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!