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.

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.

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?
Beth

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!
Beth

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.
Beth

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!
Beth

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.)