all mental health patients will be battling) along with building healthy new attitudes and outlooks as well as establishing essential daily physical exercise routines
  • Lifestyle management skills. This would involve specific meal preparation skills in which patients would learn nutritional therapy from shopping to meal preparation
  • Cooking therapy would be part of the above. Learning the joys of preparing oneself nutritional, tasty and inexpensive meals. Proper diet is a huge issue and shortfall in many suffering long term mental health issues
  • Peer to peer counseling and support based on understanding and compassion, rather than the stigmatizing judgment most people are subjected to
All of these daily activities and routines would be built on the foundation of rebuilding the esteem and souls that have been decimated by years of living with one's mind torn apart by inner turmoil, being rejected by society and kicked to the curb of life. 

It is simply not necessary for these lives to be wasted in this way. A great deal of recovery can be achieved and a return to productive society attained.

As of this writing in July 2015, a small groundswell of support has begun to start bringing this vision to fruition. 

Taming the Polar Bears is going to be registered as a charitable foundation able to take in donations for and do fund raising for establishing this much, much needed facility. 

I am hoping an announcement regarding this will be forthcoming in the next few months (though I am in the midst of considerable challenges myself). 

Bradley Esau




Tuesday, December 17, 2013

Mania and the Story of Icarus and Daedalus



This post is from a special request from a bipolar bud of mine who follows this blog. In a conversation with him the story of Icarus came up and I mentioned that I'd researched that story in relation to bipolar and found that there was indeed a link. He in turn mentioned that he'd greatly appreciate reading what I'd found in a Polar Bears blog post. So this is for him. Here's to you, bro. 

The following is an excerpt from my (unpublished) book manuscript.

Excerpt from Dancing in the Dark - Why?
March, 2013


The hallmark of true bipolar is mania – and let's try to strike from your mind all the descriptions you've ever read about bipolar, or if you are “bipolar”, your own concepts of your experiences – so let's try start with a clean slate. I think to understand anything, we have to drill down into what this poorly understood phenomenon is. Let's go back a few years and see what we can find pre-pharmacological era (IE: pre-drug tainted era and pre-run away diagnosis era (1)). Let's set aside all these unscientific observations of behaviours, the so called “symptoms” and get down to the bare bones of “mania”. If we can find that, perhaps we can solve some of the mystery of bipolar.

The earliest reference I could find of mania is in the story of Icarus. From Wikipedia, the story from Greek mythology: 

Daedalus (his father) fashioned two pairs of wings out of wax and feathers for himself and his son. Daedalus tried his wings first, but before taking off from the island, warned his son not to fly too close to the sun, nor too close to the sea, but to follow his path of flight. Overcome by the giddiness that flying lent him, Icarus soared through the sky curiously, but in the process he came too close to the sun, which melted the wax. Icarus kept flapping his wings but soon realized that he had no feathers left and that he was only flapping his bare arms, and so Icarus fell into the sea.

When I again started to try to figure out clearer what bipolar was all about and, more importantly how mania actually affected me personally, the story of Icarus for some reason leaped to mind. Well, that's not true, I know the reason. It came to me when I was writing The Roller Coaster chapter (2) and these flights of fantasy of mine followed by hard crashes reminded me suddenly of the story of Icarus and his flight too close to the sun (getting too high) and then crashing to earth (the inevitable emotional crash following mania). I then decided to look up the story, read the Wikipedia entry and bingo – this, under Interpretation:

Literary interpretation has found in the myth the structure and consequence of personal over-ambition. An Icarus-related study of the Daedalus myth was published by the French hellenist Françoise Frontisi-Ducroux. In psychology there have been synthetic studies of the Icarus complex with respect to the alleged relationship between fascination for fire,enuresis, high ambition, and ascensionism. In the psychiatric mind features of disease were perceived in the shape of the pendulous emotional ecstatic-high and depressive-low of bi-polar disorder. Henry Murray having proposed the term Icarus complex, apparently found symptoms particularly in mania where a person is fond of heights, fascinated by both fire and water,narcissistic and observed with fantastical or far-fetched-imaginary cognition.

So here we go, this is good stuff. Frontisi-Ducroux studied mythology and not modern psychiatry and his work was published in 1975 pre-dating all of today's nonsense notions of bipolar. Henry Alexander Murray (May 13, 1893 – June 23, 1988) was an American psychologist who taught for over 30 years at Harvard. He was Director of the Harvard Psychological Clinic in the School of Arts and Sciences after 1930. So again, a pre-modern era thinker and I think we can gain some insight from his interpretations of the legend of Icarus and the phenomenon of bipolar and mania that is not tainted by today's run amok notions.

First we see mention of over-ambition or high ambition. Yes, this fits well with the older concept I've had of mania and matches my own experiences from the 1991 to 1994 years when my "ambitions" included taking over the head of a large corporation, taking over as head coach of the Ottawa Senators NHL team, trying out for the BC Lions professional football team (at the ripe old age of 34 and with zero prior professional experience) and of trying out for the vacant lead singer spot of an internationally known rock group (along with a few other “up there” delusional ideas). Yes, I think these definitely qualify as “overly-ambitious”. We see mention too of the “pendulous emotional ecstatic-high and depressive-low” of bipolar disorder. Well, that describes my worst periods of rapid cycling to a 't'. 

Now as for fondness of heights, fascination with both fire and water, I can't say any of those fit me. (3) I can't recall any particular interest in any of those. I have though read of others with mania feeling like “superman” and wanting to explore heights (Icarus like) and that these literal ascensions to heights often lead to deaths from either believing they could fly and trying to or from accidental falls. Narcism and “fantastical or far-fetched imaginary cognition” again fits my model to a 't' though. I certainly fell in love with myself and my ideas, my fantastical “grandiose thoughts” and my thinking then was certainly far fetched imaginary cognition. My cognitive powers got way too carried away.

But let's examine this portrayal of mania more closely. Now in the story, Daedalus constructed two pairs of wings. Now this suggests that Daedalus wanted his son to fly higher, in other words was encouraging Icarus to have ambition. Now if we return again to The Roller Coaster and look at my how my concepts of ambition were influenced by the short story Jonathon Livingston Seagull, we can again see the metaphor of flight and “flying high” and that at that point of that chapter that I saw nothing wrong with this ambition. 

Is there anything wrong with ambition? No, this is what makes humans what they are. This is what leads to all discoveries. This is what put men on the moon. Ambition is one of the – back to the human brain for a moment – fundamental things that separate the human mind from the animal mind (or at least we've taken it far farther than animals can. We can see some signs of ambition in the animal world as well). 

But – but! - Daedalus also warned his son not to fly too high, not too close to the sun. In other words, not to get overly ambitious. Daedalus understood the dangers here (from his own previous experience?) And look at what the description says – Icarus got “giddy from flying too high” and that he “soared through the air curiously”, and got carried away and could not control his flight and he got too high, got “burned” by being too high and thus crashed back to to the sea where he drowned (the metaphor here for depression... how we seem to “drown” in the sea of depression). So is “mania” just a form of ambition, of ambition being carried away by giddiness, by, in other words, over excitement? Of “soaring through the air too curiously”? This is an extremely important part of our examination here and we're going to drill down into this with as much detail as I can muster.




Over excitement, giddiness, again is as age old a normal behaviour as mankind. Nothing new under the sun here. So is “mania” excitement and giddiness run amok and carried to extremes? Again, this could describe many, many people. Where is the line between “mania” and excitement driven passion? Once again, and I'll just keep hammering this point home, are we looking at normal human behaviour and not a pathology of an “illness”?

But let's carry on. My “why?” is not done with this yet. So here we go, we have this basic concept of excitement and giddiness leading to getting “too high”. Now, again, is this a bad thing? I think we here have to explore the part of mania that has been buried in the mad modern rush to medicalize it and drug people into a coma to “control” it. Here we explore the up side of “mania”.


Mania has long been linked to creativity and, as we've seen, ambition. A look at famous figures thought to be “bipolar” (or manic depressive) is impressive. Since creativity and ambition are part of the mix of what's thought to be mania, this naturally leads to some famous people with big accomplishments. But again, in my drive for pure data, we have to go back to pre-pharmacological revolution figures. I can't trust any diagnosis or manifestation of mania (and hence bipolar) in the drug era (50's onward). In fact, it's hard to trust any of them because “self-medication” has always been a problem associated with bipolar like symptoms. This puts a fly in my ointment of seeking purely raw data (IE: unmedicated subjects) so I'm in a bit of a dilemma here. 

Ernest Hemingway, for example, I see is on my list of “bipolar” people. We all know how creative Hemingway was and also we can see a very adventurous life – two things that I certainly can attest for signs of possible mania in a person – but he was also a famously ferocious drinker and alcohol is rather notorious for mood alterations in people. Many people, it has long been observed, lose their inhibitions when high on alcohol and do stupid things – exactly as we see in accusations of “manic” behaviour. Alcohol can also deepen depression, the other side of mania. So it is impossible to know with ol' Ernest, outside of pure speculation, whether the metaphorical chicken or the egg came first here – did alcohol use trigger mania and/or depression, or did he drink to control the moods? Impossible to know. And once we introduce any foreign substances to the brain, we know that all bets are off as we saw in our examination of psychiatric and so called recreational drugs back in Analysis of Prescription. (4) It is just, therefore, too hard to know where the lines of the mental phenomenon of manic depression and signs of alcoholism are, the lines become too blurred. So let's move on. 

End of Excerpt

I then went on to explore the lives of several famous people from the past (including Isaac Newton) but that gets too long to include here. Perhaps another time. 

(1) There is a lot of back story here as I wrote several massively long chapters tearing down modern psychiatry's notions of "mental illnesses". These were not my own creations but instead sought to consolidate enormous amounts of academic literature and the works of science research writer Robert Whitaker. It was all, in other words, very well founded evidence. 

Whitaker's Anatomy of an Epidemic is absolutely must reading. In the chapter Bipolar Boom he very firmly establishes that many, many cases of "bipolar" that he investigated (and he is a Pulitzer Prize nominated and highly respected science investigator and writer) were either connected to recreational or psychiatric drug use (IE: the "bipolar" cleared up when the drug use stopped) and he presents very strong medical evidence for this and some case studies. He also very firmly establishes the massive "catch basin" for bipolar diagnosis that the pharmacological/psychiatric alliance established in order to write as many life long prescriptions as possible. His work is extremely well researched and scientifically established.

(2) The Roller Coaster is a chapter in my book in which I describe a period of some particularly insidious rapid cycling that lasted roughly 1992-ish to the fall of '94. If you are bipolar and have never experienced true rapid cycling, consider yourself extremely lucky. I wouldn't wish it on my worst enemy. 

(3) This is not exactly true. Later, when I ruminated on my various periods of high suicidality in my life, there were many times I was incredibly - and nearly uncontrollably - drawn to water. These were bizarre, almost hallucinogenic or mildly psychotic experiences (hearing voices, commands) that implored me to come into the water and go under to join this voice calling to me. It was like it was asking me to join an underwater world. I am quite convinced that many people who commit suicide by drowning (something very, very hard to do due to very powerful instinctive reflex actions, by the way) by succumbing to voices and commands very much like I experienced. 

(4) Anatomy of a Prescription was a long chapter in my book manuscript on the science, supposed pathways of efficacy and function, and side effects and brain damage of psychiatric medications. Again, these were NOT my findings, but merely a collection and summary of related academic data and research by psychiatrists dedicated to non-pharmacological methods of mental illness treatment. It was all very well supported by long term empirical research analysis and medical research data. 



Final note: this portion of my manuscript was written when I was desperately trying to believe that bipolar was not as serious of a mental health condition as psychiatry believed and presents to the public and I was exploring all aspects and angles of several major mental health disorders. I was also desperately trying to believe that mania was not "bad" (and I was very manic at the time of this writing). Nonetheless, I still strongly support all the views I put forward in this chapter of my book manuscript. I still maintain that much of what is understood about "bipolar" is nonsense put forward by the pharmacological/psychiatric alliance almost purely in the interests of profit, a point I'll further establish another time.

Whether mania is "bad" or not will have to wait for a future blog post. (Hint: in true bipolar disorder it probably is). 


Saturday, October 26, 2013

Stories From the Inside






I'm working on the next blog post in the more science bases series that I started but in the meantime I'd like to start a series of stories about people I met while staying on psychiatric wards. Part of the purpose of this blog is to educate others about the world of mental illness and this is part of that education. 



Weird Scenes Inside the Goldmine 

- Jim Morrison, 1970



"Z”

Z was about twenty-one or twenty-two years of age in March of 2011. She had the beautiful high, hooked nose that many people of her native Afghanistan have, along with high cheekbones and eyes of a pretty hue of brown that were so deep you swear you could swim in them. She was small and frail. If her five foot frame weighed ninety pounds I'd be surprised. If I'm not mistaken, she was the youngest or one of the youngest in her family. She may have had a younger brother, I can't remember now. She did have, I know from her family's visits and through Z's stories, lots of older siblings, about evenly divided between brothers and sisters.

Z and her family were from one of the more southern areas of Afghanistan. I can't recall the name of the area. I think, though, that it was a suburb of Kabul. Nor can I recall Z's family's exact religious affiliation. I didn't get the impression that it was important to her. It didn't seem to be to any of her siblings when they came to visit either. Z and all of her family dressed and acted very progressively and with modern sophistication and style. Her father had been a gold merchant (not bulk gold but of the jewelry variety, something very important in Afghani culture). Her family was not rich but of upper middle class well off means. Z and her family lived well. Their family was well known and respected in their neighbourhood. Z told of her father being a generous man, one who didn't mind rubbing shoulders and sharing tea with anyone. The life of Z's family was good. They had everything they needed and were all ambitious as far as education goes, they were expected to gain a higher education and become doctors or other such gentrified positions.

Then one day the Taliban came.

One day Z's family was “in”, the next day it was “out”. The Taliban, as Z told it, had targeted her kind of family as “out”. I don't know what your knowledge of the Taliban is but at that period in Afghanistan's history, you did not want to be “out” with the Taliban. So, as with tens of thousands of other similar people at that time, they were left with little choice but to flee. Z would have been about eight at this time. Her life went from one of sheltered upper middle class with everything she and her family needed to one on the road with whatever possessions they could carry.

For weeks they traveled over dirty and barren roads through scorching hot valleys and harrowing mountain passes. All this while her family and those that they were traveling with had to keep an eye out for the Taliban and their sympathizers and to look out for bands of thieves. Much of the gold they'd brought along had to be bartered away for their safe passage. Several months later, they had crossed the Pakistan border and had found a refugee camp. As refugee camps go, it was no different than any such camp around the world. Relief organizations had done their best to erect tent cities and provide as much as they could. It was dirty, water was rare and precious, there was little food and there wasn't a speck of shade outside of the tents to give any relief to the daily 40C temperatures that seared down on them in summer. Nor was there much protection from the harsh mountain winds that sent temperatures plunging in winter. From playing with beautiful dolls in air-conditioned rooms, Z went to playing with sticks and rocks and balls of rags in ad-hoc games played with other children in small, barren, stone strewn patches of hard, sun baked soil. From being taken care of by a nanny, she went to having daily chores of scrounging for food and water. She went from having the finest clothes to wearing nothing more than whatever rags were left from what they could bring and what they could now find. Everywhere you looked, there were tents and other large families like hers. No one had much of anything.

This was to be Z's home for the next eleven years.

Z's family were cut from sturdy cloth, however. Somehow through all of this, they not only survived, but somehow managed to relatively thrive. And through relatives who'd long ago emigrated to other countries, connections were made, money saved, refugee relief procedures navigated. And Z, her mother and father, and most of her siblings found themselves in Vancouver, BC. Z didn't really know how all of this happened. She was young and unconcerned with such things. She just knew her father, mother and family had made it happen. As she was expected to, Z was entered immediately in school, in a school in an strange English speaking world where she barely knew a single word of English.

But, as immigrants have done for centuries in sink or swim situations in new lands, in new cultures and among strange people and a new language, she learned and she learned fast. Within a year she had a part time job at McDonald's. Within six months, she had mastered everything there was to know about working in that McDonald's and all of the English needed to boot. She was promoted to an assistant manager position. At the same time, she'd graduated high school and had been enrolled in college.

Throughout those eleven years in the refugee camp and the ensuing several years adjusting to Canada, Z's family's expectations for their children had never faltered. They were still expected to get the highest education possible and the best careers possible. Not jobs, but careers. Z's expectations were no different.

All of her siblings had done well and Z loved and admired them all but she had special love and admiration for an older sister, “M”. M had not, for reasons I can't recall, fled with the rest of the family when the Taliban arrived. I believe she may had already left for university and been well into her education and that that part of Afghanistan perhaps had remained in more liberal hands. At any rate, she stayed there, had become a doctor and in the now more liberated post-Taliban Afghanistan was practicing medicine specializing in women's needs (which was in very, very sore need among Afghanistan women). M was Z's hero and when Z spoke of M, her voice and beautiful deep brown eyes made this abundantly clear. Z said that they spoke often on the phone or through Skype. Z wanted very much to be like M.

She therefore put on herself, aside from the pressure her family put on her, a enormous amount of pressure to live up to the standard set by M. But she struggled with school. College was not like the simple courses of high school. The vocabulary and demands were much higher. In college she wasn't sheltered in an ESL program like she had been in high school. The stakes were higher. The workload to keep up with normal homework and to continue learning English at ever higher levels and to hold down her part time job at McDonald's was knee buckling. Delicate and frail Z was having a very hard time keeping up with it all. She began to suffer anxiety and couldn't sleep. She saw a doctor and was put on medications to ease her anxiety and help her sleep.

Then one day, while suffering from exhaustion, Z had failed a critical test at college. Utterly distraught and humiliated, she returned home and wept in despair. And then, and she couldn't clearly remember why or explain it at all, she took her freshly renewed prescription bottles and downed their entire contents, about a hundred pills in all. It was not long before she collapsed. One hundred pills in a body as slight and tiny as Z's will go to work fast and when her mother and sister found her, the toxins were already well within her system and were shutting organs down. She was already incoherent and lapsing into a coma. Her right hand had already frozen into a death grip around the bottle of pills she'd emptied. 911 was called, she was rushed to hospital and put on life support. Through some sort of miracle she survived. She spent several weeks in ICU.

And this is what brought Z to the chair next to mine to where our very disparate paths met in the TV room of the psyche ward of Royal Columbian Hospital where she had been telling me all of this in snatches of time in the long, boring, pointless days that we had to pass. She told her story with such humility, with such lack of self-pity and with such utter charm and humour, that at times my eyes stung with tears. The only times her voice showed much emotion was when she told of how fast she'd risen in McDonald's and had learned English. She was very proud of that and rightfully so. I've taught English to many, many people in the last twenty years and the level of English with which she was speaking to me was astonishing for the short amount of time that she'd been using it. She scarcely even betrayed a trace of an accent. For all I knew, she'd grown up here. The other time was when she spoke of M. It's not that her voice was flat otherwise, it wasn't, it was very animated (and of course it would be ... she comes from country with a thousands of years old tradition of oral story telling). It's just that there were those times that her voice told of a special emotion.


It was in the TV room that we'd met and we had become bosom buddies over the Vancouver Canucks of whom she was an avid and passionate fan (the Canucks are Vancouver's professional hockey team). The Canucks were on what would be a special run that season and the city was really fired up and the psyche ward of RCH was no different. Z and several of us gathered each night of a Canucks broadcast in the TV room and raucously cheered on our boys.


Z was therefore in the psychiatric wing of Royal Columbian Hospital because of a suicide attempt. She hadn't been depressed. There wasn't a trace of depression or of feeling sorry for herself when I talked with her. She had told me a lot of detail of what had been a very difficult life and had never shown a speck of sorrow or of self-pity. Talking to her, she was as vibrant, humorous and joyful a human being as you could want to meet. Positive life force verily radiated from her. She had been under a lot of recent pressure and stress however. I have no idea what her “diagnosis” might have been. She had been, however, obviously under a great deal of stress. 

The story of Z is one of several I'd like to tell of people I met "on the inside". I'd like to tell these stories for a number of reasons but chiefly to give an idea of the kind of people one will find on a typical psychiatric ward. I met dozens of people in my four stays in psychiatric wards no two of them alike. Readers of this blog also will know that I have a particular interest in suicide and the reasons behind it so I also think of Z as an interesting case study. We'll come back to this story, and others, later. 

Friday, September 13, 2013

Psychiatry - the Emperor with No Clothes






This may come as a surprise to you but there actually is no medically based diagnostic test for any psychiatric illness. The second sobering thing to understand is that the diagnostic process that is used for any psychiatric illness cannot in any way be described as "accurate" and upon closer inspection certainly not scientific. "Diagnosis" - if it can be called that - is performed by observing "behaviours" and then checking them off a list. The behaviours are described in the DSM - the diagnostic and statistical manual, the "bible" of psychiatric diagnosis. To understand psychiatric diagnosis, we first have to understand this manual and how it gets put together. 

This is from the Neuroskeptic


In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.
Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.
It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.
Others were worse. Depression, had a frankly crap kappa of 0.28, and the new ‘Mixed Anxiety-Depressive Disorder’ came in at -0.004 (sic). It was completely meaningless.

This, by the way, was performed and compiled by the DSM-V committee in which the psychiatrists were hand picked. What this essentially boils down to is that the people who are authoring the manual upon which psychiatric diagnoses are based can't even accurately diagnose anything using their own criteria. Let me repeat that for you - the very people responsible for compiling the new (and since released) diagnostic manual that psychiatrists around the western world will depend on for diagnostic guidance and criteria cannot diagnose anything accurately based on their own diagnostic criteria. 

You might also be surprised at how "disorders" get included in the manual; they're voted in by - get this - a show of hands. 


Canadian psychologist Tana Dineen reports, “Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM-IV [and ICD-10] are terms arrived at through peer consensus”—literally, a vote by APA committee members—and designed largely for billing purposes.

The “science-by-vote” procedure is as surprising to a layperson as it is to other health professionals, who have witnessed DSM voting meetings. “Mental disorders are established without scientific basis and procedure,”
[my bold - brad] a psychologist attending the DSM hearings said. “The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. Then it’s typed into the computer. It may reflect on our naiveté, but it was our belief that there would be an attempt to look at the things scientifically.” [my bold - brad]

In 1987, a “self-defeating personality disorder” was voted in as a provisional label. Used to describe “self-sacrificing” people, especially women, who supposedly choose careers or relationships that are likely to cause disappointment, the “disorder” met with such protest from women it was subsequently voted out of DSM-IV.

Yes, you read that correctly; "disorders" can be voted in and then, on the basis of a protest, be voted out again. There is nothing medically scientific about voting "disorders" in and out of existence. Homosexuality was once a "disorder" that was only removed (for the 1980 edition) after strong protest from gay activists. 

And there's more. This from lead DSM-IV committee member Allen Frances, who in a (year) 2000 interview with Wired magazine, declared,


"There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it." ... "These concepts [of distinct mental disorders] are virtually impossible to define precisely with bright lines at the borders."

Frances became so alarmed at where the new DSM-V was going that he has become an outspoken critic of the entire diagnostic process and of psychiatry itself. 


And finally, the lead psychiatrist over the formulating of the DSM-V openly admits that there is little or inadequate "scientific research" done to back up the diagnostic claims in the DSM.

"A primary purpose of this group then, was to determine why progress has been so limited and to offer strategic insights that may lead to a more etiologically-based diagnostic system. The group ultimately concluded that given the current state of technological limitations, the field is years, and possibly decades, away from having a fully explicated etiology- and pathophysiology-based classification system for psychiatry." [bold all mine - brad]


Michael B. First, M.D. A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers. Published in May 2002.

So not only is there no clear etiology for any psychiatric disorder, by their own admission they're possibly decades away from having one (granted this quote is from eleven years ago and neuro-imaging technology has advanced considerably since then).

And this isn't mentioning the ties to drug companies that many DSM committee members have or how much funding the pharmaceutical industry supplies to the American Psychiatric Association

And just to give further idea, there's this. This was from a neuroscience paper the source for which I no longer have. My apologies. 


neuropsychiatric (NP) disorders ... can still be viewed as part of the most complex disorders that are of unknown etiology and incomprehensible pathophysiology. The complexity of NP disorders arises from their etiologic heterogeneity and the concurrent influence of environmental and genetic factors. In addition, the absence of rigid boundaries between the normal and diseased state, the remarkable overlap of symptoms among conditions, the high inter-individual and inter-population variations, and the absence of discriminative molecular and/or imaging biomarkers for these diseases makes difficult an accurate diagnosis.”

This is essentially neuroscience confirming what Dr. Frances admitted - that "there are no bright lines between the borders" and that they have no idea what causes anything. 

I will repeat - any neuroscientist will tell you that the human brain is the most complex device in the known universe. Even with the most mind boggling advanced and highly tuned instruments yet devised, bleeding edge neuroscience doesn't even really fully comprehend what is going on in there and why. Do you honestly believe that someone going by a corrupted and highly unscientific check list is going to know? I'll say again - I was seen by about twenty psychiatrists. None of them had the same thing to say. None of them could explain anything to me. None of them gave any indications they understood why these things were happening to me in my mind. Aside from a routine CAT scan to rule out concussion damage and a test to analyze my brain activity while sleeping, no actual medical tests were ever performed. And this will be true of anyone ever "diagnosed" with a mood or psychiatric disorder. This is not medical diagnosis, not even close. It's modern day voodoo at best. I'd go with a tarot card reading before I ever put myself in these people's hands again. They have about the same scientific basis. 

And then - then! - these people, after this simple check list "diagnosis", are going to pull out a prescription pad and prescribe either a drug or more likely a combination of drugs to "fix" what they "think" is "wrong". Drugs which, as I've written before, lack any kind of scientific validity for long term efficacy, drugs which could induce suicide or violent behaviour or cause critical structural changes to the brain including tissue loss.

Back to the four year old who was killed by a "psychiatrist" and for whom Tufts Medical Center felt "The care we provided was appropriate and within responsible professional standards" (60 Minutes, 2009). Seriously? Drugging a four year old to death is "within reasonable professional standards"? Where were these people during brain anatomy classes? Read any neuroscience book. The brain is still in rapid development stage at that age. Not only are behavioural issues common at that age as the developing brain struggles to make sense of and adapt to a seemingly bizarre world but it is beyond comprehension that brain altering chemicals could ethically be given to children whose brains are still developing. Yet "paediatric bipolar disorder" is now a common diagnosis and infants as young as three or four are put on cocktails of powerful drugs. And brain development goes right up past adolescence (the brain also undergoes massive changes during the teen years) and this age class is increasingly drugged (and off label at that - the drugs were never approved for non-adult use). And this isn't "Billy Bob Psychiatry" hanging a shingle out in some back water town, this is a major medical centre. And this is who we trust with our one and only precious brains?

No. I say no. And this is only the tiny, tiny tip of the iceberg of what I found for psychiatric misdeeds, the financial ties between the pharmaceutical industry, the FDA and the American Psychiatric Association and what is available for long term studies and research into psychiatric drugs (and thus psychiatry itself) efficacy. You might want to watch some of former drug company sales rep Gwen Olsen videos in which she describes how drugs are pushed to psychiatrists' and doctors' offices, old age homes and schools in order to "gain market share" and "make sales quotas" like they were widgets or some other kind of everyday product and not something that we trust to treat our brains. 

Psychiatry doesn't have a shred of clothing to wear. They have no scientific basis for diagnosis and they prescribe medications that have no scientific validity whatsoever. These are drugs that the effects of which are unobservable in the human brain (unlike medications for other medical conditions) "treating" conditions for which no biological etiology has ever been established and accepted (please try to find one - I'd be interested in seeing it. But head to the Nobel Prize committee first; they'd be interested in this discovery). I see no validation whatsoever for the "Dr" in front of their names that they so proudly flaunt. They get by entirely by the infamous "God complex" - they simply believe they "know". By what criteria? Nobody knows. A reading of psychiatric history is a reading into some of the worst horrors ever inflicted on innocent people (psychology is not innocent of this either). The barbaric practices of ice pick lobotomies and insulin shock therapy (you'd have to read about this to believe it) are not far in their past. Under their watch we have seen an explosion of people debilitated by psychiatric illnesses, including a thirty-five fold increase among children.

Personally, I wouldn't trust them to treat a headache. Anyone who's been successfully "treated" by mainstream psychiatry most likely did so through belief in their doctor and placebo effects which makes it no different or better than the shamans and witch doctors that still operate in many cultures (my friends in the Filipino community told me some fascinating stories of this). If someone claims to have been successfully treated, I'd ask for the before and after medical tests that prove that. There are none. "Successful treatment" just means that you were one of the lucky ones. Or the condition just passed normally as they did for thousands of years before "modern" psychiatry began getting involved in our brains and behaviours.

Given the hundreds of "disorders" in the DSM that cover just about every human behaviour imaginable and the completely sham system of diagnosis (described by many as merely a system to justify insurance claims and writing prescriptions) or the medicalizing of perfectly normal human behaviours (bereavement following the death of a loved one is now considered a "disorder" in the new DSM-V), I find myself highly sceptical of anyone claiming a psychiatric disorder (and given the distinct possibility that the drugs to treat it are actually prolonging or worsening it). 

This is NOT to say that psychiatric disorders do not exist or that there are not people who genuinely suffer from them, only that there's a good chance one was misdiagnosed (over diagnosis is a widely recognized problem ... a story possibly for another day but "ADHD" would be one that would be firmly in the cross hairs) or that one is simply "suffering" from being human and therefore not perfect. Situational unhappiness, temper tantrums, mood swings, acting out and dozens of other behaviours were not "disorders" until a combination of perfectionist seeking society started overreacting to them and modern psychiatry, backed by the profit seeking pharmaceutical industry (and statistics will show that "disorders" sky rocketed after these two linked up about five decades ago), decided - and I do mean decided, see again the vote by a show of hands - that so much of normal human behaviour is an "illness" that can be made to go away by a simple pill (or likely a cocktail of them).

This is an industry that has no clothes. And I see no sign of them acquiring any any time soon.  

[I apologize again for the formatting issues. It all looks normal and the same in my composition box but when I post it, the formatting is all strange - brad]

Monday, September 9, 2013

Ultimately

Ultimately it comes down to this.


Ultimately you'll be left to fight this alone. The drug pushers can't help you, all they know how to do is make random stabs in the dark and write prescriptions. I know that it appears to "help" some people and this re-enforces this practice but for many it does not work and they end up unable to function and on long term disability (Robert Whitaker cites the numbers, taken from US government sources, in his book Anatomy of an Epidemic) or commit suicide (estimates are that one in five people who are truly bipolar (as opposed to the misdiagnosed kind or minor hypomania) will commit suicide). No empirical or long term study data exists to support true efficacy of psychiatric drugs while data does exist pointing to the brain damage it causes. Psychiatric drugs such as SSRI antidepressants are strongly linked to suicide (as are other psychiatric drugs) so it is possible that long term drug use is a factor in that high suicide number. I myself became much more suicidal when on psychiatric drugs. At any rate, psychiatry is not a help to my situation and by extension the mental health care system because their entire model is based on psychiatry and drug therapy.


Ultimately family will abandon you. After a while they can no longer handle the intense mood swings between maniacal highs to suicidal lows. People are wired to distance themselves from unstable people. This is nobody's fault, it's just their own instincts of self preservation functioning normally. Fuck, even unstable people don't want to hang around unstable people (all the friends I made while "on the inside" eventually stopped contact. Which you can't blame them for. They just want to get on with their lives, not be reminded of the time they were in the loony bin.) 

It takes great courage and uncommon levels of empathy to step outside one's self preservation mode and my family could not do that. They tried, I think, but ultimately they listened to their instinct to back away. That's what my daughter had to do. She was daily witness to the swings between the highs of love of life enthusiasm and runaway optimism and suicidal depression and hospitalizations. She just simply could not handle or watch it any more. She's highly sensitive herself and HAD TO distance herself to protect herself. It's either self protection mode or they simply deny what is happening and pretend everything is fine and that there's nothing wrong, something that I found unacceptable. There's intense inner pain but worse pain is when people who "love" you deny that pain. They will see you and be social as long as they can live in their own fantasy world that everything is OK. If that is "love" then yes indeed, love hurts. I can do without that kind of "love". Others will flat out tell you that they can no longer handle your situation and that they “have their own things to deal with”. Others will tell you that you are just drama making and attention seeking. Which, whatever, that's just the way people are. The end result is abandonment though. What makes it hard is the comparison to stories of psychiatric survivors and the roles undying family support played. Sometimes, just sometimes, I wonder why I didn't get that support. Some very valuable financial support I got, and was very grateful for, but not the vital emotional support.

One thing that will affect how you're impacted by a mental illness is how emotionally sensitive you are. I am, I have to admit, extremely sensitive. I've talked to other bipolar peeps who've told me the same thing, that extreme sensitivity is a big part of their issues. This is where the psychic pain comes from. I'm not always like this but when I am, I'm extreme. (true bipolar is a world of extremes) And it seems the more the illness runs its course the more sensitive you are to psychic damage. This is also a hallmark of borderline personality disorder (extreme sensitivity to facial expressions and tones of voice causing violent mood swings) which is often, according to Psychology Today's Taming Bipolar (which, by the way, was the genesis for this blog title), "comorbid" with bipolar. Psychic pain is beyond explanation. There's no "data" or "research" to back it up or any way to look at it or measure it in a lab. It just is. David Foster Wallace and other writers describe it best. Foster described it as a sheet of flame at one's back while standing at an open window. Psychic pain eats at me like battery acid. And it can come from anyone, anywhere and any time. I can't tell you how much work I've put into controlling this but I just can't. Whatever it is, it hard wired now. It's why I battle agoraphobia. Any contact with any human can add to the pain and thus contribute to a complete suicidal melt down. All it needs is that one flick of a match to trigger it. It's beyond bizarre and incomprehensible to virtually all people but there ya go. It's daily hell to deal with it. I can go for days thinking I'm "dealing with it" well (doing all my little CBT stuff) but then it'll all come searing back and erupt without warning. Then the next thing I know I'm handcuffed in the back of a police car and off to the psychiatric ward again. Ultimately, I can't live like this - walking on the eggshells of my own mind not knowing when or why I'll melt down again. This alone is madness making. 

Ultimately I can't live on welfare. I am a proud working man. My entire sense of self is built around earning an honest living exchanging my value with someone for their money. That, deeply in my view, is the right and honest way to live. On welfare I have no value. I am not one of those who can "manufacture" value out of this situation and make it seem acceptable. Oh, I tried, I tried to put all kinds of positive spin on it but ultimately I can't. I am a man who always paid his own way. A man who was proud to have owned a home. I am a middle class man with a middle class background who lived a middle class life. The pain and shame of subsisting on welfare is unbearable to me. It is not what I was born to live. I was born to chase dreams, build a modest amount of wealth to take care of myself in old age. Losing that and falling to this is unquestionably the worst psychic pain I feel. I know I am supposed to practice "acceptance" and "letting go" but I just cannot. I can for a spell but then it too will come searing back out of the blue and the pain of the flames on my soul will be great. 

Ultimately, I can't live without my mind. I've lost everything I've ever worked for and then some (I owe tens of thousands of dollars). I lost my ability to work. All I have left is my mind. Then I lose that. There are days when my mind just will not respond. I can't read or do any writing, let alone the tougher research that has been my purpose. Days of utter waste go by. I can deal with a few hours. But when it becomes days I get incredibly distressed and frantic. Insanity is like that. It is, I'm sure of it now, the accumulative brain damage from years of manic depressive cycling and the years of constant stress. I've lived below the poverty line for more than five and a half years which research now shows produces brain altering stress. Mental instability produces its own kind of stress. There was years at a high stress job (not just high pressure, that I can handle, but stress about getting paid or not, unreasonable demands and many other things a person with extremely low tolerance for stress is badly affected by). Constant and rapid cycling changes of state appear to cause brain damage (as autopsies on deceased bipolar people reveal) and other research shows that stress can break down the brain at the neuronal and axon level. Plus, in bipolar depression the brain can just literally shut down. The stories of people in the throws of bipolar depression being completely non-functional are legion. Kay Jamison's An Unquiet Mind describes this very well (though I found her depictions of her "mania" a bit specious). There's just no doubt in my mind that the brain shut down I experience is part of the long term outcome of bipolar disorder. I tried and tried and tried to fight against this and deny that it was happening and I've improved over the worst that I experienced in previous years but it still just hammers me. And though I can rationally understand all of this I just utterly can't stand feeling so non-functional. The one dream I have remaining is to research and write about this disorder and when I can't even do that I get extremely distressed and dark feeling. My writing and research was the one way I felt I could contribute to society and "earn" the government cheque I receive. When I can't even do that I feel even more worthless.

Ultimately, this is not a life. Lying around, confined to my room and non-functional so often. I was always a man of adventure, passion, exploration and full of life. My life almost always had meaning. I've always had lovers and love and travel and romance and chased my dreams. Now I have nothing and am scared shitless to even dream about anything more. I look at this today and it's not life. Not in my books. Rising each morning and merely drawing in breathe is not life. And being totally and utterly helpless to pursue what I feel life is is literally maddening.  Or sometimes I just can't stand being a useless sack of shit welfare bum (my former working class values speaking).

I cannot even begin to tell you how hard I've worked at this. I work on my positive difference making fundamentals all the time. I am not a negative person. I smile most of the time and say kind things to people. I work like hell to have a positive attitude about everything. I read positive materials. I've retrenched probably a hundred or more times in the last five years. This doesn't work out? Retrench. That doesn't work out? Retrench. Retrench and retrench and retrench. I've retrenched all the way down to being a welfare bum. I can retrench no further. I've done everything they told me to do. I've been in the hospital four times and each time I was the hardest working person on the ward doing everything possible to get better. I've done things that I had to develop myself (based on latest neuroscience). I work almost every hour of every day at dealing with the frustration of living below the poverty line while dealing with a major mental health disorder and calming myself not to feel that frustration. And this hurts like fucking hell too. No one can see how hard I work. No one knows how hard this is. NO ONE. (in my life, not in the world. I am of course aware that many others have gone through this) One could look in my room and see me lying on the bed with my eyes closed. What's going on is that I am working like hell to avert a full catastrophic melt down. Or trying to build up my mind. It's incredibly hard work. But what do they see? A welfare bum lying around on his ass doing nothing. People will see me melt down and think that I'm just weak and not trying. What they don't see is the dozens of other times I worked through a melt down to avert it. What they don't see is the hundreds of hours I've put into research and the work I do to build up my mind. When one is seeing a person re-habbing from physical injury or illness or fighting cancer, everyone can see how hard they work. Not with mental illness. It is truly the silent illness. And you'll suffer it alone. Which leads to the final blow.

Ultimately, I cannot do this alone. Can NOT. Personally, I think I've displayed superhuman strength to get this far (and my psychologist, who was more familiar with my struggles than anyone on earth, agrees). But I'm like the fucking rat in the water stress test. The water stress test is when they put a rat in a tank of water it can't escape from. It has to keep swimming to stay alive. They'll leave the rat in until it dies. At some point it'll just give up and stop swimming. Then they'll examine it. They'll find that all kinds of things in the brain and nervous system just simply break down. The non-stop stress of struggling for survival will just start to break things down. I've been swimming non stop in the water stress test trying to stay alive for more than five years. Things are breaking down. Things HAVE broken down. I need help. I really, really, REALLY need help. I think my own program is good and would work but I cannot do it alone. I need feedback. I need support during the rough times. I need someone to hear me. So it was that for four months I looked forward to the free therapy program offered by the local university. It saved my life last year. And it is the ONLY resource that I have found that that worked for me (and trust me, I've hunted down every resource available and NONE worked out). This was ALL I had. So I literally counted down the days waiting for the new session to begin (they run with the school term from September until early May). They told me I was welcome to come back in the new session. In my darkest times I told myself to just hang in until therapy could start again. So the time finally arrives. They tell me that they have to reject me. My case is "too tough" for them (apparently handling my case was extremely stressful on my previous psychologist). What little wind I had in my sails was instantly gone. I cannot even begin to describe how devastating this was. This is what I mean about ultimately facing this alone. When your situation is bad enough and you've been in the system long enough, you WILL end up facing it alone (simpleton pill pushing psychiatrists don't count. Their toxins made me a hundred times worse and I've never met a professional group more dimly uncomprehending of human suffering). Family can't help; they're simply not equipped. No friend could handle something like this. This therapy - this free therapy - was the only hope I had for help, the only hope I had for not fighting this so fucking alone. And now that hope is crushed. Just like every other hope I've had since this began. This is not "depression talking", this is literally no hope left. There are no other options. This was IT and now it's gone.

I feel like the character of Jesus Christ in Jesus Christ Superstar from the scene Gethsemane (I only want to say) when he cries "tried for three years, seems like thirty". It truly is like that. This suicidal madness started three summers ago and I've fought it for three years. But it seems like thirty. Seems like ninety. I can fight no more. 

The brain has some remarkable survival tools for getting through dark times. That's how it evolved. We wouldn't be here as a species if it didn't. But this is what happens in brains with this kind and degree of mental illness - all that stuff breaks down. That's part of the illness, you see? With other illnesses other things are broken but the human mind is intact. The "indomitable human spirit" is merely a survival tool in the brain. A person will get down and go through extreme darkness but their essential survival tool remains intact to pull them through. But with mental illness the very thing that's needed to fight is the very part that is broken. This is why people commit suicide - that survival tool is either broken or was overwhelmed. This is what 99.9% of the population - and the medical field itself - don't understand. The essential survival tool in the brain breaks and simply cannot go on. 

Ultimately I don't know what the big deal about death is, I really don't. I don't consider this suicide, I consider it self administered euthanasia. I want to end this and to end it on my own terms. In a stretch between July of 2010 and late last year I suffered through many mania driven states of suicidal madness (during the dreaded mixed states when it's thought that most bipolar suicides occur) or horrific states of suicidal psychosis (hallucinations of great violence to myself and demands to carry it out). These always involved violent deaths. I have no idea when these may return nor does anyone. There's no "book" on this. When they do, I just know that I'll have no control over them. The brain shuts off any kind of concious cognisance. The madness is in full control then. Most people have no idea what this is like because quite frankly, few people survive this (and my suicide expert psychologist agreed. She utterly could not believe what I survived). I don't want to go violently. I want to go peaceably. So I want to choose my own terms and place and time. That's all I ask for in life now - to go on my own terms. I feel I don't have to justify this or explain it to anyone. ANYONE. I don't care for anyone's Biblical morals about this that say that "only God can take a life". Fuck that. I believe ownership of one's life is the ultimate divine right. I'll do with my life what I feel is right. You'll argue that this is "selfish". And I'll argue that your wanting me to continue to suffer is selfish and a worse kind of selfishness. I was not put on earth to suffer, that I know. I have nothing to say to people that believe that to suffer is to be noble. I see no nobility in suffering. I will accept no judgement from those who cannot feel or know my pain. Pain is relative and this is too much pain for me to bear. All I want is to be respected for my views.

I have a plan. And a place (roughly. the spirit of the place is what's important, not the exact location). I want to go peaceably overlooking a peaceful scene. My grandfather died in his sleep in his favourite recliner. I always thought that was the perfect way to go. I want to go like that. I just need to acquire the right material. 

I have things to tie up first. I want to e-publish my book first and finish a series of stories for my daughter. Then it will be time. 

[PS - I have been in a very dark state for a week now (well this bout of bipolar depression  and darkness started in late May but I mean this particular stretch of particularly bad darkness) and was very dark when I first conceived this post. This post isn't nearly as dark as when I first conceived it. I had to considerably calm myself down before I wrote it. Also about the formatting issues. I have no idea what's up with this. I copy and paste from my word program sometimes. It all looks the same font and size in my composition box but then when I post it there are different sizes and fonts. A mystery.]