Monday, December 18, 2006

TO READ: Great Books on Depression and Other Mental Illnesses
I've just finished reading a couple of terrific books on mental illness issues and want to pass my thoughts on, while hoping you'll let me know of other new ones or old favorites.

The Unholy Ghost: Writers on Depression (edited by Nell Casey with an introduction by Kay Redfield Jamison; 2001, Perennial) is titled for a phrase poet Jane Kenyon used to describe her deep depression in Having It Out with Melancholy. Though it's not brand new, it was new to me when I picked it up recently, and I've found it fascinating. The book is a collection of essays by noted writers who have dealt with the illness, either personally, or as a spouse or family member.

While these writers seek to describe what many of us find indescribable about our experiences, they also tell their own very engaging stories of despair. Some of them relate these periods to their ideas about their own creative work, wishing that depression should be abolished if that were possible, or arguing that the illness is actually useful.

The Creating Brain: The Neuroscience of Genius (by Nancy C. Andreasen; 2005, Dana Press) was an exciting read for me as a biologist and as one deeply intrigued with the relationship of mental illness to creativity. In addition to considering what constitutes creativity and how the brain creates, among other issues, it includes a full chapter on Genius and Insanity: Creativity and Brain Disease. Many of you will also be quickly drawn in, I suspect.

Building on long-reported connections, Andreasen's careful study of writers reveals a dramatically higher rate of all mood disorders (80%) than in a carefully matched set of non-writers (30%). No writers in this study had schizophrenia. She is now studying whether scientists, or their family members, have higher rates of schizophrenia. She reports that during periods of instability, poets and painters are generally unable to create, but that during remissions they can draw upon these difficult experiences in their work. Also discussed is the fear of some writers and artists that psychiatric treatment of any kind might stifle their creativity.

Both of these books offer unique, valuable and very interesting takes on illnesses that are being written about more and more, but not always with new insights. What are you reading?
TO WRITE: Spirituality's Role in Mental Health
In my way of looking at the Universe, we are all "spiritual" people -- not necessarily "religious" or even consciously spiritual in day to day life -- but spiritual just the same. We all have relationships with our self, with the world around us, with the mysteries life offers, and I believe that the way we face these things defines our spirituality. This is a very liberal use of the word "spiritual," I realize, but stay with me here.

Whether you are a Muslim, Jew, Buddhist, Christian, Hindu, agnostic, atheist or other, you have certain views about how the world operates and about what you most deeply treasure in that world. And, whether you hold truth, kindness or other principles as your highest values, whether your worldview is shaped by a traditional religious background or not, I argue that your mental health is affected by your spirituality.

The majority of psychiatric inpatients note that religion gives meaning and purpose to their life, according to several studies. In a general patient survey, 75% would like their doctors to address spiritual issues as part of their care. Clearly these are vitally important issues for many of us.

Play with this...
Write for 20 minutes on your spiritual views and how they relate to your depression or other mental illness. For example, does being an atheist ground you when you're ill? Does your belief in God help you to keep going despite your symptoms? And have your mental health experiences changed your worldview? Exploring spirituality with respect to your mental illness may make you more consciously aware of your beliefs and may even provide you with a lifeline when difficult thoughts and painful feelings strike.

Monday, December 11, 2006

TO READ: This is Your Brain on Therapy
Scientists are learning more on a daily basis about how the brains of people with depression differ from those without it. But can those differences be used to predict how best to treat depressed people? According to recent research, they can.

Using functional magnetic resonance imaging (fMRI), researchers at the University of Pittsburgh School of Medicine measured activity in two key areas of the brains of depressed persons while they responded to different words. The words were chosen to have negative, positive or neutral associations, and the patients were asked to choose words that reflected their feelings when they felt depressed. Then each person participated in a 12-week program of cognitive behavioral therapy (CBT) for their depression, and their depression levels were measured again.

The results seem strong: Among the nine patients with a particular brain activity pattern (a decrease in activity in the subgenual cingulate cortex) when responding to negative words, seven recovered during CBT. Among the five people who did not show that pattern, only one responded to CBT. The positive and neutral words produced no changes related to mood improvement in CBT.

So, even given this small initial trial, fMRI seems to provide a predictor of which depressed people will respond to CBT, a structured therapy that teaches how to control emotional reactions and rumination. Learning how to identify depressed patients who are likely to benefit from CBT versus some other therapy could provide quicker, more effective treatment for all.

For more info: Am J Psychiatry. 2006; 163:735-738.
TO WRITE: Changing Perspectives in Your Writing
In his book Writing to Heal, James W. Pennebaker reports that recent research demonstrates the importance of the writer's perspective or voice when writing about traumatic issues. People who derive the most benefit from writing on a difficult topic for several days in a row are those who can switch from writing exclusively about their own thoughts and emotions to writing about how others who were involved might have experienced and thought about the trauma.

This change in perspective can be accomplished by writing in the "first-person" voice versus the "third person" voice. (If these terms make you cringe about a failed fifth-grade grammar test, fear not. The first person uses "I, me, we," as in: I ordered a pizza for us to have for dinner. The third person uses "she, he, her, him, they," as in: She ordered a pizza for them to have for dinner.)

Play with this...
Think of an annoying event in your life -- not a massive trauma -- that you've been worrying over. Now write continuously about the event and your reaction to it for 10 minutes from your usual first-person perspective. ("I threw up my hands when...")

Now read over what you've just written. Then write on the same topic, covering the same basic information, for 10 minutes from the third-person. You'll sound like an outside observer. ("She threw up her hands when...")

Now read over your second writing and compare how these two pieces felt to write. (Writing in the third person may feel awkward at first, but does get more comfortable with practice.) Did it give you a sense of distance from the problem? Was that useful to you? This technique can be particularly helpful when you are later approaching a serious trauma through writing.

Thursday, December 07, 2006

TO READ: Reading Books as a Depression Treatment
Bibliotherapy, also known as "guided self-help," has been studied for several years as a treatment for mild to moderate depression. In bibliotherapy, people with depression are assigned to read a self-help book such as David Burns' Feeling Good, instead of, or in addition to, treatment with psychotherapy and/or antidepressant medicines. The results are impressive.

Numerous controlled studies have been conducted and, in at least some, researchers have concluded that a four-week self-study period with an appropriate book was as effective as individual psychotherapy, participation in a cognitive behavioral therapy group, or taking an antidepressant -- and bibliotherapy worked faster. In a three-year follow up study, the beneficial effects of bibliotherapy were sustained.

Can reading really alleviate depression? There are some specifics to keep in mind. The book must contain real information on how to recover from depression. Typically the books used CBT-based approaches. (Peter Lewinsohn's book Control Your Depression was also found useful; Victor Frankl's Man's Search for Meaning led to no improvement.) In some studies the reading was conducted between psychotherapy sessions that reinforced the importance of the books and their exercises. Also, bibliotherapy has not been applied to severely depressed patients.

As you may suspect, bibliotherapy provides a vastly more economic way to treat mild to moderate depression. Some researchers have suggested that conducting bibliotherapy on the Internet may be effective, and cost effective, as well.

For more info, see: Smith, et al, (1997), J. consult. clin. psychol., 65, 2.
The Wall Street Journal, August 9, 2005, p. B1.

Monday, December 04, 2006

TO WRITE: Focus the Power of Your Writing
For the past eight years, I've led a creative writing class for people with mood disorders, meeting weekly at Stanford University's Psychiatry Department. While we often explore our mental health issues through writing and sharing, we write on other topics as well.

Why bother writing about sand or your favorite meal or a photograph of a cheetah? Many reasons, I believe. For example, these exercises help us "warm up" as we begin a two-hour writing session; students report they are calming, clarifying, thought-provoking; and reading their pieces aloud helps validate writers' thoughts and feelings in a safe community. But these unusual topics also make us better, stronger writers by developing our use of techniques including: memory, the senses, and vivid detail. These three things are among those many authors (of fiction and non-fiction) emphasize when teaching others to hone their writing craft.

Writing about your family car when you were a child requires you to: Dig into your memory banks, which may lead you to long-forgotten stories as well. Describe the way the car looked and perhaps sounded as it backfired, felt as it hit a bump, or smelled of popcorn after a drive-in movie. And it encourages you to stretch yourself to come up with vivid details that will really bring the reader into your experience -- how Mom's beehive hairdo almost touched the ceiling, how big brother whined as he begged to be allowed to drive.

All these techniques help writers to better develop a narrative and to develop changes in perspective. Both these things have been found in studies to be more likely to effect health changes when writing about trauma -- something we're likely to address in the second in-class exercise of the day.

Play with this...
Write a description of your high school gym teacher. Try to use all of your senses as you look back to recall him or her. Use vivid details as much as possible to elucidate his/her character. What stories do you recall? Help an imagined reader really know this person.

Thursday, November 30, 2006

TO READ: Could Depression Relief be "All in Your Mind"?
We've all heard it, or even thought it ourselves: You're not "really sick," your depression is just "all in your mind." Before you grind your teeth too hard, read about how neurofeedback, aka EEG biofeedback, has helped a few people ease their depression by training their brains.

It seems that in depressed people a particular type of brain wave, the alpha wave, is not equally strong in the left and right brain hemispheres, but is more active on the right. This distribution of alpha waves can be related to mood. Though the technique is highly experimental, and no controlled studies have been conducted yet, researchers at Northwestern University and the NeuroQuest Neurofeedback Center in Evanston, Illinois have seen some positive results when depressed subjects learned to balance the alpha waves in their brains.

After electrodes were stuck to spots on their face and scalp, depressed research subjects were trained in 15-30 minutes sessions to play a sort of game. In this rudimentary computer game, played simply by thinking, not using the hands, success was measured in changes in brain waves. When their alpha waves in the left frontal cortex grew stronger than in the right, they heard a note played on a clarinet. Their goal was to keep this tone playing as long as possible. The training worked -- at least for some people. One woman had outstanding results: After 12 years of recurrent depressions that were not responsive to treatments, she learned in just 35 hours of training to control the waves so that her symptoms decreased dramatically. Amazingly, she remained depression-free during the next six years as the scientists followed her case.

Brain training, as it's called, is being studied for many other uses as well: predictions of seizures in patients with epilepsy, treatment of ADHD, communication for those who cannot speak or move and, yes, even improving healthy people's cognitive skills such as memory, concentration and musical abilities.

For more info, see: Scientific American Mind, February 2006.

Monday, November 27, 2006

TO WRITE: What Are You Grateful For?
As the long weekend of family, food and crazed shopping ends, I'm reflecting on what it all means. What am I really thankful for, and do I ever truly stop and think about those things? Some recent psychological research suggests that the trait of being grateful is a particularly powerful one. The psychologists involved suggest the following practice for greater contentment: Keep a special notebook, and at the end of each day, write down three specific things for which you are grateful. These can be large or small things -- I was able to sleep six solid hours last night; I called my sister for support today when I felt really low; I felt engaged when reading the front page of the newspaper. Ocassionally look back at your notebook and see what things jump out at you or form a trend. Are these things you could strive to increase in your life?

Play with this...
Try the exercise described above for a week. Then reread your notebook entries and write consistently for 20 minutes on your findings. If you feel a sense of satisfaction, lightness or joy, continue the practice and see how your feelings evolve over time and how you might apply your discoveries day-to-day.

Wednesday, November 22, 2006

TO READ: The Creativity-Depression Link: Rumination
Science, as well as centuries of popular observation, has shown that there is a strong relationship between mood disorders and creativity. Artists, writers, musicians and scientists all have higher than usual rates of depression, for example. But why? Does depression lead somehow to creativity? Or are creative pursuits somehow depressing? Research now shows that there may be no direct link between the two. Rather, their connection may be the tendency to ruminate.

In the 1990s, one overview of research studies on creativity and depression concluded that major depression in writers and artists is 8-10 times higher than in the general population. Another study found that people working in the creative arts had a lifetime prevalence of depression of 50%, while scientists came in at 24%, and the general public had a rate of 9%. In particular, poets had a depression rate of 77%; fiction writers, 59%; and visual artists, 50%.

More recently, researchers at Syracuse University and Stanford University found evidence that the strong relationship between mood disorder and creative behavior is rumination -- having conscious thoughts about a particular topic that recur whenever the person is not facing immediate outside demands. This tendency to self-reflection increases the risk for depression, and it also triggers interest in and ability for creative activities.

The results suggest that depressed people, who tend to be ruminators, may turn to creative pursuits when they are feeling better in order to express their feelings and the content of that self-reflective thought. Also, rumination may allow the depressed individual to later generate more ideas, some of which are original and can be pursued -- though of course, the possibility of having repetitive negative thoughts about oneself is higher too.

From: Verhaeghen, et al. (2005). Why we sing the blues: The relation between self-reflective rumination, mood, and creativity. Emotion, 5, 226-232.

Monday, November 20, 2006

TO WRITE: Tell me what helps!
A recent comment left on this blog -- a request for help, really -- got me thinking about how easy it can become to focus on what makes our depression and other symptoms worse, not what makes us feel better. One of the many uses of support groups for those living with mental illness is that through sharing with others, we can often identify healing techniques, be they large or small. Writing can also trigger us to pinpoint what works for us, both as we put our finger on these approaches ourselves, and as we share them with others.

Play with this...
Imagine a person who has just been diagnosed with your illness coming to you for advice on how to ease the pain. What would you suggest? I'd include both broad approaches -- educating oneself through the links listed in this blog, seeing a highly-recommended physician -- and small, specific tricks -- holding my cat, coffee with a trusted friend, writing down my feelings of confusion. Writing continuously for 20 minutes, describe what you'd say to this new acquaintance who needs your help. And let me know what you come up with!

Monday, November 13, 2006

TO READ: Depression gene enlarges "negative" brain region
If you're clinically depressed, your brain's structure is probably different than that of your healthy friends. That's right -- while the use of biochemicals such as serotonin is undoubtedly different in depression, as we've heard for years, there are gross physical differences in the brain tissue as well. Several research studies have demonstrated that numerous regions of the brains of people with depression differ from that of non-depressed people -- usually certain areas are smaller in depressed people. Now, there's evidence that the "negative emotions" part of the brain is bigger in those with depression.

Last week in the journal Biological Psychiatry, scientists reported their studies of a particular gene, the serotonin transporter gene (SERT), which has two forms, known as short and long. If you have two short SERT genes (one from each parent), you're likely to have a bigger "pulvinar" in your brain. The pulvinar region handles negative emotions. People in the study who had depression had pulvinars 20% larger and with 20% more nerve cells than people with one or two long genes. Researchers believe about 17% of the population has two SERT genes.

The SERT gene also affects the nerve cells' use of the neurotransmitter serotonin. Prozac, Zoloft and several other antidepressants act by keeping serotonin more available for cells to communicate.

How does this new information help us? "The brain is wired differently in people who have depression, and probably from the point of view of treatment, we should try to identify these people as early as possible and intervene before the 'hard-wiring' gets altered," the lead researcher told Reuters.

Friday, November 10, 2006

TO WRITE: What makes you you?
When living with depression or any other mental illness, it's all too easy to lose sight of who we really are. We're busy taking meds or going through other treatments to help change the ways we think and feel, and underneath it all our sense of self can be seriously compromised. The following quote by William James has helped me on several occasions to connect to what I consider my core -- my unique abilities, character, desires, needs, goals.

"Seek out that particular mental attribute which makes you feel most deeply and vitally alive, along with which comes the inner voice which says, 'This is the real me,' and when you have found that attitude, follow it."

Play with this...
Write continuously for 20 minutes on "What makes you the real you?" Afterward, reread your piece and see if you can come up with ideas on how to "follow it."

Wednesday, November 08, 2006

TO READ: Migraines and depression -- What's the connection?
I want to report today on migraines, usually considered a neurological, not a psychiatric issue. However, I contend that for some of us there's a real connection. I say this because of personal experiences, and because of similar stories numerous others have told me about their illnesses. (See, for example, the comment from "Patricia" below the November 1 posting in this blog.) My ill health actually began, 20 years ago, as severe daily migraines that appeared suddenly for the first time, and made it very hard to work. After a year of trying various medicines, during which my depressive symptoms first appeared, an old tricyclic antidepressant took care of both ailments. At least it largely took care of the migraines; the depression has returned umpteen times. Of course, not everyone has even that much success, though medicines used have advanced a great deal.

Interestingly, however, there may soon be non-pharmacological treatments for migraine sufferers. The New York Times reports this week on two experimental treatments being studied in large trials for migraine -- ONS, or occipital nerve stimulation, and TMS, transcranial magnetic stimulation.

ONS uses electrodes implanted just under the skin on the back of the head to deliver electric current to a specific nerve. The electrodes are wired (under the skin) to a pacemaker-like device implanted in the upper buttock. The treatment sounds analogous to the VNS, or vagus nerve stimulation, therapy now used for treatment-resistant depression, where a device implanted in the upper chest is wired to electrodes in the side of the neck and delivers pulses of electricity. Very different nerves -- similar idea.

And TMS is already being studied for the treatment of both major depression and bipolar depression. I've previously described in this blog how fabulous TMS treatment has been for me. The idea in using TMS for migraine is similar. Instead of the side-of-the head stimulation I've gotten, here the back of the head is targeted. Again, a device pressed against the head provides brief magnetic pulses, which alter the electrical activity in a localized region of the brain. In neither case is it known exactly how the stimulation helps, and it doesn't help everyone. Also, the migraine studies so far are limited to those who experience an "aura," or a premonition period, before the migraine. Still, the idea of having more electrical -- as well as chemical -- treatment options for both depression and migraine is exciting. Stay tuned for more results.

Friday, November 03, 2006

TO WRITE: How do relationships affect your mental health?
All of our personal relationships are bound to affect us in myriad ways, and our mental health is definitely one of them. Think about the people in your romantic life, for example -- your spouse, partner, or a current or former relationship. Does that person know about your depression, bipolar disorder, or other mental health problem? Can you discuss it with him/her? Is that person supportive? Have you learned over time how to best handle conversations with her/him on this topic? What would you like to change in this area?

Writing about our relationships can be extremely fruitful -- and fascinating. For a great example of writing on changing romantic relationships, check out the essays on the blog of a writer friend of mine at:

Play with this...
Choose your current partner or a person with whom you had a former romantic relationship. Writing consistently for 20 minutes, describe how you relate(d) to that person on the topic of your mental health. Does reading what you wrote provide any insight into changes you might like to make in this realm, if any?

Wednesday, November 01, 2006

TO READ: Depressed? Keep trying new meds
The final portion of a large, six-year federal study of depression was published today in the American Journal of Psychiatry. The findings: While one-third of people were helped by starting on the antidepressant Celexa, one-third more got better if they were patient and added or switched to a second, third, or even fourth antidepressant, as needed. Thus, 67% of the 3,671 of the depressed patients studied reached remission by taking one or more medicines.

The downside of trying additional antidepressants, however, is that relapse becomes more likely the more drugs you try. Among those who achieved remission with the original Celexa prescription, 40% relapsed in the first year. For those who had to use a second, third or fourth drug, the relapse rates rose to 55, 65, and 70%, respectively.

Monday, October 30, 2006

TO WRITE: Getting the pink slip
In my creative writing class for people with mood disorders at Stanford I often use quotations as writing prompts. They may come from writers, philosophers, actors, scientists, politicians or even coffee cups. You may agree or vehemently disagree with them, but they often trigger new ideas and internal dialog that creates meaningful writing. Today I'll offer a quotation from the book Unholy Ghost: Writers on Depression, edited by Nell Casey. Though it may be discouraging to read when you're down, this is a fascinating collection of essays on depression from diverse, yet articulate, writers. I found it very engaging to read when I was relatively depression-free.

Play with this...
In a piece entitled Poodle Bed, a depressed Darcey Steinke, author of novels including Suicide Blonde, describes feeling disconnected and lonely as she watches people and mailboxes go by during an early morning ride to the airport. "I felt like I'd been found incompetent and fired from my own life." Write for 15 minutes starting with this sentence.

Tuesday, October 24, 2006

TO READ: Transcranial Magnetic Stimulation
Numerous friends and acquaintances with mood disorders have had lots of questions about a treatment I've been receiving lately which uses not medicines or electricity, but a magnet. Transcranial magnetic stimulation (TMS, also known as rTMS with "r" for "repetitive) is a relatively new technique now under study for the treatment of both major depression and bipolar depression. TMS is not yet FDA-approved, but I've been fortunate enough to have had several series of experimental treatments for my sudden and severe depressive symptoms, and it has helped me tremendously, with no apparent side effects other than an occasional moderate headache.

TMS involves stimulating the nerve cells in a specific part of the brain with a magnetic field. In my case, this has been accomplished through a very simple procedure. I sit in a chair in a regular office and a psychiatrist holds a plastic "wand" against a specific spot on my head, a little above and in front of my right temple. The wand is wired to a machine that creates a strong, focused magnetic field, and is controlled by a laptop computer. For 60 seconds, I hear a rhythmic clicking sound, one click per second, as pulses of the field stimulate a part of my brain just centimeters below the skull. All I feel is a sensation of someone "knocking" on my head, and occasionally a slight muscle twitch. After a three-minute rest period, I get another 60 seconds of pulses, and I'm done.

Although ECT (electroconvulsive therapy) has worked wonders for me many times in the past, it requires a general anesthetic and, in my case, has led to significant memory loss. TMS avoids both those things. No anesthetic is needed; I can drive myself home and resume normal activities -- or whatever activities the depression allows. The one slight downside is that my TMS regimen requires treatments five days per week for four weeks. A lot of driving to Stanford for me, but well worth it.

About two weeks after starting treatment, I begin to feel my mood improve and my energy return. When we stop after four weeks of treatment, I usually feel about 90% back to baseline. However, I continue to feel improvement for another week or so, which returns me to a healthy, non-depressed state. For me, this state typically lasts three to five months.

While TMS is not a cure, early studies show it helps 25% to 43% of people with depression who have not responded to medication. I know it has helped give me back my life -- with fewer depressed periods and no additional memory impairment, I'm able to work more and take on bigger projects in life than I've been able to do in years.

Sunday, October 22, 2006

TO WRITE: Belonging to "Club Meds"
I remember the first time a doctor, who happened to be a neurologist, suggested I take antidepressants. It was not to treat depression, but migraines. It seemed an odd, unlikely idea, but my chronic daily headaches were making grad school very difficult, and no other migraine treatment had helped. I agreed to try them, quickly and arrogantly thinking, "Thank goodness I don't have depression to deal with; these are just for a neurological issue."

A few months later, after trying the little white pills for several weeks without any lessening of my migraine symptoms, then a few weeks off of them, something else was amiss. I noticed I was crying at the drop of a hat, sleeping all weekend if I could, and having to drag myself to my work in the lab each morning. My psychiatrist, who I had consulted just in case he could shed any new light on the headaches, quickly put two and two together. Those meds had been treating me effectively for something, it just wasn't my migraines: I was depressed. Now, as he suggested I restart the drug, my reaction was very different. "Who, me? Depressed? And taking pills for it? This can't be. I certainly don't need medicine to be happy! Or do I? Why can't I just change my mood by myself?"

Fearing I was on a slippery slope toward "crazy," I reluctantly went back to the daily medication. I didn't like it, even felt demeaned by the idea of it, but I also felt so lousy that I was cautiously willing to try this for some relief. The upshot: Within several more months, I was not only depression-free, but migraine-free as well. I became a believer.

Play with this...
If you take medication for your depression, bipolar disorder or other mental health issue, write continuously for 20 minutes on how you felt when you started it. Did you resist at all or welcome it with open arms? Why? Have your feelings changed at all over time? How does your attitude toward your meds affect you and your illness today?

Friday, October 20, 2006

TO READ: Stopping the Stigma Around Mental Illness
Today I spoke about mental illness stigma to clients at the substance abuse program at Highland Hospital in Oakland, along with other members of the Alameda County Mental Health Speakers Bureau. Our presentation identified and discussed stigma we sometimes receive from others concerning our illness: our personal strength and character; our need for treatment, including therapy and medication; our fitness for employment; and other things. It also discussed "internalized stigma" -- what happens we ourselves start to believe these negative messages about our worth.

I know I've felt stigmatized and discriminated against at times because of my illness. Even now, after writing and speaking publicly about it for years, there are times I meet a new person and hesitate, wondering what I want to say to the almost inevitable question "What do you do?" But I sometimes internalize it too. For example, my mind can ask nasty questions when I'm catching up with old friends and colleagues -- Why have I been out of the workforce for so long? Is my bipolar illness truly that bad, or do I not really want to get well? If I were stronger, would I need all these meds and therapy? Fortunately, at this point I can catch myself pretty quickly, or my husband or friends will help me correct my thinking. But it can be tough.

The program clients today had many questions about how reluctant they felt to "admit" that they might need therapy or even meds for depression, bipolar disorder or other mental illnesses. And the point I felt was most important to emphasize was that, while there might not be cures for these illnesses, one can recover and develop a meaningful life.

What does recovery mean? Recovery is a journey (not a destination) toward wholeness as a person, considering mental and physical health, one's spiritual self, and a role in life that one finds meaning in. That meaning could be the resumption of a high-powered, full-time career, but it is also meaningful to work part-time, create art, be a caring family member, do volunteer work, spread joy in the world, help another person, educate oneself. And we're all on a different journey toward recovery. For me, it requires, or has required, medicines, therapy, ECT, TMS (magnetic treatments), education, lots of writing, the support of my family and friends and peers, etc.

Where are you in your recovery? Even if you feel in the depths of despair, you're making a move in the right direction right now by reading this and learning of another consumer's ideas on recovery. You're educating yourself and perhaps feeling some solidarity or support. What can you do next? Check out the links listed on the right side of this page for information, encouragement, ideas on creating art and literature, and finding a support group, good doctor, or therapist. All of these resources can help you break out of the internal stigma you may be carrying. Then you'll be able to reach out and help confront the stigma and prejudice in the world around us. Bon voyage, and be in touch!

Monday, October 16, 2006

TO WRITE: "Go further" in your writing
One of the most wonderful writing teachers in the world, in my opinion, is Natalie Goldberg. Her book Writing Down the Bones is one I come back to again and again when I'm dragging and I need writing inspiration. I've also had the good fortune to study with her twice in Taos, New Mexico, where she makes her home. Natalie is a Buddhist, and that faith's philosophies and practices show up often in her approach. I should say too that Natalie is the first person I discovered who uses the "timed writing" approach that I advocate in my class and this blog.

That said, today I'm going to ask you to try to "go further" in your writing, as she puts it. After you've been doing timed writings for a while, you may be emotionally stopping yourself just as you reach the end of the prescribed period. Try now to make yourself really delve into the writing you're doing, even if you end up writing longer than you intended. You might just be getting to the good stuff.

As Natalie writes: "Push yourself beyond when you think you are done with what you have to say. Go a little further. Sometimes when you think you are done, it is just the edge of beginning. Probably that's why we decide we're done. It's getting too scary. We are touching down onto something real. It is beyond the point when you think you are done that often something strong comes out."

Play with this...
Write for 10 minutes starting with the phrase: In my opinion.... Then continue to write for 10 more. As usual, keep your pen moving and don't think too much, just write. Then continue for 10 minutes more. Repeat as desired. Later look back at your writing and see if you can identify where the writing was at its deepest or most meaningful. Remember this when you are writing anything. You may need to push a little more to get to the real issue you're writing about.

Monday, October 09, 2006

TO READ: Genetics of Depression, Bipolar Disorder and Schizophrenia
I recently attended a fascinating series of seminars at Stanford University's Bipolar and Schizophrenia Education Day. One lecture, given by Professor Doug Levinson, M.D., of Stanford, discussed what current research tells us about the genetics of these illnesses.

None of these mental disorders are as simple to follow through the family tree as, for example, eye color or blood type. The reason is that many different genes, not just one, combine forces to determine a person's susceptibility to depression, bipolar or schizophrenia. We don't yet know which of our 30,000 genes are involved. However, as scientists do "linkage studies" to physically locate these genes on human DNA, they're getting warmer. They are finding "peaks," or hot spots, on certain chromosomes for each of these three illnesses, though the peaks are at different places for each disease.

At this stage, it's clear only that these mental illnesses are caused partially by our genes, and partially by some aspect(s) of our environment. Studies show that bipolar disorder is 80-90% due to genetics; schizophrenia is 70-85% genetic; and major depression is 40-50% genetic. Furthermore, researchers have found that in the case of depression, people who have an early onset of symptoms (before age 20) have about a 50% genetic contribution to their illness, while those who have a single, later episode have about a 36% genetic contribution.

As further work allows us to eventually pinpoint a young person's genetic risk for such mental illnesses, perhaps earlier interventions and treatments will be able to avert, delay or lessen symptoms in those at high risk.
TO WRITE: The Stigma Around Depression
Even before you received your diagnosis of depression or bipolar disorder (or any other mental illness), you may have been labeled by those around you. "She's so moody." "He's just got an attitude problem."

But after discovering that you officially have a mental disorder, instead of finding those around you more understanding of your behavior and moods, you may also encounter stigma around your diagnosis itself. Have you heard any of these? "Depressed people are too self-centered; they should think of others." "People with mental illnesses should just try harder and they'd get well." "She has depression, so she'll never amount to much." "Only weak people have to take psychiatric medicines."

I speak to groups about mental health stigma on behalf of the Alameda County (California) Mental Health Board. According to that organization, stigma is "a brand of discredit or shame... a mark or token of infamy, disgrace, or reproach." And while stigma is hard to take from family, friends and colleagues, it can become internalized too. Giving yourself negative messages about who you are and what you can do can lead to decreased self-esteem and confidence, more isolation, and more difficulty leading a fulfilling life.

While all of us in the mental health community must continue to educate those around us about moving beyond stigma, there are techniques that can help you cope for now too. For example, I'm sometimes helped by reminding myself of what I have accomplished despite my illness, and by thinking about the places where I feel a sense of belonging.

Play with this...
Describe any stigmatization you've felt as a result of your illness. Who has is come from? In what form? How did you feel as a result? Then brainstorm to find things that might help you cope with this. Write continuously for 15 minutes.
Let me know what you discover!

Monday, October 02, 2006

TO READ: Hoping your antidepressant works may really help
We all know that biological phenomena (say, getting a bad cold) can affect psychological phenomena (you feel miserable). But now researchers are finding more evidence that the reverse happens too: Your biology, such as how well your antidepressants work, may change as a result of your psychological state.

Researchers at UCLA recently found that some patients with major depression had a specific brain activity pattern, and that this pattern correlated well with their positive response to an antidepressant they were later given. And it appears that this particular brain pattern was a result of hope or optimism (or perhaps simply from having positive interactions with the medical staff).

In the study, fifty-one depressed adults were given a placebo pill for a "lead-in period" of one week, and their EEGs were measured. Then half of the patients got an antidepressant while the other half continued on the placebo for eight weeks. The patients with the "hopeful" brain activity pattern were better responders to the antidepressant. (While those who improved on the placebo also had a distinct brain activity pattern, it was different than the one predicted by hope.)

Friday, September 29, 2006

TO WRITE: Sounds and sights that heal
The poet Jane Kenyon had bipolar disorder and wrote about it beautifully and evocatively. (She died in 1995 of leukemia.) Her book Otherwise: New and Selected Poems is a favorite of mine.
In part six of her poem Having It Out with Melancholy, she wrote:

In and Out

The dog searches until he finds me
upstairs, lies down with a clatter
of elbows, puts his head on my foot.

Sometimes the sound of his breathing
saves my life -- in and out, in
and out; a pause, a long sigh....

Good poets create vivid, memorable images in the reader's mind. But these "images" need not be visual. I love the auditory details of this poem -- can't you just hear the clatter and the breaths?

Play with this...
Think of a sound you love or that soothes you, and write about it in either a poem or in regular prose form. Describe it so that a reader can "hear" it, and detail how it makes you feel.

Monday, September 25, 2006

TO READ: An Antidepressant That Works in Hours
Research at the National Institute of Mental Health recently revealed that a single intravenous dose of a medication known as ketamine relieved depressive symptoms in as little as two hours in some people with treatment-resistant depression. Most antidepressants require four to eight weeks or more to be fully effective.

Ketamine, used in higher doses as an anesthetic in humans and animals, is only being used experimentally, in hopes that it will help scientists develop other new, faster-acting medications. The drug probably won't become widely used clinically because of potential side effects, including hallucinations and euphoria, at higher doses. Ketamine is thought to act quickly because it exerts its effect late in the series of biochemical actions that regulate mood, whereas current antidepressants target earlier steps in the series.

In the study, 71% of the treatment-resistant patients (who had tried an average of six medications without relief) felt improvement within one day of the treatment, and 29% of these people became nearly symptom-free during that first day. Thirty-five percent of those receiving ketamine still felt improvement a week later. None of the patients in the study had serious side effects.

TO WRITE: What are you willing to risk?
In her book on depression You Are Not Alone, Julia Thorne writes:

"Getting better means taking risks. The first risks I took were physical, like starting ballet classes at age 37. Then, I took emotional ones. I began expressing my thoughts. I joined a support group. I made new friends. If there is something good for you that feels emotionally risky, try writing it down. Sometimes seeing it in print gives you courage."

Play with this...
Take five minutes to make a list of things you could do for yourself that feel "risky." Then choose one and write continuously for 15 minutes. Imagine clearly how you could do that thing and describe in detail how it would feel. The next day, reread what you've written and see if you've gained any courage.

Monday, September 18, 2006

TO READ: Publishing your writing
There are many ways in which writing can enrich the life of a person living with a mood disorder. Releasing one's work "into the universe" to be read by family, friends, peers and everyone else is one. But where to get started?

Today I'd like to plug a wonderful organization, The Awakenings Project, which operates out of Chicago. A link to its site is at the right. The Awakenings Project encourages, promotes and disseminates many forms of art created by people with mental illness -- visual art, theatre, music and literature among them. Its journal, Awakenings Review, is a great place for writers coping with depression or bipolar disorder to consider submitting poetry, fiction or essays -- about mental health issues or other topics. Published (usually) twice a year, the Review is attractive and well-produced, and includes black-and-white photography and drawings (you can submit these too).

The submission deadline for the next issue is December 31, so you have some time to put together your best work. To read the submission guidelines, link to their site and click on "literature." You can also order back issues there. I've published poetry in this journal, and I recommend it if you're interested in taking that next step with your writing.

Friday, September 15, 2006

TO WRITE: Recovering from emotional trauma
Published authors and my own students report a variety of helpful effects from writing about their mental health and other life situations. But did you know that there is also scientific evidence that writing can help your health?

For example, after writing for 20 minutes a day, four days in a row, about a life trauma, people tend to go to the doctor much less often than usual -- they feel healthier and, after a brief period of sadness, they usually feel happier and report having more insight. When patients with asthma or rheumatoid arthritis do this four-day exercise, they experience decreased symptoms, and the effects can be seen even four months later. This kind of "expressive writing" can lower blood pressure and heart rate, and can even lead to cellular changes that boost the immune system. And, while it hasn't been studied on depressed people per se, it has led to "decreased depressive symptoms" among a more general population. These results are amazing!

Now investigated around the world, expressive writing has been studied in cancer patients, Holocaust survivors, AIDS patients and more. Professor James Pennebaker of the University of Texas at Austin has led this field of research, and you can find a link to his website at the right of this column. It includes loads of information -- and several fun self-tests.

Play with this...
Try the four-day experiment yourself. Write continuously about a traumatic event, particularly one you've kept secret. You can write about the same one each day, or vary the topics. Make a note of how you feel before and after each 20 minute writing session, and see what results you find. Then let me know!

Wednesday, September 13, 2006

TO READ: Comparing bipolar disease to arteriosclerosis and diabetes
I recently attended the California conference of NAMI -- the National Alliance on Mental Illness -- the nation's largest mental health advocacy program. Between scientific sessions, legislative ones and peer support discussions, there were plenty of tables filled with brochures, information, advertising... and, of course, give-aways, including pens and post-it pads advertising your favorite psych drug.

One of the most interesting things I picked up was an information sheet put out by the California Psychiatric Association: Comparison of Three Chronic Diseases with a Clear Combination of Biology and Behavior. In three columns it contrasted bipolar disorder (a brain/central nervous system disease), arteriosclerosis (heart/circulatory system) and diabetes (pancreas/digestive system). I won't summarize all the results here, but several were especially interesting to me. "Yes," there is a clear genetic predisposition to all three. There are typical medications for all three, and all three also require behavioral changes, such as accepting the disorder and developing insight into it, exercise, compliance with medications, and appropriate therapy, such as psychotherapy or diet.

One of the most exciting part of the comparison for me was the medical treatment effectiveness: 85-90% for bipolar, 43% for arteriosclerosis, variable for diabetes. I hadn't realized that bipolar disorder was considered this treatable. Now, the details of just how stable or symptom-free one had to be for any of these illnesses was not spelled out. However, I found it encouraging.

Still, the most important point, I think, is that it is gradually becoming more obvious to more people that mental illnesses are real illnesses -- biologically based brain disorders -- and should be treated as such. This allows no room for stigma. Few physicians, lay people, insurance companies or patients themselves would discriminate against a person with heart disease or diabetes. Mental illnesses must be treated with equal levels of concern and compassion.

Friday, September 08, 2006

TO WRITE: A story from your illness
Today I'm going to ask you to write a story. It's a story you already know well. It's the story of an episode of your depression (or mania or psychosis, if those apply to you). I'm not suggesting you write your life history here, just a single period during which you had symptoms.

Research has found that writing about difficult times in story form -- that is, with a beginning, a middle and an ending -- is one technique that can be especially helpful emotionally. First, recall how this particular episode began. Then, describe in detail how it felt. Finally, explain how it resolved, whether that was in an hour or a year. Did your symptoms lessen on their own? Did you get medical help? Social or spiritual help?

Write continuously for 20 minutes to create this short story. Research has also found that sometimes people feel sad for a short while after writing about a trauma, but that this tends to pass quickly and greater happiness and satisfaction results. However, if you feel extremely upset during or after writing, make sure you get appropriate help. (And remember the "flip out" rule described earlier -- if you think a topic is just too disturbing, write on some other topic instead.) Let me know what you discover!

Tuesday, September 05, 2006

TO READ: Transcranial magnetic stimulation -- a new option
I've been feeling pretty down lately. You know... lousy mood, feelings of dread, hard to start anything, weird thoughts flitting around. We all know our own brand of misery when our symptoms really kick in. It's discouraging when all those pills I swallow every day aren't doing their job, but I'm fortunate I've got a secret ally these days too.

For the last year and a half or so, transcranial magnetic stimulation (TMS or rTMS for "repetitive" TMS) has worked wonders for me when depression descends. Every three or four months, my neurochemistry changes and, no matter how well my life is going, I get depressed. But these days, a five-minute-a-day treatment for four weeks, which applies a strong, pulsing magnet to the right side of my skull, breaks up the dysfunctional feelings and thoughts. For me, it's as effective as ECT, but easier -- no anesthesia, no grogginess, no driving restrictions or memory loss.

TMS is still in its investigational stage, not yet FDA approved, so it's only available to certain patients at certain research sites. I'm lucky enough to have gotten in on the ground floor at Stanford (since I'm such a good customer). The treatment is done in an office. After carefully measuring the way my thumb twitches when my head is magnetically stimulated at different sites, the proper treatment location can be mapped on my skull. The doctor holds against the side of my head a plastic "wand" device which is connected to a computer and a machine that generates a precise magnetic field. The wand clicks as it sends 60 one-second magnetic pulses to a specific area of my brain, stimulating activity in that region. After three minutes' rest, we do another 60 seconds, and I can go home. Sometimes I have a moderate, but short-lived headache.

I get plenty of driving in going to Stanford five days a week for four weeks, but it's definitely worth it to me. After two weeks, I'm usually improving; after four I'm nearly back to baseline. I'm told TMS seems to help about half of those who try it for either unipolar depression or bipolar depression. Like so much in psychiatric treatments, the detailed mechanism of action isn't known. But I'm very grateful it works for me. Hopefully it will be more widely available soon and everyone will have one more treatment option to consider.

Friday, September 01, 2006

TO WRITE: What little things help?
If someone recently diagnosed with depression were to ask you what helps you cope, what would you say? Chances are you'd mention medicines, therapy, maybe ECT. But what other "little" things help you on those tough days too?

For me, talking with friends (especially those who personally know depression) over coffee often helps. Also on my list are browsing bookstores, looking at magazines, petting my cat Onyx, chocolate (in moderation!), exercise -- even a little bit such as a walk -- and, of course, sitting down and writing.

Play with this...
Make a list of things that ease your depression. Then choose one or two and describe them in detail. What do you do? How does it really feel? Why do you think it helps? Write continuously for 15 minutes. Perhaps you'll develop new appreciation of these activities or find new ideas.

Wednesday, August 30, 2006

TO READ: More remarkable people with depression or bipolar disorder
Lists of well-known figures who have dealt with depression or bipolar disorder include many, many accomplished writers, poets, visual artists, musicians and composers -- both historical and contemporary. From Sylvia Plath to Hans Christian Andersen, Michelangelo to Georgia O'Keefe, Sergey Rachmaninoff to Charlie Parker, they represent diverse times and styles. (For excellent lists, discussions, and statistics, see Kay Redfield Jamison's Touched With Fire: Manic-Depressive Illness and the Artistic Temperament.)

Indeed, there is some degree of correlation between mood disorders and creativity of these sorts. In one major retrospective study Jamison cites, which covers the years 1960-1990, individuals in the arts showed two to three times the rate of psychosis, suicide attempts, mood disorders and substance abuse than people in other professions. Poets fared worst of all: an amazing 18% of poets studied had committed suicide.

People have noticed these correlations for centuries, and this has led to a certain degree of romanticizing of "mad artists." That is, these traits go together, and society is the better for it. Even some of these creatives themselves feel their illness fuels their unique products. Susanna Kaysen, writing in Unholy Ghost: Writers on Depression, puts it bluntly: "I think melancholy is useful. In its aspect of pensive reflection or contemplation, it's the source of many books (even those complaining about it) and paintings...."

Others feel that, while emotion can be adaptive, depression should not -- as some have argued -- go untreated in our society merely to enable art. Psychiatrist Peter D. Kramer, in his book Against Depression, imagines a time when depression could be medically eradicated. "If we could treat depression reliably, we would have different artists, different subjects, different stories, different needs, different tastes," he writes. But he goes on to consider a whole new scenario without depression's existence. "I mean mainly to ask why we would not let go of melancholy, and trust ourselves with responsive minds and resilient brains."

All the books mentioned here offer elaborate, detailed considerations of these issues and more. Still, even with these few paragraphs of information, I wonder what you think. Do you feel our society romanticizes mood disorders? Do you feel your mental health situation aids your own creativity? I believe (as of this writing!) that, if I could, I would forfeit my depression for a potential loss of some degree of creative ability. What about you?

Thursday, August 24, 2006

TO WRITE: When you were diagnosed
Twenty-one years ago I was diagnosed with clinical depression. While my memories of many things have evaporated since then, that moment remains quite clear. I felt a tornado of thoughts and emotions and questions sweeping around me. I was stunned -- how could this happen to me? And I was afraid that this meant I was now on a slippery slope to crazy, whatever that is. I -- the biologist, remember -- was dumbfounded about how these pills I'd been given could actually change my moods and thoughts. But finally, I felt some relief. Maybe all my disturbing symptoms, both physical and mental, were treatable; maybe I'd get well now.

To try to get my mind around this new diagnosis, I stopped a little way from the doctor's office and sat before a big sculpture with a fountain, where I wrote a letter to an old friend who lived 2,000 miles away. I told her about what had happened and explained how I felt. It was the best thing I could have done. It helped me straighten out my thoughts and express my grief on paper -- I wasn't ready to talk about it with anyone yet.

Play with this...
How did you feel when you were first diagnosed with your illness? I've known people to describe shock, anger, sadness, fear, confusion and relief, among other things. Write continuously for 15 minutes, telling the story of how you were diagnosed and what you felt and thought then.

Monday, August 21, 2006

TO READ: Lincoln's Depression and His Writing
My friend, the Rev. Barbara Meyers, who does mental health ministry through our congregation, Mission Peak Unitarian Universalist Congregation in Fremont, CA, sent me the following fascinating information and quote from the book, Lincoln's Melancholy - How Depression Challenged a President and Fueled His Greatness, by Joshua Wolf Shenk, Houghton Mifflin, 2005. (She is also responsible for all the excellent mental health resources and information at the "MPUUC" link on the right of this page.)

Barbara wrote:

The sub-title of the book tells it all. Lincoln had throughout his life bouts of depression. He learned how to handle them with a variety of coping strategies, among them writing. Here is a quote that I thought you might enjoy. It occurs at the start of the Civil War when the Union had some losses in battle.

"Not long after McClellan's calamities at the Peninsula, O.H. Browning [one of Lincoln's friends] came to the White House. The president was in his library, writing, and had left instructions that he was not to be disturbed. Browning went in anyway and found the president looking terrible - 'weary, care-worn, and troubled.' Browning wrote in his diary, 'I remarked that I felt concerned about him - regretted that troubles crowded so heavily upon him, and feared his health was suffering.' Lincoln took his friend's hand and said, with a deep cadence of sadness, 'Browning, I must die sometime.' 'He looked very sad,' Browning wrote. 'We parted I believe both of us with tears in our eyes.' A clinician reading this passage could easily identify mental pathology in a man who looked haggard and distressed and volunteered morbid thoughts. However, one crucial detail upsets such a simple picture: Browning found Lincoln writing." (page 183)

Lincoln coped by writing, especially writing poetry, and by reading poetry and the Bible and by storytelling, especially telling funny stories.

I add:
Writing has been a coping mechanism for many literary, artistic and musical, as well as historical, figures. (Interestingly, writers suffer from mood disorders at a rate 8-10 times that of the general public. Poets tend to have the highest rates.) Stay tuned... next week I'll discuss some of the authors and poets who have used writing to help cope with their depression.

Friday, August 18, 2006

As you delve deeper into important personal issues in these writing exercises, consider how you feel about each topic. In my creative writing class for people with mood disorders, I always tell writers that if you just can't -- or don't want to -- deal with a particular subject right now, simply skip it and write about something else. James Pennebaker, Professor of Psychology at the University of Texas - Austin, and a leader in this field, calls this the "Flip-Out Rule." If something might make you "flip-out," do something else.

Wednesday, August 16, 2006

TO WRITE: How does your depression look?
In Darkness Visible: A Memoir of Madness (an outstanding book!), author William Styron describes his depression in many ways. He calls it "a storm of murk," "the abyss," "the ogre," and like "being imprisoned in a fiercely overheated room."

Play with this...
What does your depression "look" like to you? What does it "feel" like? And then, how do you see or feel improvement in your health? Write continuously for 10 minutes and see what comes up for you. Sometimes naming and putting a face on these things can help people feel that they are not their depression, but instead a person who has depression. An important distinction!

Tuesday, August 15, 2006

TO READ: ECT Side Effects
Last week I described the ECT procedure as I've experienced it, and discussed a bit of the stigma that sometimes surrounds the treatment. But what happens after ECT? It varies tremendously from person to person, and sometimes from treatment to treatment in the same person. I'll share what I've been through, since I'm frequently asked about this topic by those considering it, and the just-curious.

Upon waking from a treatment, I was typically groggy, wobbly on my feet and, whether my mood felt better -- usually after a couple of treatments in the series -- or not, I was hungry. After a nurse slowly walked me to the waiting room, the main ECT side effect became apparent: memory difficulties. I had to scan the room for someone I knew who would drive me home, but I didn't know who had brought me in that morning... my husband, my mom (a huge support who came all the way from New Mexico), a friend? My mother- and father-in-law laughed when each morning I was surprised to see them and said, evidently in the exact same voice, "You mean you came all the way here from Wisconsin to help us out?"

After a requisit donut in the cafeteria, the drive home (You can't drive for days or weeks after ECT.), and a long nap, I'd awaken to talk with my caretaker for the day, and larger memory issues came up. I generally didn't recall much at all of the past few weeks, including the details of exactly why I went into treatment.I had no idea what books I had been reading, whether I had seen a movie someone was discussing, what the news was with family and friends. I knew, however, that if I still felt extremely depressed, I needed to continue.

Sadly, as the weeks -- and now, even years -- passed, I found gaping holes in my memory that I don't think will be filled. People still frequently tell me of things I've done that I have no inkling about. Most frustrating are the major life events, such as a trip to the Galapagos Islands, and another across Canada, that I didn't even know I'd been on until I was told. On the other hand, some things are still crystal clear, and I treasure those and use them to tie together my picture of my life.

Please bear in mind that while some memory loss is the most common side effect of ECT, it varies tremendously. Some people I know experienced nearly none. I suspect that mine was made worse by having a lot of treatments over the course of several years. And, yes, even considering those frustrating gaps, I'd get ECT again if I needed to.
bp Magazine --
Already in its second year, I just discovered bp Magazine, which offers "Hope and Harmony for People with Bipolar". It looks quite good to me -- a quarterly mix of research (written for the non-scientist), profiles and ideas. Its website is:

Friday, August 11, 2006

Please note that one of the national suicide hotlines will stop operating soon. If you need help, you should now call:

National Suicide Prevention Lifeline

They will connect you to the appropriate local help.
Please pass the word.
TO WRITE: What if I don't know what to say?

You're writing along, trying to keep that pen moving or those fingers typing, pouring out thoughts and feelings, and suddenly, that dreaded question arises: What do I say next? (And sometimes lots of other uncomfortable questions come with it... Can I really do this? What do other people write about? What's wrong with me?)

The good news is that there are techniques to try and guidelines to help you when freewriting about depression or any other topic. In the Stanford class, we have honed a set of "rules" adapted from books of one of my favorite writers, Natalie Goldberg. In her Writing Down the Bones and Wild Mind (both of which I highly recommend!), Natalie stresses first and foremost the importance of keeping your hand moving even when you don't know what to write. Figure out what you want to say in the actual act of writing. I tell students that it's fine to fill a whole page with, "I don't know what to write. I don't know what to write." Eventually your brain will get bored and it will think of something to write!

Another suggestion comes from James Pennebaker, Ph.D., a leader in the research on how writing about trauma can alter everything from depressive symptoms to blood pressure to immune function. He encourages writers to simply repeat what they've already said if they get stuck. My feeling is that either technique can be very helpful.

Among the other guidelines in class:

  • - Don't cross out.
  • - Don't worry about spelling, punctuation, grammar.
  • - Lose control of that "editor voice" in your head -- just write!
  • - Don't think. Don't get logical.
  • - You are free to write the worst junk in America. (Thanks to several foreign students, we've changed this to "... worst junk in the world"!)
Play with this...
Write for 10 minutes on: How do you feel at this moment in time? Try to keep to this moment -- What are your emotions? Your thoughts? Your body sensations? How are you reacting to your surroundings? Are you ruminating on anything? If you come to a place where you don't know what to say, use one of the above techniques, or just start a new sentence with "I'm feeling..."

Let me know what you discover.

Tuesday, August 08, 2006

TO READ: Electroconvulsive therapy (ECT) experiences

"You mean they still do that?" A new writing friend stared at me the other day, mouth agape. At lunch while attending a workshop together, we had discovered our mutual experience with depression. When she asked me what had helped me back to relative stability, I mentioned medicine, acupuncture, psychotherapy, magnetic treatments... and electroconvulsive therapy (ECT) or shock treatments.

Her horrified reaction is not uncommon when I disclose this part of my healing. And people's amazement is confounded by the fact that I speak of my ECT experiences without regret or resentment. Of course, I wish I hadn't needed those treatments (more than 100 over about 10 years), but I would get them again in a minute if I were severely depressed and nothing else was helping. ECT, like writing, probably saved my life a number of times. And these days it's not like something that makes you wince while watching an old movie. No pain, no broken bones.

ECT, in fact, is frequently referred to as psychiatry's "gold standard" treatment for depression. Nothing is more effective, and ECT tends to work more quickly than medication. Most people feel better within a series of six to twelve treatments (usually given three times per week). No one knows quite why ECT works. Administration of electricity to one or both sides of the brain causes a seizure -- that is, all the brain's nerve cells "fire," or send their messages, at the same time. Somehow this seems to "reset" the brain's mood centers.

What are ECT treatments like?
In my experience, it's pretty simple. I would go to a hospital treatment room, either as an inpatient or an outpatient, where nurses put in an IV line so that I could later receive medications. They attached wires to my head and body with little sticky pads so that the doctors could monitor my heart and brain activities. Then two doctors appeared -- a psychiatrist and an anesthesiologist. After I took a few breaths of pure oxygen, I got a general anesthetic by IV. After I was asleep, I received a muscle relaxant medication, which would act for only a few minutes, keeping me from moving and potentially hurting myself during the seizure. The psychiatrist connected a machine to those wires on my head, and it delivered a carefully-determined dose of electricity (usually to just one side of my head; occassionally we opted for two sides). The electricity caused a seizure, which lasted around 30 seconds. I've been told repeatedly that the patient's body scarcely moves. The anesthesiologist ensured I got enough oxygen until I could breathe on my own again.

How do you feel afterward...?
Stay tuned for next week's "TO READ" posting!


Thursday, August 03, 2006

My class -- and how you can participate on your own

"There is NO doubt in my mind that being in your writing class has been one of -- if not THE -- most significant parts of my recovery." -- one of my students

The class
It's Tuesday afternoon. Around a conference room table in Stanford University's Psychiatry Building sit 10 people -- an attorney, two teachers, a physician, a saleswoman, a hairdresser, a graphic artist, two engineers and a college student -- all coping with profound depression. Most are on disability from their jobs. Women and men from across Northern California, they range in age from their 20s to their 60s. This creative writing group is "the most important part of my week," declares one student, with a smile.

I offer a writing prompt: What would you like to say to a trustworthy friend about your depression? Heads bow over notebooks and pens scratch away for 20 minutes. Then, with kindness, empathy and non-judgment, the group listens as each writer in turn reads aloud.

We laugh a lot in this group, and we cry sometimes too. This is a place where it's safe to share everything from daily frustrations to the traumas of abuse or a suicide attempt with people who've "been there." Students report that this kind of writing and sharing helps them modulate their moods, develop greater insight, and feel a sense of accomplishment.

Fascinating scientific studies also clearly demonstrate that some kinds of writing can change your emotions and thoughts -- and even your body. For example, in numerous experiments, writing about a trauma can lead to decreased blood pressure, improved immune function, fewer doctor's visits and decreased depressive symptoms. There's powerful evidence for what my students, as well as other writers and poets through the centuries, have experienced: Writing really can help ease depression.

Write on your own
You don't need to have a group to do the writing exercises I'll offer in this blog. Write just for yourself. You may decide later to share some of it with a friend, family member, doctor or therapist, but for now let yourself dig deeply into your writing without feeling concerned about what a reader or listener might think later.

Is this just like journaling? No, not the type of journaling or diary-keeping most people seem to do. That kind of writing tends to be very inwardly focused. While this is important, it's not everything. "Freewriting," as we'll often do here, is also about how you connect with the world outside yourself. In fact, some of the writing I'll propose is about things other than mental health issues.

So how do you do this writing to ease depression? To start, just write -- or type -- continuously for at set period of time (say, 10 minutes) on the suggested topic. Don't worry about grammar, spelling or puctuation. If you don't know what to say at some point, just repeat what you've written. Don't think too much; just have fun.

Play with this...
Let's start by writing about a simple, concrete topic, just to get your writing mind and hand in gear: Describe your childhood bedroom. Really think back. How did the room look? Did you share it? What stories do you recall about it? What happened to it? Write for 10 minutes.

Let me know how this feels!


Monday, July 31, 2006

Why this blog?

You’re depressed. Or you’ve been depressed and you’re grappling with where
that experience fits into your internal image of your life. Have you ever felt the urge to write or tell the story of your illness? I have – the pain and pressure in my chest and throat, the utter hopelessness, the certainty that the bleakness that haunted me would never, ever lift. Many people seem to share this desire to get their story of depression out, whether it’s by writing a letter or a memoir, or by creating a notebook of poetry.

I teach a creative writing class for people with mood disorders meeting at Stanford University, where the Psychiatry Department is kind enough to lend us a conference room. I’ve led this weekly class for eight years now, during and after my own recovery from severe bipolar disorder – mostly its stifling depressions.

Now I’m writing a book with the working title, Illuminating Words: The Power of Writing to Ease Depression. It draws on my writing experiences and those of my students, as well as those of well-known authors who have coped with depression through memoir, poetry and fiction – and it reports on exciting scientific research that proves that writing can have dramatic effects on the body and the psyche. It’s the first guidebook to writing specifically designed for people with depression. It’s sensitive to their issues, including medicines and side effects, stigma, and rebuilding a damaged life.

I earned my Ph.D. in biology at Stanford in 1991. During grad school, I also started writing about science and medicine for the Stanford News Service, the San Jose Mercury News, and other publications, and I was awarded a science writing internship at Newsweek. When I finished my degree, I worked as a writer for the science journal Nature, and later developed, edited and wrote for numerous college science textbooks. However, the depression that had begun in grad school changed and worsened considerably, leading to a bipolar diagnosis and eventually to being unable to work a regular job. Still, I wrote and wrote -- essays, poetry, a book-length memoir of my illness. I studied writing in classes and workshops, and I taught my creative writing class for others with depression or bipolar disorder. Now I'm back! (Thanks to still taking lots of medicines and getting experimental magnetic treatments (TMS) every few months. I'll tell you about those later too.)

I believe writing has been key to my recovery, and I hope it will be helpful to you too. I invite you to explore writing as described in this blog as an adjunct to your medical treatment. In addition to discussing mental health issues, I'll regularly post writing techniques and offer writing exercises you can try, whether you're facing a difficult life transition or a full-blown depression.

Let me know what you think!