WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Mental Illness: Gift or Curse?

This post responds to Marian’s response to my response to her initial post about the movie The Doctor Who Hears Voices (got all that?).

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I don’t disagree. And it’s not too radical.

I regret ever starting medication. But now that I’m on them, if I reduce the dose too quickly I get depressed. Yes, I can tolerate depression and even see some majesty in understanding how deeply sad and messed up the world is. But after weeks and months of that, suicide starts looking like a really, really nice option. I would have ended my life long ago if not for my wife. Since I don’t want to wreck her world, I choose to increase the dose to give myself at least a little will to live.

I don’t care whether you call it ‘disordered’ or ‘gifted’, it makes it hard to live. So hard that I’m surprised I’ve made it this far. Is it genetic? Probably; my mother killed herself. Is it environmental: Yes; I was horribly abused as a child. Do I care? Not really; all I know is I get very little joy out of life much of the time, and especially if I reduce the medications too quickly. That lack of joy is what led me to take drugs back when I started in 1995. They worked at first, then quit working. Now, like Alice in Wonderland, I need them just to keep from falling deeper, but I don’t get anywhere solid.

Cognitive techniques, acceptance training, meditation, etc., all do much more than drugs. And when I practice them diligently I do OK. But my point is that in my case whether it’s a gift or not it wrecks my life. There may be some nobility to that, but I don’t want to be a martyr and accept all the suffering of mankind at the expense of any enjoyment in life.

I don’t hear voices. I had one long episode of florid psychosis, during which I had powerful spiritual experiences, and some visual hallucinations with a chorus of angels singing in the background. Very beautiful. Went to the psych ward and had it hammered down to mere ‘delusions’ with haldol. I regret that. I don’t think it was illness; it truly was Grace. I’d gladly live in that state forever, regardless the consequences to my life.

But if I had voices telling me to kill myself and others, especially if I was trying to practice medicine, I’d probably get tired of it. Maybe those voices are demonstrating the truth: yes, the world is a painful place and what people are doing to it and to each other is brutal and ugly. Maybe suicide and homicide are the natural responses to this place. But for my part I would not want to live with that message being shouted at me day in and day out.

My impression from the film was not that Ruth’s voices left her. Rather, she learned to live with them. Good for her. I would not have made that choice, but it was a brave decision and I applaud her.

I use the term ‘psychiatrically disordered’ as shorthand for ‘having a mind that works in a way that doesn’t fit well with the modern world.’ It would be great if the world would change, but of course it won’t. If one wants to accept all the difficulties that having a ‘different’ mind bring, I don’t see any problem with that (provided the person doesn’t harm anyone besides himself or herself). I don’t even see anything wrong with suicide (outside of the pain it causes loved ones): in my opinion it is a perfectly rational response to this culture.

But many people want to try to fit in. My impression has been that for some people, the drugs help. When I get really hypomanic I sometimes am glad to take a pill to get some sleep. Yes, that reduces the edgy excitement of my experience, but I accept that. If I heard voices telling me horrible things all the time, and if a pill would help I would take it. Even if it meant reducing the range of my experience.

My concern is suffering. I understand that suffering is inevitable, even magnificent. But it gets tiresome. And it can lead you to kill yourself. Since I am not ready to do that yet, I take the pills that keep me from the deepest recesses of my abyss. Like I say, I wish I’d never taken the first one. I think I would probably be about where I am now, only I would not have the necessity to take a Wonderland pill just to stay alive. But whether that is true or not, I am currently taking the medications to take the sharpest point off my pain, though always trying to reduce the dosages.

Like I say, I don’t disagree with you. But (in this response to your response) I stand by the initial point I made in my comment about your post: every case is unique. I just want to be respected for my own choices and my own take on things. And I believe everyone else deserves the same.

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Mental Illness: Gift or Curse? was published on July 14th, 2009 . 4 comments






Computers Instead of Therapists?

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Insomnia? Depression? Anxiety? Soon, you will be able to turn on your computer and learn how to work with these problems.

Widely recognized as effective, Cognitive Behavioral Therapy (CBT) has been demonstrated experimentally to improve emotional health. The theory behind CBT, as most people involved in mental health care (whether clients or providers) understand, is that you can change how you feel by changing how you think. Leaving aside the question of whether you should change how you feel (I’ll deal with that in a later post), if you learn the techniques, they seem to work. At least they did for me. I learned to cut my depression and anxiety in half, easily. I also started sleeping better, just by not driving myself nuts with worry. Good stuff!

It’s called ‘therapy’, but is it? In truth, it is a set of methods for working with thought to keep it from wrecking your life. Person-to-person ‘therapy’ is not absolutely necessary. I got most of what I needed from a book or two, and you can search Amazon to find any number of texts on the subject. (They all look about the same to me.)

So how about learning the techniques from a computer?

I was not surprised to find out this is already possible. I came across one article about an internet-based protocol for teaching CBT techniques to manage insomnia.

I am not a big fan of therapy, even though (or because) I have undergone more than 20 years of weekly sessions. In truth, I have found it almost as often harmful as helpful. Maybe someone with a good, strong sense of identity and purpose could visit a well-skilled and careful therapist and do really well. At my best, and with the best therapists, that has been my experience. The problem has been that usually by the time I’ve stumbled into therapy I’ve been pretty well crushed emotionally. Desperate for guidance and support, I have given my counselors far too much control over my decisions. Later on, when I’ve felt better, too often the choices made under a therapist’s influence look like his or her choices, not mine. His or her values shine through, and mine get obscured.

Maybe a computer therapist would have been safer. I would not have leaned on a computer for support in the same way. I could have just learned the techniques, and relied on my own personality for courage and strategy. Given the never-ending effort by insurance companies to reduce mental health expenses, it is safe to assume that this method of delivery will become widespread. As much as I think psychiatry services should be covered by health plans, perhaps it would not be a terrible thing if some of the care came from silicon circuitry rather than the neuronal networks of a (fallible and corruptible) human brain.

I like people. There is no substitute for the warmth and support of another human being. But paying a therapist to guide me through life has not always worked well. I would not have become a doctor and a surgeon had it not been for a therapist who vehemently encouraged me to look for the highest paying job within my reach. Without those choices, I might not have damaged my neck by leaning over an operating table four days a week. I might not have lost my career at age 42, and might not have had a nervous breakdown. Who knows how my life would have gone? There’s little benefit to thinking about ‘what if..,’ but obviously therapists with poor boundaries can push vulnerable clients in directions that may prove disastrous.

The crucial decision about my career direction should have been made by me under the influence of family and friends. A person paid to help me (especially one who later admitted he was a cocaine addict and alcoholic) should not have been the one to choose. I was too young and emotionally weakened to understand how vital it was to make my own choices, and I allowed myself to be swayed away from my heart’s native desire (to study nature and ecology).

So I applaud the development of computer systems to teach mental health techniques. Psychotherapy can be helpful, but sometimes it is better to let people find strength and solutions on their own. Therapy should be a tool, not a crutch.

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Computers Instead of Therapists? was published on July 8th, 2009 . 9 comments






Needing Care, But Wishing I Didn’t

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Amanda (my wife) and I spend part of our time in the mountains, and part in the city. We go back and forth regularly. This morning we head back to town.

I hate going back. It would be easy to live up here full-time. I’d like to. Ultimately, and not long from now, we’ll need to choose one or the other. I choose here.

Amanda worries about me, however, and my occasional need to be close to doctors. She had a dream last night that showed that: we were about to jump a car across a ravine. She did not think it could make it. I ‘floated’ ahead to show her it was OK. Halfway across I plummeted to the floor of the canyon, and all she could hear was faint whimpering. A pretty clear message?

It’s tough having an illness of any kind. Between my bipolar disorder and my neck issues, I used to need doctors a lot. Right now I don’t, and I’d love nothing more than to get away from them for good. I see no advantage in living near ‘advanced’ medical care. My body has been badly damaged by medications. My father probably died as a result of a medical error. My mother had severe depression in the early 1960′s, and they treated here with valium, barbiturates, and shock therapy. Probably she had tricyclic antidepressants, too, but all she did was get worse and worse and die anyway. As a six-year-old, I was convinced that the treatments were bad for her. I still hold that view.

But what if my neck worsens, and I need intensive care just for daily life? Or if I get so depressed I need partial or full hospitalization? (As much as I am skeptical such a thing would help, sometimes it is reassuring to loved ones.) When here in the mountains, we are an hour from the nearest hospital, and almost two from the HMO of our choice. As people who have lived our whole lives in urban areas, we find it hard to imagine living so far from services. Yet I see people dwelling all around us up here in the mountains, and some of them are quite elderly. If they can do it, why can’t we?

You have to listen to your spouse’s dreams, however; both the dreams for the future she or he has by day, and the terrors by night. I hate feeling like my fate is in the hands of illnesses I can’t control. I’m not giving up on the move, but there probably needs to be a compromise here. Right now, the answer is not clear. I have made some catastrophic decisions in the past, and I don’t want to repeat the mistake of acting on poorly conceived impulse. On the other hand, my heart yearns to live in the forest.

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Needing Care, But Wishing I Didn’t was published on July 6th, 2009 .






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